精神疾病

2204 Carpenter精神分裂症诊断标准的再评价(一)精神分裂症与非精神分裂症的测验结果比较卢良超神经精神疾病杂志7(2):81,1981 广东佛山地区澜石医院应用Carpcnter的诊断标准,检查250例精神分裂症和116例非精神分裂症(器质性者48例,非器质性68例),症状总分达5分或以上者分別为225例(90％)和17例(14.7％,其中器质性组占13例)。12项症状中除语言不连贯和言谈不可信外,其余10项症状(情感淡漠,内省力缺乏,思维鸣响,无早醒、情感沟通障碍、无表情忧郁、无情绪昂扬、妄想泛化、荒谬妄想和虛无妄想)的发生濒度均以精神分裂症为高(P<0.01),在性别上得分无明显差异。器质性组和非器质性纽     

173例室性早搏心电图分析

目的 通过定位性分析，探讨功能性与器质性室性早搏(PVS)的区别。方法 将173例分为2组：A组为有器质性心脏病者，B组为无器质性心脏病者，分别描记12导联同步心电图。结果 起源于左室：A组58例、B组25例；起源于右室：A组25例、B组65例。A组PVSORS时限≥0．16s者占14．46％，有切迹者占66．27％，ST等电位线者占61．45％，T波对称者占57．83％，T波与主波方向相反者占21．69％。与B组对比有显著差异。结论 病理性PVS多起源于左室，QRS≥0．16s，QRS波形态粗钝有切迹，有ST-T改变，呈多源性、多形性或伴有短阵室速(VT)．     

频谱心电图对完全性右束支传导阻滞系器质性抑或单纯性鉴别价值的探讨

<正> 完全性右束支传导阻滞(RBBB)是心电图的一种常见表现,它既见于器质性心脏病患者,又可存在于一些单纯RBBB而无其他心血管病者之中.鉴别RBBB是器质性抑或单纯性,对于及早发现心脏疾患有积极意义.我院于1993年6月～1994年11月采用频谱心电图(FCG)对RBBB者进行检查观察,探讨FCG对鉴别RBBB的价值.资料和方法以心电图表现为RBBB的器质性心血管疾病患者(简称器质性RBBB组)及无其他心血管病证据的     

药物不良反应引起晕厥和晕厥先兆

晕厥是指一过性意识丧失,人群总发生率约20％～50％;晕厥先兆(Presyncope)则是指近似晕厥或极度头晕。晕厥和晕厥先兆的原因多种多样,包括心血管病、神经病、精神病、环境因素以及药源性疾病。这类患者中,大约50％虽经多种检查仍不能查明原因。研究对象为70例晕厥或晕厥先兆者,平均年龄58岁,女性占63％。晕厥51例(73％),晕厥先兆19例(27％)。其中,15例发作时未服药,另7例未发现可疑药物,其余48例(69％)发现可疑药物共104种。     

应用动态心电图探讨左室假腱索与室性早搏关系及其意义

应用动态心电图对50例诊为左室假腱索的健康人和无左室假腱索的健康人进行连续记录观察.结果表明:左室假腱索者来源于左室的室性早搏(室早)检出率为76.0%,与无左室假腱索者有非常显著性差异;来源右室的室早两组则无显著性差异;左室假腱索者来源于左室的室早夜间明显高于白天,且Lown 1、2级室早占多数(76.3%);室早的发生与假腱索附着的部位则无显著性差异.提示:左室假腱索是健康人引起室早原因之一,可视为功能性室早.     

左室假腱临床意义再探讨

左心室假健是指左心室腔内一些非附着于瓣膜的纤维条索样结构。近年随着超声诊断的应用 ,发现左室假腱很多 ,但其临床意义尚未明了。作者就 30例室性早搏患者发现左室假腱的情况结合有关文献进行探讨。1　临床资料　男 12例 ,女 18例 ,年龄 2 6～ 5 8岁 ,均无心脏病史 ,2例并发高血压 ,18例心脏杂音 ;30例心电图频发或偶发室性早搏 ,4例全胸导联 T波倒置 ,ST压低 ,并曾误诊为心内膜下心肌梗死 ;超声心动图示大腱索 4例 ,分别为 4 ,5 ,5 ,6 m m。2　讨论　结合文献分析左室假腱临床意义有 :1正常腱索的变异 [1 ] :正常腱索起源于乳头肌插入…     

胃切除术后胆囊收缩功能与胆结石发生率的观察

目的 研究胃切除术后胆囊收缩功能与胆结石发生率之间的关系。 方法 胃切除术后97例为观察组,另外86名健康人作对照组。在B超下测量空腹时胆囊截面积及脂餐1.5-2 h的面积。收缩功能分以下4种:良好:截面积>50％;欠佳:50％>缩小>30％;不良:缩小<30％;不收缩为无功能。 结果 观察组良好29例,欠佳和不良及无功能者计68例,占70.1％(68/97)。对照组良好69例,欠佳、不良17例,占19.8(17/86)。结石发生率,观察组32例,对照组4例,两组问统计学分析,收缩功能与结石发生率,P值均<0.01。 结论 胃切除术后,由于切断迷走神经肝胆支,胃肠重建,引起胆囊收缩素分泌减少等原因,致胆汁郁积,胆石发生率升高。     

J波的心电图特征与临床意义探讨

为探讨J波的诊断、分型及临床意义 ,总结住院患者14880例心电图中出现J波的137例资料 ,复习文献拟定J波的诊断及分型标准 ,并与临床资料作对照分析。结果显示 :137例有J波者心血管病人与非心血管病人分别为28/1670与109/13210例 (P<0.01) ,伴发心律失常7例 ,无恶性心律失常且近期预后良好 ;其平均大小为0.016±0.009mm·s,呈顿挫型23例、尖峰型114例 ,伴发心律失常分别为4/23及3/114例 ,心血管病人分别占13/23及15/114例(P均<0.01)。认为J波为较常见心电现象 ,呈尖峰型的常伴发于早期复极综合征者多属正常变异心电图 ;若为顿挫型或驼峰型J波 ,>0.016±0.09mm·s,且伴发于器质性心脏疾患者 ,多属异常J波 ,应警惕心律失常特别是恶性心律失常的发生。     

30例小儿室早与左室假腱索的关系探讨

目的 初步探讨小儿室早的发生与左室假腱索的关系。方法 室早组为30例，年龄3-13岁。其中男18例，女12例。经体检、心肌酶谱、血电解质、全胸片和心电图检查，除室早外临床无其它阳性发现。正常对照组为30例，年龄3-13岁。其中男15例，女15例，为健康体检儿童。经体检和心电图、全胸片检查无心脏疾患和心律失常。用美国DIASONICS公司2DGAIEWAYFX彩色多普勒诊断仪，探头频率2．75MHz。在2个以上切面上看到室间隔至左室后壁，室间隔至左室心尖，呈条索状或带状回声，不与二尖辨叶相连，且除外室间隔肥厚、附壁血栓及左室肉柱等，即诊断左室假腱索。结果 室早组30例中发现左室假腱索19例，检出率为63．3％。正常对照组30例中左室假腱索5例，检出率为16．7％。室早组检出率高于正常对照组，经卡方检验，差异有显性(P＜0．01)。结论 小儿室早的发生与左室假腱索可能有关系，提示左室假腱索是室早的潜在发生原因之一。     

循环系统疾病

20000139心率对左室舒张功能的影响/周华顶…//临床心血管病杂志一1999,15(8)一376 观察90例年轻、无器质性心脏病,但有左室舒张功能障碍.心率(HR)>9()次/mln的患者。在服用归受体阻滞剂心得安或氮酞心安3一5天.使HR降至60一7。次/m.n后,76例左室舒张功能恢复正常,1。例好转,4例无变化24例随访3年,无心衰表现,预后良好。提示归受体阻滞剂克服HR增快造成左室舒张功能障碍的假阳性因此对诊断左室舒张功能障碍者若确属器质性心脏病者应积极治疗:对无器质性心脏病的年轻人应首先考虑HR的影响。表1(刘唐威)20000140经胸与经食管超声心动图应…     

Significance of asymmetrically inverted T wave

Two consecutive series of patients with a T wave asymmetry ratio of 2.0 or greater have been studied. Patients with bundle-branch block or who were on digoxin or a similar drug were excluded. In 50 of the 69 patients, the heart was examined either by echocardiography or by direct inspection. Sixty-one of the 69 patients had diseases commonly associated with left (or right) ventricular hypertrophy and/or dilatation. The remaining eight patients had clinically pure ischaemic heart disease. Of the 50 hearts examined by echocardiography or direct inspection (including six with pure ischaemic heart disease), 49 were found to have abnormal thickness of the left (or right) ventricle, or increased end-diastolic left ventricular diameter, or a combination of hypertrophy and dilatation. In 12 of the 47 patients with left ventricular hypertrophy or dilatation, the electrocardiogram did not satisfy the Sokolow and Lyon voltage criterion of left ventricular hypertrophy.     

Significance of asymmetrically inverted T wave.

Two consecutive series of patients with a T wave asymmetry ratio of 2.0 or greater have been studied. Patients with bundle-branch block or who were on digoxin or a similar drug were excluded. In 50 of the 69 patients, the heart was examined either by echocardiography or by direct inspection. Sixty-one of the 69 patients had diseases commonly associated with left (or right) ventricular hypertrophy and/or dilatation. The remaining eight patients had clinically pure ischaemic heart disease. Of the 50 hearts examined by echocardiography or direct inspection (including six with pure ischaemic heart disease), 49 were found to have abnormal thickness of the left (or right) ventricle, or increased end-diastolic left ventricular diameter, or a combination of hypertrophy and dilatation. In 12 of the 47 patients with left ventricular hypertrophy or dilatation, the electrocardiogram did not satisfy the Sokolow and Lyon voltage criterion of left ventricular hypertrophy.     

Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease

Ambulatory electrocardiograms obtained in 69 patients enrolled in the nocturnal oxygen therapy trial group were examined for frequency and significance of arrhythmias in patients with stable chronic obstructive lung disease. Ventricular premature beats occurred in 83 percent, ventricular bigeminy in 68 percent, paired ventricular premature beats in 61 percent, and nonsustained ventricular tachycardia in 22 percent of the patients. Supraventricular tachycardia occurred in 69 percent. Repetitive ventricular arrhythmia occurred in 64 percent of the patients, and was significantly more frequent in men and in patients with edema or elevated PCO2. Ventricular premature beats greater or equal to 25 per hour occurred in 35 percent of the patients. Univariate and multivariate Cox proportional hazards analysis showed that a history of coronary heart disease, increased sinus heart rate and decreased maximum work load (measured by maximal treadmill exercise test)--but not arrhythmias--were predictors of death.     

Sotalol in patients with life-threatening ventricular tachyarrhythmias

Summary To assess the antiarrhythmic efficacy of oral d,l-sotalol, 68 patients with sustained monomorphic ventricular tachycardia (SMVT) (n=62) or ventricular fibrillation (VF) (n=6) were studied by programmed ventricular stimulation (PVS). Fifty-one patients had coronary artery disease with a previous myocardial infarction and there were 17 patients without coronary disease: 11 patients had right and/or left ventricular dysplasia, one patient an aortic-valve replacement, and five patients had no visible heart disease. Prior to sotalol patients were treated with a mean of 3.6±1.3 antiarrhythmic class I drugs. None of these drugs prevented SMVT or VF. During control PVS (PVS 1), VF was induced in 8 patients (12%), SMVT in 47 patients (69%), and nonsustained ventricular tachycardia (NSVT) in 13 patients (19%). After loading with oral d,l-sotalol (320 mg/day), PVS (PVS 2) was repeated 4.2±3.3 weeks after PVS 1. In one of the patients (1%) VF was inducible, in 15 patients (22%) SMVT was induced, and in 18 patients (26%) NSVT was induced. In 34 patients (50%) either no or a short ventricular response was inducible. Our data show that oral d,l-sotalol is an effective antiarrhythmic agent in patients with SMVT or VF.     

胺碘酮和普罗帕酮治疗冠心病并室性心律失常的疗效比较

比较胺碘酮和普罗帕酮治疗冠心病心肌缺血患者室性心律失常的疗效。6 9例冠心病心肌缺血合并室性心律失常患者 ,均接受冠心病正规治疗 ,其中 35例同时口服胺碘酮片 (胺碘酮组 ) ,34例口服普罗帕酮片 (普罗帕酮组 ) ,疗程 4周。疗程开始及结束时均行 2 4h动态心电图及 12导联心电图检查。结果 :两组患者用药后 2 4h室性早搏 ,短阵室性心动过速的发作次数均明显减少 (胺碘酮组用药后与用药前比较分别为 2 70 5± 14 77个vs 6 834± 45 2 8个 ,7.4 2± 3.30次vs 1.2 9± 0 .93次 ;普罗帕酮组则分别为 6 712± 3385个vs 396 2± 1983个 ,8.0 5± 3.37次vs4 .2 2± 2 .5 9次 ,P均 <0 .0 1)。胺碘酮组的疗效高于普罗帕酮组 (P <0 .0 1)。两组未见严重副作用。结论 :胺碘酮对冠心病伴室性心律失常的疗效优于普罗帕酮。     

Effect of restriction of venous return on the hemodynamics of normal persons and patients with congestive heart failure

1. 1. Restriction of venous return by occlusion of the inferior vena cava (inflation of a balloon catheter above the renal veins) was carried out 25 times in 23 patients. The procedure was safe and undetected by the subject.

2. 2. Complete inferior vena cava occlusion produced similar changes in control circulatory pressures, cardiac output and ventricular stroke work in normal subjects and in patients with elevated ventricular filling pressures. On the average, right venticular filling pressure fell to 41 per cent of control, mean pulmonary arterial pressure to 68 per cent, left ventricular filling pressure to 64 per cent, systemic arterial pressure to 88 per cent, cardiac index to 69 per cent, right ventricular stroke work index to 50 per cent and left ventricular stroke work index was decreased 70 per cent. No significant change in oxygen consumption or pulse rate occurred.

3. 3. Partial occlusion of the inferior vena cava increased venous pressure caudal to the balloon with little alteration in intracardiac pressures and slight but significant declines in cardiac output and ventricular stroke work in both patients with normal and elevated ventricular filling pressures.

4. 4. In no subjects, either with partial or complete occlusion of the inferior vena cava was there a rise in stroke work, and hence evidence for a descending limb of a Starling curve was not obtained. Since patients with severe congestive heart failure were not included in this study, the conclusion can be applied only to mild and moderate cases of heart failure under resting conditions.

     

Clinical evaluation of severe idiopathic tricuspid regurgitation

This study clarified the clinical profile and echocardiographic findings of severe idiopathic tricuspid regurgitation (TR). Among 8,538 consecutive ultrasonic examinations, a total of 63 patients had severe TR, which was depicted by color flow mapping as a regurgitant signal more than 4 cm from the tricuspid valve orifice. Thirteen of the 63 patients had no underlying diseases, and these patients with severe idiopathic TR were the subjects of the present study. All 13 patients were over 66 years of age (mean 77.3 +/- 5.6 years old) and had had episodes of right heart failure which responded effectively to diuretics. All 13 patients had atrial fibrillation. Using two-dimensional echocardiography, thickening (77%), prolapse (69%) and malaligned coaptation (54%) of the tricuspid valves were observed. The tricuspid annular diameters, cross-sectional areas of the right and left atria and the right ventricular end-diastolic dimensions were significantly greater than those of the age-and-gender-matched lone atrial fibrillation group and the normal control group (p less than 0.01). The left ventricular dimension and ejection fraction did not differ from those of the matched lone atrial fibrillation group. Other valvular regurgitations were also detected (AR 77%, MR 100%, PR 69%), but the degrees of regurgitation were minimal. We proposed severe TR with tricuspid annular dilatation, right atrial and right ventricular dilatation observed in the aged as a distinct cardiac disease entity.     

Gender differences in left ventricular structure and function in young adults with normal or marginally elevated blood pressure.

Gender differences in left ventricular structure and function were evaluated in 68 male and 69 female young adults (mean age 30 +/- 7 years) with normal or marginally elevated blood pressure. Left ventricular mass index was greater in men than in women, even after controlling for blood pressure. There were no significant gender differences in left ventricular systolic function. Doppler indices of diastolic filling were also similar in men and women. Thus, men have a significantly greater left ventricular mass index than women, but this difference in ventricular size is not associated with differences in systolic or diastolic function.     

Giardiasis in patients with dyspeptic symptoms

AIM: To investigate the prevalence of giardiasis in patients with dyspeptic symptoms. METHODS: Clinical records of consecutive patients who attended Gastroenterology Department at Aga Khan University Hospital from January 2000 to June 2003 and had esophagogastroduodenoscopy (EGD) with duodenal biopsies and international classification of diseases 9th revision with clinical modifications (ICD-9-CM) coded with giardiasis were studied. RESULTS: Two hundred and twenty patients fulfilled the above criteria. There were 44% (96/220) patients who were giardiasis positive, 72% (69/96) of them were males and 28% (27/96) of them were females. There were 65% (81/124) males and 35% (43/124) females who were giardiasis negative. The mean age of patients with giardiasis was 28±17 years, while that of giardiasis negative patients was 40±18 years (P<0.001). In patients with giardiasis, abdominal pain was present in 71% (68/96) of patients (P = 0.02) and diarrhea in 29% (28/96) (P = 0.005); duodenitis in 25% (24/96) on EGD (P = 0.006) and in 68% (65/96) on histopathology (P = 0.002). CONCLUSION: Giardiasis occurs significantly in young people with abdominal pain, while endoscopic duodenitis is seen in only 25% of giardiasis positive cases, which supports routine duodenal biopsy.