膜周部室间隔缺损合并三尖瓣反流的机制探讨

目的通过术前、术后超声心动图和彩色多普勒检查及手术所见,评价及明确膜周部室间隔缺损合并三尖瓣反流的机制.方法通过13例膜周部室间隔缺损合并三尖瓣反流的临床资料,经胸超声心动图术前诊断及术后复查,结合术中所见,观察膜周部室间隔缺损和三尖瓣反流的关系.结果所有病例均为中等膜周部室间隔缺损,中等量的左向右分流,心室收缩期,二维超声心动图可见典型的三尖瓣前向运动及三尖瓣呈开放状态.彩色多普勒血流显象,大多数病例表现为经室缺的部分穿隔血流被隔瓣阻挡,但主要血流经三尖瓣隔瓣下缘穿过,冲击到三尖瓣的前瓣,导致三尖瓣反流.室缺修补后,三尖瓣反流消失.结论膜周室缺的穿隔血流可导致膜周室缺合并三尖瓣反流.二维超声心动图及彩色多普勒血流显象发现该现象,这是外科手术修补室缺的良好指征.     

二维超声心动图诊断室间隔缺损

报道应用二维超声心动图检查室间隔缺损187例,均经手术证实。二维超声图直接显示回声失落区185例(98.9％),诊断空间隔缺损182例(97.3％),检出缺损大小0.3～4.0cm,文中讨论了室间隔缺损的部位与超声回声失落显示切面及其位置的关系及如何识别回声失落。     

彩色多普勒超声心动图诊断室间隔缺损(附49例分析)

<正> 本文报告经彩色多普勒超声心动图(CFM)诊断的49例室间隔缺损(VSD)与手术所见的比较结果,讨论CFM诊断VSD的临床应用价值,分析其合并畸形漏误诊原因。1资料和方法 本组49例,男25例,女24例,平均年龄15.8(4-34)岁。使用AU-4彩色多普勒超声仪,探头2.5-3.5MHz。病人左侧卧位,常规行二维系列切面检查,重点观察室间隔各区段有无连续中断及中断的部位、大小,彩色多普勒血流显像(CDFI)观察心内分流的部位、方向及时相,测量跨隔压差,估测肺动脉收缩压。     

室间隔完整型肺动脉闭锁的彩色多普勒超声诊断

目的 探讨室间隔完整型肺动脉闭锁（PAIVS）的超声影像特点.方法 回顾分析7例PAIVS的超声心动图表现,并与外科手术结果进行比较.结果 PAIVS的超声心动图特征明显：（1）二维超声心动图胸骨旁左心室长轴切面显示室间隔回声完整.（2）心尖四腔切面显示2个心房正位,室间隔回声完整.（3）胸骨旁大动脉短轴切面显示2条大动脉位置关系正常,肺动脉瓣无开放运动,肺动脉瓣无血流信号通过.手术证实7例PAIVS中肺血由未闭的动脉导管供应者6例;主肺动脉及分支发育不良,仅有体肺动脉侧支供应肺血者1例.心房水平右向左分流者7例：其中5例为卵圆孔未闭,2例为房间隔缺损.合并畸形包括三尖瓣闭锁,三尖瓣发育不良伴狭窄、房间隔膨凸瘤等.结论 PAIVS患儿肺血来源多样化,肺动脉发育程度不一,超声心动图特征明显,对PAIVS有特异性诊断价值.     

主动脉右窦瘤破裂、膜部室间隔瘤及右冠状动脉瘘的超声鉴别诊断

本文选择临床上和二维超声心动图(2DE)图像酷似的三种疾病:主动脉右窦瘤破入右室(18例)、膜部室间隔瘤伴破口(5例)及右冠状动脉右心痿(5例)的超声心动图(UCG)共同特征——主动脉前连续中断,在心尖四腔心切面右室内显示不同程度圆形环状回声等。UCG上有时难以区别,本文提出讨论。     

经胸实时三维超声心动图在房间隔缺损和室间隔缺损介入治疗中的应用

目的 :探讨实时三维超声心动图在房间隔缺损和室间隔缺损介入治疗中的应用价值。方法 :采用Philips公司Sonos75 0 0型超声心动仪 ,实时三维超声心动图技术 (real time 3 dimensionalechocar diography,RT 3DE) ,部分结合二维食管超声心动图 (transesophagealechocardiography ,TEE )及放射检查技术引导 12例先天性房间隔缺损 ,10例膜部室间隔缺损进行了经导管介入治疗手术。结果 :2 2例患者介入手术均获成功 ,术后无残余分流。RT 3DE对房、室间隔缺损的部位、大小、相对空间毗邻关系的判定均可获得比二维超声更丰富的数据信息 ,可靠性强。在引导介入手术中 ,无需全麻 ,操作简便 ,三维实时显像表现出良好的时间和空间分辨率 ,年龄限制少 ,一定程度上可减少放射应用剂量。术中实时测量三维距离 ,血流及多普勒技术的应用还受到技术制约。结论 :经胸RT 3DE作为无创心脏检查手段在引导房、室间隔缺损的介入手术中有肯定价值 ,并可望广泛应用于其他介入治疗 ,但其技术有一定的局限性仍需进一步改进     

应用Amplatzer封堵器关闭32例膜部室间隔缺损

目的　观察Amplatzer膜部室间隔缺损封堵器关闭膜部室间隔缺损的临床疗效及安全性。方法　经超声心动图及临床表现诊断为膜部室间隔缺损患者 ,如有临床症状但没有右向左分流 ,且膜部室间隔缺损的局部解剖结构满足以下条件 :(1)膜部室间隔缺损离主动脉瓣至少 1mm ,离三尖瓣隔瓣至少 3mm ;(2 )室间隔缺损的最窄直径小于 14mm ;(3)伴膜部室间隔瘤形成时 ,瘤体未影响右心室流出道 ;(4 )外科手术关闭膜部室间隔缺损后遗留的室间隔缺损 ,且对心脏的血流动力学有影响。在局部或全身麻醉下对患者行经导管Amplatzer双面伞膜部室间隔缺损的关闭治疗 ,手术中连续经胸或经食管超声心动图和X线监测。术后随访 3个月。结果　自 2 0 0 2年 6月至 2 0 0 3年 3月共有 32例患者行经导管Amplatzer双面伞膜部室间隔缺损的关闭治疗 ,其中男 17例 ,女 15例。超声测定膜部室间隔缺损直径为 3～ 8mm(平均 5 1mm) ,左心室造影测定膜部室间隔缺损的直径为 3～ 8mm(平均 4 4mm) ,所选Amplatzer膜部室间隔缺损封堵器直径为 4～ 12mm(平均 7 6mm)。堵闭操作技术成功率为 10 0 %。超声心动图示术后即刻残余分流为 11 5 % (少量分流 3 8% ,微量 7 7% ) ,2 4h后残余分流为 7 7% (为微量 ) ,3个月后有 3 8%的微量分流。手术中出现一过性     

超声心动图在小腰型封堵器闭合膜部室间隔缺损中的应用

目的 探讨超声心动图在小腰型室间隔缺损封堵器闭合膜部室间隔缺损(perimembranous ventricular septal defect, PmVSD)中的应用价值。 方法 使用飞利浦Sonos-5500型彩色多普勒超声诊断仪,探头频率2~4 MHz,对43例PmVSD患者术前、术中、术后进行超声心动图观测。结果 ①超声心动图测得室缺缺损口左室侧均大于右室侧,多数伴右室侧多孔(多束分流)。缺损口形态为不规则形或瘤形。②心血管造影测量缺损口左右室侧大小并与超声测量值比较,结果无显著性差异。③封堵器型号为4~14（7.7±2.5）mm,1例释放后出现少量残余分流,术后3 d消失,余成功封堵;3例少量三尖瓣返流,近期随访观察未见明显异常。结论 PmVSD缺损口形态复杂,变异较大,超声心动图指导应用小腰型封堵器闭合可获得满意的近期疗效。     

新型Amplatzer封堵器治疗膜周部室间隔缺损的临床研究

目的探讨新型Amplatzer室间隔缺损封堵器治疗膜周部室间隔缺损(PMVSD)的临床疗效。方法采用新型Amplatzer膜周部室间隔缺损封堵器,对46例PMVSD患者进行封堵治疗。对心脏多普勒超声检查符合导管封堵条件的患者术前常规进行心导管检查,测定血流动力学参数。在X线透视、食管超声心动图(TEE)的监测下建立股动静脉轨道,经右心系统释放封堵器。病人分别于术后24小时、1个月、3个月、6个月进行随访。结果46例患者中除2例因室间隔缺损膜部瘤松软未能成功置入外,其余患者均能正确置放新型Amplatzer封堵器和即刻完全封堵PM-VSD。术后24小时至6个月进行TEE复查,所有患者被完全封堵。结论新型Amplatzer封堵器治疗PMVSD是一种安全、成功率高、近期疗效可靠的介入方法。     

心血管介入治疗室间隔膜部缺损的临床分析

目的探讨经导管介入治疗室间隔膜部缺损(VSD)的可行性、方法及疗效。方法 30例室间隔膜部缺损患者,男18例,女12例,年龄在10~57(27.2±11.5)岁。术前心脏超声检查确诊为膜周部缺损VSD,缺损直径2~8(4.6±1.6)mm,缺损上缘距主动脉瓣2~5(2.7±0.8)mm。30例患者均于术中先行左心室造影,5例合并存在膜部膨胀瘤,且其中1例同时合并两处室间隔缺损,29例患者确定适合行膜部VSD封堵术。结果 28例均应用Amplatzer封堵器介入治疗成功,1例存在两处室间隔缺损合并膜部膨胀瘤者,建议外科手术治疗;1例合并膜部膨胀瘤患者封堵后存在明显分流封堵未成功。成功病例随访9~48个月,经胸超声心动图检查提示封堵器位置稳定,无残余分流,无相关并发症发生。结论在严格选择适应证和有熟练操作技巧的条件下,心血管介入治疗膜部VSD是一项操作安全、疗效可靠的治疗方法,具有创伤小,恢复快等优点。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.