帕金森病痴呆与阿尔茨海默病认知障碍特点分析

目的 分析帕金森病痴呆(PDD)与阿尔茨海默病(AD)患者的认知障碍特点.方法 采用语义流畅性、语音流畅性、动作流畅性测验与物品和动作命名测验评定PDD组(30例)、AD组(30例)与对照组(60例)患者临床情况.结果 PDD组语义流畅性测验总分(9.33±2.78)分、语音流畅性测验总分(6.17±1.67)分、动作流畅性测验总分(7.03±2.34)分,AD组分别为(6.90±2.47)分、(7.87±2.01)分、(8.30±3.17)分;PDD组物件命名测验总分(36.33±3.39)分、动作命名测验总分(17.63±2.17)分,AD组分别为(33.23±3.56)分与(22.33±2.37)分.与对照组比较,PDD与AD患者三项言语流畅性与物品和动作命名均受损(P＜0.01).其中,PDD患者以语音流畅性、动作流畅性与动作命名损害为重,而AD患者以语义流畅性与物件损害为重(P＜0.01).结论 PDD与AD患者均存在执行功能障碍与命名损害,PDD是一种伴有皮质功能损害以额叶皮质下功能障碍为主要特点的认知损害性疾病,而AD亦存在皮质下功能障碍.

Abstract：

Objective To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. Methods Cognitive function was examined in Parkinson's disease with dementia (PDD) patients ( n = 30) , Alzheimer's disease (AD) patients ( n = 30) and healthy elderly control subjects ( n = 60) . Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. Results In PDD group , the score of semantic fluency test is 9. 33 ±2. 78, 6. 17 ± 1.67 of phonemic fluency test and 7.03 ±2. 34 of action fluency test,it is 6.90 ±2.47, 7.87±2.01,8.30±3. 17 of AD group. The score of objective and action naming tests is 36.33 ±3.39, 17.63 ±2. 17 in PDD group,while AD patients is 33.23 ±3.56 and 22.33 ±2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P ＜ 0. 01 ), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group , while semantic fluency and objective naming were more impaired in AD patients (P ＜ 0. 01 ). Conclusions Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.     

川崎病的心血管病变观察

目的　观察川崎病 ( KD)的心血管病变。方法　对 2 6例 KD的住院患儿 ,于急性期或亚急性期行心电图、超声心动图、血清肌钙蛋白 I( c Tn I)及肌酸磷酸激酶 ( CK)及其同工酶 ( CK-MB)检查 ,并于病程不同时期 ( 6个月～ 2年 )进行复查。结果　冠状动脉病变 10例 ,占 3 8.5 % ,其中冠状动脉扩大 7例 ,冠状动脉瘤 3例 ,发生于急性期或亚急性期 9例 ,发生于病程第 9个月 1例。心肌炎 2例 ,主动脉瓣、二尖瓣反流各 1例。心电图异常 8例 ,占 3 0 .8%。血清 c Tn I阳性 12例 ,占 46.2 % ,CK-MB升高 7例 ,占 2 6.9%。结论　KD的心血管并发症表现形式多样 ,主要为冠状动脉扩大和冠状动脉瘤 ,其次是心电图异常 ,c Tn I阳性 ,CK-MB升高 ,主动脉瓣及二尖瓣反流。     

慢性肾脏病不同阶段血尿酸的变化及其与心血管疾病的关系

目的研究慢性肾脏病（CKD）患者肾损害不同阶段血尿酸（uricacid，UA）水平的变化及其与心血管疾病的关系。方法对189例非透析治疗的CKD患者的临床及实验室资料作回顾性研究，分析肾损害不同阶段血UA与其他相关因素特别是与心血管事件的关系。结果CKD患者肾损害不同阶段均存在高尿酸血症（hyperuricemia），其血UA水平均较对照组呈显著性升高（均P〈0．05）。血UA水平与超声心动图异常、心电图异常及心血管事件的发生（P〈0.01）、收缩压及舒张压（P〈0．05）、血总胆固醇（T—ch）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）浓度及血肌酐呈正相关（P〈0．05）；而与血高密度脂蛋白胆固醇（HDL—C）浓度呈负相关（P〈0．05）。结论CKD患者普遍存在尿酸代谢的异常，血UA水平的升高与心血管事件的发生呈正相关。血UA升高的原因部分可能与其代谢受肾功能的影响有关，可能是CKD患者并发心血管事件的危险因素之一。     

Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease

BACKGROUND: Patients with peripheral arterial disease (PAD) have increased mortality compared with patients without PAD. Coronary artery disease (CAD) accounts for almost 75% of deaths in PAD patients. Studies suggest that PAD is underdiagnosed and atherosclerotic risk factors undertreated when compared with CAD. OBJECTIVE: To determine whether cholesterol guidelines are being met in patients with PAD and to determine whether any independent factors increase the likelihood of reaching goal low-density lipoprotein (LDL). DESIGN: A retrospective chart review of subjects diagnosed with PAD in 2001 at 2 Veterans Affairs Medical Centers. MEASUREMENTS: Univariate analysis compares baseline characteristics between those reaching goal and those who do not. Multivariate logistic regression analysis identified predictors of meeting LDL goal among PAD patients. RESULTS: Of 315 patients, 62% reached goal LDL. Those more likely to reach goal were older, had hypertension, and a history of CAD and stroke. Positive predictors of LDL goal were age and CAD, while smoking was a negative predictor. CONCLUSION: The majority of veterans with PAD received lipid-lowering medication and achieve goal LDL, but they are more likely to do so if they are older than 70 and have a history of CAD.     

Prevalence of Coronary Artery Disease in Patients with Valvular Heart Disease

ABSTRACT. To evaluate the usefulness of preoperative coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost-benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut-off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.     

同型半胱氨酸血症的治疗概况及进展

同型半胱氨酸是一种含巯基的氨基酸,它是蛋氨酸和半胱氨酸过程中的一个重要的中间产物,其本身并不参加蛋白质的合成。当与同型半胱氨酸代谢有关的酶或辅助因子缺乏使同型半胱氨酸代谢受阻时,就会导致高同型半胱氨酸血症。近年来大量研究证实高同型半胱氨酸与心脑血管疾病、外周血管疾病、神经系统退行性疾病、糖尿病等发病高度相关,同型半胱氨酸已成为心脑及外周血管疾病的危险因素及预测指标。本文将同型半胱氨酸血症的近年治疗概况及进展作一综述。     

肝病鼻出血500例临床分析

目的总结肝病鼻出血的临床特点、易发因素,探讨合适的临床处置及预防办法。方法回顾性分析500例肝病鼻出血病例,总结相关因素,提出注意事项,交流诊疗体会。结果 500例鼻出血患者中,出血部位以Little’s区多见者53.4%,合并肝硬化、肝癌者75%,多次反复出血者61%,70.6%合并血小板减少及凝血功能障碍。结论肝病患者鼻出血发生率高,与鼻腔黏膜干燥、血小板减少及凝血功能障碍密切相关,晚期肝病患者发生率明显增高。鼻腔保湿护理及鼻腔填塞仍为主要的防治手段。     

合并代谢综合征的急性心肌梗死患者临床特征

目的探讨合并代谢综合征（MS）的急性心肌梗死（AMI）患者临床特征。方法对81例合并MS的AMI患者及94例无MS的AMI患者进行回顾性研究,比较两组患者的基础临床情况、诱发因素、临床表现、梗死部位及心肌损伤标记物情况。结果与非MS组相比,MS组年龄较大,女性患者较多（34.6%vs.17.0%;P〈0.01）,而吸烟和冠状动脉粥样硬化性心脏病（冠心病）家族史较低（分别为43.2%vs.59.6%;13.6%vs.25.5%;P均〈0.05）,饱餐后或情绪激动时发病较高（分别为18.5%vs.7.4%;13.6%vs.4.3%;P均〈0.05）,有胸痛者少（66.7%vs.81.9%;P〈0.05）,泵功能≥KillipⅡ级者较多（35.8%vs.22.3%;P〈0.05）,住院病死率高（22.2%vs.10.6%;P〈0.05）,前壁梗死较高（51.9%vs.36.2%;P〈0.05）,肌酸激酶同工酶（CK-MB）较高[（147±19）U/Lvs.（122±14）U/L;P〈0.01]。结论与无MS的AMI患者相比,合并MS的AMI患者年龄较大,女性患者较多,近期预后较差。     

Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease

Abstract. Mechtouff L, Touzé E, Steg PG, Ohman EM, Goto S, Hirsch AT, Röther J, Aichner FT, Weimar C, Bhatt DL, Alberts MJ, Mas J‐L, on behalf of the REACH Registry Investigators (Paris‐Descartes University; Université Paris 7; Paris, France, Duke University, Durham NC, USA, Tokai University, Isehara, Japan, University of Minnesota, Minneapolis, MN, USA, Academic Teaching Hospital Hannover Medical School, Minden, Germany, Academic Teaching Hospital Wagner‐Jauregg, Linz, Austria, University of Duisburg‐Essen, Essen, Germany, VA Boston Healthcare System, and Brigham and Women’s Hospital, Boston, MA; and Northwestern University Medical School, Chicago, IL; USA). Worse blood pressure control in patients with cerebrovascular or peripheral arterial disease compared with coronary artery disease. J Intern Med 2010; 267 :621–633. Objectives. Poor blood pressure (BP) control is common amongst patients with symptomatic atherothrombotic disease. It is unclear whether BP control and management differ across atherothrombotic disease subtypes. Methods. We analysed the baseline data of 44 984 patients with documented coronary artery disease (CAD) only (n = 30 414), cerebrovascular disease (CVD) only (n = 11 359) and peripheral arterial disease (PAD) only (n = 3211) from the international REduction of Atherothrombosis for Continued Health Registry and investigated the impact of atherothrombotic disease subtype on BP control and use of antihypertensive drugs. Results. The proportion of patients with BP controlled (<140/90 mmHg) was higher in CAD (58.1%) than in CVD (44.8%) or PAD (38.9%) patients (P < 0.001). Amongst patients with treated hypertension, CAD patients were more likely to have BP controlled than were CVD patients [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.59–1.75] or PAD (OR = 2.30; 95% CI = 2.10–2.52). These differences were smaller in women than in men and decreased with age. Amongst treated patients, CAD patients were more likely to receive ≥3‐drug combination therapies than were CVD (OR = 1.73; 95% CI = 1.64–1.83) or PAD (OR = 1.64; 95% CI = 1.49–1.80) patients. Adjustment for age, gender, waist obesity, diabetes, education level and world region did not alter the results. Conclusions. Coronary artery disease patients are more likely than CVD or PAD patients to have BP controlled and to receive antihypertensive drugs, particularly combination therapies. Promotion of more effective BP control through combination antihypertensive therapies could improve secondary prevention and therefore prevent complications in CVD and PAD patients.     

Association of chronic kidney disease categories defined with different formulae with major adverse events in patients with peripheral vascular disease

Objective

The aim of this study was to compare the ability of eGFR calculated by modification of diet in renal disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Lund-Malmö formulae in predicting major adverse events in peripheral vascular disease (PVD) patients.

Methods

We prospectively recruited 2137 patients, measured serum creatinine to calculate eGFR using three different formulae and grouped patients into eGFR categories ≥90, 60–89, 45–59, 30–44, 15–29 and <15 ml/min/1.73 m². Patients were followed up for a median of 1.3 (inter-quartile range 0.3–3.6) years. The primary outcome was the combined incidence of myocardial infarction, stroke or death. The ability of eGFR categories defined with the different formulae to predict outcome was assessed using the net reclassification index.

Results

1450 (67.9%), 1515 (70.9%) and 1813 (84.8%) patients had eGFR <90 ml/min/1.73 m² according to the CKD-EPI, MDRD and Lund-Malmö formulae, respectively. Using the CKD-EPI formula 276 (12.9%) patients were reclassified to a different eGFR category in comparison to the MDRD formula and the prediction of outcome was improved (net reclassification index 0.106, p < 0.001). Using the Lund-Malmö formula 563 (26.3%) patients were reclassified to a different eGFR category in comparison to the MDRD formula and the prediction of outcome was improved (net reclassification index 0.108, p < 0.001). Classification using the CKD-EPI and Lund-Malmö formulae was equally effective at predicting outcome (net reclassification index - 0.002, p = 0.397).Conclusions: eGFR categories determined with the CKD-EPI and Lund-Malmö formulae are equally effective at predicting major adverse events in patients with PVD.     

Magnetic resonance microscopy with cardiovascular applications

Traditional methods of imaging and studying cardiac and arterial disease are either invasive and require histological sectioning or they involve ionizing radiation. Magnetic resonance microscopy makes it possible to nondestructively study the in vivo hemodynamics of single vessels as small as 100 μm in diameter and the morphology of prepared vessels as small as 10 μm. The techniques described here are performed on specialized magnetic resonance scanners that are available at fewer than 20 sites worldwide. This review describes the phenomena that are detected and measured in magnetic resonance microscopy experiments and highlights applications that have contributed to cardiovascular research. © 1996, Elsevier Science Inc. (Trends Cardiovasc Med 1996;6:247–254).     

Nonsecretory multiple myeloma in a 26-year-old man with acquired immunodeficiency syndrome, presenting with multiple extramedullary plasmacytomas and osteolytic bone disease

High grade B-cell lymphoma and leukemia have been well described in patients with the acquired immunodeficiency syndrome (AIDS). Malignant transformation of more differentiated lymphoid cells has not been well described in these patients. We report a 26-year-old man with AIDS-associated multiple myeloma, who had a highly unusual presentation and clinical course. A review of the literature indicates that monoclonal gammopathy in patients seropositive for the human immunodeficiency virus (HIV) is common. Multiple myeloma and extramedullary plasmacytomas, diseases that are extraordinarily rare in young persons, are now being reported in patients with AIDS and should be added to the list of neoplastic diseases now associated with HIV infection.     

Association of BP with Death,Cardiovascular Events,and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

Background and objective

The optimal BP target to reduce adverse clinical outcomes in patients with CKD is unclear. This study examined the relationship between BP and death, cardiovascular events (CVEs), and kidney disease progression in patients with advanced kidney disease.

Design, setting, participants, & measurements

The relationship of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with death, CVE, and progression to long-term dialysis was examined in 1099 patients with advanced CKD (eGFR≤30 ml/min per 1.7 3m²; not receiving dialysis) who participated in the Homocysteine in Kidney and ESRD study. That study enrolled participants from 2001 to 2003. Cox proportional hazard models were used to examine the association between BP and adverse outcomes.

Results

The mean±SD baseline eGFR was 18±7 ml/min per 1.73 m². During a median follow-up of 2.9 years, 453 patients died, 215 had a CVE, and 615 initiated long-term dialysis. After adjustment for demographic characteristics and confounders, SBP, DBP, and PP were not associated with a higher risk of death. SBP and DBP were also not associated with CVE. The highest quartile of PP was associated with a substantial higher risk of CVE compared with the lowest quartile (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.10 to 2.52). The highest quartiles of SBP (HR, 1.28; 95% CI, 1.01 to 1.61) and DBP (HR, 1.36; 95% CI, 1.07 to 1.73), but not PP, were associated with a higher risk of progression to long-term dialysis compared with the lowest quartile.

Conclusions

In patients with advanced kidney disease not undergoing dialysis, higher PP was strongly associated with CVE whereas higher SBP and DBP were associated with progression to long-term dialysis. These results suggest that SBP and DBP should not be the only factors considered in determining antihypertensive therapy; elevated PP should also be considered.     

Gilbert综合征96例临床分析

目的总结Gilbert综合征的临床特点,便于诊断、鉴别诊断及治疗。方法总结了经肝组织活检明确诊断的Gilbert综合征96例,从家族史、临床表现、实验室检查、病理变化及治疗等多方面进行分析。结果患者中男85例,女11例。6.1%有明确家族史,70%发病年龄在10～30岁,其主要症状是皮肤巩膜黄染、尿黄。肝功能示：总胆红素（50.5±18.24）μmol/L,间接胆红素（36.19±16.86）μmol/L,90%患者ALT正常。肝组织病理显示肝细胞轻度水肿及少量炎性细胞浸润,肝细胞内可见棕黄色色素颗粒沉积。超声主要表现为肝脏回声粗欠均匀、脾大和慢性肝损害。应用苯巴比妥治疗有效率高于一般保肝治疗。结论 Gilbert综合征多见于青少年,男性多见。症状以黄染为主,胆红素轻中度升高,以间接胆红素升高为主。病理变化轻微,苯巴比妥疗效确切。     

Multiple Coronary Artery Aneurysms of the Right Coronary Artery in Neonate with Pulmonary Atresia with Intact Ventricular Septum

Pulmonary atresia with intact ventricular septum (PA/IVS) with right ventricular‐dependent coronaries is a rare congenital cardiac anomaly. It has been associated with wide range of considerable anomalies including sinusoids, fistulae, coronary stenosis, or complete atresia. Coronary artery aneurysms in a neonate with PA/IVS have not been described. We report a case of neonate with pulmonary atresia with intact ventricular septum with giant coronary artery aneurysms.     

Carotid stenting with a new system for distal embolic protection and stenting in high-risk patients: the carotid revascularization with ev3 arterial technology evolution (CREATE) feasibility trial.

The purpose of this study was to evaluate the feasibility of carotid artery revascularization using a new system for carotid stenting and distal embolic protection in 30 patients with severe carotid stenosis and high risk for carotid endarterectomy (Carotid Revascularization With ev3 Arterial Technology Evolution, or CREATE). Previous studies suggest that patients with carotid stenosis and serious comorbid cardiopulmonary and anatomic conditions are at high risk for carotid endarterectomy. All patients underwent percutaneous revascularization using the Protégé GPS self-expanding nitinol stent (ev3, Plymouth, MN) and the Spider distal embolic protection system (ev3). In-hospital and 30-day outcomes were analyzed. High-risk features included age > 75 years (63%), left ventricular ejection fraction < 35% (20%), and restenosis after prior carotid endarterectomy (53%). Procedural success was 100%. In-hospital complications included severe vasovagal reactions in six patients (20%) and a popliteal embolus in one patient (3.3%), treated by successful embolectomy. During 30 days of follow-up, two patients (6.6%) experienced minor neurological deficits, including transient expressive aphasia that resolved without therapy in one patient and homonymous hemianopsia due to contralateral posterior circulation stroke in one patient. This study supports the feasibility of percutaneous carotid artery revascularization with the Protégé GPS self-expanding stent and Spider distal embolic protection system, which will be evaluated in a large multicenter pivotal trial (CREATE Pivotal Trial).     

Castleman's病合并糖尿病Graves病1例

1病历资料患者女,53岁。主因Castleman s病6年,糖尿病5年,烦热伴消瘦明显6个月,咳嗽伴发热2 d入院。患者自     

慢性阻塞性肺疾病合并肺心病患者预后的相关因素分析

目的探讨影响慢性阻塞性肺疾病（COPD）合并肺心病患者预后的相关因素和防治措施。方法对170例CDPD合并肺心病住院患者的预后进行临床分析。结果本组资料显示患者年龄越大，病死率越高，80岁以上患者病死率高达36．11％。COPD病情和右心功能不全越严重，病死率越高。重度COPD和右心功能不全病死率分别为28．89％和38．78％。患者急性加重次数越多，病死率越高，每年急性加重次数〉3次者，病死率高达46．0％。患者冬季病死率最高（57．78％），夏季最少（2．22％）。重度营养不良者，病死率高达68．75％。≥3个合并症者病死率高达62．85％。PaO2〈6.65kPa者病死率高达49．02％。结论年龄、病情严重程度、急性加重次数、合并症、营养状况及动脉血气等因素均与COPD肺心病患者的预后关系密切，在综合治疗的同时，应重视营养支持氧疗。