急性肺栓塞药物治疗前后的心电图观察

目的探讨急性肺栓塞(PE)患者药物治疗前后心电图改变及临床意义。方法回顾性分析23例PE患者治疗前后心电图的改变。结果急性肺栓塞经治疗后窦性心动过速、SⅠQⅢTⅢ、胸前导联T波倒置加深、aVR导联出现终末R波增高、顺钟向转位、电轴右偏、期前收缩等心电图指标较治疗前有明显改善,差异有显著意义(p<0.05)。结论心电图在急性肺栓塞诊断中虽然是非特异性的,但如能结合临床症状并及时仔细观察心电图改变,对急性肺栓塞的诊断有重要意义。     

肺栓塞的早期诊断探讨

目的探讨肺栓塞(PE)的早期诊断。方法对近年来我科收治的20例PE患者的临床资料进行回顾性分析。结果 20例中有呼吸困难者18例(90%),低氧血症16例(80%),低血压12例(60%),心电图呈典型SⅠQⅢTⅢ者4例(20%),血浆D-二聚体500μg/L者20例(100%),螺旋CT检查有典型表现者15例(75%),超声心动图有典型表现者14例(70%),首诊误诊8例(40%),溶栓治疗14例(70%),死亡3例(15%)。结论 PE临床表现缺乏特异性,易误诊。提高对本病的警惕性,对有PE危险因素的患者,一旦出现不明原因的呼吸困难、低氧血症时,合理选择床旁无创检查是提高PE早期诊断率的有效方法 。     

急性肺栓塞患者心电图特征分析

目的通过对急性肺栓塞患者的心电图资料进行研究分析,掌握其心电图特征,提高心电图诊断肺栓塞水平。方法对在我院住院期间被确诊为急性肺栓塞的56例患者的心电图资料进行回顾性分析。结果 56例急性肺栓塞患者中,心电图正常5例,异常51例。心电图主要表现有心电图动态改变46例(82.1%)、V1~V4导联(至少两个导联)T波改变21例(37.5%)、窦性心动过速18例(32.1%)、不完全性右束支传导阻滞9例(16.1%)以及完全性右束支传导阻滞、显著顺钟转、SⅠQⅢTⅢ、右偏电轴、QⅢTⅢ、SⅠ图形(≥0.15 mv)、QⅢ图形、频发房性期前收缩、心房纤颤、QRS波低电压、a VR导联R波电压增高等,患者心电图改变无特异性。结论急性肺栓塞患者心电图异常表现多种多样,缺乏特异性,正确掌握肺栓塞的心电图变化规律,结合病史、临床表现、D-二聚体检测、CT肺动脉造影、超声心动图等各种检查进行综合判断,可以减少误诊漏诊。     

肺栓塞心电图的鉴别诊断

由于急性肺栓塞心电图改变的多样性 (高达 2 8种 )、多变性 (随栓子大小、发病时间动态改变 ) ,且相当一部分患者心电图可完全正常 ,而其他许多临床情况也可能出现类似急性肺栓塞样心电图改变 ,因此 ,心电图诊断急件肺栓塞的特异性相当有限。应全面考虑病史、临床症状和体征 ,结合血气分析、肺动脉造影、X线胸片、增强CT、磁共振、同位素扫描、超声心动图检查等进行综合分析 ,做出诊断。肺栓塞心电图的表现呈现多样性 ,不具有特异性 ,但有重要的临床价值。使用恰当 ,有助于肺栓塞的诊断 ,可以提高肺栓塞的检出率 ;使用不当 ,可导致漏诊或…     

老年急性肺栓塞心电图变化特点

目的探讨老年急性肺栓塞患者心电图改变的特点及临床意义。方法选择老年急性肺栓塞患者76例,分析治疗前后心电图的变化。结果 76例急性肺栓塞患者均出现异常心电图改变,其中窦性心动过速63例(82.9%),aVR导联R波振幅增高57例(75.0%),V1～V4导联T波倒置加深42例(55.3%),SⅠQⅢTⅢ现象40例(52.6%),房性或室性期前收缩16例(21.0%)等,治疗后心电图改变较治疗前明显改善,差异有统计学意义(P<0.05)。结论心电图在急性肺栓塞发病初期多有异常改变,但改变缺乏特异性,通过心电图的分析,仍有一些特征规律可循,结合临床症状,认真分析心电图的细微改变和辅助检查,对急性肺栓塞的诊断有重要意义。     

急性肺栓塞患者的心电图分析

目的探讨急性肺栓塞（PE）患者的心电图（ECG）表现及临床价值。方法选择23例肺血管造影确诊的急性肺栓塞患者进行ECG分析。结果入院时具有SⅠQⅢTⅢ相关心电图表现者11例（47.8%）。结论PE时其ECG表现有一定的特异性,可以作为诊断PE的辅助方法。     

53例急性肺栓塞心电图分析

目的分析和总结肺栓塞时的心电图特点及其在急性肺栓塞的诊断与鉴别诊断中的应用。方法回顾性分析6年来我院确诊的53例急性肺栓塞患者住院期间的心电图表现并对每位患者治疗前后的心电图形进行对比。结果 53例患者中,出现心电图改变者占98.14%,窦性心动过速最多占77.35%,其次是ST-T改变(ST段改变占64.15%,T波改变占62.26%),典型SⅠQⅢTⅢ征者占22.64%,肺型P波占7.55%,完全性或不完全性右束支阻滞的占18.87%,aVR导联出现终末R波占28.30%。经溶栓抗凝治疗后,比对原有心电图上述项目皆发生了动态变化过程。结论心电图对于提示肺栓塞的诊断有一定的临床价值重大意义。     

急性肺栓塞的心电图分析

目的探讨心电图特征及其在诊断急性肺栓塞（PE）中的作用。方法回顾性分析6年来确诊的32例急性肺栓塞患者的心电图特征及治疗前后的改变。结果出现心电图改变者95%,最多见为窦性心动过速,达75%,ST-T改变占59%,SⅠQⅢTⅢ征占31%,右束支传导阻滞（RBBB）占31%,肺型P波占28%,顺钟向转位占21%,房性早搏（PAS）占19%,电轴右偏占16%,室性早搏占6%,阵发性房颤、SⅠSⅡSⅢ综合征、低电压各占3%。结论PE的心电图变化是多变性的,但有些特征在诊断及鉴别诊断中仍具有一定价值。     

85例肺栓塞临床心电图分析

目的 分析心电图改变在临床肺栓塞诊断中的作用。方法 病例选自我院1995年1月至2003年2月期间住院的85例经肺CT、灌注／通气扫描或肺动脉造影明确诊断的肺栓塞患者，主要分析患者住院期间的心电图特征以及治疗前后心电图改变的对比。结果 肺栓塞患者出现心电图改变者为98．8％，其中最多见的为QⅢ，达到60．0％，其它SI 55．3％，TⅢ 44．7％，同时具备SⅠQⅢTⅢ占32．9％，右胸导联Vl—V3T波倒置占42．4％，aVR导联出现终末R波占36．5％，右束支阻滞占25．9％，ST段下移改变占25．9％，肺型P波仅占5．9％。结论 心电图在临床肺栓塞的诊断虽然是非特异性和非诊断性的，但有许多特征对提示肺栓塞有一定价值。     

肺动脉碎栓术治疗肺栓塞八例

肺动脉栓塞 (pulmonaryembolism ,PE)是一种常见的心肺疾病 ,由于其诊断困难 ,误诊率高。未经治疗的PE病死率约30 %。为了提高PE的诊治率 ,自 2 0 0 1年 5月～ 2 0 0 2年 8月期间 ,通过对 8例PE的患者行肺动脉碎栓术治疗 ,取得了较满意的临床效果 ,现将结果报道如下 :1　资料与方法根据临床症状 ,D 二聚体 >0 .5mg L ,心电图改变 (QRS电轴右偏 ,SⅠQⅢTⅢ 型 ,右胸前导联及Ⅱ、Ⅲ、aVF导联T波倒置 ,完全性或不完全性右束支传导阻滞 ) ,血气分析等指标 ,疑诊为PE者行肺动脉造影。共筛选 8例住院患者 ,最大年龄 72岁 ,平均年龄 6 2 .…     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.