心脏瓣膜置换术后持续性心房颤动的电复律

目的探讨心脏瓣膜置换术后持续性心房颤动(简称房颤)电复律的成功率和安全性。方法对瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者135例行同步直流电复律治疗。电复律之前常规抗凝,加用厄贝沙坦和胺碘酮,积极处理原发心脏疾病。复律成功后继续服用厄贝沙坦和胺碘酮,3个月后停止。随访至电复律后12个月。结果135例,6例(4.4%)加用药物后自行转复。126例电击成功(97.7%)。3例(2.3%)未能转复。132例复律成功者12个月后123例维持窦性心律(93.2%),9例复发;复律后3,12个月左房内径较复律前缩小(P<0.05),左室射血分数增加(P<0.05)。结论对于瓣膜置换术后病程长、左房增大(≥50mm)的持续性房颤患者,应尝试给予转复的机会,在经过充分准备和抗心律失常药物协同应用下,其电复律成功率高,窦性心律维持时间长,并发症少。     

心脏瓣膜置换术后持续性心房颤动的电复律

目的探讨心脏瓣膜置换术后持续性心房颤动（简称房颤）电复律的成功率和安全性。方法对瓣膜置换术后病程长、左房增大（≥50mm）的持续性房颤患者135例行同步直流电复律治疗。电复律之前常规抗凝，加用厄贝沙坦和胺碘酮，积极处理原发心脏疾病。复律成功后继续服用厄贝沙坦和胺碘酮，3个月后停止。随访至电复律后12个月。结果135例，6例（4．4％）加用药物后自行转复。126例电击成功（97．7％）。3例（2．3％）未能转复。132例复律成功苦12个月后123例维持窦性心律（93．2％），9例复发；复律后3，12个月左房内径较复律前缩小（P〈0．05），左室射血分数增加（P〈0．05）。结论对于瓣膜置换术后病程长、左房增大（≥50mm）的持续性房颤患者，应尝试给予转复的机会，在经过充分准备和抗心律失常药物协同应用下，其电复律成功率高，窦性心律维持时间长，并发症少。     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用。方法风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦+胺碘酮组(61例)。两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用。试验随访时间为18月。比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径。结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮+厄贝沙坦组,P<0.05。厄贝沙坦+胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异。结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发。     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的 评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用.方法 风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦 胺碘酮组(61例).两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用.试验随访时间为18月.比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径. 结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮 厄贝沙坦组,P＜0.05.厄贝沙坦 胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异. 结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发.     

电复律治疗风湿性心脏病瓣膜置换术后持续性心房颤动的疗效观察

目的探讨电复律治疗风湿性心脏病瓣膜置换术后伴左房明显增大的持续性心房颤动的疗效。方法将164例风湿性心脏病瓣膜置换术后持续性心房颤动的患者（左房内径均〉50mm）随机分为3组：胺碘酮组20例;胺碘酮＋雷米普利组76例;胺碘酮＋厄贝沙坦组68例。所有患者在经静脉应用胺碘酮后,房颤如未转复,则行电复律治疗。复律成功者胺碘酮改为口服200mg／d,联合雷米普利及厄贝沙坦组同时口服雷米普利5mg／d、厄贝沙坦150mg／d,3～6个月后停用。结果即时成功率92．7％（152／164例）。平均随访（1．8±0．4）年,128例（78．0％）保持窦性心律。联合雷米普利组窦律维持率为86．8％（66／76例）,联合厄贝沙坦组窦律维持率为75．0%（51／68例）无统计学差异,单独口服胺碘酮组55．0%（11／20例）维持窦性心律,与联合雷米普利组、厄贝沙坦组比较,有显著差异。末次随访,胺碘酮组左房内径较复律前明显增加[（60．5±3．8）mm vs（57．7±4．5）mm;P=0．04];联合雷米普利组[（58．2±4．3）mm vs（57．3±5．8）mm,P=0．283和联合厄贝沙坦组[（57．2．±5．5）mm vs（56．4±4．9）mm,P=0．373前后对照无显著差异。三组患者心功能均改善,两两比较无显著差异。结论对于房颤时间长,左房增大的患者只要正确掌握电复律的指征及方法,并予以辅助药物维持治疗,电复律的成功率较高,转复后维持率亦高,并能改善患者心功能。胺碘酮联合雷米普利或厄贝沙坦能延缓左房增大,提高窦律维持率。     

胺碘酮与普罗帕酮对换瓣后慢性房颤电复律后维持窦性心律效果比较

风心病瓣膜病变并慢性房颤(Af)为临床最常见的心律失常之一,瓣膜置换术电复律后窦性心律的维持,仍为目前临床研究的热点。本研究旨在分析小剂量胺碘酮与普罗帕酮对电复律转复后维持窦性心律的疗效。 1 资料和方法 选择上海长海医院1993年1月至1997年1月风心病慢性Af伴二尖瓣病变或合并主动脉瓣病变行单瓣或双瓣置换术者,于换瓣术后3～12个月行同步直流电复律共108例,电复律患者中9例行电复律失败,其余99例电转复为窦性心律后,给予小剂量胺碘酮或普罗帕     

厄贝沙坦在胺碘酮治疗持续性心房颤动中的影响

观察厄贝沙坦与胺碘酮联合运用在持续性心房颤动(简称房颤)复律的作用。128例持续性房颤患者随机分为A组64例,B组64例。A组单独给予胺碘酮治疗,B组联合给予胺碘酮和厄贝沙坦治疗。结果:B组转复房颤为窦性心律的成功率明显高于A组(76.56%vs54.60%,P<0.01,),至6个月时仍维持窦性心律的比例亦高于B组(91.94%vs74.29%,P<0.05)。结论:联合胺碘酮和厄贝沙坦转复房颤并维持窦性心律的比例高于单独使用胺碘酮。     

尼非卡兰在心房颤动射频消融中的初步运用

目的观察心房颤动(简称房颤)消融术中环使用尼非卡兰复律的有效性及安全性。方法行导管消融治疗的房颤患者41例,术中行环肺静脉电隔离(CPVI)后心律仍为房颤,经静脉给予尼非卡兰注射液(50 mg)(负荷量0.3 mg/Kg 5 min,后予维持剂量(0.4 mg·Kg~(-1)·h~(-1))转复。术后予心电监护2 h。以60例同期行CPVI术但心律为房颤而行电复律患者作为对照组,比较两组即刻转复成功率,不良反应发生率,术后1、3个月超过30 s房性心律失常发生率。结果尼非卡兰组31例转复为窦性心律(简称窦律),3例转为心房扑动,进一步消融后转复为窦律,另3例患者仍为房颤,行电复律后转为窦律。电复律组1例3次电复律后仍不能维持窦律。尼非卡兰组即刻复律成功率低于电复律组(31/41 vs 59/60,P<0.05)。尼非卡兰组1例出现心室颤动,电复律组3例出现嗜睡、6例出现呕吐、1例出现低血压。术后7天内及1个月内超过30 s房性心律失常发生情况,尼非卡兰组为9/41,12/41;18/60,22/60,P>0.05。结论观察初步表明房颤消融CPVI后使用尼非卡兰复律具有较高的成功率,其不良反应发生率较低。     

风湿性二尖瓣狭窄伴心房纤颤患者在经皮球囊二尖瓣成形术后的心房纤颤电复律治疗(附538例报告)

探讨风湿性二尖瓣狭窄伴心房纤颤（房颤）球囊二尖瓣成形术（PBMV）后房颤复律治疗的方法及复律后影响维持窦性心律的因素。方法：PBMV术后4～6周仍不能转复为窦性心律的房颤患者538例进行电复律治疗，转复后随诊3～6个月，动态观察房颤复发情况。结果：538例行体表电复律者，恢复窦性心律。     

持续性心房颤动线性消融的五年随访结果

目的 导管消融对于持续性心房颤动(房颤)的远期疗效存在争议,本研究旨在观察基于心房基质改良的线性消融对持续性房颤的远期疗效,并探讨消融术式与消融远期成功率的关系.方法 回顾性分析了87例因药物无效而接受了步进式线性消融的持续性或长程持续性房颤病例,依据房颤能否被消融转复为窦性心律分为消融转复组和消融加电复律组并平均随访至术后5.3年.结果 87例患者中有50例(57.5％)术中通过线性消融直接终止了房颤,37例(42.5％)患者线性消融无法转复,除1例之外均行电复律成功.平均随访(5.3±1.0)年,单次消融后34例(39％)患者维持窦性心律,其中消融转复组24例(48％),消融加电复律组10例(27％)可维持窦性心律,消融转复组的远期成功率高于消融加电复律组(P=0.047).结论 对于持续性或长程持续性房颤患者,通过线性消融策略进行心房基质改良消融可能有助于提高远期成功率.术中通过消融直接转复为窦性心律是远期成功率的预测因素.     

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.     

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.     

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.     

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.