伊布利特转复心房颤动和心房扑动的疗效观察

目的观察和比较伊布利特和普罗帕酮终止心房颤动(房颤)/心房扑动(房扑)的疗效及其不良反应。方法 268例发作持续时间<90 d的房颤/房扑患者,随机分组,分别静脉应用(1～2次,每次10 min推注)伊布利特(1.0 mg和1.0 mg)和普罗帕酮(70.0 mg和70.0 mg)。结果伊布利特转复房颤/房扑的成功率分别为67.6%(46/68)和92.4%(61/66),普罗帕酮转复房颤/房扑的成功率分别为32.5%(26/80)和29.6%(16/54)。伊布利特组平均转复时间(27±13)min,转复窦性心律时平均使用量为(1.5±0.4)mg。普罗帕酮组平均转复时间(39±7)min,转复窦性心律时平均使用量为(134.1±6.4)mg。房颤的转复率与左心房直径呈负相关,左心房直径<4.0 cm患者的转复率明显高了左心房直径≥4.0 cm患者的转复率;房扑持续时间可作为房扑终止的预测因子。扑动波周长延长是伊布利特终止房扑的主要特征。结论伊布利特作为一种Ⅲ类的抗心律失常药,在监测的条件下,能迅速、安全、有效地终止房颤/房扑。     

静脉普罗帕酮和毛花甙C转复阵发性非瓣膜病心房颤动

目的　对比普罗帕酮和毛花甙C在转复阵发性非瓣膜病心房颤动 (房颤 )的作用。方法　房颤发作在 0 5～ 72小时的患者 ,随机分入普罗帕酮组和毛花甙C组。静脉推注毛花甙C 0 4～ 0 6mg或普罗帕酮 70～ 2 10mg ,观察房颤转复情况及心室率的变化。 结果　共 70例患者 ,阵发性房颤病程 ( 2 8 2± 4 2 0 )个月。毛花甙C组 3 4例 ,转复成功 15例 ( 4 4 1% ) ;普罗帕酮组 3 6例 ,转复成功 2 8例 ( 77 8% ) ;P <0 0 1。转复成功时间 :毛花甙C组 ( 86 1± 5 3 5 )分钟 ,普罗帕酮组 ( 4 7 6±3 7 7)分钟 ,P =0 0 5 ;未转复成功者的心室率下降情况 :毛花甙C组由 ( 12 4 6± 2 0 3 )次 /min降至( 93 1± 19 2 )次 /min ,普罗帕酮组由 ( 12 4 0± 3 2 1)次 /min降至 ( 118 6± 2 1 0 )次 /min ,P >0 1。结论　在阵发性房颤的转复中静脉普罗帕酮的成功率高于毛花甙C ,普罗帕酮转复时间较毛花甙C短 ,而毛花甙C在减慢心室率方面优于普罗帕酮。     

普罗帕酮治疗心房颤动的Meta分析

应用Meta分析评价普罗帕酮转复心房颤动 (简称房颤 )和 (或 )心房扑动及药物、电转复后抑制房颤复发的疗效。应用检索公开发表的相关的英、中文文献建立数据库 ,应用Meta统计分析方法按观察时间、给药途径对数据进行综合分析。结果 :普罗帕酮转复阵发性房颤的疗效随时间延长而增加 ,静脉转复率 1h为 3 7.0 %( 95 %可信区间3 2 .9%～ 4 1.2 %)、8h为 61.4 %( 4 8.2 %～ 74 .5 %) ;口服普罗帕酮转复房颤疗效在 2 ,4 ,8h分别达到 4 .0 %( 3 .8%～4 .2 %)、4 7.3 %( 4 3 .8%～ 5 0 .8%)、72 .6%( 62 .8%～ 82 .4 %) ,2 4h为 81.4 %( 5 2 .0 %～ 10 0 %)、4 8h为 76.5 %( 5 4 .1%～ 98.8%)。前 4h静脉用药比口服起效迅速。口服普罗帕酮与安慰剂对比 ,转复房颤的差异在用药后 8h最显著[3 7.7%( 2 9.4 %～ 4 5 .9%) ,P <0 .0 0 1],在 2 4h两者之差减少为 17.3 %( - 5 .0 %～ 3 9.7%) (P =0 .13 )。药物或直流电转复后普罗帕酮长期应用预防复发、维持窦性的疗效 ,在给药后 1个月的病人中为 63 .80 %( 5 8.2 %～ 69.4 %) ,6个月后为 5 4 .70 %( 4 8.0 %～ 61.4 %)。结论 :普罗帕酮能安全有效转复房颤 ,长期应用可预防转复后复发 ,耐受性好。     

胺碘酮对特发性房颤心房重构逆转作用观察

目的 :探讨胺碘酮对特发性房颤的治疗及对逆转心房心肌重构的作用。方法 :选择 1998- 0 6～ 2 0 0 0 - 0 7住院的特发性房颤患者 （除外房颤持续时间小于 6月和阵发性房颤间隔小于 1月 ,每次持续时间少于 48h者 ） 94例。随机分为胺碘酮治疗组 32例 ,普罗帕酮治疗组 32例及安慰剂组 30例。治疗前后行心电图、心脏超声、肝、肾功及甲状腺功能检查。出院后嘱患者 1,3,6 ,12月复查上述项目 1次。结果 :胺碘酮与普罗帕酮治疗组 ,均可使特发性房颤复律 ,但胺碘酮组较普罗帕酮组复律时间稍长 （约 1周 ） ,维持窦性心律的作用中 ,胺碘酮优于普罗帕酮组 ,12月后转复成功率分别为 81%和 5 6 % ,与安慰剂组自动复律 2 0 % （6 / 30 ）比较有显著差异 （P<0 .0 1）。随访 1,3,6 ,12月胺碘酮组左心房直径缩小 ,左心室舒张早期经二尖瓣血流的最高值 （E峰值 ）和左心房收缩时经二尖瓣血流的最大值 （A峰值 ）、E/ A增大。1,3,6 ,12月间比较有显著性差异 （P<0 .0 1） ,普罗帕酮组上述指标有所改善 ,但差异不显著 （P>0 .0 5 ） ,安慰剂组则无变化。结论 :胺碘酮对特发性房颤复律及对逆转心房心肌重构安全有效     

静脉注射普罗帕酮与西地兰转复阵发性房颤的疗效比较

目的　比较静注普罗帕酮和西地兰转复阵发性房颤的疗效。方法　将 5 8例阵发性房颤患者随机分成普罗帕酮组和西地兰组 ,分别静脉推注西地兰 0 4mg～ 0 6mg或普罗帕酮 70mg～ 2 10mg ,观察房颤转复情况、心室率变化及药副作用。结果　普罗帕酮组 30例 ,转复成功 2 2例 (73 3% ) ;西地兰组 2 8例 ,转复成功 13例 (46 4 % ) ;P <0 0 1。半小时转复成功率 :普罗帕酮组 4 3 8% ,西地兰 7 8% ;P <0 0 1。转复成功时间 :普罗帕酮组 (47 6± 37 7)分钟 ,西地兰组(86 1± 5 3 5 )分钟。P <0 0 1。结论　在转复阵发性房颤中普罗帕酮的成功率高于西地兰 ,普罗帕酮转复成功时间比西地兰亦有显著差异     

口服负荷量普罗帕酮转复阵发性心房纤颤的临床疗效观察

目的　探讨口服负荷量普罗帕酮转复阵发性心房纤颤 (PAF)的临床疗效和安全性。方法　将 62例房颤持续时间 2～ 48小时的患者随机分为两组 ,治疗组 3 2例口服悦复隆 3 0 0mg～60 0mg ,对照组 3 0例静注西地兰 0 .4～ 0 .8mg。记录从用药到转复为窦性心律的时间。 结果　治疗组转复率 4小时内为 5 6.3 % ( 18/3 2 )、8小时内为 62 .5 % ( 2 0 /3 2 )、12小时内为 71.9% ( 2 3 /3 2 ) ;对照组转复率则分别为 16.7% ( 5 /3 0 )、40 .0 % ( 12 /3 0 )及 46.7% ( 14 /3 0 )。各时间段治疗组PAF转复率均明显高于对照组 (P <0 .0 5 )。 4小时内平均转复时间治疗组明显短于对照组 (P <0 .0 1)。治疗组中未转复成功的 9例患者房颤持续时间明显高于转复成功者 (P <0 .0 1)。结论　对于不伴有心功能不全、缓慢心律失常及急性心肌缺血的非瓣膜病PAF患者 ,口服负荷量普罗帕酮能有效和迅速地使PAF转复 ,缩短PAF持续时间     

口服负荷量普罗帕酮转复新近发生的心房颤动

目的研究口服负荷量普罗帕酮转复新近发生的非瓣膜病心房颤动(房颤)的临床疗效和安全性.方法有症状就诊的房颤患者61例,最近房颤持续发作在48h之内,既往无心力衰竭表现,本次发作不伴急性心肌缺血和其他急性心外病症,临床排除心脏瓣膜病、预激综合征、病态窦房结综合征及甲状腺机能亢进.随机分为口服负荷量普罗帕酮组和静脉毛花甙C组.普罗帕酮组顿服负荷量普罗帕酮450mg(2例体重过轻者给以300mg).毛花甙C组采用0.4mg静脉小壶滴人,若4h仍未转复则追加0.2mg.所有患者均在心电监护下观察心电、血压及症状变化,记录从服药到转复为窦律的时间.比较两组4h和8h的转复率和转复时间.结果普罗帕酮组共31例,4h转复17例(54.8%),平均转复时间(1.6±0.2)h;4～8h转复6例(19.4%),未转复成功8例的房颤持续时间明显长于转复成功者(P<O.01),未发现明显副作用.静脉毛花甙c组共30例,4h内转复8例(26.7%),平均转复时间(2.7±0.9)h;4～8h转复5例(16.7%).两组比较4h内普罗帕酮组房颤转复率明显高于毛花甙c组(P<0.05),4h内的平均转复时间亦有明显差异(P<O.01).结论对于新近发生的(持续发作48h之内)、不伴心功能不全和急性心肌缺血及其他急性心外病症的非瓣膜病房颤患者,口服负荷量普罗帕酮是一个快速、方便、安全的转复方法.     

静脉注射胺碘酮与普罗帕酮转复阵发性心房颤动的疗效比较

目的对比研究静脉注射胺碘酮与普罗帕酮转复阵发性心房颤动(房颤)的作用.方法72例房颤持续时间＜48h的患者随机分为二组,胺碘酮组(n=36):胺碘酮150mg 生理盐水10ml,静注,10min注完;普罗帕酮组(n=36):普罗帕酮70mg 生理盐水10ml,静注,5～10min注完.观察30min若未转复可重复应用,最大累积量胺碘酮为450mg,普罗帕酮为210mg.结果转复率:胺碘酮组77.8%(28/36),普罗帕酮组75.0%(27/36),二组转复率比较差异无统计学意义(x2=0.0770,P＞0.05).转复时间:胺碘酮组(50.1±14.8)min,普罗帕酮组(39.6±13.7)min,二组比较差异有统计学意义(t=3 124,P＜0.01).结论胺碘酮和普罗帕酮对阵发性房颤均有较高的转复率,但转复时间普罗帕酮短于胺碘酮.     

伊布利特转复心房颤动/心房扑动的临床观察

目的探讨静脉应用伊布利特转复心房颤动(房颤)/心房扑动(房扑)的有效性及安全性。方法筛选18~80岁,持续时间≤90d(3h~90d)、心室率≥60次/min的阵发或持续性房颤/房扑患者共31例,随机分为伊布利特组和普罗帕酮组各16和15例。伊布利特组体重≥60kg者首剂1mg、体重<60kg者首剂0.01mg/kg,如无效10min后再给予1mg或0.01mg/kg;普罗帕酮组首剂70mg,如无效10min后再给予35mg。结果两组均能有效降低房颤/房扑的心室率,但组间比较差异无统计学意义;转复率:伊布利特组62.5%(10/16),普罗帕酮组26.7%(4/15),两组差异有统计学意义(P<0.05);普罗帕酮组转复失败的病例中有6例改用伊布利特,其中2例转为窦性心律,而伊布利特组转复失败的4例改用普罗帕酮后均未转复。转复时间伊布利特组显著短于普罗帕酮组(12.70±10.27)min对(39.75±10.08)min,(P<0.01)。副作用:伊布利特组1例合并有左心室功能不良者用药后即刻出现尖端扭转性室性心动过速(室速),经直流电击后转复为窦性心律;普罗帕酮组1例出现左心衰竭,另1例出现头晕、手麻。结论伊布利特转复房颤/房扑的疗效高于普罗帕酮,转复时间短于普罗帕酮,但须在严格监控下进行。     

顿服普罗帕酮治疗非瓣膜性阵发性心房颤动疗效观察

目的研究顿服普罗帕酮转复非瓣膜性阵发性心房颤动(房颤)的临床疗效和安全性。方法有症状的阵发性心房颤动患者78例,无严重心肌缺血、充血性心力衰竭和电解质紊乱,并排除瓣膜性心脏病和肝、肾功能损害。随机分为普罗帕酮组和毛花甙C组:普罗帕酮组一次顿服普罗帕酮负荷量300-600 mg(6-8 mg／kg);毛花甙C组静推西地兰0．4 mg,4 h后仍为心房颤动则追加0．2 mg。在心电监护下密切观察患者心律、速率、血压及症状变化,记录从给药到心房颤动转复的时间及转复瞬间心电图情况。比较两组患者4 h、8 h和12 h内房颤转复率及转复时间。结果普罗帕酮组39例,其中4 h内转复21例(53．85％);毛花甙C组共39例,其中4 h内转复10例(25．64％)。4 h内普罗帕酮组房颤动转复率明显高于毛花甙C组(P<0．05),4 h内平均转复时间亦有明显差异(P<0．05)。结论对于不伴有心力衰竭、严重心肌缺血的非瓣膜性阵发性心房颤动,顿服普罗帕酮是简便、安全、有效的方法。     

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.