二尖瓣脱垂与急性风湿性心脏炎的相关性研究

目的探讨二尖瓣脱垂(MVP)与急性风湿性心脏炎(ARC)的相关性。方法对108例风湿热并ARC的患者行超声心动图检查以观察MVP的发生率。结果超声心动图检查发现MVP76例,发生率为70％,其中前叶脱垂57例(53％),后叶脱垂13例(12％),前后叶均脱垂6例(6％)。与对照组比较有明显的差异(P＜0．01)。ARC所致MVP中74例(97％)并发二尖辫关闭不全(MI),且MVP与MI的严重程度密切相关(P＜0．01)。结论ARC是MVP,尤其是二尖瓣前叶脱垂的重要原因之一,而MVP是ARC所致MI的重要因素。     

酷似冠心病心肌缺血的二尖瓣脱垂的鉴别诊断

２０２例胸痛患者，心电图有ＳＴ段下移及Ｔ波低平，但无心肌梗塞图形，行左室造影及冠状动脉造影。结果显示，有７２例冠状动脉正常或仅有≤３０％的狭窄，左室收缩期均见二尖瓣后叶呈“高跟鞋的后跟”样突入左房，符合二尖瓣后叶脱垂；含服硝酸甘油无效，而β阻滞剂对胸痛有不同程度的缓解。冠状动脉造影及左室造影是鉴别冠心病及二尖瓣脱垂的较好方法。     

二尖瓣脱垂——附4例报告

<正> 二尖瓣脱垂是一种独立的疾病,是指二尖瓣前叶或后叶或前、后两叶在心脏收缩期脱垂入左心房而引起的一组综合征,表现为心悸、胸痛、呼吸困难及疲乏。多数病人具有收缩中—晚期喀喇音及/或收缩期杂音,部分病人伴有心电图ST—T变化。自1963年Barlow氏从心血管造影证实了二尖瓣脱垂以来,已引起广泛重视,国外已有大量报告,国内的资料还不多。近一年来,我们通过临床和超声心动图检查先后遇到5例,现将住院检查资料较全的4例分析报告于后,另一例为门诊病人,因资料不全,未列入文内。     

二尖瓣和三尖瓣的对比性解剖学研究

目的:为二尖瓣和三尖瓣的疾病诊断及手术治疗提供部分解剖学数据并积累国人体质学方面的资料.方法:采用42例经福尔马林固定的成人心脏标本,观测房室口纤维环的周长和面积,二尖瓣和三尖瓣的面积及瓣膜各部附着的腱索条数.结果:[1]二尖瓣环和三尖瓣环的周长分别为91.42±11.63mm和104.97±12.84mm,面积分别为672.58±142.94mm2和924.83±205.93mm2;[2]二尖瓣和三尖瓣的面积分别为1087.90±226.28mm2和1310.23±196.26mm2;二尖瓣和三尖瓣与对应房室口纤维环的面积比均值分别为1.64±0.24和1.45±0.23,经检验差异显著(P＜0.05);③二尖瓣和三尖瓣上附着的腱索条数分别为27.18±5.32条和27.15±.98条;它们的腱索密度则分别为2.488±0.802条/mm2和2.125±0.57条/mm2,经t检验差异显著(P＜0.05).结论:二尖瓣与二尖瓣环的面积比大于三尖瓣与三尖瓣环的面积比,二尖瓣的腱索密度也比三尖瓣大,房室瓣手术时应注意此差别.     

北京乐山香港地区和日本儿童龋齿流行病学研究

调查了北京、四川乐山和香港３、６，１２和１５岁男女儿童的龋病流行情况，每组约６０人。将所得结果与日本国相同年龄组比较。结果表明，中国儿童乳牙患龋率高，城市高于农村，恒牙患龋率相对较低，乳牙和恒牙龋齿的治疗率均较低；香港儿童乳牙患龋率低于北京和乐山；日本儿童患龋率及治疗率均最高。     

CHANGING PREVALENCE AND PATTERN OFCARDIOVASCULAR DISEASES IN HONG KONG A PERSPECTIVE IN THE 1990s

The prevalence and pattern of cardiovascularproblems in Hong Kong are basicaliy those of an ageing subtropical Chinese community, influenced by the impact of westernization and urbanization. Their trends over the past decades have been hall-marked by a decreasing prevalence of theumatic and corr genital heart disease, and a plunging incidence of theumatic fever, associated with a rapidly increasing prevalence of ischemic and degenerative type of cardiovascular diseases. In the 1990s, theumatic heart disease will be less prevalent but may still account for tOTo of the problem. Ischemic heart disease and degenerative type of Icsions will certain- ly be more commonly seen and accottnt for 40% and 25U/o respectively, while the prevaleuce of hyperten- sive diseases and congenital heart disease may hope fully stays at 10% and 5% levels, respectively.     

主动脉瓣脱垂6例临床及超声心动图分析

6例病人都有主动脉瓣关闭不全的体征,并均经超声心动图检查诊断为主动脉瓣脱垂.本文根据6例病人的临床资料,进一步分析了主动脉瓣脱垂的发病原因、机理.并对超声心动图诊断主动脉瓣脱垂的一些特殊表现作了探讨.     

中国人二尖瓣的观察

观察了50例经福尔马林固定过的正常成人离体心脏,提供了关于二尖瓣环、瓣膜、腱索乳头肌的解剖学数据。二尖瓣环周径的平均数为8.25±0.74cm二尖瓣环的空间面积为4.41±0.75cm~2。二尖瓣前、后瓣的平均高度分别为2.0±0.26cm、1.26±0.26cm;平均宽度分别为2.68±0.44cm、3.96±0.70cm;瓣膜面积分别为3.37±0.7cm~2、2.86±0.62cm~2。二尖瓣腱索主干的总数为21.56±3.66支,左心室前、后乳头肌各有1—4个。     

A GROWTH VELOCITY STANDARD FOR CHINESE CHILDREN IN HONG KONG

Racial differences in the size of children make it questionable that a widely used Caucasian velocity reference standard can be used for Chinese children. In the present study, the growth velocity in 935 healthy Chinese children aged 4-6 was examined, showing that height velocity was significantly lower than Tanner's references. With the Caucasian velocity standard, Chinese children might be misinterpreted as growing abnormally slowly. In order to detect growth and endocrine disorders of childhood and adolescence, a Chinese growth velocity standard for children of 0 to 18 years must be established.     

TOTAL OCCLUSION OF THE LEFT MAIN CORONARY ARTERY IN A HONG KONG CHINESE

Total occlusion of the left main coronary artery (LMCA) is a rare finding in patients with stable angina pectoris. To the best of our knowledge, it has not been described in Hong Kong Chinese before. In this paper, we report the clinical and angiographic findings of a Hong Kong Chinese with this condition treated in our unit.     

肝硬化性肾小球肾炎7例临床与尸解

11例肝硬化患者尸解,病理显示有肾损害者7例,占64％,光镜下均见不同程度系膜细胞及系膜基质的增多,系膜区有免疫复合物IgA、C_3、IgG沉积;7例肾损害者其中肾功受累6例,占85.7％;也有呈蛋白尿、血尿、管型尿。本文探讨了肝硬化性肾小球肾炎的诊断,本病的预后取决于肝病的程度。     

FIBEROPTIC BRONCHOSCOPIC ANALYSIS OF RESULTS: IN l,450 CHINESE PATIENTS IN HONG KONG

Fiberoptic bronchoscopy (FOB) was per- formed in l,450 Chinese patients from 1978 to 1982. Diagnostic tiss.ue was obtained in 76.017'7。 (372/489) bronchial biopsies and 66,18TO (319/482) transbronchial lung biopsies (TBB). The three commonest tissue diagno.ses were broinchial carcinoma (56.44), acute bronchitis/pneumonia (20.95To) and tuberculosis Ql.4P/o). Bronchial cancer is the commonest lethal malignant disease in both men and women in Hong Kong. Sarcoi.- dosis, cryptogenic fibrosing alveolitis and ex- trinsic allergic alveolitis are rare in Chinese. FOB gave a diagnos.is of 93.53Vo foir bronchoscio- pically visible tumour and 87.6570 for nonvisible tumour. FOB also providecl the diagnosis in 117 patients with sputum sme'ar negative pulmon- ary tuberculosis, 21 0f 24 (87.5To) irrrrriuriosup- pressed patients with diffuse pulmonary in- filtrates, and 39 0f 168 (23.2To) patients with hemoptysis and normal chest radiographs. Bronchoscopic aspira.te and brush examinations were useful techniques providing the exclusive diagnosis iri 12% of bronchos.co.pically vis.ibile tumour and 2370 0f nonvisible tumour. 36To of sputurri smear-negative tuberculosis and 3 thrombocytopenic, immunocompromised subjects.     

扩大细小主动脉根部及保留二尖瓣装置双瓣膜替换术的体会

对2例风湿性联合辩膜病合并细小主动脉根部病例施行扩大主动脉根部及保留全部二尖瓣装置的双瓣替换术，疗效满意．本文提出对细小主动脉根部术前诊断的重要性和术中探查的必要性。扩大主动脉根部采用Nicks术式。同期施行改良二尖瓣替换术可有效地维护左室功能。     

二尖瓣粘液退行性变的诊断和外科治疗

目的研究二尖瓣粘液退行性变的诊断、病理改变和治疗方法。方法二尖瓣粘液退行性变患者36例,均在中度低温体外循环下进行手术。28例行二尖瓣置换术,其中1例保留全部二尖瓣叶及其瓣下结构,4例保留部分前叶和全部后叶及其瓣下结构,20例保留部分后叶及其瓣下结构。8例行二尖瓣成形术,其中4例行Carpentier's环成形术,2例行De Vega成形术,2例行腱索乳头肌缩短+瓣叶折叠。结果围术期因严重低心排死亡1例。随访5～84个月,1例因抗凝过量致脑出血死亡。其余34例中,心功能Ⅰ级21例,心功能Ⅱ级12例,心功能Ⅲ级1例。二尖瓣成形8例中,3～6个月复查心脏超声多普勒,2例无返流,5例轻度返流,1例重度返流,二尖瓣瓣口面积均在2.5cm2以上。结论本病确诊依靠术中所见及病理结果,结合病史、心脏超声检查。二尖瓣置换术是目前本病最为有效的治疗方法,保留瓣下结构对术后左室功能的恢复极为重要。二尖瓣成形是目前最理想的治疗方法,根据瓣叶及瓣下结构特点选用相应的处理方法可获得满意的手术效果。     

THE SPUR VALVE JEJUNAL INTERPOSITION IN CHOLEDOCHUS CYSTECTOMY A CLINICAL AND EXPERIMENTAL STUDY

A ncw operation of "spur-valve artificial bile duct" for congenital choledochus cyst is introduced. The main procedures include: a bleeding-saving cystectomy, that is the free part of the cyst wall is excised in full-thickness while only the mucosa is peeled off from the rest small part of the wall adherent to the portal vessels; a short jejunal loop of 10 cm is interposed between the hepatic duct and duodenum; an.d a spur-valve is made at the duodenal anastomosis. Thirty one operations of the type were performed in 1983-1985 with satisfactory anti-reflux effect and follow-up results. From the experiments wiLh 35 dogs, it was concluded that a 5-cm spur is the optimum one in maintaining a normalintrabiliary pressure (15 mm Hg) and also in protecting from the reflux due to intestinal obstruction (back-pressure 20-41 mm Hg); the anti-reflux effect is decreasing in the first month after operation but recovering by the second month; postoperative gastric analysis revealed normal findings; and autopsies disclosed no foad particles or inflammation in the artificial bile-duct, rior uicers in the stomach or duodenum. However, a long-term evaluation should be made after follow-up of a larger number of cases.     

1392例儿童尸检的病理诊断与临床诊断符合率分析

对我室１９６０－１９９５年间做的１３９２例儿童尸检的病理与临床诊断进行了分析，结果表明：总的儿童尸检率为６９．５３％。尸检率以１９８１－１９９０年间为高，１９７１－１９８０年间最低。总的临床误诊率为３０．９。各年代，各种疾病及各年龄组诊断符合率各不相同。     

MITRAL VALVE REPLACEMENT WITH PORCINE HETEROGRAFT A FOLLOW UP STUDY OF 74 CASES

74 patients undergoing mitral valve replacement with porcine heterograft were followed up. Before operation, 49 patients were in cardiac function Class III, and 25 in Oass IV. Five patients (6.8%) died during the perioperative period. Of the sur. vivors, 64 were folfowed up for more than 3 months and 3 for 4 years, averaging 24 months. Cardiac function was improved to Class I in 40 patients, Oass II in 23, and Class III in l. The mean value of cardiothoracic ratio before and after operation was 0.64+0.0,662 and 0.55+0.0,543 respectively (p<0.001). In 14 patients examined with two.dimen- sional echocardiography preoperatively and l t0 3 months postoperatively, reduction in size of the left atrium was more significant than that of the left ventricle. Nevertheless, the size of the right atrium and ventricle and the ejection fraction remained unchanged. Five patients underwent cardiac cathe- terization before and 3 t0 5 months after operation. Their pulmonary capillary wedge pressure declined to normal, and the pressure and resistance of the pulmonary artery and the cardiac index were also improved. Thus, all-round judgement on the thera- peutic effect of valve replacement should be made. As to the cardioversion of atrial fibrillation, our paiients were compared with those who underwent mitral valvulotomy and those who did not undergo any operations in our hospital. The successful rate of cardioversion was similar to that of the latter two groups, but the recurrence rate was much lower than that of the two groups. The mechanisms of above findings are discussed.     

主动脉瓣及二尖瓣双瓣置换术48例临床观察

目的探讨主动脉瓣及二尖瓣双瓣置换术的手术方法和效果.方法全组病例在全麻、低温、体外循环下实施手术.中度血液稀释,主动脉根部灌注冷停跳液,心包腔内放置冰屑,经右心房、房间隔置换二尖瓣,主动脉根部横切口置换主动脉瓣.18例合并三尖瓣关闭不全者同期行De-Vega环缩术,9例合并左心房血栓者同期行血栓取出术,1例合并动脉导管未闭者同期行动脉导管缝闭术.结果术后低心排6例,二次开胸止血5例,放置起搏器2例,死亡2例,死亡率为4.16%.结论对风湿性心脏病主动脉瓣及二尖瓣双瓣置换患者,加强围术期处理,提高手术技巧,术中良好的心肌保护以及平稳的灌注,重视三尖瓣病变的处理和保留二尖瓣瓣下结构是手术成功的关键.     

SMOKING PREVALENCE IN CHINESE AGED 15 AND ABOVE

A nation-wide survey on smoking was carried out from April to November 1984, covering all 29 provinces, autonomous regions and municipalities directly under the Central Government (except Tai- wan). Stratified random sampling was done in the general population in those aged 15 years and above. A total of 519600 persons were surveyed, including 258 422 males and 261 178 females. It was shown that the average smoking rate of Chinese is 33.88%, with 61.01% males and 7.04 females. The heaviest male smokers are workers and peasants, and the females ones are professionals and workers. The highest educated peoplc have the lowest smoking rate in both sexes. Of 343 563 non-smokers interviewed, 39.75To are passive smokers. The quit smoking rate is only 4.17% in males and 9.73% in females.