定尔心治疗冠心病稳定型心绞痛21例疗效观察

稳定型心绞痛(Sfable angina pectoris SAP)亦称普通型心绞痛,为常见的类型,是指由心肌缺血、缺氧引起的典型心绞痛发作。其疼痛性质、部位、时限、发作次数及诱发因素都在1～3个月内无明显改变。1997年10月至1998年3月用印度托兰特制药公司生产的定尔心SR(盐酸地尔硫(艹卓)90mg缓释片剂),治疗SAP 21例,取得满意疗效。报导如下。     

急性心肌梗死前心绞痛对心功能的影响

国内外临床研究发现,梗死前心绞痛(preinfarction angina pectoris)对急性心肌梗死(acute myocardial infarction,AMI)发作时严重的心肌缺血具有保护作用,不但影响心肌梗死面积和心功能,而且与患者的预后有关[1,2].但是,具体机制尚不明了.本文回顾性分析近年我院收治的158例AMI患者,根据其发病前48h内有无心绞痛发作分成二组,观察分析梗死前心绞痛对AMI患者心功能的影响,探讨可能的发生机制.     

体外冲击波在心血管疾病中的治疗进展

正在冠心病的治疗领域中,难治性心绞痛或称为顽固性心绞痛(refractory angina)一直是治疗的难点之一。根据欧洲心脏病学会的定义,难治性心绞痛是指冠心病患者存在至少3个月以上的慢性心绞痛,尽管已经给予优化药物治疗、再血管化治疗和(或)冠状动脉旁路移植手术,仍不能缓解心绞痛症状,并有心肌缺血证据。这些患者不仅反复发作心绞痛,生活质量差,而且近1/3的患者合并心力衰     

老年急性初发心肌梗死前有无心绞痛对心功能及预后的影响

目的观察老年急性心肌梗死前有无心绞痛对心功能及预后的影响。方法76例老年初发急性心肌梗死患者按急性心肌梗死发病前有无心绞痛发作分为两组,有心绞痛发作组42例,无心绞痛发作组34例,观察其心律失常、梗死后心绞痛、心功能和病死率。结果心肌梗死前有心绞痛发作组的心原性休克和心力衰竭的发生率及病死率均低于心肌梗死前无心绞痛发作组(分别为33.3%vs58.8%,2.4%vs23.5%),两组间差异有显著性,P<0.05;超声心动图检查发现LVEF和E/A有心绞痛发作组高于无心绞痛发作组(分别为0.52±0.056vs0.45±0.03,0.86±0.29vs0.54±0.35),两组间差异有显著性,P<0.05。结论心肌梗死前有心绞痛对老年初发急性心肌梗死患者的心功能有保护作用,可改善患者的近期预后。     

丹红注射液治疗不稳定型心绞痛的研究进展

<正>不稳定型心绞痛(unstable angina pectoris,UAP)是介于稳定型心绞痛与急性心肌梗死之间的一组临床综合征,发病率高,病情变化快,具有进行性恶化趋势,极易恶化为急性心肌     

不稳定型心绞痛的分类

1937年,Sampson及Eliaser等分别描述一组综合征,其特点是严重的、持续时间长的心绞痛,常导致急性心肌梗塞,他们称之为“濒临急性心肌梗塞”(impending acute myocardialinfarction)。用于这一综合征的其他术语尚有“梗塞前心绞痛”(preinfarction angina)、“渐强性心绞痛”(crescendo angina)、“心绞痛持续状态”(status anginosus)、“加速性心绞痛”(acceleraed angina)、“急性冠状动脉供血不全”(acute coronary insufficiency)及“冠状动脉中间综合征”(intermediate coronary syndrome)。目前最常用的是1971年由Fowler及Conti等提出的“不稳定型心绞痛”(unstableangina)。     

变异型心绞痛

1959年Prinzmetal等报告一种类型的心绞痛,不具备典型心绞痛的特点,称为反向性心绞痛(inverse angina)——变异型心绞痛临床特点 1.发病年龄较轻,以40-60岁多见,男性比女性多见。 2.心绞痛多在休息或一般日常活动时发生,不因心脏工作明显增加而诱发,疼痛性质、部位与典型心绞痛相同,但疼痛较重,持续时间较长,发作呈周期性,休息不能使疼痛减轻,硝酸甘油可使之缓解,有些患者劳动及休息时均可发生。 3.心绞痛发作时多个导联ST段明显上抬,凹面向上,T波高耸,对应导联出现ST段下移。疼痛停止后心电图很快     

颈椎性心绞痛

颈椎性心绞痛(Cervical angina),是由变形性颈椎病等颈椎疾患引起的一种较特殊的症候群,表现以前胸部疼痛为主,与冠状动脉缺血时的症状极为相似。     

心绞痛发作频率与生存质量相关性分析

目的探讨冠心病心绞痛发作频率的影响因素及其对患者生存质量(QOL)的影响。方法对400例稳定性心绞痛患者,通过调查问卷调查一般资料、抗心绞痛药物和加拿大心血管病学会(Canadian Cardiovascular Society,CCS)心绞痛分级等因素与心绞痛发作频率的相关性,同时采用SF-36量表评价不同心绞痛发作频率对QOL的影响。结果收回有效问卷363份,其中年龄、静息心率、空腹血糖、收缩压、舒张压、CCS心绞痛分级、慢性阻塞性肺病(COPD)、心力衰竭、糖尿病、抗心绞痛药物数量等与心绞痛发作频率呈正相关(P0.05),男性、β受体阻滞剂使用比例与心绞痛呈负相关(P0.05),BMI、外周血管性疾病、钙离子拮抗剂、长效硝酸酯类、短效硝酸酯类和其他抗心绞痛药物与心绞痛发作频率不相关(P0.05),SF-36量表中各维度得分与心绞痛发作频率呈负相关(P0.05)。结论心绞痛发作频率与众多因素相关,目前仍未得到满意控制,过高的发作频率影响QOL,大部分患者需要更进一步的医学干预。     

难治性心绞痛的非药物治疗进展

随着医学的发展,冠心病优化药物治疗及再血管化治疗得到很大程度的普及,但仍有部分患者存在心绞痛.临床上将经充分治疗仍有慢性心绞痛型胸痛(持续3个月以上),并伴有可逆性缺血的称为难治性心绞痛(refractory angina,RA).根据欧洲心脏病学会RA治疗的联合研究小组报道,稳定型冠心病患者中RA患病率为5％ ～ 1...     

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.