肥厚型梗阻性心肌病经皮经腔间隔心肌消融术与室间隔心肌切除术疗效比较

目的应用超声心动图比较肥厚型梗阻性心肌病患者经皮经腔间隔心肌消融术与室间隔心肌切除术的疗效。方法分别于经皮经腔间隔心肌消融术及室间隔心肌切除术前、后测量肥厚型梗阻性心肌病患者左室流出道压差,比较术前及术后压差。结果肥厚型梗阻性心肌病患者在进行经皮经腔间隔心肌消融术与室间隔心肌切除术后,左室流出道压差均较术前明显减低。经皮经腔间隔心肌消融术肥厚型心肌病患者术前左室流出道压差(99±19)mm Hg(1 mm Hg=0.133 kPa),术后降至(36±20) mm Hg(P<0.05)。进行室间隔心肌切除术肥厚型心肌病患者术前左室流出道压差(117±32) mm Hg,术后降至(28±17) mm Hg(P<0.05)。经皮经腔间隔心肌消融术与室间隔心肌切除术患者术后左室流出道压差差异无统计学意义[(36±20)mm Hg比(28±17)mm Hg]。结论经皮经腔间隔心肌消融术可以明显减低肥厚型梗阻性心肌病患者左室流出道压差,且与室间隔心肌切除术疗效相似。     

经胸超声心动图评价高血压心脏病与左心室流出道梗阻的应用价值

目的:应用经胸超声心动图(transthoracic echocardiography,TTE),评价高血压心脏病与肥厚型心肌病(HCM)左心室流出道梗阻的二维及血流动力学特征,为临床鉴别诊断提供影像学依据。方法:左心室流出道梗阻患者31例,其中高血压性左心室流出道梗阻12例,肥厚型梗阻性心肌病19例,二维图像下测量两组患者的室间隔厚度及左心室后壁厚度,在静息状态和激发试验后测量两组患者的左心室流出道流速及最大压差,分别进行组间及组内比较。结果:室间隔厚度肥厚型心肌病组(19.6±1.8)mm明显高于高血压组(12.4±0.6)mm,差异有统计学意义(P<0.05)。左心室后壁厚度:肥厚型心肌病组(11.5±0.5)mm,高血压组(11.3±0.6)mm,两组间比较差异无统计学意义(P>0.05)。高血压组组内比较激发试验后左心室流出道流速(398.6±36.7)cm/s及压差[(68.4±12.9)mmHg,1 mmHg=0.133kPa],均高于静息状态下流速178.2±23.4)cm/s,压差(13.5±6.2)mmHg,差异有统计学意义(P<0.05)。结论:经胸超声心动图能准确评价左心室流出道梗阻的解剖结构与血流动力学特征,可准确鉴别梗阻类型及梗阻程度。     

经皮腔内冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效观察

目的评价经皮腔内冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效。方法选择梗阻性肥厚型心肌病患者29例,利用Sigwart法行经皮腔内冠状动脉室间隔化学消融术,99%无水酒精注入间隔支,并记录注入前后即刻左心室流出道压力阶差和心电图的变化。在消融术前及术后30天通过超声心动图测量室间隔厚度及左心室舒张末直径。结果间隔支内平均酒精注射量为2.97 mL;术后即刻左心室流出道压力阶差平均下降到36.0±9.3 mmHg;术后30天室间隔厚度降低3.2±0.3 mm;2例需要再次另外一支间隔支消蚀;3例患者术中出现一过性完全性房室传导阻滞;所有患者临床症状都有不同程度的缓解。结论经皮腔内冠状动脉室间隔化学消融术能显著降低左心室流出道压力阶差,治疗梗阻性肥厚型心肌病的近期疗效可靠,但应该严格控制适应症,以减少严重并发症发生。     

经皮经腔间隔心肌化学消融术治疗肥厚型梗阻性心肌病两年疗效观察

目的　评价经皮经腔间隔心肌化学消融术 (PTSMA)治疗肥厚型梗阻性心肌病 (HOCM)的中期疗效。方法　 1 998年 8月～ 2 0 0 1年 1 0月 1 1 9名HOCM患者入选行PTSMA ,其中 34例随访近 2(2± 0 5)年。在消融术前及术后半年 (5～ 7个月 )至 2年行超声心动图测量室间隔厚度及左室流出道宽度。结果　 34例术后 2年随访平均室间隔厚度 (1 6 1± 4 8)mm ,[术前 (2 3 9± 6 0 )mm ,术后半年(1 8 8± 4 1 )mm] ,平均左室流出道宽度 (1 5 1± 5 3)mm ,术前 [(6 6± 2 3)mm ,术后半年 (1 2 1± 3 3)mm]。结论　PTSMA能显著降低室间隔厚度 ,增加左室流出道的宽度 ,随着时间延长疗效逐渐增加。     

经皮室间隔化学消融术治疗肥厚梗阻型心肌病

目的评价室间隔化学消融术治疗肥厚梗阻型心肌病在急性期的效果。方法对52例确诊肥厚梗阻型心肌病患者进行经皮室间隔化学消融术治疗,并于术前、术后急性期进行超声心动观察。结果41例患者介入治疗成功,成功率为78.8%。术前超声观察室间隔平均厚度(22.96±5.15)mm,左室流出道压力阶差(LVOTPG)(92.64±38.69)mm Hg(1mm Hg=0.133kPa),术后急性期(4.8±3.2)d,室间隔平均厚度(21.27±4.64)mm,较术前比变薄,P<0.05;LVOTPG(51.79±38.99)mm Hg,较术前明显降低,P<0.001。结论经皮室间隔化学消融术治疗肥厚梗阻型心肌病,在急性期可使室间隔平均厚度降低,收缩期左室流出道压力阶差显著下降。     

肥厚型梗阻性心肌病行左心室流出道疏通术与经皮室间隔化学消融术治疗的远期疗效分析

目的:回顾性方法研究肥厚型梗阻性心肌病患者行左心室流出道疏通术与经皮室间隔化学消融术治疗的临床资料,评价两种治疗方法的远期疗效.方法:57例患者,28例行左心室流出道疏通术,29例行经皮室间隔化学消融术,分别比较两种方法治疗前、后左心室流出道压力阶差、室间隔厚度及每种方法治疗前后超声心动图结果,电话随访患者治疗后的临床症状.结果:28例左心室流出道疏通术患者平均年龄(36±16)岁,与术前比较,左心室流出道疏通术后室间隔厚度和左心室流出道压差明显下降,差异均有统计学意义(P<0.05);治疗后随访平均时间(3.8±1.2)年,并发症主要为心律失常,发生率64.3%,以完全左束支阻滞为主,胸闷好转率75%.经皮室间隔化学消融术患者平均年龄(43±11)岁,与术前比较,室间隔消融术后室间隔厚度和左心室流出道压差亦明显下降,差异均有统计学意义(P<0.05),治疗后随访平均时间(3.6±1.2)年,术后并发症主要为心律失常,发生率37.9%,以完全右束支阻滞为主,胸闷好转率75%.结论:外科左心室流出道疏通术及经皮室间隔化学消融治疗肥厚型梗阻性心肌病均可降低左心室流出道压力阶差,改善患者临床症状,有较好的远期疗效.     

经皮腔内间隔心肌化学消融术治疗肥厚性梗阻性心肌病临床分析

目的评价桡动脉途径行经皮腔内间隔心肌化学消融术(PTSMA)治疗肥厚性梗阻性心肌病的安全性和有效性方法选取2010年1月~2015年11月本院收治的经桡动脉行PTSMA治疗的肥厚性梗阻性心肌病患者39例作为研究对象,利用多普勒超声心动图在PTSMA术前以及术后1个月对患者进行检查,观察患者的左心室流出道宽度、左心室流出道压力阶差、间隔厚度等指标。结果所有患者均成功行PTSMA,观察发现患者术后室间隔厚度、左心室流出道压力阶差皆低于术前,而左心室流出道宽度高于术前,差异均有统计学意义(P0.05)。术后部分患者出现心律失常,仅1例植入永久起搏器。结论经桡动脉途径行PTSMA治疗肥厚性梗阻性心肌病安全可行,效果明显。     

经皮间隔心肌消融术联合支架置入术治疗肥厚型梗阻性心肌病伴发冠心病

目的:评价经皮间隔心肌消融术联合支架置入术治疗肥厚型梗阻性心肌病伴发冠心病的安全性及疗效。方法:5例肥厚型梗阻性心肌病伴发冠心病患者,经皮间隔心肌消融术后即刻行冠状动脉支架置入术治疗(其中3例靶病变覆盖酒精消融靶间隔支),随访住院期间出院后主要心血管事件(包括死亡,急性心肌梗死,靶血管血运重建)。结果:经皮间隔心肌消融术联合支架置入术手术成功率100,平均随访(2.2±1.8)年,随访期间无死亡、急性心肌梗死、靶血管血运重建。术后12个月超声心动图检测示左室流出道压力阶差较术前持续明显下降分别为(56.8±11.4)mmHg及(19.5±6.2)mmHg(1mmHg=0.133kPa),P<0.05;室间隔厚度持续明显下降[(23.4±2.1)mm及(13.8±1.3)mm,P<0.05];左室流出道宽度持续明显增宽分别为[(9.8±1.8)mm及(17.3±2.6)mm,P<0.05]。结论:间隔心肌消融术联合支架置入术治疗肥厚性梗阻型心肌病伴发冠心病可能是一种安全、有效的治疗方法。     

浅谈经皮腔内间隔心肌化学消融术治疗肥厚性梗阻性心肌病临床分析

目的探讨经皮腔内间隔心肌化学消融术(PTSMA)对肥厚性梗阻性心肌病(HOCM)治疗的临床效果。方法选取2013年1月~2014年10月本院接诊的20例肥厚性梗阻性心肌病患者作为研究对象,男12例,女8例,利用多普勒超声心动图在进行PTSMA术前以及术后两周对患者进行检查,观察患者的左心室流出道宽度、左心室流出道压力阶差、间隔厚度、心肌酶谱变化、心率失常等指标。结果观察得知术后左心室流出道宽度、室间隔厚度以及左心室流出道压力阶差都优于手术前,其中室间隔厚度以及左心室流出道压力阶差明显低于术前,两组差异具有统计学意义(P0.05)。术后患者均出现各种类型的心律失常反应,部分患者可在几日内自行恢复,部分患者采用药物辅助后也可迅速恢复正常。结论经皮腔内间隔心肌化学消融术可以有效的防止肥厚性梗阻性心肌病患者的并发症产生,对于缓解患者的病情有较好的临床成效,值得加以推广运用。     

经皮经冠状动脉室间隔化学消融术治疗梗阻性肥厚型心肌病的近期疗效观察

目的评价经皮经冠状动脉室间隔化学消融术（PTSMA）治疗梗阻性肥厚型心肌病（HOCM）的近期疗效。方法自1998年8月～1999年11月收治HOCM34例,入选行PTSMA26例。利用Sigwart法行PTSMA,注入96%～99%无水酒精消融间隔支前后记录左室流出道压力阶差变化、心电图变化。在消融前及术后2周通过超声心动图测量室间隔（IVS）厚度及左室流出道宽度。结果术前平均静息左室流出道压力阶差为（72.8±24.6）mmHg（1mmHg=0.133kPa）,术中球囊加压后为（30.6±18.5）mmHg,术后为（24.3±17.6）mmHg,差异有显著性（P<0.001）。术前室间隔平均厚度为（23.00±6.03）mm,术后2周为（20.55±5.38）mm。术前左室流出道宽度为（6.54±2.36）mm,术后2周为（11.36±3.37）mm（P<0.01）。术前心功能（NYHA分级）为3.4±0.6,术后2周为1.6±0.8。术后CPK与CPK-Mb峰值分别为（1050±514）U/L与（131±78）U/L。术中及术后可见短阵室速、结性逸搏心律、三度房室传导阻滞及束支传导阻滞。1例发生永久性三度房室传导阻滞,安装永久性双腔起搏器。出现下壁及前壁心肌梗死心电图表现者各1例。结论PTSMA能显著降低左室流出道压力阶差,治疗HOCM的近期疗效可靠,但尚需进一步完善方法,以减少严重并发症发生,并需继续随访其中、远期疗效。     

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.     

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.     

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.     

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.