小剂量抑肽酶对肝移植围术期凝血和纤溶功能的影响

目的观察小剂量抑肤酶对肝移植围术期凝血及纤溶功能的影响。方法19例行原位肝移植（OLT）术晚期肝病患者随机分为两组：对照组10例（C组）；抑肽酶组9例（A组），A组以100000KIU／h持续静脉泵注抑肤酶，直至术毕，C组泵注等量生理盐水。观察两组在术前（T0）、手术60min（T1），无肝10min（T2），新肝5min（T3）和新肝120min（T4）5个时间点的凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原浓度（FIB）、血小板计数（PIt）、纤溶酶活性（PL）、α2-抗纤溶酶活性（α2-PI）、ACT、凝血速率（clot rate）、达峰时间（time to peak）及血小板功能（PF）变化，并记录所用的凝血药物及血制品用量情况。结果与C组比较：A组PT在T2，T3，T4时点延长（P〈0．05）；APTT在T1，T2，T3时点延长（P〈0．05）；PL在T2，T3及T4时点减弱（P〈0．05）；PIt及PF在围术期差异无显著性（P〉0．05）。围术期所输凝血物质及血液成分差异无显著性（P〉0．05）。结论小剂量抑肤酶能改善PL，但使APTT及PT延长，对围术期凝血物质及血液成分的输注影响不大。【关键词】肝移植凝血纤维蛋白溶解抑肽酶     

原位肝移植术的围术期麻醉管理（附60例报告）

目的：探讨原位肝移植手术的麻醉方法和围手术麻醉期的管理与调控。方法：60例终末期肝病患者在全麻下行原位肝移植术。分别于术前（T0）,无肝前10min（T1）,无肝期30min（T2）,新肝期30min后（T3）,新肝期60min后（T4）和术毕（T5）,通过桡动脉置管和Swan-Ganz导管获得心脏指数（CI）、平均肺动脉压（MPAP）、肺动脉楔压（PAWP）、中心静脉压（CVP）、全身血管阻力（SVR）、肺血管阻力（PVR）、氧供（DO2）、氧耗（VO2）、氧摄取率（ERO2）、动脉血乳酸（ABL）、混合静脉血氧饱和度（SvO2）和血气与电解质分析;同时亦通过血栓弹力图仪（TEG）监测围术期凝血功能及指导输血与凝血因子输注。术中根据血流动力学变化情况使用多巴胺、去甲肾上腺素和肾上腺素,根据检查结果及时适当补充电解质和调整酸碱平衡。结果：与T0比较,T2-5HR增加,在T2时MAP、CI、CVP、MPAP、PCWP急剧下降,SVR增加（P〈0.05或P〈0.01）,T3时CI上升（P〈0.05）,SVR下降（P〈0.05）,T5时各项指标逐渐恢复至T0水平。T2时DO2、VO2、DO2I、VO2I下降（P〈0.05）,ERO2增加（P〈0.05）,T3时DO2、VO2、DO2I、VO2I升高（P〈0.05）;ABL在T2-5增加（P〈0.05）。结论：原位肝移植术围术期具有复杂的血流动力学改变、氧代谢变化、内环境紊乱及凝血功能不全,术中应密切监测各项指标以指导术中麻醉管理,同时注意加强心、肺、肾等系统功能的保护。     

背驼式原位肝移植的围术期特点及麻醉管理

目的:研究成人背驼式原位肝移植术围术期循环功能、呼吸功能、血气、电解质、血糖的变化特点、处理和麻醉管理的方法.方法:背驼式原位肝移植48例,均采用气管内插管静吸复合麻醉;术中分别于切皮前、无肝前期、无肝期30 min、新肝期初期1 min、新肝期30 min、术毕6个时点记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、心排量(CO)、血气分析、电解质、血糖、体温.根据背驼式原位肝移植术各期病理生理变化不同特点,给予相应的麻醉处理及对症治疗.结果:48例病人均安全渡过围术期,无一例术中发生心脏事件.无肝期30 min与切皮前相比心率显著增快、血压显著下降、CVP显著下降(P<0.01).新肝初期与切皮前相比心率显著减慢、血压显著下降(P<0.01)、CVP显著升高(P<0.05).PCWA、MPAP、CO均显著升高(P<0.01)呈高排低阻.新肝期30 min血流动力学趋于平稳直至术毕.围术期有代谢性酸中毒倾向.无肝期30 min主要表现低钙、低钾(P<0.01),新肝初期1～5 min表现为高血钾、低钙(P<0.01),经综合处理,均可纠正.术中血糖偏高(P<0.01),新肝期血糖逐渐下降.结论:背驼式原位肝移植术围术期血流动力学有较大波动,血气、电解质、血糖变化大,体温易降低,应正确处理.尽量用不经肝脏代谢的药物,麻醉深度要适当,才能使病人安全渡过围术期.     

原位肝移植患者围术期血糖和相关激素水平的临床研究

目的观察原位肝移植（OLT）患者围术期的血糖、胰岛素、C肽、胰高血糖素、皮质醇的变化，探寻血糖升高的原因。方法终末期肝病行OLT手术患者22例。人手术室后，予左右桡动脉穿刺置管，右侧桡动脉测血压，左侧备用；开放左右上肢静脉通路输液，行右侧颈内静脉穿刺并置入Swan—Ganz管监测血流动力学指标。全麻诱导下用70～8．Omm的钢丝导管行气管插管，术中用静吸复合法维持麻醉。于患者入室后麻醉诱导前（T0）、门静脉阻断前5min（T1）、门静脉阻断后30min（T2）、新肝移植后开放门静脉即刻（T3）、门静脉开放后30min（T4）、门静脉开放后60min（T5）、手术结束时（T6）、术后24h（T7）从左侧桡动脉抽血3ml，用血糖仪检测血糖，用放射免疫法测定胰岛素、C肽、胰高血糖素和皮质醇水平。结果（1）血糖水平自T4开始就较T0明显升高（均P〈0.01）。（2）各时点C肽平均值在正常范围内，但除T6外其余各时点均较T0明显降低（均P〈0．01）。（3）各时点胰岛素平均值均高于正常值，自T1开始各时点均较T0明显升高（均P〈0．01）。（4）各时点胰高血糖素水平均高于正常范围，但自T3开始较T0明显降低（均P〈0.01）。（5）皮质醇水平除T0和T1外，其余各时点均显著高于正常值，自T2开始较T0明显升高（均P〈0．01）。（6）C肽与胰高血糖素、血糖与皮质醇呈正相关（均P〈0.01）。结论OLT术中血糖水平呈逐步升高趋势。OLT患者的高胰高血糖素血症、无肝期和新肝期肝细胞功能的缺如及低下、术中使用大剂量甲基强的松龙和肾上腺素等药物均会影响血糖水平的变化。     

经典原位肝移植围术期肺血管通透性和内皮素-1浓度的变化

目的观察经典原位肝移植（OLT）围术期血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）和内皮素-1（ET-1）的变化规律。方法26例终末期肝病拟行OLT患者,围术期采用全凭静脉麻醉维持,经右颈内静脉和右股动脉放置PiCCO导管,通过PiCCO监护仪测定基础值（T1）、无肝期30min（T2）、新肝期30min（T3）、新肝期90min（T4）及关腹前10min（T5）的EVLWI和PVPI,同时在上述对应时间点抽取静脉血液,通过放免法检测血清中ET-1浓度。结果与基础值比较,EVLWI、PVPI及ET-1在T3、T4及T5时点明显升高（P〈0.05）;与T2比较,PVPI在T3时点及ET-1在T3和T4时点明显增加（P〈0.05）;与T3比较,ET-1在T5时点明显降低（P〈0.05）。结论非转流经典原位肝移植术新肝期EVLWI、PVPI和EI-1明显增高,提示存在肺损伤的可能。     

改良背驮式原位肝移植病人术中无肝期及新肝早期酸碱变化及处理探讨

目的探讨原位肝移植术中无肝期及新肝早期酸碱的变化。方法35例肝移植病人采用改良背驮式原位肝移植术,均未采用静脉-静脉转流,麻醉前做桡动脉穿刺置管测定直接动脉血压并抽取血液样本,观察麻醉前、无肝前期、无肝期、新肝期不同时点pH、PaCO2、PaO2、BE、HCO3-指标的变化。结果在无肝前期观察指标均在正常范围内（P〉0.05）,在无肝期随着手术时间的延长,pH值逐渐降低,BE负值加大,出现较明显的代谢性酸中毒。新肝期随着移植肝循环的开放,酸中毒进一步加重,与术前值相比,pH、BE、HCO3-在无肝期及新肝早期明显下降（P〈0.01）,大多数病人血管开放后PaCO2有不同程度的升高（P〈0.05）。结论在改良背驮式原位肝移植术中,无肝期及新肝早期容易发生较为明显的代射性酸碱中毒,且逐渐加重。     

8例同种异体原位肝移植患者术中凝血功能的变化

为观察肝移植患者手术过程中凝血功能的改变,选择8例肝移植病人,在全身麻醉下行经典式和背驮式原位肝移植手术,分别于麻醉后、无肝期30min、新肝期前10min、新肝期后5min、新肝期后30min五个时点采动脉血测定PT、APTT、FIB和PLT。结果与麻醉后相比,PT在无肝期30min开始升高明显,并持续到新肝期后30min(P<0.01);APTT、FIB和PLT指标在新肝期前10min、新肝期后5min和30min明显高于麻醉后(P<0.05或<0.01)。因此肝移植手术过程无肝期及新肝期前后凝血变化明显,应注意及时调整。     

控制性低中心静脉压对肝叶切除术患者血流动力学及凝血功能的影响

目的探讨控制性低中心静脉压（CLCVP）对肝叶切除术患者血流动力学及凝血功能的影响。方法选取该院肝胆外科2012年1月—2013年12月接收的98例行择期肝叶切除术患者为研究对象,按照入院顺序随机分为对照组（n=49）和LCVP组（n=49）。对照组患者整个手术过程中维持CVP在6∽12 cm H2O;LCVP组患者在肝实质离断过程中,运用控制输液等方法维持CVP在0∽5 cm H2O。分别于麻醉诱导前（T0）、开始肝切时（T1）、肝切完成时（T2）、术毕（T3）,监测并比较两组患者平均动脉压（MAP）、心率（HR）、右心房压（RAP）、平均肺动脉压（MPAP）、肺动脉楔压（PCWP）、心输出量（CO）等血流动力学指标及凝血酶原时间（PT）、纤维蛋白原（FIB）等凝血功能指标。结果两组患者MAP、MPAP、PCWP、PCWP值呈现逐渐下降趋势,而后于T3时出现反射性的升高;HR、RAP呈现逐渐升高趋势,而后于T3时出现反射性的降低。组间比较,T1∽T3时,对照组HR、RAP显著高于LCVP组（P〈0.05）,MAP、MPAP、PCWP、PCWP显著低于LCVP组（P〈0.05）。LCVP组各血流动力学指标均一直维持在正常范围内。组内比较,两组患者PT、FIB、CR、PF均呈现逐渐下降趋势,而后于T3时出现反射性的升高。组间比较,T1、T2时,LCVP组PT、CR显著高于对照组（P〈0.05）;T3时LCVP组PF显著高于对照组（P〈0.05）。结论对于行肝叶切除术的患者,CLCVP能够维持血流动力学的稳定,对凝血功能有正向意义,值得在临床上推广应用。     

背驮式肝移植术中肺动脉压及血流动力学的变化

目的：探讨背驮式肝移植术中肺动脉压力及血流动力学的变化。方法：35例改良背驮式肝移植病人采用静吸复合全麻,连接迈瑞PM-9000多功能生理监测仪,麻醉后经右颈内静脉置入Swan-Ganz漂浮导管,记录麻醉后30min、无肝期前10min、无肝期5min、无肝期10min、无肝期30min、新肝期5min、新肝期10min、新肝期30min和新肝期60min平均动脉压（MAP）、中心静脉压（CVP）、心排血量（CO）、心脏指数（CI）、平均肺动脉压（MPAP）、肺动脉楔压（PCWP）、肺循环阻力指数（PVRI）、体循环阻力指数（SVRI）的变化。结果：与麻醉后30min比较,MAP、CVP、CO、CI、MPAP、PCWP在整个无肝期下降明显（P〈0.05）,PVRI和SVRI在无肝期上升（P〈0.05）;MAP在新肝期5min下降明显（P〈0.01）,MPAP、PCWP和CVP在新肝期10min明显升高（P〈0.01）,CO和CI在新肝期10min有一定增加（P〈0.05）,PVRI在新肝期5min上升明显（P〈0.01）,SVRI在新肝期5min降低（P〈0.05）。结论：背驮式肝移植术虽然缩短了无肝期时间,但术中肺动脉压力及血流动力学的变化仍较明显,加强术中监测并及时给予处理十分重要。     

背驮式原位肝移植术无肝期门静脉血气与血生化的变化

目的观察背驮式原位肝移植术无肝期门静脉血气与生化的变化，为新肝期体循环血气及生化变化寻找依据。方法12例行背驮式原位肝移植术病人开腹后游离出肠系膜上静脉置入导管，在切除痛肝门脉阻断前（T1）、门脉阻断30min（T2）、门脉开放前（T3）、门静脉开放后即可（T4）、门静脉开放后10min（T5）分别抽取上腔静脉血和门静脉血行血生化检查和血气分析。比较同一时点门静脉血与体循环静脉血血气与电解质变化，并比较不同时点门静脉血与体循环静脉血各自的血气与电解质变化。结果门静脉阻断后门静脉血K^＋、乳酸值T2，T3，T4都明显高于T1（P〈0．05），且T4与T3相比较差异有统计学意义（P〈0．05）。pH值在门静脉阻断后逐渐降低，到开放后（T4）降到最低（P〈0．05），且在门静脉开放后与开放前相比较，差异有统计学意义（P〈0．05）。K^＋、乳酸、pH值三者都在T5时刻恢复到术前水平。门静脉阻断后体循环K’浓度在开放后T4明显高于开放前T3（P〈0．05）。pH值在开放后T4明显低于开放前T3（P〈0．05）。乳酸值从T2开始明显升高（P〈0．05），到T4时刻最高（P〈0．05），且在门静脉开放后（T4）明显高于开放前（T3）（P〈0．05）。三者都在T5时刻恢复到术前水平。结论背驮式原位肝移植术在无肝期门静脉阻断和部分阻断下腔静脉的情况下，门静脉系统酸性代谢产物和血钾浓度将随门静脉阻断时间的延长而升高，从而在新肝开放后加重体循环一过性高钾和酸中毒。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.