ThromCat血栓切除导管系统在急性冠状动脉综合征介入治疗中的应用

目的:评价ThromCat血栓切除导管系统(ThromCat Thrombectomy Catheter System,TTC)在急性冠状动脉综合征(ACS)介入治疗应用中的安全性、工作性能及有效性.方法:入选14例ACS患者进行经皮冠状动脉介入治疗(PCI),分析TTC操作的成功率、TTC应用的临床成功率、术中并发症和术后随访30 d心脏不良事件.结果:TTC操作成功11例,TTC临床成功10例,PCI成功13例,并不伴有心脏不良事件.在PCI中,心肌梗死溶栓治疗(TIMI)血流由使用TIC前的0.5(2.0)升高至使用后的2.0(1.0),心肌灌注分级(MBG)由使用前的1.0(2.0)升高至使用后的2.0(1.0),差异均有统计学意义(均P<0.01).结论:在ACS患者中行PCI,TTC能安全有效地去除非严重钙化的冠状动脉内的血栓.并发症少,操作简单易行,减少PCI手术引起的并发症.     

Detection of reactive oxygen species (ROS) and apoptosis in human fragmented embryos

In human in-vitro fertilization (IVF)-embryo transfer, the in-vitro culture environment differs from in-vivo conditions in that the oxygen concentration is higher, and in such conditions the mouse embryos show a higher concentration of reactive oxygen species (ROS) in simple culture media. ROS are believed to cause damage to cell membranes and DNA fragmentation in somatic cells. This study was conducted to ascertain the level of H2O2 concentration within embryos and the morphological features of cell damage induced by H2O2. A total of 62 human oocytes and embryos (31 fragmented, 15 non-fragmented embryos, 16 unfertilized oocytes) was obtained from the IVF-embryo transfer programme. The relative intensity of H2O2 concentrations within embryos was measured using 2',7'-dichlorodihydrofluorescein diacetate by Quanti cell 500 fluorescence imaging and DNA fragmentation was observed with transmission electron microscopy and an in-situ apoptosis detection kit. The H2O2 concentrations were significantly higher in fragmented embryos (72.21 +/- 9.62, mean +/- SEM) compared to non-fragmented embryos (31.30 +/- 3.50, P < 0.05) and unfertilized oocytes (30.75 +/- 2.67, P < 0.05). Apoptosis was observed only in fragmented embryos, and was absent in non-fragmented embryos. Electron microscopic findings confirmed apoptotic bodies and cytoplasmic condensation in the fragmented blastomeres. We conclude that there is a direct relationship between increased H2O2 concentration and apoptosis, and that further studies should be undertaken to confirm these findings.      

Hereditary angioedema: diagnosis and management

Hereditary angioedema is a rare autosomal dominant disorder due to the deficiency of functionally active C1-inhibitor. It is characterised by recurrent episodes of subcutaneous and mucosal edema. We report a case of hereditary angioedema presenting with the classic features of recurrent swelling of the extremities, abdominal pain and laryngeal edema. Serum complement C3 level was normal but C4 was low. She responded well to danazol and had no further attacks of angioedema.     

Thyroid function after hemithyroidectomy for benign nodules

In order to assess the need for thyroxine therapy to maintain normal thyroid function in patients who have undergone hemithyroidectomy for benign solitary nodules, pre- and postoperative serum thyroxine (T₄) and serum thyrotropin (TSH) concentrations were measured in a prospective study on 103 patients. Thyroid function measurements were normal before the operation. Postoperative thyroid function tests showed a significant reduction of serum T₄ at 3 years and a significant elevation of serum TSH between 6 months and 3 years after surgery, but the altered levels remained within the normal range. Thirteen patients had abnormal postoperative thyroid function tests. Eight patients had subnormal T₄ levels, which were accompanied by concomitant increases in TSH levels above normal in 3 individuals. Five patients had supranormal TSH values associated with normal T₄ levels, but only 1 of them showed clinical recurrence of a goiter. These observations suggest that most patients remain clinically and biochemically euthyroid after hemithyroidectomy. Thus, routine replacement thyroxine therapy is not necessary to prevent biochemical hypothyroidism, but it may be indicated in the few patients in whom a subnormal T₄ level develops. The clinical significance of these subtle changes in serum T₄ and TSH within the normal range is not clear especially with respect to goiter recurrence.

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Resumen Con el propósito de determinar la necesidad de terapia con tiroxina para el mantenimiento de función tiroidea normal en pacientes que han sido sometidos a hemitiroidectomía por nódulos tiroideos benignos, se midieron las concentraciones pre- y postoperatorias de T₄ y de TSH en un estudio prospectivo realizado en 103 pacientes. Las mediciones de función tiroidea aparecieron normales antes de la operación. Las pruebas postoperatorias de función tiroidea mostraron una reducción significativa de T₄ sérica a los 3 años y una elevación significativa de TSH entre 6 meses y 3 años después de la cirugía, pero tales niveles alterados permanecieron dentro del rango normal. Trece pacientes exhibieron pruebas postoperatorias de función tiroidea anormales. Ocho pacientes presentaron niveles subnormales de T₄, los cuales se acompanaron de elevaciones concomitantes, por encima del nivel normal, de TSH en 3 individuos. Cinco pacientes presentaron valores supranormales de TSH asociados con niveles normales de T₄, pero solo 1 de ellos desarrolló recurrencia clínica del bocio. Estas observaciones sugieren que la mayoría de los pacientes permanecen clinica y bioquímicamente eutiroideos después de la hemitiroidectomía. Por consiguiente, la terapia rutinaria de reemplazo con tiroxina no es necesaria para la prevención del hipotiroidismo bioquímico, pero puede estar indicada en los pocos pacientes que desarrollen un nivel subnormal de T₄ sérico. La significación clínica de estos sutiles cambios que se presentan dentro de los niveles normales de T₄ y de TSH no es clara en lo que se refiere a la posibilidad de recurrencia del bocio.

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Résumé Au cours d'une étude prospective concernant 103 sujets, les concentrations dans le sérum de la T₄ et de la TSH ont été dosées en préopératoire et en postopératoire dans le but de savoir s'il était nécessaire de leur donner de la thyroxine pour maintenir une fonction thyroïdienne normale après qu'ils aient subi une hémithyroïdectomie pour traiter un noyau thyroïdien bénin. Les dosages étaient normaux avant l'intervention. Les tests après l'opération ont montré une réduction significative du T₄ sérique après 3 ans et une élévation également significative de TSH de 6 mois à 3 ans après l'exérèse mais ces variations restaient dans les limites de la normale. Treize opérés ont présenté des tests fonctionnels thyroïdiens anormaux. Huit d'entre eux présentaient un dosage au-dessous de la normale de T₄ qui s'accompagnait 3 fois d'une élévation de TSH au-dessus de la normale. Les 5 autres avaient des taux de TSH supérieurs à la normale avec des taux normaux de T₄ mais un seul présentait une récidive clinique de goitre. Ces observations suggèrent que la majorité des opérés qui ont subi une hémithyroïdectomie restent cliniquement et biologiquement euthyroïdiens. Par conséquent, l'emploi classique de la thyroxine en postopératoire n'est pas nécessaire pour prévenir un éventuel hypothyroïdisme mais il peut être indiqué chez quelques opérés chez qui apparait un dosage de T₄ dont le taux est inférieur à la normale. La signification clinique de ces modifications discrètes du taux sérique de T₄ et de TSH n'est pas évidente, en particulier en ce qui concerne la récidive du goitre.

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Presented at the International Association of Endocrine Surgeons in Paris, September 1985.

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Supported by grants from the University Research Grants Committee, the Medical Faculty Research Grant Fund, and the Pauline Chan Medical Research Fund of the University of Hong Kong.     

Comparison of propofol and thiopentone as induction agents for laparoscopy

Fifty two patients for laparoscopy were randomly divided into two groups and induced with propofol 2 mgkg-1 or thiopentone 4 mgkg-1. The two groups were similar for race, age, weight, premedication and duration of operation. General anaesthesia with endotracheal intubation, nitrous oxide/oxygen with 0.5% halothane and muscle relaxation with suxamethonium was used throughout. Induction times were similar for both groups. The systolic, diastolic blood pressures and heart rates of both groups fell significantly from baseline values two minutes after induction. The fall in systolic blood pressure was greater with propofol (p less than 0.01). Following intubation the rise in systolic, diastolic blood pressures and heart rate above baseline values were greater with thiopentone (p less than 0.001 for all three variables). Discomfort on injection and involuntary movements were significantly more common with propofol. Laryngospasm was significantly more common with thiopentone. Patients given propofol could sit up unaided earlier after the anaesthesia (p less than 0.01). There was no difference in eye opening and orientation time.     

Primary actinomycosis of the abdominal wall

Two cases of primary actinomycosis of the abdominal wall masquerading as abdominal wall tumours are presented. The interesting clinical presentation and the difficulty in diagnosis are discussed.     

Effects of controlled-released sirolimus from polymer matrices on human coronary artery smooth muscle cells

Sirolimus-loaded bi-layer polymer matrices were fabricated and the effects of sirolimus release on proliferation and viability of human coronary artery smooth muscle cells (cSMCs) were investigated. Human cSMC recovery after sirolimus treatment and the attachment of human cSMC to sirolimus-eluting films were also studied. It was found that the released sirolimus inhibited growth factor stimulated human cSMC proliferation successfully. However, different drug doses appeared to have the same effect in the extent of inhibition of proliferation in this study. Cell viability was also observed to decrease with the presence of sirolimus and the attachment to sirolimus-eluting films was inhibited. The recovery of human cSMCs was found to be related to the duration of inhibition time by sirolimus. Longer inhibition resulted in a slower recovery, which suggests that sustained release is more effective than rapid release of a higher amount in the inhibition of cSMC proliferation. This observation may be important for the design of a drug-eluting stent.