THE VALUE OF 99mTc-MIBI MYOCARDIAL PERFUSION SPECT IMAGING IN DETECTING CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR DISEASE BEFORE OPERATION

Objective. The aim of this study was to detect coronary artery disease using ^99mTc-MIBI myocardial perfusion imaging in patients with valvular disease. Methods. Thirty patients with valvular disease confirmed by echocardiography underwent ^99mTc-MIBI myocardial perfusion imaging using multiSPECT lh after stress test (exercise, dipyridamole or dobutamine test) and were performed coronary angiography within 1 month before valvular operation. Results. For 29 out of the 30 patients, the results of ^99mTc-MIBI myocardial perfusion imaging were similar with those of coronary angiography, the concordance rate was 96.7 % and the negative predictabili-ty was 100%. Conclusion. ^99mTc-MIBI myocardial perfusion imaging is a reliable non-invasive method for detecting coronary artery disease in patients with valvular disease and so as to draw up suitable operation programs for them.     

内皮素及NO在严重烧伤早期胃肠粘膜缺血中的应用

OBJECTIVE: Inadequate perfusion in splanchnic organs and especially in the gut during acute burn period has been reported in many conventionally "successfully" resuscitated patients, but the mechanisms still remain unclear and its early preventive measures need to be further studied. The aim of this study is to evaluate the role of endothelin and nitric oxide in gut ischemia. METHODS: Eighteen male pigs were randomly assigned to one of the three groups: group C, a sham burn group that was subjected to all surgical procedures except burn; group B, sustained 30% TBSA cutaneous thermal burn; Group N, NO donor (C87-3754) was given intravenously (0.0125 mg.kg-1.min-1) at the beginning of resuscitation. RESULTS: In group B, PVF decreased rapidly after burn, and did not recover in the observation period (72 h), ET levels in portal blood and intestinal tissue elevated contrary to the changes in NO. In group N, PVF was higher than in group B. CONCLUSION: 1. Changes in ET and NO may influence the protal blood flow. 2. NO donor was proved to be beneficial in improving GI tissue perfusion by releasing NO.     

内毒素休克大鼠组织生物喋呤及其合成限速酶基因表达的改变

目的 了解内毒素休克时重要器官生物喋呤及其合成限速酶基因表达的改变和病理生理意义。方法 采用大鼠内毒素休克模型,检测肝,肾,肠等组织生物喋呤含量,三磷酸鸟苷环水解酶Ｉ（ＧＴＰ－ＣＨＩ）ｍＲＮＡ表达及器官功能指标等。并观察内毒素拮抗剂－重组杀菌／通透性增加蛋白（ｒＢＰＩ２１）的防治效果。结果 内毒素休克动物肝,肾,肠等组织生物喋呤含量明显增多,伤后８小时升高幅度尤为显著（Ｐ〈０．０５,Ｐ〈０．０１０     

烫伤后脂多糖受体CD14和肿瘤坏死因子-α基因表达的变化规律

目的 观察烫伤后机体主要脏器脂多糖受体ＣＤ１４（ＣＤ１４）和肿瘤坏死因子－α（ＴＮＦ－α）ｍＲＮＡ的表达的变化规律及二者的相互关系。方法 采用大鼠３５％Ⅲ度烫伤模型,分别于伤前,伤后１２,２４,４８,７２小时活杀动物,留取组织标本或分离腹腔巨噬细胞,检测组织或巨噬细胞ＣＤ１４,ＴＮＦ－αｍＲＮＡ表达。结果 烫伤后肝,肺,肾,肠等组织ＣＤ１４ｍＲＮＡ水平均有不同程度增高,分别于伤后１２小时和４８小时     

Surgical treatment of Ebstein's malformation: report of 108 cases

OBJECTIVE: To review retrospectively the experience of surgical treatment of Ebstein's malformation in 108 patients. METHODS: One hundred and eight patients with Ebsteins malformation underwent surgical correction, including tricuspid valve annuloplasty in 83 patients (73.4%) and tricuspid valve replacement in 30 (5 with redo-operation). Concomitant procedure included division of the abnormal accessory conduction pathway in 8 patients. RESULTS: The overall hospital mortality was 8.8%. The hospital mortality rate was 10.4% before 1990 and 5.5% after that time. There was a significant difference between the two periods (P < 0.05). The main causes of death were low cardiac output, arrhythmias and right heart failure. The mean follow-up time was 6.3 years. The heart function improved to be NYHA class I or II in 92% of the patients. CONCLUSIONS: Early surgical intervention is recommended for patients with Ebstein's malformation, especially for those with symptoms and cardiac enlargement. Tricuspid valve repair should be performed if anterior leaflet of the tricuspid valve well developed. However, tricuspid valve replacement is advocated if anterior leaflet is dysplastic or its origin displaced.     

Quantitative analysis of technetium 99m 2-methoxyisobutyl isonitrile single-photon emission computed tomography and isosorbide dinitrate infusion in assessment of myocardial viability before and after revascularization

Background

Assessment of viable myocardium in territories of hypoperfused myocardium is important for predicting functional recovery after revascularization. This study was designed to evaluate quantitative analysis of ^99mTc-labeled 2-methoxyisobutyl isonitrile (MIBI) myocardial perfusion imaging combined with isosorbide dinitrate (ISDN) infusion to detect myocardial viability in patients with chronic coronary artery disease before and after revascularization.

Methods and Results

Twenty-seven consecutive patients with previous myocardial infarction and left ventricular dysfunction (left ventricular ejection fraction 35.2%±13.5%) referred for coronary artery bypass (CABG) were studied with ^99mTc-labeled MIBI single-photon emission computed tomograpy at rest and during ISDN infusion before CABG followed by resting imaging after CABG. Quantitative analysis was performed with circumferential profiles. Left ventricular function (global and regional) was assessed by radionuclide ventriculography before and after CABG. Out of 212 abnormal perfusion segments with resting ^99mTc-labeled MIBI SPECT, 99 segments (47%) showed improved uptake of ^99mTc-labeled MIBI during ISDN infusion. The mean ratio of myocardial uptake was 0.58±0.25 (resting 0.53±0.23; p<0.05). After CABG, of 212 segments with hypoperfusion, 108 segments (51%; p>0.05 vs ISDN) showed improved uptake of ^99mTc-labeled MIBI. The mean ratio of myocardial uptake was 0.60±0.26 (resting 0.53±0.23; p<0.05). The concordance between the improvement of post-CABG wall motion and that of pre-CABG ISDN perfusion imaging was 83%, between the improvement of wall motion and perfusion imaging after CABG 94%, and between the improvement of pre-CABG ISDN and post-CABG perfusion imaging 83%, respectively.

Conclusion

ISDN infusion can improve the uptake of ^99mTc-labeled MIBI in hypoperfused myocardium and increase the efficiency of ^99mTc-labeled MIBI in the detection of viable myocardium in patients with previous myocardial infarction and left ventricular dysfunction.     

心外管道全腔肺动脉吻合术的临床应用

目的 评价心外管道全腔肺动脉吻合术的临床应用价值。方法 １９９８年６月～１９９９年８月,１０例先天性心脏复杂畸形的患者接受了心外管道全腔肺动脉吻合术。包括单心室８例,均伴有完全性大动脉转位;右心室发育不良２例。均在全麻低温体外循环下手术。结果 患者全部治愈出院。术后随访６～１８个月,无晚期死亡。所有患者症状消失,无静脉压明显升高现象,超声检查显示心外管道血流通畅,无血栓形成;心电图检查显示无严重心     

大面积烧伤后多器官功能障碍综合征的临床防治

目的　将临床与实验研究所得结果应用于临床治疗 ,分析其对降低严重烧伤患者多器官功能障碍综合征 (MODS)发病率的作用。　方法　总结自 1970年 1月至 1999年 10月共收治的严重烧伤 (烧伤面积均大于 30 %TBSA)患者 6 5 7例 ,以 1990年 1月 1日为界分为 2组。 2组的伤情有可比性。 1990年 1月至 1999年 10月之间的患者广泛地应用了新的治疗措施 ,主要为及时、快速、充分的液体复苏 ,应用山莨菪碱恢复肠道血供 ,氧自由基清除剂阻止氧自由基的损害 ,休克期广泛切痂、植皮 ,早期经口营养 ,主要器官功能支持等。　结果　 1990年 1月前 36 9例 ,MODS的发病率为 17 3% ,病死率为 87 5 % ;1990年 1月至 1999年 10月之间 2 88例的MODS发病率为 6 9% ,病死率为 40 0 % ,两组结果差异有显著意义。　结论　严重烧伤患者在治疗中减轻或消除MODS的病因或诱因的措施 ,可以显著地降低MODS的发病率。     

脾切除对大鼠血浆及肝肺组织中内毒素廓清的影响

目的 观察脾切除对血浆中内毒素清除的影响及内毒素在主要脏器的分布特征,探索脾切除后上反应与组织损害的发生机制。方法 雄性Ｗｉｓｔａｒ大鼠１１２只,随机分为有脾组（ｎ＝５６,行大网膜切除术,保留脾脏）、脾切除组（ｎ＝５６,行脾切除术）。术后１周静脉注射内毒素０．１ｍｇ／ｋｇ,分别于注射前、注射后１０ｍｉｎ、０．５、１．５、４、１２、２４ｈ活杀动物,测定血浆和肝、肺组织内毒素水平,同时检测肝、肺脏器功     

中药脑肺康对地鼠实验性肺气肿及肺动脉高压的防治作用

目的 观察中药肺康对缺氧性肺动脉高压和肺气肿的防治效果并探讨其作用机制。方法 以弹性蛋白酶溶液滴注入金黄地鼠气管内,正常饲养３０ｄ后,常压下缺氧１５ｄ,分别设立中药脑肺康预防组、治疗组、肺气肿＋缺氧组及正常对照组。于处死动物前,测量平均肺动脉压,取静脉血进行循环内皮细胞计数;处死后测量右心肥大指数,光镜下计数左侧肺支气管肺泡灌洗液内细胞总数,对右侧肺进行光镜图像分析。结果 中药脑肺康预防组和治疗３