人体心肌造影二维超声心动图—血流灌注与解剖学研究

本文对17例没有严重冠状动脉疾病的患者冠状动脉内注射声处理的Renografin-76,通过观察各心肌节段声学显影效果,来研究左右冠状动脉的血流灌注分布特征。结果显示本组患者中14例为右冠状动脉优势,其前间隔、左室前壁、左室前侧壁、左室后侧壁及前外侧乳头肌都由左冠状动脉供应,另外左冠状动脉还供应13/14例的中间隔,12/14例的左室后壁,1/14例的下间隔及后内侧乳头肌。其余节段由右冠状动脉供应。结果表明本组患者其心肌的血流灌注基本上同心表面的冠脉分布一致。但个别心肌节段的血流灌注形式有所变异。     

直肠癌根治术后尿管拔除方法的改进研究

目的探讨改进直肠癌留置尿管患者尿管拔除的方法，以减轻拔管时的疼痛和拔管后的膀胱刺激症。方法将80例直肠癌术后患者随机分为试验组40例，对照组40例。试验组拔除尿管前行膀胱灌注，拔管时边灌边拔，对照组按常规方法拔管。结果2组在拔管时引起的疼痛等自觉症状例数、拔管后尿液中的红细胞、膀胱刺激症症状方面有显著性差异。结论对直肠癌根治术留置尿管的患者先行膀胱灌注后再拔除尿管，并在拔管时边灌边拔．可有效减轻拔管时的疼痛和不适，预防尿道损伤的发生。     

Hormonal and metabolic characteristics of geneticall obese Zucker and dietar obese Sprague-Dawle rats

Abstract. The endocrine-metabolic plasma pattern and the capacit of isolated perfused livers to produce triglcerides and ketone bodies have been studied in geneticall and diet-acquired obese rats (Zucker and Sprague-Dawle obese rats), and in control groups of the same strains.
An increased plasma insulin/glucagon molar ratio with hperinsulinaemia and hpoglucagonaemia was associated with hpertriglceridaemia, normal ketonaemia, elevated free fatt acids and normal or slight hperglcaemia in obese rats.
During oleate perfusion, the livers of Zucker and Sprague-Dawle obese rats showed an increase in triglceride output and liver triglceride content. The ketone bod output as well as the mitochondrial carnitine palmitol transferase activit were normal or slightl decreased.
In our rat population, a positive correlation between the insulin/glucagon molar ratio and triglceride output has been found.     

Utility of perioperative skin perfusion pressure measurement for treatment of ulcers caused by arteriovenous access ischaemic steal

Arteriovenous access ischaemic steal is a serious complication following arteriovenous fistula (AVF) construction. The aim of treatment is to improve distal circulation without impairing the function of the fistula. Therefore, any repair should be performed with intraoperative monitoring. We report 2 cases of this disorder treated using perioperative measurement of skin perfusion pressure (SPP) for preoperative surgical planning and intraoperative guidance. A 73‐year‐old woman with a left cubital AVF developed gangrene of the tip of the left little finger. Arteriovenous access ischaemic steal was suspected. The SPP of the little finger was 18 mm Hg, which increased to 65 mm Hg after manual occlusion of the fistula. A 58‐year‐old woman with a left antebrachial AVF had gangrene of the tip of the left middle finger. The SPP was 19 mm Hg, and steal syndrome was suspected based on angiography and the SPP with manual occlusion of the fistula. In both cases, serial plication of the fistula was performed based on intraoperative perfusion pressure monitoring, leading to the successful resolution of the ischaemic steal syndrome. In both cases, haemodialysis could be continued through the repaired fistula.     

Evaluation of effects of rofecoxib on platelet function in an in vitro model of thrombosis with circulating human blood

BACKGROUND: Cyclooxygenase (COX)-2-selective non-steroidal anti-inflammatory drugs have been used for anti-inflammatory therapy. However, it has also been described that they may increase risk of cardiovascular events. OBJECTIVES: To study the effects of COX2 inhibitor rofecoxib on platelet function using in vitro tests. Results were compared with those obtained in a parallel experiment with acetyl salicylic acid (ASA). METHODS: Studies of platelet aggregation, using different agonists, were performed by a turbidimetric method. Adhesive and cohesive function of platelets were analyzed by perfusion techniques, treated blood was exposed to thrombogenic surfaces and platelet interaction was morphometrically evaluated. RESULTS: Twenty-five micro M of rofecoxib induced a prolonged lag time and a reduction in the percentage of aggregation when arachidonic acid, ADP or collagen were used as agonists. In perfusion studies with parallel chamber rofecoxib 50 microM and ASA 500 microM reduced overall platelet interaction with the collagen surface (17.4 +/- 3.7, P < 0.05; vs. 32.1 +/- 2.6%P < 0.05 and 17.9 +/- 2.4, vs. 31.9 +/- 3.24, P < 0.05, respectively). In studies performed on annular chambers, 25 micro M of rofecoxib reduced platelet interaction; values of the thrombus and covered surface were 17.4 +/- 4.5%; P < 0.05 and 21.1 +/- 4.1%; P < 0.05, respectively, vs. 30.4 +/- 7.5% and 33.5 +/- 6.5 in the control. ASA did also impair thrombus formation but differences did not reach the levels of statistical significance. Moreover, rofecoxib but not ASA reduced significantly thrombus height and thrombus area (7.4 +/- 0.5 microM; P < 0.005 and 96.0 +/- 21.2 microM(2); P < 0.05 vs. control 11.2 +/- 0.9 microM and 220.0 +/- 47.7 microM(2), respectively). CONCLUSION: We conclude that under our experimental conditions, rofecoxib diminished platelet aggregation induced by different agonists and inhibited platelet-mediated thrombogenesis in an in vitro model of thrombosis.     

多层螺旋CT脑灌注成像在急性脑缺血中的应用

目的探讨多层螺旋CT脑灌注成像在急性脑缺血中的应用价值。方法应用GE lightspeed 16层螺旋CT扫描机,对经证实的16例急性脑缺血患者先行CT平扫,选定感兴趣区行多层螺旋CT脑灌注成像,经灌注软件处理,计算出局部血容量图(rCBV)、局部血流量图(rCBF)、对比剂平均通过时间(MTT)、对比剂峰值时间(TP),并与对侧相应脑组织灌注参数进行比较。所有病例均经CT随访或经MRI证实,所有病例联合头颈部CTA扫描。结果16例患者中15例其脑缺血侧rCBF减低,MTT、TP延长,rCBV正常或轻度降低,存在半暗区;4例患者rCBV未显示病灶。1例患者rCBF减低,MTT、TP延长,rCBV明显下降,经随访证实为脑梗死。结论多层螺旋CT脑灌注成像能早期发现脑缺血灶部位和范围及推测半暗带区域、评估脑缺血预后,是一种最具潜力的脑缺血检查方法。     

彩色多普勒血流显像在深低温循环逆行灌注脑保护实验研究中的血流监测作用

目的　本实验通过应用彩色多普勒血流显像技术 ,探索其在深低温循环经上腔静脉逆行灌注 (RCP)期间观察脑血流的可行性 ;通过血流动力学变化对脑灌注效果进行评估。方法　对三只健康纯种猪在体外循环建立前及RCP期间进行彩色多普勒超声检查眼底血管的血液灌注。结果　彩色多普勒血流显像检查证实 ,RCP期间实验所观察的血管内均存在有效血流灌注。结论　彩色多普勒血流显像检查是直观而敏感的观察脑血流的方法。     

High prevalence of (99m)tc-tetrofosmin reverse perfusion pattern in patients with myocardial infarction and angiographically smooth coronary arteries

Background: There are no published data in the literature on the scintigraphic perfusion pattern in patients with myocardial infarction (MI) and normal coronary arteries (NCA) Objectives: To evaluate myocardial perfusion imaging in a series of patients with MI and NCA. Methods: Twenty-seven patients who had developed a MI and had NCA were studied. As a control group we included 27 patients with a recent MI and coronary artery disease (CAD). All patients underwent stress/rest tetrofosmin myocardial perfusion SPECT within 6 months from MI. Results: In patients with NCA tetrofosmin stress images revealed 41 hypoperfused segments in 17 patients (63%). On rest images, 13 segments remained unchanged, 4 showed partial reperfusion, 10 normalized and 14 worsened. Additionally, there were 18 new hypoperfused segments in nine patients. Therefore, perfusion worsened at rest in 18 patients (67%) (32 segments). Overall, at rest there were 49 hypoperfused segments in 22 patients (81%). In patients with CAD, stress images revealed 71 hypoperfused segments. On rest images, 39 segments remained unchanged, 16 showed partial reperfusion and 12 normalized. Four segments worsened at rest and only four patients (15%) showed new perfusion defects at rest. Conclusions: Myocardial perfusion with tetrofosmin might appear considerably worse at rest than at stress in patients with MI and NCA. Specifically, a reverse perfusion pattern in the infarct area is a frequent finding and is likely to be due to residual tissue viability. We postulate that in these patients the hyperemic response to exercise may mask resting underperfusion areas.     

Arterial concentration of 99mTc-sestamibi at rest, during peak exercise and after dipyridamole infusion

Tracers for myocardial perfusion imaging during stress should not only have high cardiac uptake but they should also have a fast blood clearance to prevent myocardial tracer uptake after the ischaemic stimulus. The present study characterize the early phase of the arterial (99m)Tc-sestamibi (MIBI) time-activity curve after venous bolus injection at rest, during peak exercise and after dipyridamole infusion. We included 11 patients undergoing angioplasty for one-vessel disease (rest study) and 20 patients evaluated for the detection of haemodynamic significant coronary stenoses by (99m)Tc-sestamibi single photon emission computed tomography (SPECT) using either bicycle exercise testing (10 patients) or standard dipyridamole testing (10 patients). Arterial blood samples of 1 ml were taken from the left femoral artery (rest study) or the right radial artery (exercise and dipyridamole studies) every 5 s during the first 5 min postinjection. In the exercise and the dipyridamole studies blood sampling were extended to include blood samples every 5 min 5-30 min postinjection. Peak MIBI concentration was lower and decrease in concentration slower after tracer injection during exercise than during dipyridamole stress testing. This may cause an underestimation of perfusion defects during exercise because of MIBI uptake after the ischaemic stimulus. The implications of the study not only refer to the choice of stress modality when using MIBI. This study also underlines the importance of considering early blood clearance in addition to regional myocardial tracerkinetic aspects such as myocardial extraction fraction when new tracers are introduced.     

Beneficial effects of Salvia miltiorrhiza in the healing of burn wounds: an experimental study in rats

Introduction: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing.

Material and methods: Twenty rats were included in this study and divided into two groups. 3?×?2?cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1?ml/day saline and 1?g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas.

Results: Neovascularization was increased in the SM group when compared with the control group (p?=?0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p?=?0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p?=?0.0002).

Conclusion: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.