Thrombolytic therapy with tissue plasminogen activator for the treatment of nonstructural malfunction of bileaflet cardiac valve prostheses

This study was conducted to determine the effect of thrombolytic therapy with tissue plasminogen activator (t-PA) for nonstructural malfunction of bileaflet cardiac valve prostheses. Twenty-seven patients with bileaflet prosthetic valve malfunction diagnosed by a combination of cineradiography and transthoracic echocardiography were treated with the administration of intravenous t-PA. The treatment resulted in complete success in 55.6% (15 of 27), partial success in 22.2% (6 of 27), and no change in 22.2% (6 of 27). In the complete success and partial success groups, the condition of the patients in 85.7% (18 of 21) of the cases improved within 24 h after the administration of t-PA. Six cases in whom thrombolytic therapy was instituted more than 1 month (ranged from 1 to 38 months, mean 14.7 months) after the diagnosis of prosthetic valve malfunction showed significantly less effectiveness of thrombolytic therapy with t-PA. Only one patient (3.7%) had a major complication (thromboembolism) after t-PA treatment. The results suggest that thrombolytic therapy with t-PA in patients with nonstructural malfunction of bileaflet cardiac valve prostheses is effective with low incidence of complication when the treatment is instituted early after the diagnosis.     

Experimental evaluation and early clinical results of a new low-profile bileaflet aortic valve

We performed an experimental and clinical evaluation of a new low-profile bileaflet aortic valve (Regent, St. Jude Medical Inc., St. Paul, MN, U.S.A.). Common valve sizes were experimentally tested for leakage volume, pressure drop, and transvalvular hemodynamics using a pulse duplicator. Thirty patients (mean age 60 +/- 7 years, predominant valve stenosis n = 25) received the Regent prosthesis for initial clinical evaluation. In vitro evaluation revealed equivalent leakage volumes, larger performance indices (0.552 versus 0.513), and lower pressure drops in comparison to SJM hemodynamic plus valve controls. Clinically, 21 mm (n = 9), 23 mm (n = 12), and 25 mm (n = 9) valves were implanted with no significant perioperative complications. Echocardiography revealed low transvalvular flow velocities (2.2 +/- 0.4 m/s) and low pressure gradients (20 +/- 6 mm Hg) postoperatively and at 6 months follow-up. In vitro testing and early clinical results are promising; however, long-term performance has to be proven.     

Columellar lengthening using the interdigitation of triangular flaps

The most common and striking feature of the bilateral cleft lip nose deformities is a short columella. This problem can be resolved by lengthening the columella. In this article the authors lengthen the columella using the interdigitation of triangular flaps in the upper lip tissue. The columellar elongation is made by an advancement of nostril tissue and an interdigitation of the triangular flaps. Our method shows good aesthetic results. The triangular flaps that are intersected without excision make the columellar base pyramidal and medially directs the alar bases, narrowing the width of the nostril sills. Though the optimal columellar lengthening procedure can vary according to the deformed anatomy of the nose and lip, this method deserves to be considered especially in patients who have sufficient tissue in their nostril sills.     

Tyrosine hydroxylase-immunoreactive interneurons in the olfactory bulb of the frogs Rana pipiens and Xenopus laevis

We studied tyrosine hydroxylase (TH)-immunoreactive neurons and neuropil in the olfactory bulb of the leopard frog, Rana pipiens, and in the clawed frog, Xenopus laevis. In both frogs, TH processes in the main olfactory bulb showed a trilaminar organization, with a densely stained external glomerular layer (GL), a moderately stained middle mitral cell layer (MCL), and internally a weakly stained internal plexiform layer (IPL) and granule cell layer (GRL). TH-positive cells in the MCL and IPL could be divided into two types. Type 1 cells had one or two thick dendrites that arborized within glomeruli in the GL and often had a thin "axon-like" process that exited the cell on the internal surface, with a recurrent collateral that ascended into the GL. Type 2 cells had beaded dendrites arborizing in the MCL and no discernible axons. Both type 1 and type 2 cells were numerous in the MCL and IPL of Rana, whereas only type 2 cells were common in the MCL and IPL of Xenopus. In the GL, labeled cells were numerous in Xenopus but rare in Rana. Mitral cells were stained retrogradely by tracer injection into the lateral olfactory tract and by local injection into the bulb. In no case was double labeling for TH observed, suggesting that TH-positive cells in frog olfactory bulb are likely to be interneurons. Double labeling with an anti-gamma-aminobutyric acid (GABA) antibody showed that the TH-positive cells formed a population separate from the GABA-containing interneurons.     

Extreme fenestration of the basilar artery associated with cleft palate,nasopharyngeal mature teratoma,and hypophyseal duplication

The authors present the case of a newborn girl with extreme fenestration of the basilar artery. This anomaly was found incidentally during MR imaging study for cleft palate and nasopharyngeal teratoma. Magnetic resonance angiography showed a totally duplicated basilar artery with connections at the proximal and distal ends of the artery, suggesting an extreme fenestration. Duplicated pituitary gland was also found on MR imaging.     

β-受体阻滞剂结合常规药物治疗瓣膜性心脏病心衰的探讨

目的 观察β-受体阻滞剂对心脏瓣膜病合并重症心力衰竭患者血流动力学和心功能的影响。方法 对31例风湿性心脏病合并重症心衰患者在常规抗心衰治疗基础上加用β-受体阻滞剂治疗，观察β-受体阻滞剂治疗前及治疗后1周、2周患者心率、血压、临床症状的改善情况。结果 β-受体阻滞剂治疗后1周、2周，患者心室率明显下降（P〈0.01），分别有41．9％和71．0％患者的心功能改善1级以上而不伴有收缩期及舒张期血压的变化。结论 采用β-受体阻滞剂治疗心脏瓣膜病合并心衰，正确掌握适应证及β-受体阻滞剂用药剂量可取得良好治疗效果，但远期疗效需进一步观察。     

托拉塞米在重症心脏联合瓣膜置换病人围手术期中的应用

目的:通过对比托拉塞米与呋塞米的利尿作用,探讨托拉塞米在重症心脏联合瓣膜置换病人围手术期中的应用价值。方法:重症心脏联合瓣膜置换病人60例,随机分为2组。托拉塞米组30例,男性6例,女性24例,年龄(54±s 12)a,围手术期中应用托拉塞米静脉注射治疗;呋塞米组30例,男性5例,女性25例,年龄(54±12)a,围手术期中应用托拉塞米静脉注射治疗。观察用手术前及手术后1,3,7,14d,24h尿中钾、钠、肌酐的含量。结果:手术后,2组24h尿钠、钾和肌酐含量均增高,与手术前比较差异非常显著(P<0.01);手术后3d起,托拉塞米组24h尿钾、钠含量低于呋塞米组,肌酐含量高于呋塞米组,差异非常显著(P<0.01)。不良反应发生率托拉塞米组10％(3/30),呋塞米组80％(24/30),差异非常显著(P<0.01)。结论:托拉塞米具有排钠又相对保钾的作用,减少了不良反应的发生,是一种比呋塞米更加适合于重症联合心脏瓣膜置换术病人的围手术期利尿药物。     

Ahmed青光眼阀盘周纤维包裹二次手术后的临床分析

目的分析Ahmed青光眼阀盘周纤维包裹二次手术切除后的效果和并发症。方法回顾分析在我院行全视网膜冷凝后Ahmed青光眼阀植入后因Ahmed阀的盘和引流管周围形成包裹、眼压超过30 mmHg导致手术失败的患者共11例,进行二次纤维包裹切除后,分析其眼压、视力的变化和发生并发症的原因。结果11例患者术后进行1~12月的随访,远期成功率为72.7%。术前和术后眼压平均为(40.72±9.05)mmHg和(17.36±8.09)mmHg,术后较术前显著下降(t=6.38,P<0.001)。主要并发症为Ahmed阀盘和引流管的暴露。结论二次选择性的瘢痕切除辅以抗增殖药物的应用,能够进一步提高Ahmed青光眼阀植入术的成功率。     

再次人工心脏瓣膜置换术临床研究

目的研究再次人工心脏瓣膜置换的病因、手术适应证、手术技巧及高危因素。方法回顾性分析了2000年3月～2006年7月所行的18例再次人工心脏瓣膜置换术，年龄21～69岁，平均45岁，4例为急性起病，14例为慢性发病。术前心功能（NYHA）Ⅱ级2例，Ⅲ级7例，Ⅳ级9例。再次换瓣的病因有人工生物瓣衰败7例，瓣周漏5例，左心房血栓形成3例，主动脉瓣叶上血栓形成1例，感染性心内膜炎致主动脉瓣架边缘菌栓2例。再次手术共植入人工瓣膜20枚，3例选用生物瓣，另外15例共17枚瓣膜采用机械瓣。结果因术后出现严重低心排综合征及多脏器功能衰竭死亡2例，均为术前心功能Ⅳ级者，16例痊愈出院。随诊4个月～6a，心功能恢复良好。结论对于人工瓣膜置换术后瓣膜功能障碍要及时处理，有再手术指征者果断手术。只要术中谨慎操作，围术期严密监护，再次手术也是安全的。     

Noonan syndrome and related disorders

Noonan syndrome is a common multiple malformation syndrome seen in children with congenital heart disease. Recently, a mutation in the PTPN11 gene was found to be present in about 50% of individuals with Noonan syndrome. Over 80% of these patients have some form of congenital heart disease with pulmonary stenosis often associated with a dysplastic valve being, by far, the most common lesion. Hypertrophic cardiomyopathy occurs in 20–30%. Characteristic facies, chest deformity, short stature, undescended testes in the male and learning disabilities comprise the Noonan phenotype but there is wide phenotypic variation and a changing phenotype with age. This phenotype is noted in several other syndromes which share similar cardiac defects. These include LEOPARD, neurofibromatosis, Noonan syndrome, cardio-facio-cutaneous syndrome and Costello syndrome. A definitive diagnosis is particularly difficult in infancy.