左室重量与左心功能不全相关性的研究

目的：研究可否用左室重量表达并判定左心功能不全的可能性。方法：将左心功能不全按NYHA标准分成4个级别,每级1组,并设正常对照组,用超声心动图测量同一个病人的左室射血分数（LVEF）和左室重量。用SAS统计软件做方差分析。结果：LVEF与左心功能不全高度负相关（R＝－0．77270）,左室重量与左心功能不全高度正相关（R＝0．73421）。LVEF、左室重量各级指标间差别显著（n＝153,F＝64．85,P＜0．01;n＝153,F＝53．39,P＜0．0001）。各级与对照组比统,LVEF指标从Ⅱ级开始方有显著差别（P＜0．05）;而左室重量指标从Ⅰ级开始就有显著差别（P＜0．05）。结论：LVEF与左室重量指标均与左心功能不全高度相关,但心功能Ⅰ级的病人,左室重量指标更为敏感。     

急性心肌梗塞心肌缺血再灌注损伤18例临床分析

目的：利用间接指标的方法,观察急性心肌梗塞（ＡＭＩ）后心肌再灌注损伤（ＭｙｏｃａｒｄｉａｌＲｅｐｅｒｆｕｓｉｏｎＩｎｊｕｒｙ,ＭＲＩ）的临床表现,了解ＭＲＩ对左室射血功能及梗塞后心绞痛的影响。方法：对尿激酶静脉溶栓后３２例冠脉再通者和１０例冠脉未再通者进行心电图和心肌酶学动态监测,ＡＭＩ后３周所有患者接受心脏彩超检查。结果：临床判断冠脉再通者中ＭＲＩ发生率为５６２５％（１８／３２）,心电图主要表现为突发短暂性ＳＴ段明显抬高,其次是再灌注心律失常,束支或房室传导阻滞最少见。ＭＲＩ时血清ＣＰＫ峰值时间为１３８６±４２６小时,较冠脉再通而无ＭＲＩ组１９１７±５３６小时显著前移（Ｐ＜００５）。ＭＲＩ组ＬＶＥＦ（４５２５±１０７７％）显著高于冠脉未再通组（３８６０±９２５％）（Ｐ＜００５）,但与无ＭＲＩ组（５３２８±１２７７％）相比,Ｐ＞００５。ＭＲＩ组梗塞后心绞痛发生率为２７２８％,与无ＭＲＩ组４２８０％和冠脉未再通组１０００％相比,Ｐ均＞００５。结论：ＡＭＩ静脉溶栓后部分患者发生再灌注损伤,ＭＲＩ对ＬＶＥＦ和梗塞后心绞痛发作无显著影响。     

一期切除吻合术在左半结肠急性梗阻中的应用(附33例报告)

目的：探讨左半结肠急性梗阻如何安全实施一期切除吻合术。方法：回顾分析左半结肠急性梗阻行一期切除吻合术３３例。结果：一期愈合３１例,吻合口瘘１例,死亡率１例。结论：左半结肠急性梗阻只要正确掌握一期切除吻合术适应症,以及完善术中术后处理,可以安全施行一期切除吻合术。     

Acute clinical deterioration in a patient with end-stage dilated cardiomyopathy and left ventricular thrombus formation

The case of a 17-year-old male patient with severe end-stage dilated cardiomyopathy and a large thrombus formation within the cavum of the left ventricle is reported. After an acute thrombectomia combined with a partial left ventriculectomy (Batista procedure), the patient was successfully treated with an appropriate left ventricular assist device (LVAD) system using a centrifugal nonocclusive pump (Biomedicus, Medtronic, Anaheim, CA, U.S.A.). Mechanical support was removed on Day 9, and the patient was discharged from the hospital on Day 19. The effectiveness of emergency mechanical support in patients with very unfavorable prognoses is discussed.     

基于自适应方向滤波的左心室轮廓提取

提出基于自适应方向滤波方法来提取左心室轮廓。在噪声的干扰下,引入经平滑处理的方向滤波能够得到精确的边缘,所获得的边缘方向矢量能够在边缘跟踪时对边缘走向预测,同时对参数进行自适应地调整。通过尽量少的人机交互,算法能够自动提取出左心室的轮廓。实验证明该算法增加了边缘提取的精度和一致性,同时显著地降低了计算复杂度。     

Left ventricular hypertrophy and geometry in a population sample of elderly males

BACKGROUND: Recent studies have shown that left ventricular geometric adaptationto hypertension is complex. The spectrum of geometric adaptationsin a general population and its relationship to systolic anddiastolic function has, however, not been investigated. OBJECTIVES AND METHODS: This echocardiographic and Doppler study investigated the relationshipsbetween left ventricular geometric shape (normal, concentricremodelling, concentric hypertrophy and eccentric hypertrophy)and left ventricular systolic and diastolic function in a populationsample of 584 males aged 70 in Uppsala, Sweden. The influencesof hypertension, coronary heart disease and diabetes mellituswere also evaluated. RESULTS: Sixteen percent of the healthy population (n=167) demonstratedthe presence of left ventricular hypertrophy (mainly eccentric).Subjects with hypertension (n=115) showed an increased leftventricular mass (eccentric left ventricular hypertrophy 31%,concentric left ventricular hypertrophy 15%), when comparedwith healthy subjects (P<0.001). Subjects with coronary heartdisease (n=32) without hypertension also showed an increasedleft ventricular mass (most often eccentric) (P<0.05). UsingDoppler determinations of cardiac index, no differences werefound in cardiac index between the geometric groups. Raisedtotal peripheral resistance, increased blood pressure and enlargedleft atrium were found in both concentric and eccentric leftventricular hypertrophy (P<0.01–0.05). Disturbed diastolicfunction was seen with a prolongation of the isovolumic relaxationtime in eccentric (P<0.01) and increased atrial-dependentleft ventricular filling in concentric left ventricular hypertrophy(P<0.05). CONCLUSIONS: Alterations in left ventricular geometry were common in thispopulation-based study of elderly males, both in healthy subjectsand in subjects with hypertension or coronary heart disease.Raised total peripheral resistance and left ventricular diastolicdysfunction were common findings in both concentric and eccentricleft ventricular hypertrophy.     

Regional myocardial motion and thickening assessed at rest by ECG-gated99mTc-MIBI emission tomography and by magnetic resonance imaging

We have validated ECG-gated emission tomography using technetium-99m methoxyisobutylisonitrile for the assessment of regional ventricular function by comparing it with cine magnetic resonance imaging (MRI). Gated tomography was performed at rest in 24 patients referred for myocardial perfusion imaging [17 males and seven females with a mean age of 58 years, nine of whom had had a previous myocardial infarction (MI)]. Scores were assigned to each of nine myocardial segments for wall motion and for thickening. Cine MRI was analysed in an identical fashion. Four out of 216 (2%) segments were uninterpretable by gated tomography because of inadequate tracer uptake. In eight patients without coronary artery disease (CAD), wall motion and thickening were normal by both methods. Gated tomography showed abnormal wall motion or thickening in all patients with previous MI and in five of seven patients with CAD but no prior MI. Association between wall motion and thickening was good (r _s=0.86). Overall, there was good agreement between gated tomography and MRI for both wall motion (178/212 segments, =0.66) and wall thickening (184/212 segments, =0.69). In segments with severely reduced perfusion, however, there was poorer agreement (=0.31). Interobserver and intraobserver agreement was high ( from 0.61 to 0.78). Thus, in patients investigated for CAD, there is good overall agreement between gated tomography and MRI but the agreement is lower in segments with severe perfusion defects.     

Assessment of left ventricular function: comparison between radionuclide angiography and semiquantitative two-dimensional echocardiographic analysis

Measurement of global left ventricular function is important in the follow-up of cardiac patients and is a good prognostic indicator in acute cardiac situations. We compared quantitative measurements of global left ventricular function made with radionuclide angiography (RNA) and contrast cardiac ventriculography (CVG) to visual semiquantitative estimates from two-dimensional echocardiographic images (2D-echo). Three hundred and thirty-nine consecutive patients who underwent RNA were assessed with 2D-echo within 3 months. In addition, 92 of these patients also underwent CVG (correlation of ejection fraction between CVG and RNA:r=0.82;P<0.0001). The RNA mean ejection fractions in the four 2D-echo groups (0=normal, 1=slightly, 2=moderate, or 3=severe reduced left ventricular function) differed markedly (P<0.0001); however, there was overlapping among the groups (2D-echo score/RNA ejection fraction: 0=57.3%±12.8%; 1=46.0%±12.9%; 2=29.6%±12.2%; and 3=24.6%±11.5%) and the difference between 2D-echo scores 2 and 3 was not significant. 2D-echo showed a good concordance in RNA classes (0=505; 1=35%–49%; 2=21%–34%; and 3=520% ejection fraction) 0 (133/166; 80%) and 3 (18/30; 60%) but low concordance in classes 1 (27/82; 33%) and 2 (21/61; 34%). For accurate assessment of global left ventricular ejection fraction, visual semiquantitative judgement of a 2D echocardiographic image is limited in comparison to CVG or RNA, especially in patients with a slight or moderate reduction in left ventricular ejection fraction.     

Chick gonadogenesis following early surgical bursectomy

Left ovaries of bursectomized chick embryos were examined on the 17th day of incubation in comparison to normal and sham-operated controls, by histological and histochemical observations. The results show that in bursectomized embryos the cortex appears irregulary developed, with a significant decrease in the mean thickness and in the percentage of the secondary sex cords in the total cortical area. Furthermore, the germinal epithelium appears thicker and the subcortical medulla and the tunica albuginea more compact. The greater activity of the enzyme ⁵–3-hydroxysteroid dehydrogenase ( ⁵3HSD) found in ovaries of bursectomized embryos (histochemical method) could be related to an endocrine dismetabolism affecting the cortical development. On the basis of these results and those of other authors, some hypotheses are advanced. In particular, an action of the bursal factor on GTH receptors could be the factor responsible of the enhanced steroidogenic activity altering the hormonal environment.     

Prognostic significance of the evolution of left ventricular ejection fraction in patients with acute myocardial infarction not treated with thrombolytic therapy

Several controlled trials on the thrombolytic treatment of acutemyocardial infarction (AMI) have failed to demonstrate thatthrombolysis has a simultaneous positive effect on left ventricularfunction and survival. One explanation may be that spontaneouschanges in left ventricular function occurred during the progressionof AMI in control patients. The aim of this study was to evaluatethe spontaneous evolution of left ventricular ejection fraction(LVEF) and its prognostic influence on early (1 month) and late(1 year) mortality in patients with AMI. We studied 216 patientsadmitted to our CCU within 24 h of the onset of symptoms. LVEFwas determined by radionuclide ventriculography on admission(RNV1) and at the end of the necrotic phase (RNV2). Fourteenpatients died before RNV2. On the basis of LVEF values at RNV1,the remaining 202 patients were divided into two groups: thosewith a normal LVEF (55%), and those with an abnormal LVEF (<55%). Among patients with a normal LVEF at RNV1 (64 patients) a significantincrease (>12%) in LVEF at RNV2 was observed in 12.5%, asignificant decrease (>12%) in 12.5% and no change at allin 75%. All of these patients survived, regardless of the evolutionof LVEF. In patients with an abnormal LVEF at RNV1 (138) a significantincrease (>5%) in LVEF at RNV2 was observed in 72.5%, a significantdecrease (>5%) in 6.5% and no change at all in 21%. In patientswith a LVEF increase, both early and late mortality were significantlylower than in patients with a LVEF decrease: (early mortality4% vs 55.5%, P<0.001; late mortality 6% vs 66.6%, P<0.001)respectively. In patients without any LVEF change, mortalitywas significantly lower than in patients with a LVEF decrease:(early mortality 10% vs 55.5%, P = 0.01; late mortality 14%vs 66.6%, P=0.004) respectively. In conclusion, our data demonstrate that a significant increasein LVEF occurs in most patients with an early depression ofleft ventricular function. This behaviour is associated witha low early and late mortality in comparison with the patientswith a LVEF decrease and is independent of thrombolytic treatment.When the early measurement of LVEF is normal the prognosis isnot influenced by LVEF evolution. These findings must be keptin mind when LVEF is used as a prognostic index and as an end-pointfor the evaluation of the effects of thrombolytic therapy.