Left ventricular growth in a patient with critical coarctation of the aorta and hypoplastic left ventricle

An infant is presented who at birth met criteria consistent with hypoplastic left heart syndrome. He was followed clinically and by 11 weeks of age demonstrated substantial growth of the left ventricle. He underwent successful repair of coarctation of the aorta and continues to do well with moderate aortic stenosis. The difficulties of predicting left ventricular growth and function are discussed, and management options are reviewed.     

超选择眼动脉插管局部溶栓治疗视网膜中央动脉阻塞

目的　观察超选择眼动脉插管灌注尿激酶溶栓治疗视网膜中央动脉阻塞的疗效。方法　经股动脉或颈动脉插管 ,应用微导管技术将导管插入眼动脉局部溶栓治疗 12例中央动脉血栓形成致视力障碍患者。结果　治疗后 ,患者视力有不同程度提高 ,获得了比较满意的效果。结论　正确诊断 ,早期应用超选择局部溶栓、扩血管并尽可能应用较大剂量溶栓药物 ,可能比其他治疗方法更为有效     

血管腔内支架成形术治疗下肢动脉硬化闭塞症45例

目的探讨血管腔内支架成形术治疗下肢动脉硬化闭塞症的疗效。方法采用经皮穿刺股动脉或切开动脉直视下穿刺,造影明确病变动脉部位及病变长度后,利用导丝或超声消融导管开通闭塞段,球囊导管行扩张成形后置入血管内支架。结果45例(53条患肢)血管腔内支架均释放成功,踝肱指数由0.36±0.14增至术后7 d 0.77±0.21(t=2.397,P=0.021),45例随访6~54个月,平均23个月,一期肢体通畅率90.6%(48/53)。结论血管腔内支架成形术操作简便、微创、安全是治疗下肢动脉硬化闭塞症的有效方法。     

心脏连续横断断层的解剖学研究

用20个成人尸体心脏,从右心耳上缘平面向下作1.0cm厚的连续横断断层切片。对心脏每一断层下断面,进行各项观测,同时还观察了心脏各断层与胸壁的对应关系。     

MRI visualization of the aortic nipple

The aortic nipple, a small “pseudotumor” adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance, images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate, vein obstruction.     

Validation of esophageal pressure occlusion test after paralysis

Measurements of respiratory mechanics are frequently made in ventilated infants and children. Esophageal pressure measurements (P_es using a balloon on a catheter have been used to partition the respiratory mechanics into lung and chest wall components. Appropriate positioning of this balloon is crucial to obtain accurate estimates of pleural pressure. Traditionally, in spontaneously breathing subjects the balloon position is assessed with an occlusion test. In ventilated subjects, it is not always possible to perform an occlusion test prior to paralysis, and even if such a test is performed it may not be relevant under conditions of positive pressure ventilation. We have assessed a positive pressure occlusion test that is suitable for paralyzed subjects. By occluding the airway opening and applying gentle pressure to the abdomen or rib cage, positive swings in pressure can be measured by both P_es and airway opening pressure (P_ao). We compared traditional occlusion tests measured in 16 spontaneously breathing puppies to the positive pressure occlusion test performed after paralysis. In 2 pups we were unable to obtain a reasonable traditional occlusion test (>15% difference between P_es and P_ao) but we obtained 10 traditional occlusion tests in each of the remaining 14 pups (2.1–14 kg). In 11 of these animals Ape, was within 10% of P_ao. This compared well to positive pressure occlusion test using abdominal pressure performed after paralysis, where Apes was within 10% of ΔP_ao in 10 animals. In 9 of these pups occlusion tests were also performed by applying pressure on the rib cage, where ΔP_es was within 10% of ΔP_ao in 6 animals. These results suggest that it is possible to perform accurate occlusion tests in paralyzed subjects by abdominal or rib cage compression with the airway occluded. Pediatr Pulmonol. 1994; 17:56–62. © 1994 Wiley-Liss, Inc.     

Role of glycolysis in the genesis of early postocclusion arrhythmias

Antiarrhythmic effects of phosphorylated glycolysis intermediates glucose-1-phosphate, fructose-1,6-diphosphate, and phosphoenolpyruvate in early postocclusion arrhythmias are shown in rat experiments; in contrast to these, D-glucose, sodium pyruvate, and monoiodacetate, a glycolysis inhibitor, exert no appreciable antiarrhythmic effect. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 117, N ^o 6, pp. 625–626, June, 1994 Presented by P. V. Sergeev, Member of the Russian Academy of Medical Sciences.     

原发性高血压患者左室肥厚与血浆肾上腺髓质素前体N端20肽的关系

目的:探讨原发性高血压(EH)患者血浆中肾上腺髓质素前体N端20肽(PAMP)与左室肥厚的相互关系。方法:观察62例EH患者血浆PAMP的变化以及与左室重量指数之间的关系。结果:经超声心动图检查显示,62例EH患者中伴左室肥厚者42例,无左室肥厚患者20例。EH伴左室肥厚患者血浆PAMP浓度较无左室肥厚患者明显增高(65·8±12·0)∶(60·8±9·0)ng/L,P<0·05。结论:EH患者血浆PAMP的升高可能为机体的代偿反应,有助于改善患者的预后。     

A "grapple hook" technique using a deflectable tip catheter to facilitate complex proximal circumflex interventions.

We present two patients with angulated, proximal left circumflex lesions, one a chronic total occlusion and one an acute subtotal occlusion. In both cases, use of the deflectable tip Venture Catheter (Velocimed, Minneapolis, MN) facilitated guide wire passage and successful percutaneous coronary intervention (PCI) after prior attempts at guide wire passage with standard wires were unsuccessful.     

慢性心房颤动患者心室率变化意义的探讨

目的分析探讨慢性心房颤动患者心室率变化的意义，为临如何预防心房颤动患者出现脑栓塞、心功能降低等并发症提供理论依据。方法将入院或门诊就诊病程超过1年的慢性心房颤动患者分为脑栓塞组和非脑栓塞组，各30例，观察比较两组患者临床特征，动态心电图计数比较两组患者最大心室率、平均心室率及最小心室率变化，超声心动图测定两组患者左房内径大小、左室射血分数变化，血浆凝血酶原时间凝固法测定两组患者血浆凝血酶原时间国际标准化比值（INR）变化。结果两组患者一般临床特征、左房内径大小、INR值比较。差异无统计学意义。脑栓塞组最大心室率、平均心室率及最小心室率均明显快于非脑栓塞组，左室射血分数明显低于非脑栓塞组。结论慢性心房颤动患者降低心室率对预防脑栓塞、左心功能降低有重要意义。