右心房孤立性转移性肝细胞癌1例报告及文献复习

目的：探讨右心房孤立性转移性肝细胞癌的临床病理特征。方法：分析1例右心房孤立性移性肝细胞癌的临床表现、组织学特征和免疫组织化学（免疫组化）结果,结合文献分析讨论。结果：患者男性,47岁;活动后胸闷,伴双下肢水肿;组织学显示瘤细胞多边形,呈巢状、片状或条索状排列,可见片状坏死;免疫组化：肝细胞特异性抗原-1（Hepatocyte specific antigen-1,Hep-1）、甲胎蛋白（Alpha fetoprotein,AFP）、细胞角蛋白18（Cytokeratin18,CK18）和癌胚抗原（Carcinoembryonic antigen,CE A）阳性,细胞增殖核抗原（nuclcar-associated antigen Ki-67,Ki-67）阳性标记指数为60%,CD34血窦阳性。结论：右心房孤立性肝细胞癌转移比较罕见,早期症状不明显不易引起注意,依据临床和病理组织学特点,结合免疫组化染色可明确诊断。     

右正中神经电刺激对高血压脑出血后昏迷患者早期促醒治疗的研究

目的 探讨早期右正中神经电刺激对于高血压脑出血后昏迷患者的促醒效果以及对其远期康复的影响。方法 选择2016年1月~2018年6月安徽医科大学附属安庆医院收治的高血压脑出血性昏迷患者41例,按照随机数字表法分为对照组（n=20）和实验组（n=21）,对照组给予常规临床治疗,实验组在此基础上增加右正中神经电刺激治疗。通过比较两组患者治疗前后的脑电图（EEG）评分、格拉斯哥昏迷量表（GCS）、残疾分级量表（DRS）评分、NICU住院日以及6个月时两组患者的苏醒率,了解早期右正中神经电刺激对于高血压脑出血性昏迷患者的疗效。结果 在接受不同治疗措施后,实验组NICU住院日低于对照组,6个月的苏醒率高于对照组,两组间差异有统计学意义（P＜0.05）;在治疗后的不同时间维度,实验组的EEG评分,GCS评分,DRS评分均优于对照组,差异有统计学意义（P＜0.05）。结论 右正中神经电刺激治疗可提高HICH昏迷患者苏醒率,减少NICU平均住院日,改善患者预后,提高生存质量。该方案经济有效,操作简便,作为一种早期临床辅助促醒治疗措施,值得临床借鉴应用。     

Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study

OBJECTIVE:

Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.

METHODS:

The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.

RESULTS:

The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.

CONCLUSION:

Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate     

改良法制作兔右冠状动脉缺血再灌注损伤模型

目的　 探讨兔右冠状动脉穿线结扎后放松建立兔右冠状动脉缺血再灌注损伤模型的可行性。 方法　新西兰大白兔20只,雌雄不限,体重（2.5±0.3）kg,分为两组,缺血再灌注组14只,假手术组6只。假手术组右冠状动脉只穿线不结扎,另一组通过预置缝线结扎30 min后松开线结构建兔右冠状动脉缺血再灌注损伤模型。记录心电图情况、结扎前后肌酸激酶同功酶变化,术后软管插入离体心右冠状动脉验证结扎效果。 结果　ST段明显抬高、软管插入右冠状动脉不易拉出并肌酸激酶同功酶升高8例,制模成功率57%（8/14）。假手术组上述指标无明显变化。 结论　本实验改良制作右冠状动脉缺血再灌注模型,造模成功。     

儿童急性肺源性心脏病的发病机制

急性肺源性心脏病通常继发于严重肺部疾病或肺循环障碍所导致的肺动脉高压,以急性右心功能障碍、右心衰竭为主要特征。其中,低氧血症、高碳酸血症及正压通气均可导致肺动脉高压的发生。在危重患儿救治过程中,特别是呼吸支持过程中,应早期识别急性肺源性心脏病,考虑实施以右心功能监护和保护为核心的"肺保护"及"循环保护"。     

局部晚期肺癌外科手术治疗(附18例报告)

目的为提高晚期肺癌患者的外科手术切除率及提高手术疗效,总结18例晚期肺癌患者手术治疗中切开心包处理肺静脉或切除部分左心房的经验。方法对18例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房。左肺下叶切除5例、左全肺切除3例、右肺中下叶切除4例、右肺下叶切除4例、右全肺切除2例;术中发现13例患者的肺静脉根部有癌侵犯或有癌栓,在心包外元法常规处理肺静脉,在切开心包后可较满意地处理肺静脉,切开心包后发现其中有9例明显有左心房侵犯,行肺切除的同时切除部分左房;5例虽可在心包外处理,但癌肿离肺静脉根部太近处理肺静脉困难,而切开心包后处理肺静脉很轻松。结果18例均无手术死亡,术后有2例发生心律失常,2例并发肺炎,1年生存率61．2％（11／18）、3年生存率38．8％（7／18）、2例生存〉5年。结论晚期肺癌累及肺静脉根部或左心房时应切开心包处理肺静脉或同时切除部分左心房以达到肿瘤学上的根治性切除,从而延长病人的寿命。     

超声斑点追踪成像技术在右心功能评估中的研究进展

一直以来,右心室被认为在心功能构成中并未发挥主要作用.随着对右心室结构和功能研究的深入,人们逐渐意识到右心室形态与功能在临床与预后评价中的重要作用,各种用于整体评估右心室功能的成像技术不断得到发展.随着超声心动图技术的发展,斑点追踪成像(STI)技术在右心室功能评估中得到了广泛应用,为不同临床条件下右心室功能评估与研究,以及为与右心室功能相关的心肺疾病诊断与预后评价提供了简单且实用的新方法.对STI技术在右心室功能评估中的原理、方法和意义,以及其在临床应用中的问题作一综述.     

ANF-Konzentrationen und Drücke im kleinen Kreislauf unter Belastung vor und nach Koronardilatation

Summary According to several reports of close correlations between pulmonary artery pressure and ANF plasma levels it would be convenient to replace invasive pressure monitoring by ANF determination.Mean pulmonary artery and right atrial pressures and pulmonary artery as well as peripheral venous ANF plasma concentrations were measured in 24 patients before and after coronary angioplasty (PTCA) continuously at rest and during exercise: At rest, both pressure and ANF-values remained unchanged before and after PTCA. At exercise, there was a decrease of mean pulmonary artery pressure (from 41.3±8.6 to 31.5±7.4 mmHg,p<0.001), mean right atrial pressure (from 11.9±3.0 to 9.0±2.3 mmHg,p< 0.001), pulmonary artery (282.5±191.0 to 207.3±157.2 pg/ml,p<0.05) and peripheral venous (112.7±48.0 to 97.1±53.2 pg/ml, n.s.) ANF concentration after PTCA. We found no correlation between PTCA-induced changes of right arterial pressures and ANF concentrations, while changes of pulmonary artery pressures were significantly correlated to changes of peripheral venous (r=0.79,p<0.001) as well as pulmonary artery (r=0.59,p<0.01) ANF concentrations at exercise. In 6 of the 24 patients, however there was an inverse relationship between changes of pulmonary artery pressures and ANF concentrations. — Our data demonstrate a significant correlation between changes of ANF plasma level and pulmonary artery pressure values at exercise after PTCA. In the individual case however invasive pressure monitoring cannot be replaced by determination of ANF plasma levels.

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Abkürzungsverzeichnis ANF Atrialer natriuretischer Faktor - PTCA Perkutane transluminale Koronarangioplastie - PPa mittlerer pulmonalarterieller Druck - PPc mittlerer pulmonalcapillärer Druck - PRA mittlerer rechtsatrialer Druck Herrn Prof. Dr. med F. Scheler zum 65. Geburtstag gewidmet     

Supported decision making for people with mental health disorders in clinical practice: a systematic review

Abstract

Objectives: The Convention on the Rights of Persons with Disabilities (CRPD) was adopted at the United Nations Assembly in 2006. The main aim of the convention is to ensure equal rights for people with disabilities including the expression of people’s own “will and preferences” concerning health treatment. Article 12 demands the respect of a person’s “rights, will and preferences” (CRPD) and suggests supported decision making (SDM) when possible. The aim of this review was to gather information regarding the SDM implementation from a clinical perspective for people with mental health disorders.

Methods: A systematic literature search was performed on electronic databases MEDLINE, PsycARTICLES, and PsycINFO using the keywords “supported decision making” and “UN convention on the rights of persons with disabilities” in March 2018.

Results: Eleven articles were included in the final review, which focussed on three themes: (1) different models of SDM, (2) stakeholder views, and (3) challenges for implementation. A limited number of papers described clinical models that had good theoretical consistency with SDM. The main challenges of implementation related to critical situations when “will and preferences” are poorly understood or appear contradictory. Future studies should assess specific models of SDM implementation, including related outcomes and process measures.