急性冠脉综合征与血清尿酸的关系

目的:探讨急性冠脉综合征(ACS)与血清尿酸的关系。方法:应用酶联免疫吸附试验测定ACS组、稳定型心绞痛组、正常对照组血清尿酸水平,并进行统计学处理。结果:血清尿酸水平:ACS组的与稳定型心绞痛组、正常对照组的比较有显著性差异(P<0.05);稳定型心绞痛组的与正常对照组比较也有显著性差异(P<0.05)。结论: ACS发生与血清尿酸水平存在密切关系。     

Cocaine-associated Chest Pain: One-year Follow-up

Objective: To determine the one-year mortality and incidence of myocardial infarction (MI) post-hospital discharge or ED release for patients with cocaine-associated chest pain.
Methods: A prospective, observational study of an inception cohort of consecutive patients who presented to one of four municipal hospital EDs with cocaine-associated chest pain. Patients were followed for one year from the end of the enrollment period. Main outcome parameters were the one-year actuarial survival and the frequency of nonfatal MI.
Results: Mortality data were available for all 203 patients at a mean of 408 days. Additional clinical information was available for 185 patients (91%). There were six deaths (one-year actuarial survival 98%; 95% CI, 95–100%); none from MI. Nonfatal MI occurred in two patients (1%; 95% CI, 0–2%). Continued cocaine use was common (60%; 95% CI, 52–68%) and was associated with recurrent chest pain (75% vs 31%, p < 0.0001). No MI or death was reported for patients who claimed to have ceased cocaine use.
Conclusions: Patients who presented with cocaine-associated chest pain commonly continued to use cocaine after discharge. Urgent evaluation of coronary anatomy or cardiac stress tests may not be necessary for patients for whom MI is ruled out and who do not have recurrent potentially ischemic pain. The subsequent risk for MI and death in this group appears to be low. Intervention strategies should emphasize cessation of cocaine use.     

心肌缺血预适应对老年单支动脉闭塞性急性心肌梗死患者的影响

目的观察心肌缺血预适应对老年急性心肌梗死患者并发症及预后的影响。方法对比分析 4 2例无心肌缺血预适应的老年急性心肌梗死患者 (A组 )和 5 4例有心肌缺血预适应的老年急性心肌梗死患者 (B组 )的近期临床资料。结果两组患者在泵功能、肌酸磷酸激酶 (creatinephosphokinase,CPK)峰值和主要并发症发生率的比较中显示 :A组心脏射血分数及KillipI(无泵功能障碍 )率低于B组 ,A组KillipII IV(有不同程度的泵功能障碍 )率高于B组 ;CPK峰值和主要并发症发生率A组高于B组 ,均有显著性差异 (P 均 <0 .0 1)。结论B组CPK峰值降低 ,表明老年B组梗塞后所致心肌坏死面积减小 ,从而可以解释其泵功能障碍的发生率降低 ,梗死后室性心律失常、Ⅱ°以上房室传导阻滞、再灌注性心律失常发生率减少 ,这可能是心肌缺血预适应使老年急性心肌梗死患者病死率降低的主要原因     

Identification of differentially expressed genes in coronary atherosclerotic plaques from patients with stable or unstable angina by cDNA array analysis

Summary.  The composition of atherosclerotic plaques is a crucial factor in determining rupture, thrombosis and clinical events. In this study, we analyzed gene expression in coronary plaques from patients with stable or unstable angina using gene arrays. Total RNA was extracted from eight plaques collected by therapeutic directional coronary atherectomy. cDNA probes, generated by amplification, were hybridized to nylon arrays containing 482 genes. Here we report the results for the inflammation, adhesion and hemostasis subsets. Many genes not previously associated with atherosclerosis, such as the lymphocyte adhesion molecule MadCAM, were expressed in the plaques. anova analysis showed higher tissue factor (TF) expression in unstable angina samples. Five genes were expressed at lower levels in unstable angina samples: anticoagulant protein S, cyclooxygenase (COX)-1, interleukin (IL)-7 and chemokines monocyte chemotactic protein (MCP)-1 and -2. Gene arrays provide a new approach to study plaque composition and identify candidate markers of plaque instability.     

高龄老年不稳定性心绞痛低分子肝素的应用

目的：探讨高龄老年不稳定性心绞痛应用低分子肝素的疗效及安全性。方法：对高龄老年不稳定性心绞痛病人入院常规应用硝酸甘油等药24小时不能缓解的病人加用低分子肝素。结果：所有病人用药后疼痛缓解或减轻。结论：高龄老年不稳定心绞痛患者应用低分子肝素有效而安全。     

Supraacetabular External Fixation for Pelvic Ring Fractures

Abstract Objective: Closed reduction and maintenance of pelvic ring injuries by external stabilization. Indications: Emergency management of unstable type B and type C pelvic ring fractures. Definitive treatment of type B injuries. Definitive treatment of the anterior pelvic ring in type C injuries with transpubic instability after posterior internal stabilization. Adjunct stabilization of internal fixation. Stabilization of pelvic ring fractures in children. Contraindications: Poor general condition. Local soft-tissue damage. Local infection. Surgical Technique: Bilateral percutaneous insertion of Schanz screws into the supraacetabular area of iliac bone. Closed reduction and stabilization of the pelvic ring by compression and application of a connecting rod under image intensification. Postoperative Management: Depending on the patient’s condition and the degree of pelvic instability, a change to an open procedure may become necessary. Mobilization of the patient with partial weight bearing (one fifth of body weight) on the side of the injured posterior pelvic ring using forearm crutches, irrespective of the degree of stability of the pelvis. Results: Retrospective analysis of 64 supraacetabular external fixator applications to stabilize the anterior pelvic ring in 20 type B and 44 type C injuries. Iatrogenic lesions of the lateral femoral cutaneous nerve: 4.5%; all sensory disturbances completely reversed within 1 year. No pin site infection. In two patients (3%) primary perforation of the Schanz screw into the small pelvis not necessitating any treatment. No secondary displacements of the anterior or posterior pelvic ring in type B injuries nor for type C injuries, sacral fractures associated with fractures of the pubic ramus. One pseudarthrosis of the pubic and ischial rami requiring surgical treatment. The following is a reprint from Operat Orthop Traumatol 2005;17:296–312 and continues the new series of articles at providing continuing education on operative techniques to the European trauma community. Reprint from: Operat Orthop Traumatol 2005;17:296–312 DOI 10.1007/s00064-005-1134-2     

丹参多酚酸治疗心绞痛患者的临床疗效及对血小板功能的影响

目的　探讨丹参多酚酸盐治疗稳定性心绞痛的临床疗效以及对血小板功能的影响。方法　将稳定型心绞痛患者 5 6例随机分为丹参多酚酸高剂量组、低剂量组和丹参对照组 ,均治疗 14d ,观察3组的症状缓解、平板运动试验改善情况 ,以及比浊法检测的血小板聚集率、全血法流式细胞术检测的P选择素变化情况。结果　丹参多酚酸组在症状缓解、平板运动试验改善方面与丹参组相近 ,在降低血小板聚集率和P选择素方面优于丹参组。结论　丹参多酚酸能明显抑制血小板的聚集和活化 ,改善心绞痛症状及平板运动试验心电图ST T改变     

疏肝化瘀豁痰法治疗不稳定型心绞痛疗效及对血小板-白细胞相互作用的干预观察

目的观察疏肝化瘀豁痰法及其组方心痛方治疗不稳定型心绞痛的疗效以及对血小板-白细胞相互作用的干预效果。方法将不稳定型心绞痛患者随机分为治疗组(心痛方加西医常规处理)与对照组(单用西医常规处理)各30例,比较两组疗效及PS、PSGL-1、PS/PSGL-1、血小板-白细胞聚集率等指标的变化。结果与治疗前比较,治疗后两组不稳定型心绞痛患者的症状、心电图等情况均有明显改善,治疗组心绞痛、中医证候的改善明显优于对照组;两组治疗后PS、PSGL-1、PS/PSGL-1、血小板-白细胞聚集率均明显降低,治疗组降低幅度大于对照组。结论疏肝化瘀豁痰法(心痛方)治疗不稳定型心绞痛有良好疗效,可明显干预血小板-白细胞相互作用。     

ST Depression and Left Ventricular Haemodynamics during Exercise in Patients with Angina Pectoris

ABSTRACT. The mechanism of ischaemic ST depression and the cause of its low sensitivity to coronary artery stenosis are not well understood. Of 30 patients with severe stable effort angina, 19 (63%) showed ischaemic ST depressions after exercise (the STAE group) and 11 did not. The highest load during the symptom-limited exercise test and the heart rate on that load did not differ between the two groups. The clinical characteristics and angiographic findings were also similar, bat the findings at heart catheterization differed during exercise (in supine). Although the load was similar, the stroke index was significantly lower (38 vs. 53 ml/m² BSA) and the left ventricular end-diastolic pressure rose to a significantly higher value in the STAE group (40 vs. 32 mmHg). When STAE occurred, they were exclusively or concomitantly present in chest lead 5. These findings suggest that ischaemic STAE may not reflect regional ischaemia but the consequent left ventricular dysfunction. The mechanism may, for example, be that a sufficiently elevated left ventricular diastolic pressure causes a global subendocardial ischaemia.     

Penbutolol and molsidomine synergism in angina pectoris. A double blind ergometric trial

Summary In order to test the additional efficacy of the combination of a beta blocker (penbutolol 40 mg single dose) with molsidomine (2 mg single dose), a double blind cross-over trial was performed in 30 patients with stable angina pectoris. Stress tests were done before and 1 h after the beta blocker alone and the combination therapy. Some training effect could be detected on comparing results from the first and second days. Combined therapy showed a better response of resting systolic arterial pressure, resting and maximal diastolic pressure, heart rate gain (from rest to maximal effort) and particularly in the angina severity score. All of these variables changed significantly in comparison to the beta blocker alone, 46 out of 60 post-drug ergometric studies were negative; of the 14 positive tests, 11 followed the beta blocker and only 3 the combined therapy. The combination of a preload reducer molsidomine and a beta blocker may be adequate for patients only partially compensated or with cardiomegaly and/or a depressed ejection fraction.