Häufigkeit pathologischer Veränderungen des oberen Gastrointestinaltraktes bei Patienten vor Herzoperationen

Resümee Schwerwiegende gastroduodenale Erkrankungen sind bei fast der Hälfte aller Patienten, die sich einer Operation am offenen Herzen unterziehen müssen, auch bei Fehlen von Symptomen nachweisbar. Das erhebliche Überwiegen von Magenläsionen spricht dafür, daß die arteriosklerotisch bedingte Perfusionsminderung der Schleimhaut die entscheidende Ursache hierfür ist. Routinemäßige präoperative Ösophago-Gastro-Duodenoskopien können die nicht unerhebliche durch gastrointestinale Komplikationen bedingte postoperative Mortalität senken helfen.

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Pathological changes in the upper gastrointestinal tract in patients awaiting open heart surgery

Summary While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22–76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart.In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%).In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 41, in patients with other cardiac diseases it was 21, respectively (p<0,001).Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p<0.001).51 patients on acethylsalicylic acid (160 mg/ die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects.The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively, which are known to have a high mortality.

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Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt     

宫内胎肝细胞移植形成血小板GPⅡb Bak a/b嵌合体的研究

目的　探讨宫内胎肝细胞移植是否形成人工血小板杂合子嵌合体 ,评估其在治疗血小板无力症的临床应用前景。方法　选择血小板膜GPⅡbBaka/b(GPⅡb异亮氨酸 84 3丝氨酸多态性 )作为遗传标记 ,采用等位基因特异引物PCR和FOKⅠ限制性内切酶消化技术从 4 2名引产妇筛选一例纯合子GPⅡbBaka/a作为供者 ,一例纯合子GPⅡbBakb/b作为受者 ,制备供者胎肝细胞 ,取 4ml(2 2× 10 5细胞 )在B超引导下通过脐静脉穿刺输给受者。结果　移植后 2 1天 ,用PCR FOKⅠ消化技术检测引产后受者外周血DNA和血小板RNA ,发现已形成Baka/b嵌合体。结论　我们认为宫内胎肝细胞移植可能提供一种治疗血小板无力症和其他遗传性疾病的方法。     

国产全热解碳双叶瓣的动物实验

目的 :探讨人造瓣膜动物实验的方法 ,并对国产瓣的性能作动物体内评价。方法 :体外循环下行羊的二尖瓣替换术 ,先作预实验以确定实验方法 ,后作正式实验。用心导管和超声 ,并用多巴酚丁胺负荷法模拟运动条件 ,分别测定人造瓣的血流动力学参数 ;根据动物存活情况及有无血栓形成和血栓栓塞等评价其生物相容性。结果 :预实验 10只羊均死亡 ,主要与瓣环撕裂有关 ;正式实验 5只羊均存活。术中和术后 2 .5年用导管法测得平均跨瓣压差分别为 0 .69± 0 .2 3k Pa、0 .81± 0 .0 4k Pa;动物尸检未见血栓形成和血栓栓塞。结论 :瓣环撕裂是本组手术主要死亡原因 ,选择适当体重的动物和保留瓣叶的折叠缝补 ,及术后合理的呼吸支持等是实验的关键 ;该国产瓣在动物体内血流动力学和抗血栓性能优良     

糖尿病患者胰岛素基因启动子的突变检测和临床应用

目的 :探讨胰岛素基因启动子突变是否与中国人 2型糖尿病相关。方法 :随机选择黑龙江省中国汉族人 89例 2型糖尿病 ,应用聚合酶链式反应———单链象多态性 (PCR -SS CP)检测方法检测胰岛素启动子突变。结果 :89例 2型糖尿病中未发现 1例异常泳动变化。结论 :胰岛素基因启动子突变可能不是中国人 2型糖尿病的重要遗传因素。文献报道美国黑人中胰岛素基因启动子突变 ( 8个碱基TGGTCTAA的重复序列 )与 2型糖尿病相关 ,本研究结果提示此种相关有明显的种族异质性     

胶体金层析法检测恶性疟原虫HRPII抗原的应用研究

目的 :建立一种简易快速 ,适于基层或流行病学调查的自测式胶体金免疫层析法 (GICA)用于检测恶性疟原虫中 H RPII抗原 ,判定是否现症感染。方法 :用 GICA测试条检测全血及滤纸血样中的 H RPII抗原。结果 :40例恶性疟全血及滤纸血 H RPII抗原阳性检出率均为 1 0 0 ,与镜检结果相符合 ;2 5例间日疟均为阴性。结论 :GICA检测血中恶性疟原虫 H RPII抗原特异性强、灵敏度高、简便快速 ,无需特殊仪器设备 ,滤纸血的应用使样本的采集、保存和运输更为便利 ,适合大规模流行病学调查和基层使用 ,有广泛应用价值。     

D—二聚体测定在换瓣病人抗凝治疗效果评价中的意义

为探讨Ｄ－二聚体（Ｄ－Ｄ）测定在换瓣病人抗凝治疗效果评价中的意义,用一期法和ＥＬＩＳＡ快速法分别测定了６６例服用华法令的换瓣病人血浆凝血酶原时间（ｔｐ）和Ｄ－Ｄ的含量。初步结果表明：Ｄ－Ｄ与ｔｐ测定值是基本符合的;在ｔｐ测定低于正常值的６例中,Ｄ－Ｄ测定仅２例阳性;在Ｄ－Ｄ测定高于正常值（即发生血栓）的３例中,ｔｐ测定仅２例低于正常值。提示ｔｐ作为换瓣病人抗凝治疗的唯一指标似存在局限性,同时测定ｔｐ和Ｄ－Ｄ可防止临床误诊;建议对换瓣病人进行药量调整时,有必要作Ｄ－Ｄ检测     

洛沙坦抗高血压及左室肥厚的疗效观察

目的 :观察血管紧张素 受体拮抗剂—洛沙坦的降压效果及对高血压病合并左室肥厚的影响。方法 :4 6例合并左室肥厚的 期高血压病患者服用洛沙坦 5 0 mg/ d,观察其血压的变化及治疗前和 6个月后左室质量 (L VM)。结果 :用洛沙坦后 4 d～ 6d血压开始下降 ,2周血压趋向正常 ,4周血压继续缓慢下降 ,6周时达到最大降压效果。 L VM在 12周时无明显变化。 2 4周表现轻度 L VM减少。结论 :洛沙坦是抗高血压的一个有效治疗药物 ,对左心室肥厚有轻度逆转作用     

Cosmetic improvement of testicular prostheses for children

A new testicular prosthesis for pediatric use is presented. This differs from the model usually available in that it is pink-pigmented and opaque. Over a period of 2 years and 6 months, 57 testicular prostheses were implanted in 53 boys. Seventeen of these were opaque, pigmented ones, while the others were regular translucent prostheses. No complications occurred with either type. Even when applied in adults, the traditional translucent prosthesis gives the unpleasent impression of hydrocele. In pediatric cases, this unesthetic appearance is enhanced because of the disproportion between the scrotum and the size of the prosthesis. The cosmetic appearances of these scrota have been partially improved by the use of colored, opaque prostheses. Offprint requests to: F. Ferro     

Detachable shape-memory sewing ring for heart valves

The novel sewing ring concept consists of a detachable ring snap connection between valve housing or stent and suture cuff. The suture cuff itself is a memory metal ring of nickel-titanium (NiTi) that is embedded within a textile fabric torus. After a special training program the ring can assume two geometric shapes when alternately cooled and heated. Due to this physical property, the sewing ring can be safely fixed within a groove of the housing or stent by changing between room and physiological temperature. This allows the surgeon first to implant the sewing ring followed by arbitrary positioning and final fixation of the valve by the shape-memory effect. Additional advantages are an increased stiffening of the valve base for minimizing potential leaflet dysfunction, and reduced time and risk of implantation, particularly when a reoperation is necessary.     

Ca~(2+)经钙激活非选择性阳离子通道进入ECV304内皮细胞

目的　研究钙离子进入ECV30 4内皮细胞株的途径和血管紧张素Ⅱ (AⅡ )对钙内流的影响。方法　用膜片钳的细胞贴附式和全细胞方式记录ECV30 4内皮细胞的通道活动。结果　 (1 )在记录单通道电流时电极液含 1 2 0mmol·L- 1 CaCl2 ,细胞浴液不含K+ 、Na+ 时 ,Ca2 + 经非选择性阳离子通道 (CAN)内流的电导为γ0 =(1 2 90± 2 1 1 ) pS(n =4)。1× 1 0 - 7mol·L- 1 AⅡ可显著增强通道电流幅度和延长通道开放时 ,其电导增大为γ1 =(2 2 1 8± 2 2 9)pS(n =4)。全细胞记录得到的结果与单通道的一致。 (2 )用全细胞方式记录到ECV30 4内皮细胞的电压依赖性钙通道电流 ,记录到该峰值电流为 (2 9 32± 3 56)pA(n =4) ,2 0 μmol·L- 1 nifedepine能抑制这个峰值电流 ,被抑制后的电流峰值为 (6 0 0± 3 94)pA(n =4)。 2 μmol·L- 1 BayK8644能显著激活通道活动。结论　Ca2 + 经CAN进入ECV30 4细胞 ,AⅡ可显著增强CAN的钙流