心脏瓣膜置换术后中远期疗效分析

目的　分析探讨心脏瓣膜置换术的中远期疗效。方法　 1978年至 2 0 0 1年 12月 ,行瓣膜置换手术 2 14 1例 ,同期随访 16 81例 ,计 80 2 1 1人·年 ,平均 4 77人·年。通过回顾病因、手术方式、瓣膜类型等因素 ,观察术后病人心功能改善情况 ,病死率及并发症等 ,采用t检验 ,多因素回归等统计学方法分析。结果　 92例死亡。总体生存率 5年为 (92 3± 2 2 ) % ,10年生存率为 (90 1± 2 7) %。并发症有血栓栓塞、机械瓣膜功能障碍、瓣周漏、溶血、机械瓣膜感染性心内膜炎。术后心功能 (NYHA)与术前比较有明显的提高。结论　 1.机械瓣置换术后中远期疗效满意 ,病死率及并发症均较低 ;与术前心功能和手术种类直接相关 ;2 .使用保留瓣下结构及三尖瓣成形术对术后心功能恢复有明显效果 ;3.术中良好心肌保护是提高手术成功率的关键。     

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.     

328. Mechanismen der langzeitakzeptanz allogener rattenlebertransplantate: makrophagenaustausch und suppressorzellaktivierung

Summary After orthotopic rat liver transplantation in the fully allogeneic BN (RT-1n) to LEW (RT-11) combination, the phenomenon of spontaneous tolerance of donor antigen occurs. We demonstrate two different immune mechanisms that may account for this process. Using adoptive transfer assays we show the presence of donor-specific T-suppressor lymphocytes in the spleens of long-term surviving liver graft, recipients. These cells prolong - adoptively transferred into irradiated syngeneic hosts — the survival of donor-specific (BN) but not third-party (DA) renal allografts (I00 days vs 1I days in control groups). Secondly, we demonstrate the replacement of Kupffer cells in the graft by recipient macrophages using polymorphic monoclonal antibodies in an immunoperoxidase technique. This may contribute to graft adaptation and thus to long-term graft acceptance.     

Effects of the rate and composition of fluid replacement on the pharmacokinetics and pharmacodynamics of intravenous furosemide

Effects of differences in the rate and composition of intravenous fluid replacement for urine loss on the pharmacokinetics and pharmacodynamics of furosemide were evaluated using the dog as a model animal. Each of six dogs received 8-hr constant intravenous infusion of 20 mg (15 mg used in one dog) of furosemide with 0% replacement (treatment I), 50% replacement (treatment II), and 100% replacement (treatment III) with lactated Ringer's solution, as well as with 100% replacement with 5% dextrose in water (treatment IV). Most pharmacokinetic parameters, such as plasma clearance, steady-state volume of distribution, mean residence time, and terminal half-life, were essentially the same in all four treatments. Renal clearances and urinary excretion rates of the drug in treatments II–IVwere essentially the same, but about 20% higher than those in treatment I.In spite of the similarities in kinetic properties, diuretic and/or natriuretic effects from furosemide were markedly different among the four treatments. For example, mean 10-hr urine outputs were 646, 1046, 3156, and 1976 ml and mean 10-hr sodium excretions were 87.0, 142, 383, and 97.2 mmole for treatments I–IV,respectively. Except for treatment III,diuresis and/or natriuresis were found to be time-dependent, generally decreasing with time until reaching a low plateau during later hours of infusion. The present findings also showed that (1)no fluid replacement and 100% replacement with 5% dextrose solution both produced the same degree of severe acute tolerance in natriuresis, indicating the insignificance of water compensation in tolerance development; (2)in treatment II,where neutral sodium balance was achieved, the development of acute tolerance in diuresis and natriuresis can mainly be attributed to negative water balance under this special condition; (3)at steady state the hourly diuresis and natriuresis could differ up to about ten times between treatments. Some implications for the kinetic/dynamic relationship or modeling, in the clinical use, and in the bioequivalence evaluation of dosage forms are discussed.     

Oocyte donation by gamete intra-Fallopian transfer to amenorrhoeic and cycling patients given replacement steroids

Thirteen procedures of oocyte donation by the gamete intra-Fallopiantransfer (GIFT) technique are described. The patients includedsix women with premature ovarian failure, four normally cyclingwomen with unexplained infertility who responded poorly to super-ovulationinduction in preparation for GIFT, and lastly one woman carrierof a 16/21 balanced translocation. Two patients had oocytesdonated on two occasions. Oocyte donors were recruited eitheramong the patients' relatives (n = 4), or among GIFT or IVFpatients (n = 8), who altruistically donated their extra oocytes.Donors were superovulated and oocytes collected laparoscopicallyor vaginally under ultrasound guidance. Donors did not sufferany complications. Recipients were given exogenous oestrogens,and exogenous progesterone was added from the day of donation.Seven clinical pregnancies were obtained (53.8% per attempt);one set of triplets aborted at 14 weeks. Donation took placeon replacement day 12–18 and pregnancies were obtainedin patients receiving oocytes throughout this temporal window.The increasing availability of embryo-freezing facilities willprobably reduce the number of ova available for donation. Therefore,the patients' families may become a precious source of donatedeggs, especially for those patients having large families, withstrong family ties.     

Synthesis and biological activity of Substance P C-terminal hexapeptide and heptapeptide analogues

The analogues [Glu(OBzl)¹¹]SP_6–11 and [Glu(OBzl)¹¹]SP_5–11 of the C-terminal hexapeptide and heptapeptide of Substance P have been synthesized by conventional solution methods. In each analogue the SCH₃ group of Met¹¹ is replaced by the COOCH₂C₆H₅ group. The in vitro activity of both analogues has been determined on three biological preparations: guinea pig ileum (GPI), rat vas deferens (RVD), and rat portal vein (RPV). The selectivity for the different receptors has been studied by utilizing atropine-treated guinea pig ileum (GPI + At). The results showed that both analogues are mainly active on GPI through the NK-1 receptor and that both analogues are equipotent to Substance P.     

老年糖尿病患者髋关节置换手术围手术期处理

目的探讨老年糖尿病患者髋关节置换手术围手术期血糖的控制方法和对手术的影响。方法回顾性分析32例老年糖尿病髋关节置换手术治疗围手术期血糖调控情况。结果32例患者入院时空腹血糖(12.8±1.7)mmol/L,经术前用胰岛素控制空腹血糖至(7.1±1.2)mmol/L后,分别接受全髋关节置换、股骨头置换手术,术中及术后继续使用胰岛素控制血糖至基本正常水平。本组术中血糖为(8.9±1.1)mmol/L。32例中,仅1例(3.2%)伤口愈合不良,未发生感染等其他明显并发症。结论老年糖尿病患者经正确的围手术期处理,将血糖控制至基本正常水平,可耐受髋关节置换手术。     

Bupropion and nicotine patch as smoking cessation aids in alcoholics.

This is a double-blind placebo-controlled study of sustained-release bupropion as a smoking cessation aid in alcoholics undergoing treatment for their alcoholism. Participants (N=58) were enrolled within 1 week of entry into alcohol treatment from community and Veterans Affairs Substance Use Disorder programs. All participants received nicotine patch and were invited to attend a smoking cessation lecture and group. Cigarette smoking and alcohol outcomes were measured at 6 months. Bupropion when added to nicotine patch did not improve smoking outcomes. One third of participants on bupropion reported discontinuing the drug during weeks 1-4. Participants reported cigarette outcomes with nicotine patch that are similar to those seen in the general population. All study participants significantly reduced cigarette use. Comorbid affective disorder or antipersonality disorder did not affect outcomes. Alcohol outcomes were improved in those who discontinued cigarettes.     

计算机导航对人工髋关节股骨柄假体置入的精确性验证

Objective To evaluate the accuracy of surgical navigation for localization and orientation of the femoral stem component in total hip arthroplasty, nethods In the hypothesized space, 3-D images of femoral stem were reconstructed. The coronal, sagittal and horizontal axes and scale divisions were established to calculate the displacement and rotation of the stem. Matching between the stem and its 3-D images was performed while the stem was moved in various distances and angles on the digital motion-platform. Then the actual change in the position of the implant and the caleulative data obtained from the navigation system were compared to evaluate the accuracy. Results The mean difference in displacement between the measurements and the actual changes was (1.01 ±0.47) mm, and the mean difference in the measured and actual angles was 1.09°±0.62°. The duplicate test found no significant difference (t = 0.238, P > 0.05). Conclusion Precise placement of the stem in the desired location and orientation can be achieved by the navigation system in the total hip arthroplasty.     

Gait biomechanics and the evolution of total joint replacement

The history and evolution of total knee and total hip replacement has been influenced substantially by the knowledge obtained from gait analysis studies. Many of the mechanical problems associated with these devices have been analyzed and evaluated in terms of the mechanics of walking. The magnitude and pattern of the forces at the hip and knee joints derived from gait analysis studies have provided valuable input into the design criteria of both total hip and total knee replacements. Information generated from the gait analysis of patients with total joint replacements has provided objective criteria for assessing functional recovery following this procedure. In addition to providing a basis for design evaluation, the key to the analysis of function following joint replacement is the ability to identify functional adaptations specific to design features. Gait analysis provides a unique opportunity to obtain objective information that cannot be obtained through other clinical means and provides a means for evaluating current designs and future design modifications.