Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background:

Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.

Methods:

Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.

Results:

After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm² vs. 0.9 ± 0.3 cm², P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm² vs. 14.2 ± 6.5 cm², P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm² vs. 25.4 ± 4.3 cm², P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm² vs. 1.7 ± 0.3 cm², P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.

Conclusions:

PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.     

CT 仿真内镜与双对比造影检查诊断胃肠道间质瘤价值

目的：比较 CT 仿真内镜（CTVE）与气钡双重造影（双对比造影）对胃肠道间质瘤的诊断价值。方法：89例经手术证实的胃肠道间质瘤患者先进行双对比造影检查,待造影剂排空后行 CTVE 检查,比较两种检查方法对胃肠道间质瘤的检出率、部位及肿瘤大小。结果：CTVE 检出胃肠间质瘤的阳性率高于双对比造影,尤其是胃、小肠及直肠间质瘤的检出;CTVE 对瘤体＜5 cm、瘤体5～10 cm 的检出率明显高于双对比造影检查。结论：CTVE 对早期间质瘤检出敏感性高,能够生动反应瘤体大小及黏膜皱襞改变情况,具有一定早期诊断价值。     

脊伤颗粒对大鼠急性脊髓损伤后运动功能及Caspase-3表达的影响

目的 研究脊伤颗粒对大鼠脊髓损伤(spinal cord injury,SCI)后运动功能及半胱氨酸蛋白酶-3(Caspase-3)表达的影响.方法 随机抽取大鼠32只作为假手术组,其余118只大鼠采用改良Allen'S打击器制作大鼠SCI模型,将造模成功的96只大鼠随机分为模型组、甲基强的松龙组(下称甲强龙组)、脊伤颗粒组.分别给予假手术组、模型组生理盐水灌胃,甲强龙组尾静脉注射药物,脊伤颗粒组予以相应药物灌胃.在给药后1、3、7、14 d的4个不同时间点采用BBB行为学功能评分;再分批处死大鼠,取出SCI组织用HE染色观察其病理变化,用免疫组化染色检测Caspase-3表达阳性细胞,原位末端标记法(TUNEL法)标记凋亡细胞.结果 (1)BBB运动功能评分方面,与假手术组比较,模型组评分低(P＜0.01);与模型组比较,脊伤颗粒组、甲强龙组评分高(P＜0.05);与甲强龙组比较,SCI后1、3d,脊伤颗粒组评分偏低,(P＜0.05),SCI后7、14 d脊伤颗粒组评分偏高(P＜0.05).(2)在平均积分光密度值和细胞凋亡率方面,与假手术组比较,模型组数值偏高(P＜0.01);与模型组比较,甲强龙组、脊伤颗粒组平均数值低(P＜0.05);与甲强龙组比较,SCI后1、3d,脊伤颗粒组平均数值偏高(P＜0.05),SCI后7、14 d,脊伤颗粒组平均数值偏低(P＜0.05).结论 脊伤颗粒能部分恢复SCI后模型大鼠的运动功能并可明显抑制细胞Caspase-3表达和细胞凋亡.     

经皮椎体成形术中斜面针应用效果观察

目的探讨斜面穿刺针和菱形穿刺针在经皮椎体成形手术中的应用方法和优势.方法解离成人25~40岁尸体腰椎1~5椎节(L1~5),共计10×5节,完成各椎节骨含量检测,符合骨含量减少或轻度骨质疏松标准.分别应用斜面穿刺针和菱形穿刺针完成在尸椎上经皮椎体成形术手术模拟操作.手术后行椎体正侧位拍片,使用简易的学生用角度尺和直尺测量穿刺针道偏转数据;观察CT断层扫描下骨水泥在椎体内的分布特点.针道偏转计量数据应用统计软件完成统计分析.结果斜面穿刺针在椎体骨质内发生背向斜面的偏转,偏转角度为(1.83±0.2)°至(3.30±0.3)°.菱形穿刺针在椎体内未发生针道偏转.骨密度值与修正后偏转角度经Pearson相关分析结果显示:2者存在负相关关系,r=-0.991,P=0.001.CT断层扫描显示:自斜面穿刺针之斜面溢出的骨水泥团分布呈现为偏向分布的类椭圆体,随着针体旋转调整,可控制骨水泥注射方向和分布区域;骨水泥自菱形穿刺针顶端溢出后,直接冲向针尖远端,成为类球形体,旋转针体后,不能调整骨水泥注射方向和分布区域.结论实验观察表明,应用斜面穿刺针具实施经皮椎体成形手术,可以在进针和注射过程中充分发挥其所具有天然的设计优势,获得精确的进针路径控制和骨水泥在靶区内的填充控制效果.     

A new method for measurement of blood flow,pH, and transmucosal potential difference in rat gastroduodenal mucosa by endoscopy

A method was developed to measure the mucosal blood flow (BF), mucosal pH (pH), and transmucosal potential difference (PD) in various sites from the oral cavity to the duodenum without surgical operation or damage to the subject rats. These measurements were carried out by using three indicator electrodes, which were attached to the various sites through the suction channel of an endoscope. The hydrogen gas clearance method was used for the measurement of BF. BF values obtained at the fundic, pyloric, and duodenal regions were 119±17, 69.9±8.8, and 114±18 ml/min/100 g (mean±se), respectively. The pH values were lowest at the cardiac portion and the forestomach and highest at the duodenum. PD showed higher values at the stomach and lower values at the pharynx and duodenum. Using this technique, it was possible to measure the BF, pH, and PD repeatedly and safely at various sites in the same rat. Therefore, it was suggested that this method is useful in studying the physiological functions of the stomach and duodenum and the pathogenesis of gastroduodenal ulceration and that this method is applicable to measure the change of the above parameters in the healing process of gastric ulcer in rats.     

Clinical application of wireless capsule endoscopy

BACKGROUND: Diagnostic modalities for identifying lesions within the small bowel have been quite limited. Wireless capsule endoscopy (WCE) is a new, innovative technique that can detect very small mucosal lesions in the entire small bowel and can be used in the outpatient setting. The present study explored the diagnostic value, tolerance and safety of WCE in the identification of small bowel pathology that was not detected with conventional small bowel imaging studies. METHODS: From May through September 2002, 15 patients with suspected small bowel diseases were prospectively examined, Of them, 12 presented with persistent obscure gastrointestinal bleeding and negative findings on upper endoscopy, colonoscopy, small bowel radiography, and bleeding‐scan scintig‐raphy or mesenteric angiography. RESULTS: Wireless capsule endoscopy identified pathologic small bowel findings in 11 of the 15 patients (73%): angioectasias, Dieulafoy's lesion, polypoid lesion, submucosal mass, Crohn's disease, carcinoid tumor, lipoma, aphthous ulcer, and hemorrhagic gastritis; four of the patients had two lesions. The images displayed were considered to be good. The capsule endoscopes remained in the stomach for an average of 82 min (range 6?311 min) and the mean transit time in the small bowel was 248 min (range 104?396 min). The mean time of recording was 7 h 29 min (from 5 h to 8 h 30 min). The mean time to reach the cecum was 336 min (180?470 min). The average number of the images transmitted by the capsule was 57 919 and the average time the physician took to review the images transmitted by the capsule was 82 min (range 30?120 min). The average time of elimination of the capsule was 33 h (range 24?48 h). All 15 patients reported that the capsule was easy to swallow, painless, and preferable to conventional endoscopy. No complications were observed. CONCLUSIONS: Wireless capsule endoscopy is safe, well tolerated, and useful for identifying occult lesions of the small bowel, especially in patients who present with obscure gastrointestinal bleeding.     

Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy

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冠状动脉介入术后腹膜后血肿的危险因素研究

目的探讨冠状动脉介入术(PCI)后腹膜后血肿(RPH)的发生率、临床特征和危险因素。方法对北京安贞医院心内科2000-01—2005-09共3729例经股动脉穿刺进行PCI术的病例进行回顾性分析,其中并发RPH的21例设为观察组,选择另外30例未发生RPH的病例设为对照组。采用单因素和多因素分析RPH发生的危险因素。结果RPH的发生率为0·6%。RPH最常见的临床特征为贫血(100%),其余还包括低血压(95%)、出汗(57%)、腹股沟痛(48%)、下腹痛(38%)和背痛(38%)。RPH的独立预测因素有3个:女性(OR=5·23,P<0·0001)、体表面积(BSA)<1·53m2(OR=7·11,P=0·005)和高部位股动脉穿刺(OR=5·42,P=0·001)。结论女性、低BSA和高部位股动脉穿刺是RPH发生的独立预测因素。     

Is formal training necessary for capsule endoscopy?: The largest gastroenterology trainee study with controls

BACKGROUND: Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified. AIMS AND METHODS: To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees. RESULTS: Trainees were better at determining the gastric emptying time (p=0.013) and more likely to record true positives compared to the students (p=0.037). They were also less likely to record false positives (p=0.005) and more likely to reach the correct diagnosis (p=0.001, OR 3.6, CI 1.8-7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training. CONCLUSION: This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.