欧洲2003年心衰会议简介

综述了欧洲 2 0 0 3年心衰会议有关欧洲心衰指南、心衰治疗现状、失败的临床试验和失败的原因等论文报道     

心脏跳动下修补小儿室间隔缺损的临床研究

目的　探讨在浅低温体外循环心脏跳动下完成小儿室间隔缺损修补术的可行性。方法　 18例小儿室间隔缺损随机分为观察组和对照组 ,观察组在浅低温体外循环心跳下修补室间隔缺损 ,对照组为常规心脏停跳下修补室间缺损。测定心肌同功酶释放和三磷酸腺苷 ,观察左室压力 ,评价术野显露及气栓预防效果等。结果　观察组心肌同功酶释放明显低于对照组 ,三磷酸腺苷含量明显高于对照组 ,心肌超微结构基本正常 ,术中左室压力低于主动脉压力 ,术后无气栓发生。结论　浅低温体外循环心脏跳动下行小儿室间隔缺损修补术能更好地保护心肌。术野显露技术和防气栓的方法简便可行。     

糖尿病是一种心血管疾病和心身疾病的观点探讨

本文就糖尿病患者最早就诊的是心血管内科医师,以及负性情绪可明显影响糖尿病的发展进行了分析,并提出改善心境可明显增加自我控制糖尿病的能力。     

慢性多发性肌炎临床及病理分析

目的探讨慢性多发性肌炎的发病机制、临床和病理特征。方法回顾性分析95例慢性多发性肌炎患者临床表现、肌酶学和肌电图检查结果,总结肌肉病理学特征。结果慢性多发性肌炎以四肢近端肌无力、肌萎缩为主要表现,血清酶谱轻-中度增高,肌电图以肌源性损害为主,病理改变为灶性坏死、炎性细胞浸润与再生肌纤维共存。结论临床特点结合病理学检查有助于慢性多发性肌炎的诊断,多数患者激素治疗有效。     

A light-hearted look at a lion-hearted organ (or, a perspective from three standard deviations beyond the norm) Part 2 (of 2 parts)

Throughout history, the heart has been associated not only with its life-sustaining function but also with its close ties to the human emotions. In this literature and internet review, we attempt to gather and organize information from both of these perspectives as they relate to the heart in the following 11 categories: (1) fun facts, (2) medical photography, (3) history, (4) languages (etymology), (5) nonmedical English expressions, (6) death, (7) the arts, (8) movie titles, (9) song titles, (10) Shakespeare, and (11) the Bible. Part 1 (previously published) covered the first five topics, and Part 2 will cover the last six topics. These data may be useful to those who are engaged in teaching about the cardiovascular system.     

肺隔离症的影像诊断和介入治疗

目的探讨肺隔离症的影像学表现及介入治疗的应用价值. 资料与方法对5例肺隔离症患者的X线平片、CT、MRI表现进行分析,并对隔离的肺组织的供血动脉进行栓塞. 结果 X线平片主要表现为囊状或团状高密度影及支气管扩张样改变,CT、MRI可发现部分异常供血动脉,血管造影均能发现供血动脉,经异常供血动脉采用不锈钢圈栓塞后临床症状逐渐减轻、消失,随访6个月～1年,症状未再复发. 结论在影像诊断方面,X线平片难以确诊,CT、MRI可部分确诊,而DSA检查是肺隔离症诊断的金标准.经异常供血动脉栓塞治疗肺隔离症安全,患者痛苦小,并发症少,是一种有效的治疗方法.     

维生素D衍生物联合供者骨髓细胞输注诱导异基因大鼠心脏移植免疫耐受

目的 探讨同种异基因心脏移植后免疫耐受的诱导。方法 建立大鼠颈部异位心脏移植模型，按分组分别给予门静脉输注供者骨髓细胞(DBMC)(B组)、骨化三醇灌胃(C组)、输注DBMC及骨化三醇灌胃(D组)以及环孢素A(CsA)灌胃(E组)。观察移植心脏的存活时间及心肌组织病理改变，测定心肌组织中肿瘤坏死因子及细胞间粘附分子-1 mRNA的表达以及血清钙、磷浓度，进行受者与供者及无关第三品系大鼠脾细胞混合淋巴细胞培养(MLR)。结果 D组移植心脏的存活时间较其它各组显著延长(P＜0．05)；术后7d，C组、D组、E组受者脾细胞均能显著抑制供者及第三方无关供者脾细胞作为刺激细胞引起的MLR；D组手术前后血磷、血钙浓度的差异无显著性(P＞0．05)；各组急性排斥反应的程度，D组最轻；D组肿瘤坏死因子及细胞间粘附分子-1 mRNA的表达受到显著抑制，与对照组(A组)、B、C组比较，差异有显著性(P＜0．05)。结论 骨化三醇灌胃联合DBMC输注可显著延长移植心脏的存活时间，二者具有协同作用。     

Assay of cytomegalovirus susceptibility to ganciclovir in renal and heart transplant recipients

Ganciclovir (GCV) prophylaxis or pre-emptive therapy significantly reduce the rate of cytomegalovirus (CMV) disease and viremia, but increase the potential for emergence of ganciclovir-resistant CMV strains. The inhibitor concentration at 50% (IC(50)) of GCV from 156 CMV isolates from 59 renal or heart transplant recipients was calculated by means of a rapid phenotypic susceptibility assay. Twenty-seven strains were from 14 patients undergoing GCV therapy. The IC(50) was higher in patients under the prophylaxis regimen. One CMV strain, from a heart transplant recipient, became GCV-resistant after 1 month of therapy (IC(50)=13.7 micromol/l). These data, together with clinical and virological markers, suggested that a switch to foscarnet was necessary, and good evolution was observed. Thus, assay of CMV susceptibility to GCV could be helpful in clinical management.     

Coronary stenting for coronary artery narrowing in a heart transplant recipient

Transplant atherosclerotic coronary disease remains the leading cause of death in heart transplant recipients. We report the first case of coronary stent implantation in a heart graft for epicardial focal stenosis. Due to the lower rate of restenosis after stenting in the native coronary artery, we suggest that coronary stenting be considered an acceptable, first intention therapeutic option instead of angioplasty alone whenever possible.