双腔右心室(附四例报告)

本文对我院1983～1985年经手术证实的4例双腔右心室病例,进行了分析讨论。本病除右心导管检查发现肺动脉与右心室有压力阶差移行曲线、右心造影时心腔内显示充盈缺损、超声心动图等检查有助于诊断外,X线心脏平片、心电图、临床症状、体征均无特异性的诊断价值。认为,由于本病多合并室缺,因此对室缺修补时,应常规探查右心室腔,以免漏诊。另外,对本病与法乐氏四联症的鉴别作了较详细的讨论。     

Heart rate response to breathing: dependency upon breathing pattern

Summary. Heart rate responses to stepwise and periodic changes in lung volume were studied in seven young healthy males. Stepwise inspiration and expiration both resulted in an increase in heart rate followed by a rapid decrease in heart rate. The fastest heart rate was reached in 1·6 ± 0·5 s and in 3·6 ± 1·4 s in response to inspiration and expiration, respectively (P < 0·01). The slowest heart rate was reached in 4·8± 1·0 s and in 7·6± 1·9 s in response to inspiration and expiration, respectively (P < 0·01). Following this biphasic change the heart rate returned to a steady level. The difference between the fastest and the slowest heart rates was significantly larger in response to inspiration (21·7 ± 7·3 beats per minute) than in response to expiration (12·0±7·3 beats per minute; P < 0·01). Periodic changes in lung volume were performed with frequencies from 3·0 to 12·0 respirations per minute (r.p.m.). The changes in heart rate showed a constant amplitude in the frequency range below 5·5 r.p.m. Maximal heart rate changes were found at frequencies of 5·5 to 7·0 r.p.m. Changes in heart rate decreased in a linear manner on a log-log scale in the frequency range above 7·0 r.p.m. The relation between frequency and changes in heart rate is explained by interference between the transient changes in heart rate induced both by inspiration and by expiration. It is concluded that if heart rate changes in response to periodic changes in lung volume are to be used as a measure of vagal function a number of factors have to be taken into consideration and to simplify the analysis of heart rate responses to breathing we recommend, instead, the use of the transient changes in heart rate induced by stepwise changes in lung volume.     

合并心律失常的心力衰竭56例治疗评价

目的探讨心力衰竭并发心律失常的发病规律及治疗方法。方法回顾性分析了93例慢性心力衰竭病人的临床资料，包括临床特点、诊断治疗方法以及预后。结果心律失常发生率为60．2％，以室性早搏发生率最高32．1％，其次是房性早搏26．8％，心房纤颤21．4％，其他19．7％，经治疗有效71例，总有效率76．3％。结论纠正心功能不全是治疗的关键，应根据具体情况选择性地应用抗心律失常药。     

Inadequate dietary magnesium intake increases atherosclerotic plaque development in rabbits

Epidemiological studies have shown dietary magnesium (Mg) intake and serum Mg levels to be inversely correlated with the development of atherosclerosis. We hypothesized that low levels of Mg would promote atherosclerotic plaque development in rabbits. New Zealand white rabbits (4 months old, n = 22) were fed an atherogenic diet containing 0.12% (−Mg), 0.27% (control), or 0.43% (+Mg) Mg for 8 weeks. Blood samples were obtained at baseline, 2, 4, 6, and 8 weeks and were assayed for total cholesterol, high-density lipoprotein (HDL), non-HDL, triglycerides (TG), C-reactive protein, serum Mg, and erythrocyte Mg. Aortas from −Mg had significantly more plaque, with an intima thickness 42% greater than control and 36% greater than +Mg. Serum cholesterol levels rose over time, and at 8 weeks, −Mg had the highest and +Mg the lowest total and non-HDL cholesterol and TG levels, although these results did not reach significance. Over time, serum Mg levels increased, and erythrocyte Mg levels decreased. C-reactive protein significantly increased in all groups at 4 and 6 weeks but returned to baseline levels by 8 weeks. This study supports the hypothesis that inadequate intake of Mg results in an increase in atherosclerotic plaque development in rabbits.     

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     

BKV in Simultaneous Pancreas-Kidney Transplant Recipients: A Leading Cause of Renal Graft Loss in First 2 Years Post-Transplant

With the introduction of more potent immunosuppressive agents, rejection has decreased in simultaneous pancreas/kidney transplant (SPK) recipients. However, as a consequence, opportunistic infections have increased. The purpose of this report is to outline the course of SPK patients who developed polyomavirus-associated nephropathy (PVAN). A retrospective review of 146 consecutive SPK recipients from January 1, 1996 to December 31, 2002 was performed. Immunosuppression, rejection and development of PVAN were reviewed. Nine patients were identified. All received induction with either OKT3 or thymoglobulin. Immunosuppression included tacrolimus/cyclosporine, MMF/azathioprine and sirolimus/prednisone. Two patients were treated for kidney rejection prior to the diagnosis of PVAN. Time to diagnosis was an average of 359.3 days post-transplantation. Immunosuppression was decreased but five ultimately lost function. However, none developed pancreatic abnormalities as demonstrated by normal glucose and amylase. Two underwent renal retransplantation after PVAN diagnosis and both have normal kidney function. PVAN was the leading cause of renal loss in SPK patients in the first 2 years after transplantation and is a serious concern for SPK recipients. The pancreas, however, is spared from evidence of infection, and no pancreatic rejection occurred when immunosuppression was decreased.     

The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty.

BACKGROUND: The effect of mitral valve morphology (MVM) on the long-term results of mitral balloon valvuloplasty (MBV) is not well established. The aim of the study was to evaluate the impact of MVM on long-term outcome of MBV. METHODS: Five hundred and eighteen consecutive patients (mean age, 31+/-11 years) who underwent successful MBV were followed up for 0.5-16.5 (mean, 6+/-4.5) years. Patients were divided into two groups according to their mitral echo score (MES) before MBV: group A (n=340; MES8). RESULTS: We report the immediate and long-term clinical and echocardiographic results of the above-mentioned 518 consecutive patients. The mitral valve area was significantly larger in group A than in group B, both immediately after MBV (2.0+/-0.3 vs. 1.82+/-0.3 cm2, respectively; P<0.0001) and also at the last follow-up (1.8+/-0.33 vs. 1.5+/-0.33 cm2, respectively; P<0.0001). Restenosis occurred in 38/340 (11%) in group A vs. 73/178 (41%) in group B (P<0.0001). Actuarial freedom from restenosis at 5, 10, 15 years were 92+/-2%, 85+/-3%, 65+/-6% for group A vs. 72+/-4%, 44+/-5%, 9+/-6% for group B (P<0.001). Event-free survival rates at 5, 10, 15 years for group A were 93+/-1%, 88+/-2%, 66+/-6% vs. 82+/-3%, 59+/-6%, 8+/-7% for group B (P<0.0001). Stepwise Cox multivariate regression analysis identified MES, preprocedure functional class, and postprocedure mitral valve area相似文献   

危重新生儿应激性高血糖及其预后分析

目的探讨危重新生儿预后与应激性高血糖之间的关系。方法对85例危重新生儿入院后即采静脉血用葡萄糖氧化酶法测血糖,血糖>7mmol/L诊断为高血糖,此后应用微量血糖仪进行动态监测。结果入院时高血糖者56例,占65.9%,治愈组与死亡组的血糖值分别为7.38±2.70、17.8±8.50mmol/L(P<0.01);无脏器功能衰竭、单器官及多器功能衰竭患儿的血糖分别为6.02±2.82、10.8±3.85、14.1±4.80mmol/L(P<0.01)。高血糖与器官功能衰竭关系密切,血糖越高,病情越严重,预后越差。结论危重新生儿血糖水平可作为预后判断的一项依据。     

Fetal cardiac screening by three- and four-dimensional ultrasound

Objective. The objective of our paper is to show that the spatio-temporal image correlation (STIC) and tomographic ultrasound imaging (TUI) is very convenient and helpful for the fetal screening of complex congenital heart defects (CHD).

Methods. Ultrasound examinations were performed using a Voluson 730 EXPERT or PRO system (GE Medical system, Kretztechnik, Zipf, Austria), and the transabdominal probe (RAB 4-8 MHz or 1-5 MHz) was used to acquire the STIC volumes. Various complex CHD including heterotaxia, ventricular septal defect (VSD), atrio-ventricular septal defect (AVSD), tetralogy of fallot (TOF), transposition of great artery (TGA), hypoplastic left heart syndrome (HLHS) were examined between 20 weeks and 35 weeks. After routine cardiac screening and examination by two-dimensional ultrasound, three- and four-dimensional ultrasound were performed by gray-scaled and color flow mapping. After the examination detailed analysis of CHD were performed by STIC and TUI.

Results. In the case of heterotaxia, STIC and TUI was useful for the detection of stomach and cardiac apex in the different slices. In the case of VSD and AVSD, they were useful for the exact determination of septal defect location. In the cases of TOF, TGA and HLHS, they were helpful for observation of outflow tract and exact diagnosis.

Conclusion. In the screening of complex CHD including heterotaxia, VSD, AVSD, TOF, TGA and HLHS, STIC is very useful and powerful tool.