Right ventricular-pulmonary arterial interactions

The application of pulsatile models to hemodynamic data has made possible a more complete understanding of the relationship of pulmonary pressure and flow. To review the genesis of these concepts, the unique characteristics of the pulmonary artery and right ventricle are outlined as a basis for understanding why differences in their pulsatile properties from the systemic circuit must exist. The pulmonary impedance spectrum is introduced and the concept of optimal right ventricular-pulmonary artery coupling is explored based on a review of extensive experimental data. Finally, available studies of normal pulmonary impedance in man and abnormal impedance in human disease states are reviewed, with emphasis on disturbances in optimal ventricular-vascular coupling. The important implications of these concepts for understanding and treatment of cardiovascular disease are developed.     

心脏连续横断断层的解剖学研究

用20个成人尸体心脏,从右心耳上缘平面向下作1.0cm厚的连续横断断层切片。对心脏每一断层下断面,进行各项观测,同时还观察了心脏各断层与胸壁的对应关系。     

血清脂质结合唾液酸测定对肺部病变的诊断价值

本文介绍正常人113名,肺部恶性病变49例及肺部良性病变33例的血清LSA测定结果,正常人血清LSA含量平均值为0.1243±0.0358g/L。特异性97.40％,男女间无差异,48例肺癌血清LSA平均值0.2698±0.0915g/L,敏感性85.40％;33例良性病变LSA平均值0.1712±0.0767g/L,特异性78.79％。肺癌患者血清LSA较良性病变明显升高,故测定血清LSA对鉴别良恶性病变有一定价值。     

Changes in CSF pressures during experimental acute arterial subdural bleeding in pig

Summary The effects of acute arterial subdural bleeding on cerebrospinal fluid (CSF) pressure and 12 other vital parameters were studied in spontaneously breathing pigs (group 1, n=9) and in mechanically ventilated pigs (group 2, n=18) to analyze quantitatively the bleeding course and the lethal mechanism.Spontaneously breathing animals all succumbed after a mean bleeding volume of 45.6±8.9ml, corresponding to about 50 per cent of the intracranial volume, and a mean bleeding duration of 11.0±2.6 min. Rapid rise in CSF pressures, marked transtentorial pressure gradients, and progressive reductions of cerebral perfusion pressure leading to a permanently iso-electric EEG, apnoea and to a terminal rise in arterial pressure (Cushing response), was the rule in these animals.The mechanically ventilated animals had smaller bleeding volumes (34.3±8.1 ml), but longer bleeding durations (13.8±5.8 min). In this group 7 animals survived. They had no pressure gradients, and only moderate changes in arterial pressure and EEG. The 11 animals that succumbed had marked transtentorial pressure gradients, but smaller increments in arterial pressure than the spontaneously breathing animals.At autopsy, subdurally located blood was found throughout the intracranial and spinal subdural compartments and along the spinal nerve roots in both groups.The results of this study suggest that survival after acute subdural haematoma is influenced by the presence of transtentorial pressure gradients and by the spinal sac acting as a space for expansion. The beneficial effect of artificial ventilation is discussed.This study has been supported by the University of Oslo, The Anders Jahre Foundation for The Advance of Research, and by the Norwegian Society for fighting Cancer.     

31例活动性肺结核治疗前及治愈后的CT征象分析

目的 探讨抗结核疗前及治愈后活动性肺结核CT征象的变化特点.方法 选取临床治愈的活动性肺结核31例,对比观察活动性肺结核的CT征象转归表现.结果 肺结核活动性CT征象治愈前检出率为100.0%,治疗后检出率为35.5%.活动性CT征象中毛玻璃阴影、节段分布小叶中心结节影、小叶样实变影、树芽征、支气管壁增厚、厚壁空洞和肺实变治疗前检出率分别为87.1%、80.6%、80.1%、61.3%、58.1%、48.4%和32.3%、,治愈后检出率分别为0、19.4%、0、0、12.9%、0和3.2%.治疗前活动性肺结核CT检查可检出多种活动性影像,而疗程结束后上述征象减少并多以单发为主,两者有显著差异（P＜0.01）.结论 CT检查有助于活动性肺结核治疗疗效的判定,并具有较高的敏感度,但特异度较低.     

高血压病合并脑梗死的动态血压特点

目的 :观察高血压病合并脑梗死患者的动态血压特点。方法 :对 70例高血压病合并脑梗死患者和 1 0 2例单纯高血压病患者进行 2 4h动态血压监测。结果 :84 %高血压病合并脑梗死患者血压昼夜节律消失 ,而单纯高血压病患者 5 8%消失 (P <0 .0 1 ) ;高血压病合并脑梗死组 85 %出现晨峰 ,而单纯高血压病组 5 5 %出现晨峰 (P <0 .0 1 )。结论 :血压的昼夜变化和晨峰与高血压病合并脑梗死密切相关。高血压病合并脑梗死患者晨峰明显增加 ,昼夜节律消失明显     

下腔静脉滤器在治疗下肢深静脉血栓中的应用

目的：探讨下腔静脉滤器在治疗下肢深静脉血栓(DVT)中的应用价值。方法：选择10例DVT患，使用进口铁质滤器，经股静脉或颈静脉途径置人下腔静脉，随访8—20个月。结果：10例患中无一例发生肺动脉栓塞和其他严重并发症。结论：下腔静脉滤器置人方法简单，安全；可有效防止肺动脉栓塞的发生。     

不同手术方法对高血压脑出血患者康复的影响

目的：探讨不同手术方法对高血压脑出血患康复影响的临床意义。方法：采用立体定向血肿排空术(34例)和骨瓣开颅术(40例)进行对照研究。结果：2组近期疗效无明显差异，远期疗效立体定向组并发症发生率低，神经功能恢复快，ADL评定优于骨瓣组。结论：微创、减压及超早期手术是高血压脑出血较佳的外科治疗方法。     

叶内型肺隔离症致咯血的栓塞治疗

目的探讨叶内型肺隔离症患者咯血的栓塞治疗效果。方法结合文献复习，回顾性分析6例叶内型肺隔离症患者血管造影表现，并对畸形动脉行栓塞治疗。结果6例叶内型肺隔离症患者血管造影显示畸形动脉7支，表现为粗大、迂曲的体循环血管影；在毛细血管期可见隔离肺叶染色及引流静脉早显；静脉期显示引流静脉（肺静脉）。6例患者均进行畸形血管栓塞治疗，临床止血总有效率100％，随访1a均未复发。结论畸形血管栓塞术对叶内型肺隔离症致咯血的治疗，安全有效。