A monitoring,feedback, and triggering system for reproducible breath-hold MR imaging

A technique is described that provides improved reproducibility of breath-holding for MR image acquisition by monitoring the superior-inferior (S/I) position of the diaphragm. The method incorporates detection of the level of inspiration using an MR signal, rapid display to the patient of diaphragm position to enable breath-hold adjustment, and triggering of image data acquisition once appropriate position is attained. The response time of the system is short, approximately 10 ms. Studies in six volunteers using this method demonstrate a considerable decrease in the S/I range of diaphragm position over 10 consecutive periods of suspended respiration. The mean range is 1.3 mm with the system, while it is 8.3 mm without using it is expected that this method will be of assistance in many abdominal and cardiothoracic studies that use breath-hold techniques.     

吡那地尔对高血压心脏结构和功能重构的影响

在等降压剂量下吡那地尔和赖诺普利可使４月龄自发性高血压大鼠的血压下降６．０￣８．０ｋＰａ，并接近同种属正常血压大刀瓣血压水平。     

A New Low Threshold Platinized Epicardial Pacing Electrode: Comparative Evaluation in Immature Canines

A prospective comparison of pacing and sensing capabilities between the conventional Medtronic Model 4951 platinum-iridium epicardial pacing electrode and a new modified "platinized" version of the same electrode was performed in immature canines to determine if the new electrode design improves pacing in the immature myocardium. The conventional electrode was modified by electroplating platinum black particles onto the surface to increase the effective or true microscopic surface area, yet essentially maintain the same overall geometric electrode size. Both epicardial electrodes were inserted into the right ventricular myocardium with the lead pad sutured to the epicardium, and externalized to the scruff in five puppies (age 3 months). An additional left ventricular lead was implanted to permit chronic pacing following epicardially-induced atrioventricular block. Acute and chronic sensing and pacing capabilities of each externalized electrode were performed at implant and weekly up to 4 months. Histologic examination of each electrode implant site was performed at the end of the study period. At implant, both electrodes exhibited comparable values for sensed R waves, lead impedances, and pacing thresholds. During the study, the platinized electrode exhibited lower pacing thresholds. Analysis of all postimplant data demonstrated this threshold difference to be significantly lower (P less than .01) for the platinized version. Lead impedance and sensing capabilities remained comparable between the two designs. Histologic study demonstrated less fibrotic infiltration at the platinized electrode site. This preliminary evaluation indicates that for the duration of the postimplant study period, the platinized epicardial electrode design was associated with significantly lower thresholds and less fibrosis as a function of time compared to the conventional smooth electrode surface design. The new platinized electrode limits exit block in the developing immature myocardium and permits safe pacing at lower pulse widths and voltages to increase battery life.     

Surgery in Jehovah’s Witnesses

This is a retrospective study of the outcome of surgical procedures in patients who were Jehovah's Witnesses. Over a 75-month period, 58 Jehovah's Witness patients had 78 surgical procedures at the Vancouver General Hospital. Three patients had preexisting anaemia of less than 100 g.L-1 haemoglobin. Postoperative haemoglobin concentration decreased below 50 g.L-1 in three patients. One patient had a postoperative haemoglobin of 34 g.L-1 (haematocrit 10.1 per cent) and survived. One patient died from uncontrollable postoperative haemorrhage. Perioperative morbidity was not uncommon, including significant hypotension (eight cases), cardiac arrhythmias (six), myocardial ischaemia (three), excessive bleeding (four), postoperative nausea or syncope (four), and wound or urinary tract infection (four).     

Differential Fear of Cardiopulmonary Sensations in Emergency Room Noncardiac Chest Pain Patients

Fear of bodily sensations has received extensive attention in relation to panic disorder, and more recently, other types of anxiety pathology and chronic pain problems. Extending this work, the present study examined fear of bodily sensations and its underlying dimensions in emergency room patients with Noncardiac Chest Pain (NCCP; n = 63). We posited a differential specificity hypothesis, expecting that specific cardiopulmonary fears would be more strongly associated with NCCP symptoms relative to other bodily fears. As hypothesized, participants reported cardiopulmonary sensations as significantly more fear-provoking than numbness, dissociation, and gastrointestinal sensations. Additionally, regression analysis indicated that after accounting for theoretically relevant demographic variables and health status, cardiopulmonary fear was the best predictor of a composite index of cardiac complaints intensity, even after removing variance related to the absolute number of cardiac complaints. We discuss these findings in relation to the specific role for the fear of cardiopulmonary sensations in chest pain complaints, with implications for better understanding the underlying psychological processes involved in NCCP.     

Pathomorphological characteristics of cardiac remodeling after myocardial infarction

Dilatational, hypertrophic, aneurysmal, and endocardial variants of remodeling were revealed in the postinfarction heart. The most prevalent dilatational remodeling is characterized by uniform or nonuniform elongation of ventricular cavities and increase in ventricular volume. Characteristic features of the hypertrophic type are hypertrophied interventricular septa and left ventricular wall and reduced or unchanged left ventricular volume. Pronounced changes in the configuration of the left ventricle due to the formation of single or multiple aneurysms were typical of aneurysmal remodeling. Endocardial remodeling was characterized by cicatricial changes and smoothed relief of the parietal endocardium. These variants and forms of remodeling determine disturbances in intracardial hemodynamic and thanatogenesis in the postinfarction period.     

肝脏血管瘤的手术指征和手术方法选择（附46例报告）

目的 探讨肝脏血管瘤的手术指征和手术方法。方法 回顾性分析采用手术治疗46例肝脏血管瘤病人资料，判断其手术指征，评价不同手术方法的治疗效果厦其手术并发症发生情况。结果 46例病人中，19例采用肝叶或肝段切除术，17例出现并发症，以胸腔积液和膈下积液多见，采用血管瘤摘除术的27例病人无并发症。结论 对肝脏血管瘤直径大于5cm并有明显临床症状，或不能除外恶性肿瘤的病人可以采用手术治疗。血管瘤摘除术是安全有效、并发症少的手术方法。     

Effect of age on cardiac index,stroke index and left ventricular ejection fraction at rest and during exercise as studied by radiocardiography

Radiocardiography was used to measure cardiac output, stroke volume and left ventricular ejection fraction at rest and during muscular exercise in relation with age in 148 healthy subjects (age range: 6–78 years). A clear dependence of these parameters on age was found. The mean annual decrease at rest was 22±9 ml/min/m² for cardiac index, 0.22±0.04 ml/m² for stroke index and 0.0017±0.0003 for left ventricular ejection fraction. Male subjects had significantly (p < 0.001) greater cardiac (9±4%) and stroke indices (11±23%) than females. During submaximal exercise cardiac index increased from 3.5±0.7 l/min/m' to 8.1±1.6 l/min/m² in male subjects (mean age: 32 years) and from 3.1±0.4 l/min/m² to 7.2±1.2 l/min/ m² in female subjects (mean age: 29 years). The corresponding increases in stroke index and left ventricular ejection fraction were: from 52±7 ml/m² to 62±9 ml/m². from 46±7 ml/m² to 51±9 ml/m² and from 0.66±0.08 to 0.79±0.05 and from 0.64±0.10 to 0.72±0.10. In subjects who were 60 years and older the increases of these parameters during exercise were considerably smaller.