Intrafamilial circulation of Tropheryma whipplei, France

Tropheryma whipplei, which causes Whipple disease, has been detected in 4% of fecal samples from the general adult population of France. To identify T. whipplei within families, we conducted serologic and molecular studies, including genotyping, on saliva, feces, and serum from 74 relatives of 13 patients with classic Whipple disease, 5 with localized chronic T. whipplei infection, and 3 carriers. Seroprevalence was determined by Western blot and compared with 300 persons from the general population. We detected T. whipplei in 24 (38%) of 64 fecal samples and 7 (10%) of 70 saliva samples from relatives but found no difference between persons related by genetics and marriage. The same circulating genotype occurred significantly more often in families than in other persons. Seroprevalence was higher among relatives (23 [77%] of 30) than in the general population (143 [48%] of 300). The high prevalence of T. whipplei within families suggests intrafamilial circulation.     

休克指数和修正休克指数评估心脏骤停自主循环恢复患者的预后

目的 评价休克指数和体温修正休克指数(以下简称“修正休克指数”)评估心脏骤停后自主循环恢复患者预后的价值.方法 以心肺复苏Utstien模式前瞻性注册登记并分析111例院内心脏骤停经心肺复苏恢复自主循环患者的生命体征等资料,以进一步评价休克指数和修正休克指数评估其预后的价值.结果 收缩压、心率在成活出院组与死亡组患者组间差异无统计学意义,P＞0.05.死亡组患者休克指数和修正休克指数[(1.109±0.428)和(1.082 ±0.410)]明显高于成活出院组[(0.899±0.303)和(0.844 ±0.265)],P＜0.05.修正休克指数＞1.1的患者死亡风险比为5.4,明显高于收缩压＜90 mm Hg组(1.6)和心率＞100次/min组(3.1),P＞0.05.休克指数＞1.1预测该组患者死亡风险的比值比为2.8.结论 休克指数和修正休克指数是易于记忆和获取的有效评价指标,有助于预测诸如心脏骤停循环恢复患者最终死亡或成活出院等病情预后.     

The effects of enoximone (MDL-17043) on forearm venous circulation in healthy volunteers and patients with heart failure

Summary The effect of intravenous enoximone on forearm venous circulation was studied in ten healthy volunteers (group A) and in ten patients with NYHA class III–IV congestive heart failure (group B). Distensibility of the forearm capacitance vessels was assessed from pressure-volume curves by venous occlusion plethysmography using a mercury-in-rubber strain gauge. Three recordings each at 3-min intervals were obtained before the infusion and again 20 min after completion of the infusion. Venous volume changes (VV) at congesting pressures of 10, 20, and 30 mmHg before and after enoximone were compared. Forearm muscle blood flow was also measured by venous occlusion plethysmography; electrocardiogram, heart rate, and cuff blood pressure were recorded throughout. Enoximone at a dose of 1 mg/kg body weight was infused over 10 min through a peripheral vein in group A and via a central line in group B. In group A, the effect of the injection vehicle was also assessed.VV₁₀, VV₂₀, and VV₃₀ did not differ from baseline values after enoximone in both groups A and B. The vehicle caused a small but significant degree of venoconstriction in group A (VV₂₀, 2.64±0.9 to 2.48±0.83 ml/100 ml,P<0.05; VV₃₀, 3.47±1.27 to 3.33±1.20 ml/100 ml,P<0.05), which could be explained by an acute response to local pain from the infusion. This effect was not evident following enoximone, perhaps as a result of its counterbalancing vasodilating action to venoconstriction induced by acute pain. Muscle blood flow increased in both groups (group A, 3.05±0.33 to 4.62±1.32 ml/100 ml/min,P<0.01; group B, 2.33±0.93 to 3.13±0.95 ml/100 ml/min,P<0.02) after enoximone and did not change in group A after vehicle (3.08±1.50 to 2.73±0.87,P—not significant).It is concluded that enoximone at the dose studied does not exert appreciable effects on the forearm venous system in normal subjects or in patients with heart failure.     

Spontaneous oscillations of systemic arterial pressure during cardiopulmonary bypass in man

Summary Extracorporeal blood circulation (ECC) provides a steady flow and minimal pulmonary circulation in the absence of cardiac function. Oscillations of systemic arterial pressure were observed in 70 patients during ECC. At the onset of oscillations the frequency was as a rule 4 cycles per minute but depended on the temperature and showed a positive correlation with it. Correspondingly, the amplitude was about 6 mm Hg and depended on aortic pressure and showed a positive correlation with it. During the cooling phase of ECC the frequency decreased and the amplitude increased. The oscillations were independent of central venous pressure and ventilation. The oscillations disappeared either at the beginning of restitution of cardiac function or with decreasing arterial pressure caused by drug administration or rewarming. Arterial blood pressure oscillations have been described in experimental animals under various conditions but also in conscious man. The mechanisms underlying these oscillations are suggested to be nervous in origin, as is possible also in the present findings.     

重组人生长激素对急性心肌梗死大鼠冠状动脉侧支循环的影响

目的 :探讨重组人生长激素 (rh GH)对急性心肌梗死 (AMI)大鼠冠状动脉侧支循环及血管内皮细胞生长因子 (VEGF)、成纤维细胞生长因子 (bFGF)的影响。方法 :5 0只Wistar大鼠经 10 %戊巴比妥钠麻醉后开胸 ,剪开心包腔 ,经左冠状动脉前降支结扎术致其发生AMI ,术后 2 4h存活者 37只被随机分为治疗组 (19只 )和对照组 (18只 )。治疗组以rh GH 0 .2 5IU/kg肌内注射 ,对照组肌内注射同等容积的0 .9%氯化钠溶液 ,3周后处死大鼠 ,开胸经升主动脉向冠状动脉内灌注 4 %多聚甲醛 2 0～ 30min固定心脏 ,心脏标本经切片处理。分别测定血浆和心肌的VEGF、bFGF的量及左室毛细血管密度。结果 :治疗组与对照组在AMI后 3周其血浆bFGF、VEGF浓度均较实验开始时明显增加 (P <0 .0 5 )。治疗组较对照组升高更加显著 ,分别为 (6 8.72± 4 .5 7)∶(35 .6 0±4 .31)和 (4 7.0 5± 5 .13)∶(32 .13± 5 .70 ) (均P <0 .0 5 )。大鼠心肌内bFGF及VEGF治疗组均较对照组高 ,分别为 (79.0 5± 6 .96 )∶(30 .7± 3.4 9)和 (72 .0 5± 6 .73)∶(39.33± 6 .78) (均P <0 .0 1)。血浆bFGF、VEGF的浓度与心肌内毛细血管密度呈正相关 (r分别为 0 .91和 0 .86 ,均P <0 .0 1)。结论 :rh GH能促进AMI大鼠心肌细胞生长因子bFGF和VEGF的表达和分泌     

心血管疾病活血化瘀论治

就活血化瘀法的沿革、作用原理和在心血管疾病中的应用及注意事项做一论述。     

Coronary blood flow reserve measured by contrast media injection depends on myocardial viability

Coronary blood flow reserve may be affected by several physiological variables besides hydraulic impediment to flow. A hyperaemic response induced by hyperosmolar radiopaque contrast medium was recorded in the left anterior descending and left circumflex arteries with a steerable pulsed Doppler system in four patients with Q wave anterior myocardial infarction chronic scar and non-stenotic coronary arteries. Resting flow velocities were similar in both arteries. The magnitude of the hyperaemic response induced by contrast media in the circumflex artery (mean flow velocity increase from 5.9 +/- 2.5 baseline to 12.2 +/- 0.6 cm s-1 at peak flow, P less than 0.05) was almost twice that induced in the left anterior descending artery (mean flow velocity increase from 6.1 +/- 2.2 baseline to 7.4 +/- 2.6 cm s-1 at peak flow, P = N.S.). The peak flow to baseline flow velocities ratios were 1.22 +/- 0.15 in the left anterior descending artery vs 2.23 +/- 0.75 in the circumflex artery. Thus when a post-myocardial infarction chronic scar is supplied by a non-stenotic coronary artery, the coronary blood flow hyperaemic response to contrast media-induced transient ischaemia is decreased, suggesting that coronary blood flow reserve depends on a myocardial metabolic stimulus which is impaired by ischaemic cell death.     

Closure of extracardiac Fontan fenestration by using the covered Cheatham Platinum stent.

OBJECTIVE: The purpose of this study was to describe our experience concerning the use of covered Cheatham Platinum (CP) stent in patients with fenestrated total cavopulmonary connection (TCPC). BACKGROUND: Closure of TCPC fenestrations has been achieved by utilizing different devices designed to close intra-cardiac or aorto-pulmonary communications. METHODS: We used the covered CP stent in 6 patients with fenestrated TCPC. Median age and weight were 11 years and 38 Kg, respectively. Femoral approach was used in all but 1 patient having bilateral thrombosis of femoral veins. The CP stent was crimped on a BiB balloon in 5 patients and on a simple balloon in 1 patient. The balloon's diameter was the same size or 1-2 mm larger than the TCPT conduit, according to angiographic diameter. RESULTS: Mean procedural and fluoroscopy time were 41 +/- 8 and 8 +/- 2 min, respectively. Immediate full occlusion of fenestration was obtained in all patients. Mean central venous pressure was not significantly increased from 10.8 +/- 2.5 to 11.8 +/- 2.8 mm Hg and oxygen saturation significantly increased from (91.5 +/- 4.4)% to (98.5 +/- 1.9)% (P = 0.003). No procedural or intra-hospital complications occurred. In particular, no arrhythmias, systemic embolism, or acute venous thrombosis were observed. At a median follow-up of 2.8 months all patients have normal oxygen saturation and are symptom-free. CONCLUSIONS: The covered CP stent can be easily and effectively used for closure of TCPC fenestrations. This method has the advantage to avoid protrusion of prosthetic material into the left atrium and to prevent early or late embolism.     

降纤酶对脑梗死病人血液流变学及脑循环动力学指标的影响

目的观察急性脑梗死病人应用国产降纤酶后血液流变学及脑循环动力学指标的变化。方法入选59例病人,其中治疗组32例,对照组27例,检测两组病人用药后的血液流变学及脑循环动力学等指标。结果治疗组用药后全血低切黏度为9.55mPa.s±1.74mPa.s、全血高切黏度为4.05mPa.s±0.81mPa.s、血浆黏度为1.79mPa.s±0.07mPa.s、红细胞聚集指数为2.09±0.22、红细胞变形指数为0.47±0.05、平均血流速度为3.33cm/s±2.69cm/s、最低血流速度为2.19cm/s±1.87cm/s。对照组全血低切黏度为10.91mPa.s±2.28mPa.s、全血高切黏度为4.67mPa.s±1.02mPa.s、血浆黏度为1.89mPa.s±0.09mPa.s、红细胞聚集指数2.23±0.21、红细胞变形指数0.42±0.06、平均血流速度为0.53cm/s±1.66cm/s、最低血流速度0.45cm/s±1.10cm/s,两组比较均有统计学意义（P〈0.05）。结论降纤酶具有改善血液流变学及脑循环动力学等指标的作用。