非体外循环下心外膜微波消融治疗心房颤动的临床效果

目的探索非体外循环下心外膜微波消融术治疗心房颤动(房颤)的临床应用效果。方法从2003年4月至2005年4月对46例持续性房颤患者进行了非体外循环下心外膜消融术,其中二尖瓣病变28例、二尖瓣合并主动脉病变5例,冠心病8例、孤立性房颤5例。将FLEX10微波探头完整包绕4个肺静脉入口及下腔静脉开口至三尖瓣环,微波能量65W、90s进行连续性心外膜消融,然后在体外循环下行瓣膜置换术或不停跳冠状动脉旁路术。术前平均左房直径(52.5±15.3)mm,左室射血分数42%~70%。所有病例均于出院时和术后3、6、12个月行标准12导联心电图、24hHolter、超声心动图及临床检查进行随访。结果本组病例均成功进行了心外膜微波消融术并于术中消除房颤,无手术死亡及手术相关的并发症。微波消融时间平均(37.7±7.8)min,成功率为63.0%;随访窦性心律维持率:出院时为63.0%,3个月为66.7%,6个月为72.7%,12个月为80.6%,且左房内径<50mm。结论非体外循环下心外膜微波消融术可以达到肺静脉电学隔离治疗房颤的目的,在合并或不合并心脏器质性病变的持续性房颤外科治疗中有较低的风险和良好效果。     

The Incidence of Secondary Tumors of the Heart and Pericardium: A 10-Year Study

Secondary tumors of the heart and pericardium are much morecommon than primary tumors. During a 10-year period (1976–1985),only one instance of a primary tumor (malignant mesothelioma)was identified among 2,649 autopsies of malignant tumors atthe National Cancer Center Hospital. In contrast, there were407 cases in which heart and/or pericardium were secondarilyinvolved with a malignant tumor from other organs. In 78 cases,the secondary tumors were present only in the pericardium, whilein 329 cases, the tumors involved the heart itself with or withoutpericardial involvement. Among the primary tumors, three-quarterswere carcinomas of various organs. In addition there were 53hematologic malignancies, 19 melanomas and 17 sarcomas. In 31cases, cardiac failure was the direct cause of death. The secondarytumors of the heart were often overlooked clinically becausethe cardiac dysfunction appeared to be part of the deterioratinggeneral condition. Electrocardiography and echocardiographywere often helpful in suggesting the presence of cardiac metastases.Appropriate diagnostic procedures and therapeutic interventionshould be considered for the care of patients with advancedmalignancy and sudden onset of cardiac failure.     

经混合醇改性后的戊二醛鞣制的牛心包免疫原性测定

目的：本实验采用免疫细胞细胞方法－Biotin-Streptavidin-Peroxidase(S.P法），在体外，对戊二醛鞣制和混合醇改性后的牛心包进行免疫原性检测。方法：取新鲜牛心包制备抗牛心包抗体，采用S．P法在体外进行免疫原性检测。结果：新鲜牛心包表现为强抗原性，戊二醛组和混合醇改性组的牛心包，抗原性显著降低，与对照组明显差异。结论：（1）戊二醛靶制的牛心包经混合醇改性处理后，免疫原性显著降低。（2）S．P法做为一种体外免疫检测方法，具有临床实用价值。     

Heart,tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption.     

MR imaging of the pericardial cyst.

Findings obtained with magnetic resonance (MR) imaging in four patients with pericardial cyst are reported. MR imaging allowed not only localization and diagnosis in all four cases but characterization of cystic content. MR imaging, including RARE (rapid acquisition with relaxation enhancement) MR hydrography, which shows only liquids with T2s greater than 500 msec, proved to be useful in characterizing the fluid content of a mediastinal lesion and monitoring follow-up. In one case, MR imaging allowed differentiation of a pericardial cyst from a suspected necrotic lymph node in a patient with colic carcinoma, with subsequent correction of staging and therapy. The authors conclude that MR imaging is the method of choice for diagnosis (especially in unusual locations) and monitoring of pericardial cysts and for differential diagnosis of malignant mediastinal cystic tumors that show a solid part.     

Reconstruction of the Hemidiaphragm and Hemipericardium Using Combined Reversed Latissimus Dorsi and Serratus Anterior Muscle Flaps

We used autologous tissue for the reconstruction of intrathoracic structures after extrapleural pneumonectomy in six patients. The resected areas of the hemidiaphragm and hemipericardium were reconstructed using combined reversed latissimus dorsi and serratus anterior muscle flaps. Based on our results, we conclude that the combined reversed latissimus dorsi and serratus anterior muscle flaps are broad enough to cover any defect within the hemithorax. Thus, we think that this technique is the best choice for multisite reconstruction after extrapleural pneumonectomy.     

Identification of elastic fibers and lamellae in porcine pericardium and aorta by confocal, fluorescence and polarized light microscopy

Pericardial connective tissue has been used to construct bioprostheses to repair various types of injuries, including aortic wall repairs. The arrangement and the distribution of elastic and collagen staple fibers are related directly to the biomechanical properties of the tissue and thus determine the choice tissue for the construction of bioprostheses. Although elastic fibers can be visualized using several histochemical methods, the specificity and mechanism of binding involved remain to be clarified. In this work, we compared the elastic net of the porcine pericardial matrix with that of the aortic wall using 1-anilino-8-naphthalene sulfonate (ANS) and dansyl chloride (DCl) as fluorescent probes and the permanganate-bisulfite-toluidine (PBT) method. Polarized light and fluorescence microscopy were simultaneously used to analyze the tissues. Some samples also were examined using confocal microscopy. Aorta and pericardium treated with ANS and DCl showed elastic fibers and lamellae with an intense blue fluorescence. When stained with the PBT method, the aortic elastic lamellae were clearly metachromatic and, under polarized light, they showed a greenish birefringence. DCl provided clearer fluorescent labelling of elastic fibers when examined using confocal microscopy.