Acute viral myocarditis A death associated with anaesthesia

The death of a 35-year-old woman in the immediate postoperative period as a result of undiagnosed acute viral myocarditis is described. The presentation, diagnosis and course of the disease is discussed. It is recommended that wider use to be made of routine electrocardiographs as a screening test.     

Sudden Death and Staged Therapy for Hemodynamic Stabilization in Patients Enrolled in a Heart Transplantation Program

To investigate the impact of staged therapy for advanced heart failure on therapeutic endpoints, 236 consecutive patients (coronary artery disease/dilated cardiomyopathy in 61/175 patients, left ventricular ejection fraction 14%± 5%, New York Heart Association Class IIl/IIIIV in 102/79/55 patients, respectively) with advanced heart failure were prospectively followed. One hundred thirtyseven patients enrolled from January 1989 to December 1991 were treated conventionally with digoxin, furosemide, and low dose angiotension converting enzyme (ACE) inhibition. Patients refractory to this therapy underwent urgent heart transplantation. Ninetynine patients enrolled from January 1992 to August 1993 underwent staged therapy: stage 1: maximal tolerated ACE inhibition; stage 2: therapy with PGE₁ for preand afterload reduction to achieve hemodynamic stabilization; or stage 3: refractory patients bridged to heart transplantation with continuous outpatient dobutamine. Sudden death was defined as death within 1 hour of symptoms if heart failure symptoms remained stable over the previous 7 days. Conventionally treated patients were followed for 10 ± 9 months; patients who underwent staged therapy for 9 ±5 months. In the group of patients that underwent standard therapy, 39 of 137 (28%) patients died: 5 (13%) deaths occurred suddenly, and death due to progressive pump failure occurred in the remaining 34 (87%) patients. In the group of patients that underwent staged therapy, 25 of 99 (25%) patients died: 13 (52%) deaths occurred suddenly, and 12 (48%) deaths occurred due to progressive pump failure. Thus, patients who underwent staged therapy were at increased risk for sudden death (P = 0.01, relative risk 3.4, 95% confidence interval 1.2–9.7) but were at lower risk for death from pump failure (P = 0.009, relative risk 0.44, 95% confidence interval 0.22–0.84). In patients who underwent therapy with continuous outpatient PGE₁ (n = 7) or dobutamine (n= 21), risk for sudden death (P = NS by log rank test) did not increase. In conclusion, staged therapy significantly reduced death from pump failure; however, patients who could be stabilized and considered too well for heart transplantation were at increased risk for sudden death. Thus, overall survival did not improve. Of note, outpatient dobutamine did not increase the risk for sudden death.     

Cardiokymograph system with a capacitance transducer and its preliminary application in the measurement of heart wall movement

A novel cardiokymograph system is introduced. The new system features a capacitance transducer with increased sensitivity and can be used in multichannel measurements. The novelty of this technique is the injection of a current into the patient coupled with the use of a capacitive displacement transducer and the possibility of multichannel monitoring. It provides for the possibility of removing breath noise when some signal processing technique, such as adaptive filtering, is used. Further investigation is needed to demonstrate clinical significance and pathologies.     

胎儿声振动刺激反应的研究

目的：了解不同孕龄胎儿对声振动刺激的反应。方法：对４３５例次正常中、晚期妊娠妇女进行声振胎心试验（ＶＡＳ－Ｔ）、声振胎动试验（ＳＰＦＭ），并对声振动刺激前、后胎心率变化规律进行前瞻性研究。结果：（１）从２４周开始，胎儿对声振刺激有反应，但大部分未能达到ＶＡＳ－Ｔ诊断标准，而胎动反应良好。（２）妊娠２８周开始，声振刺激后，９０％以上的胎儿出现显著的胎动、胎心率加速反应，足月胎儿反应率在９８％以上。（３）ＳＰＦＭ阳性率的显著提高早于ＶＡＳ－Ｔ。提示：２８周后胎儿神经系统发育已趋完善。胎儿运动神经的发育成熟早于植物神经。     

Multiple Cerebral Haematomata and Peripheral Nerve Palsies Associated with a Case of Juvenile Diabetic Ketoacidosis

A 15-year-old girl presented de novo in diabetic ketoacidosis having been comatose for 24 h (day 1). A CT scan and lumbar puncture performed on admission were normal and her conscious level slowly improved over several days. On day 7 she had central neurological signs of bilateral knee clonus and an extensor plantar response. In addition, she had developed lower motor neurological signs of an ulnar nerve palsy of the left forearm, and ulnar, median, and radial nerve palsies of the right forearm. Magnetic resonance imaging (MRI), performed on day 12, showed multiple small cerebral haematomata with appearances at least several days of age. The scattered lesions were localized particularly to the parieto-occipital region, with sparing of the basal ganglia and without cerebral oedema, a novel feature not previously described in juvenile ketoacidosis. Four months later there was minimal residual disability of her right arm. The clinical findings together with the MRI images suggested that the peripheral nerve and central lesions were temporally related, suggesting a common aetiology. However, it is likely that MRI showed cerebral lesions which may have been missed by the conventional CT scanning performed initially.     

Regeneration of kidney tubular epithelial cells

Conclusion The mechanisms that regulate regeneration of kidney epithelial cells after acute tubular necrosis are poorly understood. Repair of the nephron can take place in the adverse systemic metabolic setting caused by failure of renal function. This clinical observation suggests that factors released at the site of the tubular insult can mediate repair. Studies carried out in this and other laboratories show that kidney epithelial cells can release and respond to polypeptide growth factors which may thereby contribute to renal regeneration by autocrine and paracrine mechanisms. Specific growth factors secreted by cells and deposited in the tubular basement membrane prior to injury may subsequently participate in nephron repair. In addition, adenine nucleotides released from injured or dying cells at the injury site or provided exogenously could stimulate surviving renal epithelial cells at the edges of the wound to migrate along the basement membrane to rapidly reepithelialize the nephron and subsequently initiate mitogenesis to replace cells lost by necrosis.The nephrotoxic effect of many agents used in cancer chemotherapy and the older age of patients undergoing complicated surgical procedures has increased the incidence of ARF, whereas the mortality rate has not changed since the early 1950s [22]. Thus there is considerable need for innovative therapeutic strategies. An important goal of future research efforts is to identify new growth factors that facilitate migration, differentiation, and proliferation of renal epithelial cells at sites of tubular necrosis. Isolation and use of these agents in combination with dialysis and nutritional support could speed renal regeneration and thereby improve the outcome in patients with this condition.Abbreviations ARF acute renal failure - ECM extracellular matrix - EGF epidermal growth factor - FGF fibroblast growth factor - IGF insulin-like growth factor - MGSA melanocyte growth-stimulating activity - PDGF platelet-derived growth factor - IGF transforming growth factor     

700例高血压病临床分析

目的：通过对700例高血压病患者的临床分析，探讨高血压病的常见并发症及主要死亡原因。方法：对搜集诊治的700例高血压病患者的病例，从发病年龄、病程、并发症、死亡原因等方面进行回顾性分析。结果：30－59岁是高血压病的多发年龄；并发症以脑血管疾病和心血管疾病居多；死亡原因以脑梗塞、脑出血、心肌梗塞为多。结论：在高血压病的多发年龄之季，应采取有效的防治措施，以控制高血压及其并发症的发病率。减少死亡率。     

地尔硫卓联合地高辛治疗心力衰竭并慢性快速房颤分析

目的观察地尔硫卓联合小剂量地高辛对心力衰竭并慢性快速房颤患者血压、心室率和心功能的影响。方法 :心功能Ⅱ～Ⅲ级慢性房颤患者 10 6例 ,随机分为二组 ,对照组 5 0例 ,单用地高辛 ,治疗组 5 6例 ,地尔硫卓与地高辛联用 ,其余治疗二组相同 ,7～ 10d为一疗程 ,观察治疗前后血压、心率、左室射血分数 (LVEF)、心输出量 (CO)。结果 :治疗组较对照组心室率明显下降 ,控制满意 ,血压、LVEF及CO变化二组相似。结论 :地尔硫卓联合小剂量地高辛治疗心衰并慢性快速房颤患者心室率较单用地高辛效果更好 ,且较为安全。     

腺嘌呤核苷酸载体的功能和表达与心力衰竭

腺嘌呤核苷酸载体（ANT）是一种位于线粒体内膜上的转运蛋白，它在组织细胞能量产生和消耗的耦联中起关键性作用。作者就ANT的功能和表达情况及其与心力衰竭之间的关系作一综述。