组织多普勒成像技术评价正常胎儿心脏纵轴功能

目的利用组织多普勒成像技术（TDI）测量正常胎儿心肌运动速度,观察其心脏纵轴功能及临床应用价值。方法应用组织多普勒技术测量152例孕龄21—39周的正常胎儿心脏进行测量,在心尖四腔切面将取样容积分别放置于右室游离壁、室间隔、左室侧壁与房室环交界处,测量收缩期Sm波、舒张早期Em波和舒张晚期Am波,计算Em／Am比值,进行统计分析和处理。结果右心室收缩期Sm及舒张早期Em测值明显大于左心室及室间隔处,左、右心室Sm、Em、Am、Era／Am均随孕周的增加而增加,呈正相关关系。左、右心室的Sm与左、右心室的心输出量有相关性,左：右心室Em／Am与E／A有相关性。结论利用TDI评价胎儿心脏纵轴运动是安全、准确、可行的。     

长Q-T间期综合征的临床实践指南

长Q-T间期综合征(Long Q-T syndrome,LQTS)是一种单基因遗传性心脏离子通道病,以QT间期延长、T波异常、尖端扭转型室速(torsade de pointes,TdP)为心电图表现,反复发作晕厥、抽搐、甚至猝死为临床特征。尽管LQTS的总体患病率不高,但由于高发心源性猝死,已引起心血管医师的密切关注。目前国内缺少针对性的LQTS临床实践指南。本指南的编写参考了国内外本领域的基础研究、临床研究和其他国家的相关指南共识,对LQTS的临床表现、遗传学机制、诊断标准、治疗与预后、遗传咨询等方面进行总结,以期促进和规范其临床诊疗实践。     

成人四肢长骨的非对称性

本文测量了乌鲁木齐地区出生土的200副成年四肢长骨,在左、右两侧长度相差大于0.1厘米时,四肢六骨(男性腓骨外)均以非对称性为主,若以肱骨加桡骨、股骨加胫骨长作为上、下肢长,则右上肢与左下肢占优势,上、下肢单侧优势呈交叉关系。在左右侧重相差大于1%时,四肢六骨不论男女也均以非对称性为主,其中上肢以右大于左的占优势,而下肢也以右大于左的居多,在重量上看不出上、下肢单侧优势呈交叉关系。     

Aging and Counseling:

Counselors are needed to help meet the mental health needs of older person; yet, to be effective they must understand fully the special needs of the older population. Counseling, an applied psychological science, is thus a field of study where gerontology curricula can be implemented optimally in a partnership manner. This article reviews the historical evolvement of gerocounselors and includes resources for special training of these professionals. Suggestions and resources for development of training programs and integration of gerontology and counseling curricula are provided.     

Long-Term Function After Restorative Proctocolectomy

PURPOSE Early functional outcome after restorative proctocolectomy and formation of an ileoanal pouch is known to be good, but there are minimal data on the long-term function of the pouch. The aim of this study was to look at the long-term functional outcome in patients who had undergone restorative proctocolectomy and formation of an ileoanal pouch.METHODS A total of 151 consecutive patients (96 males, 55 females) who underwent ileoanal pouch surgery between April 1983 and May 1993 were identified. Functional outcomes from the previous 12 months were appraised by a standardized questionnaire.RESULTS The median age at surgery was 31 years (range, 6–63 years), with a median follow-up of 142 months (range, 100–221 months). Eighteen patients have had their pouches excised, with another patient being defunctioned. Therefore 19 patients (13 percent) had suffered pouch failure. Altogether, 115 patients were available for follow-up, and 98 patients (85 percent) returned questionnaires. The median pouch-emptying frequency was five times (range, 1–17) during the day and one time (range, 0–6) at night. A total of 74 percent of patients had perfect continence during the day. Most of the patients had no life-style restrictions related to the pouch, and 98 percent of patients would recommend a pouch to others.CONCLUSIONS Long-term functional outcome after ileoanal pouch surgery is good in most patients. For patients requiring proctocolectomy, ileoanal pouch surgery can now be recommended as an excellent long-term option.Presented at the Association of Coloproctology of Great Britain and Ireland, Manchester, United Kingdom, July 2 to 5, 2002 Reprints are not available.     

Clinical and therapeutic aspects of congenital and acquired long QT syndrome.

The long QT syndrome is characterized by prolongation of the corrected QT (QTc) interval on the surface electrocardiogram. It is associated with precipitation of a polymorphic ventricular tachycardia, torsade de pointes, which may cause sudden death. The syndrome is a disorder of cardiac repolarization caused by the alterations in the transmembrane potassium and sodium currents. Six genetic loci for the congenital forms of the syndrome have been identified; sporadic cases occur because of spontaneous mutations. Acquired causes of the long QT syndrome include drugs, electrolyte imbalance, toxins, marked bradycardia, subarachnoid hemorrhage, stroke, myocardial ischemia, protein-sparing fasting, autonomic neuropathy, and human immunodeficiency virus disease. Clinical symptoms are the result of the precipitation of torsade de pointes and range from such minor symptoms as dizziness to syncope and sudden death. Short-term treatment is aimed at preventing the recurrences of torsade de pointes and includes intravenous magnesium and potassium administration, temporary cardiac pacing, and correction of electrolyte imbalance; rarely, intravenous isoproterenol is indicated. Long-term management includes use of beta-blockers, permanent pacemaker placement, and cardioverter-defibrillator implantation. Asymptomatic patients are treated if under the age of 40 years at the time of diagnosis.