心血管疾病血清甲状腺激素测定的临床意义

本文用放射免疫分析(RIA)法,对348例心血管疾病患者及40例正常者进行了血清三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)、游离甲状腺激素(FT_3、FT_4)及促甲状腺众素(TSH)测定。结果心血管疾病患者出现血清T_3、FT_3值下降,部分伴有T_4值下降,FT_4及TSH值正常,表明甲状腺激素浓度可因所患非甲状腺疾病发生改变。     

核素、多普勒和心尖搏动图反映冠心病左室舒张功能的比较——Fish判别分析

用电子计算机对核素、多普勒和心尖搏动图中的8项左室舒张功能指标进行判别分析,比较各指标与冠心病的密切程度。结果显示患者年龄和各项舒张功能指标明显不同于正常组。判别方程为:Z=0.21X_1+23.86X_2-22.88X_3-0.18X_4+2.83X_5+2.06X_6+66.86X_7+1.66X_8。临界值为42.99。判别正确率为100％。各指标的贡献率大小依次为EV/AV,1/3FF,A/E-O,PFR,DATI,EDC,IRT和1/3FFd。提示:多普勒EV/AV与冠心病的关系最为密切,核素的1/3FF次之,心尖搏动图的A/E～O亦是一个较好的指标。     

二维彩色多普勒超声心动图诊断扩张型心肌病（附100例分析）

应用ＡＴＬ－ｕｌｔｒａｍａｒｋ超６型彩色多普勒超声诊断仪诊断扩张型心肌病１００例，并与性别、年龄相应的正常人对比分析。结果：除扩张型心肌病各组室间隔及左室后壁舒张期厚度与相应正常对照组相比无显著性差异（Ｐ＞０．０５）外，其左室舒张内径及收缩内径、左房内径明显大于正常对照组（Ｐ＜０．０１），左室射血分数及左室内径缩短分数较正常对照组明显降低（Ｐ＜０．０１），并见心腔内血流速度缓慢，颜色变淡。另在７７例病人中探及４０例瓣膜返流。提示该诊断方法对扩张型心肌病具有直观、简便、准确、迅速的优点，为本病的诊断及鉴别诊断提供了良好的手段。     

空管药物疗法治疗牙髓病和根尖周病疗效观察

用ＳＭＴＤ复合药物对牙髓病和根尖周病实施空管药物疗法。７８例１０３颗获得完整随访资料患牙经两年观察，９２．２％治愈率。文章介绍了治疗方法，讨论了空管药物疗法的愈合机理、优点、失败原因及其预防措施。     

Techniques for high-resolution MR imaging of atherosclerotic plaque

Atherosclerotic cardiovascular disease is the most common cause of death in the United States. Investigation of atherosclerotic plaque morphology and composition is important because the findings may be useful in predicting prognosis or response to therapy. This study presents high-resolution magnetic resonance (MR) imaging techniques developed on a 1.5-T whole-body imager with a custom-built surface coil, for characterizing the composition and morphology of plaque removed at carotid endarterectomy. The initial comparison of MR imaging and histologic results showed good correlation. In conjunction with MR angiography, these techniques could be used in in vivo imaging to define the size, location, and contents of atherosclerotic plaque at the carotid bifurcation.     

Nodular sarcoidosis of the liver and spleen: Appearance on MR images

Small nodular lesions in the liver and spleen have been reported as an infrequent manifestation of sarcoidosis. Five patients with this appearance on either dynamic contrast material—enhanced computed tomographic (CT) or ultrasound scans underwent magnetic resonance (MR) imaging with and without dynamic gadolinium enhancement. The lesions were relatively uniform in size, ranging from 0.5 to 1.5 cm. On CT scans, they were hypoattenuating relative to surrounding parenchyma. On MR images, the lesions were hypointense relative to background parenchyma with all sequences. No substantial enhancement was observed in the lesions, although lesion conspicuity decreased over time on serial postcontrast images. Lesion conspicuity was greatest on either T2-weighted fat-suppressed (T2FS) images or early-phase dynamic contrast-enhanced images. Abdominal adenopathy was seen in three of the five patients and was hyperintense relative to liver on T2FS images in two and intermediate in intensity in one patient.     

Prediction of outcome from intensive care after gastroenterologic emergency

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.     

Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia

Background: The prevalence of respiratory diseases in smokers and nonsmokers and the incidence of perioperative respiratory events (PREs) were investigated for patients undergoing general anaesthesia. The aim was to quantify well-known problems and to identify possible new associations between smoking and PREs.
Methods: From July 1992 to December 1994, risk factors, demographic data, and PREs were documented by an automatically readable anaesthetic record (ARAR). PREs were used as defined by the German Society of Anaesthesiology and Intensive Care.
Results: Of 26 961 subsequent anaesthesias in adults, 7122 (26.4%) were performed in smokers with a prevalence of chronic bronchitis of 23.3% (4.8% in nonsmokers). 1573 PREs occurred in 1397 (5.2%) of all anaesthetics. 459 events concerned intubation problems and problems in technical airway management. 1114 specific respiratory events (SPREs) like re-intubation, laryngospasm, bronchospasm, aspiration, hy-poventilation/hypoxaemia and others had a total incidence of 5.5% in smokers and 3.1% in nonsmokers. The relative risk (RR) of SPREs was 1.8 in all smokers, 2.3 in young (16–39 years) smokers, and 6.3 in obese young smokers. The RR of perioperative bronchospasm was 25.7 in young smokers with chronic bronchitis.
Conclusion: The impact of smoking on perioperative respiratory problems should make anaesthetists take this widespread preoperative condition seriously, particularly in young adults. The presented method of incident reporting (based on a national classification) could contribute to future research in anaesthetic epidemiology.     

膀胱憩室的手术治疗

作者总结３１例膀胱憩室的手术治疗结果，并介绍一种处理巨大膀胱憩室的简易手术。多数憩室继发于膀胱流出道梗阻。憩室内并发肿瘤７例，结石形成９例。膀胱憩室多由膀胱造影或Ｂ超诊断。憩室切除常采用膀胱内外联合入路。本组２６例手术同时处理膀胱出口梗阻和膀胱憩室。获得随访的２３例中，２１例尿路症状消失。７例憩室肿瘤患者中，５例在两年半内死亡，余２例分别存活２年和６年。本组２例巨大膀胱憩室行经膀胱内憩室旷置术，无并发症，膀胱造影无异常。作者认为，膀胱憩室的治疗应依据每个患者的情况而选用不同的手术方式。对位于膀胱后下方，粘连广泛的巨大憩室，宜采用经膀胱内入路憩室旷置术。