原发性高血压患者细胞外间质水平及其临床意义

检测血清Ⅲ型前胶原 (PCⅢ )、层粘连蛋白 (LN)和透明质酸 (HA)的水平与研究其对高血压心肌纤维化患者的临床价值。高血压左心室肥大组 35例、高血压不伴左心室肥大组 30例及对照组 4 0名 ,用超声心动图测定左心室重量指数 (LVMI) ,用酶联免疫吸附分析法 (ELISA)测定血清PCⅢ、LN和HA。高血压左心室肥大组较高血压不伴左心室肥大组和对照组的血清PCⅢ、LN和HA含量明显增高 (P <0 .0 1 )。结论是血清PCⅢ、LN和HA可以作为高血压左心室肥大患者心肌纤维化的观察指标     

培哚普利对急性心肌梗死后心肌纤维化的血清指标影响

目的 :观察冠心病急性心肌梗死患者心肌纤维化的血清指标变化和血管紧张素转换酶抑制剂对心肌纤维化及心室重构的逆转作用 ,探讨血清指标作为临床判断心肌纤维化与心室重构及其逆转的临床价值。方法 :正常对照组20例 ,心肌梗死组44例 ,心肌梗死后应用培哚普利治疗12周 ,用放射免疫分析法测定血清指标PCⅢ (Ⅲ型前胶原 )、LN(层粘连蛋白 )、HA(透明质酸 )。结果 :心肌梗死2周后较正常对照组血清PCⅢ、LN、HA明显增高 (P<0 01) ,培哚普利治疗12周后血清PCⅢ、LN、HA明显下降 (P<0 01)。结论 :血清PCⅢ、LN、HA可以作为心肌梗死后心肌纤维化与心室重构的间接观察指标。     

Clinical Profile of Commotio Cordis: An Under Appreciated Cause of Sudden Death in the Young During Sports and Other Activities

Blunt Chest Impact Leading to Cardiac Arrest. Not particularly well recognized are athletic Held catastrophes in which virtually instantaneous cardiac arrest is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart (commotio cordis). To better characterize the clinical profile of this syndrome, we have assembled 70 cases, including 34 occurring during organized competitive athletics and 36 others that occurred during informal recreational sports at home, school or the playground, or during nonsporting activities. Ages were 2 to 38 (mean age: 12) with 70% < 16 years old. Most common sports involved were youth baseball (n = 40), softball (n = 7), and ice hockey (n = 7). Seven (10%) of the 70 commotio cordis victims, including six with documented ventricular fibrillation, have survived the consequences of their chest blow. Eleven of the events (16%) occurred despite the presence of chest padding believed to be potentially protective. Four victims experienced modest chest blows while in circumstances completely unrelated to sports activities; three of the four individuals who delivered these blows were ultimately convicted of criminal acts within the justice system. An experimental model of low-energy chest wall impact demonstrates that commotio cordis events are due largely to the exquisite timing of blows during a narrow window within the repolarization phase of the cardiac cycle, 15 to 30 msec prior to the peak of the T wave.     

杨关林教授治疗胸痹经验

胸痹的病机有虚实两方面,杨关林教授认为现代人胸痹可多从气虚痰浊血瘀而论,治疗上以益气化痰、活血通络为主,随证加减。     

Trisomy 18 with Ectopia Cordis, Omphalocele, and Ventricular Septal Defect: Case Report

A case of thoracoabdominal ectopia cordis was diagnosed by ultrasonography at 21 week's gestation. Chromosomal analysis showed full trisomy 18. This case supports the associationl of thoracoabdominal ectopia cordis (Cantrell's pentad) with chromosomal errors, specifically trisomy 18.     

Fetal Echocardiography in Ectopia Cordis

Ectopia cordis is an extremely rare congenital abnormality occurring in 5.5 to 7.9 per 1 million live births with high lethality. Between January 1995 and October 1997 eight cases of ectopia cordis were diagnosed at our institute before birth. On the basis of echocardiography the fetal heart anatomy was categorized as either normal heart anatomy (NHA; n= 3) or congenital heart defect (CHD; n= 5). In the majority of cases (seven of eight) other abnormalities were present. Some reports have described ectopia cordis being diagnosed in the first trimester of pregnancy. In our study group the average gestational age at diagnosis was 26 weeks. The prenatal diagnosis of isolated ectopia cordis is easy; counseling the patient, the perinatal management including term, place, and method of delivery, and optimal care of the newborn are more difficult. Ectopia cordis is a malformation that pediatricians rarely encounter, even at pediatric cardiology centers. Much more frequently it is a problem for sonographers and obstetricians; however, pediatric cardiologists should be aware of diagnostic algorithm for such cases, especially when additional abnormalities are present.     

冠心病心绞痛的中医辨证论治

冠心病心绞痛,其临床表现与中医心阳不振、气滞血瘀等引起的症状极为相似。因此中医把它归属于“胸痹”、“心痛”、“厥心痛”、“真心痛”等范畴。兹就该病的中医辨证论治分述如下。１　病因病机　　本病多因中老年脏腑功能渐衰,高粱厚味损伤脾胃,或七情内伤所致气滞、血瘀、痰浊内生,使脉络不通,不通则痛而发病〔１〕。《金匮要略·胸痹心痛短气病脉证治》认为：“胸痹”的主要表现为胸中气塞,心痛,短气,其病理关键为胸部的“阳气”极虚所致;故临床上往往表现出本虚标实之病证〔２〕。本虚以脏气亏虚为主;标实以血瘀痰阻为多见…     

First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature

A case of ectopia cordis (EC) with gastroschisis in a 27-year-old primigravida was diagnosed at 10^3/7 weeks of gestation. The pregnancy was terminated by suction dilatation and curettage. With the increasing use of first trimester ultrasonography, early detection of fetal abnormalities is becoming more frequent. We review other published cases of EC detected in the first trimester and discuss the possible advantages of early diagnosis including options of termination at earlier gestational ages which might decrease the physical and psychological trauma on some patients.