除颤仪技术的讨论

本文通过介绍了除颤仪原理、单相波和双相波电流、波形、能量,分析了除颤仪双相波技术的优点。     

左心室巨大室壁瘤不同左心室成形方法的对比研究

目的研究左心室巨大室壁瘤的左心室成形方法,对改进的左心室心内膜环缩技术和传统的线性缝合技术进行近、远期疗效对比。方法自1992年1月至2004年12月,对148例左心室巨大室壁瘤患者进行手术治疗,按照手术中左心室成形方法不同分为两组,传统术式组:89例,采用传统的线性缝合成形技术;改良术式组:59例,采用改良的心内膜环缩成形技术,旷置梗死的心肌组织,再缝合环缩后的切口。采用多次信访、电话随访和门诊复查相结合的方法对两组患者术后的近、远期疗效进行对比观察。结果手术死亡5例(3.4%),其中传统术式组4例,改良术式组1例(P=0.320)。术后主要并发症为低心排血量和心室颤动。随访134例(93.7%),随访时间51.4±27.0月。远期死亡21例,术后早期心功能Ⅲ级以上是影响远期死亡的危险因素(P=0.000)。改良术式组5年和8年生存率明显优于传统术式组(91.6%vs.76.3%,P=0.040;91.6%vs.61.4%,P=0.000)。两组心功能分级(NYHA)和左心室射血分数(LVEF)术后早期和随访期间较术前改善和升高(P<0.05),改良术式组改善更明显。两组左心室舒张期末内径(LVEDD)术后早期与术前比较明显减小(P=0.000),但随访30个月时有重新增大的趋势(P=0.046)。传统术式组随访30个月时LVEDD扩大比率明显高于改良术式组(38.8%vs.16.7%,P=0.030)。结论左心室巨大室壁瘤的手术近、远期疗效满意,保持适当的左心室形态和容积是手术的关键。心内膜环缩法进行左心室成形是一种简单有效的手段,其远期结果优于线性缝合法。     

强心通脉灵对大鼠急性心肌梗死后心室重构的影响

目的探讨强心通脉灵对急性心肌梗死(AMI)大鼠心室重构(VR)的干预机制。方法选择Wistar大鼠85只,随机分为强心通脉灵大剂量组(QXLmax组)12只、强心通脉灵小剂量组(QXLmin组)14只、卡托普利组11只、模型组15只和假手术组13只,采取冠状动脉结扎造成AMI模型,术后均予口服给药治疗,模型组及假手术组予以相应的生理盐水。4周后处死,放射免疫法测血浆血管紧张素Ⅱ(AngⅡ)和超氧化物歧化酶(SOD)含量,计算左心室质量指数,光镜下观察心尖组织病理形态学改变,采用ABC染色测TGF-β1的表达量。结果模型组及各给药组AngⅡ水平较高,各给药组较模型组有下降趋势,其中QXLmax组较卡托普利组及QXLmin组更低。模型组及各给药组SOD水平较假手术组降低,QXLmax组及QXLmin组较模型组有升高趋势,左心室质量指数模型组较假手术组显著升高,各给药组较假手术组有升高趋势,QXLmax组较QXLmin组及卡托普利组低。卡托普利组及QXLmin组健存心肌细胞周围胶原组织明显减少,QXLmax组病理改变最轻,偶有少量胶原纤维增生。TGF-β1表达QXLmax组较QXLmin组及卡托普利组低(P<0.01)。结论强心通脉灵可降低AMI后大鼠血浆AngⅡ水平,增加SOD活性,降低左心室质量指数及心肌组织TGF-β1表达,从而平稳AMI后VR的进程。     

第三脑室脑膜瘤(九例报告及文献回顾)

目的探讨第三脑室脑膜瘤的组织发生学、临床特点和外科治疗。方法报道9例经影像学、手术和病理学证实的第三脑室脑膜瘤，并回顾相关文献。结果第三脑室前部脑膜瘤5例，第三脑室后部脑膜瘤4例，平均发病年龄25．6岁，无明显性别差异；最常见的症状是梗阻性脑积水，缺乏硬脑膜附着为其影像学特征。肿瘤全切除6例。结论第三脑室脑膜瘤是一种罕见的脑室内脑膜瘤，起源于中间帆脉络组织或脉络丛，经半球间裂-胼胝体-穹隆间入路是合理的手术路径选择。     

小脑后下动脉动脉瘤的诊断和治疗

目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。     

An analysis of the paradoxical effect of morphine on runway speed and food consumption

A previously reported paradigm in which rats run down a runway for food reward followed by morphine injection was analyzed to assess the utility of the paradigm in studies of opiate reinforcement. One experiment replicated the original report that post-trial morphine caused both an increase in runway speed and a decrease in food consumption (taste aversion) over successive trials, and showed in addition that the increase in runway speed did not occur as a result of food deprivation alone, but required the animals to have consumed food in the goal box. A second study using the quaternary opiate antagonist methyl naltrexone to block the peripheral effects of morphine suggested that the increase in runway speed has a peripheral locus while the taste aversion has a central one. A third experiment in which morphine was microinjected into either the lateral ventricle or the ventral tegmental area supported these observations, in that intracranial morphine failed to result in an increased runway speed, but did produce taste aversion after microinjection into either site. These findings also suggest that the increase in runway speed caused by post-trial morphine in this experiment has a peripheral locus of effect, which is probably distinct from the central effect that supports morphine self-administration and conditioned place preference. Offprint requests to: W.A.CorrigallThe views expressed in this publication are those of the authors and do not necessarily reflect those of the Addiction Research Foundation     

Large colloid cyst in lateral ventricle simulating brain tumour

Summary This case report describes a patient presenting with symptoms of increased intracranial pressure, whose computerized tomographic (CT) scan was highly suggestive of a large low-grade glioma invading the basal ganglia. Magnetic resonance imaging (MRI) revealed a well-demarcated space-occupying mass of increased intensity in the left lateral ventricle and adjacent white matter. Following stereotactic biopsy, which yielded a homogeneous jelly-like material, the mass was removed microsurgically and was found to be most like a colloid cyst on histological examination. Discussion focusses on the clinical and differential diagnostic implications of this very unusual combination of findings.