加味五味消毒饮外洗治疗湿热壅盛型湿疹临床观察

[目的]观察分析加味五味消毒饮外洗治疗湿热壅盛型湿疹的临床疗效。[方法]对上海市浦东新区肺科医院所收治的28例湿热壅盛型老年湿疹患者用五味消毒饮加味方进行治疗。分析其有效率、复发率及所产生的不良反应情况。[结果]总有效率为89.3%,随访半年,复发率3.6%,未发现患者出现不良反应。[结论]加味五味消毒饮外洗治疗老年湿热壅盛型湿疹临床疗效确切,安全性好,复发率低,无不良反应,使用方便,可为兼有其他疾患、不宜长期应用激素的老年患者提供新的治疗方案。     

中药外洗配合玻璃酸钠治疗早期踝关节创伤性骨关节炎的临床观察

目的:观察中药外洗配合玻璃酸钠治疗早期踝关节创伤性骨关节炎的临床疗效。方法:对46例诊断为早期踝关节创伤性骨关节炎患者运用中药外洗配合玻璃酸钠进行治疗,治疗前后采用疼痛分级指数(PRI)与Mazur评分系统对患者进行评分,治疗5周后进行疗效评定。结果:治疗前后疼痛分级指数(PRI)评分为:9.22±1.81与6.47±1.07,治疗前后Mazur评分为57.93±8.15与79.69±9.62,经统计学分析差异有统计学意义(P<0.05),疗效评定结果为;优26例,良14例,中3例,差3例,总有效率93.5%。结论:中药外洗配合玻璃酸钠治疗早期踝关节创伤性骨关节炎具有缓解临床症状改善关节功能的作用,临床疗效满意。     

Reproducibility of myocardial thallium-201 washout in studies applying a standardized dipyridamole stress protocol

Thallium-201 (²⁰¹T1) washout analysis was proposed as an adjunctive tool to improve the detection of coronary artery disease (CAD). Since reproducibility of ²⁰¹T1 washout in dipyridamole (DPM) stress studies is unknown, this item was evaluated in 32 patients (24 with CAD, 8 without CAD), who were scintigraphed twice within 1–2 weeks. At 2 minutes following DPM infusion (0.5 mg/kg/5 min), 2 mCi ²⁰¹T1 were injected. Global and segmental washout were calculated by comparing circumferential profiles of respective background-corrected stress (left anterior oblique (LAO) 45°: 8 min postinfusion (p.i.), 35 min p.i.; anterior (ANT): 17 min p.i.; LAO 70°: 26 min p.i.) and redistribution (4 h p.i.) images. Whereas visual findings were comparable for study I and II, reproducibility of ²⁰¹T1 washout was low, indicated by comparing variances among patients with variance between studies, which were 28.8 and 71.2% of total variance, respectively. Mean differences of segmental washout between the studies ranged from 9.75 to 19.24% with only minor differences with regard to the different views and segments evaluated. Variability was lower using the intermediate instead of the initial scintigram as reference for the redistribution image (12.87±11.64% vs. 18.59±14.43%, n = 85; p<0.01). Variability was higher for nonstenosed compared to stenosed segments (14.54 ± 11.41%, n=32 vs. 9.89±8.03%, n=28, p<0.05). Correspondent with results of visual interpretation, variance of relative differences of washout values between neighboring segments was lower than variance statistically expected from variability of washout values between study I and II (12.79%, n=216 vs. 21.55%, n=270; F=2.76, p<0.01). It is suggested, that considerable washout variability might explain the controversially discussed diagnostic value of ²⁰¹T1 washout analysis in DPM stress studies.     

Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement

ObjectivesThe aim of this study was to evaluate flow dynamics in the aortic sinus and the neosinus (NS) after transcatheter heart valve (THV) implantation in valve-in-valve (ViV).BackgroundLeaflet thrombosis may occur on THVs and affect performance and durability. Differences in flow dynamics may affect the risk for leaflet thrombosis.MethodsHemodynamic assessment following THV implantation in a surgical aortic valve was performed in a left heart simulator under pulsatile physiological conditions. Assessment was performed using a 23-mm polymeric surgical aortic valve (not diseased) and multiple THV platforms, including self-expanding devices (26-mm Evolut, 23-mm Allegra, small ACURATE neo) and a balloon-expandable device (23-mm SAPIEN 3). Particle image velocimetry was performed to assess flow in the sinus and NS. Sinus and NS washout, shear stress, and velocity were calculated.ResultsSinus and NS washout was fastest and approximately 1 cardiac cycle for each with the Evolut, ACURATE neo, and Allegra compared with the SAPIEN 3, with washout in 2 and 3 cardiac cycles, respectively. The Allegra showed the largest shear stress distribution in the sinus, followed by the SAPIEN 3. In the NS, all 4 valves showed equal likelihoods of occurrence of shear stress <1 Pa, but the Allegra showed the highest likelihoods of occurrence for shear stress >1 Pa. The velocities in the sinus and NS were 0.05, 0.078, 0.080, and 0.075 m/s for Evolut, SAPIEN 3, ACURATE neo, and Allegra ViV, respectively.ConclusionsSinus and NS flow dynamics differ substantially among THVs after ViV. Self-expanding supra-annular valves seem to have faster washouts compared with an equivalent-size balloon-expandable THV.     

Measurement of Ejection Fraction in Man by Videodensitometry

This report describes a new method based on roentgen videodensitometry for the measurement of left ventricular ejection fraction in man. The net forward ejection fraction (NFEF) is calculated directly from the formula NFEF = 1-exp (?.693/N), where N is the number of cardiac cycles necessary for half of the injected contrast material to be washed out of the left ventricle. The derivation of this formula is presented, and the technique is validated by comparison with washout curves from a Lucite model of the heart and with simultaneous angiographically determined left ventricular ejection fractions in man. The videodensitometry technique offers the following advantages over the conventional volume technique: (1) only a small amount of contrast material is required; (2) ectopic beats are uncommon during the washout phase when measurements are made; (3) the ejection fraction measured is an average of several cardiac cycles; and (4) dependence upon operator interpretation is minimized. Furthermore, given adequate mixing within the chamber, NFEF should be independent of ventricular geometry. Thus, NFEF of the unusually shaped left ventricle can be readily determined.