Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis

From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p < 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p < 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p < 0.005) and long-term (p < 0.005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation.

Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.     

粪便钙卫蛋白对炎症性肠病和肠易激综合征的鉴别诊断价值研究

目的粪便钙卫蛋白（FCP）被认为是判断炎症性肠病（IBD）的肠道炎症的非侵入性标志物。本研究旨在探讨FCP对IBD和肠易激综合征（IBS）的鉴别诊断价值,并比较FCP与C-反应蛋白（CRP）和红细胞沉降率（ESR）诊断IBD的临床价值。方法应用FCP酶联免疫试剂盒检测正常对照组42例,炎症性肠病组50例,包括16例溃疡性结肠炎（UC）,34例克罗恩病（CD）患者的FCP浓度;同时检测36例IBS患者的FCP浓度。其中39例IBD患者在留取FCP标本的同期进行了ESR和CRP的检测。绘制受检者操作特征曲线（ROC曲线）,确定FCP鉴别诊断IBD和IBS的诊断临界点。结果 IBD组FCP浓度的中位数和四分位间距分别为131.1μg/g（72.64～518.37μg/g）,显著高于IBS组的39.43μg/g（20.58～56.18μg/g）,和正常对照组的27.7μg/g（10.87～44.01μg/g）,FCP浓度比较,P〈0.001。IBS组与正常对照组FCP浓度无统计学差异,P〉0.05。FCP检测IBD的阳性率分别为87.5%和88.2%,显著高于ESR和CRP的阳性率,P〈0.05。以68.76μg/g作为最佳的诊断临界点,此时FCP鉴别诊断IBD和IBS的敏感性为84.0%,特异性为88.89%。结论检测FCP是一种简单易行且无创的检查方法,对于IBD和IBS鉴别诊断具有较高的临床价值。     

山茱萸多糖对雄性大鼠性功能损伤的影响

目的:观察山茱萸多糖(Fructus Corni polysaccharides,FCP)对半去势大鼠性功能的影响。方法:将70只SD雄性大鼠随机分为正常对照组(灌胃生理盐水),阴性对照组(摘除右侧睾丸+灌胃生理盐水),阳性对照组(摘除右侧睾丸+丙酸睾丸素,皮下注射2 mg.kg-1.d-1),FCP实验组(摘除右侧睾丸+灌胃FCP 10,50,100,150 mg.kg-1.d-1),通过交配试验及阴茎勃起试验观察FCP对半去势大鼠性功能的影响,以双抗放射性免疫法(RIA)测定血清性激素水平。结果:正常对照组、阳性对照组、FCP各实验组能明显缩短阴茎勃起潜伏期、爬高潜伏期,提高爬高动物百分率;提高血清T水平,降低E2水平;提高其包皮腺、精囊腺-前列腺、提肛肌等脏器系数、精子计数及活力,与阴性对照组相比差异有显著性(P0.01,P0.05)。结论:FCP可以改善半去势大鼠的性功能,其机制可能是通过促进与改善下丘脑-垂体-性腺轴的功能调节系统而起作用。