用QRS积分方法评价西拉普利对急性前壁心肌梗塞的影响

目的用QRS积分方法评价西拉普利对急性前壁心肌梗塞的梗塞面积及心功能的影响。方法将64例急性前壁心肌梗塞患者分入西拉普利组(40例)与对照组(24例),治疗组给予西拉普利2.5mg/d。对每例患者住院即刻、24h、3d、7d、21d做常规心电图,用Wagner提出的QRS积分方法记录每份心电图分值。入院后21天采用核素心血池测定左室射血分数。结果西拉普利组第21日QRS分值(5.30±2.15)显著低于对照组(6.45±1.98),P<0.05;西拉普利组左室射血分数(51.9%±8.8%)明显高于对照组(45.2%±11.4%),P<0.05。结论西拉普利可明显减低急性前壁心肌梗塞患者QRS的分值,提示西拉普利对防止梗塞的延展、促进心肌梗塞后心功能的恢复有一定作用。     

梗死前心绞痛对女性急性前壁心肌梗死的保护作用研究

目的　观察梗死前心绞痛对女性急性前壁心肌梗死有无保护作用。方法　选择女性急性前壁心肌梗死 98例 ,有梗死前心绞痛者为A组 ( 4 8例 )、无梗死前心绞痛为B组 ( 5 0例 ) ,行心电图、心肌酶、超声心动图、核素心血池等检查。对心电图QRS积分值、心肌酶峰峰值、左室射血分数、心源性休克、室壁瘤形成及短期病死率进行比较。结果　B组心肌梗死患者QRS积分值、心肌酶峰值、心源性休克、室壁瘤形成及 1个月病死率明显高于A组 ,P <0 .0 5 ,左室射血分数明显低于A组 ,P <0 .0 5。结论　梗死前 2 4小时内心绞痛可减低女性急性心肌梗死患者QRS积分值、保护心功能、降低短期病死率     

心肌梗死前心绞痛对老年急性前壁心肌梗死的保护作用研究

目的　观察心肌梗死前 2 4h内心绞痛对老年急性前壁心肌梗死有无保护作用。方法　选择老年急性前壁心肌梗死 10 8例 ,有梗死前心绞痛者为A组 (5 3例 )、无梗死前心绞痛者为B组 (5 5例 ) ,行心电图、心肌酶、超声心动图、核素心血池等检查。对心电图QRS积分值、心肌酶峰值、左室射血分数、心源性休克、室壁瘤形成及短期病死率进行比较。结果　B组心肌梗死患者QRS积分值、心肌酶峰值、心源性休克、室壁瘤形成及 1个月病死率明显高于A组 (P<0 .0 5 ) ,左室射血分数明显低于A组 (P<0 .0 5 )。结论　梗死前 2 4h内心绞痛可减低老年急性心肌梗死时QRS积分值 ,保护心功能 ,降低短期病死率。缺血预处理可能是梗死前心绞痛保护作用的主要机制。     

经皮腔内冠状动脉成形术对心肌梗塞患者心电图及运动耐量的影响

对23例心肌梗塞(MI)患者于发病后6±3周行经皮腔内冠状动脉成形术(PTCA),并于PTCA前(平均3±2d)、后(平均6±3d)记录心电图和行平板运动试验.结果显示,PTCA成功19例(管腔狭窄由93.5%±6.4%降至16.3%±11.1%).其运动耐量、时间、最大心率及心率与收缩压乘积明显增高,而QRS积分显著减低.提示,PTCA对MI恢复期患者心功能改善具有明显的有益作用.     

急性心肌梗死QRS波终端变形与其预后的关系

试探讨通过静息心电图形态的改变对急性心肌梗死 (AMI)患者的预后进行判定。将 397例AMI患者根据心电图QRS波终端变形分为两组即QRS(+)组 (即qR型导联的J点≥ 5 0 %的R波或Rs型导联的S波消失 )和QRS(- )组 ,通过冠状动脉造影结果及肌酸激酶和QRS计分法对梗死面积的估计将两组进行对比研究 ,并对其预后进行随访。结果 :QRS(+)组 89例 ,QRS(- )组 30 8例 ,QRS(+)组年龄偏大 ,前壁心肌梗死发生率较高。QRS(+)组血浆肌酸激酶峰值水平 (332 1± 2 5 77u/l)较QRS(- )组 (2 2 6 9± 32 5 1u/l)高 (P <0 .0 0 1) ,前壁心肌梗死患者QRS(+)组坏死面积 (7.3± 0 .34 )明显大于QRS(- )组 (5 .5± 0 .34 ,QRS计分法 ,P <0 .0 5 )且一年死亡率高于后者 (2 0 .5 %vs 9.8% ,P <0 .0 5 )。结论 :心电图QRS波终端变形可以作为早期判断心肌梗死病人预后的评价指标 ,对于前壁AMI的病人更有意义。     

急性心肌梗死面积,QRS积分与临床预后的关系

为探讨急性心肌梗死面积、QRS积分与临床预后的关系 ,采用Michelle等公式及WagnerQRS评分标准 ,观察113例急性心肌梗死患者。结果显示急性前壁心肌梗死死亡组心肌梗死面积 (22.14±6.26)、QRS积分(7.28±3.74)均较存活组显著增大 (17.83±5.65、4.91±2.63,P<0.05) ,存活组QRS积分与梗死面积的回归方程为 :QRS积分=2.59 0.13×梗死面积 ,但急性下壁心肌梗死死亡组与存活组这两项指标差异无显著意义 (P>0.05)。提示利用入院时12导联心电图测算心肌梗死面积 ,对判断急性前壁心肌梗死临床预后有重要意义 ,但对急性下壁心肌梗死无意义。     

急性室间隔破裂的心血管造影、形态学特征和临床评价

本文回顾分析1971年至1987年间收治的急性室间隔破裂患者20(男14、女6)例,年龄66.8±7.9(46～79)岁,均经心脏插管检查。在18例中,心肌梗塞症状出现至临床医师闻及收缩期杂音平均6.6(1～22)天。其余2例持续胸痛7天和14天,临床未能确诊心肌梗塞,但手术发现左室后壁表面有纤维化。心电图诊断心肌梗塞部位如下:下壁或下后壁梗塞8例(其中1例兼有右室梗塞),前壁梗塞4例(其中1例兼有右室梗塞),前壁和前侧壁梗塞6例。插管检查前心功能 Killip 分级如下:4级11例,3级6例,2级2例,1级1例。9     

急性心肌梗塞患者梗塞前心绞痛对于维持左室功能的意义

为了评价梗塞前心绞痛对于急性心肌梗塞(AMI)患者左室功能储备的意义,作者应用左室荧光电影摄像术对37例近期首次AMI恢复期病人(男30例,女7例,年龄41～76岁,平均59岁)进行了研究。患者入选档准为:①前壁Q波梗塞;②左前降支冠脉全部或部分阻塞;③梗塞急性期冠脉内溶栓失败者。其中,15例患者AMI起病前心绞痛发作超过1周,为A组,左室射血分数(LVEF)54%±3%,梗塞部位局限性室壁运动(RWM)10%±3%:10例患者AMI起病前心绞痛发作不足一周。为B组,LVEF和RWM分别是42%±3%和1%±2%;12例患者无梗塞前心绞痛发作、为C组,LVEF和RWM分别是38%±3%和-1%±2%。B、C两组LVEF和RWM明显低于A组(P<0.05),而心率     

急性下壁心肌梗死伴V_(1～3)和V_(4～6)导联ST段压低的临床意义

目的 :探讨急性下壁心肌梗死 (MI)时前壁 V1～ 3 和 V4～ 6 导联 ST段压低的临床意义。方法 :回顾性分析 5 9例首发急性下壁 MI患者的心电图和冠状动脉造影资料。分为 3组 :组 1:急性下壁 MI不伴前壁导联 ST段压低 (30例 ) ;组 2 :急性下壁 MI伴前壁 V1～ 3导联 ST段压低 (15例 ) ;组 3:急性下壁 MI伴前壁 V4～ 6 导联 ST段压低 (14例 )。结果 :组 2的左旋支狭窄 (≥ 70 % )例数明显多于另外两组 (6 0 % vs 2 7%、2 8% ,P <0 .0 5 ) ,其多支血管病变较多 (10 .0 %、2 8.6 % vs6 6 .7% ,P<0 .0 5 ) ,肌酸激酶同工酶峰值较高 [(173.78± 5 8.83) U/ L 、(16 4.2 2± 38.12 ) U/ L vs(2 39.6 5± 45 .34) U/ L,P <0 .0 5 ],左室射血分数较低 [(6 1± 7) %、(5 6± 5 ) % vs(4 5±10 ) % ,P <0 .0 5 ]。组 1与组 3相比 ,两者的各种参数差异无显著性意义 (P >0 .0 5 )。结论 :急性下壁 MI伴 V1～ 3导联 ST段压低提示和左旋支的病变有关 ,其 MI面积较大、射血分数较低。     

经皮冠状动脉内成形术与冠状动脉内支架术的临床应用

1996年 1 1月～ 2 0 0 0年 7月 ,我院对 44例冠心病患者实施经皮冠状动脉腔内成形术 (PTCA)和支架置入术 ,除 4例未置入支架外 ,其余 40例共置入支架 48枚 ,现报告如下。1　资料与方法1 .1　一般资料　本组男 40例 ,女 4例 ;年龄 34～ 74岁 ,平均 55.4± 9.3岁。不稳定心绞痛 1 7例 ,心肌梗塞 2 7例 ,其中急性心肌梗塞恢复期 1 0例 (前壁梗塞5例 ,前间壁梗塞 1例 ,下壁梗塞 2例 ,前壁合并下壁梗塞 1例 ,前壁广泛合并高侧壁梗塞 1例 ) ,陈旧型心肌梗塞 1 7例 (前壁梗塞 7例 ,前间壁梗塞 4例 ,下壁梗塞 2例 ,前壁合并下壁梗塞 2例 ,下壁合并…     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

急性肺动脉栓塞心电图多指标关联时变模式研究

目的:研究急性肺动脉栓塞(APE)的临床心电图动态演化规律,阐明其多样性表现的机制。方法:收集42个APE病例的心电图系列,每一例按记录时间顺序对7个特征性指标(心率,SⅠ、QⅢ、TⅢ、TV1,、STV、RV1或r'V1波)采样。分析该7个特征指标的时变特征,并总结归纳出APE心电图的多指标关联时变模式。结果:该时变理论模式表明,典型APE患者心电图随病程的动态变化,以TV1波倒置达峰时间为界,可化分为3个阶段。发病至TV1波倒置达峰前为第一阶段,TV1波倒置逐渐加深,表现为下降线,其它各指标在该阶段即已迅速完成上升或下降的演变而进入快速回复期,其时变模式曲线呈"反S"型或"S"型;第二阶段即为TV1波倒置达峰阶段,其时间大概处于TVI波总演变时间的前1/3处;自TVI波倒置达峰后至回复发病前水平为第三阶段。结论:临床APE心电图表现之多样性,是不同阶段各指标的联合表现特征和形式多样性的反映。该时变模式曲线可应用于临床判断疾病阶段。     

115例布鲁菌病临床特点分析

目的 探索布鲁菌病(布病)患者临床特征及治疗转归情况,为临床诊治提供参考。方法 收集并分析115例成人布病患者的人口学和流行病学资料、临床表现、血液学指标及治疗与转归情况。结果 布病患者常常伴有发热、乏力、多汗、关节疼痛、肝脾肿大等临床症状,其HGB、红细胞压积(hematocrit,HCT)、嗜酸性粒细胞(eosinophil,EO)、红细胞分布宽度(red blood cell distribution width,RDW)和CRP异常率较高。而WBC、PLT、中性粒细胞计数、淋巴细胞计数、单核细胞计数、平均细胞体积、血小板分布宽度、ESR和降钙素原的异常率较低。治疗上大部分患者[53.04%(61/115)]接受利福平联合多西环素治疗,部分患者尤其是合并骨质侵犯患者常使用三联抗菌素治疗。其中47例并发骨关节痛患者,经规范足疗程治疗后皆好转或痊愈。结论 布病患者常伴有发热、乏力、多汗、关节疼痛、肝脾肿大等临床症状,其HGB、HCT、EO、RDW和CRP异常率较高,可作为布病的辅助诊断指标。布病临床表现多样,明确诊断后应尽早给予规范的抗菌治疗,抑制疾病进展,减少并发症发生。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

A comparison of methods of pathogen inactivation of FFP

Introduction Current methods for pathogen inactivation of plasma involve four major processes using solvent–detergent (SD), methylene blue (MB), amotosalen and riboflavin as additives. Three of these methods involve the use of visible or ultraviolet light. Methods A comparison of the four methods was made using publications in Medline, Pubmed, Embase and Biosis to obtain data on the logistics of use, the quality of the plasma proteins and the effectiveness of pathogen inactivation. Results Three of the methods, MB, amotosalen and riboflavin, are designed for use in a blood bank; the SD method is generally applied at a centralized manufacturing centre and involves large plasma pools. All methods result in a reduction in protein values with the per cent retention of FVIII activity in the range of 67–78% and fibrinogen of 65–84%. Protein S and alpha₂‐antiplasmin are lower following solvent–detergent treatment. Alterations in fibrinogen structure have been reported with methylene blue. Discussion Three of the methods are designed for small volume use in a blood bank. All four methods have some effect on the coagulant proteins; however, the final concentrations are within regulated limits. While there is variability in the effectiveness against pathogens, direct comparison is difficult because of the methodologies used. Nonetheless, all are effective in inactivating HIV and other lipid‐enveloped pathogens. Clinical studies on the effectiveness of these products are surprisingly sparse, and no randomized clinical trials have yet been performed with amotosalen or riboflavin plasmas.