老年人钙化性心脏瓣膜病六年随访

通过对９５例超声心动图检出的老年人钙化性心脏瓣膜病及９５例年龄、性别与其相匹配的无瓣膜钙化者的六年对照观察发现，瓣膜钙化组患者心前区杂音、心脏扩大、窦房结病变、传导障碍及房颤的发生率显著高于对照组（Ｐ＜０．０１），充血性心力衰竭、心肌梗塞、脑血管病及晕厥的发生率也高于对照组（Ｐ＜０．０５）。合并二尖瓣环钙化者的心前区杂音、心肌梗塞、充血性心力衰竭及心源性病死率均显著高于无二尖瓣环钙化者（Ｐ＜０．０５）。由于合并瓣膜钙化的患者窦房结病变及心脏传导阻滞发生率高，起搏器的植入率也明显高于对照组（Ｐ＜０．０５）。瓣膜钙化组的总病死率为１４．７％，其中心源性死亡占６４．３％，显著高于对照组的３．２％及３０．０％（Ｐ分别＜０．０１及０．０５）。     

经皮穿刺二尖瓣球囊成形术术后及随访结果

采用Ｉｎｏｕｅ及国产球囊对４１例患者施行了经皮穿刺二尖瓣球囊扩张术（ＰＢＭＶ），成功的４０例平均左房压由术前的１５．７±３．１ｍｍＨｇ降到６．７±２．９ｍｍＨｇ（Ｐ＜０．００１），跨瓣压差由术前的１３．１±２．１ｍｍＨｇ降到４．５±２．４ｍｍＨｇ（Ｐ＜０．００１），二尖瓣口面积由术前的１．１０±０．２５ｃｍ２增加到１．９９±０．２７ｃｍ２（Ｐ＜０．００１），左房内径由４５．８±５．３ｍｍ减少到４１．２±４．９ｍｍ（Ｐ＜０．０５），心功能由术前的３．１０±０．６２级改善到１．５８±０．７４级（Ｐ＜０．０１）。２４例随访９±５个月结果示除２例发生再狭窄外，其余病例与术后３天相比，二尖瓣口面积和心功能无明显改变，左房内径进一步下降到３８．２±４．６ｍｍＨｇ（Ｐ＜０．０５）。表明，ＰＢＭＶ的近远期效果良好。     

小剂量前列腺素E1对严重充血性心力衰竭及内皮素的影响

为探讨小剂量前列腺素Ｅ１（ＰＧＥ１）对重度充血性心力衰竭及内皮素（ＥＴ）水平的影响,对２０例经传统治疗无效的心衰患者小剂量静滴ＰＧＥ１１周,观察治疗前后临床症状、血流动力学及ＥＴ变化。结果发现,临床总有效率为９５％。肺动脉压（ＰＡＰ）、肺毛细血管嵌楔压（ＰＣＷＰ）比治疗前明显下降（４．９３±０．５３对４．００±０．５３ｋＰｓ,Ｐ＜０．０１;３．４７±０．５３对２．５３±０．４０ｋＰａ,Ｐ＜０．０１）,体循环阻力指数（ＳＶＲＩ）下降（２０４．８±２１．３对１５０．６±１．３ｋＰａ·ｓ·Ｌ－１·ｍ－２,Ｐ＜０．０５）,心指数（ＣＩ）上升（２．２±０．１对２．８±０．２Ｌ·ｍｉｎ－１·ｍ－２,Ｐ＜０．０５）。内皮素明显降低（１５４．５６±４．４０对１１８．１３±２．２４ｎｇ／Ｌ,Ｐ＜０．０１）。提示ＰＧＥ１可降低ＥＴ水平并通过多种机制对心衰产生有益的作用。     

地尔硫缓释剂对高血压合并冠心病患者动态血压及心电图的影响

目的观察地尔硫缓释剂对高血压合并冠心病患者疗效。方法２９例高血压合并冠心病患者口服地尔硫缓释剂９０ｍｇ，２／ｄ，用药４周，应用２４ｈ动态血压和动态心电图观察用药前后血压和缺血性ＳＴ段的变化。结果用药后２４ｈ收缩压（ＳＢＰ）从１４５±９降至１２７±１２ｍｍＨｇ，舒张压（ＤＢＰ）从１０６±１１降至８２±１５ｍｍＨｇ（Ｐ＜０．０５）；ＳＢＰ负荷由６４±９％降至３８±９％（Ｐ＜０．０１），ＤＢＰ负荷由５４±１４％降至２９±１０％（Ｐ＜０．０１）。心肌缺血发作频率从４．３±２．０降至２．３±１．０／２４ｈ，缺血总时间（ｍｉｎ／２４ｈ）从１６．９±３．９降至９．４±２．９，最大ＳＴ段下移由１．４±０．５ｍｍ降为０．８±０．３ｍｍ（Ｐ＜０．０１）。结论地尔硫缓释剂能显著改善高血压合并冠心病患者的心肌缺血和降低患者血压。     

老年人非溃疡性消化不良的超声胃动力学研究──47例检测结果对照分析

采用单切面实时超声显像法对３１例老年非溃疡性消化不良患者及１６例健康对照者进行流体胃动力学多项指标检测。结果显示：患者组胃液体排空Ｔ＿１／２为３８．８±１０．５分钟，对照组２９．４±７．７分钟，差异有显著性（Ｐ＜０．０５）。同时患者组的胃窦收缩频率为３．３±１．０次／２分钟、胃窦收缩幅度为０．４±０．１、胃窦运动指数为１．５±０．９，对照组分别为４．４±１．７次／２分钟、０．６±０．２及２．７±１．９，差异均有显著性（Ｐ＜０．０５），且患者组胃液体排空时间延长与其胃窦运动指数下降相关（Ｐ＜０．０１）。老年患者组男性胃液体排空Ｔ＿１／２为３５．２±７．７分钟，女性为４４．４±１２．１分钟，差异有极显著性（Ｐ＜０．０１），表明老年男性患者胃液体排空Ｔ＿１／２正常，而女性患者延迟。提示胃动力学功能障碍在老年人非溃疡性消化不良发病中起一定作用。     

急性一氧化碳中毒时的心功能损害

３０例急性ＣＯ中毒患者，在应用２ＡＴＡ高压氧治疗前和治疗后即时观察心肌酶和超声心动图测定心功能。结果发现：ＣＯ中毒可致心肌损伤，心肌酶谱有明显的改变，其中ＣＫ－ＭＢ为６８．２±５１．４，ｖｓ３６．４±６２．２，Ｐ＜０．０１；α－ＨＢＤ为２９３．５±１８．５，ｖｓ２６６．６±１６３．７，Ｐ＜０．０２。超声心动图提示Ｃ０中毒主要影响心肌的收缩功能，ＥＦ为５２．６±５．３，ｖｓ６４．６±７．２，Ｐ＜０．００１；ＳＶ为０．０３９±０．０１２，ｖｓ０．１０５５±０．０１１，Ｐ＜０．００１；ＣＯ为３．９±０．９，ｖｓ４．５±０．８，Ｐ＜０．０５。舒张功能的影响变化不大（Ａ／Ｅ），Ｐ＞０．０５．提示在救治ＣＯ中毒的过程中，不可忽视对心脏功能的关注。     

老年慢性阻塞性肺疾病患者血浆心钠素浓度与肺血液动力学及动脉血气的关系

目的探讨老年慢性阻塞性肺疾病患者（ＣＯＰＤ）肺血液动力学及动脉血气对血浆心钠素分泌的影响。方法使用右心漂浮导管同步测定３５例ＣＯＰＤ患者肺血液动力学、血浆心钠素浓度、血气参数，分析其相关性。结果老年与非老年患者血浆心钠素浓度、肺动脉平均压及血气参数差异无显著性。老年ＣＯＰＤ伴肺动脉高压患者血浆心钠素浓度（１３６．３±６１．９ｎｇ／Ｌ）明显高于无肺动脉高压患者（９２．９±１７．０ｎｇ／ＬＰ值＜０．０５），其备浆心钠素浓度与肺动脉平均压及肺血管阻力明显相关（ｒ值分别为０．７８及０．７４，Ｐ值＜０．０１），与ＰａＯ２及ＰａＣＯ２亦有明显相关性（ｒ值分别为－０．６８及０．６３，Ｐ值＜０．０５）。结论老年ＣＯＰＤ伴肺动脉高压患者右心后负荷的增加可能是引起血浆心钠素浓度增高的主要因素，而缺氧及二氧化碳潴留亦可能通过直接或间接机制影响血浆心钠素的分泌。     

内镜下Oddi括约肌测压的临床意义

为观察胆石症、胆囊切除术后等胆系疾病及功能性消化不良（ＦＤ）、糖尿病胃轻瘫（ＤＧＰ）等非胆系疾病Ｏｄｄｉ括约肌（ＳＯ）功能变化，通过内镜采用灌注式高分辨多道胃肠功能测定仪，对１５例胆系疾病患者、１３例非胆系疾病患者进行Ｏｄｄｉ括约肌测压。结果显示，胆系疾病组的胆总管压力、ＳＯ基础压及蠕动波振幅明显高于非胆系疾病组（６．８６±０．６３ｋＰａ与１．２７±０．１０ｋＰａ，Ｐ＜０．０１；７．３１±０．９５ｋＰａ与１．８７±０．１６ｋＰａ，Ｐ＜０．０１；３２．００±１．２ｋＰａ与２４．１４±１．５ｋＰａ，Ｐ＜０．０５）；同时，非胆系疾病组的十二指肠压、ＳＯ蠕动频率及间期较胆系疾病组明显降低、减慢及延长（１．４２±０．２６ｋＰａ与０．３０±０．１０ｋＰａ，Ｐ＜０．０１；３．６±１．２次／分与２．２±０．４次／分，Ｐ＜０．０５；７．４±１．２秒与１１．０±１．８秒，Ｐ＜０．０５）。结果显示，无论是胆系疾病还是ＦＤ及ＤＧＰ等非胆系疾病均有ＳＯ功能紊乱，但表现形式相反，对指导临床诊断与治疗有一定价值。     

螺内酯对肝硬变门脉血流动力学的实验和临床研究

目的探索螺内酯对门脉高压实验犬和肝硬变患者门脉血流动力学的作用．方法用直接门脉插管测压和９９ｍＴｃＭＩＢＩ心肝放射性摄取比值（Ｈ／Ｌ）测定慢性胆总管结扎肝硬变犬（ｎ＝１６）门静脉压力和门体分流，口服螺内酯２０ｍｇ／（ｋｇ·ｄ）．肝硬变患者１４例测定Ｈ／Ｌ，门静脉内径和流速后口服螺内酯８０ｍｇ／ｄ，４ｗｋ为１疗程．结果完成试验的犬１３只治疗前后门脉压力（ｋＰａ）从２５９±０５１下降为２４２±０４７（Ｐ＜００５），Ｈ／Ｌ从０３３±００６降至０３０±００８（Ｐ＜００５）．１４例肝硬变患者治疗前后Ｈ／Ｌ值从１２０±０２６降为１０２±０３４（Ｐ＜００５），门脉内径（ｍｍ）从１３９±２３缩小为１２３±２０（Ｐ＜００５）．门静脉流速明显增加．结论螺内酯口服可降低门脉压力和门体分流．     

国产米力农对慢性充血性心力衰竭患者的血流动力学效应及临床疗效

为验证国产米力农治疗慢性充血性心力衰竭（ＣＨＦ）的效果，对４０例ＣＨＦ患者分①血流动力学观察组１０例，采用安慰剂对照、随机双盲、自身交叉试验，②临床观察组３０例，又等分为米力农治疗组和安慰剂对照组进行观察。结果：血流动力学观察组用米力农后平均肺毛细血管楔压下降２７．４％，平均肺动脉压下降２４．５％，体循环血管阻力下降２０．６％，心脏指数增加１２．８％，均Ｐ＜０．０５；临床观察组中的米力农组心功能改善１１例（１１／１５，７３．３％），而安慰剂对照组仅４例（４／１５，２６．７％），两相比较，Ｐ＜０．０５。表明：应用国产米力农，可显著改善ＣＨＦ患者的血流动力学状况和心功能。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.