球囊漂浮电极导管行床旁临时起搏62例

目的探讨静脉应用球囊漂浮电极导管行床旁心脏临时起搏的方法和可行性。方法回顾性分析62例球囊漂浮电极导管行床旁临时起搏的患者的临床资料．着重分析球囊漂浮电极导管行床旁临时起搏的方法。结果62例均床旁成功完成带囊临时起搏电极右心室起搏,从穿刺到起搏的时间为10～20min,中位时间15min,除外1例出现起搏导线打结外,所有患者均无出现严重心律失常、局部血肿、气胸、栓塞、心脏穿孔、感染等并发症发生。结论经静脉应用球囊漂浮电极导管进行床旁右心室临时起搏安全、可行。     

Atrial fibrosis quantified using late gadolinium enhancement MRI is associated with sinus node dysfunction requiring pacemaker implant

Atrial Fibrosis and Sinus Node Dysfunction . Introduction: Sinus node dysfunction (SND) commonly manifests with atrial arrhythmias alternating with sinus pauses and sinus bradycardia. The underlying process is thought to be because of atrial fibrosis. We assessed the value of atrial fibrosis, quantified using Late Gadolinium Enhanced‐MRI (LGE‐MRI), in predicting significant SND requiring pacemaker implant. Methods: Three hundred forty‐four patients with atrial fibrillation (AF) presenting for catheter ablation underwent LGE‐MRI. Left atrial (LA) fibrosis was quantified in all patients and right atrial (RA) fibrosis in 134 patients. All patients underwent catheter ablation with pulmonary vein isolation with posterior wall and septal debulking. Patients were followed prospectively for 329 ± 245 days. Ambulatory monitoring was instituted every 3 months. Symptomatic pauses and bradycardia were treated with pacemaker implantation per published guidelines. Results: The average patient age was 65 ± 12 years. The average wall fibrosis was 16.7 ± 11.1% in the LA, and 5.3 ± 6.4% in the RA. RA fibrosis was correlated with LA fibrosis (R²= 0.26; P < 0.01). Patients were divided into 4 stages of LA fibrosis (Utah I: <5%, Utah II: 5–20%, Utah III: 20–35%, Utah IV: >35%). Twenty‐two patients (mean atrial fibrosis, 23.9%) required pacemaker implantation during follow‐up. Univariate and multivariate analysis identified LA fibrosis stage (OR, 2.2) as a significant predictor for pacemaker implantation with an area under the curve of 0.704. Conclusions: In patients with AF presenting for catheter ablation, LGE‐MRI quantification of atrial fibrosis demonstrates preferential LA involvement. Significant atrial fibrosis is associated with clinically significant SND requiring pacemaker implantation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 44‐50, January 2012)     

CT仿真内镜与多平面重建对垂体瘤患者蝶窦显示情况的比较

目的:比较CT仿真内镜(CT virtual endoscopy,简称CTVE)与CT多平面重建(multiplannar reconstruction,MPR)对垂体瘤患者蝶窦、鞍底的显示情况.方法:在119例垂体瘤经蝶手术中,对术前常规垂体CT检查数据分别进行MPR及CTVE重建,对两者显示的蝶窦情况进行比较.结果:在蝶窦表面解剖结构:蝶窦开口、蝶窦中隔、鞍底形状、斜坡凹陷、颈内动脉隆起、视神经管隆起方面,CTVE与MPR的显示率无明显差别,CTVE对颈内动脉视神经隐窝的显示率优于MPR,CTVE所提供的为三维图像,MPR提供的为二维图像.在显示深部解剖标志:斜坡松质骨、蝶窦壁厚度方面MPR明显优于CTVE.结论:CTVE能显示蝶窦浅表解剖结构的三维图像,可做为经蝶垂体瘤手术的术前了解蝶窦三维解剖结构的一种方法.     

Symptomatic Sinus Bradycardia After a Treatment Course Of High-dose Oral Prednisone

Background

High-dose corticosteroid therapy is used to treat several severe autoimmune diseases. Despite a common knowledge in the medical community of the adverse effects of chronic corticosteroid use, there is much less awareness of the affects that can occur after very high doses are administered in a relatively short period of time.

Objective

Our objective was to report on the outpatient-based practice of administering high-dose corticosteroids for autoimmune disease and the possible bradycardic response that can occur as a result.

Case Report

We present a case of a 45-year-old female with multiple sclerosis who presented to the emergency department with symptomatic sinus bradycardia secondary to a regimen of high-dose corticosteroid therapy.

Conclusions

More patients with autoimmune diseases may be placed on outpatient-based treatment regimens of high-dose corticosteroids in the future. It is important for emergency physicians to be aware of bradycardia as a possible adverse effect, as many of these patients may present to the emergency department for evaluation.     

系统性红斑狼疮合并颅内静脉窦血栓的临床特点

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并颅内静脉窦血栓(cerebral venous sinus thrombosis,CVST)的临床特点。方法回顾性分析北京协和医院2000年1月至2013年6月SLE中合并CVST患者的神经系统表现、全身病情活动度、血栓形成部位、影像学特点及治疗和预后。结果 SLE并发CVST患者13例,占同期SLE住院患者(4540例)的0.29%。女10例,男3例,平均年龄30.5岁。神经系统表现以头痛(1113)、视力下降(713)、意识障碍(513)、癫痫(413)最为常见。脑脊液压力升高9例,其中7例330 mm H2O,脑脊液蛋白升高5例。磁共振静脉血管成像提示血栓形成部位常见于横窦(1113)、乙状窦(813)、上矢状窦(413)等,多数(1013)患者为2处以上静脉窦血栓形成。患者平均SLE疾病活动指数为(11.7±2.8)分(不包括CVST)。经脱水降颅压、抗凝、糖皮质激素冲击、免疫抑制剂及地塞米松鞘注治疗,9例患者好转,3例死亡,1例失访。结论 CVST是SLE的罕见并发症,多发生于SLE活动期,有特殊的临床症状、体征及脑脊液压力升高等提示,需早期识别、积极治疗以改善预后。     

心房感知起搏器的临床应用探讨

目的：探讨心房感知起搏器(AAI)的临床应用状况和对病态窦房结综合征(SSS)患者预后的影响。方法：回顾性调查1998-2002年在长征医院进行起搏治疗的175例SSS患者的病例资料。将其中132例患者分成AAI、双腔感知起搏器(DDD)、心室感知起搏器(VVI)三组，定期门诊随访，观察房颤、中风、心力衰竭、起搏器综合征、手术并发症、起搏电极脱位、生活质量改善以及Ⅱ度以上房室传导阻滞(AVB)发生率等临床情况。结果：175例SSS患者中共有AAI适应证42％(73例)，但仅有13％(22例)置入AAI起搏器。AAI组的房颤、中风、心力衰竭发生率显著低于VVI组。AAI组中未发现新发生的AVB。结论：AAI起搏较其他起搏方式更有利于SSS的预后。应该注意纠正临床上AAI起搏器应用率偏低的不合理情况。     

Angiogenesis in ischaemic and hypertrophic hearts induced by long-term bradycardia

Angiogenesis and improved left ventricular function as a consequence of long-term bradycardia were first demonstrated in normal hearts, either electrically paced (rabbits, pigs) or treated with a selective sinus blocking drug alinidine (rats). Here we review the evidence that chronic heart rate reduction can have similar effects in the heart with compromised vascular supply, due to either hypertensive or haemodynamic overload hypertrophy (rats, rabbits) or ischaemic damage (rats, rabbits, pigs). Bradycardia induced over several weeks increased capillarity in all hypertrophied hearts, and in border and remote left ventricular myocardium of infarcted hearts. In some, but not all cases, coronary blood flow was improved by heart rate reduction, suggesting enlargement of the resistance vasculature in some circumstances. Cardiac or left ventricular function indices, which were depressed by hypertrophy or ischaemic damage, were preserved or even enhanced by chronic heart rate reduction. The expansion of the capillary bed in the vascularly compromised heart induced by bradycardia may be stimulated by mechanical stretch of the endothelium and/or VEGF activated by chamber dilation and myocyte stretch. The increased number of capillaries and more homogeneous distribution of capillary perfusion would support the better pump function, even in the absence of higher coronary flow. The beneficial impact of chronic heart rate reduction on myocardial angiogenesis and function in cardiac hypertrophy and infarction may be major factor in the success of beta-blockers in treatment of human heart failure. Correspondence to: Dr. M.D. Brown, School of Sport and Exercise Sciences, University of Birmingham, Birmingham B 15 2TT, UK. Tel: +44-121-4144268; Fax: +44-121-4144121; E-mail: m.d.brown@bham.ac.uk     

How does pouch construction for a final diagnosis of Crohn's disease compare with ileoproctostomy for established Crohn's proctocolitis?

PURPOSE: There is a difference of opinion concerning the role of ileal pouch-anal anastomosis in Crohn's disease, even in the absence of small-bowel or perianal disease. One view is that ileal pouch-anal anastomosis should never be entertained, the other is that ileal pouch-anal anastomosis, like ileoproctostomy, can be justified sometimes, because it allows young people a period of stoma-free life. The aim of this study was to examine the outcome of ileal pouch-anal anastomosis and to contrast it with ileoproctostomy in patients with Crohn's disease without small-bowel or perianal disease. METHODS: Ileal pouch-anal anastomosis was performed in 23 patients with Crohn's disease (12 of whom had evidence of Crohn's disease at the time of operation and 11 who were eventually found to have Crohn's disease as a result of complications) and ileoproctostomy in 35. Patients were matched for age, gender, follow-up, and medication, but all ileoproctostomy cases had relative rectal sparing. Thus, the groups were not comparable and the reasons for ileal pouch-anal anastomosis and ileoproctostomy were therefore quite different. RESULTS: The outcome in ileal pouch-anal anastomosis at a mean follow-up of 10.2 years was pouch excision, 11 (47.8 percent); proximal stoma, 1 (4.3 percent; patient preference); average small-bowel resection, 65 cm; persistent perineal sinus, 8 of 11 having pouch excision (73 percent); and mean time in hospital, 37 (range, 8–108) days. Of those in circuit having ileal pouch-anal anastomosis (n=12), 24-hour bowel frequency was 6, with no incontinence or urgency, but 6 (50 percent) were on medication. When ileal pouch-anal anastomosis was done for Crohn's disease in the resection specimen, only 4 of 12 (33 percent) were excised compared with 7 of 11 (64 percent) in whom the diagnosis was made as a result of complications. The outcome in ileoproctostomy at a mean follow-up of 10.9 years was rectal excision in 3 (8 percent), proximal stoma in 1 (3 percent), average small-bowel resection was 15 cm, persistent perineal sinus in 1 (3 percent), and time in hospital was 21 (range, 8–36) days. Of those in circuit (n=32), 24-hour bowel frequency was 5, 2 had incontinence, 3 had urgency, and 12 (36 percent) were taking medication. CONCLUSIONS: These results indicate that the overall outcome of ileal pouch-anal anastomosis is inferior to that of ileoproctostomy, especially if Crohn's disease was diagnosed as a result of complications. Nevertheless, the functional results of those with a successful outcome are comparable.Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.     

单侧鼻窦疾病的临床特征分析

【目的】探讨单侧鼻窦发病的规律。【方法】回顾性分析了1998年1月至2004年10月间收治的6266例鼻窦疾病患者中793例单侧鼻窦疾病患者的诊断资料。【结果】793例患者中慢性鼻窦炎者425例，占53．6％；鼻窦真菌病102例，占12．9％；鼻窦乳头状瘤51例，占6．4％；鼻窦囊肿117例，占14．8％；上颌窦出血坏死性息肉23例，占42、9％；上颌骨骨纤维组织异常增殖症2例．占0.25％；骨瘤11例，占1．4％；上颌窦血管瘤2例，占0.25％；脑膜或脑膜-脑膨出5例，占0.6％；恶性肉芽肿19例，占2．4％；恶性肿瘤36例，占4．6％。【结论】有近半数(46．4％)的单侧鼻窦疾病患者所患的疾病为非普通的性性炎症性疾病，这对于指导临床诊断思维有重要意义。