Haemodynamic flow: symmetry and synthesis

This paper is presented as a summary and synthesis of the presentations at the conference entitled "Breaking Symmetry in Haemodynamics". As the accompanying papers will attest, there has been enormous progress in understanding the effects of fluid flow on the arterial endothelium and the consequential effects on the vessel wall. It is now clearly understood that the focal lesions found in atherosclerotic arteries are the product of asymmetrical flow and the resulting disturbed flow that occurs near arterial bifurcations and other selected points around the human vasculature. The flow in large vessels can now be determined accurately with MR and in vitro cast models. Although theory allows arterial flow to be characterized by asymmetry in time and space, our understanding of the processes that act to translate this asymmetry into pathology is becoming much more symmetric, or complete. The new frontiers of research in arterial flow are now translating to smaller scales, at the cellular level and below.     

New Trends in the Treatment of Angina Pectoris

Traditionally when considering the pharmacologic basis of therapy in angina pectoris, attention is focussed on alterations of coronary blood flow. Yet the diseased coronary arteries in these patients often do not appear to be capable of responding to vasodilatory drugs. Since the pain of myocardial ischemia is relieved by a number of interventions without an increase in coronary blood flow, the concept herein considered is that angina pector is best viewed as an unfavorable relation between myocardial oxygen requirements and availability. Thus, the clinical value of the major antianginal agents is thought to be based importantly upon their actions to reduce myocardial oxygen consumption rather than to increase coronary blood flow.Sublingual nitroglycerin possesses a powerful dilator effect on veins which reduces venous return and thereby the size of the heart and intra-myocardial tension; thus myocardial oxygen requirements are diminished.The beta-adrenergic receptor blocking drug, propranolol (Inderal®), inhibits sympathetic stimulation of the heart at rest and during exercise. Thus, myocardial oxygen requirements are diminished by the reduction in heart rate and diminished contractility. As a result of this latter action, cardiac output is reduced and thereby arterial pressure and intramyocardial tension is lowered. In patients with advanced heart disease and borderline cardiac compensation, propranolol is hazardous because it removes the availability of one of the important reserve mechanisms for maintaining cardiac compensation—the sympathetic support of the failing heart.The introduction of electrical stimulation of the carotid sinus nerves as a means of therapy in patients with angina pectoris has provided a powerful tool for the treatment of patients with refractory ischemic pain.     

Neuropsychological Aspects of Liver Disease and its Treatment

Liver disease can lead to serious impairment in cognitive functioning, through the development of a condition known as hepatic encephalopathy (HE). While gross impairment is clinically obvious, milder variants of the condition may escape detection at bedside examination and yet may have a significant impact on day-to-day activities. In this brief review article, the neuropsychology of liver disease is examined, focusing on nature, aetiology and significance. The possible contributory role of endogenous benzodiazepines in HE is described, as is the evidence regarding the effect of benzodiazepine antagonism on cognitive functioning in HE. The functional localisation of HE is briefly reviewed, as is the use of neuropsychological measures to evaluate treatment efficacy, e.g. following shunt procedures or liver transplantation. Finally, living donor liver transplantation is described, and the case is made for rigorous longitudinal neuropsychological evaluation of potential donors and recipients. Special issue article in honor of George Fink.     

120 例不稳定型心绞痛的地尔硫卓治疗临床观察

目的:探讨地尔硫卓治疗不稳定型心绞痛的临床疗效,以供医生参考使用。方法:将我院2010年1月~2011年5月收治的120例不稳定型心绞痛的患者随机分为两组,对照组患者给予硝酸甘油,实验组患者给予地尔硫卓,比较两组患者的治疗效果。结果:实验组患者的总有效率为93.33%(56/60),对照组患者总有效率为78.33%(47/60),实验组明显优于对照组患者,P<0.05。结论:地尔硫卓治疗不稳定型心绞痛具有较好的疗效,值得在临床应用。     

Modern Aspects of the Treatment of Hemophilia

The prognosis of hemophilic hemorrhages is greatly dependent on the therapy which is administered during the first three to five days. To prevent overloading of the circulation, highly active preparations of the antihemophilic factor should be available.A survey of the recently developed concentrated products of this factor and of their suitability for clinical use is presented. The authors describe their own experiences in the treatment of a number of patients with hemophilia A by administration of so-called “two-donor” fibrinogen.The effect of this “two-donor” fibrinogen was not inferior to results obtained else-where with the so-called I-O product, prepared from a much greater quantity of blood plasma.