静脉导管留置及胸腔注射尿激酶治疗结核性胸腔积液影响

探讨中心静脉导管胸腔穿刺留置抽液联合胸腔内注入尿激酶(urokinase,UK)治疗结核性渗出性胸膜炎对胸膜肥厚、粘连的预防作用。方法:将52例收治的结核性渗出性胸膜炎所致大量胸腔积液患者随机分为治疗组(27例)和对照组(25例),对照组给于常规抗结核以及传统单纯胸腔穿刺抽液(每周3次)等治疗;全身结核中毒症状严重者,予口服泼尼松30mg．d-1,每周减量5～10mg,疗程约4～6周。在以上药物治疗同时,治疗组第一次穿刺时使用一次性中心静脉导管代替传统胸穿针穿刺置入并保留于胸腔,抽液后从导管注入尿激酶10～20万U,保留24小时后再次抽液;可以再次或多次使用尿激酶10万u注入胸腔;此后不定时抽液,经B超证实抽尽胸水后拔除导管。结果:治疗组住院时间(12．3±6．6)天,住院费用(2219．5±1171．9)元,治疗后第三个月的胸膜厚度(1．00±0．23)mm,无病例发生胸膜增厚、粘连及包裹性胸腔积液。对照组住院时间(20．4±7．9)天,住院费用(2721．9±1711．7)元,治疗后第三个月胸膜厚度(2．1±0．31)mm,另有3例发生胸膜增厚、粘连,2例形成包裹性胸腔积液。各项指标对比差异有显著性。结论:中心静脉导管胸腔穿刺留置抽液及尿激酶胸腔内保留注射治疗结核性胸腔积液具有简便、安全、创伤少、疗效确切;缩短住院时间,降低住院费用;且能有效预防胸膜肥厚和粘连发生。值得临床推广应用。     

In vivo Measurement of the Mouse Pulmonary Endothelial Surface Layer

The endothelial glycocalyx is a layer of proteoglycans and associated glycosaminoglycans lining the vascular lumen. In vivo, the glycocalyx is highly hydrated, forming a substantial endothelial surface layer (ESL) that contributes to the maintenance of endothelial function. As the endothelial glycocalyx is often aberrant in vitro and is lost during standard tissue fixation techniques, study of the ESL requires use of intravital microscopy. To best approximate the complex physiology of the alveolar microvasculature, pulmonary intravital imaging is ideally performed on a freely-moving lung. These preparations, however, typically suffer from extensive motion artifact. We demonstrate how closed-chest intravital microscopy of a freely-moving mouse lung can be used to measure glycocalyx integrity via ESL exclusion of fluorescently-labeled high molecular weight dextrans from the endothelial surface. This non-recovery surgical technique, which requires simultaneous brightfield and fluorescent imaging of the mouse lung, allows for longitudinal observation of the subpleural microvasculature without evidence of inducing confounding lung injury.     

Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice

Dobutamine is a β-adrenergic agonist with an affinity higher for receptor expressed in the heart (β₁) than for receptors expressed in the arteries (β₂). When systemically administered, it increases cardiac demand. Thus, dobutamine unmasks abnormal rhythm or ischemic areas potentially at risk of infarction. Monitoring of heart function during a cardiac stress test can be performed by either ecocardiography or cardiac catheterization. The latter is an invasive but more accurate and informative technique that the former.Cardiac stress test induced by dobutamine and monitored by cardiac catheterization accomplished as described here allows, in a single experiment, the measurement of the following hemodynamic parameters: heart rate (HR), systolic pressure, diastolic pressure, end-diastolic pressure, maximal positive pressure development (dP/dtmax) and maximal negative pressure development (dP/dt_min), at baseline conditions and under increasing doses of dobutamine.As expected, in normal mice we observed a dobutamine dose-related increase in HR, dP/dt_max and dP/dt_min. Moreover, at the highest dose tested (12 ng/g/min) the cardiac decompensation of high fat diet-induced obese mice was unmasked.     

A fatal case of fungal endocarditis of the tricuspid valve associated with long-term venous catheterization and treatment with antibiotics in a patient with a history of alcohol abuse

We report a fatal case of fungal (candidal) endocarditis of the tricuspid valve with clinico-pathologically interesting findings following and associated with candidal pneumonia during long-term central venous catheterization (CVC) for intravenous therapy and long-term treatment with antibiotics for bacterial and fungal infection in a patient with a history of alcohol abuse. We review the literature on fungal cardiac infection related to long-term catheterization and alcohol abuse, and discuss the pathogenesis. This revised version was published online in June 2006 with corrections to the Cover Date.     

Evaluation of a ventricular septal defect in an orangutan: a case report

A 15-year-old male Sumatran orangutan (Pongo pymaeus abeli) with a history of an interventricular septal defect was evaluated with cardiac catheterization and two-dimensional echocardiography. Results demonstrated that by Homo sapiens standards the right heart pressures were normal. The oxygen saturations were consistent with a small ventricular septal defect. Echocardiography demonstrated a slight enlargement of the right ventricle.     

In vitro evaluation of fresh sperm quality in tomcats: A comparison of two collection techniques

The collection of semen from tomcats by urethral catheterization (CT) after medetomidine administration offers a novel and easy approach to obtain good quality sperm for in vitro fertilization. This study was designed to compare the sperm quality parameters and in vitro fertilizing capacity of CT spermatozoa with those of spermatozoa retrieved after epididymal slicing (EP). Semen was collected in seventeen adult cats by urethral catheterization, after which the cat was orchiectomized. Motility, morphology, plasma membrane integrity, acrosomal status, and in vitro fertilizing capacity of both fresh CT and EP samples were evaluated. The results showed that both total and progressive motility, as well as the percentage of normal spermatozoa, were higher for EP sperm than for CT sperm (P < 0.01). Epididymal sperm had a lower percentage of spermatozoa with an intact acrosome (P < 0.01), while CT sperm contained more spermatozoa with tail abnormalities (P < 0.01). Other morphological parameters, as well as plasma membrane integrity, did not differ (P > 0.05) between CT and EP sperm. Nevertheless, no difference (P > 0.05) in in vitro fertilizing capacity between spermatozoa collected by means of the two different methods was found. In conclusion, semen collection by means of urethral catheterization after medetomidine administration yields fertilization results similar to epididymal slicing, despite the fact that several sperm variables were different. Since this novel catheterization technique is repeatable, is easy to perform and facilitates semen preparation protocols, it may be preferable for routine IVF experiments with fresh spermatozoa.     

大鼠心脏插管留置术的探讨

目的探讨大鼠右心房插管留置术实验方法。方法20只SD大鼠进行右心房导管置入术,术后随机分为2组（导管穿弹簧正内孔组、导管穿弹簧侧边入内孔组）,每组各10只。导管在体内固定后由颈背部引出,穿过弹簧,导管另一端固定于饲养笼外的支架上,导管外接三通管等。结果24 h对两组模型进行实验观察。（1）导管穿弹簧正内孔组：只有1只导管弹簧设备未完全破坏,另9只模型的导管被咬断或拉出了出来,10只模型都不能从导管抽取血液样本。（2）导管穿弹簧侧边入内孔组：导管和弹簧设备都完好,其中9只模型都能从导管抽取血液样本。结论导管穿弹簧侧边入内孔组模型方法是成功的,有一定的推广价值。     

微型移动导管手术室的民用模式研究

微型移动导管手术室是为适应野战条件下心血管急重伤病的快速诊治而研制的新型医疗设备。本文主要研究探讨该微型移动导管手术室的民用模式,包括针对STEMI病人的人机一体化反送救治模式,突发事件中伤员的现场救治模式,重要活动的卫生安全保障模式以及对三线以下城市乡镇的医疗巡诊模式。     

小鼠经颈外静脉右心导管法测定心室压力的实验方法研究

目的：研究可行性高的测定小鼠右心室压力的实验方法。方法：通过自制PE导管,连接powerlab多通道生物信号记录系统,经颈外静脉插管,右心导管法测定小鼠右心室压力,并借以研究肺动脉压力变化。结果：用此方法对51只小鼠进行插管,46例成功进入心室并测压,成功率90．2％。其中33只正常小鼠中,成功30例,测得压力值：收缩压（23．4±5．7）mmHg,舒张压（3．7±2．6）mmHg,平均压（12．0±3．7）mmHg;18只肺动脉高压模型小鼠中,成功16例,测得压力值：收缩压：（32．2±2．8）mmng,舒张压（3．8±2．0）mmng,平均压（14．94±2．3）mmHg。共失败5例,经解剖发现2例进入下腔静脉,2例穿破心耳,1例穿破腋静脉进入胸壁。结论：使用自制的PE导管经颈外静脉插管,右心导管法测定右心室压具有成功率高、数据更准确、操作省时、方法易普及的优点。是一种较好的对小鼠进行右心室压力测定的方法。     

Thrombus development on a transseptal sheath in the right atrium before electrical pulmonary vein isolation

We describe the case of a patient who developed a thrombus on the transseptal sheath in the right atrium before transseptal puncture for circumferential pulmonary vein isolation for paroxysmal atrial fibrillation treatment. The use of intracardiac echocardiography allowed to its identification and probably prevented the patient from suffering a serious thromboembolic complication.