Some hazards of invasive cardiology

Since the introduction of cardiac catheterization by André Cournand and Dickinson Richards, the valuable diagnostic and therapeutic device has encouraged many action-minded physicians to use cardiac catheterization to develop a new specialty, invasive cardiology. The data to be presented here derive from a catastrophe that occurred during an invasive treatment of a 54-year-old man who had experienced an ordinary myocardial infraction.     

先天性心脏病新技术——介入导管术

近20年间,伴随着科学技术的发展以及医疗水平的提高,介入导管术治疗先天性心脏病逐渐成为主要选择。该项技术微创、疗效好、安全、并发症少、住院时间短,深受患者青旺火。本文讨论该项技术的主要适应范围以及今后的发展趋势,同时指出医疗技术的创新必须遵守的哲学性原则。     

Magnetic resonance imaging changes in a patient with migraine attack and transient global amnesia after cardiac catheterization

The presence of magnetic resonance imaging (MRI) abnormalities in patients with transient global amnesia has been an interesting phenomenologic finding. Several theories surround the occurrence of this syndrome, but little is known about its true physiopathology. We present a case of transient global amnesia after cardiac catheterization associated with migraine headache and MRI changes compatible with an ischemic insult. A discussion on potential explanations for this finding is made, as well as a review of the pertinent literature.     

心脏病外科治疗之趋势——微创

在近20年间,伴随着科学技术的发展以及医疗水平的提高,微创已经成为了外科医生行使手术的重要选择之一;由于国家生活水平的提高,患者不但追求高生存率,同时提出了更高的要求——低病痛,快恢复期,伤口美观等,微创外科得到了越来越多的人的青睐。本文主要探讨了微创心脏外科的分类(小切口技术,电视胸腔镜辅助心脏外科技术,机器人辅助心脏外科技术)以及各种新技术在心脏外科领域所存在的优势和不足,同时辩证地指出了心脏外科的未来发展趋势以及在发展过程中可能存在的一系列矛盾,同时指出了医疗为患者个体服务的观点。     

心导管技术的发明与诺贝尔奖之启示

德国医生维尔纳·福斯曼(Werner.Forssmann,1904-1979)因其对心导管技术的创造所做的里程碑式的贡献而荣膺1956年度生理学和医学诺贝尔奖.回顾福斯曼创造心脏导管技术的历程带给我们一些启示:科学研究需要强烈的探索欲为动力,无畏的探索精神为保障,科学的辩证法思想为指导.     

Personality correlates of smoking behaviour in men with heart disease

In two populations of male patients attending a cardiac clinic who underwent invasive procedures [coronary angiography (n = 67)] and coronary artery bypass graft surgery (n = 78) there was an association between smoking behaviour and the personality dimension of psychoticism. Follow-up assessment 12 months after both procedures revealed that the resumption of smoking was also highly correlated with psychoticism, and to a lesser extent with extraversion. There was an inverse association between duration of anginal symptoms and a smoking history, and among smokers, those with the heaviest consumption had shorter histories of chest pain both non-smokers and light smokers. Poor compliance among high P scorers has implications for the management of patients with coronary heart disease (CHD). Because cessation of smoking is the most important single measure in reducing mortality from CHD, more effort should be directed towards patients with these personality characteristics before cardiac surgery is undertaken.     

Moderators of the relation between perceived control and adjustment to chronic illness.

It was predicted that the relation between perceived control and adjustment to chronic illness would be stronger when (a) perceptions of control were based in reality and (b) the threat was severe. Perceived control was assessed during the hospitalization of 80 first cardiac event patients, and adjustment was assessed during hospitalization and 3-month follow-up. Results indicated that perceptions of vicarious control (perception that other people and things have control) were related to better adjustment only for patients who had undergone invasive procedures by physicians. The relation between control and adjustment was stronger under more severe threat conditions (poor prognosis and rehospitalization).     

利多卡因凝胶在手术室麻醉诱导后留置尿管中的应用

分析手术室麻醉诱导后留置尿管产生尿路疼痛等不良反应的原因,探讨利多卡因凝胶在克服上述反应方面的作用及其他预防措施。采用方便取样将70例留置尿管的患者分为试验组和对照组,麻醉诱导后试验组在尿管上涂抹利多卡因凝胶（0．5ml／cm）后再按常规操作插管;对照组以石蜡油为润滑剂按常规操作留置尿管。比较两组患者心率、血压情况及躁动、疼痛评分。结果提示麻醉诱导后留置尿管可以有效减轻患者清醒状态下置管引起的尿路疼痛等问题,但不能避免患者苏醒期出现上述反应;使用利多卡因凝胶可有效预防患者苏醒期出现的尿路疼痛及其它不良反应,增加患者的舒适度。     

对微创脊柱外科发展历程的思考

微创脊柱外科是现代脊柱外科发展的必然趋势。近几十年来,微创技术不断革新,微创理念也逐渐深入人心。在取得了巨大成就的同时还有许多问题值得我们去思考和探索。我们不仅应注重微创技术的创新和应用,更要注意应用微创理念,做到二者的有机统一。     

医学人性的复归:微创医学与全人医疗

微创医学是现代医学发展进程中的一种紧急转向,是当代医学治疗思想的一次重要调整,同时也是古代自然疗法的复归与提升.从微创外科到微创医学,到微创医学体系,到全人医疗,是医学人性复归之路.     

幽门螺杆菌诊断方法评价

诊断幽门螺杆菌（Hp）感染有侵入性和非侵入性两类方法。前者需通过胃镜取胃粘膜活检,包括快速尿素酶试验（RUT）、病理组织学检查、细菌培养及基因检测等;非侵入性方法包括尿素呼气试验（UBT）、血清Hp抗体测定及Hp粪便抗原检测等。各种检测方法的敏感性及特异性不一,适用范围也不同,选择合适的检测方法需结合Hp感染特点、检测条件及费用情况等。     

A general systems approach to suicide prevention: lessons from cardiac prevention and control

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.     

从医学人文角度看微创医疗中的危险因素

微创医疗是现代医学的一项新技术和新兴理念,由于具有创伤小、恢复快等特点而风靡全球,人们迷恋于微创技术的绝对化作用,关注的焦点也更多地是在微创技术自身的创新与改进,而对微创技术带给患者及麻醉的附加伤害和危险却很少问津,当今微创医疗技术发展的基础在于直面问题和解决问题,用技术自身发展解决技术缺陷问题,用人文理念改善和解决医学的人性问题。成功的微创技术是多学科协助的结果,务必认清医学的仁学特性,坚持微创发展的人性化方向,科学规避微创中的危险因素,为微创技术的可持续发展奠定基础。     

微创神经外科发展的思考

神经外科的发展历史就是一个不断追求微创的过程。微创神经外科狭义的理解,更多侧重于微创技术手段的应用;而广义的理解,则是指微创理念。微创神经外科取得了很大的成就,但还有许多问题需要解决。在微创神经外科的实践和发展中,不仅应重视微创技术的应用,更要注意应用微创理念。     

GATA4在心肌肥厚中的作用

新近观点认为,病理性心肌肥厚是心肌细胞与冠脉血管不平衡生长的结果,即冠脉系统的生长不能够赶上心肌生长,从而导致心肌收缩障碍和心力衰竭。GATA4是其中一个重要转录调控因子,传统认为它与心肌收缩障碍和心力衰竭密切相关;现在研究发现GATA4是鼠类心脏血管生成的关键调控因子,在各种疾病导致的心肌肥厚中,冠脉血管生成有利于持续的心脏功能代偿,延缓心衰发生。由此看来,在心肌肥厚发病过程中,GATA4既是一个破坏者,也是一个保护者。     

Effect of drugs on the cardiac conditioned response of dogs

Dogs were conditioned to an anxiety response characterized by an increase in heart rate upon presentation of a musical tone. Meprobamate, chlordiazepoxide and diazepam effectively prevented the cardiac conditioned response. Phenobarbital and chlorpromazine were less effective. Amphetamine, 1.5 orally, also blocked the cardiac conditioned response. Atropine, meperidine, caffeine, imipramine and -methyl-dopa had no effect on the cardiac conditioned response. Morphine and methyl phenidate were clearly active only in doses producing marked side effects. Ethanol in relatively small doses was mildly effective.     

Exploring self‐esteem of Hong Kong Chinese adults cardiac diseases

Low self‐esteem appears to be both a vulnerability factor for cardiac diseases and a result of cardiac diseases. Thus enhancing self‐esteem might facilitate recovery and/or help to prevent recurrence. Since some evidence suggests that self‐esteem might even serve as an important gauge of cardiac rehabilitation, it is therefore important to know more of the construct of self‐esteem to enable the planning of a more promising rehabilitation process. This paper explores the source and basis of the self‐esteem of Hong Kong Chinese with cardiac diseases. One hundred and fifty‐two adults with cardiac diseases and 146 adults not suffering from any major illness participated in this study. The Adult Source of Self‐Esteem Inventory (ASSEI) (Elovson & Fleming, 1989), open‐ended questions on self‐evaluation, and interviewing were the major procedures used to identify the sources and basis of the self‐esteem of persons with and without cardiac diseases. The subjects' important life aspects were identified through interpreting their responses to open‐ended questions and interviews. Moreover, a structured questionnaire on their subjective perceptions of importance and satisfaction in different life areas was used to identify the relationships between discrete self‐concept variables. Factor analysis of their responses to the 20 ASSEI items revealed four factors, namely, Interpersonal Relationship, Personal Quality, Physical Self, and Personal Achievement. We also examined and compared the means and ranks of the ASSEI items as indicated by the subjects. Content analysis of open‐ended questions further confirmed the self‐esteem domains of persons with cardiac diseases. The discrepancy of ideal‐actual physical abilities was found to be more prominent in the cardiac group. It was also found that family is an important entity to Chinese individuals with cardiac diseases. Implications of the findings to rehabilitation of persons with cardiac diseases were also discussed.     

Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing.     

Should a school honor a student's DNR order?

Physicians first present the case of a sixteen-year-old cardiac patient who has refused a heart transplant and cardiac resuscitation. Her family and physicians accept the decision. The family has asked the school system to honor her do not resuscitate order if she goes into cardiac arrest in school The school system has refused to do so. Following the case presentation, a lawyer, a physician/ethicist, and an educator consider the important issues raised by this ongoing case.     

Cardiac and behavioral responses to rocking stimulations in one- and three-month-old infants

Cardiac and behavioral reactions to lateral rocking stimulations were analysed at two different ages (1 and 3 months) and at two speeds of motion for the younger infants. Sixteen 1- and 3-mo.-old infants received 12 10-sec. trials of four complete cycles of vestibulokinesthetic stimulation (rapid rocking) and another group of 10 1-mo.-olds received one complete cycle in the same time period (slow rocking) provided by a motorized cradle. Stimulations were given when infants were in an alert state. Rapid and slow rocking induced similar cardiac responses in younger infants; these responses varied according to the type of motor reaction observed at stimulus onset. Cardiac acceleration was shown with motor activation and cardiac deceleration with motor quieting. In 3-mo.-olds, cardiac deceleration appeared with both types of motor reaction. A strong link between cardiac and behavioral responses in younger infants may prevent the occurrence of the usual simple cardiac index of orienting (heart-rate deceleration). In older infants, cardiac deceleration to rocking stimulation appeared even when it produced concomitant behavioral arousal. Vestibulokinesthetic stimulation is interpreted as having an important homeostatic effect on the young organism.