胰管支架预防高危ERCP术后胰腺炎的临床分析

目的 观察胰管支架置人预防高危患者内镜逆行胰胆管造影（ERCP）术后胰腺炎及高淀粉酶血症的效果.方法 将确定有ERCP指征并符合纳入标准的72例高危患者按照随机数字表法分为胰管支架组和对照组,每组36例.比较两组术后3h、24 h血清淀粉酶水平及高淀粉酶血症、急性胰腺炎、重症胰腺炎的发生率.结果 胰管支架组术后3h和术后24 h血淀粉酶值分别为（128.68±173.35） U/L和（92.41±88.44） U/L,均低于对照组（432.37 ±515.20） U/L和（465.89±736.54） U/L,差异有统计学意义（P＜0.05）;胰管支架组术后高淀粉酶血症、急性胰腺炎、重症胰腺炎的发生率分别为5.6％、2.8％、0,对照组为22.2％、16.7％、11.1％,两组比较差异有统计学意义（P＜0.05）.结论 胰管支架置入能明显降低高危患者ERCP术后高淀粉酶血症、急性胰腺炎及重症胰腺炎的发生率.     

胰管支架对伴有危险因素的患者发生ERCP术后胰腺炎的预防作用

背景:胰腺炎是ERCP的主要并发症,多个危险因素累加会增加发生风险。研究显示临时胰管支架可降低ERCP术后胰腺炎(PEP)发生率。目的:探讨胰管支架置入预防伴有危险因素的患者发生PEP的有效性和安全性。方法:选取2013年11月—2016年11月安徽省淮北市人民医院接受ERCP且具备1项及以上PEP相关危险因素的患者,随机分为胰管支架置入组(观察组)和未置入胰管支架组(对照组)。比较两组患者术后4 h、24 h、48 h血淀粉酶水平和PEP发生率。结果:共297例患者纳入研究,其中观察组147例,对照组150例。两组患者性别、年龄和ERCP疾病谱等均无明显差异(P0.05)。观察组PEP发生率显著低于对照组(6.1%对16.0%,P0.05),术后4 h、24 h、48 h血清淀粉酶水平显著低于相应对照组(P0.05),但两组术后高淀粉酶血症发生率无明显差异(59.2%对54.7%,P0.05)。结论:预防性胰管支架置入可降低伴有PEP危险因素患者的PEP发生率,尤其可降低PEP的严重程度,但高淀粉酶血症的发生率并未下降。     

清胰汤灌肠对ERCP术后胰腺炎及高淀粉酶血症发生的预防

[目的]探讨清胰汤保留灌肠预防内窥镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)致术后胰腺炎(postoperative pancreatitis,PEP)及高淀粉酶血症的临床疗效.[方法]将73例拟行ERCP术的患者随机分为对照组36例,中药组37例,对照组给予西药常规治疗,中药组在此基础上加用清胰汤保留灌肠.检测2组患者术前、术后血清淀粉酶水平,观察2组术后高淀粉酶血症和PEP的发生情况、血清淀粉酶恢复正常的时间和临床症状缓解的时间.[结果]中药组ERCP术后高淀粉酶血症和PEP发生率明显低于对照组,血清淀粉酶恢复正常的时间和临床症状缓解的时间亦明显短于对照组,2组差异有统计学意义(P＜0.05);中药组ERCP术后不同时间血清淀粉酶水平明显均低于对照组,2组差异有统计学意义(P＜0.05,P＜0.01).[结论]ERCP术后患者在西药常规治疗基础上加用清胰汤保留灌肠对预防ERCP致PEP及高淀粉酶血症发生的效果明显优于单用西医治疗.     

胰管支架预防困难胆管插管ERCP术后急性胰腺炎的前瞻性研究

目的探讨经内镜逆行胰胆管造影术（ERCP）中置入胰管支架对困难胆管插管患者ERCP术后急性胰腺炎（PEP）的预防效果。方法120例行ERCP诊疗发生困难胆管插管的患者采用随机数字表法随机分成2组,一组术中置入胰管支架（观察组）,另一组未置入（对照组）,对比分析2组ERCP术后高淀粉酶血症、PEP的发生率以及术后患者腹痛评分结果。结果观察组发生ERCP术后高淀粉酶血症15例（27．3％）,PEP5例（8．3％）,无一例重症PEP,术后患者腹痛评分（3．82±1．48）分;对照组发生ERCP术后高淀粉酶血症18例（30．0％）,PEP14例（23．3％）,重症PEP2例（3．3％）,术后患者腹痛评分（4．78±1．93）分。2组ERCP术后高淀粉酶血症发生率比较,差异无统计学意义（P〉0．05）;观察组PEP、重症PEP发生率以及术后患者腹痛评分均明显低于对照组,差异均有统计学意义（P〈0．05）。结论置入胰管支架可以有效降低胆管插管困难所引起的PEP的风险,并能有效缓解患者术后疼痛,具有较好的临床应用价值。     

胰管塑料支架在ERCP选择性胆管插管困难时的应用研究

[目的]探讨胰管塑料支架在内镜逆行性胰胆管造影术(ERCP)选择性胆管插管困难时的应用。[方法]将在ERCP中选择性胆管插管困难的104例患者分为无胰管塑料支架组、胰管塑料支架组,观察并比较2组选择性胆管插管成功率,术后胰腺炎、高淀粉酶血症和腹痛等并发症的发生率。[结果]胰管塑料支架组与无胰管塑料支架组选择性胆管插管成功率比较差异无统计学意义(P0.05),胰管塑料支架组术后胰腺炎、高淀粉酶血症和腹痛等并发症的发生率较无胰管塑料支架组显著性降低(P0.05~0.01)。[结论]对ERCP选择性胆管插管困难的患者预防性放置胰管塑料支架,虽然未能提高胆管插管的成功率;但是可明显降低术后胰腺炎、高淀粉酶血症和腹痛并发症的发生率。     

双导丝技术联合胰管支架预防经内镜逆行胰胆管造影术后急性胰腺炎的初步研究

初步探讨双导丝技术联合胰管支架对经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)后急性胰腺炎（post-ERCP pancreatitis, PEP）的预防效果。采用随机数字表法,将纳入的拟行ERCP的胆总管结石患者分为试验组和对照组,试验组采用双导丝技术联合胰管支架,对照组采用传统胆管选择性插管,对比分析两组插管时间、PEP及术后高淀粉酶血症发生率和术中、术后出血情况。2016年1月—2018年12月共入组80例患者,试验组40例,对照组39例。试验组插管时间为（384±102）s, 2例发生高淀粉酶血症,无术后胰腺炎、术中术后出血发生。对照组插管时间为(427±115)s,6例发生高淀粉酶血症,3例发生术后胰腺炎,1例发生术中出血。试验组和对照组PEP发生率分别为0和 7.7%（3/39）,术后高淀粉酶血症发生率分别为5.0%(2/40)和15.4%（6/39）,差异均有统计学意义（P均<0.05）。双导丝技术联合胰管支架可以成功进行胆管选择性插管,同时有效预防PEP发生。     

奥曲肽联合置入胰管支架对胆总管结石伴插管困难患者ERCP术后胰腺炎的预防作用

[目的]旨在探讨奥曲肽联合置入胰管支架预防胆总管结石伴插管困难患者ERCP术后胰腺炎的效果。[方法]选取本院内镜中心于2014年1月~2016年6月间收治行ERCP术胆总管结石伴插管困难患者50例作为研究对象,随机数字表法将患者分为观察组25例和对照组25例。行EPCP术后,对照组患者接受术后抑酸、抑酶、抗炎、补液、对症支持治疗,在此基础上,观察组患者接受术后静脉泵入奥曲肽注射和术中后置入胰管支架治疗。观察和比较2组患者症状消失时间、住院时间和治疗费用。观察和比较2组患者术后胰腺炎(PEP)、高淀粉酶血症发生情况。测定和比较2组患者术后3h和术后24h血清淀粉酶(AMS)表达、降钙素(PCT)和血清C反应蛋白(CRP)表达。[结果]对照组患者PEP发生率44%和高淀粉酶血症发生率28%明显高于观察组患者12%和4%,差异有统计学意义(P0.05)。术后3h,对照组患者血清AMS表达(1388±468)U/L明显高于观察组患者AMS表达(364±424)U/L,差异有统计学意义(P0.05),2组患者PCT和CRP表达差异无统计学意义(P0.05);术后24h,2组患者AMS表达差异无统计学意义(P0.05),观察组患者PCT和CRP表达低于对照组患者,差异有统计学意义(P0.05)。观察组患者治疗费用高于对照组患者,住院时间低于对照组患者,差异无统计学意义(P0.05),症状消失时间低于对照组患者,差异有统计学意义(P0.05)。[结论]奥曲肽联合置入胰管支架可显著降低胆总管结石伴插管困难患者ERCP术后PEP及高淀粉酶血症发生率,值得临床推广。     

大黄保留灌肠预防逆行胰胆管造影术后胰腺炎和高淀粉酶血症的临床研究

[目的]观察生大黄保留灌肠对逆行胰胆管造影(Endoscopic Retrograde Cholangio-Pancreatography,ER-CP)术后并发胰腺炎(Post-ERCP-Panreatitis,PEP)和高淀粉酶血症的的预防作用。[方法]选取2008年3月～2010年6月在我院消化科住院需行ERCP检查及相关治疗的患者共300例,随机分为2组。观察2组患者术前、术后6h血清淀粉酶水平,并评估ERCP术后胰腺炎和高淀粉酶血症发生率及预后。[结果]所有患者术前血淀粉酶均正常。ERCP术后6h血清淀粉酶水平,大黄组[(167.2±87.9)U/L]低于对照组[(234.5±214.3)U/L],2组比较差异有统计学意义(P<0.05);ERCP术后高淀粉酶血症的发生率,大黄组(8.3%)低于对照组(18.7%),2组比较差异有统计学意义(P<0.05);ERCP术后PEP的发生,大黄组(4.0%)低于对照组(6.0%),2组间差异无统计学意义(P>0.05)。[结论]ERCP术后应用大黄保留灌肠可有效降低ERCP术后高淀粉酶血症的发生率,但对术后胰腺炎的预防无统计学意义。     

联合应用质子泵抑制剂、生长抑素和加贝酯预防ERCP术后胰腺炎和高淀粉酶血症的临床研究

背景：急性胰腺炎和高淀粉酶血症是内镜逆行胰胆管造影术（ERCP）的主要并发症,术前用药对预防和减轻并发症的作用尚存争议。目的：探讨联合应用质子泵抑制剂、生长抑素和加贝酯对ERCP术后胰腺炎（PEP）和高淀粉酶血症的预防作用。方法：共纳入510例行ERCP的患者,随机分为加贝酯组、生长抑素组、联合治疗组（质子泵抑制剂＋生长抑素＋加贝酯）和安慰剂组。观察术后2h、12h和24h血清淀粉酶水平,评估PEP和高淀粉酶血症的发生率．并分析PEP和高淀粉酶血症的危险因素。结果：ERCP术后2h、12h、24h,联合治疗组、生长抑素组和加贝酯组血清淀粉酶水平显著低于安慰剂组（P〈0．05或P〈0．01）,联合治疗组血清淀粉酶水平亦显著低于生长抑素组或加贝酯组（P〈0．05）。ERCP胰管显影者的PEP和高淀粉酶血症发生率显著高于胆管显影者（P〈0．05）。单变量分析显示ERCP操作过程中胰管多次显影、导丝多次插入胰管、导丝辅助、反复插管以及操作中发生上腹疼痛为PEP和高淀粉酶血症的技术相关性高危因素。结论：ERCP术前后联合应用质子泵抑制剂、生长抑素和加贝酯可改善PEP和高淀粉酶血症的发生。     

吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的临床研究

目的 探讨吲哚美辛对ERCP术后胰腺炎和高淀粉酶血症的预防作用.方法 将拟施行ERCP手术的600例患者随机表法分为吲哚美辛组、奥曲肽组和安慰剂对照组,每组200例,观察其术前、术后24 h血清淀粉酶水平,并评估ERCP术后胰腺炎和高淀粉酶血症发生率及预后.结果 3组患者ERCP术前血清淀粉酶均为正常值.ERCP术后24h血清淀粉酶水平,吲哚美辛组[(101.3±77.7)U/L]低于奥曲肽组[(176.6±138.3)U/L]及对照组[(227.2±264.9) U/L],差异均有统计学意义(P=0.040,P=0.048);奥曲肽组低于对照组,但差异没有显著意义(P＞0.05).ERCP术后胰腺炎发生率,吲哚美辛组(2.5％)低于对照组(9.5％),差异有显著性意义(P=0.003);奥曲肽组(4.5％)低于对照组,但无统计学差异(P=0.05).ERCP术后高淀粉酶血症发生率,吲哚美辛组(5.5％)低于对照组(13.5％),差异有显著性意义(P=0.006);奥曲肽组(10.0％)低于对照组,但差异没有统计学意义(P＞0.05).结论 ERCP术前应用吲哚美辛可有效降低胰腺炎和高淀粉酶血症的发生率.     

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.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.