胃镜检查诱发心脏骤停抢救成功1例报告

胃镜检查诱发心脏骤停抢救成功１例报告王富红，宋建侠，花奎岭患者男，５５岁。因上腹部持续性疼痛伴饱胀、纳差而行胃镜检查。胃镜检查前体检及心电图均正常。既往身体健康。否认有心脏病史。检查前用２％利多卡因作咽喉部喷雾局麻２次，约１０分钟后行胃镜检查，用日产...     

咪唑安定联合芬太尼在无痛胃镜检查中的应用

目的探讨咪唑安定联合芬太尼在胃镜检查中的应用效果及安全性。方法随机选择在惠州市中心人民医院胃镜室接受胃镜检查的400例患者，将其分为对照组（m=200）和麻醉组（m=200）。对照组患者咽部经喷雾利多卡因局麻后，常规进行胃镜检查；麻醉组患者咽部局麻后，静脉注射咪唑安定（0．05mg/kg）和芬太尼（0．5mg），使患者进入睡眠状态后立即行胃镜检查。两组患者在胃镜检查中均监测血压、心率、指脉搏血氧饱和度，观察检查中患者的反应以及操作时间和成功率，并在检查后询问患者的感受。结果在胃镜检查中，麻醉组患者心率和收缩压均较对照组低（P〈0．05），两组指脉搏血氧饱和度差异无显著性（P〉0．05），麻醉组不良反应发生率明显低于对照组，感觉难受和不适患者所占的比例较小（2％），感觉尚可和舒适的比例较大（98％），对照组则相反，而麻醉组检查成功率、操作时间与对照组比较差异无统计学意义。结论咪唑安定联合芬太尼进行胃镜检查安全、舒适、有效。     

胃镜检查诱发心肌梗死二例

我们开展胃镜检查２０年来，共发现２例检查诱发心肌梗死意外。例１：男，６１岁，因上腹部不规律隐痛１年多，于１９８９年行胃镜检查。患者无高血压及心脏病史。胃镜检查前检测血压、心电图均正常。常规局麻，采用OlympusGIFK１０型胃镜，常规检查插镜顺利，当胃镜行将进入贲门区时，患者呈痛苦貌，大汗，面色苍白，呼吸急促。急速退镜，查心电图示：急性前间壁心肌梗死，经积极抢救治疗，患者于２０d后康复出院，至今健在。例２：女，７２岁，因间断性剑突下烧灼不适１月余于１９９９年行胃镜检查。患者有阵发性胸闷、心前区疼痛史１年…     

270例胃镜检查局麻方法比较

２７０例胃镜检查局麻方法比较戴建宜，程同霞丁卡因与利多卡因是麻醉剂，本文总结２７０例胃镜检查病人在术前准备中用三种方法比较丁卡因与利多卡因作表麻的不同效果。材料和方法对象：１９９２年７月到１９９２年１１月２７０例门诊胃镜检查病人，男性１６２例，女性１...     

胃镜检查前患者自发意外事件临床分析

胃镜检查前出现对局麻药物过敏致喉头水肿甚至过敏性休克死亡,检查过程中出现心跳骤停等严重并发症已有一些报道,已引起内镜工作者们的高度重视.然而,与胃镜检查操作过程没有任何关系、发生在拟行胃镜检查前数分钟至数十分钟内的严重不良事件少见报道.我科自开展胃镜检查以来的20余年中,共遇到3例发生在胃镜检查前患者自发出现的严重不良事件.为提高对胃镜检查前发生的与胃镜检查无任何关系的不良事件的认识,减少医患纠纷,本文对这3例意外事件报道如下.     

老年患者对咽部局麻加静脉麻醉无痛胃镜检查的安全性

目的分析老年患者在咽部局麻加静脉麻醉无痛胃镜检查的不良反应与临床指标。方法选取2015年4月~2016年2月来我院消化内科就诊并接受胃镜检查的老年患者132例作为本次实验的研究对象,根据自愿以及随机的原则,将其分为研究组与对照组,各66例,对照组患者采取常规的胃镜进行检查,研究组则为患者提供无痛胃镜进行检查,对两组患者的临床指标以及不良反应进行比较。结果检查期间,研究组MAP以及HR指标明显优于对照组,差异有统计学意义(P0.05)。通过比较后得知,研究组恶心、呛咳以及躁动的发生率明显低于对照组,差异有统计学意义(P0.05)。结论老年患者在咽部局麻加静脉麻醉无痛胃镜检查的安全性较高,值得临床推广与应用。     

心理疗法辅助老年患者纤维胃镜检查的护理干预

胃镜检查是目前诊断上消化道疾病最常用的方法，但在检查前，很多患者，特别是老年患者会感到一定程度的紧张、担心、疑虑，以往医护人员只重视疾病的诊断、治疗，而忽视护理这一重要环节，使许多老年患者害怕行胃镜检查而延误了疾病的诊断。本文为使老年患者以最佳状态进入胃镜检查，采取最有效的关爱和心理干预，取得了较好的效果。     

小剂量咪唑安定在胃镜检查术中的应用

近期，我们将小剂量咪唑安定用于胃镜检查术，镇痛效果满意。现报告如下。 资料与方法：拟行胃镜检查术的患者80例，年龄20-40岁，ASAⅠ或Ⅱ级，排除肝、肾功能不全，精神疾病，听力障碍、消化道大出血，凝血功能异常者。将患者随机分为观察组与对照组各40例，其一般资料具有可比性。胃镜检查术均由同一操作熟练的医师施行。患者术前禁食、     

胃镜检查致阿-斯综合征1例报告

患者男性,81岁,因上消化道钡餐透视怀疑胃癌,行纤维胃镜检查术。患者既往有高血压病史5年,术前测血压135/85 mmHg。查血常规、肝功能、生化,结果均正常。心电图示:窦性心律,左室肥大。口服利多卡因胶浆局麻后,行纤维胃镜检查,手术顺利,术中无明显不良反应,退出胃镜后约1min,患者突然意识丧失,四肢抽搐。测血压60/45 mm Hg,心律28次/min,律不齐。心电图示:窦性+室性逸搏心律,ST—T显著改变。考虑阿-斯综合征。立即给阿托品1mg静推,吸氧等一系列抢救。患者神志转清,血压正常,收住病房治疗。     

局麻下经胸腔镜胸膜活检效果分析

目的目的为局麻下行经胸腔镜活检提供依据。方法对36例胸膜疾病患者行胸腔镜胸膜活检,于两个不同部位分别取活检2-4次,一个部位行局麻后取活检组织,另一部位于非局麻下取活检组织,观察术中患者疼痛情况及心率、呼吸变化。结果局麻后取活检组织时患者的胸膜疼痛程度明显轻于非局麻下取活检,肺膨胀发生率明显低于非局麻下取活检,心率、呼吸均无明显变化。结论局麻下经胸腔镜局麻胸膜活检术效果确切,可减少因疼痛而继发肺膨胀对胸腔镜手术的影响。     

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.