后退式旋切导管治疗冠状动脉阻塞性病变的初步报告

目的评价后退式旋切导管(PAC)治疗冠状动脉病变的有效性和安全性.方法 55例冠状动脉病变选用PAC导管治疗,其中17例为支架内再狭窄病变,应用定量冠状动脉造影评价即刻和近期疗效.结果 55例患者手术成功率为95%,PAC导管使血管最小管腔直径从(1.07±0.51)mm 增加至(1.98±0.39) mm,并发症包括血管内膜撕裂7例,完全闭塞1例,6个月随访造影最小管腔直径为(1.97±0.67)mm,造影再狭窄率为27%.首次介入治疗病变与支架内再狭窄病变即刻与近期疗效相同,向心性病变较偏心性病变有更好的即刻效果.结论 PAC旋切导管能安全有效去除冠状动脉内粥样斑块,具有较高的即刻和近期有效率.     

旋切刀外径与病变特征对后退式旋切导管疗效的影响

目的　探讨旋切刀外径与病变特征对后退式旋切导管 (PAC)治疗冠状动脉病变即刻与近期疗效的影响。方法　 5 5例冠状动脉病变选用PAC导管治疗 ,其中 17例为支架内再狭窄病变 ,应用定量冠状动脉造影评价即刻和近期疗效。结果　 5 5例患者PAC导管的器械成功率为 95 % ,PAC导管最小管腔直径增益 (0 91± 0 5 9)mm ,主要并发症包括血管内膜撕裂 7例、完全闭塞 1例 ,6个月随访造影再狭窄率为 2 7%。使用 2 4mm导管较 2 0mm导管有较大的即刻血管内腔拓宽 ,随访时血管腔直径丢失较少 (但P >0 0 5 )。PAC导管对向心性病变较偏心性病变有更好的即刻效果 ,但 6个月再狭窄率相近 (2 4 %对 30 % ,P >0 0 5 )。结论　PAC导管直径、血管病变特征可能影响PAC导管即刻和近期疗效。     

经皮切割球囊成形术治疗支架内再狭窄的研究

目的　研究切割球囊成形术对治疗支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊组 (38例 )和普通球囊治疗组 (31例 )。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。观察随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率均为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 .7± 2 .3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组(15 %∶38%及 18%∶4 2 % ,P <0 .0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1.72±0 .5 2 )mm和 (1.15± 0 .5 4 )mm ,随访 3个月及随访终点时切割球囊组的血管直径晚期丢失分别为 (0 .2 6± 0 .0 5 )mm(3个月 )及 (0 .38± 0 .0 6 )mm ,同时的普通球囊组丢失值分别为 (0 .78± 0 .19)mm(3个月 )及 (0 .89± 0 .16 )mm。结论　切割球囊成形术治疗老年冠心病患者支架内狭窄效果可靠 ,安全 ,容易操作 ,再狭窄率低     

经皮切割球囊成形术治疗老年冠心病患者冠状动脉支架内再狭窄69例分析

目的　观察切割球囊对老年冠心病患者支架内再狭窄的即刻和 6个月时治疗效果。　方法　 6 9例支架内再狭窄患者分配到切割球囊 (38例 )和普通球囊 (31例 )治疗组。球囊扩张前及扩张后即刻 ,用定量冠状动脉造影和冠状动脉内超声测定相关参数。随访 6个月时临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死、需要冠状动脉旁路移植或再介入治疗。　结果　两组的手术成功率为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 7± 0 3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组 (分别为 15 %对 38%及 18%对4 3% ,均为P <0 0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1 72± 0 5 2 )mm和 (1 15± 0 5 4 )mm ,而 3和 6个月后切割球囊组的血管直径晚期丢失值为 (0 2 6± 0 0 5 )mm及(0 38± 0 0 6 )mm ,普通球囊组丢失值为 (0 78± 0 19)mm及 (0 89± 0 16 )mm(均为P <0 0 0 1)。　结论　切割球囊治疗老年冠心病患者支架内再狭窄效果可靠、安全 ,容易操作 ,再狭窄率低 ,易于被患者接受 ,是一个较有前途的治疗手段。     

冠状动脉支架再狭窄预测因素的探讨

目的　为探讨冠状动脉支架再狭窄的预测因素。方法　收集我院行冠状动脉支架术并随访冠脉造影的病例 6 2例 ,按冠脉造影结果分为支架再狭窄组 33例 ,无再狭窄组 2 9例 ,并分别比较两组病人的临床特点、血管病变特征及术后即刻血管并发症。结果　再狭窄组病人合并有糖尿病史比例较无狭窄组明显增多 (30 3%∶6 9% ,P <0 0 5 ) ;再狭窄组前降支及开口病变比例均明显高于无狭窄组 (81 8%∶5 9 4% ,P <0 0 5 ;2 1 7%∶6 3% ,P <0 0 5 )。再狭窄组的长支架 (≥ 30mm)、单支血管多支架及小支架比例均明显高于无再狭窄组 (2 2 7%∶5 0 % ,P <0 0 1;40 5 %∶15 6 % ,P <0 0 5 ;2 7 2 %∶2 5 % ,P <0 0 5 ) ;再狭窄组病人的支架边端残余狭窄≥ 2 0 %的比例明显高于无再狭窄组(2 4 3%∶3 1% ,P <0 0 5 )。结论　冠状动脉支架术病人合并糖尿病史、前降支、开口病变、长支架、单支血管多支架、小支架及术后即刻支架残余狭窄可能是术后再狭窄的预测因素     

切割球囊对冠状动脉支架内再狭窄的近期及远期疗效

目的　比较切割球囊成形术 (CBA)与普通球囊成形术 (POBA) ,对支架内再狭窄病变的近、远期血管造影结果 ,评价CBA对支架内再狭窄病变的有效性。方法　 16 6例支架内再狭窄PTCA病人 ,按所用球囊不同 ,分为CBA组 (98例 ) ,POBA组 (6 8例 ) ,分别比较术后即刻及远期定量冠脉造影最小血管径 (MLD)、狭窄度及再狭窄率。结果　术后即刻MLD及狭窄度两组差别无显著性 ,CBA组最大扩张压明显为低 [(8 3± 0 9)atm比 (14 7± 4 6 )atm ,P <0 0 5 ]。追踪造影结果 ,CBA组MLD明显大于POBA组 [(1 7± 0 5 )mm比 (1 4± 0 5 )mm ,P <0 0 5 ]、狭窄度明显小于POBA组 [(36± 13) %比(46± 15 ) %,P <0 0 1],再狭窄率低于POBA组 (2 6 1%比 4 0 3%,P <0 0 5 )。结论　CBA的低压扩张效果在支架内再狭窄病变亦是有效的 ,并且获得了较POBA低的再狭窄率 ,值得进一步探讨总结。     

球囊血管成形术治疗冠脉支架内再狭窄21例观察

目的　观察单纯采用球囊扩张血管成形术 (PTCA)方法治疗支架内再狭窄的近期疗效。方法　应用与支架直径相同的球囊行支架内扩张治疗 2 1例支架内再狭窄的病人 ,随访半年临床疗效。结果　治疗病变 2 8处。第 1次介入治疗前后血管内径分别为 ( 1 12± 0 71)mm∶( 3 12± 0 87)mm ,第 2次为 ( 0 91± 1 0 5 )mm∶( 3 0 1±0 82 )mm。 2次治疗后的支架内径无显著差别 (P >0 0 5 )。半年随访仅见 3处病变 ( 10 % )再次出现支架内狭窄。结论　单纯应用球囊扩张血管成形术治疗半年内发生的支架内再狭窄 ,可达到理想的临床疗效。     

104例冠状动脉血管内支架置入术后的血管造影随访研究

目的探讨影响冠状动脉内支架植入术后再狭窄的因素。方法对2001-2003年成功接受冠状动脉内支架植入术后患者进行定量冠状动脉造影,分析冠状动脉狭窄程度、病变长度及血管直径参数的影响。结果104例病人的138处病变植入152个支架,再狭窄率为35.5%。再狭窄组病变血管植入支架的长度(22±6)mm明显大于非再狭窄组(18±6)mm,(P<0.001)。短支架的再狭窄率显著小于长支架及植入多个支架者(P<0.01)。再狭窄组直径小于3.0mm中小血管的比例明显多于非再狭窄组。BX支架的再狭窄率最高,达46%,Supra-G的再狭窄率最低,为10.5%。结论冠状动脉内支架植入术后再狭窄与支架长度、构型等因素有关,小血管内植入支架仍须慎重。     

冠心病并糖尿病患者使用药物支架与普通支架初步随访结果比较

目的 :观察药物支架在冠心病并糖尿病患者介入治疗的临床疗效。方法 :并发糖尿病的冠心病患者70例常规冠状动脉造影 ,进行经皮冠状动脉介入治疗 ,其中 32例置入雷帕霉素药物涂层支架 ,38例置入普通支架 ,术前术后常规使用阿司匹林和噻氯吡啶 ,术后进行随访。结果 :冠状动脉造影显示 2支以上血管病变占70 .5 6 % ,一共置入雷帕霉素药物涂层支架 5 4枚 ,普通支架 6 2枚 ,所有患者均获得成功。平均随访 (10 .2± 3.5 )个月 ,其中药物支架组复发心绞痛 9例 ,5例发生心肌梗死 ;普通组复发心绞痛 2 0例 ,8例发生心肌梗死 ,所有患者均再次进行冠状动脉造影 ,药物支架内发生再狭窄 4例 ,普通支架内发生再狭窄 2 0例 ,均进行了靶病变重建术。结论 :药物涂层支架对冠心病并发糖尿病患者近期和远期疗效确切 ,能减少再狭窄的发生     

冠状动脉支架内再狭窄的相关因素分析

目的　探讨可能引起支架内再狭窄的临床及支架相关因素。方法　选择随访的冠状动脉造影资料较全的 137例支架术后患者。依冠状动脉造影结果将其分为支架内再狭窄组和非再狭窄组 ,然后对可能引起支架内再狭窄的临床和支架相关因素在两组中进行对比分析。结果　两组年龄、吸烟、饮酒等情况相似 ,高血压病及糖尿病的发生率差异无显著性。再狭窄组术前靶血管狭窄程度较非再狭窄组重 ,分别为 91%± 7%和 88%± 14% (P =0 0 33)。再狭窄组所选支架的平均直径较非再狭窄组的小 ,分别为 (3 19± 3 90 )mm和 (3 6 3± 0 30 )mm(P =0 0 0 5 ) ;支架长度却较非再狭窄组的长 ,分别为 (2 1 91± 8 98)mm和 (18 2 0± 6 0 7)mm(P =0 0 11)。再狭窄组的支架扩张总时间明显短于非再狭窄组 ,分别为 (2 2 74± 19 5 6 )s和 (2 9 12± 2 5 72 )s(P =0 0 2 6 )。两组的支架扩张次数和扩张压力差异无显著性。结论　本文资料提示年龄、吸烟、饮酒、高血压病、糖尿病、支架扩张次数及压力的大小等因素对支架内再狭窄无明显影响 ,但术前靶血管狭窄程度和支架长度与支架内再狭窄呈正相关 ,而支架直径和支架扩张总时间则呈负相关。     

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.     

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.     

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.     

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.