内镜下黏膜剥离术中使用碘伏维持镜头及透明帽清晰度效果观察

[目的]探讨在内镜下黏膜剥离术(ESD)中,使用碘伏棉签擦拭镜头及透明帽以维持其清晰度的效果。[方法]选取2017-06-2017-08期间,接受ESD治疗且病灶直径≥2 cm的消化道早期癌或癌前病变的101例患者,随机分为观察组(51例)和对照组(50例)。观察组先使用碘伏棉签擦拭镜头及透明帽再进行手术,术中电刀产生烟雾致镜头及透明帽模糊用内镜注水功能冲洗不能解决时,退镜再用碘伏棉签擦拭;对照组术中镜头及透明帽模糊时使用0.9%氯化钠溶液棉签。对比分析2组擦拭方法维持镜头及透明帽清晰度的时间及手术时间内擦拭次数。[结果]观察组手术时间明显少于对照组,差异有统计学意义(P0.05);观察组、对照组在总时间为≤30 min的手术中维持的清晰度时间比较差异无统计学意义,但在30 min的手术中,观察组较对照组维持的清晰度时间更长;观察组术中退出内镜擦拭的次数少于对照组的次数。[结论]ESD中,用碘伏棉签擦拭可有效预防镜头及透明帽模糊,减少退镜擦拭镜头及透明帽次数,有利于手术连续、顺利进行,缩短手术时间,降低手术风险,值得推广。     

透明帽在消化内镜诊治中的应用

随着各种内镜治疗附件的应用,镜下止血、息肉切除、异物取出、支架置放、圈套器结扎等内镜治疗技术逐渐成熟.透明帽作为治疗附件在内镜诊断及治疗中应用广泛,包括食管上端及锐利异物的取出、协助结肠镜进镜、提高放大内镜成像效果以及在内镜下黏膜切除(endoscopic mucosal resection,EMR)、内镜黏膜下剥离(endoscopic submucosal dissection,ESD)、食管静脉曲张套扎(endoscopic variceal ligation,EVL)中应用.现将透明帽在消化内镜诊治中的作用做一综述.     

透明帽结合胃镜取物术治疗消化道异物的疗效及其安全性

目的探讨透明帽结合胃镜取物术治疗消化道异物的疗效及其安全性。方法选取2014年6月至2017年6月西安医学院第二附属医院收治的消化道异物患者100例,依据治疗方法分为透明帽组和常规组,每组50例,常规组给予胃镜取物术治疗,透明帽组在此基础上辅加透明帽。结果透明帽组和常规组胃镜入消化道时(T1)、取异物时(T2)的心率(HR)、平均动脉压(MAP)明显高于术前(T0),透明帽组T1、T2时刻的HR、MAP明显低于常规组,差异有统计学意义(P0.05);透明帽组视野优良率、手术成功率明显高于常规组,透明帽组手术时间、并发症发生率明显低于常规组,差异有统计学意义(P0.05)。结论透明帽结合胃镜取物术治疗可有效改善消化道异物患者术中应激反应和提高视野优良率,有利于提高患者的治疗效果,且安全性更好,值得临床进一步推广。     

透明帽在食管上段异物取出中的应用及护理体会

食管异物为常见急症,若处理不当,可引起严重并发症[1].食管上段异物在食管异物中较为多见,常规内镜下行异物取出时常因操作视野暴露欠佳,较为困难.2010年至2011年我院在胃镜下采用透明帽辅助的方法对食管上段异物进行取出处理,效果良好,现将护理体会小结如下.     

钛夹牙线牵引辅助技术在内镜黏膜下剥离术中护理体会

正内镜黏膜下剥离术(endoscopic submucosal dissection)已经用于胃癌癌前病变以及早期胃癌的标准治疗,在治疗较大的上消化道黏膜病变时,有时需要一些辅助手段进行黏膜下层的显露,如牙线牵引术比以往的内镜操作在镜头前加用透明帽更能良好的暴露视野,使视野更加清晰减少术中出血穿孔     

消化内镜前端透明帽的临床应用进展

内镜前端透明帽在内镜诊断和治疗中发挥了重要的作用,包括透明帽辅助黏膜下肿瘤结扎术、内镜下黏膜切除术、异物取出、内镜下静脉曲张结扎术和硬化剂注射术、内镜黏膜下剥离术、经口内镜下肌切开术、经内镜隧道式黏膜剥离术等。本文就不同类型透明帽在消化内镜诊疗中的作用作一综述。     

透明帽在消化内镜诊疗中的应用进展

随着消化内镜诊疗技术的快速发展,各种内镜治疗附件的应用越来越普遍。透明帽作为最广泛应用的治疗附件之一,在内镜诊断及治疗中发挥了重要的作用,其中包括透明帽在内镜下黏膜切除术、内镜黏膜下剥离术、内镜下静脉曲张结扎术及硬化剂注射术、内镜诊断及取出食管入口细小异物等中的应用。本文现将透明帽在内镜诊治中的应用作一概述。     

新型内镜扩张球囊在上消化道异物取出中作用研究

目的 探讨一种新型内镜扩张球囊取出上消化道异物的安全性并评估其疗效.方法 收集2018年7 月至2019年3 月收治于苏州大学附属第一医院经传统方法取出失败的10例上消化道异物患者的临床资料,其中食管异物8例,胃石2例,内镜扩张球囊辅助胃镜取出异物,观察操作成功率、异物取出所用时间、视野清晰度、黏膜损伤及并发症等情况....     

内镜下应用改良透明帽治疗食管狭窄处异物的疗效观察

目的 探讨内镜下应用改良透明帽治疗食管狭窄处异物的疗效.方法 回顾性总结58例内镜下应用改良透明帽治疗食管狭窄处异物患者的临床资料,通过分析异物的类别、滞留部位、内镜下治疗状况、治疗时机及并发症的发生情况,评价改良透明帽的应用价值.结果 58例中,54例食管狭窄处有异物的患者得到成功治疗,成功率为93.1％;治疗并发症发生率为5.2％ （3/58）,主要并发症为出血;治疗过程中无一例死亡.结论 内镜下用改良透明帽取出食管狭窄处异物安全、有效,值得临床推广使用.     

电子胃镜加用不同型号透明帽在食管异物取出术的效果研究

目的探究电子胃镜加用透明帽在食管异物取出术中的应用效果。方法选取接受治疗的食管异物患者126例作为研究对象,依据异物取出方式不同进行分组,对照组采用电子胃镜,试验组采用在透明帽辅助下应用电子胃镜,观察两组患者异物取出时耐受性、取出所需时间、术野清晰度、成功率、并发症等。结果试验组患者耐受率为98. 41%,对照组患者耐受率为87. 30%(P 0. 05)。试验组上段与中段及下段食管异物患者异物取出所需时间分别为16. 25±2. 05min,18. 65±2. 14min,22. 26±2. 05min,均明显小于对照组(P 0. 05)。试验组患者异物取出成功率为100. 00%明显大于对照组的85. 29%,对比差异有统计学意义(P 0. 05)。试验组63例患者异物取出后并发症发生率为3. 17%,显著小于对照组的12. 70%,对比差异有统计学意义(P 0. 05)。结论行食管异物取出术中,在不同型号透明帽辅助下应用电子胃镜,有助于提升手术操作成功率,同时降低基于操作而引发的并发症。     

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.     

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.     

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.