硝苯地平控释片对肝硬化患者门脉血流动力学影响的双功多普勒观察

目的 研究硝苯地平控释片对门脉高压的治疗作用。方法 以双功多普勒技术检测了３２例肝硬化门脉高压患者在用硝苯地平控释片３０ｍｇ１次／ｄ前后门脉血流动力学的变化。结果 用药后门静脉流速降低，充血指数上升；脾静脉流速、流量降低、肝动脉、脾动脉的阻力指数及脉动指数降低；肝总血流量增加；平均动脉压及心率无显著变化。结论 肝、脾动脉的阻力指数及搏动指数是门脉阻力的良好指标。硝苯地平控释片可通过如下机制降低门脉     

当归对肝硬化门脉高压影响的临床与实验研究

目的和方法：通过对胆管结扎肝硬化犬门脉系压力的直接测定，超声多普勒监测肝硬化患者的门脉血流，研究当归对肝硬化门脉血流动力学的影响。结果：（１）当归静脉给药，肝硬化犬的门静脉压（Ｐｐｖ）、嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著降低（Ｐ＜００５～００１），平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显变化（Ｐ＞００５）；（２）当归口服用药后（１０～１２周），肝硬化患者门静脉内径（Ｄｐｖ）、脾静脉内径（Ｄｓｖ）、脾静脉血流量（Ｑｓｖ）显著降低（Ｐ＜００５～００１），门静脉血流量（Ｑｐｖ）降低无显著意义（Ｐ＞００５）。结论：用药后，患者症状与肝功能（ＡＬＴ）部分好转，未见副作用。表明，当归为降低门静脉高压安全有效的药物     

丹参对门脉高压血流动力学影响的实验与临床研究

为研究丹参对肝硬化门脉血流动力学的影响，利用血管插管测定用药前后胆管结扎肝硬化犬门脉系统压力变化，超声多普勒监测肝硬化患者用药后门静脉系统血流动力的改变。结果：（１）丹参静脉给药可使肝硬化犬门静脉压（ＰＰＶ）、嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著降低（Ｐ＜０．０５～０．０１），而平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显变化（Ｐ＞０．０５）；（２）丹参长期口服（１０～１２周），可显著降低肝硬化患者（Ｃｈｉｌｄ－ＰｕｇｈＡ、Ｂ级）门静脉内径（ＤＰＶ）、脾静脉内径（ＤＳＶ）、门静脉血流量（ＱＰＶ）、脾静脉血流量（ＱＳＶ）（Ｐ＜０．０５～０．０１），并对患者乏力、厌食、腹胀及肝功能（ＡＬＴ）具有部分改善作用，未见副作用。本研究表明，丹参为安全有效的降低门静脉压力药物，值得对其做进一步研究。     

丹参等活血化淤中药对门脉高压血流动力学影响的临床与实验研究

目的探讨丹参、当归等及硝苯啶对门脉高压血流动力学的影响。方法采用血管插管测定胆管结扎肝硬化犬门脉系统压力变化；超声多普勒观测肝硬化患者门脉血流动力学变化。结果（１）静脉滴注丹参、当归后，肝硬化犬门静脉压（Ｐｐｖ）、嵌塞肝静脉压（ＷＨＶＰ）、肝静脉压力梯度（ＨＶＰＧ）显著降低（Ｐ＜０．０５～０．０１），平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显变化（Ｐ＞０．０５），硝苯啶则使Ｐｐｖ，ＷＨＶＰ，ＭＡＰ．ＨＲ显著降低（Ｐ＜０．０５）。（２）丹参、丹参＋硝苯啶．丹参＋水＋硝苯啶口服药１０－１２周，能显著降低肝硬化患者门静脉内径（Ｄｐｖ）、脾静脉内径（Ｄｓｖ）．门静脉血流量（Ｑｐｖ），脾静脉血流量（Ｑｓｖ）（Ｐ＜０．０５－０．０１，当归作用较弱。结论对比表明，丹参、当归等中药较硝苯啶对门脉压力作用为慢，但较持久，无副反应。     

当归对肝硬化门脉高压患者全身及门脉血液动力学的影响

为了解当归对肝硬化门脉高压的降压效果，对１１例肝硬化门脉高压患者在输注当归注射液期间（每分钟２０ｍｇ／ｋｇ体重）进行了全身及门脉血液动力学指标的观察。结果表明：静脉滴注当归注射液后，患者全身血液动力学无明显变化，门脉血液动力学则变化显著，表现为肝静脉嵌塞压（ＷＨＶＰ）和肝静脉压力梯度（ＨＶＰＧ）显著下降，门静脉和脾静脉血流量显著减少，但其降压效果与基础ＷＨＶＰ呈反比。提示当归可通过减少门静脉血流量而降低门脉压，但没有全身性副作用     

狗肝硬化门脉高压症血浆儿茶酚胺浓度变化的实验研究

本研究通过结扎狗胆总管形成肝硬化门脉高压症的动物模型，对模型成前后门静脉压力、肝静脉压力、门静脉血流量、肝动脉血流量、门静脉血管阻力，肝动脉血管阻力和门静脉、肝静脉、脉主动脉。下腔静脉四部位血浆儿茶酚胺浓度的变化进行了自身对照性对比研究。结果：①肝硬化形成后门脉压力明显增高，肝静脉嵌塞压也明显增高，门脉血流量减少而肝动脉血流量增加，门脉血管阻力增加而肝动脉血管阻力则下降，这些变化与人类肝硬化门脉高压症相同。②门静脉、肝静脉。腹主动脉和下腔静脉血浆去甲肾上腺素的含量均在门脉高压形成后明显增加。提示肝硬化时血浆去甲肾上腺素的增加可能参与门脉高压症的某些病理生理过程，并进一步支持用a受体阻滞剂降低门脉压力和门脉血管阻力，治疗肝硬化食道静脉曲张破裂出血或预防出血。     

微创治疗肝硬化食管胃底曲张静脉破裂大出血研究

食管胃底曲张静脉破裂是肝硬化门静脉高压上消化道大出血的主要原因，经皮经肝曲张血管栓塞术（percutaneous transhepatic varices embolization，PTVE）和部分脾动脉栓塞术（partial splenic embolization，PSE）是近年来治疗肝硬化门脉高压症的新技术。本研究旨在探讨PTVE联合PSE对门静脉（PV）压力、PV血流量的影响，及对止血、延长出血间期、降低死亡率的价值。     

双剂量奥曲肽对肝硬化门脉高压症断流术后患者血流动力学的影响

目的研究双剂量奥曲肽对肝硬化门脉高压症断流术后患者门脉压力、肝脏血流动力学影响。方法肝硬化门脉高压症断流术患者26例,随机分两组,术后24h开始用奥曲肽。A组12例,奥曲肽50μg／h;B组14例,奥曲肽25μg／h;胃网膜右静脉插管至门静脉主干,动态测定门脉压力;彩色超声多普勒测定门脉直径（PV）、门脉最大血流速度（PFVmax）、门脉平均血流速度（PFVmean）、肝动脉最大血流速度（HAVmax）、肝动脉最小血流速度（HAVmin）;计算门脉血流量参数（PFI）、肝动脉血流量参数（HAFI）。结果断流术后,两组患者门脉压力平均降幅15．4％,PFI降低（P〈0．05）;HAVmax、HAVmin、HAFI增加（P〈0．05）。用奥曲肽72h后,两组PFI、PFVmax、PFVmean降低（P〈0．05）;用药5min门脉压力降低,24h达高峰,门脉压力平均降幅20．6％。A组停药后48h内,门脉压力未见回升,平均降幅23．1％;B组停药后2h门脉压力有回升趋势,平均降幅11．6％;停药后24h、48h两组患者门脉压力比较差异有统计学意义（P〈0．01）。Logistic分析发现,PV、PFVmax、PFVmean、HAVmax、HAVmin与门脉压力无独立相关性。结论肝硬化门脉高压症患者行断流术后,门脉压力降低。双剂量奥曲肽均能明显降低门脉压力;停药后48h内,奥曲肽50μg／h组门脉压力未见回升。提示,临床用奥曲肽50μg/h对防止静脉曲张再出血更合理。     

强肝软坚汤与心得安联合治疗肝硬化门脉高压症临床观察

对110例肝硬化门脉高压症患者随机分组,前瞻性研究强肝软坚汤、心得安及强肝软坚汤与心得安联合用药三组临床疗效,结果联合用药组疗效优于单独用药二组(P<0.01)。提示强肝软坚汤与心得安二者不同的治疗机制,对肝硬化门脉高压症可起到协同治疗效果。     

软肝冲剂对肝炎肝硬化门脉高压患者血清一氧化氮、内皮素的影响

目的：观察软肝冲剂对肝炎肝硬化门脉高压患者门静脉主干内径及血流量、血流速度和血清一氧化氮（NO），内皮素（ET）的影响。方法：选择肝炎肝硬化门脉高压患者97例，随机分为两组，治疗组口服软肝冲剂，对照级以西药常规治疗，观察治疗后的总有效率、肝功能，门静脉主干内径及血流量、血流速度和血清NO、ET的变化。结果：经治疗后治疗组总有效率优于对照组（P＜0．05），患者ANT，TBil明显降低，Alb和A／G均明显升高，门静脉内径变窄，血流量增多，血流速度变快，同时NO及ET亦显著降低，与对照组比较，差异有显著性意义（P＜0．05或0．01）。结论：软肝冲剂治疗肝炎肝硬化门脉高压疗效显著，能明显改善肝功能，降低门静脉压力，其作用机制之一是降低血清NO、ET水平。     

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.