动脉导管未闭合并重度肺动脉高压Amplatzer法封堵治疗的临床应用--12例初步报告

目的评价Amplatzer封堵器治疗动脉导管未闭(PDA)合并重度肺动脉高压(SPH)的初步疗效.方法对12例(女9例,男3例)PDA合并SPH患者实施封堵治疗.其中10例采用Amplatzer动脉导管未闭封堵器,2例采用Amplatzer房间隔缺损封堵器.结果全组12例PDA封堵器均放置成功.11例PDA封堵后30分至1小时肺动脉收缩压、肺动脉平均压均明显降低.1例封堵术后即刻肺动脉压无变化.术后36小时彩色多普勒估测肺动脉压明显下降,封堵术后30分降主动脉造影,无残余分流9例,微量残余分流2例,少量残余分流1例.全组术后24～48小时彩色多普勒检查,动脉水平左向右分流均完全消失.无重要并发症发生.随访1～24个月(平均8个月),患者症状改善,11例心脏缩小,无1例发生再通.结论采用Amplatzer法封堵治疗PDA合并SPH,近期疗效满意.     

高原地区用Amplatzer封堵器治疗动脉导管未闭

目的:应用Amplatzer封堵器在高原地区治疗动脉导管未闭(PDA)并评价其疗效。方法:本组40例,年龄1.5～44(22.5±14.2)岁,PDA最窄处内径5～14(9.3±3.3)mm,均用Amplatzer封堵器介入治疗。结果:19例成功,1例严重阻塞性肺动脉高压不适宜封堵。术后即刻降主动脉造影显示35例封堵完全无残余分流,4例少量残余分流。1例术后1h封堵器脱落入右肺动脉,第3小时急诊外科手术关闭PDA并取出封堵器。24 h彩色多普勒检查显示封堵36例患者均无分流,随访2个月～1年半,无一例分流。结论:高原地区PDA发病率高,并发肺动脉高压早且多,巨大PDA(内径>0.8 cm)比率高,用Amplatzer封堵器治疗PDA是高原地区一种适应性强、安全有效的介入治疗方法。     

应用Amplatzer封堵器经导管治疗动脉导管未闭并发重度肺动脉高压的疗效评价

目的 :应用 Amplatzer封堵器经导管治疗动脉导管未闭 （PDA）并发重度肺动脉高压 （SPH） ,并对其疗效进行评价。方法 :全组 15例 ,年龄 2 5± 2 2 （5～ 54）岁。PDA最窄处直径为 11± 4（8～ 18） mm。 PDA 8例采用 AmplatzerPDA封堵器治疗 ,7例采用 Amplatzer房间隔缺损封堵器治疗。封堵后 3 0 min行侧位降主动脉造影 ,术后 1d及 1月行超声心动图检查 ,观察有无残余分流及 PDA再通。结果 :14例 （93 ） %封堵后 3 0 min至 1h肺动脉收缩压由 90～ 150 （10 6± 2 7） mm Hg降至 45～ 110 （65± 2 1） mm Hg,肺动脉平均压由 60～ 10 5（82± 2 1） mm Hg降至 2 6～ 65（50± 19） mm Hg。 1例封堵后 3 0 min至 1h肺动脉收缩压无下降 ,反而有轻度上升 ,考虑为阻力性重度肺动脉高压 ,撤出封堵器。 6例主动脉压力有不同程度增高。术后 3 0 min降主动脉造影示 ,5例存在微至少量残余分流 ,10例封堵完全无残余分流。在术后 2 4h2例仍存在微至少量残余分流 ,其中 1例并发溶血 ,48h后行外科 PDA缝合术。其余病例术后 1月超声心动图检查未见残余分流及再通。结论 :应用 Amplatzer封堵器治疗 PDA并发 SPH是一种安全有效的介入方法     

国产蘑菇伞介入治疗成人动脉导管未闭的临床疗效评价

目的: 评价国产蘑菇伞经导管介入治疗成人动脉导管未闭(PDA)的临床疗效。方法: 选择我科156(男54,女102)例成人PDA实施经导管介入治疗的患者,年龄18～65(32±13)岁;体质量43.8～68.5(51±8)kg;行右心导管检查测定肺动脉压力、主动脉压力,行主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径1.5～18.2 (5±5)mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24 h、1、3、6 和12个月行彩色多普勒超声心动图检查随访。结果: 4例封堵后30 min肺动脉收缩压无下降,反而有轻度上升,考虑为阻力性重度肺动脉高压,撤出封堵器。余152例成功地植入封堵器,术后30 min肺动脉压收缩压由术前(48±23)mmHg降为(36±12)mmHg(P<0.05),肺动脉平均压降由术前(40±14)mmHg降为(27±11)mmHg(P<0.05),主动脉压由术前(102±13)mmHg变化至(107±14)mmHg(P>0.05)。术后30 min主动脉弓降部造影显示,119例(78.3％)封堵完全,33例(21.7％)可见极少量残余分流,术后24 h心脏彩超复查147例(96.7％)封堵完全,5例(3.3％)有少量残余分流,术后1个月彩超复查皆无残余分流;无再通和堵闭器移位等并发症发生。结论: 在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。     

国产蘑菇伞型封堵器封堵巨大动脉导管未闭的可行性研究

目的探讨采用国产蘑菇伞型封堵器经导管封堵巨大动脉导管未闭(PDA)的可行性。方法全组15例,其中男3例,女12例,年龄21±8(16～46)岁。PDA最窄处直径为16±3mm(13～22mm),均采用国产蘑菇伞型封堵器经股静脉途径对PDA进行封堵。封堵前后行主动脉弓降部造影并测定肺动脉压力。封堵成功者分别于术后1周、1个月和6个月复查超声心动图。结果15例巨大PDA选用的封堵器直径为23±4mm(18～32mm),封堵后30min主动脉弓降部造影均显示主-肺动脉水平仅有经封堵器孔眼的微量到少量残余分流。封堵后13例患者肺动脉收缩压峰值较封堵前有不同程度下降(70±29mmHgvs113±21mmHg,P<0.05,1mmHg=0.133kPa),2例因试封堵后肺动脉压力升高而放弃封堵。无一例发生严重并发症。封堵成功者术后复查超声心动图,其中11例于术后1周、1例于术后1个月残余分流消失,另1例于术后6个月时残存少量分流。结论采用国产蘑菇伞型封堵器经导管封堵巨大PDA是一种安全有效的介入治疗方法。     

国产封堵器介入治疗小儿动脉导管未闭并发肺动脉高压的临床疗效

目的评价国产封堵器经导管介入治疗小儿动脉导管未闭（PDA）并发肺动脉高压的临床疗效。方法回顾分析2003年12月2007年11月86（男30,女56）例小儿PDA并发肺动脉高压实施经导管介入治疗;年龄8月12（8±7）岁;体质量1146（31±8）kg;行左、右心导管检查及主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径413（7±5）mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24h、1个月、3个月、6个月、1年行彩色多普勒超声心动图检查。结果2例（2%）封堵后30 min肺动脉收缩压无下降,反而有轻度上升,考虑为阻力性重度肺动脉高压,撤出封堵器。余84例（98%）术后30 min肺动脉压收缩压由术前平均（69±24）mmHg（1mmHg=0.133 kPa）降为（36±14）mmHg（P<0.05）,肺动脉平均压由术前（45±14）mmHg降为（30±8）mmHg（P<0.05）,主动脉压由术前（94±10）mmHg升至（99±6）mmHg,但无统计学差异。术后30min主动脉弓降部造影显示,18例（21%）可见极少量残余分流,术后24h心脏彩超复查4例（4%）有少量残余分流,术后1月彩超复查皆无残余分流;无严重并发症发生。结论国产蘑菇伞经导管封堵治疗儿童PDA并发肺动脉高压,安全、有效,值得推广应用。     

国产封堵器介入治疗巨大动脉导管未闭的临床评价

目的应用国产封堵器经导管治疗巨大动脉导管未闭（PDA）并对其疗效进行评价。方法全组27（男8,女19）例,年龄6～54（24±15）岁,主动脉造影示PDA最窄径为13～28（16±4）mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少～中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微～少量残余分流,1例仍为少～中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1～6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。     

婴儿动脉导管未闭的介入治疗

目的 总结婴儿行动脉导管未闭(patent arterial duct,PDA)堵闭术的临床经验.方法 PDA 29例,年龄在1岁以下,体重4.5～10.5 kg,PDA最窄处直径2.0～7.4 mm,其中合并肺动脉高压13例,行蘑菇伞型封堵器封堵术.结果 所有病例1次封堵成功,术后即时升主动脉造影,发现有微量残余分流3例,术后3 d消失,1例有中量残余分流伴肉眼血尿,24 h后血尿消失,1个月后仅存微量残余分流,无其他并发症出现.结论 介入治疗对婴儿PDA疗效良好.     

经导管封堵治疗动脉导管未闭伴重度肺动脉高压

目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上，肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例，回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183（112±28）mmHg，肺动脉平均压63～130（82±22）mmHg。其中30例经导管封堵成功（成功率97％），1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min，26例肺动脉收缩压下降30mmHg以上，2例肺动脉收缩压下降20％以上，另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭，在术后3d复查心脏超声时发现封堵器脱人肺动脉而转入外科手术治疗；在5例双向分流者中，1例于术后2个月因重度肺部感染死亡，1例于封堵后血氧饱和度明显增加，但肺动脉压无明显下降，术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人，若心脏超声检查示左向右分流，可用经导管封堵术进行根治；但若为双向分流时，经导管封堵治疗应慎重。     

介入封堵术在老年继发孔型房间隔缺损患者中的临床应用

目的观察老年继发孔型房间隔缺损(ASD)患者进行介入封堵术的中、远期疗效和安全性。方法老年继发孔型ASD患者206例,缺损8～38(26.5±8.1)mm。封堵术前、术后行右心导管检测肺动脉压、右心室压,随访6个月,评价心功能(NYHA)改善情况。结果成功封堵203例,成功率98.5%。封堵器直径12～42(31.5±7.3)mm。与封堵术前比较,患者封堵术后肺动脉收缩压、右心室平均压明显下降(P<0.05,P<0.01);3～6个月随访时,患者右心室容积缩小、LVEF升高、心功能改善明显。术后心包积液1例(0.5%);即刻残余分流10例(4.9%);术后出现心律失常30例(14.8%)、出现急性心功能不全16例(7.9%)。6个月随访,患者均未发现有残余分流、脱落、栓塞。结论老年继发孔型ASD患者行介入封堵治疗中、远期相对安全、有效。     

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.