颅外动脉狭窄支架置入术治疗的临床研究

目的　观察支架置入 (SP)术治疗颅外动脉狭窄的疗效及其并发症 ,探讨其安全性与可行性。方法　 2 2例 (平均年龄 6 6岁 )因颅外动脉 (颈内动脉颅外段、椎动脉、锁骨下动脉 )狭窄 >70 %患者行SP术治疗。术前术后行脑血管造影、颈动脉双功能彩超检查。术中术后给予抗凝治疗。术后每 3个月复诊。结果　术后立即行脑血管造影 ,狭窄血管均开通 5 0 %以上。术后 3～ 12个月临床随诊仅 1例出现短暂性脑缺血发作 (TIA) ;颈动脉双功能彩超检查 ,1例出现舒张期短流。本组患者术后 5d内主要并发症有 :1例脑出血合并金黄色葡萄球菌感染死亡 ,1例上消化道出血伴右下肢体无力 ,5例出现TIA。结论　SP为脑血管严重狭窄者提供了新的、有前途的治疗手段 ,但必须严格的掌握适应证与禁忌证。     

支架成形术治疗颈内动脉颅外段重度狭窄36例临床分析

对36例颈内动脉颅外段重度狭窄（狭窄程度〉75％）患者行支架成形术（CAS）。结果均成功置入了支架．术后即刻DSA显示狭窄程度降到31．4％以下；2例置入一次性滤器保护装置（FPD）时出现反复短暂性脑缺血发作（TIA），支架成功置入后即缓解；随访3～18个月，无再发TIA或脑梗死。临床症状完全消失13例、好转20例、病情稳定3例，彩色多普勒超声见支架与血管壁连接紧密，主干内膜完整，均未见支架移位或再狭窄。认为CAS治疗颈内动脉颅外段重度狭窄近期效果良好，安全性高。     

青年颈内动脉系统短暂性脑缺血发作临床分析

回顾性分析27例青年颈内动脉系统短暂性脑缺血发作（TIA）患者的临床资料,其中14例行全脑血管造影（DSA）检查。结果22例症状完全缓解,5例进展为脑梗死。TIA发作〉2次／24h,持续时间〉30min,有合并疾病是短期内进展为脑梗死的危险因素。DSA示71．4％有阳性发现,7例为颅内外动脉多发性狭窄或闭塞,2例为单纯颅外血管狭窄或闭塞,1例为单纯颅内血管狭窄;1例颈内动脉颅外段狭窄〉80%者行自膨式支架置入术,术后随访2a,无TIA再发作。提示青年颈内动脉系统TIA患者多已存在颅内外血管的狭窄或闭塞,应尽早治疗。     

高危颅外脑供血动脉狭窄的血管内治疗

对26例高危的颅外脑供血动脉狭窄患者行血管内支架成形术和（或）球囊扩张成形术（PTA）治疗。围手术期根据患者情况，控制血压，抗凝和抗血小板治疗。结果术后即刻血管造影显示32处血管狭窄部位恢复正常血管直径；23例置入颈动脉支架（18例应用血栓保护伞）；球囊前扩或后扩时出现脉搏、血压下降13例（包括心脏停跳1例）给予对症处理缓解。术后无手术操作相关的并发症发生。26例临床症状均明显改善，经颅多普勒超声（TCD）、颈部血管超声均显示血管形态正常，血液动力学恢复满意。认为血管内支架成形术和（或）PTA治疗高危颅外脑供血动脉狭窄效果确切；术前综合评估是作出正确治疗策略的前提。     

血管内支架成形术治疗有症状大脑中动脉狭窄

目的：探讨血管内支架成形术在有症状大脑中动脉狭窄治疗中的应用。方法：对3例临床诊断脑梗死和3例短暂性脑缺血发作患者行全脑血管造影术，发现大脑中动脉M1段存在不同程度狭窄，对狭窄段大脑中动脉行颅内支架成形术。结果：6例大脑中动脉支架成形术均获得成功。大脑中动脉M1段平均直径狭窄程度从92．8％降至6％（P〈0．01）。1例患者在支架置入10min后出现急性血栓形成，术中经微导管注入尿激酶接触性溶栓，25min后血栓溶解。术后随访6个月，所有患者均无脑缺血事件发生。结论：采用血管内支架成形术治疗有症状大脑中动脉狭窄可行。     

经皮血管内支架术治疗颅外脑动脉狭窄11例报道

目的观察经皮血管内支架成形术治疗颅外脑供血动脉狭窄的疗效、安全性和并发症。方法选择11例伴随临床症状的颅外脑动脉狭窄患者实施经皮血管腔内支架成形术,通过临床症状、经颅多普勒和全脑血管造影术评价其疗效,术后随访2～6个月。结果11例支架植入术成功率为100%,术中即刻造影显示狭窄程度明显改善,狭窄率由术前的88.91%±5.92%,下降到术后的7.73%±4.67%,下降了91.32%±5.17%。术后随访2～6个月,未见新的短暂性脑缺血发作或脑梗死,经颅多普勒复查未见再狭窄。结论经皮血管内支架成形术是治疗颅外脑动脉狭窄的一个安全有效的手段。     

红皮血管内支架术治疗颅外脑动脉狭窄11例报道

目的 观察经皮血管内支架成形术治疗颅外脑供血动脉狭窄的疗效、安全性和并发症.方法 选择11例伴随临床症状的颅外脑动脉狭窄患者实施经皮血管腔内支架成形术,通过临床症状、经颅多普勒和全脑血管造影术评价其疗效,术后随访2～6个月.结果 11例支架植入术成功率为100%,术中即刻造影显示狭窄程度明显改善,狭窄率由术前的88.91%±5.92%,下降到术后的7.73%±4.67%,下降了91.32%±5.17%.术后随访2～6个月,未见新的短暂性脑缺血发作或脑梗死,经颅多普勒复查未见再狭窄. 结论 经皮血管内支架成形术是治疗颅外脑动脉狭窄的一个安全有效的手段.     

血管腔内旋切术治疗下肢动脉硬化闭塞症

使用瑞士产Straub旋切仪对28例下肢动脉闭塞症（31支闭塞动脉）行血管腔内旋切术，术后对残留血管狭窄行支架置入术，共放置16枚血管内支架。结果完全开通者27支（87．1％），部分开通3支（9．7％），未开通1支；12枚支架因原有狭窄或旋切后残留狭窄放置，4枚因旋切后内膜损伤放置。1例胭动脉闭塞开通成功后造影发现闭塞段血管穿孔，经压迫止血后恢复。随访3～23个月，1例术后5h因心肌梗死死亡，4例症状复发。认为血管腔内旋切术治疗下肢动脉闭塞症是一种简便可行、安全、有效的介入治疗新方法。     

颈内动脉狭窄或闭塞的TCD、DSA对比研究

回顾分析51例脑梗死患者的经颅多普勒（TCD）与脑血管造影（DSA）检测结果，评估对脑梗死颈内动脉狭窄或闭塞诊断的准确性及其不同的诊断价值。结果TCD对判断脑梗死患者颈内动脉（ICA）狭窄或闭塞诊断的特异性为83．6％、敏感性为63．4％，大脑中动脉（MCA）分别为75．O％、86．4％，大脑前动脉（ACA）分别为97．7％、41．7％。ICA假阳性率为27．8％、假阴性率为22．7％，MCA分别为51．3％、4．8％，ACA分别为28．6％、7．5％。提示TCD可作为脑血管狭窄预防性筛选方法之一。     

Neuroform支架在治疗症状性颅内动脉狭窄中的应用

目的评价使用Neuroform支架在治疗症状性颅内动脉狭窄的安全性、可行性。方法症状性颅内动脉狭窄患者11例,其中前循环狭窄2例(1例狭窄位于颈内动脉眼段交通段,1例狭窄位于大脑中动脉M1段),后循环狭窄9例(3例狭窄位于基底动脉,6例狭窄位于基底动脉交界处);均进行支架成形术治疗,术后全脑血管造影复查及使用美国国立卫生研究院脑卒中量表(NIHSS)进行评定。结果11例患者支架全部置放成功,造影复查显示动脉直径狭窄率从术前(85.6±7.4)%降至术后(35.7±12.1)%。按NIHSS评分评估,11例患者术后症状明显改善,其中1例患者术后15天出现Wallenberg综合征,随访1~12个月,其他患者未出现脑缺血再发作及支架内再狭窄。结论应用Neuroform支架治疗症状性颅内动脉狭窄合并路径血管纡曲不光滑的患者,可以提高手术成功率,减轻临床缺血症状和改善预后。     

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.