支气管动脉栓塞术联合支气管镜肺泡灌洗治疗支气管扩张症并大咯血的疗效观察

目的:观察支气管动脉栓塞术联合支气管镜肺泡灌洗治疗支气管扩张症并大咯血的临床疗效。方法:将47例支气管扩张并大咯血的患者随机分为治疗组和观察组。观察组23例,仅采用常规临床治疗,包括抗感染、止血、祛痰、扩张支气管、物理治疗等;治疗组24例,在临床常规治疗基础上加用支气管动脉栓塞术联合支气管镜肺泡灌洗。治疗7 d后,比较2组的临床疗效。结果:治疗组临床疗效明显优于观察组(P0.05);治疗组1年内复发率低于观察组(P0.05)。结论:支气管动脉栓塞术直接栓塞患者的病理血管,能达到即时止血的效果;支气管镜肺泡灌洗直接清除气管和支气管内脓性分泌物、痰栓及致病菌;两者联合,疗效较好,可减少复发。     

经支气管镜行肺泡灌洗对支气管扩张合并感染的疗效观察童良娥 彭清臻

目的：对经支气管镜行肺泡灌洗应用于支气管扩张合并感染治疗的疗效进行观察。方法：选取2013年2月至2015年12月间我院收治的治疗前痰中检测出病原菌的58例支气管扩张合并感染者随机分作两组，一组为对照组，一组为观察组，两组各29例；对照组采取吸氧、排除痰液与全身应用抗菌药和维持水电解质平衡、营养支持等常规治疗；观察组则在对照组基础上通过支气管镜进行肺泡灌洗治疗，观察两组的疗效情况。结果：观察组治疗后的总有效率是93.10%；对照组治疗后的总有效率是75.86%，两组对比差异明显（P＜0.05）；观察组治疗后病原菌清除率为86.2%；对照组治疗后病原菌清除率为65.5%，两组对比差异明显（P＜0.05）；观察组患者住院时间、痊愈时间及再次就诊的次数明显比对照组少（P＜0.05）。结论：经支气管镜肺泡灌洗对于支气管扩张合并感染的疗效显著，值得临床普及应用     

支气管镜肺泡灌洗术联合哌拉西林他唑巴坦治疗支气管扩张的临床观察

目的探讨支气管镜肺泡灌洗术联合哌拉西林他唑巴坦治疗支气管扩张的临床疗效。方法收集符合标准的患者80例,随机分为观察组和对照组各40例,两组患者均给予基础治疗,对照组加用哌拉西林他唑巴坦静脉滴注,观察组在此基础上合用支气管镜肺泡灌洗术,比较两组临床治疗效果。结果观察组患者临床症状缓解时间和住院时间均短于对照组,P<0.05。观察组临床治疗总有效97.50%,显著高于对照组的75.00%,P<0.05。治疗结束后,两组患者血气分析指标均上升,与治疗前比较均有显著性差异(P<0.05),但是观察组改变幅度更大(P<0.05)。结论支气管镜肺泡灌洗术联合哌拉西林他唑巴坦治疗支气管扩张,可以缩短患者临床症状改善时间和住院时间。     

支气管肺泡灌洗氨溴索治疗支气管扩张并感染的效果分析

目的 探讨支气管肺泡灌洗氨溴索治疗支气管扩张并感染的疗效.方法 将120例支气管扩张并感染患者随机分为用氨溴索灌洗的治疗组60例和用生理盐水灌洗的对照组60例,均每3天灌洗1次,连续3次,于治疗前及治疗2周做肺功能和胸部CT检查.结果 治疗组疗效明显优于对照组（P＜0.01）,与对照组相比PEF、FVC及FEV1均明显改善（P＜0.05）,住院时间明显缩短（P＜0.05）.结论 支气管肺泡灌洗氨溴索治疗支气管扩张并感染是一种很好的治疗手段.     

支气管动脉栓塞治疗支气管扩张大咯血的疗效观察

目的观察支气管动脉栓塞术（BAE）治疗支气管扩张大咯血的疗效,评价支气管动脉栓塞术的临床价值。方法21例支气管扩张大咯血患者,男13例,女8例,全部病例采用Seldinger技术经股动脉穿刺插管,DSA造影,首先明确出血部位,然后进行支气管动脉内栓入明胶海棉十丝线微粒＋欧乃派克或小直径不锈铜丝圈。结果21例患者术后咯血量即刻明显减少,1周内咯血完全停止。3例患者2周左右复发,行第2次BAE止血所有病例随访6～24个月均无复发。结论支气管动脉栓塞术成为控制支气管扩张大咯血的有效、安全的治疗方法。     

支气管灌洗术在支气管扩张症治疗中的作用

目的 分析支气管灌洗术在支气管扩张症治疗中的效果.方法 选取82例支气管扩张症者予以支气管灌洗术作为观察组,再抽取予以抗生素等常规治疗的80例支气管扩张症者对比作为对照组;观察、分析两组临床疗效等.结果 观察组近期疗效（总有效率86.59%）、远期效果（82.93%）,均高于对照组;且观察组临床症状、体征消失或改善时间和抗生素应用时间和住院时间较对照组缩短（P〈0.05）.结论 支气管灌洗术在支气管扩张症治疗中应用效果显著且起效迅速.     

去甲肾上腺素盐水气管导管内灌洗术治疗大咯血患者防止气管导管堵塞的疗效观察

目的观察去甲肾上腺素盐水气管导管内灌洗术治疗大咯血患者防止气管导管堵塞的疗效。方法选择2011年1月~2015年1月气管插管行机械通气大咯血患者36例,随机分为两组。试验组18例(常规抗感染、化痰、止血、支气管动脉栓塞术+机械通气+去甲肾上腺素盐水气管导管内灌洗术治疗),对照组18例(常规抗感染、化痰、止血、支气管动脉栓塞术+机械通气)。结果试验组和对照组有效率分别为88.8%,33.3%(P0.05)。结论在常规抗感染、化痰、止血、支气管动脉栓塞术+机械通气基础上治疗大咯血,去甲肾上腺素盐水气管导管内灌洗术治疗可以有效防止气管导管堵塞,避免反复气管插管、窒息,临床效果好。     

支气管肺泡灌洗术在支气管哮喘中的应用简

目的 探讨应用支气管镜行支气管肺泡灌洗术治疗支气管哮喘的作用.方法 将常规治疗无效的61例支气管哮喘患者随机分成两组,对照组继续采用支气管舒张剂等常规治疗,支气管镜肺灌洗组在常规治疗基础上加用支气管肺泡灌洗术.治疗前及治疗后48小时观察患者的临床表现,检测第1 秒用力呼气容积（FEV1）、呼气峰流速（PEF）等,选用改良英国MRC呼吸困难指数（mMRC）进行病情评估.并对两组患者住院天数进行比较.结果 两组患者治疗后哮喘症状、体征好转,肺功能指标及mMRC均得到改善,两组比较,经支气管镜肺灌洗组显著优于对照组,且住院天数缩短,差异具有统计学意义（ P ＜ 0.05）.结论经支气管镜行肺泡灌洗术能清除支气管内黏性分泌物,通畅气道,改善气道的炎症反应,是治疗由黏液栓引起的哮喘急性发作最有效手段,且见效快.     

支气管肺泡灌洗术联合机械通气治疗重症哮喘患者的疗效观察简

目的 观察支气管肺泡灌洗术联合无创机械通气治疗重症哮喘患者的临床疗效.方法 50例重症哮喘患者随机分为两组,对照组（n=25例）给予无创通气治疗,观察组（n=25例）在对照组治疗基础上加用支气管肺泡灌洗.比较两组患者肺功能及病情缓解时间等情况.结果 观察组治疗总有效率（92.0%）明显高于对照组（80.0%）（P〈0.05）;观察组治疗后肺功能指标（FEV1/L、FVC/L和FEV1/FVC）改善程度明显优于对照组（P〈0.05）;观察组临床症状改善时间及ICU住院天数较对照组缩短（P〈0.05）.结论 支气管肺泡灌洗术联合无创机械通气治疗重症哮喘患者疗效显著,患者肺功能恢复快,症状缓解时间及ICU住院天数短.     

肺泡灌洗治疗支气管扩张合并感染的疗效观察

目的观察支气管肺泡灌洗联合局部注药治疗支气管扩张合并感染的临床疗效。方法 57例支气管扩张合并肺部感染患者随机分为2组,所有患者均予以全身抗感染、祛痰等对症支持治疗,对照组(n=27例)采用体位引流排痰,观察组(n=30例)采用支气管肺泡灌洗术联合局部注药治疗。比较两组临床疗效、症状体征消失时间、住院时间及血气指标等变化情况。结果观察组治疗总有效率(86.7%)明显高于对照组(70.4%)(P0.05);观察组热退、咳嗽咳痰及肺部湿啰音消失时间、住院治疗时间均明显短于对照组(P0.05);观察组治疗后血气指标(PaO2、SaO2、PaO2/FiO2)改善程度明显优于对照组(P0.05)。结论支气管肺泡灌洗联合局部注药治疗支气管扩张合并感染疗效显著,可迅速改善患者症状体征及肺通气功能,值得临床推广应用。     

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.