同种异体带瓣主动脉行主动脉根部替换85例随访结果

目的:随访应用低温保存的同种异体带瓣主动脉行主动脉根部替换术的临床效果.方法:85例主动脉根部或瓣膜病变的患者行同种异体带瓣主动脉根部替换手术,术后随访1.5～91个月观察临床结果.结果:随访1.5～91(38.9±13.2)个月.术后早期病死率1.2%(1/85),远期病死率5.9%(5/85);与术前比较心功能明显改善(P＜0.01);术后随访心内膜炎发生率2.4%(2/85);生存者中瓣膜无或有轻度反流84%(66/79),中度反流16%(13/79).结论:同种异体带瓣主动脉根部重建手术效果可靠,成功率高且并发症低,尤适于治疗心内膜炎造成的瓣膜病.     

同种异体带瓣主动脉行主动脉根部置换的临床效果

目的 :探讨应用低温保存的同种异体带瓣主动脉行主动脉根部重建手术的临床效果。方法 :85例主动脉瓣膜病变患者行同种主动脉根部置换手术 ,术后随访观察临床结果。结果 :随访 39± 13（1.5～ 91）个月。早期手术死亡率 1% （1/ 85 ） ,远期手术死亡率 6 % （5 / 85 ） ;与术前比较心功能明显改善 （P<0 .0 5 ） ;术后随访心内膜炎发生率占2 % （2 / 85 ） ;生存者中瓣膜无或有轻度返流 84 % （6 6 / 79） ,中度返流 16 % （13/ 79）。结论 :同种异体带瓣主动脉根部重建手术效果可靠 ,且并发症少。     

David-Ⅰ手术治疗主动脉夹层合并主动脉瓣反流

目的:总结David-Ⅰ手术治疗主动脉夹层合并主动脉瓣反流的临床经验。方法:回顾性分析2005-2010年我科收治的9例主动脉夹层合并主动脉瓣反流患者行David-Ⅰ手术的临床资料。其中急诊手术2例,余7例为常规择期手术;术前心功能Ⅰ级7例,Ⅲ级2例;术前心脏超声测定主动脉瓣轻度反流6例,中度2例,重度1例;术前心脏超声、16排螺旋CT测定主动脉瓣瓣环7例轻度扩张,2例无扩张;9例全部行David-Ⅰ手术。结果:术后患者死亡1例,其余8例康复出院。手术体外循环时间(206.3±11.1)min,阻断时间(141.3±11.2)min。术后随访(12.8±1.0)个月,8例康复出院患者心功能均为Ⅰ级;术后主动脉瓣无反流5例,轻度反流3例。随访心脏超声发现8例患者均无瓣环扩张,无患者需二次换瓣治疗。结论:对主动脉夹层合并主动脉瓣反流者,可优先采用保留主动脉瓣的主动脉根部替换术。     

先天性主动脉瓣狭窄的外科治疗

我院自1984年7月至1995年3月共收治48例先天性主动脉瓣狭窄患者，其中30例行外科治疗，占62．5％。22例主动脉瓣替换术（73．3％）中，同种动脉瓣13例，机械瓣9例。主动脉瓣交界切开术8例。术后随访1月至9年，每半年一次。治疗效果：术后早期死亡2例，死亡率6．7％；晚期死亡1例，术后1年死于感染性心内膜炎，占33％；27例随诊良好。结合先天性主动脉瓣狭窄的临床征象，对其诊断及外科治疗进行讨论。     

二叶式主动脉瓣畸形合并感染性心内膜炎的临床及预后分析

目的:总结二叶式主动脉瓣畸形合并感染性心内膜炎的临床特点及治疗,明确影响主动脉瓣感染性心内膜炎预后的因素。方法:将2001-01-2010-12期间我院收治的符合DUKE诊断标准的自体主动脉瓣感染性心内膜炎患者98例,分为二叶式主动脉瓣畸形组和三叶式主动脉瓣畸形组,评价临床表现、实验室检查、超声心动图、瓣膜形态、手术治疗与死亡率的相关性。结果:31例(31.6%)二叶式主动脉瓣感染性心内膜炎患者更年轻,易发生瓣周脓肿(35.5%)。二叶式主动脉瓣是瓣周脓肿的独立预测因素(OR=4.015,95%CI 1.307～12.335,P<0.05)。二叶式主动脉瓣畸形组与三叶式主动脉瓣畸形组的早期手术及院内死亡率均差异无统计学意义。严重心力衰竭(OR=8.955,95%CI1.811～44.687,P<0.01)及未控制的感染(OR=0.170,95%CI0.041～0.697,P<0.05)是主动脉瓣感染性心内膜炎死亡的独立预测因素。瓣膜手术可以降低主动脉瓣(OR=0.222,95%CI0.006～0.822,P<0.05)及二叶式主动脉瓣(OR=0.320,95%CI0.090～1.140,P<0.05)感染性心内膜炎的死亡率。结论:二叶式主动脉瓣畸形是主动脉瓣感染性心内膜炎常见的瓣膜异常。二叶式主动脉瓣感染性心内膜炎的患者更年轻,易发生瓣周脓肿。手术治疗可降低二叶式主动脉瓣感染性心内膜炎的死亡率。     

感染性心内膜炎主动脉瓣置换手术方法探讨

目的探讨感染性心内膜炎主动脉瓣置换的手术方法。方法回顾分析我院手术治疗的3例感染性心内膜炎主动脉瓣病变患者的临床资料及间断全层缝合主动脉壁置换主动脉瓣的手术方法。术中均可见主动脉瓣赘生物,瓣叶裂,穿孔,主动脉瓣环水肿,主动脉内膜断裂,瓣周脓肿形成。切除病变主动脉瓣,清除坏死组织及赘生物,以碘伏涂抹主动脉根部并浸泡机械瓣膜及换瓣线,游离主动脉根部至瓣环水平,避免损伤冠状动脉,带垫片换瓣线自主动脉壁外进针,垫片置于主动脉壁外侧,16-20针间断缝合,机械瓣环上打结,置换机械瓣膜。结果3例患者术后恢复顺利,3个月至1年随诊,预后良好。结论间断全层缝合主动脉壁置换主动脉瓣方法可以预防复发感染性心内膜炎,减少瓣周漏的发生,安全、有效,远期效果良好。     

同种带瓣管道的研究和应用进展

Ross于1962年首次将异体同种主动脉瓣成功地用于主动脉瓣替换术以来，抗生素灭菌、程控降温、深低温保存等方法的应用推动了同种带瓣管道在心脏外科手术中的广泛应用，成为复杂先心病重建右室流出道的主要材料之一。本文就同种瓣研究和应用的进展作一简要综述。     

主动脉左心室通道的外科治疗

目的 总结9例主动脉左心室通道的外科诊治经验.方法 回顾性分析我院2002年7月至2008年8月收治主动脉左心室通道患者9例,术前心功能(NYHA):Ⅱ级7例,Ⅲ级2例.9例患者中8例术前通过经胸超声心动图诊断,全部经术中食道超声确诊.结果 9例均于术中确诊并行手术治疗,主动脉侧直接缝合2例,其中1例缝合通道后行主动脉瓣置换术;自体心包片或涤纶片衬心包从主动脉侧修补5例,其中1例修补通道后行主动脉瓣置换术;自体心包从主动脉侧及左室侧修补1例;切开主动脉左心室通道行主动脉瓣置换术1例.1例术后2个月因感染性心内膜炎、急性心力衰竭死亡;随访3个月至6年,随访7例,失访1例,心功能(NYHA标准)Ⅰ级患者3例,Ⅱ级3例,Ⅲ级1例.超声心动图示主动脉瓣无或微量反流2例,1例少量反流,2例少到中量反流,主动脉瓣功能正常1例,瓣周漏1例,远期无死亡.结论 主动脉左心室通道是一类非常罕见的先天性心脏病,超声心动图在本病诊断方面有着明显的优势;手术是治疗的有效方式,单纯修补效果良好.     

重症感染性心内膜炎的外科治疗

目的 评价重症感染性心内膜炎手术治疗效果.方法 回顾性分析2003年1月至2007年6月手术治疗的复杂性心内膜炎患者33例临床资料,均为原发性心内膜炎,其中感染侵犯二尖瓣16例、主动脉瓣11例、二尖瓣和主动脉瓣6例.术中发现瓣叶严重毁损27例、主动脉瓣周脓肿1例、均有瓣膜赘生物形成.脓肿清除后遗留残腔采用间断褥式缝合1例、主动脉瓣替换术11例,二尖瓣替换术16例,主动脉瓣及二尖瓣双瓣替换术6例.结果 早期无死亡,术后3个月心功能(NYHA分级)恢复Ⅰ级33%(11/33)、Ⅱ级66%(22/33).结论 重症心内膜炎瓣膜及瓣环受损重,积极手术,彻底清除赘生物,病灶创面的恰当处理是影响手术本身能否成功以及术后近期效果的关键.     

单纯主动脉瓣反流病因超声心动图与手术对照分析

目的 探讨行手术治疗的单纯主动脉瓣反流病因分布.方法 手术治疗的单纯主动脉瓣重度反流患者86例,通过超声心动图观察主动脉瓣反流、瓣膜形态及异常回声、升主动脉内径,综合超声心动图、手术所见、部分病理结果和临床资料确定最终病因.结果 在手术治疗单纯主动脉瓣反流患者中,瓣膜松弛、感染性心内膜炎和升主动脉夹层分别排行前3位病因.风湿性心脏病、退行性变、白塞病排行并列第4位.其余病因为主动脉瓣二叶瓣和梅毒.结论 本组行手术治疗的单纯主动脉瓣反流病人中,病因以瓣膜病为主,超声心动图在确定病因方而起重要作用.     

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.     

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.     

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.     

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.