起搏器植入术常见并发症分析

目的探讨起搏器植入术常见的并发症及防治方法。方法男188例，女122例，年龄22～85岁。310例起搏器中单腔起搏器94例，双腔起搏器216例，分析并发症的发生原因。结果共发生起搏器相关并发症25例，术后常见的并发症分别是囊袋血肿7例、电极导线脱位4例、囊袋破溃及感染9例，起搏器综合征5例。囊袋血肿的发生与术前使用阿司匹林有关，电极导线脱位、囊袋破溃及感染等大部分与手术有关，起搏器综合征与VVI起搏模式有关。结论加深对起搏器常见并发症的了解、提高鉴别能力、重视术前预防，术中规范操作和加强术后随访，可将起搏器并发症降低到低限。     

256例永久起搏器植入术后并发症的分析

目的：分析256例永久起搏器植入术后并发症发生的原因及防治。方法：收集256例永久性起搏器植入患者的临床资料进行回顾性分析。结果：发生起搏器术后并发症共28例,其中囊袋血肿12例,囊袋破溃感染2例,电极导线脱位2例,起搏综合征4例,心外肌肉收缩2例,精神神经症状3例,起搏器介导心动过速3例。结论：提高起搏器并发症早期识别能力并及时处理,完善术前准备,术中规范操作,术后定期随访及加强对患者的宣教,可降低并发症的发生率。     

80岁以上老年人心脏起搏器植入术及减少并发症的对策

目的 探讨80岁以上老年人起搏器植入手术方式的选择,旨在减少相关并发症及提高生活质量.方法 80岁以上老年人127例植入起搏器.其中双腔起搏（包括双室三腔起搏）95例（74.8%）;单腔心室起搏32例（25.2%）.所有患者首选经头静脉放置起搏电极导线,并对寻找头静脉及电极导线植入方式做了较大的改进.电极导线的头端应固定在心腔内,切口内起搏器囊袋处的固定也十分重要.在电极导线送入心内前制作起搏器囊袋,并放置纱布压迫止血,对少数渗血较多的患者,局部适当加凝血酶或用电凝刀止血.鼓励患者术后早期下床（手术当日或次日）.结果 经头静脉送入起搏导线的成功率,在单腔起搏器为92.0%,双腔起搏器81.5%.术中及术后早期发生并发症5例（3.9%）,分别是：囊袋血肿3例（2.4%）,电极导线与起搏器连接处松动1例（0.8%）,心肌穿孔1例（0.8%）.无血气胸、电极导线脱位及起搏器囊袋感染发生.结论 经头静脉送入起搏电极导线可避免锁骨下穿刺所导致的并发症,在老年人中尤其重要;电极导线脱位主要与手术操作有关,而与早期下床活动无关;应采用适当方法达到囊袋内彻底止血,减少术后囊袋血肿及感染.     

116例永久起搏器植入术后并发症的分析

目的分析116例永久起搏器植入术后并发症发生的原因,探讨处理方法和减少并发症的策略。方法对2003年1月~2006年10月本院安装的116例永久起搏器患者临床资料进行回顾性分析。结果发生起搏器并发症共18例,术中严重心律失常发生1例,术后并发症发生17例,其中囊袋内积血及血肿9例,囊袋皮肤溃破起搏器外露1例,电极导线脱位2例,电极导线断裂2例,起搏介导性心律失常(PMT)1例,起搏综合征2例。结论提高起搏器并发症早期识别能力并及时处理,完善术前准备,术中规范操作,术后定期随访及加强对患者的宣教,可降低并发症的发生率。     

130例次埋藏式永久起搏器术后随访的临床分析

目的研究埋藏式永久起搏器植入后并发症的发生率、相关因素以及防治方法。方法对接受永久性心脏起搏治疗的130例患者术后进行临床随访6个月~20年,随访内容包括临床资料、并发症、起搏器囊袋的状态、起搏器电极位置和各参数测量。结果原有的晕厥、头晕、乏力、心悸等与心动过缓有关的症状完全消失或减低82例;更换起搏器脉冲器术后切口处反复皮肤破溃1例;囊袋血肿3例;出现起搏器膈肌刺激症状1例;起搏电极移位3例;单纯电池耗竭更换脉冲发生器20例次;死亡2例,1例随访2年后发生脑出血死亡,另1例随访6年后因突发心力衰竭死亡,此2例患者死前检测起搏器功能正常;所有病例术后随访期间未出现其他起搏治疗相关并发症。结论永久性人工心脏起搏作为症状性心动过缓的惟一标准的治疗方法,其疗效确切,安全性好,同时坚持定期的随访,及时发现和处理与起搏器相关的并发症及排除起搏故障是非常重要的。     

639例永久起搏器植入术后并发症原因及处理方法的分析

目的探讨永久起搏器植入术后出现并发症的原因和处理方法。方法对我院近5年植入的639例患者资料进行回顾分析。结果共出现并发症21例,占3.38%,其中合并气胸3例,感染4例,囊袋血肿2例,导线脱位或断裂4例,心肌穿孔1例,起搏器综合征2例,起搏器介导心动过速2例,肌肉跳动3例。结论对起搏器植入术后可能产生的各种并发症,术前充分准备,术中规范操作,术后严格护理和定期随访,发生后及时处理是关键。     

永久性心脏起搏器并发症21例分析

目的探讨植入永久性心脏起搏器并发症发生的原因及处理措施。方法对21例植入或更换起搏器出现并发症患者的临床资料进行回顾性分析。结果囊袋血肿8例,电极脱位7例,切口和(或)囊袋感染3例,感知不良3例。结论应加强对植入起搏器常见并发症的认识,严格术中规范操作,加强术后随访,尽可能将并发症降到最低。     

钝性分离囊袋纤维网格对心脏起搏器更换术患者囊袋出血和感染的影响

目的通过探讨不同时期起搏器更换术囊袋相关并发症的发生情况,总结更换起搏器的方法和临床经验,从而提高起搏器更换的安全性和有效性。方法回顾性分析2001年1月至2011年12月共10年间167例更换起搏器时局部囊袋处理方法的变化,即2008年以前原囊袋内周围形成的纤维网格不予以分开,仅在囊袋上部切口附近分离皮肤及组织,形成大小适中的囊袋;2008年以后尽量将原囊袋中形成的纤维网格分开,适当扩大原囊袋,并加强术后囊袋管理;同时观察起搏器更换术后囊袋感染和血肿的发生情况。结果 167例更换起搏器患者,均为起搏器电池耗竭;其中2008年1月以前更换者为77例,2008年1月以后更换者为90例。2个时间段,与起搏器囊袋并发症相关的患者和植入因素无显著不同,与2008年以前相比,2008年以后行起搏器更换术囊袋相关并发症发生率明显降低,差异有显著性(6.7%vs 27.3%,P0.01),其中局部囊袋血肿10例(5.9%),8例(80%)为2008年以前更换,局部囊袋感染17例(10.2%),13例(76.5%)为2008年以前更换。结论起搏器更换术中将由结缔组织形成的原囊袋周围钝性分开的处理方法可降低起搏器更换术囊袋相关并发症发生。     

传统心脏起搏器转用无导线起搏器的可行性临床研究

目的：探讨当传统心脏起搏器引起并发症或需要重置、更换时,转用无导线起搏器治疗的可行性。方法：纳入2020年1月至2022年11月云南省阜外心血管病医院传统心脏起搏器改用无导线起搏器的8例患者,其中4例为传统起搏器囊袋感染,1例为电极导线断裂,3例为电量耗竭,收集临床资料及随访资料,并记录转用起搏器后新发并发症情况。结果：8例患者中位随访时间为8.5个月,转用无导线起搏器后1例出现慢性心包填塞。无新发感染,无导线起搏器（微）脱位及工作故障。结论：传统心脏起搏器转用无导线起搏器可行;对于心腔内遗留有传统电极导线的患者,再植入无导线起搏器存在一定远期并发症的风险,需要慎重对待。     

永久起搏器并发症的临床分析

目的 观察植入永久性心脏起搏器的并发症情况,寻找其原因,并探讨其防治策略.方法 对382例植入或更换起搏器出现并发症患者的临床资料进行回顾性分析.结果 并发症情况：囊袋血肿15例,电极脱位8例,电极断裂2例,囊袋破溃并（或）感染4例,感知不良6例,起搏器综合征5例,弄摆综合征1例,静脉血栓形成1例.结论 应加强对植入起搏器常见并发症的认识,严格术中规范操作,加强术后随访,尽可能将并发症降到最低.     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.