带膜血管内支架置入治疗B型主动脉夹层

目的:探讨带膜血管内支架置入治疗B型主动脉夹层的效果。方法:B型主动脉夹层5例,切开股动脉置入带膜血管内支架封堵原发破口后重复造影检查。结果:均成功置入支架,置入的人造血管支架使降主动脉和腹主动脉真腔扩大,明显改善降主动脉及分支血管血流。术后4例患者肾功能恢复正常,1例内漏患者术后随诊,7个月后消失,夹层近端假腔内均有血栓形成。结论:带膜血管内支架置入是B型主动脉夹层有效的治疗途径,远期效果还有待进一步观察。     

腔内血管支架植入治疗胸主动脉夹层

目的：总结腔内血管支架植入治疗主动脉夹层临床经验。方法：胸主动脉夹层5例,男3例,女2例,平均年龄(53.5±4.5)岁。经多排 CT 增强扫描或磁共振成像确诊。切开右侧股动脉,植入腔内血管带膜支架,封堵原发破口。植入后重复造影检查。随访行胸部 X 线平片与多排螺旋 CT 检查。结果：支架植入均成功,术后即刻造影5例均无内漏。降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有明显改善。术后3月随访,降主动脉及腹主动脉真腔扩大,近端夹层动脉瘤消失。结论：腔内血管带膜支架植入治疗胸主动脉夹层近期疗效满意。     

覆膜支架治疗37例Stanford B型胸主动脉夹层的疗效分析

目的:分析覆膜支架腔内修复治疗Stanford B型胸主动脉夹层的临床疗效。方法:对2015年1月至2016年12月收治的37例因Stanford B型胸主动脉夹层行覆膜支架腔内修复术患者的病历资料进行回顾性分析,其中男性29例,女性8例。术前诊断依据临床表现及CT血管造影(CTA),术中造影再次评估病变部位及解剖位置,切开股动脉,行覆膜内支架置入,封堵原发破口,手术成功后再次造影检查。结果:37例患者共置入支架37枚,全部获得成功。术中造影见少量内漏4例,3例经支架近端球囊扩张后内漏消失,1例无需特殊处理。患者临床症状均明显改善,降主动脉及腹主动脉真腔明显扩大。结论:采用覆膜支架腔内修复术治疗Stanford B型胸主动脉夹层安全、创伤小、恢复快,临床效果显著。     

覆膜血管内支架置入治疗B型主动脉夹层的临床应用研究

目的:评价覆膜血管内支架置入治疗B型主动脉夹层的疗效。方法:180例B型主动脉夹层,男158例,女22例,年龄(50．4±10．9)岁。术前行计算机体层摄影术(CT)增强扫描检查。在数字减影血管造影(DSA)监测下选用覆膜血管内支架封堵夹层原发破口。置入后即刻重复DSA检查。随访行胸部X线平片与CT增强扫描检查。结果:技术成功率99．4％(179／180),1例支架位置过高,行外科升主动脉-左颈总动脉-左锁骨下动脉搭桥术。术后即刻造影160例无内漏,18例少量内漏,2例中量内漏近段加短袖套支架(Cuff)后内漏消失;降主动脉真腔明显扩大,腹主动脉及分支供血均有不同程度的改善。术后随访(18．6±7．2)个月,18例少量内漏12例6个月内消失、6例无加重;21例支架段假腔消失,余者近端假腔内均有血栓形成;1例支架远端形成假性动脉瘤破裂死亡。结论:覆膜血管内支架置入治疗B型主动脉夹层安全有效,近、中期疗效满意,远期疗效有待于进一步观察。     

带膜支架置入治疗胸主动脉夹层

目的探讨带膜支架置入治疗胸主动脉夹层的指征、方法及疗效。方法5例Stan-ford B型亚急性期主动脉夹层患者,在局麻、数字减影血管造影术(DSA)监控下,切开股动脉,将带膜支架置入胸主动脉内膜破口处,封闭破口,置入后重复造影。结果患者原发主动脉夹层破口完全封闭,真腔血流恢复正常,术后1月及6月用多普勒超声和CT血管造影(CTA)复查显示无内漏及移位等并发症,假腔血栓形成。结论Stanford B型主动脉夹层适合带膜支架介入治疗,具有技术可靠,安全性高,术后恢复快等优点,临床应用前景良好。     

带膜支架置入治疗胸主动脉夹层

目的探讨带膜支架置入治疗胸主动脉夹层的指征、方法及疗效.方法 5例Stanford B型亚急性期主动脉夹层患者,在局麻、数字减影血管造影术(DSA)监控下,切开股动脉,将带膜支架置入胸主动脉内膜破口处,封闭破口,置入后重复造影.结果患者原发主动脉夹层破口完全封闭,真腔血流恢复正常,术后1月及6月用多普勒超声和CT血管造影(CTA)复查显示无内漏及移位等并发症,假腔血栓形成.结论 Stanford B型主动脉夹层适合带膜支架介入治疗,具有技术可靠,安全性高,术后恢复快等优点,临床应用前景良好.     

三分支支架血管在急性A型主动脉夹层全主动脉弓重建术中的应用

目的探讨应用三分支支架血管进行急性A型主动脉夹层全主动脉弓重建的可行性。方法对3例急性A型主动脉夹层需全主动脉弓重建的患者实施术中直视下三分支支架血管置入。当鼻咽温度降至23℃时,停止下半身灌注,于无名动脉近端横断升主动脉,经此切口将三分支支架血管置入主动脉弓和降主动脉真腔内,并将其分支支架血管依次置入左锁骨下动脉、左颈总动脉和无名动脉。将主干支架血管近端与无名动脉近端的升主动脉切口重建后与替换近端升主动脉的人造血管端端吻合。结果3例患者术中顺利地置入三分支支架血管。术后无并发症,均痊愈出院。术后电子束CT检查结果示：主干支架血管及其分支支架血管通畅,三分支支架血管均无扭曲,三分支支架血管置入部位的主动脉夹层假腔闭合。结论应用三分支支架血管直视置入进行急性A型主动脉夹层患者的全主动脉弓重建是可行的。这种方法避免于常规全主动脉弓替换术中的主动脉弓三分支血管吻合和左锁骨下动脉远端较深部位的远端人造血管一降主动脉的吻合,从而简化了全主动脉弓的重建,并提高了手术的安全性。     

用腔内隔绝术治疗B型主动脉夹层动脉瘤46例

目的评价用主动脉夹层动脉瘤腔内隔绝术治疗StanfordB型主动脉夹层动脉瘤的近、中期临床疗效。方法2002年5月至2006年9月,行主动脉腔内隔绝术治疗B型主动脉夹层46例。其中男36例,女10例;年龄62±18岁。46例均经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访1~52个月,平均17±16个月,分析其临床特点及疗效。结果住院期间及随访30d内无患者死亡;发生主动脉腔内隔绝术后综合征11例;2例患者左锁骨下动脉被封闭;5例发生内漏,术后3个月时其中4例内漏自行封闭。随访3个月时,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后半年1例发生截瘫,原因不明。术后1年1例出现迟发性内漏;1例升主动脉发现夹层,未行外科手术。随访期间3例死亡,4年生存率89.3%。结论用主动脉夹层动脉瘤腔内隔绝术治疗B型主动脉夹层动脉瘤的近、中期疗效满意。     

腔内隔绝术治疗112例Stanford B型主动脉夹层动脉瘤患者疗效观察

目的评价主动脉夹层腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期临床疗效。方法选择行主动脉腔内隔绝术治疗Stanford B型主动脉夹层患者112例。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后冠状动脉造影检查证实疗效,术后随访平均(39±18)个月。分析其临床特点及疗效。结果手术成功112例,共置入覆膜支架119枚。左锁骨下动脉完全被封闭8例,合并严重狭窄病变的冠心病患者完成PCI 16例,主动脉腔内隔绝术后综合征19例,术后1个月内夹层破裂死亡3例。随访3个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后明显残余内漏10例,3个月自行封闭。术后6个月,再发升主动脉夹层3例,其中行升主动脉外科手术1例,截瘫1例,胃癌多器官转移死亡1例。术后1年迟发性内漏1例。结论腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期疗效满意。     

腔内隔绝术治疗主动脉夹层动脉瘤107例分析

目的 探讨应用覆膜支架腔内隔绝术治疗主动脉夹层动脉瘤的方法和效果.方法 对107例(男88例,女19例,年龄28～83岁)主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析.术前采用CT血管成像(computerized tomography angiography,CTA)、经胸心脏超声(transthoracic echocardiography,TTE)、磁共振血管成像(magnetic resonance aniography,MRA)等技术对主动脉夹层动脉瘤进行评估.术中穿刺左肱动脉行主动脉造影了解破口的位置及撕裂的范围,在数字减影血管造影(digital subtraction angiography,DSA)监视下经股动脉将覆膜支架送入胸降主动脉封闭夹层破口.结果 107例成功进行了主动脉夹层动脉瘤腔内隔绝术.术后主动脉造影证实夹层裂口完全封闭或内漏明显减少,无中转开胸手术.术后随访1～48个月,术后1个月3例死亡.104例行CTA复查,术后3个月,所有患者内膜破裂口封闭,胸降主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常.术后6个月,1例再发生升主动脉夹层,置入一枚支架后后假腔消失.术后1年,主动脉均未见病变.结论 覆膜支架腔内隔绝术是治疗主动脉夹层动脉瘤的安全、有效的方法,近期疗效好.手术死亡率和并发症发生率低,手术成功率和生存率高.     

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.     

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.     

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.