门静脉-肠系膜上静脉广泛栓塞1例并文献复习

背景内镜下套扎术是食管胃静脉曲张出血的一线治疗方法.食管胃静脉曲张密集套扎后形成门静脉-肠系膜上静脉广泛新发血栓临床罕见.病例简介本文回顾性分析1例乙肝肝硬化脾切除术后食管胃静脉曲张出血患者,经食管胃底曲张静脉密集套扎治疗后出现门静脉-肠系膜上静脉广泛新发血栓,积极给予抗凝治疗后,新发血栓消失.结论对于肝硬化脾切除术后食管胃静脉曲张出血,尤其同时存在慢性门静脉血栓者,如需行套扎治疗,勿使套扎范围过密,不要追求一次性全部阻断血流,以防门静脉-肠系膜上静脉新发血栓形成.     

内镜下套扎联合部分脾动脉栓塞术治疗食管静脉曲张破裂出血

目的探讨内镜食管曲张静脉套扎联合部分脾动脉栓塞术治疗胃底食管静脉曲张破裂出血的疗效。方法对30例肝硬化食管胃底静脉曲张破裂出血病人行内镜下曲张静脉套扎术（EVL），联合部分脾动脉栓塞术（PSA）。观察近期止血效果、远期出血率、脾脏厚度和外周血细胞变化。结果联合术后病人脾功能亢进缓解，远期出血率降低，无严重并发症。结论EVL＋PSE是治疗肝硬化食管静脉曲张破裂出血和脾功能亢进安全有效的方法。     

内镜下套扎联合经皮经肝TH胶栓塞治疗肝硬化食管胃底静脉曲张的临床应用

目的评价内镜下套扎(EVL)联合经皮经肝曲张静脉TH胶栓塞术(PTVE)治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法 44例肝硬化食管胃底静脉曲张出血患者,先行食管曲张静脉的内镜下套扎治疗,1周后再行TH胶PTVE,栓塞食管胃底曲张静脉区域及其来源血管。联合治疗术后定期复查胃镜,观察曲张静脉消失情况,随访治疗后曲张静脉复发率及再出血率。结果 44例食管胃底静脉曲张患者,32例食管曲张静脉基本消失,消失率72.7%;8例胃底静脉曲张基本消失,消失率100%;12例食管静脉曲张程度明显减轻,总有效率100%。随访6~39个月,平均25.6个月,5例食管静脉曲张复发,复发率11.4%;3例再出血,再出血率6.8%。结论内镜下套扎治疗能机械性地消除食管曲张静脉,经皮经肝TH胶栓塞能栓塞食管胃底曲张静脉区域及其供血血管,二者联合能达到协同作用,具有更好的远期疗效。     

内镜套扎-部分脾栓塞联合术治疗门脉高压症的临床疗效观察

探讨内镜套扎-部分脾栓塞联合术治疗门脉高压症的临床应用价值。对2 5例合并食道静脉曲张和脾功能亢进的门脉高压患者进行内镜套扎-部分脾栓塞联合术,对其术前术后外周血象、脾脏大小、门静脉、脾静脉内径的变化进行对比研究。联合术后患者食道静脉曲张得到根治,脾功能亢进明显缓解,脾脏缩小(P <0 .0 1)、门静脉、脾静脉内径缩小(P <0 . 0 1)。内镜套扎-部分脾栓塞联合术治疗门脉高压症具有简便、安全、效果显著、创伤小、并发症少等优点,是治疗肝硬化门脉高压症的一种新的途径。     

食管静脉曲张套扎对痔疮、肛门直肠静脉曲张及门脉高压性结肠病的影响

近几年,内镜下曲张静脉套扎术(EVL)已基本取代了硬化剂注射(EST)而成为食管静脉曲张的治疗性手术。已知EVL后,食管静脉曲张的消退会导致门脉高压性胃病(PHG)的发病率增高,但是并未明确食管静脉曲张套扎对痔疮、肛门直肠/结肠静脉曲张以及门脉高压性结肠病的影响情况。本项实验的目的是研究内镜下食管静脉曲张套扎术对痔疮、肛门直肠/结肠静脉曲张以及门脉高压性结肠病的影响。 病人和方法:60例肝硬化门静脉高压病患者参加了这项前瞻性研究。患者均至少有一次食管曲张静脉破裂出血史,而那些已经接受过EST/EVL治疗以及做过门静脉高压手术的病人被排除在外。将病人随机分组,每周一次或隔周一次     

脾切除贲门周围血管离断术治疗晚期血吸虫病并门静脉海绵样变

目的 目的 探讨晚期血吸虫病门静脉高压症合并门静脉海绵样变的外科治疗方式。 方法 方法 对湖南省血吸虫病防治 所附属湘岳医院18例晚期血吸虫病合并门静脉海绵样变患者的临床资料进行回顾性分析。结果 结果 16例患者行脾切除贲 门周围血管离断术; 2例患者先行内镜食管曲张静脉套扎术, 后因再次食管静脉曲张破裂出血, 分别于术后32、 40个月行脾 切除贲门周围血管离断术。术后随访6～72个月, 未再发现食管胃底静脉曲张。结论 结论 脾切除贲门周围血管离断术适用 于晚期血吸虫病门静脉高压合并门静脉海绵样变的治疗。     

心得安对食管曲张静脉套扎后门脉高压性胃病的影响

食管静脉曲张(EV)破裂出血是肝硬化致死的重要原因之一,食管曲张静脉套扎术因其疗效好、创伤小,已成为EV的重要治疗手段.但食管曲张静脉套扎后会并发或加重门静脉高压性胃病(portal hypertensive gastropathyl,PHG)[1-2],这也是食管曲张静脉套扎后再出血的-个重要原因,因此预防套扎后PHG有重要的临床意义.心得安被证实能降低门静脉压力,临床已用来预防食管胃底静脉曲张破裂出血,但能否预防PHG,尤其是套扎后的PHG?我们通过前瞻性研究观察心得安对食管曲张静脉套扎后PHG的影响,探索预防套扎后PHG的方法.     

我国门静脉高压症外科治疗的现况和展望

门静脉高压症外科曾引领现代外科的发展。然而,在过去的10~20年里,筛查和控制食管胃曲张静脉破裂出血的药物、曲张静脉套扎和经颈静脉肝内门体分流术等非手术疗法获得广泛应用。手术治疗只适用于内镜疗法无效、肝功能Child-Pugh A级的患者。目前公认可取的3种手术是远端脾肾分流术、广泛的贲门周围离断术加脾切除术和二阶段经胸腹联合断流术。由于在中国供肝短缺,因此肝移植难以普及。腹腔镜脾切除以及腹腔镜脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者乃是重大挑战。认为外科治疗门静脉高压症应与非手术疗法合作,从而对肝硬化和非肝硬化门静脉高压症患者采取个体化治疗方案。     

经皮经肝组织粘合剂栓塞联合内镜下套扎治疗食管静脉曲张的临床应用

目的 探讨经皮经肝组织粘合剂(TH胶)栓塞(PTVE)联合内镜下套扎(EVL)治疗食管静脉曲张的合理性和临床疗效.方法 23例食管静脉曲张患者先行PTVE使TH胶栓塞胃冠状静脉主干及胃底贲门周围静脉,1个月后对食管黏膜下曲张静脉行内镜下套扎治疗.结果 该组患者TH胶未栓塞食管下段曲张静脉,PTVE后静脉曲张缓解,但未完全消失;联合EVL后17例患者静脉曲张基本消失,消失率73.9%.21例行1次套扎治疗,2例行2次套扎治疗,平均套扎次数1.1次/例.随访3～31个月(平均19.2个月),静脉曲张复发或加重3例(13.1%),2例(8.7%)患者门脉高压性胃病出现少量出血.结论 经皮经肝TH胶栓塞能阻断冠状静脉主干、食管胃底周围血管等曲张静脉的供血血管,而内镜下套扎治疗则消除食管下段黏膜下曲张静脉,二者联合可优势互补,从而取得更好的远期疗效.     

无痛胃镜联合多层螺旋CT在肝硬化食管胃静脉曲张治疗中的应用

目的研究无痛胃镜联合多层螺旋CT治疗肝硬化食管胃静脉曲张的临床效果。方法选取我院普通外科自2010年3月至2015年9月收治的经内镜证实为肝硬化门静脉高压症患者90例,按照随机数字表法将患者分为两组,每组45例,对照组行无痛胃镜下食管胃底曲张静脉套扎硬化术,观察组行64层螺旋CT对门静脉及食管胃静脉成像,并在其指导下在无痛胃镜下进行食管胃底曲张静脉套扎硬化术,对比两组治疗前后食管静脉曲张分级,随访24、48周复发率、再出血率及并发症发生率。结果观察组治疗前与对照组治疗前食管静脉曲张分级方面差异无统计学意义(P0.05)。对照组与观察组治疗后较治疗前相比均轻度比例增高,中度及重度比例降低,但观察组治疗后较对照组治疗后相比上述指标改善更加显著(P0.05)。观察组与对照组相比随访24、48周复发率、出血率及并发症发生率均较低,差异具有统计学意义(P0.05)。结论多层螺旋CT指导无痛胃镜下治疗肝硬化食管胃静脉曲张具有显著很好的效果,可在临床上广泛应用。     

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.     

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.