经闭孔或耻骨后无张力尿道中段悬吊术治疗女性压力性尿失禁

17例女性压力性尿失禁(SUI)患者,7例行经闭孔无张力阴道悬吊术(TVT-O)治疗(TVT-O组),10例行经耻骨后无张力阴道悬吊术(TVT)治疗(TVT组).TVT-O组平均手术时间25 min、术中出血10 ml、术后住院时间3.6 d,TVT组平均手术时间为40 min、术中出血15 ml、术后住院时间4.6 d.随访6～12个月,无尿失禁复发,尿动力学指标明显改善.认为TVT-O、TVT是治疗女性SUI的有效方法之一.     

TVT-O治疗女性压力性尿失禁临床疗效观察

目的观察经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效。方法对30例SUI患者行TVT-O治疗,观察手术并发症情况;术后随访3～12个月,对手术疗效及术后生活质量进行评估。结果 30例患者手术均成功,平均手术时间30 min,平均出血量35 mL,平均住院天数为4.5 d。术后大腿内侧疼痛2例,尿频、尿急2例,经相应处理症状均消失。本组30例均无明显排尿困难,无膀胱损伤、神经损伤,无尿失禁复发,无慢性疼痛、吊带侵蚀及网片排异反应等远期并发症发生。治愈28例,改善2例,无效0例,治愈率为93.3%,有效率为100%。结论 TVT-O治疗SUI疗效确切,具有操作简便、手术时间短、创伤小、不损伤膀胱、疗效持久、不易复发等优点。     

老年女性压力性尿失禁两种尿道吊带手术治疗对比

目的对比观察经阴道无张力尿道吊带术(TVT)和经闭孔阴道无张力尿道吊带术(TVT-O)治疗老年女性压力性尿失禁的临床疗效、安全性和对患者生活质量的影响。方法 92例老年压力性尿失禁女性患者按照随机数字表法分为观察组和对照组,每组46例,对照组患者采用TVT,观察组采用TVT-O,对比观察两组治疗效果、手术时间和术中失血量、术后并发症以及手术前后生活质量的变化;生活质量采用盆底功能影响问卷简表7(PFIQ-7)、排尿困扰量表(UDI-6)和尿失禁影响程度相关问卷(IIQ-7)评价。结果观察组治愈率高于对照组,但差异无统计学意义(P0.05);观察组手术时间短于对照组,术中失血量少于对照组(P0.05);两组并发症发生率比较无统计学意义(P0.05);两组术后3个月PFIQ-7、UDI-6和IIQ-7评分均较术前显著降低(P0.05),两组间比较无统计学意义(P0.05)。结论 TVT和TVT-O是老年女性压力性尿失禁两种安全有效的尿道吊带手术治疗方法,均能改善患者的生活质量,但TVT-O操作简单,创伤小。     

经闭孔无张力尿道悬吊术的护理

张力性尿失禁(SUI)是一种女性常见的妇科疾患,中老年女性的发病率约为40％～60％.SUI是指患者经完整的尿道不随意的遗尿,在腹压增加的情况下(如咳嗽、大笑等)即可引起排尿.1996年国外率先提出了经阴道无张力尿道中段悬吊术(TVT)治疗SUI的方法.我院自2008年采用经闭孔阴道无张力尿道悬吊术(TVT-O)治疗女性SUI,现报告如下.     

盆底三维超声辅助诊断女性压力性尿失禁的价值及对TVT-O效果的评估

目的分析盆底三维超声对压力性尿失禁(SUI)的诊断价值以及对经闭孔无张力尿道中段悬吊(TVT-O)手术效果的评价作用。方法测量118例SUI患者术前和术后及100例阴性对照组盆底结构二维和三维超声数据指标,评估膀胱尿道连接部的直接移动度(UVJ-M)、静息期及Valsalva动作后膀胱尿道后角、耻骨直肠肌厚度、盆膈裂孔面积,并观察两组肛提肌形态和TVT-O术后植入吊带的形态。结果 SUI组UVJ-M、Valsalva动作后膀胱尿道后角较对照组增大(P<0.05);静息期及Valsalva动作后耻骨直肠肌厚度小于对照组(P<0.05);静息期SUI组盆膈裂孔面积与对照组无显著性差异(P>0.05),Valsalva动作后SUI组盆膈裂孔面积大于对照组(P<0.05);SUI组TVT-O术后吊带位置、形态及活动情况可清晰观察,TVT-O术后UVJ-M小于术前(P<0.05),Valsalva时吊带的位置和形态无明显改变,可在尿道中段形成闭合效应,盆膈裂孔面积较术前无统计学差异。结论三维超声显像能直观有效地观察女性盆底结构,对诊断SUI是一个良好的辅助手段;并可为TVT-O术后评估提供更好依据。     

TVT-O治疗老年女性压力性尿失禁的临床观察

目的探讨经闭孔无张力阴道吊带悬吊术(TVT-O)治疗老年女性压力性尿失禁的有效性、安全性及其并发症的防治。方法对2009~2011年93例中重度老年女性压力性尿失禁患者采用TVT-O治疗,手术后采用Grouts-Blaivas评分法评价治疗效果,并定期随访观察远期疗效。结果所有手术过程均顺利完成,均未出现膀胱损伤或穿孔、吊带排斥和闭孔神经血管的损伤等严重并发症。患者术后随访6~23月,按Grouts-Blaivas评分法,尿失禁的最终治愈率为91%(85/93),改善良好7例,改善中等1例,无失败病例。结论 TVT-O手术治疗老年女性压力性尿失禁,操作简便,手术时间短,并发症少,疗效满意,能有效提高老年女性患者的生活质量。     

经阴道闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁20例临床体会

女性压力性尿失禁（SUI）是严重影响中老年妇女健康和生活质量的常见病,其发病与年龄相关。目前,治疗SUI的术式很多,经阴道闭孔无张力尿道中段悬吊术（TVT-O）是治疗SUI最有效、安全的术式。2006年1月～2009年6月,我院采用TVT-O治疗SUI患者20例,疗效满意。现报告如下。     

TVT-O 治疗女性压力性尿失禁疗效观察

目的：探讨经闭孔尿道中段阴道无张力悬吊术（TVT-O）治疗女性压力性尿失禁（SUI）的疗效与安全性。方法对25例女性SUI患者行TVT-O术式治疗,术前、术后进行1 h尿垫实验,术后随访9个月,采用尿失禁生活质量问卷以及性生活质量问卷评价疗效。结果手术时间平均36．6 min,术中出血量平均30 mL,术后1 h尿垫实验、术后漏尿量较术前明显减少（ P均＜0．05）。治愈24例,有效1例,治愈率为96％,有效率为100％。尿失禁生活质量问卷评分显示,术后6个月和9个月与术前比较明显好转（P均＜0．05）;性生活质量问卷评分显示,术后6个月和9个月与术前比较有所改善,但差异无统计学意义（P均＞0．05）。结论 TVT-O治疗女性SUI疗效确切、安全可靠,具有操作简单、手术时间短、并发症少等优点。     

T-sling尿失禁吊带治疗女性压力性尿失禁疗效观察

<正>女性压力性尿失禁(SUI)是中老年妇女的常见病,其特点是正常状态下无遗尿,腹压突然增高时尿液自动流出。发病率国内报道约为29.8%~36.5%[1-2],其中60岁女性SUI发病率可达47.5%[2]。无张力阴道吊带术(TVT)是治疗SUI的有效、微创术式,其临床应用价值已得到广泛的认可。而经闭孔阴道无张力尿道中段悬吊术(TOT)是在TVT基础上进行改良,避免了损伤膀胱、尿道和引起耻骨后血肿的风险。     

TVT-O治疗老年女性压力性尿失禁的疗效

压力性尿失禁(SUI)是指正常状态下无遗尿,而腹压突然增加时尿液自动流出,是盆底功能障碍性疾病的一种,随年龄的增长发病率呈上升趋势。据统计,60岁以上女性尿失禁发病率高达66%,其中SUI约占60%〔1〕,严重影响女性的生活质量及身心健康。本研究旨在探讨经阴道-闭孔尿道中段无张力悬吊术(TVT-O)治疗老年女性SUI的疗效、安全性及围术期管理。     

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.