国产封堵器介入治疗动脉导管未闭198例

目的 观察应用国产蘑菇伞型封堵器介入治疗动脉导管未闭(PDA)的临床疗效.方法 198例PDA患者于主动脉弓降部造影,测量动脉导管大小,在透视下经传送装置将国产蘑菇伞型封堵器置入动脉导管内,使之在动脉导管处固定,即刻造影,术后行超声心动图(UCG)检查.结果 全组成功196例,技术成功率99%;主动脉弓造影即刻无分流146例;50例存在微量或少量残余分流,经UCG复查,其中25例术后48 h分流消失,22例术后1个月分流消失,3例术后3个月分流消失;封堵术后即刻肺动脉平均压由封堵前(42.8±16.4)mmHg下降至(31.3±14.5)mmHg(P<0.05);术后3个月心室舒张末期容积均较术前缩小(94.2±28.4)mL vs(112.5±31.5)mL,(52.1±12.4)mL vs(61.0±15.7)mL(P<0.05).结论 应用国产蘑菇伞型封堵器治疗动脉导管未闭操作方法简便,治疗范围广,成功率高.     

伴重度肺动脉高压的动脉导管未闭封堵器疗效观察

目的应用封堵器治疗动脉导管未闭(PDA)伴重度肺动脉高压(SPH)患者,并评价其临床疗效。方法回顾性分析22例PDA合并SPH患者,应用国产封堵器封堵PDA,观察封堵前及封堵后肺动脉压力改变,术后24h及1、3、6个月行超声心动图、胸部正侧位片检查随访。结果19例封堵成功,PDA最窄处直径6.3￣11.0(8.2±3.6)mm。术前肺动脉收缩压为81￣128(97±26)mmHg,平均压为69￣102(80±23)mmHg,封堵后30min测肺动脉收缩压为45￣78(55±19)mmHg,平均压为42￣66(49±16)mmHg,较封堵前显著降低(P<0.05),3例PDA伴SPH者术中试封堵证实为阻力性肺动脉高压而未行封堵。封堵后30min降主动脉造影示16例封堵完全,无残余分流,3例存在微量残余分流。术后24h超声心动图示1例仍存在微量残余分流,1个月后所有患者均未见残余分流,术后未见溶血、封堵器脱落、移位及左肺动脉狭窄等并发症。结论应用封堵器治疗一些PDA伴SPH的患者是一种可行的、有效的介入方法。     

国产蘑菇伞型封堵器封堵巨大动脉导管未闭的可行性研究

目的探讨采用国产蘑菇伞型封堵器经导管封堵巨大动脉导管未闭(PDA)的可行性。方法全组15例,其中男3例,女12例,年龄21±8(16～46)岁。PDA最窄处直径为16±3mm(13～22mm),均采用国产蘑菇伞型封堵器经股静脉途径对PDA进行封堵。封堵前后行主动脉弓降部造影并测定肺动脉压力。封堵成功者分别于术后1周、1个月和6个月复查超声心动图。结果15例巨大PDA选用的封堵器直径为23±4mm(18～32mm),封堵后30min主动脉弓降部造影均显示主-肺动脉水平仅有经封堵器孔眼的微量到少量残余分流。封堵后13例患者肺动脉收缩压峰值较封堵前有不同程度下降(70±29mmHgvs113±21mmHg,P<0.05,1mmHg=0.133kPa),2例因试封堵后肺动脉压力升高而放弃封堵。无一例发生严重并发症。封堵成功者术后复查超声心动图,其中11例于术后1周、1例于术后1个月残余分流消失,另1例于术后6个月时残存少量分流。结论采用国产蘑菇伞型封堵器经导管封堵巨大PDA是一种安全有效的介入治疗方法。     

动脉导管未闭合并重度肺动脉高压Amplatzer法封堵治疗的临床应用--12例初步报告

目的评价Amplatzer封堵器治疗动脉导管未闭(PDA)合并重度肺动脉高压(SPH)的初步疗效.方法对12例(女9例,男3例)PDA合并SPH患者实施封堵治疗.其中10例采用Amplatzer动脉导管未闭封堵器,2例采用Amplatzer房间隔缺损封堵器.结果全组12例PDA封堵器均放置成功.11例PDA封堵后30分至1小时肺动脉收缩压、肺动脉平均压均明显降低.1例封堵术后即刻肺动脉压无变化.术后36小时彩色多普勒估测肺动脉压明显下降,封堵术后30分降主动脉造影,无残余分流9例,微量残余分流2例,少量残余分流1例.全组术后24～48小时彩色多普勒检查,动脉水平左向右分流均完全消失.无重要并发症发生.随访1～24个月(平均8个月),患者症状改善,11例心脏缩小,无1例发生再通.结论采用Amplatzer法封堵治疗PDA合并SPH,近期疗效满意.     

高原地区用Amplatzer封堵器治疗动脉导管未闭

目的:应用Amplatzer封堵器在高原地区治疗动脉导管未闭(PDA)并评价其疗效。方法:本组40例,年龄1.5～44(22.5±14.2)岁,PDA最窄处内径5～14(9.3±3.3)mm,均用Amplatzer封堵器介入治疗。结果:19例成功,1例严重阻塞性肺动脉高压不适宜封堵。术后即刻降主动脉造影显示35例封堵完全无残余分流,4例少量残余分流。1例术后1h封堵器脱落入右肺动脉,第3小时急诊外科手术关闭PDA并取出封堵器。24 h彩色多普勒检查显示封堵36例患者均无分流,随访2个月～1年半,无一例分流。结论:高原地区PDA发病率高,并发肺动脉高压早且多,巨大PDA(内径>0.8 cm)比率高,用Amplatzer封堵器治疗PDA是高原地区一种适应性强、安全有效的介入治疗方法。     

国产封堵器介入治疗动脉导管未闭的临床分析

目的总结应用国产封堵器治疗动脉导管未闭的临床疗效。方法本组动脉导管未闭患者10例,男4例,女6例,年龄3~55岁,体重10.5~54 kg,平均肺动脉压33~49 mm Hg。降主动脉侧位造影显示病理解剖类型为管型8例,漏斗型2例,最窄处直径2~8 mm,应用国产封堵器经静脉途径行封堵术。术后超声心动图随访。结果10例患者均成功封堵,术后即刻完全封堵9例,1例有少量残余分流,术后24小时彩色多普勒超声检查示分流消失,肺动脉压均有下降,随访无严重并发症。结论国产封堵器治疗动脉导管未闭是一种安全有效的方法。     

国产蘑菇伞形封堵器治疗未闭动脉导管15例报告

目的评价国产蘑菇伞形动脉导管封堵器治疗动脉导管未闭(PDA)的即刻和早期疗效.方法15例患者,男4例,女11例,平均年龄23±18(5～65)岁.PDA平均最小直径为4.9(2.5～12.0)min,应用F7～F9长鞘管输送封堵器.结果15例患者均获成功.术后10min动脉造影显示PDA完全堵塞.无并发症.结论应用国产蘑菇伞形动脉导管封堵器经导管封堵术是治疗PDA的有效方法.     

经导管封堵治疗动脉导管未闭伴重度肺动脉高压

目的评价经导管封堵术治疗动脉导管未闭伴重度肺动脉高压病人的临床疗效与安全性。方法选择在我院接受经导管封堵术治疗且肺动脉收缩压在80mmHg或以上，肺动脉平均压在60mmHg或以上的动脉导管未闭病人31例，回顾性分析病人术中及术后随访资料。结果31例病人术前肺动脉收缩压80～183（112±28）mmHg，肺动脉平均压63～130（82±22）mmHg。其中30例经导管封堵成功（成功率97％），1例巨大型动脉导管未闭因无合适封堵器而行手术治疗。封堵后10min，26例肺动脉收缩压下降30mmHg以上，2例肺动脉收缩压下降20％以上，另2例肺动脉收缩压无明显改变。1例用房间隔缺损封堵器封堵巨大型动脉导管未闭，在术后3d复查心脏超声时发现封堵器脱人肺动脉而转入外科手术治疗；在5例双向分流者中，1例于术后2个月因重度肺部感染死亡，1例于封堵后血氧饱和度明显增加，但肺动脉压无明显下降，术后2年出现右心功能不全表现。结论动脉导管未闭伴重度肺动脉高压病人，若心脏超声检查示左向右分流，可用经导管封堵术进行根治；但若为双向分流时，经导管封堵治疗应慎重。     

国产封堵器介入治疗巨大动脉导管未闭的临床评价

目的应用国产封堵器经导管治疗巨大动脉导管未闭（PDA）并对其疗效进行评价。方法全组27（男8,女19）例,年龄6～54（24±15）岁,主动脉造影示PDA最窄径为13～28（16±4）mm。封堵后即刻和30min行侧位降主动脉造影,术后2d,1、3、6个月分别行超声心动图及X线平片检查。结果24例成功,3例PDA封堵后判断为有阻力性肺动脉高压,放弃治疗。成功的患者中,14例选用国产PDA封堵器,10例选用国产ASD封堵器。术后即刻降主动脉造影检查示,使用ASD封堵器中,有2例微量残余分流,5例少量残余分流,1例少～中量残余分流;PDA封堵器中,有4例微量残余分流,2例少量残余分流。术后30min,ASD封堵器4例微～少量残余分流,1例仍为少～中量残余分流;PDA封堵器仅2例微量残余分流。1例ASD封堵器治疗术后7h发生溶血,治疗72h溶血无减轻迹象,外科开胸取出封堵器并行PDA结扎术。术后2d,超声心动图示PDA封堵器1例微量残余分流,ASD封堵器5例微量残余分流。随访1～6个月,所有左心内径增大的患者均明显回缩,未发现残余分流和导管再通。结论应用国产封堵器经导管治疗直径≥13mm的PDA是一种安全有效地介入方法。     

Amplatzer封堵器和Rashkind封堵伞治疗动脉导管未闭的对比研究

目的 :比较Amplatzer封堵器和Rashkind封堵伞治疗动脉导管未闭 (PDA)的疗效。方法 :42例PDA患者施行Rashkind封堵伞封堵术 (为Rashkind组 )。在施行Amplatzer封堵器封堵术的PDA患者中 ,选出年龄、体重匹配且PDA最小直径≤ 8mm的患者共 42例 (为Amplatzer组 )。对比两种方法治疗PDA的临床效果、并发症等情况。结果 :Amplatzer组 ,技术成功率 10 0 % ,溶血 1例。即刻残余分流发生率 16 7% ,术后 1～ 18个月 ,均无残余分流。Rashkind组 ,技术成功率 97 7% ,1例患者Rashkind封堵伞脱落至右肺动脉 ,经手术取出并行PDA结扎术。术后即刻和12个月残余分流发生率分别为 83 3%和 41 2 % ,均显著高于Amplatzer组 ,有非常显著性差异 (P <0 0 1)。结论 :Amplatzer封堵器比Rashkind封堵伞更安全、有效     

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.     

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.     

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.