常规检查对疑难腹水的诊断价值

目的 腹腔镜技术的发展为疑难腹水的诊断提供了手段,但该技术为有创性,其临床价值受到限制.我们对我院近8年经腹腔镜明确诊断的94例疑难腹水患者的各项常规检查结果进行分析,并总结其在疑难腹水诊断中的价值.方法 收集我院自2005年2月～2013年5月经腹腔镜和病理检查明确诊断的疑难腹水患者94例的临床资料,分析其常规检查的特点,探讨常规检查在疑难腹水诊断中的价值.结果 单纯症状学差异在鉴别结核和肿瘤所致腹水中的作用不大.肿瘤患者腹水中间皮细胞比例〉10%及乳酸脱氢酶明显升高较结核更常见;多种肿瘤标记物的升高较单一指标升高对肿瘤的诊断意义较结核大;腹水腺苷脱氨酶升高对诊断结核有临床意义;影像学CT或MRI检查无特异性;静脉血干扰素-γ的阴性结果有助于排除结核的诊断.结论腹腔镜检查在疑难腹水的诊断中有非常重要的作用,但是常规检查仍然有着不可替代的价值,其结果应受到临床医师的足够重视.     

诊断性腹腔镜的临床应用价值

目的 探讨诊断性腹腔镜在临床的应用价值。方法 回顾性分析1994年2月至2000年10月进行的75例诊断性腹腔镜检查。结果 对28例不明原因腹水,24例腹外伤、急腹症,9例不明原因腹内肿块,6例性质不明肝脏肿块,6例肿瘤待查及2例膈肌病变,除2例不明原因腹水患诊断未明外,余皆在腹腔镜下得到明确诊断及相应的有效治疗。总诊断明确率为97．4％。有3例发生并发症,发生率4．0％。结论 诊断性腹腔镜检查是一种较安全、有效的检查方法。在评估腹腔内病变,如肝脏疾病,不明原因腹水,腹腔内肿瘤的诊断、转移病灶的发现和恶性病变的分期,某些腹外伤及急腹症方面有其独特而重要的作用,     

诊断性腹腔镜的临床应用价值

腹腔镜检查对诊断腹腔内器官病变方面已得到了广泛应用。我院自 1994年 2月至 2000年 10月行 75例诊断性腹腔镜检查,现分析如下。 　　一、资料与方法 　　1．一般资料：本组 75例中男 38例,女 37例;年龄 9～ 78岁,平均（ 44.3± 17.9）岁。其中 28例不明原因腹水, 24例腹外伤急腹症, 9例不明原因腹内肿块, 6例不明性质肝脏肿块, 6例肿瘤探查,另有 2例膈肌病变。 　　2．方法：检查时采用全身麻醉,根据观察需要于适当位置取 2～ 4个操作孔,避开由于手术或炎症引起的粘连部位。对于腹水患者预先引流一定量的腹水,以有足够的气腹…     

诊断性腹腔镜的临床应用研究

目的：评价诊断性腹腔镜的检查方法、效果及安全性，提高腹部疑难疾病的早期诊断率。方法：回顾分析58例腹部疑难疾病患者的腹腔镜检查情况，其中腹水原因待查35例，腹水＋腹部包块23例。结果：58例患者中诊断为结核性腹膜炎31例，恶性腹膜间皮瘤23例，腹膜转移癌2例，盆腔结核及慢性盆腔炎各1例。不同疾病在腹腔镜下有不同表现。操作时间25－70min，平均38min。并发症为活检处出血4例，其中3例为自限性因，1例经局部喷洒凝血酶后停止，术后伤口漏水5例。对腹腔镜下有肯定判断的12例患者同时进行治疗。结论；腹腔镜检查具有安全、简便、微创、痛苦小、确诊率高等优点。诊断性腹腔镜值得进一步推广应用。     

双镜法针式腹腔镜胆囊切除术

为探讨双镜法针式腹腔镜胆囊切除术的应用价值，对４０例慢性胆囊炎胆囊结石患者进行了１０ｍｍ腹腔镜和２ｍｍ腹腔镜互换使用的双镜法针式腹腔镜胆囊切除术。结果示针式腹腔镜胆囊切除术与普通腹腔镜胆囊切除术相比，具有瘢痕小、疼痛轻、术后恢复快等优点。与国外单镜法针式腹腔镜相比，该方法具有手术视野广、清晰度高、安全可靠、操作方便等优点。结果提示：双镜法针式腹腔镜胆囊切除术是治疗胆囊炎胆石症的一种新的安全有效的微创手术方法。     

腹腔镜对不明原因腹水的诊治价值

目的探讨腹腔镜对不明原因腹水的诊治价值。方法回顾性分析53例不明原因腹水进行腹腔镜检查的临床病理资料。结果53例患者中51例完成腹腔镜检查,44例明确诊断,确诊率为86.3%,无严重并发症发生。结论诊断性腹腔镜检查诊断不明原因腹水是一种安全有效的方法。     

腹腔镜在消化疾病诊断中的价值浅析

目的探讨腹腔镜检查在腹部疑难疾病诊断中的价值．方法临床诊断困难的腹水、腹部包块患者18例，应用45°斜视式腹腔镜进行检查，同时进行直视下活检，其中腹水13例，腹部包块5例，男11例，女7例，年龄19岁～62岁，检查结束后比较直视与病理诊断符合情况．结果18例患者均检查成功，其中17例明确诊断，确诊率94．4％，直视与病理检查符合率88．8％，诊断为结核6例、肝硬变5例、肝癌3例、恶性间皮瘤2例、结肠癌腹膜转移回例．无并发症发生，术后恢复快．结论腹腔镜检查准确、安全、损伤小、恢复快、经济，对腹部疑难病的诊断有独到之处，可替代不必要的剖腹探查，同时还可进行适当的治疗，因此有着极高的临床适用价值．     

34 例疑难性腹部疾病腹腔镜诊断分析

我们在1995年1月～1999年12月,对34例临床难以诊断的腹痛、腹水和腹块患者进行了电视腹腔镜下检查及活检,探讨疑难性腹部疾病腹腔镜检查的诊断价值。1　对象和方法1.1　对象1.1.1　临床资料:34例患者均系我院消化内科、肝胆外科住院病人。男15例,女19例,年龄6～69岁,中位年龄41.36岁。病程10天～3年。34例患者的主要症状、体征及腹腔镜检查前临床诊断和腹腔镜诊断资料见表1。表1　34例疑难性腹部疾病临床与腹腔镜诊断资料临床主要表现(ｎ)临床诊断(ｎ)腹腔镜诊断(ｎ)腹水(13)结核性腹膜炎(12)腹膜结核(5)盆腔恶性肿瘤(2)腹膜转移癌(5)腹腔恶…     

腹腔镜对原因不明腹水的诊断价值

腹腔镜对原因不明腹水的诊断价值杨大明堵浩荣邹萍陆静娴孟宪镛我们回顾性分析因腹水性质不明而行腹腔镜检查的３３例患者资料，３３例中有３０例明确了诊断，并评价腹腔镜对原因不明腹水的诊断价值，报告如下。一、临床资料本组３３例均为近年我院和邻近医院住院患者，男...     

腹腔镜检查对诊断疑难性腹部疾病的价值

我们自１９９５年１月～１９９９年１月,对３１例临床难以诊断的腹痛、腹水和腹块患者进行了电视腹腔镜下检查及活检;作了腹腔镜诊断与腹腔穿刺液细胞学和影像学诊断分级的比较,以评价腹腔镜检查在疑难性腹部疾病病因诊断的价值。材料和方法一、病例选择３１例均系我院住院患者。其中男１２例,女１９例,年龄为６～６８岁,平均４０．５２岁。病程为１０天～３年。临床以腹水、腹水＋腹块、腹痛和腹块为主要表现者分别为１１、８、７和５例。临床诊断为结核性腹膜炎２０例、腹盆腔恶性肿瘤５例、慢性阑尾炎２例、回肠憩室２例和回盲部肿…     

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.