内镜下凝血酶治疗上消化道出血

目的观察凝血酶局部应用对上消化道出血的疗效．方法男20例，女12例，年龄15岁～71岁．胃溃疡11例，十二指肠溃疡7例，急性胃粘膜病变10例，残胃一吻合口炎3例，Dieulofoy病1例．其中喷射性出血1例，涌出性出血10例，活动性渗血21例．所有病例均做术前准备．酬情采用喷洒、注射方法．喷洒时采用凝血酶生理盐水（100IU／mL）直接喷洒．注射时采用500IU／mL在出血灶四周分点注射．24h后内镜观察有无再出血，必要时重复治疗．术后继续给予抑酸治疗．结果19例喷洒后有17例30s内止血．15例注射后有13例迅速止血，另2例经再次注射后止血.总止血有效率100％，喷射性、涌出性出血一次止血有效率82％．未见副作用和并发症．随访24例患者1mo～8mo未见复发者．结论凝血酶局部喷洒、注射的方法治疗非静脉曲张性上消化道出血效果良好．     

内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血42例

[目的]观察内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血的疗效.[方法]对42例胃底静脉曲张破裂出血患者进行内镜下注射组织黏合剂治疗.[结果]所有患者均一次成功止血,注射2周后内镜复查见固化组织黏合剂开始排出,随访3个月,无再出血及及死亡病例发生.[结论]内镜下注射组织黏合剂治疗胃底静脉曲张破裂出血是行之有效、快速的镜下止血方法,其操作简单,患者痛苦小,并发症少.     

食道、胃切除术后上消化道大出血的原因及内镜下治疗的体会

目的探讨食管、胄切除术后近期上消化道大出血的原因及内镜下治疗的方法、效果。方法对食管、胃切除术后近期引起大出血的患者行急诊内镜检查。用冰冻生理盐水冲洗暴露出血部位后在病灶周围黏膜下注射1：10000肾上腺素及高渗盐水，无出血后，退镜前于出血部位喷洒云南白药及凝血酶，防止再次出血。结果20例中只有1例因出血时间较长，约10天，胃内凝血块过多无法清除，无法找到出血灶转外科手术治疗，余19例均首次止血成功．结论黏膜下注射药物治疗消化道出血控制出血迅速有效，合并镜下喷洒云南白药、凝血酶防止再次出血，可避免外科再次手术治疗。     

内镜下喷洒凝血酶与去甲肾上腺素盐水治疗上消化道出血

目的探讨内镜下喷洒凝血酶与去甲肾上腺素盐水对上消化道出血的治疗效果．方法对90例上消化道出血的患者采用随机分组的原则，分别给予内镜下喷洒凝血酶和去甲肾上腺素盐水治疗，统计即刻止血率、再出血率、急诊手术率．结果凝血酶组即刻止血率95．8％，去甲肾上腺素盐水组即刻止血率85．7％，两组比较P＜0．05．凝血酶止血疗效优于去甲肾上腺素盐水．结论对急性上消化道出血采用内镜下喷洒凝血酶是一种较好的止血方法，简便易行，值得推广     

胃底孤立静脉团破裂出血一例

患者,男性,42岁.2011年12月因"黑便、头昏、乏力l天"入院.急诊胃镜检查见胃底可见一孤立性静脉团,并可见活动性出血,给予去甲肾上腺素溶液及凝血酶溶液内镜下喷洒,并给予降门脉压力等治疗.上腹部核磁共振平扫检查显示脾门区及胃底静脉海绵样变性,脾脏肿大,胆囊炎,双肾多发小囊肿.诊断为胃底孤立静脉团破裂出血.并于10天后行胃镜下胃底曲张静脉组织胶注射及硬化治疗,手术顺利,术后予抑酸、护胃、降门脉压等治疗后出血停止.     

胃镜下喷洒凝血酶治疗上消化道出血28例

胃镜下喷洒止血药是治疗上消化道出血的一种重要手段,以往常用的药物有去甲肾上腺素和孟氏液。我院于1995.10～1996.10在胃镜下喷洒凝血酶治疗上消化道出血28例30人次,现总结报告如下。     

经十二指肠镜喷洒凝血酶治疗急性胃、十二指肠溃疡出血

经胃管注入凝血酶治疗溃疡病上消化道出血,因药物往往不能到达出血部位而止血效果欠佳。我们采用十二指肠镜直视下喷药使凝血酶直接覆盖溃疡底面,可迅速、准确止血。1.一般资料:选择经紧急(2～12小时)内镜检查证实为胃、十二指肠溃疡出血患者27例。其中男21例,女6例;年龄为21     

凝血酶在急性上消化道出血行急诊胃镜中的应用探讨

对126例因急性消化道出血行急诊胃镜检查,发现有上消化道活动性出血的病人在内镜直视下局部喷洒凝血酶止血的疗效报道如下:一般资料126例经急诊胃镜检查确诊的上消化道活动性出血的病人,其中男86例,女40例,平均年龄46.8岁,其中急性出血性糜烂性胃炎21例,胃溃疡29例,十二指肠球部溃疡68例,胃癌8例。     

组织黏合剂联合套扎术治疗食管胃底静脉曲张出血403例

目的研究内镜下胃底静脉曲张组织黏合剂栓塞术联合食管静脉曲张套扎术治疗食管胃底静脉曲张出血的临床应用价值。方法回顾性分析2004年7月至2015年7月滨州医学院烟台附属医院(原牟平人民医院)收治403例上消化道出血患者临床资料,患者入院后急诊胃镜检查发现Ⅱ°以上食管静脉曲张合并胃底静脉曲张出血,先采用碘化油-组织黏合剂-碘化油"三明治"法行胃底静脉曲张栓塞治疗,再行食管静脉曲张套扎术。观察其即刻止血率、近期再出血率、术后并发症及死亡率。结果 403例患者平均栓塞注射2.4次(984/403),套扎11.6(6~18)环,即刻止血成功率100%,近期再出血率3.7%(15/403)。术后并发胸骨后疼痛21例,咽痛5例,低热7例,胃食管反流3例,并发症发生率8.9%(36/403)。死亡3例,2例死于失血性休克,1例死于肝性脑病。结论内镜下组织黏合剂栓塞术联合套扎术治疗胃底静脉曲张出血合并食管静脉曲张出血疗效显著,成功率高,降低了病死率及再出血率。     

胃镜下尼龙绳圈套加异物钳拖拉法巧取上消化道长条型硬异物

目的通过对实验组10例,采用胃镜下尼龙绳圈套加异物钳拖拉取出方法,探讨上消化道长条型硬异物的胃镜下取出方法.方法上消化道长条型硬异物15例.常规组5例,采用圈套器取出;实验组10例,采用胃镜下尼龙绳圈套加异物钳拖拉方法取出.结果常规组5例胃内异物,其中有1例在异物取出过程中导致贲门轻度撕裂出血,用去甲肾上腺素稀释液喷洒后可止血,所有5例均有在异物取出过程中导致食管不同部位擦伤渗血,未经特殊处理而止血.实验组10例胃内异物均顺利取出,其中8例无贲门及食管损伤情况,其中2例在异物取出过程中见食管不同部位有轻微擦伤渗血,未行特殊处理而止血.结论采用胃镜下尼龙绳圈套异物钳拖拉方法取上消化道长条型硬异物比采用圈套器方法更安全可靠,临床值得推广应用.     

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.     

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.