转流术治疗布—加综合征

转流术是将人工血管 (涤纶 Dacron,聚四氟乙烯 PTFE)吻合在肠系膜上静脉或下腔静脉与右心房之间 ,以恢复肝静脉和下腔静脉血流 ,解除肝脏和下肢淤血 ,降低门脉压力 ,防治消化道出血和治疗顽固性腹水的一种手术方法。1　肝前腔房转流术手术目的是解除下腔静脉阻塞 ,恢复下腔静脉血流 ,同时使肝脏淤血改善、门静脉压力降低。其适应症为 :1下腔静脉阻塞而肝静脉通畅者 ,或肝静脉在肝内形成丰富的侧支血管、相互交通与阻塞远端下腔静脉交通者。 2下腔静脉阻塞位于膈肌裂孔水平者。其手术禁忌症为下腔静脉广泛阻塞、狭窄或肝静脉完全阻塞者。手…     

经特殊途径封堵并发下腔静脉异位引流的先天性心脏病的临床分析

下腔静脉异位引流是因为胚胎时期下腔静脉发育畸形导致肝心静脉和主静脉连接阻碍,造成下腔静脉上段缺如使肾段以下体静脉血经奇静脉或半奇静脉引流,通过上腔静脉或其它途径汇入心脏,故又称下腔静脉中断或下腔静脉肝段缺如,其发生率占心血管畸形的0.6%左右。先天性心脏病并发下腔静脉异位引流,常规轨道无法建立,     

根治矫正术治疗布—加综合征

B- CS可不伴或伴有下腔静脉高压综合征。我国、东方国家和南非所报道的本病病变绝大部分由肝后段下腔静脉阻塞所致 ,且多由下腔静脉隔膜引起。根治性手术的目的是清除肝静脉及其相关腔静脉内的阻塞性病变 ,使肝静脉恢复向心血流 ,从而使门脉血流经过肝组织 ,与诸种肠房、肠腔转流后形成的逆肝血流显然不同。对急性肝静脉、腔静脉血栓形成病例采用纤溶疗法 ,对下腔静脉隔膜或局限性狭窄病例施行破膜、扩张和支架置放术。对上述方法失败病例可施行根治性手术 ,手术分为前径和侧径入路两种 ,术中阻断下腔静脉和肝静脉出血 ,既可使术野清晰、…     

布─加综合征经皮球囊成形术治疗（摘要）

布─加综合征经皮球囊成形术治疗（摘要）大连医学院附属第一医院心脏科方唯一，于文信，旅朝霞，李新明，部德秀布－加综合征是指肝静脉流出道－肝静脉或肝段下腔静脉阻塞引起的门静脉或下腔静脉高压所产生的综合征。在下腔静脉和右心房之间膜样堵塞物形成按Ｈｉｒｏｏｋ...     

布—加氏综合征的诊断和外科治疗

布—加氏综合征(Budd-Chiari Syndrome,BCS)是指肝静脉流出道—肝静脉或肝段下腔静脉梗阻引起门静脉及下腔静脉高压而产生的综合征。临床上主要表现为肝肿大、进行性肝功能损害和大量腹水。本病     

Budd-Chiari综合征血管造影分型及介入治疗

柏一查氏综合征（ＢＣＳ）是由于肝段下腔静脉和／或肝静脉阻塞或狭窄所引起的一系列临床症状,该综合征在国外（主要是日本、南非等国）报告较多,国内血管造影表现由陈巨坤等较早报道Ｌ门。随着介人放射学的广泛开展,以前将该病误为肝硬化者也逐步获得正确认识。尤其是血管腔内成形术（ＰＴＡ）和血管内支架（ＥＭＳ）的应用,对该病的治疗较外科取得了更为理想的效果。临床与病理原发性ＢＣＳ系肝段下腔静脉或肝静脉的先天发育异常所致,尤其是下腔静脉上段的先天性蹼膜。日本学者的研究表明该噗膜为胚胎期肝段下腔静脉部存在之螺旋瓣,…     

介入放射对Budd-chiari综合征下腔静脉节段性狭窄的再认识

回顾性分析146例Budd—chiari综合征患者下腔静脉和肝静脉造影表现,观察下腔静脉节段性狭窄和肝静脉病变的联系。在美国GE公司LCV＋数字减影血管造影机监视下行下腔静脉造影和肝静脉造影。结果41例单纯肝静脉阻塞的病例均有下腔静脉节段性狭窄．所有下腔静脉节段性狭窄均见于单纯肝静脉阻塞病例。提示下腔静脉节段性狭窄为肝静脉阻塞的继发改变，介入治疗时应以处理肝静脉病变为主。     

影像学评价对选择Budd-Chiari综合征介入治疗途径的价值

目的 探讨BCS介入术前彩色多普勒超声、CT、磁共振、血管造影等影像学检查对设计介入治疗途径的价值。方法 根据彩色多普勒超声、CT、磁共振、血管造影等影像学检查结果，依据下腔静脉与肝静脉、副肝静脉的关系．采用不同的介入手术方法及入路，经股静脉、经颈静脉、经皮经肝穿刺或经副肝静脉开通下腔静脉、肝静脉、副肝静脉或同时开通。结果 根据术前影像学检查，决定手术方案、选择合理的术式和入路。50例手术均获得成功，疗效确切。其中下腔静脉狭窄34例（膜性20例，节段性14例），肝静脉狭窄、闭塞10例，下腔静脉狭窄伴肝静脉阻塞3例，肝静脉闭塞伴副肝静脉狭窄、闭塞2例。49例下腔或，和肝静脉开通后球囊扩张，共置入金属支架29例。肝小静脉闭塞1例，行TIPS术。术后随访1～36月，其中2例下腔静脉膜性狭窄球囊扩张术后分别于6和8个月出现再狭窄，后行金属支架置入．症状消失。1例因肾功能衰竭死亡。结论 通过术前检查．正确选择手术方式，可避免手术盲目性，避免再次手术，减少手术并发症，节约手术费用，获得良好的手术效果。     

CT诊断肝硬化门静脉右后支与下腔静脉自发分流1例

肝硬化门静脉高压时，内脏的静脉血液不易或不能经肝回流到心脏，而通过肝外门静脉系统与腔静脉之间的交通支或吻合支开放、扩张，使部分内脏血液回流到上、下腔静脉，形成侧支循环，亦称门-腔循环或门一体循环。其通路有胃静脉-食管静脉、肠系膜下静脉-髂内静脉、副脐静脉-腹腔静脉、脾-肾、胃-肾吻合支等，笔者遇到一例门脉右后支与下腔静脉自发分流，较罕见，报道如下。     

CT诊断肝硬化门静脉右后支与下腔青岛自发分流1例

肝硬化门静脉高压时，内脏的静脉血液不易或不能经肝回流到心脏，而通过肝外门静脉系统与腔静脉之间的交通支或吻合支开放、扩张，使部分内脏血液回流到上、下腔静脉，形成侧支循环，亦称门-腔循环或门一体循环。其通路有胃静脉-食管静脉、肠系膜下静脉-髂内静脉、副脐静脉-腹腔静脉、脾-肾、胃-肾吻合支等，笔者遇到一例门脉右后支与下腔静脉自发分流，较罕见，报道如下。     

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.     

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.     

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.     

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.