显微手术治疗大及巨大垂体腺瘤的入路选择

56例大及巨大垂体腺瘤，分别采用经蝶入路或经颅入路在显微镜下切除肿瘤。手术均顺利，其中肿瘤全切除44例，次全切除9例，部分切除2例。认为采用显微外科技术，针对肿瘤的特点选择不同的手术入路是提高垂体腺瘤全切率的关键。     

经单鼻蝶窦入路显微外科手术切除垂体腺瘤(附51例报告)

目的探讨经单鼻孔蝶窦入路显微外科手术切除垂体腺瘤的手术技巧以及并发症的处理方法。方法回顾性分析我院手术治疗的51例垂体腺瘤患者。对比手术前后视力视野变化、垂体内分泌变化,并分析并发症的发生率及相关影响因素。结果经单鼻孔蝶窦入路显微外科手术全切除垂体腺瘤46例、次全切5例,视力症状改善(改善率82.1%),内分泌功能改善,术后出现尿崩症12例(2周后均恢复),术中脑脊液漏9例(经同期手术修补后痊愈)。结论经单鼻孔蝶窦入路切除垂体腺瘤具有安全、简便、微创等优点,是大部分垂体腺瘤的首选手术方式。     

经鼻蝶入路显微外科治疗老年垂体腺瘤68例临床经验

目的 探讨经鼻蝶入路显微外科治疗老年垂体腺瘤的治疗结果 .方法 2000年12月至2007年12月期间68例老年垂体腺瘤的病例在我院接受经鼻蝶入路显微外科切除.通过其治疗效果进行分析,总结治疗经验.结果 术中15例发生脑脊液漏,采用鞍底重建.10例垂体腺瘤巨大,手术无法全切,术后辅以伽马刀放射治疗.5例术后发生严重的电解质紊乱及尿崩,8例术后发生垂体功能低下.随访1年,未见肿瘤复发,恢复良好.结论 经鼻蝶入路显微外科治疗老年垂体腺瘤,由于其术中损伤小,术后恢复快,能有效的治疗老年垂体腺瘤,获得满意的效果.     

经鼻蝶窦入路显微手术治疗垂体腺瘤

目的 探讨经鼻蝶窦入路切除垂体腺瘤的显微手术治疗及术后处理.方法 回顾性分析经单鼻孔蝶窦入路显微手术切除的38例垂体微腺瘤患者的临床资料.38例垂体腺瘤中泌乳素( PRL)腺瘤18例,生长激素(GH)腺瘤12 例,促肾上腺皮质激素(ACTH)腺瘤5例, 无分泌功能腺瘤3例.结果 肿瘤全切33例, 次全切5例;术后复查激素水平,降至正常26例, 下降大于50%的4例, 8例变化不明显.结论 单鼻孔经蝶入路显微手术切除垂体腺瘤是一种安全、有效的方法.     

经纵裂胼胝体前入路显微全切除鞍膈脑膜瘤(附13例报告)

目的 提高鞍膈脑膜瘤手术全切除率，减少术后复发，有效治疗和预防术后并发症，降低病死率。方法 对13例患者采用改良手术入路，扩大病变部位的暴露范围，减少术中因牵拉所造成的脑损害，利用显微外科技术在分块切除肿瘤的同时．有效保护与病变关系密切的血管、神经、丘脑下部、垂体、垂体柄等重要结构。结果 13例均一次全切除肿瘤，随访1～8年，无肿瘤复发，除1例术前视力已完全丧失外．3例生活自理。9例均恢复正常。结论 经纵裂胼胝体前切除鞍膈脑膜瘤是较理想的手术入路，可一次全切除肿瘤，并能有效保护肿瘤周围的重要结构。微侵袭显微外科技术是其必备条件。     

巨大垂体腺瘤的显微手术治疗

为提高巨大垂体腺瘤显微手术的疗效 ,回顾性分析 5 6例巨大垂体腺瘤患者的临床资料及治疗方法。依据肿瘤的生长方向及部位将 5 6例分为四型 ,据此分别采用经蝶、经额下、额下经蝶、扩大经蝶、扩大额下硬膜外、额下 -翼点等 10种入路进行显微手术。5 6例巨大垂体腺瘤全切 2 9例 ,近全切 2 0例 ,大部切除 7例。无死亡者。提示依据巨大垂体腺瘤的不同位置及生长方向选择适当的手术入路是提高全切率、降低死亡率及复发率的重要手段     

经鼻蝶窦入路垂体腺瘤切除术46例疗效观察

目的观察经鼻蝶窦入路手术治疗垂体腺瘤的效果。方法 46例垂体腺瘤患者均采用单鼻孔经鼻蝶窦入路显微镜下肿瘤切除术。结果肿瘤全切39例,次全切或大部分切除6例,未能切除1例。术后发生脑脊液漏3例,尿崩症19例,视力下降2例。结论经鼻蝶入路垂体腺瘤切除术是治疗垂体腺瘤安全有效的术式。术前准确评估病情、熟悉解剖和精湛的手术操作是手术成功的保证。     

显微全切除巨大侵袭型垂体腺瘤：附30例报告

显微全切除３０例巨大侵袭型垂体腺瘤,肿瘤全切除率达７３％。２７例随访２－３年,２３例恢复正常工作,肿瘤无复发。就手术入路,手术方法,肿瘤对周围结构的浸润方式,影响预后的因素和注意事项进行了探讨。     

老年垂体腺瘤的经蝶显微手术治疗

目的：对22例老年人垂体腺瘤的经蝶显微手术治疗,探讨老年性垂体腺瘤的临床特点及治疗原则,方法：本组老年人垂体腺瘤均经血清激素检查,CT或MRI扫描确诊,采用经蝶显微手术治疗,术后治疗特别注意水和电解质的平衡,结果：无分泌功能腺瘤17例,肿瘤全切12例,次全切7例,大部分切除3例,无手术死亡,无并发症死亡。在平均3．1年随访中,20例恢复良好,2例症状复发,结论：老年性垂体腺瘤绝大部分为无功能性,经蝶入路显微手术切除是一种安全,有效的方法,但要注意手术适应症的选择和术后体液,电解质平衡。     

神经内窥镜辅助下经单鼻孔蝶窦入路切除老年大型垂体腺瘤

目前垂体腺瘤手术主要以经鼻入路为主,具有操作简便,并发症少等优点,但术中存在光线衰减及观察视角,很难达到肿瘤全切.我科自2005年3月到2007年1月在神经内窥镜辅助下经单鼻孔蝶窦入路切除老年人大型垂体腺瘤16例,取得了较好治疗效果.     

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.