急诊心瓣膜置换的临床体会

本文报告１０例急诊心脏瓣膜置换术。急诊手术原因：重度心衰心源性休克２例，重度心衰并发急性肾衰２例，大咯血１例，感染性心内膜炎并心衰１例，心导管检查或介入性治疗致心脏穿孔心包填塞４例。行二尖瓣置换术８例，主动脉瓣置换１例，双瓣置换１例。术后２例死亡，８例随访１月～２年心功能Ⅰ～Ⅱ级７例，Ⅲ级１例。对急诊瓣膜置换手术指征进行了讨论。     

原发性心腔外心脏肿瘤的诊断及外科治疗（附6例报告）

手术治疗６例原发性心腔外心脏肿瘤。结果１例术后病情明显改善，心功能提高Ⅱ级；５例提高Ⅰ级。对心脏外心脏肿瘤的诊断和外科治疗进行了讨论。     

双孔成形术治疗二尖瓣关闭不全

目的总结双孔二尖瓣成形术治疗二尖瓣关闭不全的经验。方法诊断为二尖瓣关闭不全接受此手术治疗30例，男12例，女18例，年龄14～52（33±17）岁。心功能Ⅱ级5例，Ⅲ级23例，Ⅳ级2例，用超声心动图对瓣膜进行评价。结果全组术前二尖瓣反流面积（9．8±3．5）cm^2，术后为（0．72±0．31）cm^2。全组无术后死亡，痊愈出院。随访1～48个月，效果满意，心功能为Ⅰ～Ⅱ级。结论双孔二尖瓣成形术是一种简单有效的手术方法。     

急性心肌梗塞恢复期的冠状动脉内支架置入术

１６例急性心肌梗（ＡＭＩ）患者发病后恢复期（２～４周）行及冠状动脉内支架术治疗。分为两组，梗塞后心绞痛组６例，梗塞后心功能不全组１０例。经冠脉造影证实其梗塞相关冠状动脉均处于完全闭塞及次全闭塞状态。１５例为单支，１例为双支。术前平均狭窄度（９２．５±５．１）％，平均狭窄长度（１９．５±５．３）ｍｍ。共植入１９枚支架。手术成功率１００％，１例术后３天发生亚急性血栓形成。术后造影显示平均狭窄度为０～１０％，梗塞后心绞痛组临床症状消失，梗塞后心功能不全组的超声心动图提示左房内径（３６．８±３．４）ｍｍ，左室内径（５５．１０±３．７３）ｍｍ，左室射血分数０．６１±０．０８，优于术前的左房内径（３９．４０±４．１２）ｍｍ，左室内径（５９．６０±５．２５）ｍｍ，左室射血分数０．５２±０．１０。随访１～２０个月无１例死亡，无再梗塞，心功能均在Ⅰ～Ⅱ级。本文说明ＡＭＩ恢复期冠脉再通是增加冠脉血流，维持正常心功能和降低死亡率的一个有效方法。     

老年急性胃扩张8例手术治疗

老年急性胃扩张８例手术治疗江苏省丹徒县人民医院外科（２１２００３）吴胜英本院１９７７年４月至１９８９年８月经手术治疗的老年急性胃扩张８例，其中６例治愈，２例死亡，现报道如下。１临床资料１．１一般资料本组男７例，女１例。年龄６２～７５岁，平均６６．５岁...     

高龄患者非体外循环冠状动脉旁路移植术200例临床体会

目的：探索高龄冠心病患者非体外循环冠状动脉旁路移植术（OPCABG）治疗的策略。方法：选取我院2010年1月1日至2012年12月31日,心外科70岁以上旁路移植患者200例,年龄70～79岁,平均年龄（73.2±2.1）岁。超声心动图提示升主动脉硬化54例,心功能Ⅱ级152例,心功能Ⅲ级48例。全组患者术前冠状动脉造影均提示3支血管病变。对病例进行统计分析,并对围术期治疗方法提出建议。结果：全组患者均顺利完成手术,术后死亡2例（病死率1%）,死亡原因均为术后急性左心功能不全合并多脏器功能衰竭。术后并发症8例（4%）,平均住院天数（9.2±2.4）d,其余均治愈出院。结论：高龄患者需简明外科操作,即以最短的时间,最小的创伤完成手术以及合理的术后监护治疗,会收到最佳的治疗效果。     

Ebstein心脏畸形24例的外科矫治

目的总结24例Ebstein畸形患者的外科手术治疗经验。方法回顾性分析2002年9月至2009年5月24例Ebstein畸形患者手术治疗的临床资料,采用Danielson水平折叠法矫治畸形17例,其中同时行瓣环成形12例,瓣交界成形5例,瓣叶修补4例;采用Carpentier纵行折叠5例,均同时行瓣环成形;1例采用解剖矫治;1例行三尖瓣置换术。合并畸形同期处理。结果全组无死亡,无严重心功能不全和顽固性低心排出量综合征发生,无因三尖瓣病变再次手术者。随访2～81个月,心功能Ⅰ级15例,Ⅱ级7例,2例恢复稍差,心功能Ⅱ～Ⅲ级。结论 Ebstein畸形应尽早外科矫治,外科治疗应根据每例患者瓣膜和心室的具体条件选择恰当的术式,恰当的瓣膜成形或瓣膜置换可以取得较好的中、远期效果。     

43例二尖瓣腱索断裂的外科治疗

本文总结４３例二尖瓣腱索断裂的诊断和外科治疗经验。全组病例均有不同程度的心功能不全,２６例行二尖瓣置换术（ＭＶＲ）,１７例行瓣膜修复成形术。术后存活３９例,４例围手术期死亡（死亡率９．３％）。存活病例术后随访２～５７个月。除其中１例风湿性病变患者行二尖瓣、三尖瓣成形术,术后１年又出现二尖瓣中度关闭不全外,其余心功能均有不同程度改善。我们初步认为风湿性病变及心内膜炎患者以ＭＶＲ为宜,退行性病变及先心病者应根据病理类型选择手术方式,多考虑二尖瓣成形术     

马凡综合征主动脉根部瘤的外科治疗

目的总结马凡综合征主动脉根部瘤的外科治疗经验。方法2002年1月至2006年12月,手术治疗马凡综合征主动脉根部瘤34例,年龄16～54(29.5±4.1)岁。其中合并急性I型主动脉夹层(DeBakey分型)7例,急性Ⅱ型主动脉夹层2例,慢性Ⅱ型主动脉夹层2例。术前心功能分级(NYHA)Ⅱ级17例,Ⅲ级15例,Ⅳ级2例。共行Bentall手术27例,Bentall及右半弓置换1例,Bentall及全弓置换加“象鼻”手术6例,同期行二尖瓣成形术6例,胸骨翻转1例。结果全组术后死亡1例,死亡率2.9%。33例随访1个月至5年,2例接受二次手术,其余恢复良好,心功能I～Ⅱ级,无晚期死亡。结论Bentall手术是治疗马凡综合征主动脉根部瘤的首选方法,合并I型主动脉夹层的病例应行Bentall及全弓置换加支架“象鼻”手术。     

心脏粘液瘤患者38例诊断和治疗经验总结

目的总结38例心脏粘液瘤的诊断和外科治疗经验。方法回顾性分析行外科手术治疗的38例心脏粘液瘤患者的临床资料，着重分析术前诊断，手术方法及随访结果。结果30例患者均为超声心动图确诊。2例未行外科手术治疗，其中有1例在手术前晚出现脑栓塞死亡，1例在检查过程中出现脑栓塞死亡。36例行手术治疗，术后无死亡，手术成功率100％（36／36）。术后1例合并脑梗死，34例术后随访6～24个月．未见瘤体复发和远处种植转移，心功能恢复到NYHA心功能I级～Ⅱ级。结论心脏粘液瘤术前超声心动图检查诊断准确率高；心脏粘液瘤外科手术治疗的预后极佳，手术的关键是保持瘤体完整，彻底切除是预防复发的关键。     

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.