超声引导经皮置管引流治疗急性胰腺炎早期急性液体积聚疗效分析

背景：急性胰腺炎（AP）病程早期可发生急性液体积聚,积液可继发感染或形成假性囊肿。目的：评价超声引导经皮置管引流（PCD）治疗AP早期急性液体积聚的疗效和安全性。方法：2001年9月～2011年3月泰州市人民医院103例重症急性胰腺炎（SAP）伴早期胰腺、胰周急性液体积聚的住院患者纳入研究,其中42例接受保守治疗,61例在保守治疗的基础上于入院48 h内接受超声引导PCD治疗。回顾性分析两组患者的治疗效果和并发症发生情况。结果：PCD治疗组体温和血清CRP水平恢复正常时间、积液消失时间、住院天数显著短于保守治疗组（P〈0.05）,多器官功能衰竭、败血症、假性囊肿发生率以及手术率和死亡率显著低于保守治疗组（P〈0.05）：置管和引流过程中无一例患者发生内脏损伤,局部皮肤无严重感染,拔管后无瘘管形成。结论：超声引导PCD治疗胰腺、胰周积液简单、有效、安全,可作为AP早期急性液体积聚的首选治疗方法。     

急性胰腺炎合并液体积聚患者在经皮穿刺置管引流前行腹腔穿刺引流治疗效果探讨

目的探讨急性胰腺炎合并液体积聚患者在经皮穿刺置管引流前行腹腔穿刺引流治疗的临床效果。方法将我院自2009年11月至2015年11月间收治的重症急性胰腺炎患者82例作为研究对象,所有患者采用阶梯式治疗方案,即在保守治疗的基础上行经皮穿刺置管引流(PCD),再行手术治疗,其中43例研究组患者在行PCD前行经腹腔穿刺引流(APD),39例对照组患者仅行PCD,观察两组患者的临床治疗效果。结果两组住院时间、ICU住院时间、微生物感染率、菌血症发生率和菌血症恢复时间等指标比较差异无统计学意义(P0.05);研究组住院费用、病死率、脓毒症发生率和脓毒症恢复时间等指标显著低于对照组(P0.05);治疗前CRP、IL-6、IL-10、TNF-α组间差异无统计学意义(P0.05),治疗后研究组的CRP、IL-6、IL-10低于对照组(P0.05);与治疗前相比,两组CRP、IL-6、IL-10、TNF-α水平均明显降低(P0.05)。结论对于急性胰腺炎合并液体积聚患者在PCD之前行APD安全有效,不增加感染发生率,通过减少液体积聚,降低炎症因素水平和脓毒症的发生,有效改善患者预后,降低病死率。     

彩超引导穿刺引流治疗急性重症胰腺炎并胰周积液16例临床分析

目的 探讨彩超引导下经皮穿刺置管引流术辅助治疗急性重症胰腺炎并胰周积液的价值.方法 回顾分析我院自2008年1月～2008年12月16例彩超引导下经皮穿刺置管引流术辅助治疗急性重症胰腺炎并胰周积液患者的临床资料,分析其疗效.结果 16例急性重症胰腺炎并胰周积液彩超引导下经皮穿刺置管引流术后,13例有效,2例死亡,1例术后1周因并发出血、出血性休克转外科手术治疗而好转.经皮穿刺置管引流术中未观察到严重的并发症.结论 彩超引导下经皮穿刺置管引流术操作方便,穿刺置管成功率高,值得在基层医院推广.     

奥曲肽注射液治疗急性胰腺炎的临床疗效分析

[目的]探讨奥曲肽注射液在急性胰腺炎的临床治疗效果。[方法]选择急性胰腺炎患者60例,随机分为观察组和对照组,各30例。对照组采取常规治疗,观察组在常规治疗基础上加用奥曲肽,观察2组临床治疗效果。治疗结束后对比2组患者腹痛缓解时间、血尿淀粉酶恢复时间等。[结果]观察组治疗总有效率为96.67%,高于对照组的76.67%(P0.05);观察组血、尿淀粉酶恢复至正常时间和腹痛消失时间均短于对照组(P0.01)。[结论]奥曲肽能快速抑制胰酶的分泌,能及时缓解患者临床症状及体征,减轻胰腺炎症,减少并发症发生,可明显缩短病程、缩短往院时间,有效提高临床治疗效果。     

基于升阶梯治疗原则分析重症急性胰腺炎患者行开腹坏死物清除术的危险因素

目的开腹坏死物清除术(OPN)是单纯经皮穿刺置管引流(PCD)失败后治疗重症急性胰腺炎(SAP)的有效方式,探讨导致患者需要继续行OPN的危险因素。方法选取2010年1月1日—2018年6月30日于遵义医科大学附属医院行基于“step-up”原则外科干预方式的SAP患者156例,根据后期是否行OPN分为PCD组(n=126)和PCD+OPN组(n=30)。收集患者年龄、性别、病因、入院血钙、入院白细胞、CTSI评分>7分、APACHE-Ⅱ评分、Ronson评分、是否合并胰周液体积聚、是否合并感染、是否合并多器官功能衰竭(MOF)、PCD干预时间是否超过入院后1周等临床资料。计量资料两组间比较采用t检验;计数资料两组间比较采用χ²检验。采用多因素logistic回归分析确定后期行OPN的独立预测因子。结果SAP患者后期需要行OPN的概率为19.2%。PCD组与PCD+OPN组相比,入院时合并MOF所占比例更少[34(27.0%)vs 21(70.0%),χ²=19.642,P<0.01];PCD干预时间<1周所占比例更高[78(61.9%)vs 6(20.0%),χ²=17.121,P<0.01]。入院时合并MOF、入院后首次PCD干预时间>1周、入院时合并感染[OR(95%CI)分别为5.343(1.832~15.583)、5.518(1.742~17.477)、5.016(1.322~19.378),P值均<0.05]是SAP患者后期需要行OPN的独立危险因素。结论SAP入院时合并MOF、入院后初次PCD干预时间>1周和入院时合并感染是基于“step-up”原则下的SAP患者早期行PCD治疗后需要继续行OPN的独立危险因素,在临床实践中及时识别相关危险因素有利于把握OPN的时机以改善SAP患者的临床预后。     

内镜经十二指肠乳头引流治疗胰腺假性囊肿的临床应用疗效分析

目的评估内镜经十二指肠乳头引流治疗巨大胰腺假性囊肿(脓肿)的临床应用疗效。方法2003年6月至2006年6月取沈阳军区总医院消化内镜中心按照统一标准选择入组的胰腺假性囊肿(脓肿)病例10例,其中非感染性8例,感染性1例,胰腺脓肿1例。均采用内镜经乳头引流治疗,通过回顾性总结临床治疗和相关研究指标变化,综合评估此种治疗方法的临床应用疗效。结果内镜治疗失败1例,术后并发假性囊肿感染2例,急性胰腺炎1例。8例随访观察平均16.5个月,其中假性囊肿完全消失4例,假性囊肿残腔形成1例,假性囊肿不断缩小3例。急性重症胰腺炎2例治愈。结论内镜经乳头引流治疗胰腺炎合并巨大胰腺假性囊肿(脓肿)是一种确切有效的治疗方法。     

内镜经十二指肠乳头引流治疗胰腺假性囊肿的临床应用疗效分析

目的评估内镜经十二指肠乳头引流治疗巨大胰腺假性囊肿（脓肿）的临床应用疗效。方法2003年6月至2006年6月取沈阳军区总医院消化内镜中心按照统一标准选择入组的胰腺假性囊肿（脓肿）病例10例，其中非感染性8例，感染性1例，胰腺脓肿1例。均采用内镜经乳头引流治疗，通过回顾性总结临床治疗和相关研究指标变化，综合评估此种治疗方法的临床应用疗效。结果内镜治疗失败1例，术后并发假性囊肿感染2例，急性胰腺炎1例。8例随访观察平均16．5个月，其中假性囊肿完全消失4例，假性囊肿残腔形成1例，假性囊肿不断缩小3例。急性重症胰腺炎2例治愈。结论内镜经乳头引流治疗胰腺炎合并巨大胰腺假性囊肿（脓肿）是一种确切有效的治疗方法。     

螺旋CT对重症急性胰腺炎的诊断价值

目的探讨螺旋CT对急性胰腺炎患者的临床诊断价值。方法回顾性分析45例经临床证实并行螺旋CT平扫及增强检查的急性胰腺炎的表现。结果急性水肿性胰腺炎31例(68.9%),2例胰腺无明显异常,1例胰头增,2例胰体增大,1例胰尾增大,25例弥漫性增大;急性出血坏死性胰腺炎14例(31.1%),表现胰腺密度不均、胰周积液8例,胰周脓肿2例,假性囊肿形成6例。结论 CT检查有助于急性胰腺炎的诊断,并能明确有无并发症。     

急性胰腺炎纵隔扩散途径的MR表现

[目的]研究急性胰腺炎(Acute pancreatitis,AP)胰周积液向纵隔扩散的MR表现及解剖基础,以及与急性胰腺炎MR严重指数(MR severity index,MRSI)的相关性。[方法]回顾分析69例因AP入院并进行MR检查患者。观察分析胰周积液向纵隔扩散的解剖途径并进行分级;AP的严重程度用MRSI评分分级并统计分析胰周积液与MRSI评分相关性。[结果]69例中,88.40%患者有不同程度胰周积液。胰周积液向纵隔扩散时食管裂孔受累31.14%,主动脉裂孔8.05%,下腔静脉裂孔3.25%。胰周积液评分与MRSI正相关(r=0.449,P0.01)。[结论]AP伴发胰周积液较常见,胰周积液通过膈肌裂孔向纵隔扩散。胰周积液也可以作为评价AP严重程度的辅助指标。     

CT引导下经皮穿刺置管引流术与开腹引流术治疗重症急性胰腺炎继发胰腺周围脓肿的临床疗效

目的探究CT引导下经皮穿刺置管引流术与开腹引流术治疗重症急性胰腺炎(SAP)继发胰腺周围脓肿(简称胰周脓肿)的临床疗效。方法选择2011年6月至2015年6月该院收治的SAP继发胰周脓肿患者48例,根据治疗方式分为观察组(25例)和对照组(23例),观察组给予CT引导下经皮穿刺置管引流术治疗,对照组给予开腹引流术治疗。观察并记录两组患者血淀粉酶恢复至正常时间、恢复饮食的时间、症状及体征消失时间、住院总时间、治疗有效率及并发症发生情况。结果治疗后观察组患者血淀粉酶恢复正常时间、恢复饮食时间、症状体征消失时间及总住院时间均显著低于对照组(P0.05);治疗的总有效率显著高于对照组(P0.05);治疗期间观察组并发症发生率显著低于对照组(P0.05)。结论 CT引导下经皮穿刺置管引流术治疗SAP继发胰周脓肿的效果较好,安全性高,值得临床推广应用。     

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.     

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.     

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.     

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.