应用X刀治疗脑动静脉畸形87例

目的探讨立体定向放射外科治疗脑动静脉畸形的临床效果。方法对87例脑动静脉畸形患者采用X刀治疗，动静脉畸形团大小为5～40mm。87例中单独接受X刀治疗55例，联合血管内栓塞治疗32例。治疗周边剂量17～30Gy，平均22．6Gy，等剂量曲线70％～90％。随访时间6～96个月，平均53．4个月。结果单独接受X刀治疗的脑动静脉畸形患者，41例完全闭塞，9例部分闭塞，5例无变化；联合血管内栓塞治疗的患者，26例完全闭塞，3例部分闭塞，3例无变化。两组患者完全闭塞67例(77．01％)，癫痫完全缓解7例(26．17％)，头痛、头昏症状缓解18例(38．30％)，再出血2例，症状性放射性脑水肿6例。经治疗后，完全缓解2例，遗留神经功能障碍4例。结论立体定向放射外科治疗是脑动静脉畸形的安全而有效的治疗方法之一。     

伽玛刀放射外科分次治疗颅内大型动静脉畸形的初步临床疗效

目的初步评价伽玛刀放射外科剂量分次治疗颅内大型动静脉畸形(AVM)的临床效果。方法回顾性连续纳入2001年1月至2011年12月北京市神经外科研究所伽玛刀室采取伽玛刀剂量分次治疗的18例大型AVM(10 cm~3),患者年龄为7~50[中位数18(14,30)]岁。两次伽马刀治疗间隔时间中位数32(13~96)个月。首次治疗AVM体积11.5~51.3[中位数16.0(13.0,22.0)]cm~3;边缘处方剂量13.0~17.0[中位数14.8(14.0,16.0)]Gy;第2次治疗AVM体积中位数5.3(3.0,8.2)cm~3,边缘处方剂量中位数15.0(14.0,15.0)Gy。伽玛刀治疗后随访时间中位数89.5(34.0~122.0)个月。采用MRI及DSA评估治疗效果。结果末次随访时MRI显示8例闭塞,3例次全闭塞,7例体积缩小50%。DSA显示3例闭塞。5例患者治疗后共出现6次脑出血,其中1例因脑出血死亡,2例患者出现永久性放射相关并发症。结论初步观察显示伽玛刀剂量分次照射是颅内大型AVM的一种有效治疗方式。     

旋转式伽玛刀治疗脑动静脉畸形254例

目的 评估旋转式伽玛刀对脑动静脉畸形(AVM)的治疗效果及术后并发症。方法 1996～2002年应用旋转式伽玛刀治疗脑AVM患者254例。AVM平均直径24mm，周边剂量平均17.7Gy，中心剂量平均35．6Gy。结果平均随访38．4个月(12～72个月)。9例患者(4．0％)伽玛刀治疗后5～21个月发生畸形血管破裂出血或再出血。225例患者治疗后行CT或MR检查，68例(30．2％)出现放射性水肿，其中6例(2．7％)遗留永久并发症。184例治疗后行脑血管造影或磁共振血管成像检查，治疗后1、2和3年的血管闭塞率分别为38．8％，71．2％和74．3％。结论旋转式伽玛刀是一种新的可靠的立体定向治疗设备，对AVM治疗后2—3年畸形血管完全闭塞率达70%以上，治疗后并发症少，且很少出现永久性并发症。     

立体定向放射外科治疗脑动静脉畸形的效果观察

目的分析立体定向放射外科治疗脑动静脉畸形的临床疗效和并发症发生情况。方法选取2007-07-30—2012-07-30我院脑外科收治的经磁共振(荷兰Philips 1.5T核磁共振)及数字减影血管造影(万东CGO-2100C,DSA)检查诊断为脑动静脉畸形的患者63例,均采用立体定向放射外科进行治疗。治疗结束后对所有患者随访2~3年,评价立体定向放射外科治疗的临床效果。结果经立体定向放射外科治疗后,33例(53.4%)患者完全闭塞;23例(36.5%)患者部分缩小;7例(11.1%)患者不变。术后,2例(3.2%)患者发生再出血,2例(3.2%)患者轻度水肿。结论立体定向放射外科治疗动静脉畸形临床效果令人满意,定位准确,创伤小且远期并发症相对较轻,患者容易接受,对于多支供血、广泛的动静脉畸形,联合介入栓塞治疗有效率高,尤其对于位置较深或位于脑重要结构的动静脉畸形而言,立体定向放射外科是最合适的选择。     

伽玛刀治疗复发性前列腺癌临床观察

目的 分析伽玛刀治疗复发性前列腺癌的治疗效果.方法 对31例复发性前列腺癌患者进行伽玛刀治疗.伽玛刀治疗以60%～70%等剂量线包绕计划靶区;剂量3.8～5.0 Gy/次,治疗次数为10～13次,总放射剂量41.8～55.0 Gy,每日或隔日治疗.其中13例同时及伽玛刀治疗后配合内分泌药物治疗.结果 治疗后随访期内PSA值达到完全缓解19例,部分缓解10例,结束治疗后3个月影像学检查总有效率为77.4%(24/31),3 a总的生存率为61.3%.配合内分泌药物治疗及未配合内分泌药物治疗的3 a生存率分别是61.5%、61.1%.随访期内未见严重放射性并发症.结论 对复发性前列腺癌采用伽玛刀治疗是较有效的局部治疗方式.     

脑动静脉畸形立体定向放射外科治疗的新思维

动静脉畸形(AVM)是立体定向放射外科治疗技术的主要适应证之一，经随访疗效确切。近年来，为提高脑动静脉畸形立体定向放射外科的治疗效果，在治疗方法、疗效评价和并发症的防治等方面有许多新的发展.     

立体定向囊液引流结合伽玛刀治疗囊性脑转移瘤

目的探讨立体定向囊液引流结合伽玛刀在治疗囊性脑转移瘤中的作用。方法应用立体定向囊液引流结合伽玛刀治疗脑转移瘤患者79例,伽玛刀治疗的处方剂量为12～28 Gy（平均18.7 Gy）。结果囊液抽吸前肿瘤体积为4.5～72.3 ml（平均25.6 ml）,抽吸或引流囊液3.5～45.4 ml（平均16.2 ml）,抽吸后肿瘤体积为1.8～30.1 ml（平均12.3 ml）,体积缩小率为15%～68%（平均52%）,肿瘤局部控制率为93.1%,总生存期为16个月,1年和2年生存率分别为57.1%和32.1%。结论立体定向囊液引流结合伽玛刀治疗囊性转移瘤是可行的。     

脑动静脉畸形立体定向放射外科治疗的新思维

动静脉畸形(AVM)是立体定向放射外科治疗技术的主要适应证之一,经随访疗效确切。近年来,为提高脑动静脉畸形立体定向放射外科的治疗效果,在治疗方法、疗效评价和并发症的防治等方面有许多新的发展。     

分次立体定向适形放疗治疗头颈部恶性肿瘤(附31例报告)

对31例头颈部恶性肿瘤患者行分次立体定向适形放疗，采用6MVX线照射，3～5个射野，整体铅模适形，以90％等剂量曲线包绕靶区边缘为处方剂量线，每次剂量2～5Gy，1次／d，每周5d。常规放疗后局部加量为30-36．8Gy，单用三维适形放疗者总剂量为48-60．8Gy。结果完全缓解16例，部分缓解14例，1、2、3、4a生存率分别为80．6％、51．6％、19．4％、9．7％。提示分次立体定向适形放疗技术治疗头颈部恶性肿瘤安全有效。     

体部伽玛刀配合增敏剂及热疗治疗复发性软组织肉瘤疗效观察

目的分析体部伽玛刀配合增敏剂及热疗治疗复发性软组织肉瘤的治疗效果。方法56例软组织肉瘤术后残存、复发和（或）转移患者,采用体部伽玛刀治疗,处方等剂量线采用55％～70％等剂量线包绕计划靶区;单次剂量4-5．5Gy／次,治疗10—13次,总放射剂量45～55Gy。所有患者均给予放射增敏剂治疗,31例患者配合热疗。结果治疗后3个月总的有效率为82．1％（46／56）;伽玛刀配合增敏组1、2a局部控制率分别为76．0％、68．0％,1、2a生存率分别为84．0％、72．0％;伽玛刀配合增敏及热疗组1、2a局部控制率分别为80．6％、71．0％,1、2a生存率分别为87．1％、77．4％;随访期内未见严重放射性并发症。结论对复发性软组织肉瘤采用伽玛刀配合增敏剂及热疗是较有效的局部治疗方式。     

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.