深低温间断停循环下肺动脉血栓内膜剥脱术

目的 探讨深低温间断停循环下肺动脉血栓内膜剥脱术治疗慢性肺动脉栓塞的临床效果。方法6例患者均在深低温分次停循环下经主肺动脉及左、右肺动脉切开行肺动脉血栓内膜剥脱术,手术清除段肺动脉开口以上视野可及范围内全部血栓内膜。结果 1例因术后急性灌注性肺水肿死亡,5例术后存活。肺动脉收缩压由术前的88～110 mmHg（1 mmHg=0.133kPa）下降至42～52 mmHg,同位素扫描肺血流灌注明显改善,肺动脉栓塞症状消失,心功能恢复至1级。结论 深低温间断停循环下肺动脉血栓内膜剥脱术是治疗慢性肺动脉栓塞的手术有效方法。     

体外循环下手术治疗慢性肺动脉血栓栓塞的临床研究

目的探讨体外循环下慢性肺动脉血栓栓塞的手术治疗方法及围手术期的处理,以提高慢性肺动脉血栓栓塞的外科治疗水平。方法回顾性分析2006年1月至今9例慢性肺动脉血栓栓塞的患者,在低温停循环或间断深低温停循环下行肺动脉血栓取出及内膜剥脱术。结果全组9例无一例近期(3个月)死亡,术后患者临床症状均较术前明显减轻、活动能力明显提高、部分病例心功能完全恢复正常。结论体外循环下肺动脉血栓取出术和内膜剥脱术是慢性肺动脉血栓栓塞的有效治疗方法。     

肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压

目的报告肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压的经验。方法回顾性总结了连续8例肺动脉血栓内膜剥脱术的手术要点、围术期处理以及近中期结果。结果8例均存活。肺动脉收缩压由术前的(101±24)mmHg降至术后的(39±15)mmHg、动脉血氧分压由(59±11)mmHg升至(92±7)mmHg。动脉血氧饱和度由(0.89±0.06)升至(0.98±0.01),均有显著改善。随访显示患者心功能为纽约心功能协会分级标准(NYHA)Ⅰ级(3例)或NYHAⅡ级(5例),生活质量明显改善。结论肺动脉血栓内膜剥脱术是治疗慢性栓塞性肺动脉高压的有效手段。     

慢性肺动脉栓塞的外科治疗

目的为提高慢性肺动脉栓塞性肺动脉高压的外科治疗水平。方法总结３例由作者进行的肺动脉血栓内膜剥脱术的成功经验。结果３例均术后存活至今,术后肺动脉压力由术前的９０～１００／３０～４０ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）降至４０～５０／２０～３０ｍｍＨｇ,肺动脉栓塞症状消失,心功能恢复至Ｉ级。结论肺动脉血栓内膜剥脱术是治疗肺动脉栓塞所致肺动脉高压的有效方法。     

肺动脉血栓内膜剥脱术的麻醉和脏器保护方法——阜外经验

目的回顾性总结慢性血栓栓塞性肺动脉高压患者行肺动脉血栓内膜剥脱术的麻醉和脏器保护方法。方法纳入2016年1月1日至2016年12月31日我院行肺动脉血栓内膜剥脱术的全部患者,记录术前、术中、术后的全部临床资料,对麻醉和脏器保护方法进行分析总结。结果共纳入27例患者,26例在全身麻醉深低温停循环下完成手术,1例在全身麻醉持续低流量下完成。术中漂浮导管测平均肺动脉压由术前(35±14.8)mmHg降低到手术结束时刻的(28±11.6)mmHg,术后肺部感染11例,肺动脉高压危象2例,神经系统并发症躁狂1例,躁狂+谵妄1例,围术期无再灌注肺水肿和死亡病例。结论麻醉管理过程中,应重点关注血流动力学管理,和肺、脑、血液等脏器的保护。     

慢性肺动脉栓塞的外科治疗

为探讨手术治疗慢性肺动脉栓塞的疗效,对9例临床诊断为慢性肺动脉栓塞患者在全麻及体外循环下行血栓清除及肺动脉内膜剥脱术。结果:9例患者术后恢复顺利,随访9～72个月,远期效果良好。认为对慢性肺动脉栓塞患者采用外科血栓清除及肺动脉内膜剥脱术是行之有效的治疗方法。     

30例肺动脉血栓内膜剥脱术临床结果

目的:报告肺动脉血栓内膜剥脱术(PTE)治疗慢性栓塞性肺动脉高压的结果。方法:回顾性总结连续30例肺动脉血栓内膜剥脱术的手术要点、围术期处理以及近中期结果。结果:共行PTE术30例,男24例,女6例,平均年龄45．7岁,平均病史48．0个月。术前心功能为纽约心功能协会分级标准(NYHA)Ⅳ级者12例,Ⅲ级者18例。手术均在深低温间断停循环下完成肺动脉血栓及机化内膜剥脱术。围术期死亡1例(死亡率为3．3％)。死亡原因为感染性休克。术后出现神经系统并发症4例(13．3％),再灌注肺水肿7例(23．3％),肺内出血1例(3．3％)。平均体外循环时间191．1 min,平均主动脉阻断时间95．1 min,平均停体外循环时间47．7 min。术后平均拔除气管插管时间85．1 h。肺动脉收缩压由术前的91．4 mmHg(1 mmHg=0．133 kPa)降至术后的48．3 mmHg、动脉血氧分压由56．2 mmHg升至88．9 mmHg、动脉血氧饱和度由0．90升至0．97(P均<0．01-0．05),均有显著改善。随访26例,平均随访时间36．8个月,心功能NYHA分级Ⅰ级22例,Ⅱ级3例,Ⅲ级1例,生活质量明显改善。结论:PTE术是治疗慢性栓塞性肺动脉高压的有效手段,其关键在于选择合适病例,彻底剥离肺动脉血栓和机化内膜,正确预防和治疗各种并发症。     

非体外循环下手术治疗单侧慢性肺动脉栓塞探讨

目的探讨非体外循环下手术治疗慢性肺动脉栓塞相关治疗原则。方法结合文献复习,回顾分析8例非体外循环下单侧开胸手术治疗肺动脉栓塞的诊疗过程。结果经肺动脉血栓内膜剥脱术及后期辅助支持治疗,全部患者均取得良好治疗效果。结论应区别选择体外循环与否,手术治疗慢性肺动脉栓塞,对血流动力学稳定、一般状态良好的单侧慢性肺动脉栓塞病人可选择非体外循环方式进行手术治疗。     

慢性血栓栓塞性肺动脉高压的外科治疗

慢性血栓栓塞性肺动脉高压是一种自然预后极差的疾病,疾病早期容易误诊或漏诊.目前肺动脉血栓内膜剥脱术是慢性血栓栓塞性肺动脉高压患者的首选治疗方案,该手术效果明显,术后早期可明显降低肺动脉压力和肺血管阻力,改善血流动力学和患者生活质量.术前评估患者是否已存在严重的继发性肺小血管病变至关重要.术中建立正确的内膜剥离层面和完整的剥离血栓及机化内膜是外科技术的关键.     

肺动脉血栓内膜剥脱术的远期疗效

目的　观察肺动脉血栓内膜剥脱术 (PTE)对慢性栓塞性肺动脉高压 (CTEPH )患者的远期疗效。方法　 1997年 3月～ 2 0 0 2年 6月 ,共对 15例CTEPH患者行PTE ,14例存活出院。其中 13例随访时间平均 4 0 (17～ 77)个月 ,1例失访 ;随访项目包括心功能状态、血气分析和通过超声心动图测量肺动脉收缩压。结果　随访期内 13例患者均存活 ,其术前心功能NYHA分级均为Ⅲ、Ⅳ级 ;术后 12例患者心功能NYHA分级Ⅰ级、1例Ⅲ级 ;动脉血氧分压 (PaO2 )由术前的 (5 8 1± 8 6 )mmHg上升至(90 8± 6 0 )mmHg (P <0 0 1) ;动脉血氧饱和度由术前的 (90± 5 ) %上升至 (96± 1) % (P <0 0 5 ) ;肺动脉收缩压由术前的 (97 1± 2 2 4 )mmHg下降至 (4 2 6± 10 7)mmHg (P <0 0 1)。结论　肺动脉血栓内膜剥脱术对慢性栓塞性肺动脉高压患者具有很好的远期疗效 ,它能显著改善患者的心肺功能 ,提高其生活质量     

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.