主动脉腔内隔绝术治疗老年急性Stanford B型主动脉夹层的临床观察

目的:观察主动脉腔内隔绝术治疗老年急性Stanford B型主动脉夹层患者的疗效。方法:32例老年急性Stanford B型主动脉夹层患者分为2组,接受主动脉腔内隔绝术治疗的24例患者为治疗组;采用内科方法治疗的8例患者为对照组,比较2组患者存活出院率。结果:在老年急性Stanford B型主动脉夹层患者中,治疗组存活出院率方面明显优于对照组(83.33%vs 25.00%,P0.01)。结论:对老年急性Stanford B型主动脉夹层患者,采用主动脉腔内隔绝术可以提高患者存活出院率。     

覆膜支架腔内隔绝术治疗胸主动脉夹层20例经验总结

目的总结应用覆膜支架腔内隔绝技术治疗胸主动脉夹层的经验。方法回顾性分析20例行覆膜支架腔内隔绝术治疗的胸主动脉夹层患者的临床资料,着重分析手术方法、手术结果、术后并发症和随访情况。结果20例手术即刻成功率为100％（20／20）,术后住院（5．0±1．3）d。术后并发症包括1例行升主动脉至头臂干及左颈总动脉旁路术加支架植入,术后发生脑梗死,5例出现中度以上发热．1例出现肾功能衰竭,4例术后出现左侧胸痛,均经对症治疗后康复出院。随访CT检查1年-4年,未出现脊髓损伤、支架移位、锁骨下动脉窃血等,随访存活率为95％（19／20）,1例术后半年支架末端与主动脉移行处的主动脉又出现动脉夹层,发生血管破裂死亡。结论覆膜支架腔内隔绝术是治疗Stanford B型和部分Stanford A型胸主动脉夹层的有效方法。     

主动脉支架植入术治疗胸主动脉疾病的效果

目的:探讨胸主动脉疾病支架植入术治疗的适应证和疗效。方法: 对79例胸主动脉疾病行主动脉支架植入的疗效进行回顾性分析。79例患者中,Stanford A型主动脉夹层动脉瘤18例,Stanford B型主动脉夹层动脉瘤49例;主动脉瘤5例;外伤性胸主动脉破裂7例。术前采用CT血管造影(CTA)或磁共振血管造影(MRA)对主动脉进行评估。18例Stanford A型主动脉夹层动脉瘤患者行术中支架置入,其余61例患者在数字减影血管造影(DSA)下经股动脉或髂动脉行支架腔内隔绝术。结果: 内漏8例（10%）,4例于术后3月内自行闭合,1例再次腔内隔绝治疗,3例未进一步治疗;死亡8例（10%）均在术后1月内,其中3例死于神经系统并发症, 4例死于严重的合并症,1例死于主动脉瘤破裂。随访生存3年以上7例（9%）,2年以上14例（18%）,1年以上26例（33%）,1年以内24例(30%)。结论: 主动脉支架植入术可减少手术风险,降低病死率,广泛适用于各种胸主动脉疾病。     

胸降主动脉夹层合并冠心病联合介入治疗的远期疗效

目的评价胸降主动脉夹层合并冠心病的患者行主动脉腔内隔绝术联合经皮冠状动脉介入治疗（PCI）的远期疗效。方法收集2002年4月至2013年10月完成的40例主动脉腔内隔绝术联合PCI治疗胸降主动脉夹层合并冠心病患者,首先完成主动脉腔内隔绝术,3-7 d后完成PCI,观察远期疗效。结果经桡动脉行主动脉造影：共置入40枚覆膜支架,手术成功率100%。无截瘫、死亡等并发症发生。40例患者行PCI成功率为100%,对54支靶血管共置入59枚支架,无PCI相关严重并发症发生。随访37例（92.5%）,失访3例,平均随访（56±31）个月。随访期间有3例（8.1%）死亡,其中脑出血2例,恶性肿瘤1例。2例（6.9%）主动脉腔内隔绝术联合PCI的患者随访期发生主要不良心脏事件。结论主动脉腔内隔绝术联合PCI治疗胸降主动脉夹层合并冠心病安全可行,手术成功率高,主要不良心脏事件发生率较低,远期疗效好。     

StanfordB型胸主动脉夹层腔内隔绝术治疗的经验探讨

目的探讨主动脉腔内隔绝术在治疗Stanford B型主动脉夹层（aorticdissection，AD）的价值。方法回顾性分析我院2005—2008年行腔内隔绝术的17例Stanford B型主动脉夹层患者的资料。结果所有患者均完成带膜支架置入，术后1个月CTA随访14例假腔完全血栓化，夹层破裂死亡1例，出现新发破口2例，内漏1例。结论带膜支架腔内隔绝术治疗Stanford B型胸主动脉夹层是一种安全有效的方法，但术前破口定位。术中真腔确认及支架定位是手术成功的关键。     

老年Stanford B 型主动脉夹层患者的临床特征及腔内隔绝疗效分析

目的:总结老年Stanford B型主动脉夹层患者的临床特征,分析老年患者施行腔内隔绝术的疗效及安全性。方法: 2002年4月~2010年10月入院并接受主动脉腔内隔绝术治疗的Stanford B型主动脉夹层患者210例,其中包括62例老年患者（老年组,年龄≥60岁）及148例非老年患者（非老年组,年龄<60岁）。对两组患者的临床特征、主动脉腔内隔绝术手术结果以及随访结果进行回顾性分析。结果: 老年组冠心病比例高于非老年组（P<0.01）。外伤、马方综合征、多发性大动脉炎均见于非老年组,动脉粥样硬化溃疡型夹层仅见于老年组,但两组病因构成无统计学差异。老年组以胸背部疼痛为表现者低于非老年组,以下肢疼痛和呼吸困难为表现及并发心功能不全者均高于非老年组（均P<0.01）。两组患者高血压病程、术前及术后最高收缩压、降压药种类数无统计学差异。非老年组术前及术后最高舒张压均高于老年组（P<0.05）。两组腔内隔绝术成功率均为100%。两组残余内漏、主动脉腔内隔绝术后综合征、切口感染发生率、院内死亡率无统计学差异。老年组术后胸背部疼痛发生率高于非老年组（P<0.01）。两组随访时间、总随访率、影像随访率、随访期间胸背部疼痛发生率、内漏发生率、截瘫发生率、血压控制不达标比例、主动脉夹层相关病死率无统计学差异。两组影像随访患者主动脉重构发生率均为100%。老年组全因病死率高于非老年组（P<0.05）。结论: 对于临床症状不典型的老年主动脉夹层患者需提高警惕,以免延误诊治。在有经验的中心对老年Stanford B型主动脉夹层患者施行主动脉腔内隔绝术治疗是安全而有效的。     

胸主动脉腔内隔绝术治疗DeBakey Ⅲb型夹层动脉瘤的效果

目的:观察胸主动脉腔内修复(EVR)治疗胸主动脉夹层动脉瘤的方法和疗效。方法:15例DeBakeyⅢb型胸主动脉夹层患者行腔内隔绝术。术后对所有患者行CT随访,评价其临床改善程度与真假腔的变化。结果:15例患者全麻下均成功进行了覆膜支架胸主动脉腔内隔绝术,术中造影显示夹层动脉瘤裂口完全封闭或内漏明显较少。术后1～22个月随访,术后30d内死亡1例,1例术后出现左下肢体运动障碍,余13例无明显术后并发症。结论:胸主动脉腔内隔绝术治疗DeBakey Ⅲb型夹层动脉瘤并发症少,术后恢复较好。     

影响血管腔内隔绝术治疗Stanford B型主动脉夹层预后的因素分析

目的 探讨影响血管腔内隔绝术治疗Stanford B型主动脉夹层预后的危险因素.方法 2008年1月至2011年9月在我院行覆膜支架血管腔内隔绝治疗的Stanford B型主动脉夹层患者292例,按腔内隔绝术后1周内是否发生并发症分为并发症组（81例）及无并发症组（211例）,术后半年、1年、2年随访,观察患者近、中期全因死亡.结果 292例均获临床成功,院内总死亡率1.7％.并发症组院内死亡率为6.3％,无并发症组院内死亡率为0,两组比较差异有统计学意义（P=0.002）.平均随访23个月,失访4例,随访期内总死亡率为5.6％,并发症组与无并发症死亡率分别为10.3％和3.8％,两组比较差异有统计学意义（P=0.003）.在多变量COX回归模型中,术前升主动脉最大直径（HR=3.651,95％CI 1.304～10.220,P=0.014）和降主动脉最大直径（HR=1.528,95％ CI 1.237～1.886,P=0.001）为患者2年内全因死亡的独立危险因素.结论 血管腔内隔绝术治疗Stanford B型主动脉夹层术后围手术期并发症可能导致患者近中期死亡风险增加.术前升主动脉最大直径及降主动脉直径是Stanford B型主动脉夹层腔内隔绝术后近中期死亡的独立危险因素.     

用腔内隔绝术治疗B型主动脉夹层动脉瘤46例

目的评价用主动脉夹层动脉瘤腔内隔绝术治疗StanfordB型主动脉夹层动脉瘤的近、中期临床疗效。方法2002年5月至2006年9月,行主动脉腔内隔绝术治疗B型主动脉夹层46例。其中男36例,女10例;年龄62±18岁。46例均经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访1~52个月,平均17±16个月,分析其临床特点及疗效。结果住院期间及随访30d内无患者死亡;发生主动脉腔内隔绝术后综合征11例;2例患者左锁骨下动脉被封闭;5例发生内漏,术后3个月时其中4例内漏自行封闭。随访3个月时,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后半年1例发生截瘫,原因不明。术后1年1例出现迟发性内漏;1例升主动脉发现夹层,未行外科手术。随访期间3例死亡,4年生存率89.3%。结论用主动脉夹层动脉瘤腔内隔绝术治疗B型主动脉夹层动脉瘤的近、中期疗效满意。     

腔内隔绝术治疗Stanford B型主动脉夹层的临床价值

目的探究腔内隔绝术治疗Stanford B型主动脉夹层的临床价值。方法回顾性分析内蒙古医科大学附属医院心脏大血管外科2010年1月~2013年1月收治的60例行腔内隔绝术治疗的Stanford B型主动脉夹层患者的临床资料,其中男性45例,女性15例,平均年龄(61.3±18.1)岁。所有患者在术前均通过CT血管造影(CTA)评估病情,术中通过血管造影确定手术部位,并将移植物经股动脉导入胸主动脉封闭夹层裂口。分析患者的临床资料,并对患者进行为期2年的随访,统计生存率和不良事件发生情况。结果 42例患者表现为单一夹层裂口,18例表现为多裂口;第一裂口在左锁骨下动脉水平的有51例,在胸主动脉水平的有9例。60例左锁骨下动脉开口胸主动脉平均直径为(28.9±4.6)mm,第一裂口距左锁骨下动脉平均距离为(23.1±8.2)mm。患者中7例出现内漏,1例发生肾功能不全,3例出现术区感染,15例出现腔内隔绝术后综合征,3例出现截瘫。术后1个月内无患者死亡,术后3个月生存率为96.7%,术后1年生存率为93.3%,术后2年生存率为88.3%。结论腔内隔绝术治疗Stanford B型主动脉夹层疗效较好,安全性高,近、中期生存率理想。     

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.