新型止吐药“枢复宁”预防由化疗药物引起胃肠道反应的疗效观察

恶心、呕吐、食欲不振等胃肠症状是抗肿瘤药物最常见的副反应。英国葛兰素制药集团提供生产的最新的止吐药枢复宁(Zofron,Ondansetron)供临床应用来预防抗肿瘤药物的胃肠反应,现将其疗效报道如下。病例选择和用法选择对化疗药物治疗第一天有明显胃肠反应的患者作为自身对照,观察内服枢复宁预防抗肿瘤药物引起的恶心、呕吐发生的效果。治疗日在化疗药物用药前1～1.5小时口服枢复宁8mg,下午再口服8mg,或连服2天后再停用枢复宁,连续观察其对化疗药物的胃肠反应。     

浙北地区药源性肝病及胃肠粘膜损伤的临床流行病学调查

目的　了解药物性肝病及胃肠粘膜损伤的流行情况。方法　采用整群分层随机抽样方法对浙北地区8所医院收治的 2 87例药物性肝病及胃肠粘膜损伤患者的流行特征和相关因素进行分析。结果　药物性肝病及胃肠粘膜损伤发生率为 1 2 4 % ,男性多于女性 ,中青年发生率高 ,致肝病的药物种类多于致胃肠粘膜损伤的药物种类 ,医疗费用高于对照组。结论　药物性肝病及胃肠粘膜损伤影响了当地人群的健康 ,研究结果可为卫生行政部门制订临床药物毒副作用的监察和控制政策提供参考依据。     

常规剂量胃肠动力药物对口-结肠转运时间的影响

背景：胃肠传输障碍是发生胃肠道症状的最重要原因之一,目前尚缺乏常用胃肠动力药物改善胃肠传输功能疗效的对比研究。目的：研究常规剂量胃肠动力药物对健康志愿者口-结肠转运时间（OCTT）的影响。方法：采用随机、双盲、拉丁方设计的自身对照研究方案,以乳果糖氢呼气试验检测7名健康志愿者的OCTT。口服乳果糖前30 min分别给予多潘立酮10 mg、莫沙必利5 mg、枸橼酸莫沙必利分散片5 mg（服用乳果糖前15 min给予）、伊托必利50 mg、匹维溴铵50 mg和曲美布汀100 mg,并比较不同药物的OCTT。结果：7名健康志愿者的基线平均OCTT为（112.0±3.2）min,多潘立酮、莫沙必利、枸橼酸莫沙必利分散片、伊托必利、匹维溴铵和曲美布汀的OCTT分别为（96.0±2.4）min、（72.2±2.6）min、（71.4±2.0）min、（105.0±2.6）min、（87.0±3.2）min、（135.0±4.1）min,与基线相比差异均有统计学意义（P〈0.05）。枸橼酸莫沙必利分散片的OCTT显著低于其他胃肠动力药物（P〈0.05）。结论：常规剂量枸橼酸莫沙必利分散片对OCTT的促进作用优于其他胃肠动力药物。     

非甾类抗炎药的胃肠副作用和对策

非甾类抗炎药(NSAIDs)是一类治疗关节肌肉疼痛的常用药物,不少患者尤其是老年病人服用这类药物后,可以导致胃肠粘膜糜烂、出血和溃疡.NSAIDs损伤胃肠粘膜的原因,除药物对胃粘膜的直接刺激作用而使患者感到胃部不适外,其基本原因是由     

生物电反馈对胃肠动力障碍的治疗价值

胃肠动力障碍所致的消化系统症状，如早饱、腹胀、嗳气等，是病人就诊的常见原因，其发病率呈上升趋势，临床上主要依赖促胃肠动力药物进行治疗。由于药物的不良反应、长期用药带来的经济负担以及部分病人的疗效不满意，故开发和应用经济实惠、安全有效的新疗法显得非常重要。近年来，胃肠起搏在治疗功能性胃肠疾病方面取得了很大进展。我们2004-08引进胃肠起搏器，采用生物电反馈治疗胃肠动力障碍病人，取得良好疗效，现总结报告如下。     

Cajal间质细胞与胃肠动力关系的研究进展

Cajal间质细胞(interstitial cells of Cajal,ICC)是胃肠慢波的起搏细胞,具有产生慢波、传导慢波电位、调节神经递质等功能,是调节胃肠动力的重要环节。ICC在维持正常胃肠动力方面发挥着重要作用,同时其形态、数量及分布的改变会导致多种胃肠动力障碍性疾病。一些以ICC为靶向治疗胃肠动力性疾病药物的研究也取得一定进展。本文就近年来ICC与胃肠动力关系的研究进展作一概述。     

术后胃瘫综合征的诊断与治疗

术后胃瘫综合征是临床常见的手术后并发症,其主要特点为术后胃排空延迟,其发病机制与手术方式、术后感染及患者情绪等相关。诊断主要以术后出现胃潴留,且排除消化系统机械性梗阻及其他能导致胃动力下降的疾病或药物等。治疗以内科保守治疗为主,包括持续胃肠减压、维持内环境稳定、肠内营养、促动力药物、中医中药治疗等。     

非甾体抗炎药物和胃肠道疾病

非甾体抗炎药物(NSAID)的临床效果已被公认,但其容易对胃肠粘膜产生损害,也是无可争辩的.非甾体抗炎药物如阿斯达林、消炎痛、布洛芬、萘普生.炎痛喜康等,可造成急慢性胃肠病变.在长期用药的病人中约一半有轻重不等的胃肠道症状.其中1/8病人因症状较重难以继续治疗.严重的出现出血、穿孔,内镜下见粘膜充血、水肿、出血、糜烂、急慢性溃疡.我国因胶元性疾病、类风关等有增多趋势,NSAID类药物应用已较普遍.此类药物可引起的胃肠病变应予以足够重视.     

西沙必利治疗高原驻军胃肠返流性胃炎病人的疗效对比观察

青藏高原驻军官兵长期生活和工作在海拔2800-5300公尺的高原环境下，气候干燥．氧气稀薄，工作及饮食皆不规律，太部分官兵皆患有不同程度的上消化遭疾病。我们在上消化道疾病与Hp关系的流行病学调查中发现胃肠返流性胃炎约占胃镜受检人数的1／3，为了给高原部队提供防治依据．我们对这些病人进行不同的胃肠动力药物治疗效果观察．现将结果报道如下。     

莱菔提取物对胃肠运动的影响

目的采用电生理学的实验方法,观察莱菔提取物（Raphanus sativus.L extract,Rex）对胃电活动和小肠消化期间移行性运动复合波（Migrating motility complex,MMC）的影响,并与促进胃肠道运动的经典药物吗丁啉和西沙比利进行对比,探讨莱菔提取物的促胃肠动力作用。方法采用旋转蒸发的方法,制备莱菔提取物。采用电生理学的方法,记录给予不同的药物对胃肠电活动的影响。结果莱菔提取物对胃电的波幅和频率的影响,与吗丁啉组相比,没有显著性差异。莱菔提取物对小肠MMC的影响与西沙比例相比差异不显著。结论莱菔提取物对胃肠道运动的影响,与经典促胃肠动力药物的作用相当。     

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.