应用染色内镜和放大内镜 提高内镜诊断水平

染色内镜是指应用特殊的染料对胃肠道黏膜进行染色,使黏膜的结构更加清晰,使病变部位与周围的对比加强,轮廓更加清楚,从而提高病变的检出率。染色内镜最早于1966年由津田报道,此后报道日渐增多,应用的染料也逐渐增多,应用范围也从最初的胃黏膜染色扩展至食管、胃、小肠和大     

神经内镜技术临床应用的发展史及展望

神经内镜技术的发展始于外科医生对住院患者颅内病变治疗的探究,特别是针对脑室结构等深部脑结构;但是,早期的技术水平过于原始以至于神经内镜技术的发展一直滞后。随后,侧脑室腹腔分流术和显微神经外科的普及使神经内镜技术更加趋向衰落,之后物理成像技术一步步发展,并为神经内镜技术提供了可靠的技术支持。神经内镜技术于上世纪80年代复兴,实践证明,神经内镜技术在神经外科领域发挥越来越大的作用。在不久的将来,内镜技术的培训和实践在现代神经外科中有望常规化。     

内镜医师眼中胃肠病学家在未来消化肿瘤学中的作用

消化肿瘤学的发展需要创建一个多学科的团队。专攻消化肿瘤学的胃肠病学专家(肿瘤-胃肠病学家)也应该包含在这样高质量的团队中。为实现这一目标,肿瘤-胃肠病学家需接受与消化道肿瘤内镜诊断和治疗所有相关方面的充分培训。本文涵盖所有需要用来保证最佳诊治的专业技术。     

早期食管癌的内镜下诊断

食管癌是世界上最常见的消化道恶性肿瘤之一。我国是世界上食管癌发病率和死亡人数最多的国家。食管癌早期症状不明显,患者就诊时常已是中晚期,大多数失去了治疗的机会。因此如何早期发现食管癌患者及指导临床对食管癌患者进行下一步治疗就成为目前医学研究的重点。本文就近年来早期食管癌内镜下诊断的相关文献作一综述。     

消化内镜应用新进展

前言:随科技发展,消化内镜由单纯性诊断工具已发展成了诊治一体的先进器械.约200年前,医学家们致力于光学内镜的研究,以期直接观察到内部脏器的病变,推动了内镜的发展.内镜的发展大致分为4个阶段:硬式内镜阶段、半曲式内镜阶段、纤维内镜阶段、电子内镜阶段.     

色素内镜对胃黏膜肠上皮化生的分析及诊断价值

胃黏膜肠上皮化生（IM）是目前国内外公认的癌前病变之一，若能及早通过内镜下识别和治疗使其病变逆转．不失为防治胃癌的有效途径。探讨内镜诊断胃黏膜肠上皮化生．对识别胃黏膜癌前病变准确性提出了更高的要求。献报道，放大内镜对诊断IM准确性达89．69％，但基层医院的内镜医师由于受放大内镜设备的限制。如何利用普通内镜提高对IM诊断率，是值得探讨的。我们采用普通染色内镜进行观察，以探讨其对IM病变诊断的可行性和准确性。     

消化内镜医师培训的目标及方法

消化内镜历经了100多年的发展,从早期的硬质内镜、纤维内镜到今天的电子内镜,以及不断出现的色素内镜、放大内镜、超声内镜、胶囊内镜、荧光内镜和共聚焦激光显微内镜等新的内镜诊断方法,使得消化内镜医师对疾病的认识越来越深刻,但是不断更新的内镜诊治技术也对消化内镜医师提出了挑战。我院消化内镜诊治培训中心是北京市消化内镜质量控制和改进中心挂牌单位,为全国仅有的两家中华医学会指定的消化内镜诊治培训中心之一,担负着北京市以及全国消化内镜医师的培训任务,每年都有相当数量的进修医生在我院消化内镜诊治培训中心学习。现就结合我们的具体实践,谈谈内镜培训过程中的几点体会。     

2009年消化内镜临床研究进展回顾

现代消化内镜技术是微创医学的重要领域。2009年是消化内镜技术取得长足发展的一年。新方法和新技术的运用丰富了消化内镜学科体系。在此,回顾2009年消化内镜研究领域的重要进展,希望能为今后的工作带来启发,以进一步提高我国消化内镜的操作水平和科研水平。     

水下内镜切除技术的临床应用进展

已有研究显示结肠镜插入过程中辅助使用注水有助于减轻患者的疼痛,且对麻醉的需求亦明显低于常规注气方法[1, 2],退镜时再吸去肠腔内残余水份并注入气体,以方便观察及实施内镜下治疗。2012年美国学者Binmoeller等[3]首次提出了一种非注气状态下的水下内镜切除技术,近几年来该项技术已逐步被用于食管,胃肠道的内镜微创治疗当中,本文现就其临床应用进展加以综述如下。     

内镜技术在早期食管癌诊治中的应用

本文介绍了普通内镜、色素内镜、荧光内镜、超声内镜和窄带成像技术对早期食管癌的诊断价值,同时重点评述了内镜下黏膜切除或剥离术对早期食管癌的治疗效果和经验,颇有指导意义。     

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.