双氧水在上消化道出血急诊胃镜检查中的应用

我院从2000年1月～2003年12月对21例急性上消化道出血患者，在急诊胃镜检查中经胃镜活检孔喷洒3％双氧水，观察改善视野和止血情况，效果满意，现报告如下。     

3%双氧水在上消化道出血急诊胃镜检查时的应用价值

我院从2000年3月～2001年8月对100例急性上消化道出血患者在急诊胃镜检查时,通过胃镜活检孔先后喷洒生理盐水及3％双氧水,观察其对胃腔视野的改善情况。取得良好效果,报道如下。 1.观察对象;100例急性上消化道出血患者,男68例,女32例,年龄19岁～78岁,平均36岁。均符合以下条件:呕血或黑便24h以内,伴或下伴周围循环衰竭;胃管内抽出血性胃液;符合胃镜检查适应证;取得患者或家属知情同意。     

内镜下喷洒过氧化氢对急性上消化道出血部位影响的临床研究

目的 :本研究旨在证明过氧化氢在急诊内镜时是否可以作为一种溶剂以改变血凝块的性质 ,使内镜下出血部位视野较清晰。方法 :急性上消化道出血患者 2 0例 ,急诊内镜对可疑出血部位先用 2 0 0ml生理盐水喷洒 ,再用 2 5～ 1 75ml 3%过氧化氢喷洒。分别在生理盐水和过氧化氢冲洗前后照相 ,然后将这些照片送给 3名消化病专家运用视野清晰度评分系统进行评分。为了评价 3 %过氧化氢的安全性 ,分别在喷洒前和喷洒后胃窦和十二指肠球部钳取组织并送病理。结果 :单独用生理盐水冲洗与用过氧化氢冲洗的视野清晰度评分 (2 .41∶0 .37)差异有显著性 (P <0 .0 5)。过氧化氢冲洗后的胃窦和十二指肠球部组织学检查均未发现有临床意义的变化。结论 :急诊内镜治疗急性上消化道出血时 ,过氧化氢可以清晰视野 ,明确出血部位 ,是一种安全、有效的方法 ,仅有轻微的不良反应。     

内镜下凝血酶治疗上消化道出血

目的观察凝血酶局部应用对上消化道出血的疗效．方法男20例，女12例，年龄15岁～71岁．胃溃疡11例，十二指肠溃疡7例，急性胃粘膜病变10例，残胃一吻合口炎3例，Dieulofoy病1例．其中喷射性出血1例，涌出性出血10例，活动性渗血21例．所有病例均做术前准备．酬情采用喷洒、注射方法．喷洒时采用凝血酶生理盐水（100IU／mL）直接喷洒．注射时采用500IU／mL在出血灶四周分点注射．24h后内镜观察有无再出血，必要时重复治疗．术后继续给予抑酸治疗．结果19例喷洒后有17例30s内止血．15例注射后有13例迅速止血，另2例经再次注射后止血.总止血有效率100％，喷射性、涌出性出血一次止血有效率82％．未见副作用和并发症．随访24例患者1mo～8mo未见复发者．结论凝血酶局部喷洒、注射的方法治疗非静脉曲张性上消化道出血效果良好．     

上消化道出血的内科治疗

1.孟氏液的止血效果:据大连医学院的经验,50例急性上消化道出血通过急症胃镜喷洒5%Monsell氏液(硷式硫酸铁)50～100ml,全部在3～5分钟内即刻止血。其中82%持续有效,未再出血;16%还继续有2～3次黑便;只有1例(2%)食管癌因出血死亡(第一届全国内科学术会议论文摘要1980)。2.激光止血的临床效果:目前激光止血还在研     

急诊床边胃镜在急性上消化道大出血中的临床应用

[目的]探讨急诊床边胃镜在急性上消化道大出血中的诊断及治疗价值。[方法]分析2006～2007年对50例上消化道大出血患者行急诊床边胃镜检查（其中内镜下治疗47例）。[结果]49例明确出血原因（1例因胃腔内积血甚多影响观察），确诊率为98．0％，其中47例经内镜下治疗后出血停止，一次性止血成功43例，总有效率为87．7％；4例再次出血行血管介入治疗，3例外科手术治疗。全部病例元一例死亡或病情加重。[结论]在急性上消化道大出血中急诊床边胃镜能及时有效地明确出血原因，并可行内镜下止血，降低病死率，且安全。     

经胃镜钛夹治疗非静脉曲张上消化道出血53例的临床分析

目的探讨在胃镜下应用钛夹治疗上消化道出血的方法与疗效。方法在胃镜探查下对53例非静脉曲张上消化道出血患者进行钛夹止血治疗并观察治疗效果。结果53例急性出血患者经胃镜下钛夹治疗分别置放钛夹1-5枚后,均成功止血（100％）。结论在胃镜下操作钛夹治疗急性非静脉曲张性上消化道出血疗效确切,创伤小,值得临床推广。     

经胃镜应用云南白药治疗上消化道出血的研究

目的 探讨经胃镜应用云南白药治疗上消化道出血的作用。方法选择90例上消化道出血病人，给予制酸药、保护胃黏膜、应用抗菌素和止血药物的内科常规治疗。其中38例除按上述内科常规治疗外，还进行胃镜检查，发现出血病灶后立即对病灶用生理盐水10ml＋云南白药0.5g喷涂出血处。随后再加服云南白药0．5g，3次／d，疗程3～10d。结果内科常规治疗组52平均住院天数是22．4d，而经胃镜应用云南白药后再加服云南白药的38例平均住院天数为12．5d。结论对上消化道出血的病人在内科常规用药的同时，经胃镜检查对病灶应用云南白药，随后又加服云南白药，可以明显缩短病程，未发现副作用，效果良好。     

内镜注射联合金属钛夹治疗上消化道动脉喷射状出血的疗效观察

目的 观察内镜下黏膜内注射高渗盐-肾上腺素溶液联合金属止血夹治疗上消化道动脉喷射状出血的效果。方法 1999-07／2004-11共16例病人因呕血和／或黑便接受胃镜检查时发现病灶呈喷射状出血，诊断胃溃疡8例，胃癌1例(溃疡型)，Dieulafoy病5例，胃巨大息肉摘除术后出血2例。全部病例应用内镜下黏膜注射高渗盐-肾上腺素溶液，随后置放金属止血夹。结果 16例应用内镜下黏膜注射高渗盐-肾上腺素溶液联合金属止血夹疗法，均一次止血成功，无一例发生再出血和其它并发症，止血成功率100％。12例病人在6～10周内复查胃镜提示病灶愈合，1例胃癌病人止血后转外科手术治疗。结论 内镜注射联合金属钛夹治疗上消化道动脉喷射状出血止血迅速，疗效可靠，再出血率低，操作简便、安全，具有较高的临床实用价值。     

内镜下胃黏膜肾上腺素注射联合金属钛夹治疗溃疡性上消化道出血的临床研究

目的观察胃镜下胃黏膜肾上腺素注射联合金属钛夹治疗溃疡性上消化道出血的疗效,探讨其优点与操作注意事项。方法将2013年7月至2014年9月入选的108例溃疡性上消化道出血患者据就诊日期单双号分为胃镜治疗组(57例)与常规治疗组(51)例,胃镜组于入院12 h内行胃镜下胃黏膜注射肾上腺素联合钛夹止血,常规组予静滴质子泵抑制剂、生长抑素,口服去甲肾上腺素冷生理盐水等内科止血,比较两组止血效果、输血例数与平均住院时间。结果胃镜组术中即时止血率100%,2例胃镜下血管裸露患者术后48 h内发生再出血,该行外科止血,5例溃疡面较大者出现钛夹脱落。常规组10例内科止血效果不佳者改行胃镜止血措施,8例成功止血,2例改行外科止血。治疗中,胃镜组输血比例(1.8%)明显低于常规组(11.8%)(P0.05);治疗48 h后两组总体止血效果构成差异显著(P0.05),胃镜组总体有效率(96.5%)显著高于常规组(84.3%)(P0.05),平均住院时间[(5.4±1.7)d]显著低于常规组[(7.7±2.1)d](P0.05)。结论胃镜下胃黏膜注射肾上腺素与放置金属钛夹治疗溃疡性上消化道出血具有协同止血作用,较常规内科药物止血效果明显提高,且极大减轻了外科手术率。     

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.