ERCP术后发热原因的分析及对策

随着内镜操作技术的迅速发展，内镜逆行胰胆管造影（ERCP）已经成为胰胆疾病的重要诊疗手段，因其创伤小、效果好、痛苦少、恢复快而部分取代了外科手术治疗。但随着诊疗数量的增加，并发症的发生数量也逐渐增多，引起了消化内镜医师的高度重视。本研究回顾性总结常州市第一人民医院ERCP诊疗患者的资料，就ERCP术后发热原因作一些分析，旨在为预防和治疗ERCP术后发热提供一些对策。     

经内镜逆行胰胆管造影在胆胰疾病中的应用

近年来,随着内镜技术和介入技术的不断发展,许多新的设备和方法已经应用于临床,使得经内镜逆行胰胆管造影(ERCP)在胆胰疾病中的应用迅速发展。回顾并总结了ERCP在胆胰疾病中的应用,包括ERCP在胃肠道改道术后患者、孕妇患者、胆道良恶性狭窄患者、胰腺假性囊肿患者中的应用,Spy Glass、光动力学疗法、射频消融术的应用,ERCP相关十二指肠穿孔的处理及ERCP术后胰腺炎的预防等。ERCP的发展和应用使得胆胰疾病的诊治不断向前迈进。     

ERCP术后胰腺炎的技术层面危险因素探讨

ERCP是目前公认的诊断胰胆管疾病的金标准,在其基础上介入治疗是胆胰疾病微创治疗的发展趋势。胰腺炎是ERCP术后最常见的并发症,占ERCP术后并发症的50％左右。本文回顾性分析1989年12月至2008年12月间我院行诊断和（或）治疗性ERCP的6017例患者的临床资料,就诊断及治疗性ERCP术后胰腺炎（PEP）的相关技术层面危险因素进行分析探讨,现报道如下。     

老年患者ERCP术后十二指肠乳头出血与原发疾病的关系研究

目的探讨老年患者经内镜逆行胰胆管造影(ERCP)术后十二指肠乳头出血与原发疾病的关系。方法回顾性分析成都大学附属医院收治的320例老年胆胰疾病患者的临床资料,分析ERCP术后十二指肠乳头出血与原发疾病的相关性。结果老年患者ERCP术后十二指肠乳头出血总体发生率为6.3%。出血组中壶腹部嵌顿结石、胆管癌、胰头癌及十二指肠乳头癌患者所占比例均明显高于未出血组(P均0.05)。出血组患者合并高血压病及十二指肠乳头旁憩室的比例均明显高于未出血组(P均0.05)。结论老年壶腹部嵌顿结石、恶性肿瘤患者以及合并高血压病、十二指肠乳头旁憩室的患者,ERCP术后十二指肠乳头出血的风险较大。ERCP术后出血治疗首选急诊内镜下止血。     

内镜逆行胰胆管造影术后胰腺炎的研究进展

内镜逆行胰胆管造影术(ERCP)是胆胰疾病的主要诊治方法。ERCP术后胰腺炎(PEP)是ERCP术后最常见和最严重的并发症。充分认识PEP对其防治有重要影响,本文就PEP的诊断、危险因素、重点在预防措施上进行综述。     

内镜下逆行胰胆管造影术围手术期用药专家共识意见

正内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)已广泛应用于胆胰疾病的诊治,但ERCP操作有一定并发症发生率,主要包括术后胰腺炎(post-ERCP pancreatitis,PEP)、出血、感染,穿孔等。围手术期合理应用药物可有效降低ERCP术后并发症,然而目前对ERCP的围手术     

ERCP术后并发症的危险因素

ERCP已广泛用于良恶性胰胆疾病的诊断及治疗,早期的研究报告,ERCP术后并发症发生率为0.8％～45％,最常见的并发症为急性胰腺炎。但罕见增加ERCP术后胰腺炎发生的危险因素或患者特征的前瞻性研究。本文分析了诊断及治疗性ERCP术后并发症,以明确其相关的危险因素。     

加贝酯预防ERCP术后胰腺炎临床研究

选择因各种胰腺胆管疾病接受ERCP治疗的患者100例,随机分为两组,治疗组ERCP术前30min给予加贝酯治疗,对照组ERCP术前、术后均不予加贝酯治疗。发现治疗组ERCP术后血淀粉酶一过性升高者19例,并发急性胰腺炎1例。对照组分别为32、15例。认为加贝酯能有效降低Oddi括约肌收缩频率和幅度,松驰括约肌,有利于提高造影导管插管的方便性和成功率,有利于预防ERCP术后胰腺炎的发生。     

ERCP相关并发症的危险因素及药物预防进展

内镜逆行胰胆管造影(ERCP)技术及内镜下乳头括约肌切开术(EST)对胆胰疾病的诊断与治疗发挥了重要作用,但ERCP术后有一定的并发症发生。现就近年对ERCP术后并发症,特别是对ERCP后急性胰腺炎及感染发生因素的认识与预防用药研究作一介绍。     

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随着技术的发展 ,胆道疾病的诊断方法越来越多 ,如B超、CT、内镜下超声检查术 (EUS) ,特别是磁共振胆管胰管成像术 (MRCP)越来越多地应用 ,但直接造影术如经皮经肝胆道造影术(PTC)、内镜下逆行性胰胆管造影术 (ERCP) ,特别是后者仍是除手术与病理检查以外诊断胆道疾病的“金标准”。不过 ,能用其他无创技术诊断的胆道疾病 ,不要轻易选择单纯诊断性ERCP ,毕竟ERCP术后有并发症 ,特别是ERCP术后胰腺炎仍有 1%～ 7%的发生率 ,且有时是无法控制的。1　胆道疾病的内镜诊断适用于疑有肝脏、胆道和胰腺疾病的患者。其操作技术较复杂 ,…     

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.