心脏介入术后使用Angioseal动脉闭合器或手压止血的临床效果对比

目的　评价在冠脉介入术后 ,穿刺动脉应用血管闭合器Angioseal止血或手压止血的安全性及Angi oseal闭合器的临床应用价值 ,临床经验。　方法　 2 4 8例病人经股动脉介入术后 ,分为两组 ,A组 1 0 1例应用Angi oseal闭合器 ;B组 1 4 7例应用手压止血作为对照组。记录止血时间 ,操作时间 ,下肢制动时间 ,及血管并发症。　结果　应用Angioseal闭合器成功率 99%。止血时间 5 0秒± 3 2秒 ,绝对制动时间 2 5h± 0 8h ,相对制动时间 2 6h±0 7h ,1例 (1 %)血肿。对照组 1 0 0 %成功止血 ,止血时间 3 5分± 1 5分 ,相对制动时间 1 3 5h± 4 2h小时 ,绝对制动时间为 1 8 3h± 6 2h ,1 1例 (7%)血肿。　结论　Angio Seal闭合器是一种安全 ,可靠的止血方法 ,与手压止血比较 ,操作简单 ,明显缩短了止血时间及制动时间 ,无明显的穿刺部位血管并发症 ,方便了病人及医务工作者。     

冠状动脉介入术后血管缝合的血管并发症分析

目的 分析冠状动脉介入术后Angioseal血管缝合器机械止血和人工压迫止血的血管并发症发生率。方法 947例冠状动脉介入诊治病例，179例术后使用Angioseal血管缝合器止血（机械组），另外768例进行人工压迫止血（人工组），比较二组的止血时间、制动时间和血管并发症发生率。结果 机械组显著缩短止血时间和制动时间(P<0.01)，但其与人工组的血管并发症发生率差异无统计学意义（P>0.05）。结论 使用Angioseal血管缝合器能显著缩短止血时间和制动时间，但不能减少股动脉穿刺并发症的发生率，不推荐介入术后常规使用机械止血装置。     

冠状动脉介入术后血管缝合器的血管并发症分析

目的分析冠状动脉介入术后Angioseal血管缝合器机械止血和人工压迫止血的血管并发症发生率。方法947例冠状动脉介入诊治病例，179例术后使用Angioseal血管缝合器止血（机械组），另外768例进行人工压迫止血（人工组），比较二组的止血时间、制动时间和血管并发症发生率。结果机械组显著缩短止血时间和制动时间（P〈0．01），但其与人工组的血管并发症发生率差异无统计学意义（P〉0．05）。结论使用Angioseal血管缝合器能显著缩短止血时间和制动时间，但不能减少股动脉穿刺并发症的发生率，不推荐介入术后常规使用机械止血装置。     

冠状动脉造影和介入治疗术后Angio-seal血管闭合器的应用

Angio-seal血管闭合器是一种新型的止血装置,本研究旨在探讨在冠状动脉造影和介入治疗术后,使用Angio-seal血管闭合器对股动脉穿刺部位进行止血的有效性、安全性及并发症发生情况.方法:2003年5月至2004年2月期间,我院心内科共对129例(男99例,女30例,平均年龄63.2±11.5岁)行冠状动脉造影或介入治疗的患者使用了Angioseal血管闭合器进行股动脉穿刺部位的止血,观察使用该装置所需的止血时间、患者的下肢制动时间以及止血即刻至术后7 d内局部并发症的发生情况.     

冠状动脉介入诊疗术后Angio-Seal血管闭合器止血的临床观察

目的 :评价冠状动脉介入诊疗术后 ,应用Angio Seal血管闭合器的安全性、有效性及临床应用价值。方法 :76例经股动脉冠状动脉介入治疗术后 ,立即应用Angio Seal装置闭合动脉穿刺点止血 ,记录止血时间、下肢制动时间及局部血管并发症。结果 :Angio Seal血管闭合成功率为 97 2 % ,止血时间(2 0 4± 1 81)min ,制动时间 (4 17± 2 0 5 )h。 3例术后少量渗血 ,1例术后即刻迷走神经反射。结论 :冠状动脉介入诊疗术后应用Angio Seal血管闭合器止血安全、有效 ,并发症发生率低 ,对高危患者同样适用 ,值得推广应用。     

冠脉介入术后3种止血方法的比较

目的评价血管缝合器（Perclose和Angioseal）在冠状动脉造影（CAG）或经皮冠状动脉内介入术（PCI）后股动脉止血的临床应用价值。方法选择2004年12月至2005年12月在我院行CAG或PCI术的患者180例,分为A、B、C3组,每组60例。A组使用Perclose封闭股动脉穿刺点,B组使用Angioseal封闭股动脉穿刺点,C组使用常规人工压迫方法止血。观察止血时间、制动时间、及术后并发症的发生情况。结果使用Perclose和Angioseal的止血时间和下肢制动时间均较手法压迫止血显著缩短（均P<0.01）,其中使用Angioseal的止血时间还要略少于使用Perclose的止血时间,且操作更简单,但二者在止血时间和制动时间方面无统计学差异。3组在术后并发症方面无统计学差异。结论Perclose和Angioseal较常规压迫止血显著缩短止血时间和患者卧床时间。     

冠状动脉介入诊疗术后两种止血方法的比较

目的:比较冠状动脉诊疗术的冠状动脉介入术（PCI）及冠状动脉造影术（CAG）后,传统压迫法与采用Angioseal缝合器止血法的制动时间和并发症发生率,为术前指导和术后护理提供依据。方法:CAG及PCI患者214例按止血方法不同分为传统压迫止血组和血管缝合组,比较两组术后制动时间和并发症的发生率。结果:采用Angioseal缝合法成功率达100%,与压迫法止血比较下肢制动时间不论单纯CAG还是PCI均显著缩短（P<0.01）,缝合法术后并发症的发生率如渗血、局部血肿、迟发出血（第3天以后,至1周）、心迷走反射等显著低于传统压迫止血组（P<0.01）。结论:Angioseal缝合器止血较传统压迫止血护理操作简便,安全性高,并发症少。     

两种血管闭合器在冠状动脉介入治疗中的应用比较

目的评价并比较Angioseal和Perclose两种血管闭合器在经皮冠状动脉造影(CAG)及介入治疗(PCI)中应用的有效性和安全性。方法1020例行冠脉造影及介入治疗的患者(男672例,女348例,年龄57.8±2.4岁)经髂动脉造影证实无血管闭合器使用禁忌,术后随机分为Angioseal组(CAG380例,PCI120例)和Perclose组(CAG392例,PCI128例),比较两组患者使用血管闭合器的成功率及局部并发症的发生率。结果Angioseal和Perclose两组成功率均较高(94%比96%),差异无统计学意义。Angioseal组发生局部血肿5例,无假性动脉瘤发生;Perclose组发生局部血肿4例,假性动脉瘤3例,两组间并发症的发生率差异亦无统计学意义。结论CAG及PCI术后,Angioseal和Perclose血管闭合器均能有效止血,并发症较低,安全性好。     

Angio-Seal血管封堵器与人工压迫止血在脑血管介入诊疗术中的作用比较

目的观察Angio-Seal血管封堵器在脑血管介入诊疗术后的应用安全性及疗效。方法对592例经皮股动脉穿刺行血管介入诊断和治疗术后病人,分别进行血管封堵器封堵或人工压迫股动脉穿刺点止血,观察病人的止血时间、下肢制动时间和止血成功率、血管并发症。结果血管封堵组的止血时间(1.5±0.67)min、下肢制动时间(3.9±0.7)h、腹股沟血肿10.56%及迷走反射发生率较人工压迫组比较明显缩短,两组间的止血成功率(99.72%vs 99.14%)、假性动脉瘤发生率(0.56%vs 1.71%)比较无统计学意义。结论应用Angio-Seal血管封堵器封堵动脉穿刺口可以大大缩短病人止血时间及平卧时间,且安全、有效。     

冠状动脉介入术后应用新型血管闭合器Boomerang(R)的初步研究

目的 评价冠状动脉造影或经皮冠状动脉介入治疗(PCI)后,应用新型血管闭合器Boomerang(R)的有效性及安全性.方法 入2005年2月至2007年3月在北京军区总医心血管内科进行冠状动脉造影或PCI的112例患者,随机应用血管闭合器Boomerang(R)(Boomerang(R)组,68例)和Angioseal(Angioseal组,44例)对股动脉穿刺部位进行封闭止血,观察两组止血时间、下肢制动时间,术后即刻、术后4h、出院前24h内出血发生率.结果 两组即刻闭合成功率均较高(94%vs 91%,P=0.78),两组止血时间[(1.89±1.23)min vs(2.01±1.21)min,P=0.633]、下肢制动时问[(5.76±2.23)h vs(5.01±2.05)h,P=0.54]、术后即刻(16%vs 15%,P=0.86)和出院前24h内(1%vs 3%,P=0.75)的小出血发生率等均无显著性差异,但术后4h Boomerang(R)组小出血发生率明显低于Angi-oseal组(7%vs 13%,P=0.04),两组均无大出血发生.与合并高血压、高脂血症的患者比较,有糖尿病和吸烟史的患者术后即刻、术后4h和出院前24h内小出血发生率均显著增加(P<0.05).结论 新型血管闭合器Boomerang(R)闭合股动脉穿刺口有效、安全,但对于有糖尿病和吸烟史的患者应谨慎选择.     

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.