复杂Stanford B型主动脉夹层46例治疗分析

【】 目的 探讨复杂Stanford B型胸主动脉夹层治疗的最佳治疗方法及临床效果。方法 我院2003年1月至2014年1月共46例复杂Stanford B型胸主动脉夹层行覆膜支架腔内植入术,其中男性41例,女性5例,年龄33-64岁,平均45岁。16例采用2枚支架植入术,30例应用长直筒支架。术后1、3、6及12个月之后每年均行CTA复查,比较两组内漏发生率、围手术期有无脊髓缺血、假腔血栓化及支架远端有无并发症。结果 46例患者中有2例发生急性脊髓缺血导致截瘫,远端支架贴附不良1例,支架远端相关并发症4例均为放置长直筒支架患者,无支架内漏、无支架移位,无脑梗及脏器缺血等并发症。所有患者无死亡。结论 采用2枚支架植入术避免了现有支架长度及直径的限制,可根据Stanford B型主动脉夹层病人不同特点制定腔内修复治疗方案。此方法适用、可行,避免支架与主动脉远端直径不匹配引起远期并发症。对于远期临床效果,有待大样本及长期的临床研究。     

利用烟囱技术治疗主动脉弓部分支血管受累Stanford B型主动脉夹层23例临床分析

【摘要】 目的 探讨烟囱技术治疗主动脉弓部分支血管受累Stanford B型主动脉夹层的临床效果,为临床治疗提供参考。方法 对我院2013年9月至2016年10月治疗主动脉弓部分支血管受累的Stanford B型主动脉夹层23例的临床资料、手术方法、随访结果行回顾性分析。结果23例患者中1例烟囱支架闭塞;1例术后死亡;1例逆剥形成A型夹层;5例术后Ⅰ型内漏;无脊髓缺血导致截瘫,无远端支架贴附不良,无支架远端相关并发症,无支架移位,无脑梗及脏器缺血等并发症。结论 对于主动脉弓分支血管受累的Stanford B型主动脉夹层采用烟囱技术扩大了腔内治疗的适应症,提高手术成功率,将复杂的手术简单化,使患者受益于这一有效的治疗手段,获得了满意的临床疗效。     

“烟囱”技术在胸主动脉夹层腔内修复术中的应用分析

目的 探讨“烟囱”支架技术在近端锚定区长度不足的胸主动脉夹层的主动脉腔内修复术治疗中的应用.方法 回顾性观察2012年8月至2013年9月广东省人民医院17例近端锚定区长度不足的胸主动脉夹层患者使用“烟囱”技术进行主动脉腔内修复术治疗的临床资料.结果 男16例,女1例,Stanford B型主动脉夹层16例,Stanford B型主动脉夹层合并腹主动脉瘤1例.手术成功率为100％,支架释放后即时血管造影显示破口封堵完全,“烟囱”支架血流正常.随访3-16个月,中位时间12个月,无术后死亡患者.随访期间,患者出现左足乏力1例、头晕1例、胸闷痛2例、Ⅰ型内漏2例.无严重神经系统及脏器缺血并发症发生.术后主动脉计算机断层扫描血管造影（CTA）未见移位、明显内漏及“烟囱支架”闭塞等异常.结论 对于近端锚定区长度不足的胸主动脉夹层的患者,使用“烟囱支架技术”进行主动脉腔内修复是安全、有效的治疗方法.     

Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层临床诊治分析

目的探讨Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层的机制与诊治。方法回顾性分析自2002年4月至2014年12月沈阳军区总医院心血管内科收治的Stanford B型主动脉夹层中行主动脉腔内修复术患者随访期间发生覆膜支架远端再发夹层的临床特点,同时分析患者发生再次主动脉夹层的影响因素以及诊疗方案。结果 10例主动脉覆膜支架远端再发夹层,7例应用直筒(近端与远端直径无落差)覆膜支架,3例应用近端与远端直径落差均为2 mm的覆膜支架,支架长度均在150 mm以内。9例再次行腔内修复术,1例患者拒绝再次行主动脉腔内修复术,行药物保守治疗。其中1例患者2次出现支架远端再发夹层,2次均行主动脉腔内修复术。所有手术患者均手术成功,无并发症,随访期间2例患者出现脑卒中,分别发生于再次腔内修复术后1个月、6个月,无截瘫和死亡事件。结论注重支架长度及直径落差选择对预防动脉夹层腔内修复术后覆膜支架远端再发夹层有临床意义。再次介入治疗可有效治疗Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层,再次治疗并发症少,安全性高。     

覆膜支架治疗37例Stanford B型胸主动脉夹层的疗效分析

目的:分析覆膜支架腔内修复治疗Stanford B型胸主动脉夹层的临床疗效。方法:对2015年1月至2016年12月收治的37例因Stanford B型胸主动脉夹层行覆膜支架腔内修复术患者的病历资料进行回顾性分析,其中男性29例,女性8例。术前诊断依据临床表现及CT血管造影(CTA),术中造影再次评估病变部位及解剖位置,切开股动脉,行覆膜内支架置入,封堵原发破口,手术成功后再次造影检查。结果:37例患者共置入支架37枚,全部获得成功。术中造影见少量内漏4例,3例经支架近端球囊扩张后内漏消失,1例无需特殊处理。患者临床症状均明显改善,降主动脉及腹主动脉真腔明显扩大。结论:采用覆膜支架腔内修复术治疗Stanford B型胸主动脉夹层安全、创伤小、恢复快,临床效果显著。     

胸主动脉钝性外伤的腔内修复治疗

目的 探讨腔内修复技术在治疗胸主动脉钝性外伤中的可行性和安全性.方法 回顾分析2010年2月至2013年12月期间7例胸主动脉钝性外伤患者的临床资料.术前CTA及术中造影评估病变,回顾术中技术成功率,死亡及截瘫等主要并发症的发生率.术后CTA随访明确有无内漏、支架移位等情况.结果 所有创伤都累及主动脉峡部,包括Stanford B型夹层1例、降主动脉假性动脉瘤6例.全部患者均接受覆膜支架腔内修复治疗,其中1例先行左-右锁骨下动脉转流术.术中6例部分或全部覆盖左锁骨下动脉开口.所有手术患者均获得技术成功,无死亡及截瘫发生.术后随访时间2～28个月,无左上肢缺血症状及神经系统并发症,支架无内漏及移位.结论 腔内修复治疗胸主动脉夹层安全、有效,可行性高.     

联合远端限制性支架腔内修复治疗Stanford B型主动脉夹层

目的：探讨联合远端限制性支架腔内修复治疗Stanford B型主动脉夹层的近期疗效.方法：回顾性分析2012年5月至2013年4月间,新疆医科大学第一附属医院,采用联合限制性支架治疗28例Stanford B型主动脉夹层患者的临床资料,分析远端限制性支架在stanford B型主动脉夹层主动脉腔内修复术（endovascular aortic repair,EVAR）术中的疗效.结果：远端限制性支架治疗Stanford B型主动脉夹层28例,其中男性25例,女性3例.年龄30～73岁,平均（49.80±12.71）岁.急性期治疗22例（均为急性复杂性夹层）,慢性期治疗6例.主体支架直径为30～36 mm,长度150 ～ 200 mm;限制性支架直径为24 ～ 28 mm,长度为60～ 80 mm,其中覆膜支架23例,大口径裸支架5例.技术成功率100％,术后即刻观察Ⅰ型内漏3例,无截瘫发生.术后随访3～ 14个月,平均7个月,3例有明确Ⅰ型内漏的患者,术后3个月随访主动脉CTA检查显示内漏消失,1例患者术后第11个月发现肾衰竭,5例患者左侧肢体发凉,2例患者头晕,无脑卒中、截瘫及死亡.结论：联合限制性支架治疗Stanford B型主动脉夹层术较传统腔内修复术近期疗效较好,远期疗效有待于进一步观察.     

国产覆膜血管内支架置入术治疗老年Stanford B型主动脉夹层的临床疗效观察

目的探讨国产覆膜血管内支架置入术对老年Stanford B型主动脉夹层治疗的临床疗效及安全性。方法对7例Stanford B型的老年主动脉夹层患者进行增强CT扫描或MRI检查明确诊断，并行主动脉造影，应用QCA血管定量分析软件进行测量，选取合适型号支架，置人大血管内封堵主动脉夹层原发破口，重复造影观察支架位置，检查有无内漏。术后1w及6个月行CT随访，观察内漏情况、支架移位和假腔变化。结果本组7例老年患者支架置入全部获得成功，成功率100％，无严重并发症及死亡病例。术后即刻造影：全部患者夹层近端破口封闭，恢复真腔血流，1例见少量近端内漏，1例累及左锁骨下动脉开口病例应用国产覆膜血管支架也成功完成手术，即封堵夹层破口同时也封堵了左锁骨下动脉开口，未行旁路移植，但也未出现相应部位缺血的表现。全部患者行CT随访，3例主动脉夹层消失，余者假腔内血栓形成。结论国产覆膜支架置入术治疗老年Stanford B型主动脉夹层安全可行，并具有创伤小、并发症少、治疗费用较低等优点，近期疗效满意。     

Stanford B型主动脉夹层局麻下支架植入32例治疗体会

目的 总结Stanford B型主动脉夹层局麻下支架植入的治疗经验。方法 回顾性分析2017-05～2019-05该院实施的32例B型主动脉夹层局麻下行胸主动脉覆膜支架腔内修复术(thoracic endovascular aortic repair,TEVAR)的病历资料,总结治疗经验。结果 32例均顺利完成手术。术中1例出现少量Ⅰ型内漏。无死亡病例,无重大心脑血管意外发生。随访6. 4～10. 5个月,1例术后6个月复查时发现远端支架膨出,再次植入支架1枚后治愈。结论 主动脉夹层经过术前的精心准备、评估、测量,可局麻下实行Stanford B型主动脉夹层的TEVAR治疗。通过改良腹股沟横切口或经皮穿刺代替纵切口,以及围手术期精心护理,可显著减少术中、术后并发症的发生。     

腔内隔绝术治疗112例Stanford B型主动脉夹层动脉瘤患者疗效观察

目的评价主动脉夹层腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期临床疗效。方法选择行主动脉腔内隔绝术治疗Stanford B型主动脉夹层患者112例。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后冠状动脉造影检查证实疗效,术后随访平均(39±18)个月。分析其临床特点及疗效。结果手术成功112例,共置入覆膜支架119枚。左锁骨下动脉完全被封闭8例,合并严重狭窄病变的冠心病患者完成PCI 16例,主动脉腔内隔绝术后综合征19例,术后1个月内夹层破裂死亡3例。随访3个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后明显残余内漏10例,3个月自行封闭。术后6个月,再发升主动脉夹层3例,其中行升主动脉外科手术1例,截瘫1例,胃癌多器官转移死亡1例。术后1年迟发性内漏1例。结论腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期疗效满意。     

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.