乙型肝炎后肝硬化门静脉高压性胃病的内镜分级

肝硬化门静脉高压性胃病(portal hypertensive gastropa-thy PHG)是门静脉高压症患者上消化道出血的重要原因。PHG分级与患者的治疗和预后有密切的关系,国外有关PHG分级的研究主要以酒精性肝硬化为对象,这与我国的情况显然不同。对于以肝炎后肝硬化为病因的PHG分级的研究,目前国内尚缺乏细致、系统的调查分析。     

肝硬化门静脉高压性胃病的发病机制及抗酸剂的治疗应用

肝硬化门静脉高压性胃病(PHG)的发病率高,并发上消化道出血的风险大。胃黏膜损伤是其主要的病理改变,抗酸剂在肝硬化PHG中的应用研究较少且存在争议。对PHG的影响因素、胃黏膜损伤机制及抗酸剂的应用进行了概括。认为治疗PHG过程中,在降低门静脉压力的同时使用质子泵抑制剂等抑酸药物可提高PHG的治愈率。但不同抑酸药物干预肝硬化PHG的疗效及安全性进行客观评价仍需通过前瞻性、大样本、随机对照试验进一步证实。     

门静脉高压性胃病与幽门螺杆菌感染血清一氧化氮内皮素水平关系的探讨

目的　探讨门静脉高压性胃病 (PHG)与食管静脉曲张分度、肝硬化病因、幽门螺杆菌 (H·pylori)感染、门静脉主干与脾静脉宽度、血清一氧化氮 (NO)、内皮素 (ET)水平关系。方法　对住院确诊的 137例肝硬化患者进行胃镜和彩色B超检查 ,同时检测患者血清NO、ET水平。结果　PHG的发生率为 35 6 % ,PHG患者血清NO、ET显著高于无PHG肝硬化患者 (P <0 0 1) ,PHG的发生率及其严重程度与食管静脉曲张程度、门静脉主干和脾静脉内径成正比。在ChildA、B、C级肝功能之间、不同病因肝硬化之间、是否感染H·pylori之间PHG的发生率差异均无显著意义 (P >0 0 5 )。结论　PHG的发生与肝硬化病因、肝功能和H·pylori感染关系不明显 ;NO、ET参与了门脉高压形成与PHG的发生与发展的机制。     

肝硬化并发门脉高压性胃病患者的门静脉及胃粘膜的血液动力学

本研究旨在调查肝硬化伴与不伴门脉高压性胃病(PHG)时患者的门静脉血液动力学及胃粘膜灌注情况。 病例及方法:56例无食管-胃静脉曲张治疗史、胃部手术史、肝脏肿瘤、经皮经肝门静脉造影禁忌证而有食管静脉曲张的门脉高压患者,在多普勒超声检测门静脉干切面面积及门静脉血流速度、计算充血指数(两者之比)以之反映     

门静脉高压性胃病胃粘膜细胞间粘附因子-1及其与幽门螺杆菌感染的关系

探讨门静脉高压性胃病（portalhy-pertensivegastropathy,PHG）的形成机理,对PHG患者胃粘膜组织中细胞;司粘附因子－1（ICAM－1）进行了研究,探讨了其与幽门螺杆菌（HP）感染的关系。1.资料与方法：（1）门静脉高压组：68例门静脉高压患者,男性41例,女性27例,平均年龄46.8岁。均为肝炎后肝硬化患者。门静脉高压的诊断以胃镜下见到胃食管静脉曲张,结合B超、螺旋CT发现门静脉扩张为依据。肝炎后肝硬化诊断以病史及血清学检查,以及影像学资料,部分患者行肝穿刺检查明确诊断。（2）对照组：35例无肝病史的非溃疡性消化不良患者…     

门脉高压性胃病发病机制的研究进展

门脉高压性胃病(PHG)是门静脉高压症伴发的一种特殊类型的胃黏膜病变,是肝硬化常见并发症之一.PHG临床上多表现为上消化道出血,在肝硬化患者上消化道出血的病因中,PHG仅次于食管胃底静脉曲张,故越来越受到重视.目前PHG的发病机制尚未完全明确,此文就近年来PHG发病机制的研究进展作一综述.     

肝炎后肝硬化门脉高压性肝病相关因素的临床研究

为探讨肝炎后肝硬化门脉高压性胃病(PHG)形成的相关因素,对68例肝炎后肝硬化门脉高压患者按胃镜下有无PHG分组对照研究,比较两组患者性别、年龄、实验室检查、B超及胃镜检查资料。发现两组的肝功能分级、门静脉内径、食管静脉曲张程度差异有显著性(P<0.05),而与性别、年龄、血氨水平及脾静脉内径无相关性(P>0.05)。PHG组幽门螺杆菌(Hp)感染率较对照组低(P<0.05)。     

肝癌患者门静脉高压性胃病的胃镜表现及相关影响因素分析

[目的]分析肝癌患者门静脉高压性胃病(portal hypertension gastopathy, PHG)的胃镜表现及相关影响因素。[方法]入选行胃镜检查的肝癌患者191例,观察其胃镜下表现及分析相关影响因素。[结果]191例肝癌患者,镜下表现为门静脉高压性胃病(PHG)137例(71.7%),其中轻症74例(54.0%),重症63例(46.0%);无PHG54例(28.3%)。PHG组患者消化道出血症状、食管胃静脉曲张、有食管胃静脉曲张术史、合并肝硬化、肝性脑病、自发性细菌性腹膜炎、中-大量腹水以及门静脉血栓形成的比例均高于无PHG组,PHG组患者肝功能Child-Pugh分级以B、C级为主,门静脉内径大于无PHG组,而血红蛋白、血小板、白蛋白低于非PHG组,ALT、AST、胆红素及PT则高于无PHG组(均P<0.05或0.01)。PHG严重程度随着食管胃静脉曲张和肝功能分级的增加而加重,消化道出血比例随之增加。[结论]肝癌患者易合并PHG引起消化道出血,食管胃静脉曲张程度和肝功能是主要影响因素,随着肝癌患者生存期延长,PHG应得到消化科足够重视。     

肝硬化患者胃黏膜表皮生长因子的研究

肝硬化患者常常并发门静脉高压性胃病（PHG）和肝源性溃疡（HU），但有关PHG及HU的发病机制，目前尚不十分清楚。表皮生长因子（EGF）是胃黏膜重要的保护因子，对其在肝硬化患者胃黏膜的含量以及与PHG、HU的关系研究，目前报道甚少。故我们对60例肝硬化患者胃黏膜EGF含量进行了检测，现报告如下。     

门脉高压性胃病研究进展

门脉高压性胃病（portal hypertensive gastropathy,PHG）是各种原因引起门静脉高压导致的胃黏膜非炎性病变,常见于肝硬化门脉高压症,可并发消化道出血,是肝脏疾病中除食管胃底静脉曲张引起消化道出血的第二大原因,严重者可危及生命。近年来,国内外对有关PHG的发病机制、诊断和治疗进行了相关研究,本文对研究进展进行了综述。     

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.