解磷注射液治疗有机磷农药中毒44例临床观察

1992年以来,我们以解磷注射液为主救治急性有机磷农药中毒病人44例,与42例以阿托品为主救治者比较,证实前者效果显著。1.一般资料:将86例口服有机磷农药急性中毒病人随机分两组,观察组44例以解磷注射液为主,同时伍用解磷定;对照组42例以阿托品为主,同时伍用解磷定。两组病人的服毒种类、服毒至就诊时间、中毒程度具有可比性。     

长托宁联合阿托品治疗急性有机磷中毒的疗效观察

目的探讨长托宁联合阿托品与单独应用长托宁或阿托品治疗重度急性有机磷中毒的疗效。方法将在我院住院治疗的98例重度急性有机磷中毒患者随机分为三组:阿托品治疗组33例,应用阿托品+氯解磷定治疗;长托宁治疗组33例,应用长托宁+氯解磷定治疗;联合治疗组32例,应用阿托品+长托宁+氯解磷定治疗。三组患者均给予相同的综合治疗。观察比较三组患者阿托品化时间、胆碱酯酶(恢复至正常值低限60%)的时间、中毒症状消失时间、平均住院天数及治疗总有效率。结果与长托宁治疗组和阿托品治疗组相比,联合治疗组阿托品化时间、胆碱酯酶恢复时间、中毒症状消失时间、平均住院天数明显缩短(P0.05),但三组间治疗总有效率差异无统计学意义。结论与单用阿托品或长托宁治疗比较,长托宁与阿托品联合应用治疗重度急性有机磷农药中毒患者,能缩短住院天数,减轻患者经济负担,值得临床推广应用。     

序贯消化道净化联合血液灌流治疗急性重度有机磷农药中毒疗效观察

目的 回顾性分析序贯消化道净化联合血液灌流治疗急性重度有机磷农药中毒的疗效.方法 从2009年1月～2011年12月收治的中毒病例中筛选64例急性有机磷农药重度中毒患者,分为实验组和对照组各32例.两组均采用电动洗胃机导泻、清洁局部皮肤、毛发,常规使用抗胆碱药阿托品、胆碱酯酶复能剂氯解磷定及并发症防治等措施.实验组在常规治疗的基础上进行持续胃灌洗、导泻,并联合床旁血液灌流治疗.观察两组患者胆碱酯酶恢复至50％以上所需时间、住院天数、阿托品总量、氯解磷定总量、中间综合征例数、多脏器功能衰竭例数、机械通气发生率及机械通气时间、治愈率.结果 实验组胆碱酯酶恢复至50％以上所需时间、住院天数明显缩短,阿托品总量和氯解磷定总量减少,中间综合征、多脏器功能衰竭例数明显减少,机械通气发生率明显减少,机械通气时间明显缩短,治愈率明显升高（P＜0.05）.结论 序贯消化道净化联合血液灌流治疗急性重度有机磷农药中毒疗效明显.     

苯克磷治疗急性有机磷农药中毒78例临床观察

急性有机磷农药中毒发病急、病情重、变化快，诊治不当可造成死亡。传统使用阿托品加解磷定治疗，因阿托品用量不易掌握，而影响抢救成功率。我们使用苯克磷治疗有机磷农药中毒78例，效果满意，现总结报告如下。     

呼吸机联合不同剂量阿托品与氯解磷定治疗重度有机磷农药中毒疗效的比较研究

目的比较重度有机磷农药中毒治疗中采用呼吸机联合不同剂量阿托品与氯解磷定的疗效。方法将收治的76例重度有机磷农药中毒患者,随机分为两组,其中观察组予以适量阿托品联合氯解磷定治疗,对照组予以最大剂量阿托品联合氯解磷定治疗,治疗后观察两组患者的治愈情况、生命体征以及治疗相关指标。结果与对照组比较,观察组的胆碱酯酶活力好转所需时间、血糖浓度水平稳定所需时间、APACHEⅡ评分、死亡率,以及生命体征如意识、体温、脉搏,阿托品用量、并发症发生率均降低明显,差异具有统计学意义(P0.05,P0.01),治愈率升高明显,差异具有统计学意义(P0.05)。结论在重度有机磷农药中毒患者中应用阿托品联合氯解磷定的基础上应用呼吸机机械通气,阿托品应适度、足量应用,可有效改善患者的生命体征及实验室指标,提高治愈率,降低死亡率,应避免大剂量应用。     

急性有机磷农药中毒阿托品用法及碘解磷定用量分析

目的　探讨急性有机磷农药中毒时 ,阿托品的含量用法及解磷定用量。方法　将患者分成轻中度中毒组、重度中毒组、中间综合征 (IMS)组 3组。将阿托品 5 0～ 2 0 0mg加入 5 0 0mL液体中静滴 ,根据病情用输液泵调整滴速。碘解磷定 2 0 g每 6h1次或每 8h1次静脉滴注 ,逐渐减量探讨。 结果　阿托品用量为 10～ 5 85 1mg,碘解磷定为 1～ 86g。用量 ,IMS组 >重度中毒组 >轻中度中毒组 (P <0 0 5 )。阿托品过量共有 4例。结论　持续性静脉滴注阿托品 ,解决了反复取药、反复抽注问题 ,且可防止阿托品用量不足。观察阿托品化指标 ,随时调整剂量 ,发生过量的机会很少。碘解磷定随病情加重 ,剂量应加大     

早期CRRT干预抢救重度有机磷农药中毒治疗体会

目的研究早期CRRT干预抢救重度有机磷农药中毒的疗效。方法 70例患者分为甲乙两组,其中甲组予CRRT,乙组给予常规阿托品+解磷定治疗,观察两组动脉血气变化、胆碱酯酶恢复正常所需时间、阿托品用量、MODS发生率、治愈率。结果与乙组相比,甲组治愈率明显提高,MODS发生率减少、胆碱酯酶恢复正常所需时间明显缩短、阿托品用量明显减少(P<0.01);结论在目前常规治疗的基础上,采用早期联合CRRT抢救急性重度有机磷农药中毒成功率更高,值得推广。     

长托宁治疗重度有机磷农药中毒的临床观察

目的观察长托宁治疗急性重度有机磷农药中毒的效果。方法将有机磷农药中毒患者46例随机分为长托宁治疗组和阿托品对照组，每组23例。治疗组使用长托宁和解磷定治疗，对照组使用阿托品和解磷定治疗。结果治疗组在用药次数、症状消失时间、治愈时间及治愈率方面均优于对照组（P〈0．05）。结论长托宁在治疗急性重度有机磷农药中毒中许多方面优于阿托品，可列为解毒的首选抗胆碱药物。     

盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒的疗效对比分析

目的 观察盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒的疗效.方法 选择47例急性有机磷农药中毒患者随机分为治疗组和对照组,治疗组予盐酸戊乙奎醚+氯磷定治疗;对照组予阿托品+氯磷定治疗.结果 治疗组与对照组相比,症状消失时间、住院时间、住院费用、不良反应发生率均显著降低(P<0.01),治愈率提高(P<0.01),给药次数、用药量显著地减少(P<0.001).结论 盐酸戊乙奎醚治疗有机磷农药中毒明显优于阿托品,值得临床推广应用.     

不同剂量的氯解磷定联合阿托品对急性敌敌畏中毒大鼠的治疗效果

目的:探讨不同剂量的氯解磷定联合阿托品对急性敌敌畏中毒大鼠模型的治疗效果。方法 :将204只健康雄性大鼠按照随机数字表法分为对照组(n=12)、染毒组(n=48)、治疗组(n=144)。对照组给予1 mL生理盐水一次性灌胃。染毒组和治疗组按照30 mg/kg敌敌畏一次性灌胃。治疗组在灌胃后立即腹腔注射阿托品15 mg/kg,同时加以30、45、60 mg/kg的氯解磷定腹腔注射。观察动物中毒表现和存活情况,分别于染毒后2、24、48和72 h处死大鼠,取血标本和肺组织。测定血清中乙酰胆碱酯酶(AChE)、丙二醛(MDA)、超氧化物歧化酶(SOD)的含量;苏木素-伊红(HE)染色观察肺组织病理变化。结果:与染毒组相比,治疗组大鼠翘尾、流涎、肌束震颤、翻正反射消失发生率明显降低,同时存活率增加,且差异具有统计学意义(均P<0.05);与染毒组相比,治疗组大鼠动脉血中AChE、SOD含量增加,MDA含量明显减少,高剂量的氯解磷定效果更明显(均P<0.05)。HE结果显示,氯解磷定治疗组大鼠肺组织损害减轻,炎细胞减少,且高剂量的氯解磷定效果更显著。结论:氯解磷定联合阿托品对急性敌敌畏中毒大鼠具有治疗作用,且高剂量的氯解磷定效果更加明显。     

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.