小儿先天性心脏病微创小切口治疗体会

目的 探讨胸骨下段小切口与右胸小切口两种微创术式在小儿常见先天性心脏病中的应用.方法 选取解放军105医院心血管外科2011年3月至2013年8月收治的先天性心脏病患儿63例,其中男性27例,女性36例.63例中采用胸骨下段小切口33例、右胸小切口30例;单纯房间隔缺损(ASD)22例,单纯室间隔缺损(VSD)25例,室间隔缺损合并动脉导管未闭(PDA)4例,室间隔缺损合并房间隔缺损10例,室间隔缺损合并肺动脉瓣狭窄(PS)2例.结果 所有患儿均顺利完成手术,无死亡,无低心排血量、肺部感染、切口感染等近期并发症.术后随访6个月至1年,无残余漏、Ⅲ度房室传导阻滞、胸廓畸形等远期并发症.结论 胸骨下段小切口与右胸小切口两种微创术式选择性应用于常见先天性心脏病,安全可靠、创伤小、切口美观,值得推广.     

胸骨下段切口在小儿先天性心脏病手术中的应用

目的 探讨胸骨下段切口在小儿先天性心脏病手术中的应用经验。方法 自2000年11月－2001年1月,39例小儿先天性心脏病患接受胸骨下段切口作为手术入路,年龄最小为11个月,最大为11岁,平均年龄4.2岁,切口长度为4－10cm,其中继发孔房间隔缺损4例,室间隔缺损34例,法乐氏四联症1例。结果 将本组病例与同期随机选择的30例通过胸骨正中切口进行室间隔缺损修补的病例进行比较,两组的手术时间、体外循环时间、主动脉阻断时间、再开胸止血发生率、伤口感染率及残余分流发生率等方面无统计学差异。结论 对于小儿先天性心脏病患,胸骨下段切口不失为一个良好、安全的入路选择。     

胸骨下段小切口治疗先天性心脏病20例(摘要)

胸骨下段小切口手术是近年来新兴的微创心脏外科手术方法。我们结合20例先天性心脏病(先心病)的治疗对这种手术方式进行报告。1　临床资料　　自1998年8月至1999年2月,经正中胸骨下段小切口进行心内直视手术20例,男11例,女9例,平均年龄25.5(16～50)岁,平均体重60.7(41.5～70)公斤。20例中房间隔缺损10例,其中合并二尖瓣关闭不全2例;单纯膜部室间隔缺损8例;干下型室间隔缺损1例;嵴下型室间隔缺损1例。　　手术方法:手术于低温体外循环下进行;患者仰卧位,皮肤切口自胸骨角下方3厘米至剑突;自下而上纵行劈开胸骨至胸骨角下方3厘米处并用摇摆锯(…     

胸骨下段小切口先心病矫治术18例分析

微创心脏手术由于手术创伤小、美观、有利于患者术后恢复而越来越为患者和医生所接受。 2 0 0 0年 9月～ 2 0 0 1年 2月 ,我院采用胸骨下段小切口行先天性心脏病矫治术 18例 ,效果满意。报告如下。临床资料 :本组 18例中 ,男 8例 ,女 10例 ;年龄 3～ 15岁 ;体重 14.5～ 42 kg。其中先天性室间隔缺损 13例 (单纯膜部 10例、干下型 2例、嵴下型 1例 ) ,先天性房间隔缺损 5例 ,均为继发孔型。所有患者术前均经查体、心脏超声、心电图及X线胸片检查明确诊断。手术方法 :手术均在全麻低温体外循环下进行。患者取仰卧位 ,皮肤切口上端起自胸骨角…     

胸骨下段小切口心内直视手术40例

目的介绍胸骨下段小切口心内直视手术体会。方法选择10岁以下房间隔缺损3例、室间隔缺损20例,纵劈胸骨上至第二肋间;10岁以上房间隔缺损5例、室间隔缺损3例、风湿性二尖瓣狭窄9例,纵劈胸骨上至第二肋间并向右侧横断。常规体外循环,胸正中小切口第三胸肋关节水平至剑突根部,完成心内直视手术。结果无手术死亡,平均主动脉阻断时间、体外循环时间、术后24h胸液量与对照组无明显差异。切口长度约为常规胸骨正中切口的60%。结论胸骨下段小切口可以顺利完成部分心内直视手术,美观且保留了胸廓的连续性,无胸骨前凸畸形。     

胸骨下段小切口心脏不停跳心内直视手术

目的评价胸骨下段小切口心脏不停跳心内直视手术的价值.方法2004年7月至2005年6月采用胸骨下段正中小切口、体外循环下心脏不停跳心内直视手术共25例,其中房间隔缺损10例,室间隔缺损13例,肺动脉瓣狭窄1例,法乐三联症1例.结果25例均治愈,无术后并发症,术后住院时间6～8 d.随访1～11个月,心功能恢复良好,无残余畸形.结论胸骨下段小切口心脏不停跳心内直视手术是一种安全、有效且创伤小的技术.     

倒"J"形胸骨下段小切口在小儿心内直视手术中的应用

目的探讨应用倒"J"形胸骨下段小切口行小儿心内直视手术的安全性和手术创伤情况.方法应用倒"J"形胸骨下段小切口,对小儿先天性心脏畸型患者行心内直视手术矫治.全组50例,年龄8个月至14岁.手术主要病种:ASD、VSD、VSD PDA、ASD PS、PS.与近年相同年龄组标准胸骨正中切口比较.结果①切口长度明显缩小.②小切口的上端未超过胸骨角,在某种程度上满足了患者的美容需求.③术后胸廓的稳定性较好,术后胸廓畸形的发生率和程度明显减轻.④应用小切口能较好完成房间隔缺损,膜部及干下型室间隔缺损,肺动脉瓣狭窄等手术;但部分心内手术结构的显露受到一定影响.结论只要手术适应证选择合适,应用倒"J"形胸骨下段小切口,并不影响手术安全性;可取得创伤小、术后胸廓畸形轻和较好的美容效果.     

右前胸小切口治疗先天性心脏病65例

目的总结应用右前胸小切口进行心内直视手术的治疗体会.方法1999年3月-2003年6月,我们采用右前胸小切口行心内直视下修补先天性房、室间隔缺损65例,其中房间隔缺损37例,室间隔缺损28例.结果所有患者无手术死亡及手术并发症.结论经右前胸小切口进行心内直视手术是一种安全可靠的微创手术,对一些简单的先天性心脏病有良好的手术和美容效果,但不适合比较复杂的心脏病手术.     

右胸前外侧小切口修补室间隔缺损

1998年 12月至 2 0 0 0年 10月 ,我们采用右胸前外侧小切口治疗先天性心脏病室间隔缺损患者 2 0例 ,收到良好效果 ,现报告如下。临床资料 :本组男 12例 ,女 8例 ;年龄 2～ 17岁 ,平均 6岁。因查体发现心脏杂音或存在不同程度的活动后心慌气短就诊。体格检查示胸骨左缘第三、四肋间可闻及 3～ 4级收缩期杂音 ,P2 亢进。心电图示正常 9例 ,左心室肥厚 6例 ,双室肥厚 5例。胸部 X线片示肺血流量增加 ,左或右心室增大。彩色多普勒超声检查均明确诊断为先天性心脏病室间隔缺损。2 0例患者均于中度低温体外循环下施行手术。患者在手术台上的位置…     

右腋下剖胸小儿心内直视术

目的 :探讨右侧剖胸小切口的手术要点及手术指征。　　方法 :本组 10 2例患者经右腋下小切口剖胸及体外循环下行小儿心内直视术 ,其中房间隔缺损 2 4例 ,室间隔缺损 6 8例 ,法乐四联症 5例 ,室间隔缺损合并房间隔缺损 3例 ,右心室双出口、Ebstein畸形各 1例。合并畸形 :左上腔静脉 4例 ,右心室双腔及动脉导管未闭各 1例。　　结果 :全组患者无死亡。　　结论 :切口的正确选择是术野良好显露的前提 ,主动脉插管是手术成功的关键。该切口适用于大部分常见先天性心脏病的矫治。     

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.