梗阻性黄疸对肝脏血流动力学的影响

目的探讨梗阻性黄疸对肝脏血流动力学的影响．方法采用彩色多普勒血流显象仪对２０例梗阻性黄疸患者的肝固有动脉和门静脉血流进行定量测量，并与２０例正常人进行对比分析．结果梗阻性黄疸患者肝固有动脉的峰值流速（ｃｍ／ｓ，９２±１５ｖｓ６９±１９，Ｐ＜００５）、血流量（ｍＬ／ｍｉｎ，７１４±３６３ｖｓ３０５±１２１，Ｐ＜００１）显著高于正常人；门静脉血管内径（ｃｍ，１２５±０２４ｖｓ１０４±０１９，Ｐ＜００１）及门脉充血指数（ｃｍ×ｓ，０１４１±００１３ｖｓ０１１９±００１３，Ｐ＜００１）明显高于正常人．但门静脉血流量及峰值流速则低于正常人．结论彩色多普勒血流显象仪探讨梗阻性黄疸时肝脏血流动力学改变的较理想非创伤性方法，根据其有效循环血容量的改变可初步判断梗阻性黄疸的预后     

经颈静脉途径肝内门体分流术的临床应用

１０２例经颈静脉途径肝内门体分流术（ＴＩＰＳＳ）的应用结果，主要探讨操作技术问题和影响食管静脉曲张出血疗效的因素。结果：９２例成功，８例失败，成功率为９２．２％。分流后，门脉压从术前３．９７±０．４４ｋＰａ降至２．３０±０．３４ｋＰａ。Ｄｏｐｐｌｅｒ超声显示：门脉主干血流速度，从术前１４．０±４．５ｃｍ／ｓ增至４６．５±１４．５ｃｍ／ｓ。８１例随访３～１８个月（平均８．５个月）．分流道狭窄６例、阻塞３例，再通成功５例。随访病例的首次通畅率为８８．９％，第二次处理后的通畅率为９５．１％。结论：ＴＩＰＳＳ创伤性较小，降低门脉压可靠，是治疗门脉高压症的优良方法，其远期疗效有待进一步观察。     

经颈静脉肝内门体分流术治疗28例肝硬化门脉高压近期及3年临床疗效评估

目的评估经颈静脉肝内门体分流术（ＴＩＰＳＳ）治疗肝硬化门脉高压的临床疗效。方法采用ＴＩＰＳＳ治疗肝硬化门脉高压,观察其近期疗效、合并症及３年随访结果。结果２５例门静脉建立有效分流,成功率８９３％,门静脉主干压由术前（４０６±０８６）ｋＰａ［（３０５３±６．４５）ｍｍＨｇ］降至（２３３±０．７９）ｋＰａ［（１７．５５±６．００）ｍｍＨｇ］,Ｐ＜００１。分流后食管静脉曲张基本消失率为３６％,减轻率为４０％。术后腹水减轻率为７６２％。脾脏缩小一半以上者６０％。术后２周内丙氨酸转氨酶升高大于２０Ｕ／Ｌ占５２％,总胆红素升高大于１７μｍｏｌ／Ｌ占４８％,并发症总发生率２８％。随访３年,复发出血３７５％,病死率３１３％。结论ＴＩＰＳＳ可迅速降低门静脉压力,近期疗效满意,中期疗效欠佳,术后并发症较多。     

门静脉高压患者门静脉压力与血流动力学的相关性研究

目的 探讨门静脉高压患者门静脉血流动力学的变化特点及其与门静脉压力的相互关系。方法 采用彩色多普勒超声对４１例肝硬化门静脉高压患者（Ｃｈｉｌｄ Ａ、Ｂ级３１例、Ｃ级１０例）于手术前检测门静脉（ＰＶ）、脾静脉（ＳＶ）和肠系膜上静脉（ＳＭＶ）的内径和血流速度，再计算出相关的面积和血流量；于手术时对３１例ＣｈｉｌｄＡ十Ｂ级患者直接测量门静脉压力。３２例健康人和２６例慢性乙型肝炎患者（慢肝组）作为对照。结累 门静脉高压两组患者ＰＶ、ＳＶ和ＳＭＶ内径（ｃｍ）分别为１．５１和１．５２、１．３２和１．３４及１．１５和１．１５较慢肝组和正常组明显增宽，ｒ分别为１．３１和１．１６、０．９６和０．７９及０．９１和０．８２（Ｐ＜０．０１）；血流速度较正常组和慢肝组明显减慢（Ｐ＜０．０１）；门静脉高压Ｃ级组门静脉血流速度（ｃｍ／ｓ）为４．６５较门静脉高压Ａ十Ｂ级组（６．４２）明显减慢（Ｐ＜０．０１），而两组 ＳＶ和 ＳＭＶ的血流速度则差异无显著意义（Ｐ＞０．０５）；门静脉高压 Ａ＋Ｂ级组三条静脉的血流量明显大于正常组和慢肝组（Ｐ＜０．０１或Ｐ＜０．０５）；门静脉高压Ｃ级组门静脉血流量明显小于Ａ十Ｂ级组（Ｐ＜０．０１）；而ＳＶ和ＳＭＶ的血流     

经颈内静脉肝内门体分流术治疗门脉高压症的临床研究

采用自制的内支撑行经颈内静脉肝内门体分流术（ＴＩＰＳＳ），对６０例Ｃｈｉｌｄ－ｐｕｇｈ平均评分为１０．０３±２．１４的门脉高压症患者进行治疗，ＴＩＰＳＳ成功率为９４．５％，并发症发生率为１８．２％，死亡率为５．５％；肝内门体分流建立后冠状静脉和食管曲张静脉消失，分流道建于肝右静脉与门静脉左支、右支和左、右支交叉分别为５５．８％、２６．９％和１７．３％；术后一周分流道血流速度为８３．４２±３１．５４ｃｍ／ｓ，术后１～１０月血流速度为８２．５５±３２．４４ｃｍ／ｓ．分流道呈内壁光滑的圆柱形结构；术后１～１０个月随访，出血复发１例，肝功能衰竭死亡１例。研究结果表明：ＴＩＰＳＳ是治疗晚期肝硬化伴食管静脉曲张出血的有效方法，肝硬化时门静脉系统解剖结构和病理生理改变有助于肝内门体分流的建立和分流道的通畅。     

食道曲张静脉套扎术对肝硬化患者门静脉血流动力学的影响

目的：了解食道曲张静脉套扎术（ＥＶＬ）后门静脉血流动力学改变与临床的关系。方法：采用彩色多普勒对２５例肝硬化患者内镜下ＥＶＬ前后的门静脉血流动力学改变进行测定。结果：ＥＶＬ治疗２周后肝硬化患者门静脉、脾静脉内径（ＰＤ、ＳＤ）、门静脉血流速度及血流量（ＰＶ、ＰＱ．ＳＱ）较治疗前明显增加（Ｐ值＜０．０１），脾静脉血流速度（ＳＶ）明显减慢（Ｐ值＜０．０１）。结论：ＥＶＬ能短时间升高门静脉压，部分地加重ＰＨＧ和ＬＦ。     

肝内型门静脉高压症大鼠内脏高动力循环状态

应用同位素标记的微球测定血流量和门－体分流的技术，检测ＣＣ１４肝硬化大鼠所致内脏和全身血液动力学变化。全部肝硬变大鼠都出现门静脉高压症（门静脉压力１．６５７±０．０６６，对照组１．２２３±０．０３６ｋＰａ；Ｐ＜０．００１）；门－体分流明显增高，但变异大（３５％±２５％，对照组０．３４±０．１６％；Ｐ＜０．０５），范围在３％～８２％间；门静脉血流量增加（７．３３±１．３，对照组６．２８±０．１８ｍＩ。ｍｉｎ－１·１００ｇＢＷ－１；Ｐ＜０．０５）；内脏血管阻力下降（０．６１±０．１４，对照组０．９±０．１９ｋＰａ·ｍ１－１·ｍｉｎ－１；Ｐ＜０．０１）；门静脉阻力未见明显增高（０．０７８±０．０１，对照１ｌｌ０．０７３±０．Ｏ０７ｋＰａ·ｍ１－１·ｍｉｎ－１；Ｐ＞０．０５）．肝硬变大鼠内脏血液动力学变化表明，门静脉高压症的维持，至少部分取决于高动力的门静脉循环，提供了肝内型门静脉高压症内脏循环高动力状态、门静脉血流量增加的定量资料。     

冠心病患者动态心电图检测过程中的Q－Tc变化

分析４３例冠心病患者与１７例非冠心病患者的２４小时Ｑ－Ｔｃ变异度（Ｑ－Ｔｃ）．发现冠心病患者与非冠心病患者的Ｑ－Ｔｃｍｉｎ分别为３８８±３８ｍｓ与３８６±３５ｍｓ（Ｐ＞０．０５）．Ｑ－Ｔｃ　ｍａｘ分别为４５８±４７ｍｓ与４２４±３０ｍｓ（Ｐ＜０．０１）．Ｑ－Ｔｃ分别为７０±４８ｍｓ与３８±３６．０ｍｓ（Ｐ＜０．０１）。单支、双支及三支血管病变Ｑ－Ｔｃ分别为５３±５２ｍｓ，７８±４９与９１±２９ｍｓ。     

经颈静脉肝内门体静脉分流术

目的：评价经颈静脉肝内门体静脉分流术对肝硬化门脉高压症的疗效及优缺点。方法：先行预造影，经颈静脉插管至肝静脉，在肝内从肝静脉向门静脉穿刺，穿刺成功后选择性行胃冠状静脉栓塞，然后行球囊导管扩张建立分流通道，放置支架。结果：共２５例病例，２１例成功，４例失败。门脉压力从术前４０２±０３９ｋｐａ降至术后２５８±０２３ｋｐａ（Ｐ＜００１），门脉主干由１３４±０２４ｃｍ降至１１４±０２１ｃｍ（Ｐ＜００５），门脉主干血流速度由术前２３０±６５ｃｍ／ｓ增至术后４５５±１２３ｃｍ／ｓ（Ｐ＜００５），脾脏长径由１５８５±１７９ｃｍ缩小为１３８５±１８０ｃｍ（Ｐ＜００５）。食管静脉曲张消失１４例，明显减轻７例，６例伴顽固性腹水者术后明显减少。术后随访３～１５个月（平均１０个月），随访期间５例发生肝性脑病，３例分流通道发生明显狭窄（内径缩小０３ｃｍ以上），再出血及再发顽固性腹水各一例。结论：ＴＩＰＳＳ对迅速缓解门脉高压症，解除出血危险性是一种比较好的方法，近期疗效满意。但术后肝性脑病和分流通道发生狭窄值得重视。     

L－精氨酸逆转一氧化氮抑制后的犬冠脉血流动力学改变和内皮素－1含量升高

观察了犬冠脉内灌注Ｎ－单甲基左旋精氨酸（Ｌ－ＮＭＭＡ）后再灌注Ｌ－精氨酸（Ｌ－Ａｒｇ）和单独灌注Ｌ－ＮＭＭＡ前后冠脉血流动力学、冠脉血流储备以及冠脉对不同浓度的乙酰胆碱（Ａｃｈ）反应的变化，同时用放免法测定冠脉前降支（ＬＡＤ）伴行静脉血中内皮素－１（ＥＴ－１）含量。结果发现，Ｌ－Ａｒｇ完全逆转了灌注Ｌ－ＮＭＭＡ引起的血流动力学改变，使心率回升，下降的基础冠脉流量（ＣＢＦ），从２０±８ｍｌ／ｍｉｎ回升至２８±７ｍｌ／ｍｉｎ，Ｐ＜０．０５），降低的冠脉储备恢复，从５１±１０ｍｌ／ｍｉｎ升至９４±１５ｍｌ／ｍｉｎ，Ｐ〈０．０１），ＥＴ－１的含量不再升高，从１５．５±３．０ｎｇ／Ｌ下降至５．０±２．０ｎｇ／Ｌ，Ｐ〈０．０１），Ａｃｈ介导的ＣＢＦ增加不再受到抑制（Ｐ〈０．０１）。结果提示提供外源性Ｌ－Ａｒｇ可增加一氧化氮（ＮＯ）的产生，使由于ＮＯ抑制而产生的血流动力学改变和ＥＴ－１升高发生逆转。     

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.