超细胃镜下Introducer法经皮内镜胃造瘘术1例临床分析

目的探讨超细胃镜引导下Introducer法经皮内镜胃造瘘术(PEG)的临床应用价值。方法 2011年8月11日采用超细胃镜引导下Introducer法PEG治疗1例食管癌患者。结果手术成功,术后无造瘘管周围皮下感染、出血、瘘管滑脱及堵塞等并发症,患者营养迅速恢复,减少静脉补液。结论 Introducer法PEG是肠内营养的一种新的治疗方法,安全、有效、降低医疗费用、并发症少。     

Introducer法经皮内镜胃造瘘术10例报告

目的探讨经皮内镜下胃造瘘术（PEG）的临床应用价值。方法采用Introducer法PEG治疗10例食管癌患者。结果手术成功,术后无造瘘管周围皮下感染、出血、瘘管滑脱及堵塞等并发症,患者营养迅速恢复,减少静脉补液。结论 PEG是肠内营养的一种新的治疗方法,安全、有效、降低医疗费用、并发症少。     

经皮内镜下胃造瘘空肠置管术在高位肠外瘘患者中的临床应用

目的探讨经皮内镜下胃造瘘空肠置管术治疗高位肠外瘘患者的方法、并发症及疗效。方法回顾性分析经皮内镜下胃造瘘空肠置管术治疗我院24例高位肠外瘘患者的手术操作时间、成功率、并发症、导管留置时间及肠瘘治愈率。结果所有患者均置管成功,成功率为100%,平均置管时间为(16.5±3.8)min,无置管相关并发症;置管后并发症发生率为12.5%(3/24):2例营养管堵塞,1例造瘘管周围感染,平均导管留置时间(83.7±46.2)d。18例患者肠瘘愈合,治愈率为75%(18/24),5例肠瘘未愈行外科手术治疗,1例因原发病死亡。结论经皮内镜下胃造瘘空肠置管术具有操作简单易行、安全,住院时间短,空肠营养管越过肠瘘给予肠内营养等优点,可用于高位肠外瘘患者的临床治疗。     

Introducer法经皮胃镜下胃造瘘术的临床应用

经皮内镜下胃造瘘术（percutaneous endoscopic gastrostomy,PEG）是一种通过胃镜介导放置胃造瘘管进行肠内营养且无需外科手术及全身麻醉的胃造瘘术。利用PEG进行胃造瘘管饲营养,是解决不能经口进食而胃肠功能良好患者营养问题的一种有效的肠内营养方法。我院2008年8月至2009年9月对9例具有适应证的患者采用Introducer法行PEG,取得了较好的临床效果,现报道如下。     

经皮内镜胃空肠造瘘术Introducer法的现状与展望

经皮内镜下胃/空肠造瘘术(PEG/PEJ)是目前用于胃肠内营养的有效新方法之一,其操作方法Introducer法较其他方法操作更简便、并发症更少、适应症更广泛.本文就Introducer法的操作技术、优势、适应症、并发症等作一简要综述.     

内镜下胃空肠造瘘联合胆道外引流治疗恶性胆道梗阻

目的观察经皮内镜下胃空肠造瘘术联合经皮肝穿刺胆管引流术治疗恶性胆道梗阻的效果，探讨其临床意义。方法9例恶性胆道梗阻患者，均经其他方法治疗未能解除胆道梗阻。按常规方法先行经皮经肝穿刺胆管外引流术（PTCD），1周后采用牵拉法完成经皮内镜下胃造瘘术（PEG）及经皮内镜下空肠造瘘术（PEJ）。在腹壁外将胃空肠造瘘管与PTCD引流管相连，经空肠造瘘管将外引流出的胆汁回输入空肠。观察所有患者胆汁引流情况、联合治疗前后临床表现、并发症等。结果9例患者手术全部成功，PEG／PEJ用时20～40min，平均35min。所有患者胆汁引流管通畅，黄疸明显消退，腹胀、腹痛、腹泻等减轻，进食改善，肝功能明显好转（P〈0．01），未见有严重并发症。结论PEG／PEJ和PTCD联合应用是完全性恶性胆道梗阻的一种新的治疗选择，安全有效。     

经皮内镜胃造瘘和小肠造瘘术的临床应用

目的 探讨经皮内镜胃造瘘术(PEG)和经皮内镜小肠造瘘术(PEJ)的临床应用价值。方法 1996—06／2002—08 PEG和PEJ共治疗24例病人，其中13例行PEG胃肠营养；11例行PEG胃肠减压加PEJ小肠内营养。结果 21例共行PEG、PEG加PEJ28例次，其中PEG17例次(4例行造瘘管置换)、PEG加PEJ11例次，手术成功率100％。2／28例次出现造瘘管周围皮下感染。所有患者造瘘管置入后营养迅速恢复，停止静脉补液。24例病人随访1～48个月无严重并发症发生。结论PEG和PEJ是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法，具有安全、有效、降低医疗费用和并发症少等优点。     

内镜下经皮胃造瘘术的并发症及防治进展

自从1980年第一次报告经内镜下经皮胃造瘘术(percutaneous endoscopic gastrostomy,PEG)以来[1],现已日益较广泛地应用于临床.方法有Pull (Ponsky)、Push(Sachs-Vine)、Introducer(Russell)及Versa(t-fastener)等.目前最常用的是Pull (Ponsky)即提拉式,被认为是比较安全和有效的方法.PEG是一种有创操作,在操作中及操作后都会有并发症出现,而且使用的镇静药物本身就可能加重患者的病情,有1％ ～2％的患者的死亡与操作相关[2].关于并发症的报道显示,因为所选病人以及医疗技术的差异,并发症的发生率有很大差异.总体样本研究显示,PEG的主要轻微并发症率为13％,严重并发症率为8％[3].     

胃壁固定术为基础的内镜下胃造瘘术

目的以胃壁固定术为基础,通过扩大胃造瘘口,直接置入更大尺寸胃造瘘管。方法采用多中心前瞻性研究,选择有PEG指征的50例患者,分为A、B两组,A组25例采用胃壁固定术及胃造瘘穿刺针穿刺造瘘口,通过血管钳扩大胃造瘘口,置入18 Fr胃造瘘管;B组25例采用24 Fr的带针胸管作造瘘口穿刺,置入18 Fr胃造瘘管。比较两组患者术中及术后并发症、胃造瘘操作时间、患者术前1 d与术后第14天的营养指标等。结果两组患者术中及术后均无并发症发生;B组操作时间更短,差异有统计学意义(P0.05);两组术后第14天营养指标均有改善,与术前比较差异有统计学意义(P0.05);术后营养指标两组间比较,差异无统计学意义(P0.05)。结论以胃壁固定术作为胃造瘘术的基础,可根据患者实际需要置入不同尺寸的胃造瘘管,患者及其家属经胃造瘘管输注营养物的依从性得以提高,有利于患者的康复。     

经皮内镜下胃造瘘术

１９９４年９月～１９９５年２月共行经皮内镜下胃造瘘术３７例，全部成功，平均手术时间为１５分钟，仅６例出现局部皮肤炎症反应，无任何严重并发症。结果表明：经皮内镜下胃造瘘术安全、便捷、有效，为患者提供了一个不需剖腹手术安放胃造瘘管的新方法，颇具推广价值。本文也对操作经验及注意事项进行了总结。     

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.