胶囊内镜诊断小肠淋巴管扩张症二例

小肠淋巴管扩张症(intestinal lymphangiectasia)是一种罕见的蛋白丢失性肠病,它以小肠淋巴液回流受阻、乳糜管扩张以及绒毛结构扭曲为特征,淋巴管的阻塞以及小肠淋巴压力的升高导致淋巴液漏出至小肠管腔,最终导致吸收不良和蛋白丢失。该病自1961年Waldmann等首次报道,目前国内报道少,主要通过手术、胃十二指肠镜或淋巴管造影     

老年小肠淋巴管扩张症合并药物性肝损伤1例报告

<正>小肠淋巴管扩张症(intestinal lymphangiectasia,IL)是由于原发或继发性因素影响正常淋巴循环,导致淋巴管异常扩张而引起的蛋白丢失性胃肠病。淋巴液漏入肠腔或腹腔,淋巴液中含有的清蛋白、乳糜微粒、淋巴细胞等物质随之丢失,从而引起一系列临床症状,如水肿、低蛋白血症、多浆膜腔积液等[1]。现对本院诊治的IL病例进行介绍。1病例资料患者女性,70岁,因"发现双下肢水肿2年,加重4个月"于2018年11月29日入本院。患者2年前无明显诱因出现双下     

原发性小肠淋巴管扩张症

原发性小肠淋巴管扩张症(primary intestinal lymphangiectasis,PIL)是一种以肠腔内黏膜下淋巴系统扩张,淋巴液向肠腔渗漏为特征的罕见疾病[1],属于蛋白丢失性肠病的一种.临床上以低蛋白血症、腹泻、低淋巴细胞血症为主要表现[2],其中低蛋白血症是其最具特征性的表现.     

小肠淋巴管扩张症

0引言小肠淋巴管扩张症是一种蛋白丢失性疾病,其特征是:低蛋白血症,非对称性水肿,浆膜腔积液,及淋巴细胞绝对数减少.由Waldmann1961年首次报道.1病因和发病机制小肠淋巴管扩张症根据病因可分为原发性和继发性,原发性小肠淋巴管扩张症病因不明,常由先天淋巴管发育不良所致,近年认为与免疫因素有关[1].自身免疫性疾病、肿瘤、感染(结核、丝虫病等)、肝硬化门静脉高压、缩窄性心包炎、Whipple病、腹外伤或手术损伤等使淋巴管狭窄,受压或回流不畅,可造成继发性小肠淋巴管扩张症[2-6].肠淋巴管分布于黏膜固有层、黏膜下层和浆膜层,主要经胸导管…     

颇得斯安治疗小肠淋巴管扩张症1例报道

小肠淋巴管扩张症是一种临床罕见疾病,以小肠黏膜及黏膜下毛细淋巴管扩张为特征。目前临床多以饮食治疗为主,药物治疗有限且疗效欠佳。颇得斯安为小肠释放型美沙拉嗪制剂,主要用于治疗小肠非特异性炎症。本文报道1例小肠淋巴管扩张症患者利用颇得斯安治疗的案例,为临床治疗小肠淋巴管扩张症提供新的治疗方案和临床依据。     

淋巴管静脉吻合后Crohn病肠道蛋白漏失减轻

肠道蛋白丢失是炎症性肠病的并发症,蛋白丢失与肠道病变的程度有关而且是非选择性,很少需要经静脉补充蛋白质.原发性小肠淋巴管扩张症或缩窄性心包炎     

问题解答

问(徐鸿达):乳糜腹水、乳糜尿、淋巴腹水、淋巴尿的发生机制是什么?常见于哪些病? 答(刘士怡):人体腹膜后有丰富的淋巴管、干、结,分布在大血管周围,分为若干组:如髂淋巴组,主动脉前、旁淋巴组,等等。最后,它们和来自肾脏的淋巴管、干汇合成左右各一条(或二、三条)的淋巴管,称为左、右腰干。由小肠来的淋巴管,干,最后形成一至四条淋巴管称为肠干。左右腰干和肠干,有的互相合并后,有的只单独的进入乳糜池。乳糜池向上行走,经胸腔称为胸导管。胸导管上行至颈部进入左侧(极少数也至右侧)锁骨下静脉内。淋巴管内有无色透明的淋巴液流通。但小肠的淋巴管内是乳白色的乳糜液,即肠管内已消化吸收的脂肪及一部分蛋白质。正常的淋巴液或乳糜液在管内流     

蛋白丢失性肠病-小肠淋巴管扩张症1例报道

蛋白质从肠道丢失情况较为常见,但在临床工作中诊断为蛋白丢失性肠病(protein losing enteropathy,PLE)的病例却非常少见,本文通过分析1例PLE-小肠淋巴管扩张症的诊治过程,加深对该病的认识。     

小肠淋巴管扩张症的诊断与治疗

目的提高对小肠淋巴管扩张症(IL)的诊治水平。方法回顾性分析我院近20年收治12例IL患者的临床、实验室、影像和病理资料。结果男7例,女5例,平均年龄40.2岁。患者以腹泻、浮肿、浆膜腔积液为主要表现。其实验室检查以淋巴细胞减少,白、球蛋白减少为主要表现。内镜主要表现为小肠黏膜弥漫性分布小白点、小息肉样改变,其它如消化道造影、淋巴管造影均有一定阳性表现。所有患者的内镜下小肠黏膜活检病理均提示不同部位的小肠淋巴管扩张。治疗上以对症支持、低脂、中链脂肪酸饮食为主。部分继发性IL通过根治原发病,或针对病变部位进行局部手术切除病变肠段,或淋巴管、静脉吻合术等使病情得到缓解。结论对于浮肿、腹泻、腹腔积液的患者,同时有明显的低蛋白血症、低淋巴细胞血症,应高度怀疑IL,若活检证实淋巴管扩张,则可诊断淋巴管扩张。治疗可给予对症支持、低脂、MCT饮食,有部分患者可尝试进行手术治疗。     

原发性小肠淋巴管扩张症一例

原发性小肠淋巴管扩张症一例张顺财，王吉，刘厚钰，朱无难原发性小肠淋巴管扩张症（ＰＩＬ）是一种罕见的疾病，国内尚未见报告。患者女，４３岁。因反复上腹部不适４年伴黑便一个月而入院。体格检查发现，严重贫血貌、少量腹水及下肢浮肿。胃镜未见消化性溃疡；结肠镜发...     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

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.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

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.     

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.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.