经胸骨下段正中小切口行心脏瓣膜手术

目的：探讨经胸骨下段正中小切口行各种心脏瓣膜手术的适应证和手术方法。 方法：３０例患者平均年龄４２．２±１０．１（１７～５８）岁。皮切口自第３胸肋关节水平至剑突根部,平均长度１１（９～１３）ｃｍ,自下而上纵行劈开胸骨至第２肋间处向右侧横断。手术于常规体外循环下进行,包括二尖瓣置换１９例,主动脉瓣置换３例,主动脉瓣及二尖瓣双瓣置换６例,二尖瓣Ｃａｒｐｅｎｔｉｅｒ环成形２例。７例同时行三尖瓣ＤｅＶｅｇａ环缩术。４例同时行左心房血栓清除。 结果：无手术死亡及并发症。平均主动脉阻断、体外循环和手术时间分别为５４．５±２４．９分、７９．２±２８．７分和１６０．９±４４．３分,术后呼吸机辅助１０．７±４．２小时,住院时间 １４．４±４．９天。术后胸液量２８２±１２５（５０～６３０）ｍｌ,有１６例患者（５３．３％）未输血。 结论：经胸骨下段正中小切口行心脏瓣膜手术安全可靠,美观,创伤小,出血少,保留了胸廓的连续性,早期结果满意。     

主动脉瓣下狭窄合并心室间隔缺损、心房间隔缺损及主动脉瓣关闭不全手术治疗一例

１　临床资料　　患者女,３７岁。发现心脏杂音３０年,活动后心悸、气促、心前区疼痛５年。胸骨左缘第３、４肋间闻及Ⅱ／６收缩期喷射性杂音伴震颤,主动脉瓣区闻及Ⅱ／６舒张期哈气样杂音。Ｘ线胸片示左心室扩大,升主动脉扩张（图１、２）。超声心动图示膜部０．６ｃｍ心室间隔缺损及主动脉瓣关闭不全。２　结果　　１９９８年１２月１４日在低温体外循环下手术。经增宽的升主动脉切口见病变的主动脉瓣叶关闭不拢,瓣下０．６ｃｍ处一纤维隔膜样狭窄环,环孔１．０ｃｍ。右心房切口见１．０ｃｍ×０．８ｃｍ心房间隔缺损、０．６ｃｍ×…     

二尖瓣狭窄闭式扩张术后的瓣膜替换术

目的：介绍二尖瓣闭式扩张术后的瓣膜替换术经验。方法：我院自１９７７年１１月至１９９３年１２月期间共行二尖瓣闭式扩张术后瓣膜替换术２２９例（男１４８例，女８１例）。瓣膜替换时平均年龄４３．９５±６．６０岁。其中急诊手术５例，择期手术２２４例，两次手术间隔为１２．９６±６．７９年。均在低温体外循环下手术，其中二尖瓣替换术２０８例（９０．８３％）；二尖瓣及主动脉瓣双瓣替换术２１例（９．１７％）。结果：总手术死亡率７．４２％，１９８７年前死亡率为２３．６８％，而近３年死亡率仅０．８８％（１／１１３）。结论：掌握好手术时机；注重心肌保护；避免广泛游离心包粘连；采用右房、房间隔切口显露二尖瓣，连续缝合法替换二尖瓣，使手术时间缩短；以及正确的术后处理等，均是降低死亡率的重要因素。     

内窥镜下心房间隔修补术

２０００年５月～７月我科采用股动、静脉体外循环，右侧胸壁打孔，电视胸腔镜下行房间隔缺损（房缺）修补术４例，现报道如下。１对象和方法 对象全组４（男２、女２）例，年龄１６～２５（平均１９．５）岁，体重４７～６５（平均 ５６．５）ｋｇ。全组均为先天性心脏病房缺，其中混合型２例，中央型１例，上腔型１例。房缺大小２．８～３．２（平均３．１）ｃｍ。 方法静脉复合麻醉，双腔气管插管，左肺单肺通气。股动、静脉插管。于右腋中线第７肋间做第１切口，长１．０ｃｍ，分离助间肌肉，入电视胸腔镜；于右锁骨中线第４肋间做第２…     

二尖瓣狭窄合并左心房血栓患者小剂量华法令抗凝溶栓作用评价

我们对３１例具有适宜于二尖瓣球囊扩张（ＰＢＭＶ）的瓣膜条件但又合并左心房血栓的患者进行了小剂量华法令（２ｍｇ／ｄ）抗凝治疗观察。所有左心房血栓均由经食道超声心动图证实和随访，体积最大者３ｃｍ×４ｃｍ×６ｃｍ，最小者１ｃｍ×１ｃｍ×０．５ｃｍ，随访期间定期复查超声心动图、凝血酶原时间（ＰＴ）和凝血酶原活动度（ＰＴＡ）。结果显示：除了３例患者失访外，其余２８例均随访到血栓消失，血栓消失的时间在２～１２个月之间，８５．７％（２４／２８）的患者血栓消失的时间是６个月以内；ＰＴ较服药前部分延长，ＰＴＡ轻度下降，无出血并发症和过度抗凝征象；对这些患者在血栓消失后成功地进行了ＰＢＭＶ。结果表明对于二尖瓣狭窄合并左心房血栓患者，小剂量华法令的抗凝溶栓作用安全可靠，药物服用时间以６个月为宜。     

青少年心脏瓣膜退行性变

目的：青少年心脏瓣膜退行性变是一种独特的疾病。研究它的发病机制、临床特点和病理变化有重要意义。方法：１９８３年１月至１９９３年１２月，对５３５例心脏瓣膜病患者行心脏瓣膜替换术。结果：２３例１９岁以下患者经手术和病理证实为瓣膜粘液样退行性变，占同期瓣膜替换手术病例的４．２９％。结论：青少年心脏瓣膜退行性变是一组临床特点鲜明、病理改变独特的疾病，其发病机制尚不明确，心脏胶原纤维代谢异常可能是原发缺陷。手术治疗方法仍在探索     

胃嗜酸性肉芽肿并溃疡7 例报告

１９９２ 年 ６ 月～１９９７ 年 ５ 月, 我们施行胃切除术６２３ 例, 其中７ 例确诊为胃嗜酸性肉芽肿, 均经病理证实。现报告如下。临床资料： 本组男４ 例, 女３ 例; 年龄３４～６７ 岁,平均５４５ 岁; 病史５～１３ 年, 平均７５ 年。７ 例均有上腹痛, 有规律２ 例, 无规律５ 例, 药物治疗效果均不佳。并发幽门梗阻４ 例; 有出血史６ 例, 其中１ 例急性大出血而急症手术;末梢血中嗜酸性粒细胞增多４ 例,其中１ 例高达２８％ ; 有过敏史３ 例。术前５ 例做上消化道钡透检查, 均发现胃窦部巨大溃疡, 形态规则, 无粘膜中断现象, 溃疡深, 周围胃壁蠕动正常; ３ 例诊断胃癌, ２ 例诊为胃溃疡恶变。经胃镜检查２ 例, １ 例发现为胃体部后壁２ｃｍ ×４ｃｍ ×２ｃｍ 息肉, 基底宽, 表面有０５ｃｍ ×０５ｃｍ 浅溃疡,诊断为胃恶性息肉;另１ 例胃窦体交界处有 ３ｃｍ ×２ｃｍ 溃疡, 溃疡深大, 基底平坦,胃粘膜纹理走行正常, 无环堤样高起, 诊断为胃溃疡可疑癌变。以上７ 例均取病理确诊为本病。术中所见： ６ 例发现胃窦部溃疡形肿物 （４ｃｍ ×３ｃｍ ×２ｃｍ ～８ｃｍ ×６ｃｍ ×５ｃｍ ）, 中心溃疡 ２５ｃｍ ～５２ｃｍ 。质硬、韧性, 侵出浆膜层致     

经尿道气化电切治疗浅表膀胱肿瘤16例报告

１９９７年以来,我们采用经尿道气化电切治疗浅表膀胱肿瘤１６例患者,获满意疗效,现报告如下。临床资料：本组男９例,女７例;年龄４６～７９岁,平均６２．５岁。肿瘤单发１０例,多发６例。肿瘤数目２６个,其中＜１ｃｍ１０个,１～２ｃｍ１４个,２～３ｃｍ２个。...     

第37例：肺部结节影,贫血,发热

第３７例：肺部结节影、贫血、发热卫生部北京医院内科病理科病历摘要患者男，７９岁。因发现右肺结节影半个月于１９９４年７月１日入院。患者于入院前半个月因行走时感气短、胸闷来我院就诊。Ｘ线胸片示右下肺结节影。胸部ＣＴ示右肺中叶结节影，约１．３ｃｍ×１．６ｃ...     

下唇交叉组织瓣修复上唇缺损6例报告

１９９７年６月～１９９９年１０月，我院采用下唇交叉组织瓣修复上后部分缺损６例，收到良好效果。现报告如下。 临床资料：本组６例中，男５例．女１例；年龄２１～５８岁。其中外伤性上唇缺损５例，上唇一侧血管瘤１例。缺损面积２ｃｍ× ２．５ｃｍ～３ｃｍ × ３．５ｃｍ。 手术方法：常规术区消毒，局部浸润麻醉。急症手术应先将伤口周围挫伤较重、失去活力的组织剪除，彻底止血。根据缺损情况将边缘修整成“Ｖ”形或方形创口，测量上唇组织的高度和宽度，自下唇设计一个以唇红为蒂的三角形或方形唇组织田，其高度等于缺损的高度，底…     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.     

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.