核磁共振胆胰管造影32例临床效果观察

核磁共振胆胰管造影 (MRCP)能够直接显示胆胰管树状结构 ,为临床诊断、治疗提供帮助。1 998年 7～ 1 2月 ,我们对 32例胆胰疾病患者行 MRCP,并与逆行胆胰管造影 (ERCP)进行对照。现报告如下。1　资料与方法1 .1　一般资料　MRCP组共 32例 ,男 2 1例 ,女 1 1例 ;年龄 2 7～ 77岁 ,平均 6 8岁。其中胆总管结石 8例 ,胆总管下端炎性狭窄 1例 ,胆总管囊肿 1例 ,胆源性胰腺炎 3例 ,胰头癌 9例 ,十二指肠壶腹部癌 4例 ,胆管癌 5例和胆管癌行胰十二指肠切除术后胆 -肠吻合口狭窄1例。检查前除禁食外无特殊准备 ,检查后无特殊处理。ERCP组共…     

内镜下逆行胰胆管造影诊治老年人胆胰疾病82例

内镜下逆行胰胆管造影 (ERCP)是一种先进的无创或微创的胆胰疾病诊治方法〔1〕。ERCP结合十二指肠乳头切开取石术(EST)及鼻胆管引流术 (ENBD)特别适合于不能耐受手术治疗的老年胆胰疾病患者 ,而目前有关老年患者方面的报道尚不多见。1　临床资料1 1　一般资料　我院自 2 0 0 0年 8月对 82例胰胆管疾病的老年患者行ERCP ,并作EST、ENBD等治疗 ,其中男 49例 ,女 3 3例 ,年龄 60～ 85岁 ,平均 72岁。病程最短 1w ,最长 10余年。82例中有胆总管结石 3 3例 ,胆囊切除术后胆总管结石 13例 ,原因不明的梗阻性黄疸 2 4例 ,胆总管扩张 4例…     

ERCP和MRCP对胆管微小结石诊治价值比较

目的 评价经内镜逆行胰胆管造影(ERCP)和磁共振胆胰管成像(MRCP)对胆管微小结石相关性疾病的诊治价值.方法 收集我院56例急性胆源性胰腺炎和16例胆道结石梗阻患者,入选患者同时完成MRCP、ERCP检查治疗,所发现胆胰结石直径均小于3 mm,分析比较两种方法 对胆管微小结石的诊断价值.结果 68例患者MRCP明确提示存在胆总管末端狭窄或胆胰管扩张,占94.4%:61例患者ERCP检查可直接发现微小结石,占84.7%:8例患者通过EST切开及取石球囊取石才发现微小结石或泥沙样结石.结论 MRCP作为胆胰疾病的一种无创检查而具有重要的应用前景:ERCP对于微小结石导致的胆胰疾病具有重要诊断意义和治疗价值.     

10955例经内镜逆行胰胆管造影术患者临床总结分析

目的探讨经内镜逆行胰胆管造影术（ERCP）对胆胰疾病的诊疗价值。方法回顾性分析1995年1月至2013年7月间完成ERCP诊治的患者10955例,其中男6186例,女4769例,平均年龄（65．57±14．44）岁。总结并分析ERCP诊治病种、发病年龄、年度数量、麻醉方式及插管成功率等指标。结果10955例患者中,诊断性ERCP167例,治疗性ERCP10788例。2002年至2012年ERCP手术例数年平均增长率是19．58％。首次ERCP胆管插管成功率是97．23％,总ERCP胆管插管成功率是99．59％。常见的ERCP诊治疾病包括肝外胆管结石（40．85％）、肝门部胆管癌（10．53％）、化脓性胆管炎（10．44％）、胰头癌（10．04％）、慢性胰腺炎（8．24％）、肝外胆管癌（7．68％）、壶腹周围癌（6．96％）、胆源性胰腺炎（3．94％）、良性乳头狭窄（3．88％）、乳头癌（3．50％）。肝外胆管结石、化脓性胆管炎、良性乳头狭窄高发年龄是40～50岁,慢性胰腺炎高发年龄是50—60岁,胆源性胰腺炎、肝门部胆管癌、肝外胆管癌、胰头癌、壶腹周围癌、乳头癌的高发年龄是70—80岁。2011年至2013年中,98．74％患者行全凭静脉麻醉ERCP。结论ERCP已经成为胆胰疾病诊治的重要手段,适合于肝外胆管结石、化脓性胆管炎、恶性胆管梗阻等疾病,尤其是高龄患者的诊治。全凭静脉麻醉ERCP是安全、有效的。     

173例胰胆管疾病患者内镜逆行胰胆管造影术诊治分析

目的 讨论内镜逆行胰胆管造影术(ERCP)及内镜治疗对胰胆管疾病的诊断与治疗价值。方法 回顾分析173例胆胰疾病患者应用十二指肠镜进行诊断和治疗的临床效果。结果 ERCP成功率为93．6％，造影发现胆道结石69例，一次性成功取净结石66例，造影发现胆胰肿瘤20例，5例放置内支架引流。ERCP术后胰腺炎2例，十二指肠乳头肌切开(EST)术后出血2例，均经非手术治疗痊愈。结论 ERCP对于胆胰疾病的诊断明确可靠，内镜下治疗可使部分患者免除外科手术。     

十二指肠乳头旁憩室与胆胰疾病的关系

十二指肠乳头旁憩室与胆胰疾病关系密切。我院自1996年1月~2005年12月共行逆行胰胆管造影术(ERCP)891例,发现十二指肠乳头旁憩室56例,发现率为6.3%。我们对十二指肠乳头旁憩室的诊断及其与胆胰疾病的关系进行探讨。临床资料1.一般资料:十二指肠乳头旁憩室患者56例,男性41例,女性15例,年龄27~70岁,平均年龄54.1岁,>50岁者44例(78.6%)。56例憩室中并发胆总管结石者32例(57.1%),急性胰腺炎15例(26.8%),其中10例合并有胆总管结石,无结石胆系感染6例(10.7%),胆管癌2例(3.6%),胰头癌3例(5.5%),胆胰正常者8例(14.3%)。总胆胰疾病合并率为85.7%(48…     

两种胆胰管造影方法临床应用价值的荟萃分析

目的评价内镜下逆行胰胆管造影术（ERCP）和磁共振胰胆管造影术（MRCP）在具有可疑胆胰疾病患者中的应用价值。方法通过MEDLINE、EMBASE等数据库检索国内外已发表和未发表的相关文献。选择针对具有可疑胆胰疾病患者,使用ERCP和MRCP两种方法进行比较的前瞻性研究。由2位评价者分别按以上检索策略收集资料,按选择标准人选,主要对两种检查方法的敏感性和特异性进行荟萃分析。结果ERCP和MRCP诊断胆总管结石、胆胰管狭窄、胆胰系统恶性疾病的敏感性差异无统计学意义。两者对上述疾病诊断的特异性方面,仅在诊断胰胆管狭窄时,ERCP高于MRCP,OR为6．17,95％CI为1,35～20．24,P=0．02。对于总体胆胰系统疾病的诊断,ERCP的敏感性和特异性均优于MRCP,OR分别为1．72和4．05.95％CI分别为1．04～2．85和1．32．12．42,P值分别为0．04及0．01。结论在诊断胆胰系统疾病时,总体敏感性和特异性都是ERCP优于MRCP。临床医生可以根据患者耐受程度和价效分析进行对ERCP和MRCP的取舍决策。     

1158例高龄胰胆疾病患者临床特征及内镜诊疗效果分析

目的评价高龄（≥80岁）胰胆疾病患者行经内镜逆行胰胆管造影术（ERCP）诊疗的临床价值。方法回顾性总结2007年1月至2013年6月行ERCP诊疗的1158例高龄胰胆疾病患者的临床资料,对临床特征、内镜诊治情况进行分析。结果1158例高龄胆疾病患者共接受1315例次ERCP诊疗,成功率为98．5％（1295／1315）。术中诊断胆管结石554例（47．8％）,恶性胆道梗阻494例（42．7％）,良性胆管狭窄42例（3．6％）,Mirrizi综合征23例（2．0％）,胰管结石21例（1．8％）,未见异常24例（2．1％）。术后并发胰腺炎67例次（6．5％）,高淀粉酶156例次（13．5％）,死亡5例（0．4％）。结论高龄胰胆疾病患者行ERCP诊疗安全有效。     

超声内镜在可疑胆胰疾病ERCP术前的初步应用

目的 超声内镜(EUS)在可疑胆胰病变患者行内镜逆行胰胆管造影(ERCP)术前的临床应用价值.方法 对15例急性胰腺炎、梗阻性黄疸、胆总管扩张或反复腹痛等病史的患者,经腹部B超、CT和/或MRCP检查可疑胆胰病变,术前行EUS检查诊断,并经ERCP确认.结果 15例患者确诊胆总管结石并行EST取石术9例,确诊壶腹部肿瘤2例,胆管内乳头状瘤2例,十二指肠乳头炎性狭窄1例,胰管结石1例.结论 EUS对可疑胆胰病变有很高的诊断价值,特别能提高胆总管结石确诊率,高于MRCP检查,并能指导ERCP,提高治疗效果,减少风险.     

ERCP联合EST诊治胆总管结石效果观察

目的观察经内镜逆行胰胆管造影（ERCP）联合十二指肠乳头括约肌切开取石（EST）诊治胆总管结石的效果。方法219例疑似胆总管结石患者,先行ERCP观察胆总管,摄片证实为胆总管结石后行EST治疗。结果本组189例患者经ERCP证实为胆总管结石,181例行EST取石成功,4例巨大结石（直径〉3．0cm）和4例胆总管内多发结石择期行腹腔镜胆管镜取石或直接切开胆总管T管引流。1例行EST后切口出血,立即停止手术并给予止血治疗后好转。术中患者均有不同程度咽部刺激、恶心、呕吐、腹胀、轻度腹痛等症状,未出现严重并发症如肠穿孔和急性胰腺炎,无死亡病例。结论ERCP联合EST诊治疑似胆总管结石效果满意。     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.