内镜下胃底组织胶注射联和套扎术对肝硬化患者食管胃底静脉曲张程度的影响

目的 探讨内镜下胃底组织胶注射联和套扎术治疗肝硬化食管胃底静脉曲张（EGV）的疗效及安全性.方法 研究对象为同期收治的76例肝硬化EGV破裂出血患者,均于内镜下选好胃底靶静脉以＂三明治＂法注射组织胶,并自胃食管黏膜连接处开始向近端螺旋式结扎曲张静脉.随访8周,观察不良反应及并发症发生情况,并复查胃镜判定EGV程度.结果 无异位栓塞等严重不良反应发生,2例出现再出血、再次注射组织胶后止血;食管静脉曲张和胃底静脉曲张程度降低者分别占88.2%和75.0%.结论 内镜下胃底组织胶注射联和套扎术可明显减轻肝硬化食管EGV程度,且操作简单、安全性高.     

内镜下圈套结扎治疗食管静脉曲张的体会

在我国食管胃底静脉曲张(EGV)破裂出血是肝硬化门脉高压症(PHG)患者常见的死亡原因，其病死率达30％-40％以上，20％-30％的肝硬化食管静脉曲张(EV)患者迟早会发生出血(EVB)。内镜下食管静脉套扎术(EVL)是近年来治疗食管静脉曲张的一种新方法。我院自1997-2003年对21例食管静脉曲张患者行内镜下圈套结扎治疗，现报告如下。     

超声胃镜在食管胃底静脉曲张中的应用进展

正食管胃底静脉曲张(esophageal gastric varices,EGV)是肝硬化的主要并发症之一,其中25%~40%患者会发生食管胃静脉曲张破裂出血(gastroesophageal varices bleeding,EGVB)[1],及早诊断及治疗对提高EGV的预后有着极大的意义。目前EGV的诊治和出血风险的预测主要依托于胃镜检     

组织粘合剂在食管胃静脉曲张内镜治疗中的应用

食管胃静脉曲张(esophageal and gastric variceal,EGV)是指由于肝硬化等病变引起的门静脉高压,致使食管和(或)胃壁静脉曲张.EGV患者50%～60%将发生出血,初次出血者病死率高达50%,因此对于可能发生出血的EGV人群及食管静脉曲张破裂出血(EGVB)的患者,应积极采取措施预防出血及急诊止血.目前对于EGV和EGVB内镜下治疗方法有:内镜下曲张静脉套扎治疗、内镜下曲张静脉硬化治疗和内镜下注射组织粘合剂等方法,本文着重论述组织粘合剂在食管胃静脉曲张治疗中的应用.     

肝硬化食管胃静脉曲张破裂出血的预防和治疗新进展

肝硬化患者门静脉系统血流受阻导致门静脉及其属支血管内静力压力升高并伴侧支循环形成,临床主要表现为腹水、脾大、肝性脑病以及食管胃静脉曲张破裂出血等.其中,食管胃静脉曲张破裂出血的病死率最高,是最常见的消化系统急症之一.肝硬化患者上消化道出血的原因中,70％是因为静脉曲张破裂出血.     

肝硬化食管胃底静脉曲张的内镜诊断治疗——从指南到临床实践

肝硬化食管胃底静脉曲张出血是临床常见、病死率高的消化系统急重症,内镜是诊治的主要手段。选择适宜的内镜技术及时诊断和有效治疗是降低其病死率的关键。根据国内肝硬化门静脉高压症临床诊治相关指南及最新临床证据,简述了内镜在肝硬化食管胃底静脉曲张及其出血的诊断和治疗中的作用,包括内镜筛查与治疗时机、内镜硬化剂与套扎治疗方法的选择、内镜治疗失败的挽救措施、内镜治疗并发症及其处理。肝静脉压力梯度指导下,可提高个体化的内镜和(或)药物防治肝硬化食管胃底静脉曲张出血的效果。总之,内镜是肝硬化食管胃底静脉曲张出血诊治的主要手段,研究早期预测内镜治疗效果的因素,规范内镜诊治技术,对提高内镜治疗的效果及安全性具有重要意义。     

食管胃底静脉曲张出血的内镜治疗时机探讨

食管胃底静脉曲张破裂出血是临床急、危、重症,病死率高,其最常见原因为肝硬化门静脉高压.随着药物及内镜治疗技术的进展,绝大多数食管胃底静脉曲张破裂出血患者获得了满意的早期止血效果,然而,有关内镜治疗时机的选择及其对患者预后的影响仍报道不一.本文对南昌大学第一附属医院收治的140例患者,共154例次内镜下治疗的食管胃底静脉曲张进行分析,探讨内镜治疗的时机.     

肝硬化食管胃底静脉曲张出血治疗进展

正1目前肝硬化患者中约有50%存在胃食管静脉曲张,每年有8%肝硬化患者发展为静脉曲张,同样每年有8%肝硬化患者由小静脉曲张发展为大静脉曲张,静脉出血的年发生率为5%~15%[1]。目前食管胃底静脉曲张的治疗实质上已经大大减少出血的风险及病死率。本文就食管胃底静脉曲张出血最近研究进展予以综述。     

食管胃静脉曲张内镜治疗的最新进展

食管胃静脉曲张(esophagogastricvarices，EGV)出血是肝硬化门静脉高压症最凶险的并发症之一，防治EGV出血对于延长肝硬化患者的生存期至关重要。现简述近年来内镜诊治EGV的新进展如下。     

肝硬化食管胃底静脉曲张再出血的预防性护理

目的 预防肝硬化食管胃底静脉曲张的破裂出血，降低再出血的复发率，减少病死率。方法 通过分析肝硬化食管胃底静脉曲张破裂出血的诱发因素，针对不同诱因采取预防性护理。结果 根据肝硬化食管胃底静脉曲张破裂出血的相关因素，培养病人的良好生活习惯，提高了其医从性，降低了再出血的复发率。结论 肝硬化食管胃底静脉曲张再出血的预防性护理，对于降低再出血的复发率、减少病死率起到了显著的作用。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.