经内镜聚桂醇治疗食管静脉曲张的临床应用价值

正食管静脉曲张破裂出血(esophageal varices bleeding,EVB)是肝硬化患者的主要并发症和致死原因,初次发生EVB的死亡率为10%,再次发生出血的死亡率为40%。如何预防消化道再出血是临床治疗肝硬化并发症中较为重要的部分。内镜下食管静脉曲张硬化术(esophageal variciform sclero therapy,EVS)是目前治疗EVB的一种安全、有效方法[1]。国内外文献对内镜硬化术治疗EVB的近期疗效进行了大量报道。本研究拟回顾性分析安徽省阜阳市第二人民医院经内镜下治疗的55例肝硬化患者,旨在研究内镜硬化术在消化道出血的二级预防中的     

组织胶注射治疗胰十二指肠术后消化道少见部位静脉曲张破裂出血疗效研究

目的 分析并总结胰十二指肠术后消化道少见部位静脉曲张(吻合口静脉曲张)破裂出血内镜下组织胶注射治疗的临床特点。方法 回顾性分析我院2011年9月至2021年9月十年间胰十二指肠术后消化道少见部位静脉曲张破裂出血内镜下治疗病例及近十年文献报道中吻合口静脉曲张病例，总结其临床特点、内镜诊断及内镜下组织胶治疗的价值。结果 4 212例内镜下考虑或确诊为消化道静脉曲张病例中，有9例为胰十二指肠切除术后病例，其中7例因消化道出血行胃镜检查，共检出3例为胰十二指肠切除术后合并消化道吻合口静脉曲张。该3例患者既往均无基础肝病，表现为不同程度的消化道出血。胃镜检查均发现同时合并有食管和(或)胃底静脉曲张，均接受内镜下组织胶注射治疗，内镜下止血效果显著。吻合口静脉曲张内镜治疗组复发率较高，介入治疗组并发症发生率较高，两组有效性及安全性差异无统计学意义(P>0.05)。结论 胰十二指肠切除术后出现消化道出血时，应警惕吻合口少见部位静脉曲张的发生，行胃镜检查时应尽量对所有吻合口进行探查，内镜下组织胶注射治疗是此类静脉曲张出血的有效治疗方法。该病复发出血率较高，应强调内镜随访，发现新发或具有出血风险曲张...     

内镜下止血夹治疗在急性非静脉曲张性消化道出血中的应用

目的 观察内镜下金属止血夹治疗急性非静脉曲张消化道出血的治疗效果.方法 收集我院2004年7月至2009年7月收治的急性非静脉曲张消化道出血患者79例,在内镜下明确出血部位,使用止血夹钳夹止血.结果 79例急性非静脉曲张消化道出血患者应用内镜下金属止血夹止血治疗,共用金属夹238枚,平均每例3.01枚,即时止血率97.47%(77/79),20例止血夹止血失败病例中1例Dieulafoy病患者改用内镜下套扎治疗止血成功,另1例转外科手术治疗.1周内再出血率3.80%(3/79),其中2例患者转手术治疗.所有患者内镜术后均未出现内镜治疗相关并发症,全组无死亡病例.结论 内镜下金属止血夹是一种治疗急性非静脉曲张消化道出血的有效方法,具有操作简单,止血效率高及无明显并发症等优点,值得临床推广应用.     

内镜下应用组织胶和套扎术治疗儿童食管胃静脉曲张出血16例临床观察

目的评估内镜下应用组织胶和套扎术治疗儿童食管胃静脉曲张出血的临床疗效。方法分析首都医科大学附属北京友谊医院2010年5月-2017年5月因食管胃静脉曲张出血接受内镜下治疗的16例患儿的临床资料。分析患儿术前情况及生理指标,术后的止血率、再出血率、并发症与进一步治疗情况。结果 16例患儿平均(8.50±4.97)岁,5例表现为单纯食管静脉曲张,其中中度(GⅡ型)1例,重度(GⅢ型)4例,11例表现为食管静脉曲张合并胃静脉曲张,其中GOV1型6例(合并GⅠ型1例,GⅡ型3例,GⅢ型2例),GOV2型5例(合并GⅡ型2例,GⅢ型3例)。16例患儿食管静脉曲张共50条,平均每例4(1~5)条,共行套扎70处,平均每例5(0~8)处。9例行组织胶注射,共注射15点,使用组织胶20 ml,平均每例应用2.22 ml,平均每处注射1.33 ml。内镜治疗后即刻止血率为100%,3个月内再出血率为6.25%(1/16),3个月以上的随访过程中,再出血率为12.5%(2/16)。随访时间3个月~7年,随访期间4例行肝移植手术,1例因出血再次行内镜治疗,全部患儿均未见明显并发症。结论内镜下应用组织胶和套扎术治疗儿童食管胃静脉曲张出血止血明确,并发症少,为患者的远期治疗提供了宝贵时间。     

组织黏合剂联合套扎术治疗食管胃底静脉曲张出血403例

目的研究内镜下胃底静脉曲张组织黏合剂栓塞术联合食管静脉曲张套扎术治疗食管胃底静脉曲张出血的临床应用价值。方法回顾性分析2004年7月至2015年7月滨州医学院烟台附属医院(原牟平人民医院)收治403例上消化道出血患者临床资料,患者入院后急诊胃镜检查发现Ⅱ°以上食管静脉曲张合并胃底静脉曲张出血,先采用碘化油-组织黏合剂-碘化油"三明治"法行胃底静脉曲张栓塞治疗,再行食管静脉曲张套扎术。观察其即刻止血率、近期再出血率、术后并发症及死亡率。结果 403例患者平均栓塞注射2.4次(984/403),套扎11.6(6~18)环,即刻止血成功率100%,近期再出血率3.7%(15/403)。术后并发胸骨后疼痛21例,咽痛5例,低热7例,胃食管反流3例,并发症发生率8.9%(36/403)。死亡3例,2例死于失血性休克,1例死于肝性脑病。结论内镜下组织黏合剂栓塞术联合套扎术治疗胃底静脉曲张出血合并食管静脉曲张出血疗效显著,成功率高,降低了病死率及再出血率。     

肝硬化食管静脉曲张内镜下套扎临床疗效分析

目的 探讨内镜下套扎治疗肝硬化食管静脉曲张出血(esophageal varices bleeding,EVB)的止血效果及影响因素.方法 对123例肝硬化食管静脉曲张(esophageal varices,EV)出血的患者应用内镜下食管静脉套扎术(endoscopic variceal ligation,EVL)进行治疗.结果 所有患者经过1次EVL治疗,EV消失31例(25.2%),EV减轻92例(74.8%),无效0例.近期出血13例,远期出血9例.结论 EVL是治疗肝硬化食管静脉曲张破裂出血的一种有效方法,但并非没有风险,影响疗效因素众多.     

内镜下食管静脉曲张套扎术治疗肝硬化食管静脉曲张56例疗效观察

目的探讨食管镜下食管静脉曲张套扎术(EVL)治疗肝硬化食管静脉曲张的疗效。方法食管静脉曲张患者56例,其中急性食管静脉出血32例;无临床症状者24例,均为中重度食管静脉曲张,为一二级预防者。56例均行EVL,术后4~6周评价疗效,观察术后并发症发生情况。结果急性出血32例中止血成功31例(96.87%),72 h内止血失败1例(3.12%),术后72 h~6周4例(12.5%)出血复发;24例无临床症状者未发生静脉破裂出血。术后4~6周50例获得随访,复查胃镜,静脉曲张根除35例(70%),基本消失15例(30%)。56例中,2例术后3 d出血复发,其中急性食管静脉曲张出血患者1例,重度静脉曲张一级预防者1例,经及时扩容、制酸、降门脉压等药物治疗后好转,后再次行EVL止血。术后出现胸骨后疼痛12例,吞咽困难5例,恶心不适4例,发热5例,未做特殊处理,自行缓解。无术后食管穿孔、狭窄者。结论 EVL治疗肝硬化食管静脉曲张疗效较好。术中规范操作、加强围术期管理可提高手术效果并减少并发症。     

食管与胃/肠吻合术后食管静脉曲张的硬化疗效分析

目的评价内镜下硬化治疗(endoscopic injection sclerotherapy,EIS)食管与胃/肠吻合术后食管静脉曲张破裂出血(esophageal varices hemorrhage,EVH)的临床疗效。方法回顾近2年解放军总医院消化内科收治的因EVH住院行EIS的4例患者的临床资料,总结患者一般情况如食管、胃/肠手术术式、肝功能分级、腹水、出血及食管静脉曲张程度等,特别对患者内镜下表现、治疗方法的选择、治疗部位、次数、硬化治疗效果进行回顾性分析。根据患者随访情况,对EV再发出血、复发情况、并发症情况进行临床分析。结果 4例患者年龄35~63岁;其中乙肝肝硬化1例、丙肝肝硬化1例、其他病因肝硬化2例;出血发生于手术治疗后1~21个月;其中食管横断术1例、近端胃癌切除食管胃吻合术后1例、胃全切食管小肠吻合术后2例;其中1例行近吻合口、套扎治疗脱环后均行EIS治疗;平均治疗次数4次;治疗后曲张静脉基本消退,内镜随访平均6个月,1例于12个月内镜复查发现曲张静脉复发并发生再出血,经再次补充治疗后消失;均未发生肝性脑病、食管穿孔、食管狭窄等并发症。结论 EIS治疗食管与胃/肠吻合术后EVH是一种简单易行、安全有效的治疗方法,值得临床推广。     

内镜下套扎联合经皮经肝TH胶栓塞治疗肝硬化食管胃底静脉曲张的临床应用

目的评价内镜下套扎(EVL)联合经皮经肝曲张静脉TH胶栓塞术(PTVE)治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法 44例肝硬化食管胃底静脉曲张出血患者,先行食管曲张静脉的内镜下套扎治疗,1周后再行TH胶PTVE,栓塞食管胃底曲张静脉区域及其来源血管。联合治疗术后定期复查胃镜,观察曲张静脉消失情况,随访治疗后曲张静脉复发率及再出血率。结果 44例食管胃底静脉曲张患者,32例食管曲张静脉基本消失,消失率72.7%;8例胃底静脉曲张基本消失,消失率100%;12例食管静脉曲张程度明显减轻,总有效率100%。随访6~39个月,平均25.6个月,5例食管静脉曲张复发,复发率11.4%;3例再出血,再出血率6.8%。结论内镜下套扎治疗能机械性地消除食管曲张静脉,经皮经肝TH胶栓塞能栓塞食管胃底曲张静脉区域及其供血血管,二者联合能达到协同作用,具有更好的远期疗效。     

影响食管静脉曲张套扎术疗效的相关因素分析

目的 探讨影响食管静脉曲张套扎术(EVL)疗效的相关因素。方法 对520例肝硬化食管静脉曲张出血(EVB)采用密集结扎法行EVL,其中肝硬化组332例,合并肝癌组70例,肝硬化断流术后组118例。比较各组EVL疗效并观察各种相关因素对EVL疗效的影响。结果 3组EVL后食管静脉曲张(EV)消失率依次分别为42.2％、27.1％、89.8％;EV复发率24.1％、42.9％、8.5％;近期再出血率3.0％、21.4％、4.2％;远期再出血率12.0％、20.0％、3.4％。肝硬化合并肝癌组近期再出血率明显高于肝硬化组(P<0.05)。断流术后组与肝硬化组比较,前者EV消失率高、复发率低(P<0.05)。EVL术前肝功能越差,EV复发、EVB再发率越高(P<0.01)。EVL术后服用普萘洛尔组EV复发率、EVB再发率低,存活率高(P<0.01)。EV复发组胃左静脉径增宽、血流速度快,且绝大部分为离肝血流。结论 EVL是治疗EVB安全、有效的首选方法,其疗效受诸多相关因素影响。     

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.