29例胃十二指肠血吸虫病的内镜表现及病理特点分析

目的探讨胃、十二指肠血吸虫病的内镜和病理表现及预后。方法对29例胃、十二指肠血吸虫病患者的内镜下表现及病理表现进行分析，并根据随访资料进行预后分析。结果胃、十二指肠血吸虫病的内镜下表现缺乏特异性。29例中内镜下表现为溃疡17例，肿瘤样病变3例，浅表性胃炎2例，糜烂出血性胃炎1例，萎缩性胃炎6例。病理检查均在黏膜层、黏膜下层或坏死组织中发现有大量血吸虫卵沉积。29例中3例合并胃癌，另在最长11年的随访中发现癌变6例，癌变率达31％。结论胃、十二指肠血吸虫病内镜下表现缺乏特异性，诊断主要依靠病史和病理学检查，预后分析表明本病易产生癌前病变并易癌变，应定期随访以便早发现早治疗。     

十二指肠隆起性病变的内镜及组织学观察

目的 探讨十二指肠粘膜直径１ｃｍ以内隆起性病变的性质及其与临床的关系。方法 观察６０例十二指肠隆起性病变的内镜表现特点，对活检标本ＨＥ染色，７例疑有胃上皮化生标本行ＡＢ－ＰＡＳ粘液组织化学染色，光下观察。结果 内镜表现为单个或多个广基息肉状隆起，病理检查显示慢性十二指肠炎４９例，其中粘膜内有继发于炎症的不同程度肠腺上皮增生，胃上皮化生及Ｂｒｕｎｅｒ腺增生等病变。另有胃粘异位５例，血吸虫病２例，良性     

胃十二指肠克罗恩病临床及超声内镜特征

目的探讨胃十二指肠克罗恩病的临床特点和超声内镜表现。方法收集1999年1月～2007年6月复旦大学附属中山医院确诊为胃十二指肠克罗恩病的相关资料并进行随访。结果 5例胃十二指肠克罗恩病患者中,1例胃克罗恩病,临床表现为中上腹胀痛和恶心,内镜表现为胃黏膜皱襞增粗僵硬伴纵行溃疡形成,超声内镜表现为胃壁黏膜及黏膜下层广泛增厚,呈均匀偏高回声。4例十二指肠球部克罗恩病,临床表现为反复上腹饱胀伴呕吐,内镜表现为十二指肠铺路石样改变、溃疡或狭窄,超声内镜表现为黏膜和黏膜下层广泛增厚。胃克罗恩病术前疑为恶性肿瘤,行全胃切除术。十二指肠球部克罗恩病经病理组织学、结肠镜检查等明确诊断,应用泼尼松等治疗缓解。结论胃镜检查病理阴性的胃十二指肠病灶应考虑克罗恩病可能,超声内镜有助于诊断的确立及与浸润性肿瘤的鉴别,结肠镜检查有助于发现回结肠病变并协助诊断克罗恩病。     

共聚焦激光显微内镜对胃非隆起型病变的诊断价值

目的探讨共聚焦激光显微内镜检查（CLE）对胃非隆起性病变良、恶性的鉴别诊断价值。方法对37例常规内镜发现的胃非隆起型病变患者行CLE检查。静脉注射荧光素钠后对病变区域进行观察,然后进行靶向活检。对CLE或靶向活检病理诊断为恶性病变者进行内镜或手术治疗,术后对整块标本进行病理学检查;对良性患者予规范药物治疗并每隔3个月复查胃镜,直至病变愈合。结果CLE诊断癌性病变11例,良性病变26例。靶向活检病理证实CLE诊断的11例癌变者中10例为癌,1例为良性;26例良性者中1例为癌,余皆为良性。共12例接受切除治疗（3例内镜治疗,9例外科手术）,术后病理学证实与靶向活检病理诊断完全一致。良性者随访中未发现有恶变,经平均3．16（3．58±1．20）个月的内镜随访,病变均愈合。CLE对胃非隆起性病变癌变诊断的灵敏度、特异度和准确度分别为90．9％、96．2％和90．9％,阳性预测值和阴性预测值分别为90．9％和96．2％;CLE与组织学检查的Kappa值为0．871。结论CLE对胃非隆起型病变具有较高的诊断价值,将有望替代活检病理做出实时组织学诊断。     

胃粘膜异型增生54例临床病理学回顾性研究

目的 通过对胃粘膜上皮异型增生（gastric epithelial dysplasia,GED)的内镜描述、病理组织学分级、不同治疗方法和癌变的回顾性研究，使内镜表现与组织学形态有机结合，为病理和临床医生制定规范统一的GED描述术语和诊断分级标准，为GED的治疗方法和预后判断提供客观依据。方法 选取54例具有随访资料的GED病例，进行HE、Goden-Sweet网染、P53和CEA免疫组化染色，观察内镜形态、组织学分级和治疗方法与癌变的关系。结果 高度GED内镜形态表现为褪色和灰白色，光泽消失，质地变硬且弹性差，呈平坦凹陷或平坦凸起伴浅表糜烂并且大于0.5cm，与癌变关系非常密切（P＜0．05）。低度GED多为隆起型，与增生性息肉和萎缩性胃炎难鉴别。结论 低度异型增生（low grade dysplasia)应当密切随访，或做内镜局部粘膜病灶切除后随访。高度异型增生应做内镜局部粘膜病灶切除或胃部分切除后密切随访。     

Barrett食管13例临床分析

目的 探讨Barrett食管（BE）的内镜表现、病理特征以及与食管腺癌的关系。方法 分析13例BE患者的临床表现、内镜诊断及病理特点。结果所有患者均有反酸、烧心感等症状，其中同时伴食管裂孔疝者3例，内镜下全周型2例、岛型7例和舌型4例。活组织病理检查均有柱状上皮化生。其中不典型增生1例，随访2年后发现癌变。结论 BE是反流性食管炎发展的一种结果，可导致食管腺癌，其诊断需内镜和活组织检查，药物治疗只能改善症状，应定期进行随访，发现恶变及早手术。     

老年人十二指肠癌伴胃溃疡3例

目的本文报道较少见的老年人十二指肠癌伴胃溃疡的内镜和病理检查，并探讨内镜下特殊表现及病理学分类．方法在1994-01／1995-10常规内镜检查590例患者中，发现其中3例老年男性的特殊病变．内镜下观察例1为十二指肠球部变形，小结节性溃疡并胃窦部溃疡，例2为十二指肠球部菜花样隆起溃疡并胃角、胃窦部溃疡，例3为十二指肠球部不规则溃疡并胃角、胃窦部多个溃疡．结果对病变组织活检多块，进一步做病理学检查，并送外院复检．例2，例3为十二指肠腺癌并胃溃疡，例1为十二指肠鳞癌并胃溃疡。结论十二指肠癌中以腺癌为主，鳞癌的发现值得我们进一步探讨，对老年患者不能凭经验或满足于胃部首发病的诊断，并对溃疡或糜烂病灶尽量进行活检，以免漏诊．     

内镜诊断十二指肠类癌1例报告

患者女,６２岁。因上腹不适１月余,伴烧灼感、反酸。于１９９５年６月在本院行内镜检查,于十二指肠球下壁见一米粒大小隆起,局部活检证实为类癌。因患者一般情况好,无明显上腹痛及消化道出血症状,故建议密切随访。于１９９６年８月２日再次内镜检查,镜下表现同前,肿瘤局部未见明显变化。体检：一般情况好,无明显异常发现,无类癌综合征表现。镜下表现及病理：食管、贲门、胃底、胃体、胃角正常,胃窦粘膜红白相间,幽门口开放良好。于十二指肠球下壁见０．２ｃｍ大小的粘膜隆起。病理诊断：十二指肠球部多中心微小类癌,免疫组化：…     

胃十二指肠血吸虫病误诊9例

临床资料本组病例均为男性,年龄24—60岁,平均为43岁.病程最短者2个月,最长者18年.有血吸虫病史者6例;6例有典型溃疡病症,其中并发上消化道出血3例,幽门梗阻1例,晚期血吸虫病脾功能亢进症3例.有1例晚期血吸虫病(巨脾型)患者的空肠、回肠、结肠、直肠有7个大小不等的血吸虫性肉芽肿病变,肿块最大直径6×6cm.治前,7例作上消化道钡餐检查,诊断为胃溃疡5例、十二指肠溃疡1例、胃癌1例;2例作胃镜检查,诊断为胃溃疡1例、十二指肠溃疡1例.病理检查血吸虫卵沉积于胃窦4例,幽门2例,胃体小弯侧3例、虫卵主要位于粘膜下层或粘膜基底层附近.虫卵沉积处炎症反应轻微,主要是淋巴细胞浸润和大量纤维组织增生.有嗜酸细胞浸润者4例,粘膜下层有嗜酸性向芽肿者4例,胃粘膜呈萎缩性胃炎伴肠上度化生与腺体囊性扩张者1例.讨论胃十二指肠血吸虫病并非罕见,但由于没有特     

大肠镜诊断小儿血吸虫病及其分型(附25例报告)

目的　探讨小儿血吸虫病的内镜诊断及其分型意义。方法　使用 Ｏｌｙｍ ｐｕｓ Ｐ Ｃ Ｆ２０ 型小儿肠镜观察并结合组织病理检查诊断小儿血吸虫病２５ 例。结果　①急性肠炎型３ 例，慢性结肠炎型５ 例。②在镜下可同时观察到急性与慢性粘膜炎症改变，活检发现既有急性虫卵结节又有慢性虫卵结节者为混合性，发现１７ 例。③合并大肠息肉７ 例。讨论　内镜是诊断小儿血吸虫病的重要方法。临床内镜分型宜加上混合型。     

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.     

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.     

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.     

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.     

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.