甲状旁腺腺瘤出血囊性变致高钙危象1例报道

本文报道1例罕见的甲状旁腺腺瘤出血囊性变引发的高钙危象患者, 并复习相关文献。患者术前影像学检查难以明确颈部囊性病灶的组织学来源, 经积极药物治疗和血液透析不能缓解高钙危象, 予手术探查并切除颈部病灶, 病理诊断证实为甲状旁腺腺瘤出血囊性变, 术后血钙和肾功能恢复正常。     

原发性胆汁性肝硬化伴甲状旁腺腺瘤诊治

原发性胆汁性肝硬化可从多种途径影响钙和维生素D的代谢,进而引起骨软化和继发性甲状旁腺功能亢进症,但当同时出现低蛋白血症时可掩盖血钙的真实水平.因此若该病合并甲状旁腺腺瘤时容易漏诊.本文详细介绍1例原发性胆汁性肝硬化合并甲状旁腺腺瘤的诊治过程,旨在提醒临床医生重视低蛋白血症对血清总钙水平的影响.     

消化系统症状为首要表现的甲状旁腺功能亢进症3例临床分析

目的探讨以消化系统症状为主要表现的甲状旁腺功能亢进症早期诊治,以降低误诊率。方法回顾性分析3例以消化系统症状为主要表现的甲状旁腺功能亢进症。结果 3例甲状旁腺功能亢进症患者血钙、尿钙、甲状旁腺激素升高,血磷水平降低。CT及放射性核素扫描99mTc-MIBI有助于定位诊断,手术治疗是目前唯一的有效措施。结论以消化系统症状为主要表现的原发性甲状旁腺功能亢进症的诊断,要重视血钙及甲状旁腺激素水平监测,达到早期诊断、早期治疗的目的。     

原发性甲状旁腺机能亢进症高血钙危象

原发性甲状旁腺机能亢进症高血钙危象为一内科急症。由于本症易与严重心脑血管及肾脏病相混淆而延误诊治,故应提高对本症的认识。本文就其病因学、临床特点以及诊断治疗诸方面作一全面的概述。     

以消化系统症状首发的原发性甲状旁腺功能亢进症的诊治分析

目的探讨以消化系统症状首发的原发性甲状旁腺功能亢进症的早期诊治。方法回顾性分析8例以消化系统症状首发的原发性甲状旁腺功能亢进病例。结果以消化系统症状首发的原发性甲旁亢患者血钙、尿钙、血清碱性磷酸酶、甲状旁腺激素升高,血磷降低,CT有助于定位诊断。治疗可以采用外科手术或者药物治疗。结论以消化系统症状首发的原发性甲状旁腺功能亢进症的诊断应重视实验室检测及CT定位检查,才能达到早期发现、早期诊治。     

原发性甲状旁腺功能亢进症诊疗指南

一定义及流行病学特征（一）定义甲状旁腺功能亢进症常分为原发性、继发性和三发性3类。原发性甲状旁腺功能亢进症（primary hyper-parathyroidism,PHPT）简称原发甲旁亢,系甲状旁腺组织原发病变致甲状旁腺激素（parathyroidhormone,PTH）分泌过多,导致的一组临床症候群,包括高钙血症、肾钙重吸收和尿磷排泄增加、肾结石、肾钙质沉着症和以皮质骨为主骨吸收增加等。病理以单个甲状旁腺腺瘤最常见,少数为甲状旁腺增生或甲状旁腺癌。     

甲状旁腺癌研究进展

甲状旁腺癌是一种少见的内分泌系统恶性肿瘤,在原发性甲状旁腺功能亢进症患者中的发病率为0.1%~5.0%。该病目前病因不明,临床主要表现为高钙血症、高甲状旁腺素血症及颈部肿块。近年来在甲状旁腺癌分子发病机制、诊断及治疗等方面的研究取得了一些进展,本文主要对此进行综述,这将有助于临床对该病的认识。     

以四肢远端肌痛起病的甲状旁腺危象一例

重症甲状旁腺功能亢进症的患者受到应激刺激后,症状加剧,可发生甲状旁腺危象,通常表现为乏力、厌食、恶心、呕吐、多尿、虚脱及神志改变,甚至昏迷,但以四肢远端肌痛起病的甲状旁腺危象未见文献报告.现报告1例如下.     

原发性甲状旁腺功能亢进症手术方式的探讨——1例多发原发性甲状旁腺增生引发的思考

目的探讨提高原发性甲状旁腺功能亢进症手术成功率的几个关键问题。方法结合文献复习,回顾性分析1例多发甲状旁腺增生所致原发性甲状旁腺功能亢进症的临床诊疗过程和经验。结果经病理证实患者为3枚甲状旁腺增生,术中2枚病变行全切、1枚病变切除1/2,术后患者甲状旁腺激素及钙磷生化指标恢复正常,随访14个月,疗效满意。结论原发性甲状旁腺功能亢进症手术成功不仅要一次性甲状旁腺激素水平达到正常,还要避免矫枉过正,防止永久性甲状旁腺功能减退的发生。在准确定位基础上,通过病理学检查鉴别甲状旁腺组织及明确病变性质,以切除病变后30分钟甲状旁腺激素(PTH)值下降50%做为手术成功的标准,同时确保剩余足够的甲状旁腺组织和防止副损伤发生。     

以骨损伤为主要表现的原发性甲状旁腺功能亢进症误诊一例

报道1例原发性甲状旁腺功能亢进症误诊病例。患者是以多发骨痛为临床表现的绝经后女性,因多发骨骼病变被误诊为原发性骨质疏松、骨髓瘤、骨转移瘤等。本文旨在警示临床医师关注骨质疏松的诊断与鉴别诊断,减少并避免误诊、误治。     

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.     

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.     

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.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

Effects of pinealectomy and melatonin administration on certain indices of ovarian hyperplasia and/or hypertrophy in rats with both ovaries intact or after unilateral ovariectomy

Abstract: In earlier studies from other laboratories it was shown that melatonin decreased ovarian weight in rats and inhibited compensatory hypertrophy of the remaining ovary after unilateral ovariectomy. This study was designed to examine the influence of melatonin on certain indices of ovarian hyperplasia and/or hypertrophy in adult female rats with both ovaries preserved and with either an intact pineal gland or with the pineal gland removed (pinealectomy, PX) or, finally, in sham-PX animals. Similar studies were conducted on rats after unilateral ovariectomy, referring the examined parameters to the remaining intact ovary. The studies included mitotic activity of granulosa layer cells and corpus luteum cells, ovarian weight, ovarian cross-sectional area, cross-sectional area of the granulosa layer of all the Graafian follicles and the cross-sectional areas of the corpora lutea, visible on the ovarian cross-section. On the basis of results, we conclude that: 1) the effect of PX on the processes of ovarian hyperplasia and hypertrophy may vary; analogously, exogenous melatonin administration may influence ovarian hyperplasia and hypertrophy in different ways; 2) PX and exogenous melatonin may, under certain conditions, exert similar biological effects, even synergistic effects; 3) melatonin inhibits ovarian growth processes, while the effects of PX are variable; 4) the results indicate that in experiments performed on rats, with the use of two control groups, i.e., intact and sham-PX, melatonin effects on these two groups may differ.