线阵式超声内镜引导下细针针吸活组织检查对粘膜下病变的诊断价值

目的 通过内镜超声检查（EUS）结合细针针吸活组织检查（简称活检）来确定粘膜下病变的起源和性质,并评价这种方法对粘膜下病变诊断的价值。方法 经胃镜发现28例食管、胃实质性粘膜下病变的患者,对他们进行超声内镜检查,以明确其来源的层次、病变的位置,观察有无淋巴结转移。排除腔外正常组织压迫,在超声内镜引导下对病变行细针针吸活检,结果 28例患者中2例经EUS证实为腔外正常组织压迫,余26例患者均行EUS引导下的细针针吸活检,3例患者穿刺取材失败,23例患者经细胞学或组织学分析显示4例恶性肿瘤（淋巴瘤2例,平滑肌肉瘤2例）及19例良性病变（平滑肌瘤18例,脂肪瘤1例）,全部20例经手术、1例经内镜电切及7例经临床随访验证。结论 EUS结合细针穿刺活检是诊断粘膜下病变安全、有效的方法。     

内镜超声引导下细针穿刺活检诊断外生型胃间质瘤2例

胃肠道间质瘤（GIST）是一种具有恶性潜能的非定向分化消化道间叶源性肿瘤．起源于胃肠道肌间神经丛的Cajal间质细胞,以腔内生长方式为主,表现为较大的球形或半球形隆起的质硬病灶,常规胃镜检查对诊断有提示作用Ⅲ。但向腔外生长的外生型GIST在常规胃镜检查时极易被漏诊。笔者等应用内镜超声（EUS）及其引导下的细针穿刺活检成功诊断了2例外生型胃间质瘤,现报道如下;     

超声内镜引导下胰腺穿刺活检的现状

内镜超声检查术(endoscopic ultrasonography,EUS)是近10 a来开展的新技术,目前已广泛应用于上消化道及邻近脏器疾病的诊断.EUS引导下穿刺活检是EUS的重大进展.现就EUS引导下穿刺活检对胰腺疾病.尤其是胰腺肿瘤的诊断价值作一综述.1胰腺的穿刺活检方法自1972Oscarson首创的血管造影下经皮胰腺活检以及Smith et al行B超引导下经皮胰腺活检以来,胰腺疾病的细胞学和组织学诊断技术发展迅速,目前胰腺疾病的穿刺活检方法主要有:①术中直视下胰腺穿刺活检;②B超、CT及经内镜逆行胰管造影术(endoscopic retrograde pancreatography,ERP)引导下经皮细针穿刺活检;③超声内镜引导下细针穿刺活检(endoscopic ultrasound guided fine needle aspiration biopsy.EUS     

内镜超声引导下细针穿刺对胰腺占位病变的诊断价值

目的 通过超声内镜结合细针穿刺活检确定胰腺占位病变的性质，并评价该法对胰腺病变的诊断价值。方法 对经CT、MRI、体表腹部超声及内镜超声发现的23例胰腺局限性占位病变进行内镜超声检查，以明确病变大小、形态、位置，并观察有无淋巴结转移。在内镜超声引导下对病变行细针穿刺活检。结果 23例患者中，21例得到了充足的细胞量，15例得到组织块，12例最终确定为胰腺肿瘤的患者，经组织细胞学检查10例为阳性（其中胰腺癌8例；胰腺囊腺瘤癌1例；无功能神经内分泌肿瘤1例），敏感性为83％，特异性为100％。全部结果经手术（16例）及临床随访（7例）证实。无1例出现不良反应。结论 超声内镜结合细针穿刺是诊断胰腺病变安全、有效的方法。     

超声内镜引导下细针穿刺活检术诊断腹膜后神经鞘瘤1例（含视频）

腹膜后神经鞘瘤临床少见，一般通过手术治疗获得病理诊断，既往术前诊断往往通过超声或者CT引导下穿刺明确。本文报道了1例腹膜后神经鞘瘤患者术前通过超声内镜引导下细针穿刺活检术明确诊断，为患者下一步治疗提供了策略。     

线阵式超声内镜引导下细针穿刺活检对粘膜下病变的诊断价值

目的 通过内镜超声检查(EUS)结合细针穿刺活检来确定粘膜下病变的起源和性质,并评价这种方法对粘膜下病变诊断的意义。方法 经胃镜发现28例食管胃实质性粘膜下病变的患,对他们进行超声内镜检查,以明确其来源的层次、病变的位置,观察有无淋巴结转移。排除腔外正常组织压迫,在超声内镜导引下对病变行细胞针穿刺活检。结果 28例患中,2例经EUS证实为腔外正常组织压迫,余26例患均行EUS导此下的细针穿刺活组织检查。3例患穿刺取材失败。23例患经细胞学分析显示4例恶性肿瘤(淋巴瘤2例,平滑肌肉瘤2例)及19例良性病变(平滑肌瘤18例,脂肪瘤1例)。全部病例20例经手术、1例经内镜电切及7例经临床随访验证。结论 EUS结合细针穿刺活检是诊断粘膜下病变安全、有效的方法。     

超声内镜引导下细针穿刺活检确诊鱼刺穿破贲门致肝胃间隙脓肿一例

超声内镜引导下细针穿刺活检确诊鱼刺穿破贲门致肝胃间隙脓肿一例     

超声内镜引导下细针穿刺/活检对于胰腺占位性病变诊断的影响因素分析

超声内镜引导下细针穿刺/活检术对胰腺肿瘤的诊断，无论是在敏感性、特异性还是准确性方面均具有较高的诊断价值。各种技术上的改变，不仅包括但不限于针头大小、针型、针随病变内移动方式，还包括医师水平、针头加速度等均可影响其诊断阳性率。本文就超声内镜引导下细针穿刺/活检技术的影响因素作一综述。     

内镜超声早期诊断直肠癌术后局部复发二例

本文报道了2例无明显症状的直肠癌术后复发患者,2例患者均经内镜超声引导下细针穿刺活检证实为局部复发,并及时接受了腹会阴根治性切除复发肿瘤手术,预后良好。与常用的CT、MRI相比,内镜超声在诊断早期直肠癌术后局部复发方面也是很有价值的随访检查手段。     

超声内镜在胰腺肿瘤治疗中的应用进展

超声内镜( endoscopic ultrasonography,EUS)应用于临床已有30多年,早期EUS仅作为一种诊断方法应用于临床.随着凸面线阵型内镜超声的诞生,以超声内镜引导下细针穿刺为基础的诊断和治疗技术也逐渐发展起来.EUS引导下细针穿刺活检(EUS guided fine - needle aspiration,EUS - FNA)在诊断方面的应用已取得重大进展.     

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.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.