垂体瘤术后垂体功能评估情况的调查

目的 分析垂体瘤患者术后1周及3个月的垂体功能复查情况,为垂体瘤手术患者的后续临床治疗提供参考.方法 收集1993年1月至2010年1月期间解放军总医院内分泌科住院诊断为垂体瘤并进行完整垂体功能评估后行垂体瘤切除术的106例患者,回顾性分析其各项临床资料.结果 患者术后1周与3个月的乖体功能评估率分别为23.6％与16.0％.术前存在垂体功能减退患者,术后1周与3个月的垂体功能评估率分别为23.5％与5.9％,术前垂体功能无减退者垂体功能评估率分别为23.6％和20.8％,术前存在垂体功能减退者并未得到更多的垂体功能评价关注.术后l周因手术导致新发垂体功能减退率为48.0％,术后3个月为35.3％.结论 垂体瘤术后1周内及3个月复查率低,垂体瘤术后可能存在较多漏诊垂体功能减退的患者.     

垂体瘤切除术对垂体瘤并发心脏扩大患者心功能的影响

目的 回顾分析垂体瘤切除术对垂体瘤并发心脏扩大患者的心功能变化的影响.方法 收集解放军总医院2005 -2011年经垂体瘤切除术治疗的14例垂体腺瘤并发心脏扩大患者临床资料,对比分析手术前后患者心功能情况及术后恢复情况,利用超声心动图等无创检测手段检测患者术前及术后血清生长激素(GH)、左室舒张末期内径(LVEDD)、室间隔厚度(ST)、左室后壁厚度(LVPWT)和左室射血分数(LVEF),进行对比分析.结果 垂体瘤切除术后GH、ST、LVEF、LVPWT 平均值较术前均显著改善(分别为GH 93.89 μg/L比5.16 μg/L、ST 11.13 mm比10.64 mm、LVEF 43.92％比49.28％、LVPWT 10.53 mm比8.87 mm).手术前后GH差值与手术前后ST、LVEDD、LVEF差值呈线性关系,与手术前后LVEF差值呈正相关,与手术前后LVEDD和ST差值呈负相关.结论 垂体瘤切除术用于治疗垂体腺瘤并发心脏扩大可显著改善患者心功能,其心功能恢复程度和手术前后GH差值关系明显.     

原发性甲状腺功能减退致垂体增生四例

原发性甲状腺功能减退（甲减）患者血循环中甲状腺激素水平降低，负反馈作用减弱，可致垂体TSH细胞和催乳素细胞增生，垂体MRI示体积增大，甚至被误诊为垂体瘤。本文报道4例此类患者，其中3例曾被误诊为垂体瘤，此现象应引起临床医师注意。     

内分泌激素水平监测对垂体瘤患者手术远期疗效的观察

目的 探讨内分泌激素水平监测对垂体瘤手术远期疗效观察的意义.方法 动态观察经显微外科手术治疗的137例垂体瘤患者手术前后血清泌乳素(PRL)、生长激素(GH)、甲状腺功能[T3、T4促甲状腺素(TSH)、血皮质醇(F)和促肾上腺皮质激素(ACTH)]的变化,并进行2年以上的随访和远期疗效评价.结果 术后1周内PRL、GH水平明显下降且与以后的PRL、GH水平基本一致,垂体GH瘤患者34例,术后GH降至0.34 nmol/L以下者11例,23例GH未降至0.34 nmol/L以下,其中13例术后5年内复发.结论 术后1周的PRL和GH水平可做为判断手术疗效的指标之一,术后GH降至0.34 nmol/L以下可做为判断临床治愈的标准.     

垂体前叶功能减退症88例回顾性分析

目的 探讨垂体前叶功能低下的临床表现，诊断和治疗，方法 回顾性分析８８例垂体前叶功能低下患者的临床资料。结果 男性２７例，女性５１例，平均病程４．８年，席汉综合征３８例，垂体瘤３２例，颅咽管瘤４例，生殖细胞瘤３例，特发性垂体功能减退６例，空泡蝶鞍２例，脊索瘤，垂体囊肿和隐球菌性脑膜炎各１例，８０％以上患者有性腺功能低下表现，甲状腺功能低下占３３．３％，严重的上腺皮质功能低下者较少，发生低血压，低血     

垂体腺瘤患者的围手术期垂体激素监测及临床意义

为了对垂体腺瘤患者进行手术前后激素测定、分型、并监测术后垂体功能以及寻求一种判断手术切除程度及术后有无复发的方法，对50例垂体腺瘤手术患者采用放免法测定手术前、后激素水平，对测定值进行回顾性分析，判断检测结果的相互关系并分析其临床意义。结果：泌乳素(PRL)腺瘤及生长激素(GH)腺瘤全切组及末全切组术后激素水平均较术前明显降低(P＜0．05)，全切组术后激素水平与末全切组比较有明显差异(P＜0．05)。认为手术治疗可以明显改善垂体瘤患者术前高激素水平状态，手术治疗有着肯定的治疗价值。其切除程度将决定着术后内分泌的改善水平，应在不损害正常垂体前提下争取全切肿瘤。     

垂体腺瘤患者围术期糖皮质激素替代疗法的研究进展及争议

垂体腺瘤是第二位常见的原发性中枢神经系统肿瘤,糖皮质激素常作为垂体腺瘤患者围术期常规替代治疗药物,用以预防术后肾上腺皮质功能低下或肾上腺危象发生.但近年随着临床对糖皮质激素不良反应认识程度的加深、对患者围术期激素动态变化研究的深入,并结合既往研究,使垂体腺瘤患者围术期常规给予糖皮质激素替代治疗的做法受到质疑.本文就垂体...     

库欣病术后预后相关因素

库欣病经蝶窦显微外科垂体腺瘤切除术后预后相关因素包括:肿瘤分级、术中发现、术后病理、术后血清皮质醇水平、血浆促肾上腺皮质激素(ACTH)水平等.尽管一些指标能够较好地预示手术失败或术后缓解,但目前无一指标是完美的,应长期监测患者下丘脑-垂体-肾上腺轴功能.本文综述了与库欣病经蝶垂体瘤术后预后相关的因素.     

无功能性垂体腺瘤围手术期内分泌水平的变化及诊断进展

无功能性垂体腺瘤起源于垂体前叶上皮细胞,约占垂体腺瘤的1/3,大多数患者临床表现为头痛、视物模糊。但是部分患者术前及术后出现垂体功能减退。肿瘤对门静脉及垂体柄的压迫导致垂体前叶缺血坏死是引起垂体功能低下的主要机制,术中操作、肿瘤大小及残留都可导致新发垂体功能低下。术前主要以生长激素缺乏为主,而术后出现各个激素轴的改变。垂体功能减退容易被忽视,仅靠激素基础值的检测诊断远远不够,必要时需行刺激试验确诊。一旦明确垂体功能减退,充足的激素替代治疗能够提高患者的生活质量。     

垂体功能减退激素替代治疗1例

目的阐明垂体功能减退患者的临床表现，探讨垂体激素替代治疗的几点经验。方法对1例垂体腺瘤切除术后的临床特征进行分析，结合检验结果，对疗效进行观察。结果该例患者病情得到缓解，生活质量提高。结论垂体功能减退经激素替代治疗后患者相应的功能得以代偿，病情改善。积极防治并发症对保证患者体内激素水平的稳定起到了不容忽视的作用。     

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.     

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.     

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.