复发性多软骨炎20例临床分析

目的：提高对复发性多软骨炎的认识。方法：收集并分析20例复发性多软骨炎患者的临床和实验室检查资料。结果：发病年龄35－86岁，平均53．4岁，平均病程1．1年。90％的患者均有耳软骨炎；80％有呼吸系统受累，其中75％有鼻软骨炎，4例出现严重的气管、支气管软骨炎；部分患者有关节、皮肤、心脏、血管和神经系统受累；20％合并有其他风湿性疾病或自身免疫病。结论：气管、支气管软骨受累是病情严重的信号。早期诊断，给予激素和免疫抑制剂治疗是改善预后的关键。     

累及气道的复发性多软骨炎2例并文献复习

目的提高对侵犯气管、支气管的复发性多软骨炎的认识,减少误诊和漏诊率。方法分析我院2例累及气道的复发性多软骨炎的临床资料。结果1例患者因就诊时较晚,最后死于呼吸衰竭,另1例患者较早得到诊断,激素治疗预后较好。结论对伴有气管、支气管受累的复发性多软骨炎及时正确诊断,在疾病早期糖皮质激素治疗能显著改善症状,延缓疾病进展。     

高血压病和钙化性瓣膜病合并复发性及多发性栓塞一例

高血压病和钙化性瓣膜病合并复发性及多发性栓塞一例邹立华张爱伦汤宝鹏马依彤热西丹·卡斯木程祖亨患者男，６８岁。因咳嗽、心悸加重１周于１９９７年４月１４日入院。既往有高血压病和脑梗塞史。查体：ＢＰ２３／１２９ｋＰａ（１ｋＰａ＝７５ｍｍＨｇ），左鼻唇沟...     

膝骨关节炎超声检查临床意义

目的：为了评价超声检查膝骨关节炎（ＯＡ）的临床应用价值。方法：采用彩色多普勒对２１例患者３１个膝ＯＡ进行了扫查并与Ｘ线平片相对照。结果：超声显示软骨异常３１个（１００％），半月板撕裂、变性２３个（７４２％），髌腱炎１１个（３５５％），局灶性肌腱炎７个（２２６％），窝囊肿３个（９６％），髌上囊肿１个（３２％），滑膜增厚５个（１６１％）。Ｘ线平片示：骨性结构有改变１９个（６１２％）。病程较短，早期Ｘ线平片未见异常的１２个膝ＯＡ在超声上显示软骨低回声带模糊、消失的轻度病损。结论：超声与Ｘ线平片结合检查相互补充，有利于临床对膝ＯＡ的诊治     

复发性多软骨炎诊治指南(草案)

复发性多软骨炎(relapsing polychondritis，RP)是一种较少见的炎性破坏性疾病，其特点是软骨组织复发性退化性炎症，表现为耳、鼻、喉、气管、眼、关节、心脏瓣膜等器官及血管等结缔组织受累。复发性多软骨炎的病因及发病机制目前仍不清楚。软骨基质受外伤、炎症、过敏等因素的影响暴露出抗原性，导致机体对软骨局部或有共同基质成分的组织(如巩膜、葡萄膜、玻璃体、视神经内膜及神经束膜、主动脉中层和内层的结缔组织、心瓣膜、心肌肌纤维膜、气管黏膜下基底膜、关节滑膜和肾小球及肾小管基底膜等)的免疫反应。复发性多软骨炎可与类风湿关节炎、系统性血管炎、系统性红斑狼疮以及其他结缔组织病并发。     

老年人带状疱疹68例分析

一、临床资料１９９４年１月至１９９６年４月，住本院老年内科患者１０５０例，其中带状疱疹患者共６８例。男６２例、女６例，男∶女为１０３∶１；年龄６０～８４岁，平均６７４岁。原发疾病：上呼吸道感染后３４例（５００％），慢性支气管炎急性发作２１例（３...     

254例胰腺癌临床分析

目的：胰腺癌发病率呈上升趋势，但早期诊断仍较困难，根治率低。提高对胰腺癌的临床认识，可能对早期诊断有所裨益。方法：采用回顾性分析的方法，分析了１９７７～１９９５年间我院的２５４例胰腺癌病例。结果及结论：男１６６例，女８８例，年龄：２７～８４岁，平均５６９岁。首发症状以腹痛（５０４％）、黄疸（１５４％）、上腹不适（９４％）最常见；病程中的主要症状有腹痛（７２７％）、厌食（７２７％）、消瘦（６８２％）、黄疸（５７０％）、腰背痛（３３１％）。胰腺癌体征主要有腹部压痛（４４２％），肿块（２４４％）；黄疸是胰头癌的突出表现（８６３％），相当一部分是无痛性黄疸。Ｂ超、内镜超声检查、ＣＴ符合率均较高。手术切除率与病程和癌肿大小有关。提出了尽可能早期诊断的措施     

以呼吸道损害为唯一表现的复发性多软骨炎1例并文献回顾

目的探讨以呼吸道损害为唯一表现的复发性多软骨炎(RP)的临床特征、诊断及治疗。方法分析我院1例经计算机体层摄影术CT及支气管软骨活检术后病理诊断的RP患者的临床资料,并结合文献进行复习。结果患者为老年男性,以发热、咳嗽、咳痰为主要表现,肺功能示阻塞性通气功能障碍,胸部CT示气管主支气管管壁增厚,纤维支气管镜检查示气管支气管软骨环消失、管腔狭窄,病理检查为慢性炎症。予以糖皮质激素治疗有效。结论 RP以呼吸道单独受累的较为罕见,而呼吸系统受累常提示预后不佳,是该疾病死亡的主要原因。呼吸系统首先受累时,诊断是困难的且病情容易被耽误。影像学检查及软骨活检有助于诊断。治疗方式包括糖皮质激素或糖皮质激素联合免疫抑制剂等药物治疗及纤维支气管镜下气道成形术。     

肌炎/皮肌炎肺部受累的诊断及鉴别诊断

肌炎/皮肌炎(PM/DM)是一种特发性炎性肌病,是结缔组织病的一种,主要累及骨骼肌及其他器官.有报道指出,在肌炎/皮肌炎患者中呼吸系统受累的发病率高达45％[1].目前治疗该病的主要方法是糖皮质激素及免疫抑制剂.肌炎/皮肌炎合并呼吸系统受累时主要表现为由于肌无力所致的慢性呼吸衰竭,并发肺部感染、肺动脉高压、间质性肺炎等.Selva等[1]对81例肌炎/皮肌炎患者进行分析研究发现,61％的患者有肺部受累,其中有39％的患者表现为间质性肺炎,5例重型,预后不良;22％的患者表现为限制性肺病,其中有3例患者呼吸肌不能维持肺通气功能.由此可见,肌炎/皮肌炎患者间质性肺炎的发病率较高.     

复发性多软骨炎致气管狭窄1例及文献复习

复发性多软骨炎是一种罕见的以软骨组织炎症为特征的自身免疫性疾病,其特点是软骨组织复发性、退化性炎症,表现为全身多处软骨和结缔组织受累.复发性多软骨炎常累及呼吸道,导致气管、支气管软骨的缺失,管壁塌陷,气管狭窄等.最终多因呼吸道感染、呼吸衰竭而死亡,预后极差.由于早期症状隐匿,表现复杂,并且很多医师对该病缺乏认识,临床易导致漏诊、误诊、误治.现将我院收治的1例复发性多软骨炎报道如下.     

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.