精氨酸加压素及其V1a受体对心肌成纤维细胞向肌成纤维细胞转化的影响

目的:探讨精氨酸加压素(AVP)及其V1a受体对体外培养的SD仔鼠心肌成纤维细胞(CFs)向肌成纤维细胞(MFs)转化的影响。方法:胰酶消化法分离培养SD仔鼠CFs,将CFs分别与不同浓度(10-9、10-8、10-7、10-6 mmol/L)AVP,或添加了不同浓度(0、10-9、10-8、10-7 mmol/L)AVP V1a特异性受体拮抗剂[d(CH2)5Tyr2(Me)]AVP的10-6 mmol/L AVP共同孵育48h后,用3 H-脯氨酸掺入法检测CFs胶原合成功能,Western blot检测CFs平滑肌肌动蛋白α(α-SMA)表达量,α-SMA免疫荧光染色观察CFs形态。结果:AVP浓度依赖性地诱导CFs的3 H-脯氨酸掺入率和α-SMA表达量增加,其中10-6 mmol/L AVP组CFs的3 H-脯氨酸掺入率和α-SMA表达量均显著高于对照组(均P<0.05),且10-6 mmol/L AVP作用下CFs体积明显增大,胞质荧光染色亮度显著增强,胞质中有明显的张力丝样结构。而[d(CH2)5Tyr2(Me)]AVP可以浓度依赖性地抑制10-6 mmol/L AVP诱导下CFs 3 H-脯氨酸掺入率和α-SMA表达量的增加,其中10-8、10-7 mmol/L[d(CH2)5Tyr2(Me)]AVP组中CFs的3 H-脯氨酸掺入率显著低于10-6 mmol/L AVP组(均P<0.05),10-9、10-8、10-7 mmol/L[d(CH2)5Tyr2(Me)]AVP组中CFs的α-SMA表达量显著低于10-6 mmol/L AVP组(均P<0.05),且10-7 mmol/L[d(CH2)5Tyr2(Me)]AVP能够将10-6 mmol/L AVP诱导下CFs的3 H-脯氨酸掺入率、α-SMA表达量和形态学变化都抑制到对照组水平(均P>0.05)。结论:AVP通过其V1a受体诱导CFs向MFs转化。     

V1受体拮抗剂对精氨酸升压素诱导的大鼠心脏成纤维细胞增殖的影响

目的探讨V1受体拮抗剂[d(CH2)5-Tyr2(Me)]AVP对精氨酸升压素(AVP)诱导的大鼠心脏成纤维细胞增殖的影响. 方法采用胰酶消化法培养新生Sprague-Dawley (SD)大鼠心脏成纤维细胞(CFs),以3H-TdR掺入法测定CFs的DNA合成功能,MTT比色法测定CFs数目,并应用流式细胞仪进行CFs细胞周期分析. 结果①CFs的3H-TdR掺入率随着AVP干预浓度的增加而增高,其中10-7mol/L AVP和10-6mol/L AVP组每5000个细胞的3H-TdR掺入率分别为(243±61)cpm和(328±68)cpm,均明显高于对照组3H-TdR掺入率(117±32)cpm(P<0.01);②MTT比色法吸光度(A490 nm)值随AVP浓度的增加而增高,其中10-7mol/L AVP、10-6mol/L AVP组的A490 nm值分别为0.24±0.01和0.29±0.02,均较对照组A490 nm值(0.16±0.01)显著增高(P<0.01);③10-7mol/L AVP组CFs细胞周期S期百分率显著高于对照组(30.20±0.88)% vs (26.86±1.06)%( P<0.01);④10-7mol/L AVP+10-7 mol/L [d(CH2)5-Tyr2(Me)]AVP组的每5000个细胞的3H-TdR掺入率、MTT比色法A490 nm值和S期百分率分别为(143±40)cpm、0.17±0.01和(25.02±0.51)%,均显著低于10-7mol/L AVP组(分别P<0.05,P<0.01,P<0.01). 结论 AVP可诱导CFs的DNA合成功能增强和细胞数目增加,其作用可被V1受体拮抗剂[d(CH2)5-Tyr2(Me)] AVP所阻断,表明V1受体可能介导了AVP促CFs增殖效应.     

p27蛋白表达对精氨酸加压素介导心脏成纤维细胞增殖的影响

目的 :观察精氨酸加压素 （AVP）作用下 p2 7蛋白表达在心脏成纤维细胞 （CFs）中的变化 ,探讨 p2 7蛋白调控AVP促 CFs增殖的作用。方法 :以培养的新生 SD大鼠 CFs为实验动物模型 ,采用胰酶消化、差速贴壁法培养CFs,四氮唑盐 （MTT）比色法检测细胞增殖 ,碘化丙啶标记细胞 DNA ,p2 7蛋白的单抗和标记了 FITC的二抗标记细胞内的 p2 7蛋白 ,采用流式细胞分析仪技术测定细胞周期及 p2 7蛋白表达的阳性率。结果 :1随 AVP浓度的增加 ,MTT法测得的 CFs的 A值呈递增趋势 ,其中 10 - 7,10 - 6 m ol/ L AVP组分别为 0 .30 7± 0 .0 0 9,0 .337± 0 .0 0 7,均明显地高于对照组 （0 .2 98± 0 .0 0 9） ,并有统计学意义 （分别 P<0 .0 5 ,P<0 .0 1） ;2随 AVP浓度的增加 ,CFs的 S期细胞百分率和细胞增殖指数 （PI）逐渐增加 ,G0 / G1 期百分率下降 ,10 - 7,10 - 6 mol/ L AVP组与对照组比较差异非常显著 （P<0 .0 1） ;3CFs的 p2 7蛋白表达阳性率随 AVP浓度的增加而呈递减趋势 ,其中 10 - 7,10 - 6 m ol/ L AVP组 （分别为 71.6 %± 2 .2 % ,6 3.1%± 2 .3% ）明显低于对照组 （86 .5 %± 2 .3% ） ,并有统计学意义 （P<0 .0 1）。结论 :p2 7蛋白是 AVP促 CFs增殖过程的重要负性调节因子 ,AVP通过下调 p2 7蛋白发挥促 CFs增殖作用 ,这可     

拉西地平对AVP诱导的大鼠心脏成纤维细胞增殖的影响及其与ERK1/2的关系

目的观察拉西地平对血管加压素（AVP）诱导的大鼠心脏成纤维细胞（CFs）增殖的影响及其与细胞外信号调节激酶（ERK）1/2的关系。方法以培养的新生SD大鼠CFs为实验模型,采用四氮唑盐比色法测定细胞数目;用流式细胞术分析细胞周期;用蛋白免疫印迹法测定总细胞外信号调节激酶（t-ERK）1/2和磷酸化细胞外信号调节激酶（p-ERK）1/2在细胞内的表达。实验按照给予CFs干预因素的不同,分为对照组、10-7mol/L AVP处理组、10-910-6mol/L拉西地平+10-7mol/L AVP干预组和10-7mol/L拉西地平单独干预组。结果①10-7mol/LAVP干预24 h后,CFs的A490值（0.232±0.013）较对照组（0.132±0.008）显著增高（P<0.01）。在10-910-6mol/L拉西地平和10-7mol/L AVP共同干预下,拉西地平可呈浓度依赖性地下调CFs的A490值,分别为0.216±0.01、0.203±0.01、0.176±0.01和0.160±0.01,均显著低于AVP组（P<0.01）。②细胞周期分析显示,AVP组CFs在S期的百分率和增殖指数（PI）分别为13.06±0.83和21.70±1.55,与对照组（分别为4.60±0.60和8.97±1.56）比较显著增高（P<0.01）。在10-7mol/L拉西地平干预下,细胞在S期的百分率（8.84±0.80）和PI（15.46±1.84）较AVP组显著降低（P<0.01）。③AVP组CFs的p-ERK1/2表达显著高于对照组（P<0.01）,10-9、10-8、10-7和10-6mol/L拉西地平组CFs中p-ERK1/2的表达与AVP组比较呈浓度依赖性地降低（P<0.01）。结论拉西地平可抑制AVP诱导的大鼠CFs增殖,提示拉西地平对预防和逆转心脏重构具有一定的作用,其机制可能与ERK1/2的磷酸化有关。     

心肌成纤维细胞NOS-NO系统活性的变化及其与AVP的关系

目的 :探讨无干预和血管升压素 （AVP）干预条件下 ,心肌成纤维细胞 （CFs）的一氧化氮合酶—氧化氮 （NOS-NO）系统活性的变化。方法 :胰酶消化法分离、培养新生 SD大鼠 CFs,采用硝酸还原酶法和分光光度法观察无干预和 AVP干预条件下 ,不同培养时间对 CFs的 NOS- NO系统活性的影响。结果 :1无干预条件下 ,CFs的 NO含量和 NOS活性随培养时间延长而增高 ,其中 36 h（4 2± 5 μmol· L- 1 ,37± 5 U· m L- 1 ）显著高于 6 h（14± 3μmol·L- 1 ,10± 4U· m L- 1 ）以及 12 h（2 1± 3μm ol· L- 1 ,15± 3U· m L- 1 ） （均 P<0 .0 5 ）。 2 AVP干预条件下 ,CFs的NO含量和 NOS活性也随培养时间延长而增高 ,其中 2 4h（6 5± 6 μmol· L- 1 ,70± 4U· m L- 1 ） ,36 h（6 2± 1μm ol· L- 1 ,6 9± 6 U· m L- 1 ）都显著高于 6 h （34± 4μmol· L- 1 ,36 +2 U· m L- 1 ）以及 12 h的 （4 5± 4μmol· L- 1 ,45± 1U· m L- 1 ） （均 P<0 .0 5 ）。 3AVP干预条件下 CFs的 NO含量和 NOS活性均较无干预条件下显著增高 ,且 NO含量随 NOS活性增高而增高 ,二者呈显著正相关 （无干预条件下 r=0 .837,P<0 .0 1;AVP干预条件下 r=0 .936 ,P<0 .0 1）。结论 :AVP提高 CFs的 NOS- NO系统活性 ,CFs的 NOS- NO系统活性与培养和 AVP?     

TGF-β1在AVP诱导的心肌成纤维细胞表型转化中的作用

目的:探讨转化生长因子β1(TGF-β1)在精氨酸加压素(AVP)诱导的心肌成纤维细胞(CFs)向肌成纤维细胞(MFs)转化中的作用。方法:用胰酶消化法分离培养SD仔鼠的CFs,将CFs分别与不同浓度的AVP、不同浓度的TGF-β1或添加了不同浓度的抗TGF-β1中和抗体的1×10-6mmol/L AVP共同孵育48 h后,用3H-脯氨酸掺入法检测CFs胶原合成的功能,用Western blot检测CFs中平滑肌肌动蛋白α(α-SMA)的表达量,用ELISA法检测CFs中TGF-β1的合成。结果:AVP可浓度依赖性地诱导CFs的3H-脯氨酸掺入率和α-SMA的表达量增加,其中1×10-6mmol/L AVP组CFs的3H-脯氨酸掺入率和α-SMA的表达量显著高于对照组(P<0.05)。AVP也可浓度依赖性地诱导CFs中内源性TGF-β1的合成增加,其中在1×10-6mmol/L AVP刺激下,CFs合成显著增加的内源性TGF-β1刚好达到外源性TGF-β1诱导CFs向MFs转化所需要的剂量(>2 ng/ml)。抗TGF-β1中和抗体虽然能够显著抑制在10-6mmol/L AVP诱导下CFs的3H-脯氨酸掺入率和α-SMA的表达量(P<0.05),但却不能将其抑制到与对照组相近的水平(P<0.05)。结论:AVP刺激下CFs中内源性TGF-β1合成的增加可部分地介导AVP诱导的CFs向MFs转化。     

辛伐他汀对血管加压素诱导大鼠心肌成纤维细胞增殖的影响及其与小窝蛋白-1表达的关系

目的研究辛伐他汀（simvastatin,Sim）对精氨酸血管加压素（arginine vasopressin,AVP,简称血管加压素）诱导成年大鼠心肌成纤维细胞（CFs）增殖的影响及其与小窝蛋白-1（caveolin-1,cav1）的关系。方法离体培养成年大鼠CFs,以四氮唑盐（MTT）比色法检测CFs的增殖,流式细胞分析仪测定其细胞周期,蛋白免疫印迹法检测cav1蛋白的表达。观察cav1在AVP诱导大鼠CFs增殖前后及Sim干预后的变化。结果10-7mol/LAVP干预24 h后,MTT比色法检测CFs的吸光值（A）（0.24±0.03）较对照组（0.15±0.02）显著增高（P<0.01）;给予10-810-5mol/L的Sim和AVP共同干预后,CFs的A值呈递减趋势,分别为0.22±0.03、0.21±0.02、0.19±0.02和0.17±0.02,均较AVP组降低,差异具有统计学意义（P<0.05,P<0.01）。以10-7mol/L的AVP干预24 h后,CFs S期的百分率（19.52±1.07）和增殖指数（48.25±1.27）较对照组（分别为7.02±0.27和18.93±3.03）均显著增高（均P<0.01）;10-710-5mol/L Sim与10-7mol/L AVP联合干预组CFs S期的百分率和增殖指数均较AVP单独干预组降低,差异具有统计学意义（P<0.05,P<0.01）。10-7mol/L的AVP分别与10-810-5mol/L的Sim共同干预后,cav1蛋白的表达呈浓度依赖性地减少。甲羟戊酸（MVA）可逆转Sim对CFs增殖的抑制效应,并拮抗Sim诱导的cav1蛋白表达的降低。结论Sim可抑制AVP诱导的CFs增殖,Sim的干预效应可能受到cav1蛋白表达的调节。     

小窝蛋白-1反义寡核苷酸在AVP诱导大鼠心肌成纤维细胞增殖erk1/2信号转导中的作用及辛伐他汀的干预效应

目的 研究小窝蛋白-1反义寡核苷酸(cav1-AS ODN)在血管加压素(AVP)诱导的成年大鼠心肌成纤维细胞(CFs)增殖erk1/2信号转导中的作用及辛伐他汀(Sim)对cav1表达的干预效应.方法 采用脂质体导入法将cav1-AS ODN导入离体培养的成年大鼠CFs,用3H-TdR掺入法定量观察CFs增殖,蛋白免疫印迹法分析cav1-AS ODN对AVP诱导大鼠CFs增殖后磷酸化erk1/2 (p-erk1/2)、p21和细胞周期蛋白A(cyclin A)表达变化及Sim对cav1表达的影响.结果 cav1-AS ODN与10-7 mol/L的AVP共同干预组,大鼠CFs内3H-TdR掺入率和p-erk1/2蛋白表达量分别相当于空白对照组的(212±6)% 和(7.9 ± 0.3)%,10-7mol/L的AVP单独干预组的3H-TdR掺入率和p-erk1/2表达量分别相当于空白对照组的(172±4)%和(5.7±0.2)%,两组比较差异非常显著(P<0.01).cav1-AS ODN单独干预或与10-7mol/L的AVP共同干预大鼠CFs 24 h后,两组CFs内p21表达丰度均较空白对照组下降,cyclin A表达丰度升高.β-环糊精、黄体酮或Sim可减少CFs胞膜上cav1蛋白表达.用10、15或20 μg/ml胆固醇分别与10-7 mol/L Sim共同干预CFs 24 h后,CFs胞膜上cav1蛋白表达量分别相当于对照组的(86±3)%、(91±4)%和(94±5)%,与10-7mol/L Sim单独作用CFs组(66±4)%比较,均有显著的统计学差异(P<0.05,P<0.01).结论 cav1-AS ODN可增强AVP促CFs增殖的作用,Sim降胆固醇作用影响CFs胞膜上cav1蛋白表达,从而影响CFs增殖.     

IL-1β对鼠心肌成纤维细胞增殖和p27蛋白表达的影响

目的 :观察 IL - 1β对基础状态及精氨酸加压素 （AVP）诱导心肌成纤维细胞 （CFs）增殖和 p2 7蛋白表达的影响。方法 :采用胰酶消化 ,差速贴壁法培养 CFs,四氮唑盐 （MTT）比色法检测细胞增殖 ,碘化丙啶 （PI）标记细胞DNA,间接免疫组化染色标记细胞内的 p2 7蛋白 ,用流式细胞分析仪 （FCM）技术测定细胞周期和 p2 7蛋白表达的阳性率。结果 :11× 10 - 7mol/ L AVP组 MTT法测定的 CFs的吸收 （A）值 （0 .386± 0 .0 11）较基础状态 （0 .32 4± 0 .0 0 7）明显升高 （P<0 .0 1） ;1× 10 5 U/ L IL - 1β单独作用组 （0 .2 98± 0 .0 30 ）和 AVP+IL - 1β组 （0 .332± 0 .0 41）的 A值均分别较基础状态和 AVP组显著降低 （均 P<0 .0 1） ;2 IL- 1β组和 AVP+IL- 1β组 CFs的 S期细胞百分率和细胞增殖指数 （PI）分别较基础状态组和 AVP组明显降低 ,而 G0 / G1 期细胞百分率则分别高于上述两组 （均 P<0 .0 1） ;3IL- 1β组和 AVP+IL- 1β组 CFs的 p2 7蛋白表达阳性率分别为 （95 .0 3± 1.0 2 ） % ,（88.2 3± 2 .87） % ,分别高于基础状态 （78.45± 1.91） %和 AVP组 （6 3.30± 1.85 ） % ,并且有统计学意义 （均 P<0 .0 1）。结论 :IL - 1β通过升高细胞内 p2 7蛋白表达水平参与 CFs增殖的负调控过程。     

辛伐他汀对血管升压素诱导鼠心脏成纤维细胞增殖和胶原合成的影响

目的探讨辛伐他汀（S imvastatin,S im）对血管升压素（AVP）诱导的新生SD大鼠心脏成纤维细胞（CF）增殖和胶原合成作用的影响,为防治高血压左室肥厚提供理论依据。方法以培养的新生SD大鼠CF为实验模型,采用胰酶消化、差速贴壁法培养CF,运用MTT比色法和3H-脯氨酸掺入法分别观察不同浓度S im对AVP诱导CF增殖和胶原合成的作用及甲羟戊酸（m evalonate,MVA）干预的影响。结果①CF的3H-脯氨酸掺入率随着S im干预浓度的增加而降低,其中1μmol/L和10μmol/L S im组的3H-脯氨酸掺入率分别为（3.67±0.39）mBq/cell和（2.35±0.36）mBq/cell,明显低于对照组（5.01±0.58）mBq/cell（P<0.01）;②MTT比色法A490值随S im浓度的增加而降低,其中1μmol/L和10μmol/L S im组的A490值分别为0.221±0.038和0.163±0.021,均较对照组A490值（0.395±0.039）显著降低（P<0.01）;③10μmol/L S im+1 mmol/L MVA组的3H-脯氨酸掺入率和MTT比色法A490值分别为（5.38±0.72）mBq/cell和0.419±0.051,均显著高于同组10μmol/L S im（P<0.01）。结论S im抑制AVP诱导的CF增殖和胶原合成,其机制可能通过MVA代谢途径实现。     

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.     

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.     

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.     

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.