甘露醇预处理后骨髓间充质干细胞移植对血管性痴呆大鼠认知功能及脑源性神经生长因子表达的影响

目的探讨甘露醇预处理后骨髓间充质干细胞（BMSCs）静脉移植对血管性痴呆（VD）大鼠认知功能及脑组织中脑源性神经生长因子（BDNF）表达量的影响。方法全骨髓培养结合细胞贴壁法分离纯化大鼠BMSCs。取健康雄性sD大鼠79只,随机分为假手术组（10只）和模型组（69只）。采用间隔3d分别结扎双侧颈总动脉法制备VD模型。造模后4周,将纳入的32只模型组大鼠随机分为甘露醇预处理BMSCs移植组（简称甘露醇预处理组;尾静脉注射甘露醇1．5g／kg,预处理10～30min后,经尾静脉注射1×10^6／ml BMSCs 1ml）、BMSCs移植组（注射等量的BMSCs,不注射甘露醇）和培养基对照组（注射等量的基础培养液）。剔除死亡大鼠,上述3组分别有9、11、8只,假手术组7只纳入统计。干预后4周,采用Morriss水迷宫实验检测大鼠认知功能,酶联免疫吸附法检测大鼠脑组织中BDNF的含量。结果（{）4组相同时间点的比较,BMSCs移植组比培养基对照组逃避潜伏期缩短（均P〈0．01）,平台象限滞留时间延长（P〈0．05）;甘露醇预处理组比BMSCs移植组逃避潜伏期明显缩短（P〈0．01）,平台象限滞留时间延长（P〈0．05）,且均与假手术组水平接近（P〉0．05）。②在额叶皮质和海马区,BMSCs移植组的BDNF含量均高于培养基对照组（P〈0．01）;甘露醇预处理组则高于BMSCs组（P〈0．01）,但均低于假手术组的水平（P〈0．01）。结论与单独静脉注射BMSCs比较,甘露醇预处理后BMSCs静脉移植治疗VD大鼠模型,认知功能改善程度更佳;额叶皮质和海马中BDNF的表达量更高。     

健脾化湿颗粒对D-IBS模型大鼠脑中5-HT及5-HTR3,5-HTR4表达的影响

目的:从前额叶皮质、海马及下丘脑中5-羟色胺(5-hydroxytryptamine,5-HT)和5-羟色胺受体3(5-hydroxytryptamine receptor3,5-HTR3),5-羟色胺受体4(5-HTR4)角度探讨健脾化湿颗粒改善腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)模型大鼠结肠运动和内脏敏感性的作用机制.方法:采用番泻叶灌胃结合束缚应激法建立D-IBS大鼠模型,应用健脾化湿颗粒进行干预,采用酶联免疫法(ELISA)检测大鼠海马中5-HT含量,采用免疫组织化学法检测前额叶皮质、海马及下丘脑中5-HT、5-HTR3、5-HTR4阳性表达,采用逆转录-聚合酶链反应法检测海马中5-H T R3 m R N A和5-H T R4m RNA的表达水平.结果:与正常组相比,模型组海马中5-HT含量(327.30±22.35 vs 265.33±13.60),前额叶皮质、海马、下丘脑中5-HT阳性表达(0.16±0.02 vs 0.08±0.01,0.19±0.02 vs 0.09±0.01,0.17±0.02 vs 0.08±0.01)明显升高(P0.01);前额叶皮质、海马、下丘脑中5-HTR3阳性表达(0.29±0.02 vs 0.10±0.01,0.23±0.02 vs 0.09±0.01,0.22±0.02 vs 0.09±0.02)及5-HTR4阳性表达(0.25±0.02 vs0.11±0.01,0.28±0.02 vs 0.10±0.02,0.27±0.02 vs 0.11±0.02)明显升高(P0.01);海马中5-H T R3 m R N A和5-H T R4 m R N A的表达(0.54±0.01 vs 0.17±0.05,0.73±0.08 vs 0.10±0.02)显著升高(P0.01).与模型组相比,阳性对照组、中、高剂量组海马中5-H T含量(298.92±12.16、286.29±24.43、279.86±20.05 vs 327.30±22.35)显著下降(P0.05,P0.01),中、高剂量组前额叶皮质中5-HT表达(0.12±0.01、0.11±0.01 vs 0.16±0.02)显著下降(P0.01),阳性对照组、中、高剂量组海马、下丘脑中5-H T表达显著下降(P0.05,P0.01);各治疗组前额叶皮质、海马、下丘脑中5-H T R3表达及5-H T R4表达下降显著(P0.05,P0.01);各治疗组海马中5-H T R3 m R N A表达及5-H T R4 m R N A表达显著降低(P0.05,P0.01).结论:健脾化湿颗粒可能通过下调脑中5-HT、5-HTR3、5-HTR4表达来改善D-IBS模型大鼠结肠运动和内脏敏感性.     

甘麦大枣汤加味对抑郁症模型大鼠海马-HPA轴的调节作用

目的 探讨甘麦大枣汤加味对模型大鼠海马-HPA轴的调节作用.方法 以孤养加慢性不可预见性温和刺激制作抑郁症模型大鼠,放免法检测大鼠血浆促肾上腺皮质激素(ACTH)、皮质酮(CORT)含量,RT-PCR法检测大鼠海马糖皮质激素受体(GR)、脑源性神经营养因子(BDNF)mRNA表达.并以西药文拉法辛为对照,观察甘麦大枣汤加味对上述各项指标的影响.结果 模型组大鼠垂体重/体重、血浆ACTH、CORT含量显著增高(P＜0.05),海马GR、BDNF mRNA表达降低;与模型大鼠比较,西药组与中药组大鼠血浆CORT含量显著下降(P＜0.05),血浆ACTH含量有下降趋势,海马GR、BDNF mRNA表达增高.结论 甘麦大枣汤加味与文拉法辛通过对海马保护作用,抑制HPA轴过度亢进,从而纠正模型大鼠行为学异常.     

丁基苯酞对血管性痴呆大鼠记忆及海马Bcl-2、Bax的影响

目的 研究丁基苯酞(NBP)对血管性痴呆(VD)大鼠记忆、海马病理变化及抗凋亡蛋白(Bcl-2)和促凋亡蛋白(Bax)蛋白表达的影响.方法 采用永久性结扎双侧颈总动脉方法制备VD大鼠模型.SD大鼠被随机分成假手术组、VD模型组、NBP治疗组、尼莫地平治疗组.应用Morris水迷宫检测大鼠记忆能力,苏术精-伊红(HE)染色观察海马神经元形态,免疫组化检测海马Bcl-2和Bax的表达.结果 VD模型组与假手术组大鼠比较记忆能力显著下降,逃避潜伏期分别为(78.79±21.93) s与(16.96±7.44) s (P＜0.05),海马神经元病理改变严重,免疫阳性细胞数量显著增加,其中Bax变化更为显著 (43.00±6.72与6.00±1.29,P＜0.05),Bcl-2与Bax的比值较对照组明显降低;NBP治疗组与模型组比较记忆能力显著改善,逃避潜伏期分别为(47.13±21.75) s与(78.79±21.93) s (P＜0.05),海马神经元病理形态明显改善,Bcl-2免疫阳性细胞数显著增多(33.14±8.05与21.81±4.97,P＜0.05),Bax免疫阳性细胞数显著减少(32.93±4.99与43.00±6.72,P＜0.05).NBP治疗组与尼莫地平治疗组之间比较,各项指标均无显著差异 (P＞0.05).结论 NBP能改善VD大鼠记忆能力,抑制海马细胞凋亡,对VD大鼠有一定的治疗作用.

Abstract：

Objective To study the effects of butylphthalide (NBP) on memory and apoptosis related protein as well as neuronal pathology in hippocampus of vascular dementia (VD) rats. Methods VD model was generated by the permanent occlusion of bilateral common carotid arteries in SD rats to produce the forebran ischemia. Male SD rats were randomly allocated into sham-operation group, VD model group, NBP treatment group and nimodipine treatment group. The function of memory was tested by the Morris water maze. The neuronal pathological changes and the expression of Bcl-2 and Bax proteins in the hippocampus were observed with hematoxylin-eosin (HE) staining and immunohistochemical staining, respectively. Results The impaired memory of VD rats was proved by the lengthened mean escape latency [(78.79±21.93)vs.(16.96±7.44),P＜0.05] and the neuron in hippocampus was severely damaged. The decveased ratio of Bcl-2/Bax resulted from the overexpression of Bax proteins in VD model group versus the sham-operation group [(43.00±6.72)vs.(6.00±1.29),P＜0.05]. The treatment of NBP notably improved the memory function of VD rats and reduced the hippocampus pathological injury (P＜0.05). The expression of Bcl-2 protein raised [(33.14±8.05)vs.(21.81±4.97),P＜0.05] along with reduced expression of Bax protein [(32.93±4.99)vs.(43.00±6.72),P＜0.05] after NBP treatment. However, there was no significant difference in the treatment effects between nimodipine and NBP group (P＞0.05). Conclusions NBP treatment could improve memory of VD rats and reduce the hippocampus pathological lesion by inhibiting the apoptosis related protein.     

雌激素对抑郁大鼠海马单胺类神经递质含量的影响及缰核在其中的作用

目的 探讨雌激素对抑郁大鼠海马内单胺类递质含量的调节以及缰核在其中的作用.方法 雌性Wistar大鼠随机被分成6组:正常对照组( Control)、抑郁模型组(Depression)、假手术组(SHAM)、去卵巢组(OVX)、雌二醇组(OV/ER)、缰核损毁组(Hb lesion).用高效液相色谱法( HPLC)检测各组海马内5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)递质的含量.结果 OVX组大鼠海马内5-HT、NE和DA含量与SHAM组大鼠相比降低,OV/ER组大鼠海马内5-HT、NE和DA含量与OVX组大鼠相比均显著回升.Depression组大鼠海马内5-HT、NE和DA含量与Control组相比明显降低;抑郁大鼠外侧缰核损毁后,海马内的5-HT、NE和DA含量均升高.结论 缰核可以通过对海马功能的影响介导雌激素改善抑郁行为的作用.     

何首乌提取物对血管性痴呆大鼠5-HT受体及生化指标的影响

目的研究何首乌提取物对血管性痴呆大鼠学习记忆的影响,初步探讨血管性痴呆大鼠5-HT2A受体的表达及血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量的变化。方法采用双侧颈总动脉永久性结扎法建立大鼠血管性痴呆模型,随机分为假手术组、模型组、阳性对照组、何首乌组。通过水迷宫实验检测各组大鼠的学习记忆能力和血清SOD活性、MDA含量的变化;通过免疫组化技术检测各组大鼠丘脑前核内5-HT2A受体的表达水平。结果模型组大鼠d4逃避潜伏期(38.95±27.42)s,平台象限游泳时间(20.35±3.52)s,穿过平台次数(1.50±0.76),SOD活性(0.855±0.094)kU/g prot,MDA含量(5.187±1.237)μmol/g prot,5-HT2A受体的阳性细胞积分光密度值增高。何首乌组大鼠d4逃避潜伏期(15.28±9.83)s,平台象限游泳时间(24.66±3.56)s,穿过平台次数2.75±1.28,SOD活性(0.968±0.158)kU/g prot,MDA含量(4.595±1.104)μmol/g prot,5-HT2A受体的阳性细胞积分光密度值降低。其机制与何首乌组与模型组差异显著(P<0.05),假手术组、阳性对照组与何首乌组差异不显著。结论何首乌提取物能够改善血管性痴呆大鼠学习记忆功能,其机制与使5-HT2A受体表达增强以及抗氧化损伤有关。     

左旋丁基苯酞对血管性痴呆大鼠神经功能、线粒体氧化应激及海马组织胶质细胞源性神经营养因子表达的影响

目的通过建立血管性痴呆(VD)大鼠模型,观察左旋丁基苯酞(L-NBP)对VD大鼠神经功能、线粒体氧化应激水平及海马组织胶质细胞源性神经营养因子(GDNF)表达的影响。方法选择6月龄雄性SD大鼠,随机分为假手术组,模型组,L-NBP组,每组20只,采用永久性结扎双侧颈总动脉建立大鼠VD模型,L-NBP组给予L-NBP 3 w,Morris水迷宫行大鼠学习记忆能力测定,取海马线粒体测定超氧化物歧化酶(SOD)、活性氧(ROS),HE染色观察脑组织神经元损伤,免疫组化法测定GDNF蛋白表达水平。结果与假手术组比较,模型组逃避潜伏期明显延长,穿越平台次数明显降低,海马组织神经元损伤明显,ROS含量明显升高,SOD活性、GDNF表达明显降低(P0.05);与模型组比较,L-NBP组逃避潜伏期明显缩短,穿越平台次数明显增加,海马组织神经元损伤明显改善,ROS含量明显降低,SOD活性、GDNF表达明显增高(P0.05)。结论 L-NBP可能通过调控线粒体氧化应激水平、上调VD大鼠海马GDNF表达,减轻VD大鼠神经元缺血损伤,改善学习记忆能力。     

补阳还五汤对血管性痴呆大鼠行为学和海马神经元形态学的影响

目的观察补阳还五汤对血管性痴呆(VD)大鼠学习记忆能力和海马神经元形态的影响。方法将60只大鼠随机分为5组:正常对照组、假手术组、模型组、补阳还五汤组、尼莫地平组。补阳还五汤组药量为50g/(kg·d),尼莫地平组药量为20mg/(kg·d),共给药30d。模型组、假手术组和正常对照组均给予蒸馏水1mL/100g灌胃。治疗后以Morris水迷宫检测其学习记忆行为能力,以HE染色、Nissl染色检测其神经细胞形态学的变化。结果Morris水迷宫实验中,正常对照组、假手术组、模型组、补阳还五汤组、尼莫地平组的逃避潜伏期分别为:7.67s±3.42s、8.76s±4.03s、29.56s±13.28s、16.96s±7.06s、20.16s±8.89s;探索次数分别为:16.86/min±5.37/min、14.42/min±4.01/min、4.26/min±0.80/min、8.96/min±1.30/min、8.74/min±2.52/min。与正常对照组比较,模型组大鼠逃避潜伏期明显延长(P0.05),平均探索次数显著减少(P0.05);与模型组比较,补阳还五汤组、尼莫地平组大鼠逃避潜伏期明显缩短(P0.05),平均探索次数显著增加(P0.05)。光镜观察显示,补阳还五汤组和尼莫地平组均可见海马CA1区神经元脱失现象明显减轻,数目增多,神经元丢失率明显降低。结论补阳还五汤可以改善VD大鼠学习记忆能力,其机制可能与减轻脑缺血再灌注对海马CA1区神经元的损伤有关。     

去卵巢痴呆模型大鼠胆碱乙酰转移酶和脑源性神经生长因子的变化及倍美力的影响

目的 观察去卵巢后痴呆模型大鼠额叶、海马CA1区胆碱乙酰转移酶(ChAT)和脑源性神经生长因子(BDNF)的变化及倍美力(Premarin)对其的影响,探讨倍美力的脑保护作用机制.方法 采用穹窿海马伞切除术及双侧卵巢切除制备痴呆及雌激素缺乏复合模型大鼠,采用Morris水迷宫观察其行为学改变,利用免疫组化法检测各组大鼠额叶、海马CA1区ChAT及BDNF阳性神经元的数量.结果 倍美力组大鼠额叶、海马CA1区ChAT、BDNF阳性神经元数量增加,与模型组比较有显著差异(P＜0.01).结论 倍美力可同时增加额叶、海马CA1区ChAT、BDNF阳性神经元含量,从而改善中枢胆碱系统的功能,实现其脑保护作用.     

大黄甘草汤对急性坏死性胰腺炎大鼠并发的肺损伤的影响

目的 观察大黄甘草汤对急性坏死性胰腺炎(ANP)大鼠并发肺损伤的治疗效果,探讨其作用机制.方法 90只Wistar大鼠按完全随机法分为假手术组、ANP组和大黄甘草汤治疗(治疗)组,每组30只.采用逆行胰胆管注射4%牛磺胆酸钠方法制备ANP模型.治疗组在制模后给予大黄甘草汤(0.25 g/ml)0.6 ml/100 g体重灌胃,1次/12 h;假手术组与ANP组予等量生理盐水灌胃.术后6、12、24 h分批处死大鼠,取胰腺及肺组织行病理学检查并评分;测血清及肺组织IL-6、IL-10、TNF-α水平;免疫组化法检测肺组织Toll样受体4(TLR4)的表达量.结果 制模后12 h,假手术组、ANP组和治疗组的血IL-6水平分别为(14.4±4.0)pg/ml、(171.4±41.3)pg/ml、(156.9±34.7)pg/ml,IL-10水平为(13.7±4.5)pg/ml、(120.5±23.7)pg/ml、(148.3±44.4)pg/ml,TNF-α水平为(22.4±4.7)pg/ml、(261.3±51.4)pg/ml、(235.3±45.9)pg/ml;肺组织IL-6水平为(257.3±55.9)pg/g、(2578.3±403.0)pg/g、(2370.0±491.0)pg/g,IL-10水平为(80.8±20.8)Pg/g、(642.0±107.3)pg/g、(695.3±151.7)Pg/g,TNF-α水平为(207.6±98.6)pg/g、(1769.1±635.6)Pg/g、(1401.1±450.5)pg/g;胰腺病理评分为0、7.0±1.3、6.3±1.0;肺脏病理评分为0、6.3±1.4、5.6±1.0;肺组织TLR4表达量为0.09 ±0.03、0.59±0.09、0.52±0.08.ANP组和治疗组的上述指标均显著高于假手术组(P值均＜0.01);除IL-10外,治疗组的指标又显著低于ANP组(P值均＜0.05).肺组织病理学损伤与胰腺组织损伤呈正相关(r=0.807,P＜0.01),与TLR4表达水平亦呈正相关(r=0.519,P＜0.01).结论 大黄甘草汤可快速改善ANP并发的肺损伤,其机制可能与抑制TLR4的表达、降低IL-6和TNF-α、升高IL-10水平有关.     

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.