二硝酸异山梨酯介入99mTc-MIBI心肌显像对梗死后存活心肌的判定及比较

目的:评价二硝酸异山梨酯(Isoket)介入99mTc-甲氧基异丁基异腈(MIBI)心肌断层显像检测心肌梗死后存活心肌的价值,并观察99mTc-MIBI心肌显像评价急性心肌梗死(AMI)与陈旧性心肌梗死(OMI)存活心肌的差异.方法:对16例OMI患者和12例AMI患者,分别进行静息99mTc-MIBI显像和Isoket静脉介入后99mTc-MIBI心肌断层显像.结果:静息99mTc-MIBI显像出现灌注异常185个节段,根据心肌放射性分布情况打分,平均得分为15.1±3.8,Isoket介入99mTc-MIBI显像后出现灌注异常节段为160个,平均得分为10.8±1.6,两者比较差别有显著性(P＜0.01).静息99mTc-MIBI显像出现的185个灌注异常的节段中16例OMI占102个,12例AMI占83个;Isoket介入后87个得到不同程度改善的节段中OMI占40个,AMI占47个,两者比较,P＜0.05.结论:Isoket介入99mTc-MIBI显像与静息99mTc-MIBI显像比较可明显提高对存活心肌检测的灵敏度,并对AMI存活心肌的检出率要明显高于OMI.     

心肌梗死患者经皮冠状动脉介入治疗术前行硝酸甘油介入心肌断层显像的临床价值

目的:探讨心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)前行硝酸甘油(NTG)介入心肌断层显像的临床价值。方法:32例MI患者PCI前行99mTc-MIBI静息和NTG介入心肌显像,术后3个月时复查静息心肌显像,并进行对比分析;术前和术后3个月时均应用超声心动图检测心功能,两者进行对比分析。结果:32例患者静息显像共有116个节段(40·28%)心肌核素摄取异常,NTG介入心肌显像后有66个节段(56·90%)呈可逆性缺损,50个节段(43·10%)呈不可逆性缺损;PCI后68个心肌节段(58·62%)心肌灌注得到改善,术前NTG介入显像显示的66个可逆性缺损节段,术后60个节段(90·91%)心肌灌注改善,术前NTG介入显像显示的50个不可逆性缺损节段,术后8个节段(16·0%)心肌灌注改善,改善与未改善节段比较均差异有统计学意义(P<0·05);19例有存活心肌的患者PCI后其左室射血分数较术前明显增高(P<0·01),左室舒张末期容积和收缩末期容积均较术前有很大程度的降低(P<0·01);而13例无存活心肌的患者,上述指标在术前和术后差异无统计学意义(P>0·05)。结论:MI患者PCI前常规行NTG介入99mTc-MIBI心肌显像对是否进行PCI治疗有决策性指导作用。     

单硝酸异山梨酯介入99mTc-MIBI再注射心肌断层显像评估心肌存活力

目的　评估静息 99m Tc- MIBI显像及单硝酸异山梨酯介入后 99m Tc- MIBI再注射显像在检测心肌梗死病人心肌存活力方面的差异。方法　对 46例心肌梗死患者进行 99m Tc- MIBI心肌断层显像以及单硝酸异山梨酯静脉介入后 99m Tc- MIBI再注射心肌断层显像。结果　静息 99m Tc- MIBI显像出现灌注异常节段为 30 4个 ,根据心肌放射性分布情况计分 ,平均得分为 1 5.1± 3.8。单硝酸异山梨酯介入 99m Tc- MIBI再注射显像灌注异常节段为 2 63个 ,平均得分为 1 0 .8± 1 .6,两者比较差异有显著性 (P<0 .0 1 )。结论　单硝酸异山梨酯介入 99m Tc- MIBI再注射显像与静息 99m Tc- MIBI显像比较可明显提高对存活心肌检测的灵敏度。     

硝酸甘油介入99 mTc-MIBI心肌断层显像对存活心肌的评价

为评价硝酸甘油（NTG）介入99m锝-甲氧基异丁基异脯（99mTc－MIBI）心肌显像估测存活心肌的价值，对24例心肌梗死病人不同日行两种方案的99mTc－MIBI心肌显像：一种在静息状态进行，另一种在舌下含服NTG0．6mg后进行。8例经皮腔内冠状动脉成形术（PTCA）的病人术后2～4周随访了99mTc－MIBI静息显像。结果显示，99mTc－MIBI静息显像有118个心肌节段摄取正常，98个摄取异常（16个节段摄取减低，82个摄取严重减低），在98个摄取异常的节段中，NTG介入99mTc－MIBI显像有39个（39．80％）节段摄取增加。8例行PTCA的病人，NTG介入99mTC－MIBI显像证实为可逆性缺损的心肌节没有84．21％在PTCA后心肌灌注改善（存活心肌），而为NTG介入99mTc－MIBI显像证实为不可逆性缺损的心肌节段有88．24％在PTCA后心肌灌注无改善。NTG介入99mTc－MIBI显像预测存活心肌的准确性为86．11％。表明，NTG介入99mTc－MIBI心肌显像可提高缺血但存活心肌的检出率。     

硝酸甘油介入~(99m)Tc-MIBI心肌断层显像对存活心肌的评估价值

目的探讨硝酸甘油(NTG)心肌断层显像对心肌梗死(MI)患者存活心肌的判断价值。方法 64例MI患者经皮冠状动脉介入治疗术(PCI)前行~(99)Tc-MIBl静息和NTG心肌显像,术后3个月时复查静息心肌显像,并进行对比分析;术前和术后3个月后均应用超声心动图检测心功能,两者进行对比分析。结果 64例患者静息显像共有232个节段(40.28%)心肌核素摄取异常,NTG心肌显像后有132个节段(56.90%)呈可逆性缺损,100个节段(43.10%)呈不可逆性缺损;PCI术后136个心肌节段(58.62%)心肌灌注得到改善,术前NTG显像显示的132个可逆性缺损节段中,术后120个节段(90.91%)心肌灌注改善,术前NTG介入显像显示的100个不可逆性缺损节段中,术后16个节段(16.0%)心肌灌注改善,二者比较差异有统计学意义(P<0.05);38例有存活心肌的患者PCI后其左心室射血分数较术前明显增高(P<0.01),左心室舒张末期容积和收缩末期容积均较术前有很大程度的降低(均为P<0.01);而26例无存活心肌的患者,上述指标在术前和术后差异无统计学意义(均为P>0.05)。结论 MI患者PCI前常规行NTG介入~(99m)Tc-MIBI心肌显像对是否进行PCI治疗的病例选择有决策性指导作用。     

药物负荷试验核素心肌断层显像识别存活心肌

目的探讨药物多巴酚丁胺、硝酸异山梨酯负荷试验核素锝[^99mTc]甲氧异丁异腈（technetium [^99mTc] methoxy isobutyl isonitrile,^99mTc-MIBI）心肌断层显像识别存活心肌的价值。方法对48例陈旧性心肌梗死伴左心室收缩功能受损患者进行静息心肌^99mTc-MIBI心肌断层显像和多巴酚丁胺、硝酸异山梨酯负荷试验^99mTc-MIBI心肌断层显像,用半定量的方法将^99mTc-MIBI摄取进行评分,区分存活心肌和非存活心肌。结果^99mTc-MIBI显像判定,经皮冠状动脉介入术前存活心肌节段有279个．非存活心肌节段235个;经多巴酚丁胺加硝酸异山梨酯负荷后,心肌显像改善：轻度稀疏节段9个、中度稀疏节段24个、严重稀疏或缺损节段10个,共计43个节段显像改善,评分减少1分以上,存活心肌节段313个,非存活心肌节段201个。两组差异有统计学意义（P〈0．05）。经皮冠状动脉介入术后6个月,随访多巴酚丁胺加硝酸异山梨酯负荷后,心肌显像改善的32个节段发现,静息^99mTc-MIBI显像改善,另有8个受损节段正常化。多巴酚丁胺加硝酸异山梨酯负荷后心肌显像无变化的389个节段在经皮冠状动脉介入术后346个节段无变化。多巴酚丁胺加硝酸异山梨酯负荷心肌显像检测存活心肌的阳性预测值93％,阴性预测值89％。结论多巴酚丁胺加硝酸异山梨酯负荷后心肌显像对存活心肌的识别能够提高存活心肌的检出率。其阳性预测值和阴性预测值较好。     

心肌梗死患者梗死部位存活心肌对心绞痛发作的影响

目的 :探讨心肌梗死 (MI)患者梗死部位存活心肌对心绞痛发作的影响。方法 :6 3例Q波MI患者分别行静息、硝酸甘油 (NTG)介入99mTc MIBI心肌灌注显像 ,评价梗死部位的存活心肌。结果 :① 6 3例MI患者的 5 6 7个心肌节段中 ,静息心肌显像共有 2 39个节段 (4 2 .15 % )灌注异常 ,含服NTG 1.0mg后介入心肌显像 2 39个节段中有 97个节段得到改善 ,占总异常的 4 0 .5 8% ;②不稳定型心绞痛者存活心肌检出率为 5 9.80 % ,稳定型心绞痛者为 2 9.2 9% ,两者比较差异有显著性意义 (P <0 .0 1)。结论 :①硝酸酯类药物介入显像可以提高严重灌注缺损区存活心肌的检出率 ;②MI后 ,有心绞痛发作 ,提示有较多的存活心肌     

硝酸甘油介入SPECT估测冠心病存活心肌

为探讨硝酸甘油（NTG）介入SPECT在估测冠心病存活心肌方面的价值。对42例冠心病患者行静息及NTG介入SPECT心肌显像，采用阅片计分法估测存活心肌，并以其中19例接受经皮冠状动脉内球囊成形术（PTCA）＋冠状动脉内支架植入术（Stent）的冠心病患者术后静息显像结果为“金标准”，评价NTG介入SPECT显像对存活心肌的检测效果。结果显示，静息显像检测存活心肌为56.3%，NTG介入显像为69.9%（P＜0.001）。NTG介入显像阅片计分法估测存活心肌准确率为81％，提示NTG介入SPECT显像可提高存活心肌检出率，为Stent治疗提供客观依据。     

急性心肌梗死患者经皮冠状动脉介入治疗术后心肌灌注水平对心肌存活性的影响

目的:应用TIMI心肌灌注分级(TMP)分析急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)后心肌灌注状况对心肌存活性的影响。方法:所有使梗死相关动脉(IRA)达到TIMI3级血流的AMI患者,根据PCI后即刻冠状动脉造影的TMP分级评价的心肌灌注状况,分为A组(TMP为2～3级,57例),B组(TMP为0～1级,31例)。运用静息及含服硝酸甘油介入99mTc-MIBI心肌灌注断层显像(MPI)来评价2组的存活心肌并于12周再次行静息99mTc-MIBI心肌灌注断层显像(MPI)评价存活心肌的恢复情况。结果:术后1周心肌存活面积A组高于B组[(5.43±4.89):(4.12±4.15),P<0.05],术后12周A组心肌缺损面积改善程度较B组明显[A组由(26.54±12.71)降至(17.86±11.59),P<0.05),B组由(39.37±16.31)降至(37.19±10.79),P>0.05]。结论:AMI患者行PCI术后心肌组织灌注TMP分级2～3级,可提高存活心肌的数量,心肌恢复较快。     

硝酸甘油99mTc-甲氧基异丁基异晴心肌灌注显像技术对冠心病诊断及其估测心肌存活性的价值

目的评价硝酸甘油99mTc-甲氧基异丁基异晴(MIBI)心肌灌注显像技术对冠心病的诊断及其估测心肌存活性的价值。方法48例可疑冠心病患者,于冠状动脉造影(CAG)术前1周内行静息、硝酸甘油介入99mTc-MIBI心肌灌注显像(SPECT)检查,以CAG为金标准,观察SPECT诊断冠心病的准确性。对于25例成功行经皮冠脉介入治疗(PCI)的冠心病患者,以PCI术后3个月室壁运动改善为检验标准,评价SPECT检测存活心肌的应用价值。结果SPECT诊断冠心病的敏感性、特异性和准确性分别为86.7%、72.2%和81.3%,评价存活心肌的敏感性为91.8%,准确性为84.9%。结论硝酸甘油99mTc-MIBI心肌灌注显像技术在诊断冠心病及其估测心肌存活性方面有较高的临床应用价值。     

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.