肝恶性淋巴瘤伴高钙血症1例

1.病例资料:男性患者,69岁,农民.因发热伴呕吐1周,外院抗炎治疗后,症状缓解,但近2日精神逐渐变差,于2008年3月24日转入我院急诊内科进一步诊治.入院时体检结果:体温37.5℃,呼吸22次/min,脉搏84次/min,血压170/90 mm Hg(1 mm Hg=0.133 kPa),平侧卧位,神清,精神萎靡,口唇不绀,双肺呼吸音稍低,右下肺可闻及少许湿音,心率84次/min,心律齐,未闻及杂音,腹平软,脐周轻压痛,无反跳痛,肝脾肋下未及.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

恶性肋间神经纤维瘤一例

患者男,16岁.因左侧胸痛、胸闷憋气1个月于2007年12月8日人院.胸片示左侧大量胸腔积液.体检:体温36.5℃,脉搏82次/min,呼吸22次/min,血压130/70 mm Hg(1 mm Hg=0.133 kPa).左肺叩浊音,左肺呼吸音消失,双肺未闻及干湿性罗音,心率82次/min,律齐.入院后行胸腔闭式引流术,引流液为血性,张力高,共引出8300 ml.     

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.