造血干细胞移植后发生出血性膀胱炎危险因素的分析

目的探讨造血干细胞移植术（HSCT）后出血性膀胱炎的发病相关因素、治疗措施和预后。方法分析我科2000年3月～2008年2月126例HSCT患者出血性膀胱炎发病情况。结果126例移植受者中17例发生出血性膀胱炎,发生率13．5％,中位发病时间36天（16～150天）,中位病程25天（10～103天）,所有患者经过再次水化、利尿和（或）留置导尿管持续膀胱冲洗等治疗,均获得治愈。结论在充分预防出血性膀胱炎后,出血性膀胱炎多为迟发型。多因素分析显示,移植方式、HLA相合程度、急性移植物抗宿主病、异基因移植、清髓性预处理和CMV感染是引起出血性膀胱炎的危险因素。     

经尿道选择性KTP激光汽化术治疗腺性膀胱炎(附11例报告)

对11例腺性膀胱炎患者行经尿道选择性KTP激光汽化术，术后联合丝裂霉素膀胱灌注治疗。结果11例患者全部治愈，1～6个月随访未见复发。认为经尿道选择性KTP激光汽化术治疗腺性膀胱炎效果确切，与经尿道电气化切除术比较，具有微创、安全、复发率低等优点。     

HLA半相合血缘性骨髓移植治疗慢性粒细胞白血病4例

目的:探索半相合未去除T细胞骨髓移植治疗慢性粒细胞白血病的可行性。方法:4例慢性粒细胞白血病患者接受HLA1或2个位点不相合亲缘骨髓移植。用阿糖胞苷、环磷酰胺和全身照射进行预处理,供者应用GCSF250μg/d,连用7d后采髓。移植物抗宿主病(GVHD)预防除用环孢菌素A(CsA)和甲氨蝶呤(MTX)外,在移植前第4天～第1天用抗胸腺细胞球蛋白ATG(兔抗)2.5mg/(kg·d),移植后第7天开始加用霉酚酸酯1.0g/d。结果:患者移植后均获得造血重建,中性粒细胞>0.5×109/L和血小板>20×109/L的中位时间分别是12.5(10～14d)和22d(18～25d)。4例患者发生急性Ⅰ度GVHD,其中1例2个位点不相合者进展为急性肠道和肝脏Ⅳ度GVHD,于+81d合并感染死亡。1例发生迟发性出血性膀胱炎。中位随访时间20个月(5～25个月)。无病存活3例,其中2例存活在1年以上。结论:供者应用GCSF后采髓,多种免疫抑制剂联合应用的HLA不全相合未去除T细胞骨髓移植,在治疗慢性粒细胞白血病过程中,有效地降低了急性重症GVHD发生,提高了无病生存。     

中西医结合治疗间质性膀胱炎的疗效观察

目的观察中西医结合治疗间质性膀胱炎的疗效。方法选取2012年4月~2014年7月我院普外科收治的间质性膀胱炎患者371例作为研究对象,将其随机分为治疗组186例与对照组185例,治疗组患者给予膀胱即时灌注术、膀胱水扩张术与中药汤剂联合治疗;对照组患者仅给予膀胱即时灌注术、膀胱水扩张术进行治疗。治疗后,比较两组疗效、治疗前后临床症状改善情况、不良反应发生情况。结果治疗后,治疗组疗效优于对照组,差异有统计学意义(P0.05);两组每天排尿次数均减少、夜排尿次数均较少,每日平均排尿量均增多,治疗组三项指标改善情况均优于对照组,差异有统计学意义(P0.05);两组患者均未发生严重不良反应,对临床治疗无影响。结论采用中医辨证治疗与膀胱即时灌注术、膀胱水扩张术联合治疗间质性膀胱炎,可有效提高治疗总有效率,缓解排尿情况,且未发现严重不良反应,值得临床推广与使用。     

经尿道电汽化术加膀胱药物灌注治疗腺性膀胱炎

2000年7月～2006年8月，我们共收治腺性膀胱炎患者19例。均予经尿道电汽化术联合丝裂霉素膀胱灌注治疗，效果满意。现报告如下。     

羟基喜树碱、小剂量结核菌素交替膀胱灌注预防膀胱癌术后复发的效果

目的 探讨羟基喜树碱(HCPT)、小剂量结核菌素(BCG)交替膀胱灌注预防膀胱癌术后复发的效果.方法 选择258例膀胱癌术后患者,随机分为HCPT和小剂量BCG交替膀胱灌注组(A组)、HCPT膀胱灌注组(B组)各129例.A组:术后第7天用HCPT 10 mg+生理盐水20 mL膀胱灌注,第14天用BCG 10 mg+生理盐水40 mL膀胱灌注;之后每隔3d交替灌注1次,至术后第56天;术后第63天开始,每隔1周交替灌注1次,各灌注8次;术后第183天开始,每隔15 d交替灌注1次,各灌注8次;术后第438天开始,每隔1个月交替灌注1次至术后2年.B组:自术后第7天起,用HCPT 10 mg+生理盐水20 mL膀胱灌注,每周灌注1次,至术后第56天;术后第70天开始,每隔2周灌注1次,共8次;术后第198天开始,每隔1个月灌注1次,共8次;术后第468天开始,每隔2个月灌注1次至术后2年.各种药物灌注剂量同首次灌注.分别观察两组0～18、19-24、25-60个月的肿瘤复发率及毒副反应.结果 随访60个月,A组复发率为0(0 ～18个月)、3.10％(19 ～ 24个月)、18.55％(25-60个月),B组分别为11.63％、7.03％、20.49％,两组0～18个月的复发率比较有统计学意义(P＜0.05);两组均出现非细菌性膀胱炎、血尿、低热、血象异常等毒副反应,但发生率比较均无统计学意义(P均＞0.05).结论 HCPT和小剂量BCG交替膀胱灌注预防膀胱癌术后复发效果较好,毒副反应较轻且发生率低.     

非清髓异基因造血干细胞移植治疗恶性血液病临床分析

目的:观察非清髓异基因造血干细胞移植(NST)治疗恶性血液病的疗效及并发症的处理。方法:对33例恶性血液病患者施行NST并随访观察。预处理方案应用氟达拉滨30mg.m-2.d-1(-7～-2d),马利兰4mg.kg-1.d-1(-6～-5d),环磷酰胺350mg.m-2.d-1(-3～-2d),HLA不全相合者加用抗淋巴细胞球蛋白(ALG)750mg/d(-2～-1d)。移植物抗宿主病(GVHD)预防应用环孢素A(CsA)和骁悉(MMF)。应用美司那、大量水化、碱化尿液预防出血性膀胱炎。应用凯时(前列腺素E1)预防肝静脉闭塞病(VOD)。结果:全部患者均成功植入,造血重建速度快。中性粒细胞0.5×109/L的中位时间是+13(+10～+16)d,血小板20×109/L的中位时间是+12(+9～+25)d。3例患者在+100d左右出现间质性肺炎,血CMV-DNA阳性,应用更昔洛维抗病毒等治疗后均痊愈。17例患者发生急性移植物抗宿主病(aGVHD)(51.5%),Ⅰ度患者10例(30.3%),Ⅱ度患者5例(15.2%),Ⅲ度患者2例(6.06%)。有20例患者出现慢性移植物抗宿主病(cGVHD)(64.5%),其中局限型15例(48.4%),广泛型5例(16.1%)。有3例患者出现VOD(9.1%),5例患者出现出血性膀胱炎(15.2%),经积极治疗均有效控制。中位随访37(2.5～58.0)个月,现存活24例(72.7%),9例死亡(27.3%),5例疾病复发(15.2%)。9例死亡患者中7例死于GVHD,2例死于疾病复发。结论:NST植入可靠,造血重建快,复发率低,移植相关并发症感染、出血性膀胱炎、VOD发生率低,治疗安全、有效。但GVHD发生率较高,是导致死亡的主要原因。     

卡介苗加顺铂膀胱灌注治疗膀胱癌30例

1992～ 1999年 ,我们对 3 0例膀胱肿瘤术后患者采用卡介苗 ( BCG)与顺铂联合膀胱内灌注治疗 ,疗效明显优于单用BCG或其他化疗药物灌注 ,现报告如下。临床资料 :本组男 2 1例 ,女 9例 ;年龄 2 9～ 70岁 ,平均 45岁 ;病程 2个月至 5年 ,平均 1年。病理检查均证实为膀胱移行上皮乳头状癌。临床分期为 A期 2 4例、B期 6例 ;细胞学分级为 级 5例、 级 14例、 ～ 级 11例。 3 0例均行开放性手术 ,其中单纯肿瘤切除 5例 ,膀胱部分切除 18例 ,膀胱部分切除加前列腺切除 7例。术后 10～ 14天经尿管 (先排尽尿液 )行膀胱灌注 ,灌注液为 BCG12 0…     

甲型流感病毒引起的出血性膀胱炎

1975年2～4月,Tehran甲型流感流行期间,发现33例患者(女27例,男6例,年龄为14～39岁)有出血性膀胱炎的临床表现:包括发热、全身不适、尿频、尿急和血尿。血尿持续3～5天,随后症状消失,全部自愈。其中7例膀胱镜检查发现膀胱充血和出血。静脉肾盂造影未见异常。尿细菌培养除4例发现葡萄球菌、大肠杆菌(菌数为900～8500)外,余皆     

二次TURBt联合THP膀胱灌注治疗非肌层浸润膀胱癌临床观察

目的观察二次经尿道膀胱肿瘤电切术(TURBt)联合吡喃阿霉素(THP)膀胱灌注治疗非肌层浸润膀胱癌的疗效。方法 60例T1期膀胱尿路上皮癌患者,连续行两次TURBt,中间间隔4～6周,术后予THP膀胱灌注化疗。结果手术均成功。第2次TURBt手术时间15～30 min,平均20 min;术中出血10～45 mL,平均25 mL。第2次TURBt时发现残存肿瘤19例,总阳性率31.5%。THP膀胱灌注时所有病例均有程度不同的尿路刺激症状,均未发生全身严重不良反应。1 a内复发9例,其中4例再次行电切后治愈,另外5例根据病理情况3例行膀胱部分切除,2例行全膀胱切除+回肠代膀胱术后治愈。结论二次TURBt联合THP膀胱灌注是治疗非肌层浸润性膀胱癌的有效的方法。     

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.