Lesions of the Colon and Rectum

Aneurysms and arteriosclerotic thrombo-obliterative disease of the aorta constitute two of the most common and serious forms of aortic lesions for which treatment has been generally unsatisfactory. Recently, however, a procedure has been developed wherein the lesion is extirpated and function restored by aortic repair or insertion of homografts. The gratifying results obtained by this method of therapy based on an experience with 41 cases suggests it is the most effective approach to the problem.     

The Rate of Synthesis of Glycosaminoglycans and Collagen by Fibroblasts Cultured from Adult Human Liver Biopsies

Adult human liver biopsies were cultured from normal, alcoholic hepatitis, chronic active hepatitis, fibrosis plus alcoholic hepatitis (active cirrhosis), inactive cirrhosis, and drug hepatitis. The synthesis of collagen was estimated in cultures from 58 livers by measuring the conversion of [¹⁴C]proline to the [¹⁴C]hydroxyproline of collagen; that of glycosaminoglycans in cultures from 57 livers by the incorporation of [³H]acetate and ³⁵SO₄ into glycosaminoglycans (GAG). The synthesis of procollagen was increased only in cultures from alcoholic hepatitis, both in the pulse medium (P < 0.05) and in the chase medium (P < 0.02). The synthesis of insoluble collagen was increased in cultures from chronic (active) hepatitis (P < 0.01), fibrosis plus alcoholic hepatitis (active cirrhosis) (P < 0.001), and inactive cirrhosis (P < 0.05). Essentially all radioactive GAG was soluble in culture media. The predominant GAG were chondroitin-4 or -6-SO₄. The synthesis of GAG was increased only in cultures from fibrosis plus alcoholic hepatitis (active cirrhosis) both in the pulse medium (P < 0.01) and chase medium (P < 0.001).     

B超引导下经直肠前列腺穿刺活检术的护理

总结了对151例B超引导下经直肠前列腺穿刺活检患者的护理.主要包括术前心理护理、物品准备、肠道准备;术中护理;术后加强并发痘的观察,及时对症治疗.认为术前做好精心准备,做好术中配合,加强术后观察及护理是保证穿刺成功的关键.     

Bicarbonate Secretion by Rabbit Cortical Collecting Tubules in Vitro

We previously reported that rabbit renal cortical collecting tubules can secrete bicarbonate in vitro (i.e., there can be net transport from bath to lumen, causing the concentration in the lumen to increase). Net bicarbonate secretion was observed most often when rabbits had been pretreated with NaHCO₃ and were excreting alkaline urine before being killed for experiments. The purpose of the present studies was to elucidate the mechanism involved by testing the effects of ion substitutions and drugs on collecting tubules that were secreting bicarbonate. Acetazolamide inhibited net bicarbonate secretion, suggesting that the process is dependent upon carbonic anhydrase. Net bicarbonate secretion also decreased when sodium in the perfusate and bath was replaced by choline, but not when chloride was replaced by nitrate or methylsulfate. Ouabain had no significant effect. Amiloride caused net bicarbonate secretion to increase. The rate of net secretion did not correlate with transepithelial voltage. The results are compared to those in turtle urinary bladders that also secrete bicarbonate. There are no direct contradictions between the results in the two tissues, i.e., in turtle bladders acetazolamide also inhibited bicarbonate secretion and ouabain had no effect. Nevertheless, it seems unlikely that net secretion of bicarbonate by collecting tubules involves specific exchange for chloride, as has been proposed for turtle bladders, because replacement of chloride by other anions did not inhibit bicarbonate secretion by collecting tubules. It was previously shown that the collecting tubules in vitro also may absorb bicarbonate, especially when the rabbits have been treated with NH₄Cl and are excreting acid urine before being killed. The effects of drugs on net bicarbonate secretion found in the present studies are compared to their previously reported effects on net bicarbonate absorption and the possibility is discussed that bicarbonate absorption and secretion are independent processes, as was previously proposed for turtle bladders.     

Adenomatous Polyps of the Rectum and Colon; Their Relationship to Adenocarcinoma

Technologic advances have greatly enhanced the use of electrocardiography and vectorcardiography, although problems of instrumentation and interpretation still exist. Increased amplification of electric signals and computer manipulation of vast quantities of data are expected to provide dramatic new insight into the electric activity of the heart.     

超声引导下穿刺活检诊断老年人结肠肿瘤

目的探讨超声引导下穿刺活检对老年人结肠肿瘤的诊断价值。方法回顾分析超声引导下穿刺活检17例疑患结肠肿瘤老年患者的临床资料。结果(1)病理结果:17例中,腺癌14例,恶性淋巴瘤1例,小细胞恶性肿瘤1例,结核1例。(2)声像图表现:17例病灶中,12例为典型的肠道肿瘤表现即“假肾征”或“靶环征;”4例仅表现为回盲部不均匀低回声肿块,不具备“假肾征”图像;1例为典型的肠套叠表现,即“同心圆征”。2例有肠梗阻征象;5例有转移征象。结论超声引导下穿刺活检安全性好、准确性高,是诊断老年人结肠肿瘤的有效方法之一。     

Suppression of Human Growth Hormone Secretion by Melatonin and Cyproheptadine

Pituitary growth hormone (GH) release in the rat is stimulated via serotoninergic pathways and can be inhibited by treatment with compounds that act as serotonin antagonists, such as cyproheptadine or the pineal gland hormone, melatonin. To investigate a possible role for serotonin in the control of human GH release, the effects of cyproheptadine and melatonin administration on the GH responses of normal male subjects were examined.The oral administration of cyproheptadine (8-12 mg daily for 5 days) to normal subjects reduced their GH responses to both insulin-induced hypoglycemia and physical exercise to a highly significant extent. Similarly, the mean GH responses of 10 subjects to insulin-induced hypoglycemia were significantly reduced after the prior oral administration of melatonin (1 g).The data presented show that serotonin antagonism has a similar effect on GH secretion in man to that observed in the rat and provides further evidence for serotoninergic, and possibly pineal, involvement in the control of human GH secretion.     

溃疡灵治疗乙状结肠及直肠溃疡性结肠炎观察

目的:观察溃疡灵灌肠及纳肛治疗乙状结肠及直肠UC的临床疗效。方法:将符合纳入标准的180例患者分为治疗组和对照组各90例。治疗组中乙状结肠UC,以溃疡灵颗粒灌肠治疗。直肠UC以溃疡灵栓剂塞肛治疗;对照组中乙状结肠UC,以美沙拉秦(5-氨基水杨酸)缓释颗粒剂口服治疗。直肠UC,以美沙拉秦栓剂纳肛治疗。2组均以3～6个月为1个疗程,疗程结束后观察疗效。结果:从临床疗效、黏膜病变疗效、证候疗效比较,治疗组均优于对照组,差异有统计学意义。结论:溃疡灵灌肠及塞肛治疗UC可取得良好效果。     

螺旋CT对直、结肠癌诊断和分期的价值

目的：探讨螺旋CT在直、结肠癌诊断和分期中的价值。方法：对35例经手术证实的直、结肠癌患者，回顾分析其CT表现，并与术后病理结果对照，分析螺旋CT诊断与分期的准确性。结果：CT显示肠壁增厚35例、肠腔内肿块21例、肠腔狭窄和形态不规则23例、浆膜面模糊17例、淋巴结转移15例。CT对直肠、结肠癌总的分期准确性达86％。结论：螺旋CT检查对中晚期直、结肠癌诊断和分期具有一定价值。     

Stimulation of Human Prolactin Secretion by Intravenous Infusion of L-Tryptophan

Previous studies have demonstrated that the secretion of human prolactin is regulated primarily by factors that influence catecholamines of the hypothalamus. In an effort to identify other factors that may regulate prolactin secretion, the amino acid L-tryptophan, a precursor in the synthesis of serotonin, was infused into normal human volunteers. Intravenous infusion of L-tryptophan, 5-10 g over a 20 min period, but not equivalent amounts of 17 other amino acids, induced marked increases in serum prolactin concentrations in eight normal human volunteers. Increases of 20-200 ng/ml above the control level were observed with peak values at 20-45 min after initiation of the infusion. In addition, infusion of L-tryptophan was associated with decreases in serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyrotropin in those subjects in whom the base-line serum hormone concentration was above the lower limits of assay detectability. No consistent change was observed in serum concentrations of growth hormone, cortisol, or glucose. Four subjects with juvenile diabetes demonstrated increases in serum prolactin values comparable with those observed in healthy individuals in response to infusions of L-tryptophan. Serum prolactin values in patients with surgically induced hypopituitarism were undetectable or deficient after infusion of 10 g of L-tryptophan. In this respect, infusion of L-tryptophan was equally effective in these subjects as the standard chlorpromazine stimulation test in identifying patients with hypopituitarism, indicating that the infusion of L-tryptophan may serve as a sensitive and reliable clinical test of prolactin secretory reserve. Further studies relating to the possible mechanism of action of L-tryptophan indicated that infusion of 5-hydroxytryptophan represents a much more potent stimulus for the secretion of prolactin and that premedication with the serotonin antagonist, methysergide maleate, serves to blunt the effect of L-tryptophan on prolactin secretion. These results support the concept that the effect of L-tryptophan on the secretion of human prolactin is mediated through its conversion to serotonin and are consistent with reported experimental observations that serotonin may participate in the reciprocal regulation of prolactin and gonadotropins.     

Relationship between Para-aminohippurate Secretion and Cellular Morphology in Rabbit Proximal Tubules

Previous studies in the mammalian proximal tubule have suggested that para-aminohippurate (PAH) secretion is ~threefold greater in the straight segment, or pars recta, than in the convoluted segment, or pars convoluta. However, the possibility that the site of maximal PAH secretion might be related better to particular tubule segments as identified by cell type had not been explored. In addition, the presence or absence of differences in PAH secretion between morphologically identical regions of superficial (SF) vs. juxtamedullary (JM) proximal tubules has not been examined. These issues were studied using a combination of histologic methods and measurement of [³H]PAH secretion in isolated perfused tubules. Measurements of microdissected SF and JM proximal tubules from young and adult rabbits revealed that SF proximal tubules were slightly but significantly longer than JM tubules ([young rabbits: SF, 8.69±SE 0.14 mm vs. JM, 7.97±SE 0.13 mm; P < 0.01] [adult rabbits: SF, 10.61±SE 0.28 mm; JM, 9.17±SE 0.19 mm; P < 0.001]). Light and electron microscopy revealed three sequential segments (S₁, S₂, and S₃) along the length of SF and JM proximal tubules as defined by cell type. PAH secretion was measured in each of these three segments by the isolated perfused tubule technique. Net PAH secretion in fmol/mm per min in SF proximal tubules was: S₁, 281±SE 21; S₂, 1,508±SE 104; S₃, 318±SE 46. Corresponding values in JM proximal tubules were 353±SE 31, 1,391±SE 72, and 188±SE 23. Net PAH secretion did not differ between comparable segments of SF and JM proximal tubules. It is concluded that differences in PAH secretion along the proximal tubule correlate best with cell type rather than the arbitrary division of the proximal tubule into pars convoluta and pars recta according to its external configuration. Evidence of functional heterogeneity between comparable segments of SF and JM proximal tubules was not observed.     

腹腔镜结直肠癌根治术中的淋巴结清扫

目的研究经腹腔镜行乙状结肠、直肠癌根治术中淋巴结清扫的范围和方法.方法 从1999年6月至2001年8月对肿瘤未侵出浆膜层的45例结直肠癌病例行腹腔镜辅助下肿瘤根治术,同时对肿瘤未侵出浆膜层的192例结直肠癌病例行开腹肿瘤根治术.术中均进行D3式淋巴结清扫.对各组淋巴结转移率和转移度进行统计. 结果 腹腔镜组45例中第一站淋巴结转移率为22.22%,转移度为7.38%;第二站淋巴结转移率为8.89%,转移度为2.46%;第三站淋巴结转移率为2.22%,转移度为0.41%.开腹手术组192例中第一站淋巴结转移率为25.52%,转移度为8.82%;第二站淋巴结转移率为7.81%,转移度为2.55%;第三站淋巴结转移率为3.13%,转移度为1.15%.两组各站淋巴结转移率和转移度分别行χ2检验,结果无明显差异(P>0.05).结论 两组淋巴结清扫范围和结果基本相同,腹腔镜手术有操作空间大、视野开阔、操作准确、创伤小、出血少等优点,亦有病例选择局限、个别部位淋巴结清扫困难、耗时长等缺点.     

腹腔镜结直肠癌根治术中的淋巴结清扫

目的研究经腹腔镜行乙状结肠、直肠癌根治术中淋巴结清扫的范围和方法。方法从1999年 6月至 2 0 0 1年 8月对肿瘤未侵出浆膜层的 45例结直肠癌病例行腹腔镜辅助下肿瘤根治术 ,同时对肿瘤未侵出浆膜层的 192例结直肠癌病例行开腹肿瘤根治术。术中均进行D3 式淋巴结清扫。对各组淋巴结转移率和转移度进行统计。结果腹腔镜组 45例中第一站淋巴结转移率为 2 2 .2 2 %,转移度为 7.38%;第二站淋巴结转移率为 8.89%,转移度为2 .46 %;第三站淋巴结转移率为 2 .2 2 %,转移度为 0 .41%。开腹手术组 192例中第一站淋巴结转移率为 2 5 .5 2 %,转移度为 8.82 %;第二站淋巴结转移率为 7.81%,转移度为 2 .5 5 %;第三站淋巴结转移率为 3.13%,转移度为1.15 %。两组各站淋巴结转移率和转移度分别行 χ2 检验 ,结果无明显差异 (P >0 .0 5 )。结论两组淋巴结清扫范围和结果基本相同 ,腹腔镜手术有操作空间大、视野开阔、操作准确、创伤小、出血少等优点 ,亦有病例选择局限、个别部位淋巴结清扫困难、耗时长等缺点。     

Genetic Factors of Human Gamma Globulin Detected by Rabbit Antisera

Antisera of rabbits immunized with isolated human myeloma proteins, urinary proteins, papain treated myeloma proteins and FII γ-globulin were studied. It was established that such antisera after absorption were able to serve as typing reagents for the detection of human genetic factors on gamma globulin. Specific antibodies were found against Gm(a), (b) and (f) and Inv(l) determinants.
It was possible to differentiate the Gm specific antibodies from those defining the heavy chain subgroups although they usually occurred together in the rabbit antisera.     

Pemphigus Antibodies Identify a Cell Surface Glycoprotein Synthesized by Human and Mouse Keratinocytes

Pemphigus is an antibody-mediated autoimmune skin disease in which loss of cell-to-cell contacts in the epidermis results in blister formation. Patients with pemphigus develop antibodies that bind to the keratinocyte cell surface, the site of primary pathology. The purpose of this study was to characterize the antigen(s) to which pemphigus antibodies bind. Because we could detect pemphigus antigen by indirect immunofluorescence on the surface of multiply-passaged cells in cultures of both a spontaneously transformed mouse keratinocyte cell line (Pam) and normal human epidermal cells, we used these cells as a source of antigen. In order to demonstrate biosynthesis of antigen and to characterize the antigen(s), we radiolabeled cell cultures with [¹⁴C]glucosamine or d-[2-³H]mannose and used different pemphigus sera to immunoprecipitate antigen from nonionic detergent extracts of these labeled cells. Specifically precipitated radiolabeled molecules were identified using sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) and fluorography. Sera from five of seven pemphigus patients specifically precipitated (from extracts of both Pam cells and human epidermal cells) a molecule that, when reduced, was ~130 kD, whereas seven normal human sera and two pemphigoid sera did not precipitate this molecule. The findings that (a) these precipitated molecules comigrated on SDS-PAGE and that (b) the 130-kD molecule could no longer be precipitated from cell extracts that had been previously reacted with a pemphigus serum, indicate that reactive pemphigus sera bind the same molecule. The molecule was not detected in the culture medium of these cells. This finding, along with the cell surface immunofluorescence pattern, suggests that the antigen is bound to the cell surface. Cultured mouse and human fibroblasts do not synthesize the antigen. The antigen contains protein because it was degraded by V8 protease and chymotrypsin, and it could also be labeled with [¹⁴C]amino acids. It is probably not a sulfated proteoglycan because it did not label with ³⁵SO₄. Taken together, these data indicate that some, but not all, pemphigus sera bind a specific cell surface glycoprotein that is synthesized by keratinocytes.     

The Mechanism of Bicarbonate Secretion in Rabbit Ileum Exposed to Choleragen

BICARBONATE MAY BE SECRETED INTO THE INTESTINAL LUMEN IN CHOLERA BECAUSE: HCO(3) (-) ions are transported, or because OH(-) ions accumulate and react with dissolved CO(2) to form HCO(3) (-). If HCO(3) (-) ions are transported into the lumen from the interstitial fluid, lumenal P(CO2) should increase (HCO(3) (-) right harpoon over left harpoon OH(-) + CO(2)); if OH(-) accumulates, P(CO2) should diminish. Net movement of H(2)O, and HCO(3) (-), and changes in pH and P(CO2) in lumenal fluid were studied in adjacent segments of rabbit ileum in vivo, one of which was exposed to choleragen. 4 h after exposure, segments were drained and infused with gassed Krebs-Henseleit solution whose P(CO2) exceeded arterial P(CO2). After 45 min, fluid was collected anaerobically from control and cholera segments. Among 13 cholera segments, lumenal P(CO2) diminished by a mean of 8.4 torr and was less than femoral arterial blood in six instances. In the paired control segments, mean P(CO2) increased by 4.4 torr, and was always greater than arterial P(CO2). Dilution could not account for the low P(CO2) in cholera segments because in hypertonic solutions that caused water to move into the lumen, the P(CO2) did not differ from control values obtained with isotonic solutions. The results suggest that OH(-) accumulation (by addition of OH(-) or removal of H(+)) causes HCO(3) (-) secretion in cholera. This does not result from secretion of some other base (e.g., HPO(4) (-)), because HCO(3) (-) accounts for most of the base in the lumenal fluid. The P(CO2) changes suggest that OH(-) reacts with CO(2) at the cell-lumen interface, but reaction at the cell-interstitial fluid interface cannot be excluded.     

Structure-Activity Relationships of Somatostatin Analogs in the Rabbit Ileum and the Rat Colon

Somatostatin increases absorption of electrolytes and inhibits diarrhea in patients with endocrine tumors and short bowel syndrome. In an attempt to develop a gut-specific somatostatin analog, each amino acid in the somatostatin molecule was replaced with L-alanine, deleted, or substituted with its D-isomer. The potency of each analog to stimulate ion transport in the rabbit ileum was then determined using the modified Ussing chamber technique. The results were compared to the ability of each analog to inhibit the stimulated release of growth hormone from cultured rat anterior pituitary cells and to inhibit the arginine-stimulated release of insulin and glucagon in the rat in vivo. Analogs that showed gut selectivity were then tested for their ion transport properties in the rat colon. Results: (a) Substitution with L-alanine or deletion of the amino acid at position 6, 7, 8, or 9 and deletion of Threonine¹⁰-produced analogs with significantly reduced ion transport properties to <4% of somatostatin's action. The substitution also markedly reduced the ability of the compounds to inhibit the release of growth hormone, insulin, and glucagon. (b) Selectivity of intestinal ion transport was achieved by any one of the following alterations: L-alanine substitution at Phenylalanine¹¹, deletion of Phenylalanine¹¹, substitution with D-lysine at Lysine⁴, or substitution with L-alanine at Lysine⁴. These compounds had intestinal ion transport properties of 52, 34, 139, and 94%, respectively, while demonstrating little or no inhibition of growth hormone, insulin or glucagon release. Conclusions: (a) Phenylalanine⁶, Phenylalanine⁷, Tryptophan⁸, and Lysine⁹ are required for the ion transport and other biologic actions of somatostatin, whereas Threonine¹⁰ serves as an essential spacer. (b) Alteration at Phenylalanine¹¹ or Lysine⁴ yields analogs that are selective for ion transport in the rabbit ileum and rat colon. These findings should be taken into consideration when developing a gut-specific somatostatin analog that can be useful in the treatment of diarrhea.     

金雀异黄素刺激人成骨细胞分泌护骨素以及抑制IL-6生成

目的：探讨金雀异黄素对人成骨细胞（hOB）作用的分子机制。方法：采用细胞培养结合RT-PCR、Western blot技术观察金雀异黄素对护骨素（OPG）、破骨细胞分化因子（RANKL）、白介素-6（IL-6）等基因mRNA及蛋白质表达。结果：金雀异黄素下调hOB细胞RANKL、IL-6 mRNA及蛋白质的表达、上调OPG mRNA及蛋白质和hOB细胞ER-α mRNA及蛋白质的表达。结论：金雀异黄素可以对雌激素核受体的表达进行调控，该雌激素样效应是其抗骨质疏松作用的分子机制之一。