CO2造影在肝门部胆管癌内镜引流中的价值

目的 探讨CO2联合造影剂造影在不可切除的肝门部胆管癌内镜引流中的价值。方法 回顾性分析兰州大学第一医院2010年10月至2015年10月间行内镜引流术治疗的43例不可切除的肝门部胆管癌患者病例资料,根据造影剂选用分为研究组（CO2联合造影剂造影）和对照组（单纯造影剂造影）,研究组23例,对照组20例,比较两组术后总胆红素、白细胞计数、降钙素原及并发症发生率。结果 43例患者内镜操作时间50～70 min,术后研究组48 h和72 h的总胆红素、白细胞、降钙素原均低于对照组[48 h 总胆红素：（173.42±66.78）μmol/L 比（210.81±78.34）μmol/L, P=0.025; 72 h 总胆红素:（104.64±56.35）μmol/L比（159.33±59.59）μmol/L,P=0.023;48 h 白细胞:（11.51±7.78）×109/L比（15.83±6.67）×109/L, P=0.026; 72 h 白细胞:（10.92±5.64）×109/L比（14.72±4.97）×109/L ,P=0.026; 48 h 降钙素原:（0.56±0.18 ）ng/mL比（1.24±0.73）ng/mL,P=0.003; 72 h 降钙素原:（0.42±0.27） ng/mL比（0.90±0.20 ）ng/mL,P=0.001]。术后胆管炎的发生率研究组低于对照组,差异有统计学意义[13.0%(3/23)比40.0%(8/20),P=0.043];两组术后胰腺炎的发生率较低,差异无统计学意义[4.3%(1/23)比10.0%(2/20),P=0.090]。结论 不可切除的肝门部胆管癌内镜引流中采用CO2联合造影剂造影是安全有效的,并且可降低术后胆管炎发生率。     

沙库巴曲缬沙坦对慢性射血分数降低心力衰竭合并肾功能不全患者的肾脏保护作用

【摘要】目的 观察沙库巴曲缬沙坦对合并肾功能不全的慢性心力衰竭（心衰）患者肾功能的影响。方法 连续入选84例慢性心衰合并肾功能不全患者,分为沙库巴曲缬沙坦（ARNI）组48例和对照组36例。ARNI组接受沙库巴曲缬沙坦治疗,对照组接受单一的缬沙坦治疗。观察2组患者服药后6个月和12个月肌酐、估算的肾小球滤过率（eGFR）、尿素氮、尿酸、肾功能恶化（WRF）指标的变化情况。结果 （1）两组患者基线资料比较差异无统计学意义。(2)服药后6个月,对比基线水平,ARNI组肌酐、eGFR的变化值与对照组比较无明显差异(P = 0.254;P = 0.061);尿素氮及尿酸下降值显著高于对照组[-2.62（1.83,3.90）mmol/L vs 0.45（0.29,0.70）mmol/L,P < 0.01;-82.74±149.55 μmol/L vs -7.46±111.69 μmol/L,P = 0.027];服药后12个月,对比基线水平,ARNI组eGFR下降值明显低于对照组[-2.21（1.33,3.49）ml/min/1.73m2 vs -22.11（12.32, 29.67）ml/min/1.73m2,P = 0.023];肌酐升高值明显低于对照组[1.50（0.98,2.07）μmol/L vs 31.65（22.77,42.53）μmol/L,P = 0.043];尿素氮及尿酸下降值也显著高于对照组[-2.80（2.01,4.23）mmol/L vs 0.80（0.58,1.14）mmol/L,P < 0.01;-97.89±133.90 μmol/L vs -6.90±107.36 μmol/L,P = 0.011]。(3)服药后6个月,ARNI组WRF发生率与对照组相比无明显统计学差异（6.25% vs 19.44%,P = 0.132）;服药后12个月,ARNI组WRF发生率显著低于对照组（8.33% vs 25%,P = 0.037）。结论 与单一的缬沙坦比较,ARNI可以延缓、控制合并肾功能不全的慢性心衰患者肾功能的进展,减少WRF的发生。随服药时间的延长,对肾功能的保护作用更显著。     

前列地尔联合通脉颗粒治疗不稳定型心绞痛的疗效及其血清IL-6、hs-CRP的变化分析

[摘要]目的 探讨前列地尔联合通脉颗粒治疗不稳定型心绞痛的疗效及其血清IL-6、hs-CRP的变化。方法 选择2016年1月至12月我院接诊的不稳定型心绞痛老年患者84例,按抛硬币法随机分为观察组和对照组,各42例。对照组患者进行常规治疗,观察组在其基础上加以前列地尔联合通脉颗粒进行治疗。治疗2周后,对比两组血脂、血液流变学、治疗效果、颈动脉粥样硬化斑块情况、血清白细胞介素-6（IL-6）及高敏C反应蛋白（hs-CRP）水平。结果 治疗后,观察组纤维蛋白原（Fbg）、三酰甘油（TG）及血清总胆固醇（TC）水平均低于对照组[（3.55±1.36）g/L vs（4.15±1.24）g/L,（1.23±0.22）mmol/L vs（1.97±0.68）mmol/L,（5.25±0.82）mmol/L vs（6.23±0.96）mmol/L] （P＜0.05）;观察组总有效率高于对照组[95.24%（40/42）vs 78.57%（33/42）] （P＜0.05）;观察组患者颈动脉粥样硬化斑块的数量、大小、厚度及颈动脉内膜中层厚度（IMT）均低于对照组[（3.02±0.84）个vs（3.55±0.93）个,（0.05±0.04）cm2 vs（0.07±0.03）cm2,（1.78±0.49）mm vs（2.05±0.42）mm,（1.22±0.58）mm vs（1.62±0.68）mm] （P＜0.05）;观察组血清IL-6、hs-CRP水平均低于对照组[（3.25±2.95）pg/L vs（5.56±3.31）pg/L,（6.35±2.88）mg/L vs（9.24±3.02）mg/L] （P＜0.05）。结论前列地尔联合通脉颗粒治疗不稳定型心绞痛可有效调节血脂,并改善患者颈动脉粥样硬化斑块情况,同时降低血清IL-6、hs-CRP水平,减少炎症反应,在治疗中具有阻断和逆转作用,疗效确切,值得推广应用。 【     

暴发性心肌炎患者降钙素原及细胞因子水平增高

摘要 目的：分析暴发性心肌炎（FM）患者炎症相关指标白细胞（WBC）计数、降钙素原（PCT）及细胞因子水平变化。方法：连续入选临床诊断FM患者120例，收集实验室炎症相关指标，包括WBC计数及分类、PCT和部分细胞因子水平及其动态变化结果。根据患者出院病情转归情况，将120例FM患者分为非好转组15例与好转组105例，并比较2组血常规、PCT、超敏C反应蛋白（hsCRP）、红细胞沉降率（ESR）及细胞因子水平。结果：①FM患者入院第1天，WBC总数高于正常范围 [均值(9.91±0.41)×109/L]，并且中性粒细胞绝对值升高 [均值(7.98±0.40)×109/L]；入院后第3和7天，WBC计数较第1天升高（P=0.045、0.013）。②入院第1天，PCT（均值2.92ng/mL，参考范围＜0.05ng/mL）显著高于正常值，第3天高达18.26ng/mL ，第7天仍为3.02ng/mL；血中细胞因子水平白介素（IL）-1β、IL-2R、IL-6、IL-8、IL-10和肿瘤坏死因子（TNF）-α水平均显著高于正常范围。③非好转组与好转组比较，仅hsCRP差异有统计学意义（P=0.027）。另外，非好转组细胞因子IL-2R及IL-10高于好转组（P=0.025、0.032）。结论：FM患者细胞因子水平、血浆PCT、外周血WBC及中性粒细胞均显著增高，并与细菌感染无关。     

左西孟旦联合主动脉球囊反搏可有效改善急性心肌梗死合并心源性休克患者的预后

摘要 目的：本研究评估左西孟旦联合主动脉球囊反搏（IABP）对急性心肌梗死（AMI）合并心源性休克（CS）患者的疗效及安全性。方法：连续收集AMI合并CS植入IABP行急性经皮冠状动脉介入治疗（PCI）患者82例,随机分为观察组（左西孟旦+IABP）和对照组（单纯IABP）,使用化学发光法检测2组血清N末端-脑钠肽前体（NT-proBNP）、肌钙蛋白I（cTnI）水平,使用酶联免疫吸附检测超敏C反应蛋白（HsCRP）的水平。统计患者IABP辅助时间、CCU入住天数及总住院天数;〖JP3〗心肌梗死后30 d心脏主要不良事件发生情况：再发心肌梗死、脑卒中、再次血运重建、死亡及再次住院率。结果：治疗5 d后,与对照组比较,观察组患者NT-proBNP下降更加明显[(-3895.37±1589.59) pg/mL vs (-2568.53±1864.23)pg/mL, P=0.0026],hsCRP降低更加显著[(-42.56±20.35)mg/L vs (-25.63±12.69)mg/L, P=0.0032],肌钙蛋白峰值更低[(89.65±36.58)ng/mL vs (98.56±32.69)mg/L, P=0.042];观察组IABP持续时间更短[（4.5±2.5）d vs(6.5±3.5)d, P=0.032],CCU入住时间更短[（7.5±3.5）d vs(9.5±4.5)d, P=0.039],总住院时间明显降低[（10.5±5.5）d vs(13.5±6.5)d, P=0.025]。2组患者住院期间死亡率比较,差异无统计学意义（P=0.696）。观察组30 d内心血管主要不良事件发生率低于对照组 (19.05% vs 25.00%,P= 0.515),急诊就医次数更少[(1.2±0.8) vs (2.2±1.8), P= 0.042],再次住院次数更少[(0.8±1.2) vs (1.5±1.6), P=0.049]。出院时,观察组标准EQ-5D-3L健康调查问卷评分低于对照组（P=0.038）,随访30 d时继续保持降低（P=0.029）。结论：左西孟旦联合IABP对AMI合并CS患者疗效肯定且安全可靠。     

补肝汤治疗肝肾阴虚型慢性乙型肝炎 效果分析及对患者中医证候积分的影响

[摘要]　目的　观察补肝汤治疗肝肾阴虚型慢性乙型肝炎（chronic hepatitis B, CHB）效果及对患者中医证候积分的影响。方法?选取2018年7月—2020年7月我院收治的肝肾阴虚型CHB患者84例作为研究对象，按随机数字表法分为观察组和对照组，各42例。对照组予常规西药治疗，观察组在常规西药基础上予补肝汤治疗，均持续治疗24周。评价2组疗效，比较中医证候积分、肝功能指标、HBeAg转阴率、HBV DNA转阴率。结果?观察组治疗总有效率为92.86%，高于对照组的69.05%（χ2=7.721，P=0.005）。治疗后，2组各项症状得分均低于治疗前（P均＜0.05），且观察组各项症状得分均低于对照组（P均＜0.05）。治疗后，2组ALT、AST、TBIL水平均低于治疗前（P均＜0.05），ALB水平均高于治疗前（P均＜0.05），且观察组血清ALT [（39.66±9.95） U/L]、AST [（37.89±6.73） U/L]、TBIL [（42.17±8.21） μmol/L]水平均低于对照组[（59.73±13.52）U/L、（46.97±9.64） U/L、（67.52±13.15）μmol/L]（P均＜0.05），血清ALB [（35.88±3.28） g/L]水平高于对照组[（29.73±3.47）g/L] （P＜0.05）。观察组HBeAg转阴率为40.48%（17/42），高于对照组的19.05%（8/42） （P＜0.05）。2组HBV DNA转阴率均为100%。结论?在常规西药治疗基础上，采用补肝汤治疗肝肾阴虚型CHB患者，有助于减轻症状，改善肝功能，促进HBeAg、HBV DNA转阴，提高疗效。     

平板运动对青年男性外周血细胞和心功能的影响

目的 研究青年男性一次平板运动对外周血细胞和心功能的影响。 方法 筛选健康青年男性21例,采用Bruce方案行平板运动试验,以次级量目标心率（220-年龄）×90%为终点。运动前1 h和结束即刻接受采血和超声心动图检查,并对比两组数据。 结果 ①运动结束即刻代表左心室收缩功能参数较运动前增高:左室射血分数（LVEF）[（65±4）%vs.（59±6）%,P<0.01],和左室短轴缩短率（FS）[（33.1±3.4）%vs.（29.1±2.7）%,P<0.01];每搏输出量（SV）未见显著变化。运动结束即刻左室舒张功能（E/A,PVS/PVD）较运动前轻度减低[（1.0±0.2）vs.（1.5±0.3）,P<0.01;（1.2±0.1）vs.（1.7±0.4）,P<0.01],运动结束即刻,室间隔和下壁在收缩和舒张期均出现组织运动增加[室间隔（0.15±0.03）m/s vs.（0.12±0.02） m/s,P<0.05;（0.17±0.04） m/s vs.（0.13±0.02） m/s,P<0.01;下壁（0.13±0.03）m/s vs.（0.12±0.02）m/s,P<0.01;（0.22±0.12）m/s vs.（0.15±0.03）m/s,P<0.01],而侧壁主要在舒张期出现运动轻度增加[（0.19±0.05）m/s vs.（0.15±0.02）m/s,P<0.01]。运动结束即刻左右心房内径略减小,左房收缩功能（A峰值和PVA/PVA-t）轻度增加[（0.7±0.1）m/s vs.（0.6±0.1）m/s,P<0.01;（0.3±0.08）vs.（0.3±0.04）,P<0.01]。②运动结束即刻较运动前,血液淋巴细胞轻度增加,而中性粒细胞轻度减少[（0.43±0.09）109/L vs.（0.35±0.10）109/L,P<0.01;（0.50±0.09）109/L vs.（0.57±0.10）109/L,P<0.01],平均血小板体积测定、血小板计数及血小板比积测定均增高[（10.7±0.6）fl vs.（10.6±0.7）fl,P<0.05;（234±43）109/L vs.（214±47）109/L,P<0.01;（0.25±0.04）fl vs.（0.22±0.04）fl,P<0.01],红细胞体积略微增大[（90.3±2.7）fl vs.（89.8±2.5）fl,P<0.05]。 结论 急性运动可以引起心脏收缩功能代偿性的增加,室壁运动增加,代偿性的红细胞体积的增加,血小板的增加和白细胞分类的变化。     

氯沙坦和氨氯地平对肥胖高血压患者瘦素、脂联素及胰岛素敏感性的影响

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦和钙离子通道拮抗剂氨氯地平对肥胖高血压患者血浆瘦素、脂联素、去甲肾上腺素（NE）水平和胰岛素敏感性的影响。方法采用放射免疫法测定血浆瘦素及脂联素水平、采用稳态模型评价胰岛素抵抗指数（HOMA-IR），以高效液相色谱检测血浆NE水平。结果氯沙坦组血浆瘦素、脂联素、HOMA—IR、体重指数（BMI）治疗16周前后差异有统计学意义[分别为（35．6±18．5vs32．0±17．1）μg／L，P〈0．05；（9．34±3．12vs12．45±4．52）mg／L，P〈0．01；8．6±2．7vs6．1±2．1，P〈0．05；（28．9±3．8vs27．3±3．2）kg／m^2，P〈0．05]，氨氯地平组在治疗前后差异均无统计学意义[分别为（35．2±18．3vs35．4±18．9）μg/L；（9．32±3．23vs9．39±3．41）mg／L；8．3±2．5vs8．7±2．9；（28．8±3．8vs28．7±3．6）kg／m^2]；血浆NE水平在氨氯地平组治疗后明显增加[（324±112vs449±122）ng／L，P〈0．01]，氯沙坦组治疗前后差异无统计学意义[（322±115vs325±121）ng／L]，两治疗组之间的疗效差异有统计学意义（P〈0．01）。结论虽然氯沙坦和氨氯地平有等同的降压效应，但氯沙坦尚能改善与肥胖相关的代谢紊乱，因此肥胖高血压患者用氯沙坦比氨氯地平治疗可能会获得更多益处。     

下肢动脉硬化性缺血疾病与炎性细胞的相关性

目的:研究外周血白细胞(white blood cell,WBC)计数等指标与下肢动脉硬化性缺血疾病的相关性。方法:用独立样本t检验回顾性分析下肢动脉硬化性缺血疾病组与非下肢动脉硬化性缺血疾病组WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数及血小板计数等的统计学差异。结果:缺血组WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数明显高于非缺血组患者(P<0.01),分别为(7.15±0.62vs4.97±0.8)×109/L,(4.59±1.57vs3.10±0.72)×109/L,(1.92±0.74vs1.41±0.60)×109/L,(0.41±0.16vs0.30±0.01)×109/L及(224±66.8vs189±51.7)G/L。结论:炎性细胞及血小板等参与了下肢动脉硬化性缺血疾病的形成过程。     

合并HBV感染孕妇口服替诺福韦对母婴传播阻断效果及安全性研究

目的　探讨合并HBV感染孕妇口服替诺福韦对母婴传播阻断效果及安全性研究。方法　选取2014年1月—2018年10月来我院就诊的80例合并HBV感染的孕妇作为研究对象,采用随机数字表法将其分为观察组（n=40）和对照组（n=40）。观察组给予口服替诺福韦至分娩,对照组给予口服替比夫定至分娩。2组新生儿出生后均给予标准免疫预防（乙型肝炎人免疫球蛋白100 IU+乙型肝炎疫苗）,对比2组孕妇血清HBV DNA、ALT及CRE水平,HBV母婴传播阻断效果,产后出血量、产后出血率、不良反应发生率。结果　分娩前,观察组HBV DNA及ALT水平均明显低于对照组[（2.87±0.37）×106 IU/ml vs.（4.27±0.51）×106 IU/ml、（27.03±3.41）U/L vs.（45.21±5.18）U/L],同时CRE水平明显高于对照组[（266.38±31.34）mg/L vs.（183.93±22.45）mg/L]（P均＜0.05）;观察组母婴阻断成功率明显高于对照组（100% vs. 87.5%）（P＜0.05）;观察组产后出血量明显低于对照组[（421.42±49.28）ml vs.（493.17±51.04）ml],同时观察组产后出血率及不良反应发生率均明显低于对照组（P均＜0.05）。结论　口服替诺福韦对合并HBV感染的孕妇可有效降低血清HBV DNA、ALT水平,提高CRE水平,母婴阻断成功率高,安全性好,在临床上值得推广及应用。     

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.     

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.     

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.