脉络膜黑色素瘤肝转移1例报告

<正>1临床资料患者女性,37岁,以"右上腹胀痛不适20 d"为主诉于2014年12月9日入院。患者20 d前无明显诱因出现右上腹胀痛不适,伴有背部酸痛,发病以来体质量下降约2 kg。入院前于门诊行彩色多普勒超声检查,显示:肝右叶多个结节融合成团块状,内可见分支状血流,左肝静脉及中肝静脉起始处受压变窄。提示:肝内多发实质占位性病变,考虑继发灶(图1)。追问其病史,患者于2011年6月10日因"左眼突发视力下降半     

原发性肝类癌伴反复腹水一例

患者女 ,6 8岁 ,因反复右上腹胀痛 17年 ,加重伴腹水 1年入院。 1985年 ,无诱因下渐感右上腹胀痛 ,不伴寒战、发热、黄疸、恶心、呕吐及黑便。B超、CT均提示“肝内占位性病变”。于 1987年在外院剖腹探查 ,术中发现肝脏呈“多囊性改变” ,诊断为“多发性肝囊肿” ,行“囊肿”切除术。病理诊断 :原发性肝类癌。术后无不适。 1998年又感右上腹胀痛 ,复查B超仍提示肝内占位性病变 ,于外院手术切除肝内肿物 ,病理检查示“原发性肝类癌” ,诊断 :复发性肝类癌。 2 0 0 1年上半年逐渐出现乏力、纳差、腹胀、小便量减少、双下肢水肿 ,半年内体重…     

腹痛、腹胀、反复黑便

病历摘要患者男,32岁。住院号156271。因中上腹痛5年,黑便3个月,右上腹胀痛月余,于1981年2月17日入院。患者近5年来常有中上腹隐痛,饥饿时好发,停返酸、嗳气,进食或服硷剂后隐痛可缓解。但半年来疼痛已无规律性,近3个月大便常呈黑色,每日1～2次,隐血试验(+～++++)。在外院作胃肠钡餐检查示十二指肠球部溃疡.给予甲氰咪胍等治疗曾有好转。近月来又感右上腹胀痛,向右背放射,和饮食无关。曾作同位素肝扫描提示肝区占位性病变,B 型超声检查诊断为肝囊肿.因诊断未明面入院。患者10     

老年人不典型多发性细菌性肝脓肿的误诊教训

随着人口老龄化、物质生活的提高、精神压力的增加,糖尿病患者的人数逐年攀升,糖尿病的易感染特性除体现在呼吸道外,更严重的体现在肝脓肿的发生,成为肝脓肿的重要诱因[1]。总结2009年3月至2011年3月入住我院老年科的不典型多发性肝脓肿病例,报道如下。1病例资料7例住院患者,其中男6例,女1例。年龄75～83岁,平均(79.43±0.31)岁。原发病均为糖尿病,部分患者因为发现肝脓肿而追查血糖,确诊为糖尿病。误诊为转移性肝癌5例。患者均为男性,进行性消瘦、乏力,右上腹胀痛伴黄疸入院,甲胎蛋白(AFP)阴性,血象高但无发热,院外曾使用抗生素,B超提示肝脏多发占位,无液性平段,肝脏增强CT     

腹膜后巨大淋巴结增生症1例

患者女,35岁。右上腹胀痛1年余。查体右上腹后侧触及一个5cm×5cm包块,压痛、质硬,界限清楚,不活动。CT示腹膜后良性占位性病变,纤维化不能排除。行剖腹探查术,术中见肿物位于     

鼻咽癌肝脏转移一例

患者 ,男性 ,5 7岁。因右上腹胀痛 10ｄ ,于 1997年 12月 16日入院。入院前 10ｄ起 ,无诱因持续性右上腹胀痛 ,并向右肩放射 ,右侧卧位明显。自服阿莫仙和胆通无缓解。无发热、尿黄。近期无明显体重变化。曾于 1996年 10月经鼻咽部活检 ,诊断为鼻咽癌 ,行放射治疗。后一直服用灵芝孢子 ,曾进食少量生鱼和动物内脏。体检 :Ｔ 36 .8℃ ,ＢＰ 12 0 /83ｍｍＨｇ ,Ｐ 76次 /ｍｉｎ ,Ｒ 2 0次 /ｍｉｎ。一般情况尚可 ,皮肤巩膜无黄染 ,无肝掌和蜘蛛痣 ,浅表淋巴结未及 ,心律齐 ,双肺无异常发现 ,腹软 ,右上腹微隆 ,全腹无肌紧张及压痛和反跳痛。肝…     

新疆和静县一例肝泡型包虫病病例报告

本文报告一例肝泡球蚴病人误诊为肝囊性包虫病。现报告如下。1　病例资料患者 ,女 ,2 9岁 ,蒙古族 ,牧民 ,新疆巴州和静县人。因右上腹胀痛不适 ,于 1997年 1月 17日入院。自述右上腹胀痛不适一年余 ,食量减少。此前曾到农二师焉耆医院行肝包虫手术。入院查体 :病人发育正常 ,营养中等 ;神志清楚 ,皮肤粘膜无黄染 ,浅表淋巴结未触及 ,巩膜无黄染 ,心肺未闻及杂音。右上腹膨隆 ,有压痛 ,可触及一质中等硬的巨大包块。左肝增大约剑突下5 cm。病人有明确的犬接触史 ,经常帮助家人剥狐狸皮和旱獭皮。实验室检查 :卡松尼试验 (2× 3) cm。包虫三…     

丝虫性肝脓疡一例

患者女性,62岁,安徽省淮北地区人。因持续高热、右上腹胀痛及发现包块1周于1981年1月7日拟诊肝脓疡住院。体检:慢性病容、消瘦、神清。体温38.6℃。脉搏92。血压110/75。巩膜无黄染。右上腹隆起,肝肿大有肋缘下5cm,剑突下6cm,质地     

原发性肝癌肝动脉化疗栓塞术后胆管损伤1例报告

<正>1病例资料男性患者,58岁,3年前因右上腹部胀闷不适来医院就诊。CT检查发现肝左叶占位性病变,直径约4 cm,考虑血管瘤,未处理,未定期复查。1年前仍感上腹部不适来医院复诊,CT检查发现肝左叶占位性病变,直径约8 cm,考虑肝癌可能,行腹腔镜左半肝切除+胆囊切除术,术后病理提示肝细胞癌。9个月前行预防性肝动脉化疗栓塞(transcatheter arterial chemoemboli-     

胆囊淋巴结血吸虫病1例

<正>1临床资料患者,男,52岁,湖北荆州人,因"右上腹胀痛半月余",无发热和恶心呕吐,于2009年7月7日入院。询问既往史,患者年轻时有疫水接触史,8年前曾患血吸虫病,口服吡     

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.