吲达帕胺和吲达帕胺联合培垛普利对高血压病治疗的临床研究

目的 观察吲达帕胺的降血压作用，不良反应，对代谢的影响及与血管紧张素转换酶抑制剂（ACEI）合用的疗效。方法 按1999年WHO标准选取原发高血压病例，分为吲达帕胺组（667例，吲达帕胺2.5mg，每日一次）与吲达帕胺＋培垛普利组（33例吲达帕胺2.5mg/d 培垛普利4mg/d)。由固定医生每周随访一次，测坐位血压，并于冲洗期末和降压治疗2周后测动态血压，冲洗期末及治疗4周后检查空腹血糖，血脂，血钾及尿白蛋白排泄量。结果 吲达帕胺组服药后4周，8周，12周，总有效率分别达72．7％，77．3％和81．8％，降压的T／P比在60％以上，对糖代谢，脂代谢和血钾无明显影响，尿白蛋白排泄量减少（P＜0．01）。吲达帕胺＋培垛普利组治疗4，8周后，总有效率分别达72．7％，84．8％。仅个别病人出现轻微的不良反应。结论 吲达帕胺对高血压患者单药降压有效率高，不良反应少，对糖代谢，脂代谢和血钾无明显影响，并能减少尿白蛋白排泄量，与ACEI合用，有良好的协同作用。     

高血压病患者血清甲状腺激素的水平及药物干预的变化

目的：探讨高血压病（ＥＨ）患者血清甲状腺激素的水平及药物干预后的影响。方法：用放射免疫法测定了６６例ＥＨ患者和３６例正常血压对照者及４１例ＥＨ患者服药（２５例服吲达帕胺２．５ｍｇ／ｄ或１６例服卡托普利１８．７５～７５ｍｇ／ｄ）８周后血清Ｔ３、Ｔ４的变化。结果：ＥＨ患者血清Ｔ３、Ｔ４水平显著高于对照组,均Ｐ〈０．０１;服吲达帕胺组或卡托普利组８周后血压,Ｔ３、Ｔ４水平较服药前均显著降低（Ｐ〈０．０５）。结论：ＥＨ患者血清Ｔ３、Ｔ４水平增高;吲达帕胺,卡托普利有效降血的同时均能显著降低血清Ｔ３、Ｔ４水平,甲状腺激素的失控可能参与高血压的形成或维持。     

硝苯地平联合吲达帕胺治疗老年高血压96例临床分析

目的探讨硝苯地平缓释片联合吲达帕胺片治疗老年人高血压的临床疗效及对肾功能影响。方法将176例老年高血压患者采用随机数字法分为对照组80例和观察组96例。对照组患者口服硝苯地平缓释片20mg,1～2次／d,连服2个月。观察组患者在对照组治疗方法的基础上,口服吲迭帕胺片1．25—2．5mg,1次／d,治疗2个月。比较治疗前后两组患者的血肌酐、尿素氮、收缩压变化及临床疗效。结果治疗后观察组收缩压、肌酐、尿素氮均低于对照组,差异均有统计学意义（P〈0．01）。观察组临床疗效明显优于对照组,差异有统计学意义（P=0．009）。结论硝苯地平缓释片联合吲达帕胺片治疗老年高血压可有效降低患者收缩压、肌酐、尿素氮,对老年人的肾脏有一定保护作用,临床疗效显著．不良反应轻微。     

吲达帕胺治疗中枢性尿崩症的临床观察

应用吲达帕胺（ｉｎｄａｐａｍｉｄｅ）２．５～７．５ｍｇ／ｄ或双氢氯噻嗪５０～７５ｍｇ／ｄ治疗１０例中枢性尿崩症，治疗后第３天患者日尿量减少近一半，尿渗透压增高１倍多，治疗后第６天上述指标无进一步改善，两种药物的疗效比较无显著性差异。吲达帕胺治疗期间，血压和血清电解质未见明显变化。双氢氯噻嗪治疗后血钾下降。提示吲达帕胺是治疗中枢性尿崩症的一种新的有效药物。     

吲达帕胺治疗老年高血压186例疗效观察

目的：探讨吲达帕胺对老年人高血压病的治疗效果及其对血脂等的影响。方法：用药前停用所有降压药物，改用吲达帕胺2．5mg或5mg、每日1次口服，连续6－8周。用药前后测量血压，查血糖、血脂等项目。结果：吲达帕胺可降低老年轻或中度高血压患的收缩压，舒张压（P＜0．05），降为正常达54％，对血清电解质、血脂、血肌酐及谷丙转氨酶的影响均不大。结论：吲达帕胺具有疗效高，副作用少，价钱便宜等优点，是老年高血压患较为理想的一线降压药物。     

吲达帕胺和吲达帕胺联合培垛普利对高血压病治疗的临床研究

目的观察吲达帕胺的降血压作用、不良反应、对代谢的影响及与血管紧张素转换酶抑制剂(ACEI)合用的疗效.方法按1999年WHO标准选取原发高血压病例,分为吲达帕胺组(66例,吲达帕胺2.5 mg,每日一次)与吲达帕胺+培垛普利组(33例吲达帕胺2.5 mg/d+培垛普利4 mg/d).由固定医生每周随访一次,测坐位血压,并于冲洗期末和降压治疗2周后测动态血压,冲洗期末及治疗4周后检查空腹血糖、血脂、血钾及尿白蛋白排泄量.结果吲达帕胺组服药后4周、8周、12周,总有效率分别达72.7%、77.3%和81.8%,降压的T/P比在60%以上,对糖代谢、脂代谢和血钾无明显影响,尿白蛋白排泄量减少(P<0.01).吲达帕胺+培垛普利组治疗4、8周后,总有效率分别达72.7%、 84.8%.仅个别病人出现轻微的不良反应.结论吲达帕胺对高血压患者单药降压有效率高,不良反应少,对糖代谢、脂代谢和血钾无明显影响,并能减少尿白蛋白排泄量.与ACEI合用,有良好的协同作用.     

高血压病患者血清甲状腺激素的水平及药物干预的变化

目的: 探讨高血压病(EH)患者血清甲状腺激素的水平及药物干预后的影响.方法:用放射免疫法测定了66例EH患者和36例正常血压对照者及41例EH患者服药(25例服吲达帕胺2.5 mg/d或16例服卡托普利18.75～75 mg/d)8周后血清T3、T4的变化.结果:EH患者血清T3、T4水平显著高于对照组,均P<0.01;服吲达帕胺组或卡托普利组8周后血压,T3和T4水平较服药前均显著降低(P<0.05).结论:EH患者血清T3、T4水平增高;吲达帕胺,卡托普利有效降血的同时均能显著降低血清T3、T4水平,甲状腺激素的失控可能参与高血压的形成或维持.     

培哚普利、卡托普利和硝苯地平对老年轻中度高血压患者肾功能的影响

目的：观察培哚普利、卡托普利和硝苯地平对老年轻中度高血压患者肾功能的影响。方法：９４例老年轻中度高血压心室肥厚患者随机分为培哚普利、卡托普利和硝苯地平３组，服用２周安慰剂后用药３个月，剂量逐月递增。用药前后测定血压、尿微白蛋白分泌率（ＭＡＥＲ）、尿素氮、肌酐、肌酐清除率和血钾、血钠。结果：３组用药后血压均明显下降达正常范围；尿ＭＡＥＲ在培哚普利组显著下降（Ｐ＜０．０１），另两组下降不显著；尿素氮、肌酐、肌酐清除率３组治疗前后无明显变化；血钾在卡托普利组和培哚普利组均有上升（Ｐ＜０．００５和Ｐ＜０．０５），血钠水平３组间均无变化。结论：培哚普利、卡托普利和硝苯地平均可有效控制血压，培哚普利同时可降低尿ＭＡＥＲ，改善肾功能，但培哚普利与卡托普利均可引起血钾升高，应引起注意。     

卡托普利与吲达帕胺或氢氯噻嗪合用的降压疗效观察

目的研究和评价卡托普利与吲达帕胺或氢氯噻嗪合用的降压疗效及对代谢的影响。方法选择60例轻、中度原发性高血压病患者,随机分成三组,每组各20例。卡托普利组:单用卡托普利12.5～50mg,3次/d;卡托普利与吲达帕胺合用组:卡托普利12.5—25mg,3次/d,加吲达帕胺2.5mg,1次/d;卡托普利与氢氯噻嗪合用组:卡托普利12.5~25mg,3次/d,加氢氯噻嗪12.5mg,2次/d。三组疗程均为12周。观察三组治疗前后的随测血压和24h动态血压及生化指标。结果卡托普利加吲达帕胺或加氢氯噻嗪组降压总有效率及随测血压、24h动态血压的变化均明显优于卡托普利单用组,且治疗前后心率和生化指标无明显改变。结论 卡托普利与吲达帕胺或氢氯噻嗪联合应用降压效果较单用卡托普利更有效,且对代谢无影响。     

氯沙坦联合吲达帕胺治疗高血压合并高尿酸血症的疗效观察

目的探讨氯沙坦联合吲达帕胺治疗高血压合并高尿酸血症的疗效。方法选取78例高血压合并高尿酸血症患者,随机分为两组,对照组39例,给予口服氯沙坦50mg,1次/d,治疗组39例,在对照组的基础上加服吲达帕胺2.5mg,1次/d;治疗12周,观察血压、血尿酸、血肌酐和血钾的变化。结果治疗组降压效果明显优于对照组（P〈0.01）,且两组降血尿酸效果比较无显著差异（P〉0.05）。结论氯沙坦联合吲达帕胺具有良好的降压、降血尿酸作用。     

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.     

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.