慢性砷暴露对雌性大鼠心肌雌激素受体结合位点相关抗原9和雌激素反应指蛋白mRNA表达的影响

目的 观察慢性砷暴露对雌性大鼠心肌雌激素受体结合位点相关抗原9(Ebag9)和雌激素反应指蛋白(efp) mRNA表达的影响.方法 将50只雌性Wistar大鼠按体质量随机分成5组,每组10只,分别饮用含砷(三氧化二砷)量为0.00(对照)、0.05、0.10、0.20、0.40 mg/L的水溶液,32周后通过实时定量PCR方法检测大鼠心肌中Ebag9和efp mRNA的表达.结果 0.00、0.05、0.10、0.20、0.40 mg/L组大鼠心肌Ebag9、efpmRNA表达量分别为0.54±0.14、0.52±0.10、0.48±0.24、0.58±0.13、0.45±0.19和0.85±0.14、0.86±0.12、0.87±0.09、0.99±0.10、0.86±0.19.与对照组比较,0.20 mg/L组Ebag9 mRNA表达有升高趋势,而其他各染砷组有降低趋势,但差异均无统计学意义(P均＞ 0.05).与对照组比较,0.20 mg/L组efp mRNA表达明显升高(P＜0.05),而其他各染砷组有升高趋势,但差异均无统计学意义(P均＞ 0.05).结论 慢性砷暴露可引起雌性大鼠心肌Ebag9和efp mRNA表达改变.砷可能对雌性大鼠心肌存在内分泌干扰效应.     

水砷暴露致人群心电图改变的研究

目的 研究不同水砷含量暴露与人群心电图改变的关系,探讨砷对心血管系统的影响.方法 2008-2013年,根据饮水型地方性砷中毒的历史监测资料,在山西省和内蒙古自治区选择15个村作为调查点,选择年龄≥20岁、饮水≥10年的当地常住居民作为调查对象,按照饮水砷含量分为对照组(＜0.01 mg/L)、低水砷组(0.01～＜0.05 mg/L)、中水砷组(0.05～＜0.10 mg/L)以及高水砷组(≥0.10 mg/L).采集调查对象家中的饮用水,应用氢化物原子荧光法检测水砷,并描记12导联心电图,比较不同水砷暴露人群的心电图改变.结果 共对1 341人进行心电图检查,异常率为11.56％(155/1 341),其中,对照组、低、中、高水砷组分别为5.7％(9/158)、12.85％(59/459)、12.02％(28/233)、12.02％(59/491).对照组的心电图异常率均低于低、中、高水砷组(x2值分别为6.141、4.391、5.090,P均＜0.05).心电图改变以心律失常和ST-T改变为主.对照组的各种心律失常异常率[0(0/158)]均低于低、中、高水砷组[4.58％(21/459)、3.86％(9/233)、3.46％(17/491);x2值分别为7.483、6.247、5.618,P均＜0.05].4组人群右心室扩大、心肌缺血心电图异常率组间比较差异均有统计学意义(x2值分别为9.525、9.848,P均＜0.05).结论 饮水型砷中毒病区居民心电图异常改变以心律失常和ST-T改变为主.水砷含量≥0.01 mg/L即可明显引起心电图异常率的增加,饮水砷对心脏组织有一定的影响.     

吸烟与饮酒对不同浓度饮水型砷暴露人群尿砷代谢模式的影响

目的 探讨吸烟、饮酒对砷暴露人群尿砷代谢的影响.方法 2008年选择山西省高砷地区不同饮水砷浓度暴露的年龄≥18岁的成年人作为调查对象,根据饮水砷浓度将调查对象分为3组:高砷暴露组(饮水砷浓度≥0.05 mg/L),低砷暴露组(0.01 mg/L≤饮水砷浓度＜0.05 mg/L),对照组(饮水砷浓度＜0.01mg/L).排除近期食用过海产品以及有慢性饮水型砷中毒症状的人群,通过问卷调查方式确定吸烟、饮酒的情况,同时采集居民家水样,以及调查对象的即时尿样.采用氢化物发生原子吸收分光光度法检测尿中无机砷(iAs)、一甲基砷(MMA)和二甲基砷(DMA)含量.以iAs、MMA及DMA的总和表示总砷(tAs)水平;以iAs/tAs、MMA/tAs和DMA/tAs分别计算iAs％、MMA％、DMA％;以(MMA+ DMA)/tAs及DMA/(MMA+ DMA)分别计算一甲基化率(FMR)和二甲基化率(SMR)水平.结果 共调查395人,高砷暴露组中烟酒嗜好者MMA％(16.24％)高于无烟酒嗜好者(12.16％),烟酒嗜好者的SMR水平(82.19％)低于无烟酒嗜好者(86.13％),差异有统计学意义(P均＜ 0.05),吸烟者、饮酒者与无烟酒嗜好者相比,各评价指标差异无统计学意义(P＞0.05);在低砷暴露组中吸烟者、烟酒嗜好者的MMA％( 13.86％、13.99％)均高于无烟酒嗜好者(11.83％),吸烟者、烟酒嗜好者的DMA％(72.87％、77.76％)和SMR水平(83.48％、83.90％)均低于无烟酒嗜好者(80.35％、86.54％),差异有统计学意义(P均＜0.05),饮酒者与无烟酒嗜好者相比,各评价指标差异无统计学意义(P＞0.05).对照组人群中吸烟者、烟酒嗜好者的MMA％( 17.27％、17.06％)均高于无烟酒嗜好者(11.52％),吸烟者、烟酒嗜好者的DMA％(73.89％、72.29％)和SMR水平(81.48％、82.58％)均低于无烟酒嗜好者(79.68％、87.19％),差异有统计学意义(P均＜ 0.05),饮酒者与无烟酒嗜好者相比,各评价指标差异无统计学意义(P＞0.05).结论 在不同浓度砷暴露的情况下,吸烟饮酒人群对砷的甲基化能力低于非吸烟饮酒人群.     

低浓度饮水型砷暴露对人群外周血血细胞参数的影响

目的 分析低浓度饮水型砷暴露对人群外周血血细胞的影响,为筛选低浓度砷暴露的早期损伤标志提供依据.方法 在山西省大同市,选择相邻且经济发展均衡的地方性砷中毒(简称地砷病)病区(水砷含量为14.41 ～ 90.34 μg/L)和非地砷病病区(水砷含量为0.00～ 0.87 μg/L),在病区与非病区各选择1个自然村,抽取饮当地水15年以上本地居民,无传染性、遗传性等疾病,无放射线和理化致病因素接触史者为调查对象.其中地砷病病区85名,为砷暴露组;非地砷病病区71名,为对照组.采集静脉血,全自动血细胞分析仪测定血细胞参数的变化.结果 白细胞各项指标:砷暴露组淋巴细胞绝对值[LYM,(2.00±0.90)×109/L]和淋巴细胞百分比[LYM％,(33.92±9.70)％]均高于对照组[(1.58±0.57)×109/L,(29.72±8.32)％,t值分别为-3.348、-2.873,P均＜0.05],单核细胞绝对值[MON,(0.15±0.07)×109/L]、单核细胞百分比[MON％,(2.53±0.77)％]均低于对照组[(0.47±0.15)×109/L,(8.64±1.97)％,t值分别为16.309、24.599,P均＜0.05].红细胞各项指标:砷暴露组红细胞[RBC,(4.44±0.46)×109/L]、血红蛋白[HGB,(136.59±13.84)g/L]、平均红细胞血红蛋白含量[MCH,(30.85±1.87)pg]、平均红细胞血红蛋白浓度[MCHC,(360.67±8.54)g/L]和红细胞体积分布宽度[RDW,(13.19±0.75)％]均高于对照组[(4.10±0.58)×109/L,(111.11±16.49)g/L,(27.68±2.99)pg,(295.20±36.82)g/L,(11.06±1.08)％,t值分别为-4.063、-10.491、-7.747、-14.651、-14.450,P均＜0.05],平均红细胞体积[MCV,(85.49±4.43)fl]则低于对照组[(92.69±7.50)fl,t=7.114,P＜ 0.05].血小板各项指标:砷暴露组血小板[PLT,(217.11±49.36)×109/L]、平均血小板体积[MPV,(7.01±1.16)fl]和血小板压积[PCT,(0.15±0.04)L/L]均低于对照组[(259.30±74.97)×109/L,(11.27±1.31)fl,(0.28±0.08) L/L,t值分别为4.073、21.486、13.428,P均＜0.05],血小板分布宽度[PDW,(18.21±0.55)％]高于对照组[(9.23±2.29)％,t=-32.228,P＜ 0.05].结论 长期低浓度饮水型砷暴露能引起人群外周血血细胞参数的改变.RBC增加,HGB含量升高,PLT数目明显减少,PLT和RBC体积异质性增加.     

喀什地区不同水平饮水砷暴露人群尿砷含量调查

目的了解新疆喀什地区不同水平饮水砷暴露人群砷中毒情况,为饮水型地方性砷中毒防治提供科学依据。方法选择水砷含量0.01 mg/L以下,0.01 mg/L～,0.05 mg/L～,0.08 mg/L～,0.09 mg/L～和0.10 mg/L以上的6个不同水平的6个村为调查点,采集50岁以上且在当地生活居住15年以上人群的一次性随机尿样检测尿砷含量。结果本次共调查507人,各调查点人群年龄(χ~2=2.218)和性别(χ~2=1.429)构成比差异均无统计学意义(P0.05);检测尿砷范围0.001～0.484 mg/L,几何均数为0.093 mg/L;不同水砷水平人群尿砷浓度不同,差异有统计学意义(Z=216.208,P0.05);尿砷含量超标202人、超标率39.84%;不同水砷水平人群超标率不同,差异有统计学意义(χ~2=103.804,P0.05)。结论新疆喀什地区调查点均已改水,但因改水工程年久失修或管理不善,水砷含量超标,人群尿砷超标率较高,随着水砷含量增加,人群尿砷有升高趋势。     

山西省饮水型慢性砷中毒病区环境介质中砷暴露水平调查

目的 调查山西省饮水型慢性砷中毒病区环境介质水、土壤以及自产粮食、蔬菜中的砷含量,了解该病区外环境中砷暴露水平,为病区地方性砷中毒的防治提供科学依据.方法 在山西省山阴县饮水型慢性砷中毒病区,按照《地方性砷中毒诊断标准》(WS/T 211-2001)选择126个家庭共309人作为调查对象,入户采集饮用水、土壤、当地自产粮食(小米、黍子)和蔬菜(马铃薯).水砷和粮食砷采用电感耦合等离子体质谱联用仪(ICP-MS)检测,土壤和蔬菜通过原子荧光分光光度计(AFS)定量检测砷含量.按饮水含砷量分为5组(≤10,＞ 10～50,＞50 ～ 100,＞100～200,＞200 μg/L),以≤10 μg/L组作为参考值,分析水砷暴露与皮肤病变的关系.结果 在抽取的126份饮用水样品中,水砷范围为4.04～720.00 μg/L,中位数为87.75 μg/L,超标率为63.49％(80/126);粮食砷浓度范围为0.16～4.58 mg/kg,中位数为0.66 mg/kg,超标率为98.73％(78/79);土壤和蔬菜中砷含量范围分别为5.34～13.74 mg/kg和0～ 0.30 mg/kg.用标准参考人估算通过饮水、粮食、蔬菜每天摄入的无机砷量,并与世界卫生组织(WHO)规定无机砷最大日允许摄入量(MTDI)比较,粮食中总砷含量为0.17 mg/kg时无机砷的摄入量相当于水砷浓度为10μg/L时无机砷的摄入量.同时,分析水砷暴露与皮肤病变关联强度,组间比值比(OR)分别为3.219、9.001、56.127、97.734,呈递增趋势,地方性砷中毒皮肤病变发病危险性逐渐增加,进一步对水砷暴露水平与皮肤病变严重程度进行Spearman等级相关检验,r=0.501 (P＜0.05),水砷暴露与砷中毒的皮肤病变存在关联性且水砷暴露水平越高,皮肤病变程度越严重.结论 山西省山阴县饮水型慢性砷中毒病区饮用水、自产粮食砷含量偏高,而土壤和蔬菜砷含量不高.饮用高砷井水是导致慢性砷中毒的主要危险因素,通过饮食摄入的砷也不容忽视.     

停经前与停经后年轻女性冠心病患者危险因素及冠状动脉病变特点比较

目的探讨年龄在50岁以下的停经与未停经的女性冠状动脉粥样硬化性心脏病(冠心病)患者的危险因素、临床及冠状动脉造影特点。方法选取经临床及冠状动脉造影确诊的年龄50岁以下女性冠心病住院患者共173例,按月经情况分为停经组与未停经组,对比分析两组间冠心病危险因素、临床及冠状动脉造影特点。结果未停经组年龄小于停经组,差异有统计学意义[(44.5±5.6)岁vs.(48.4±2.1)岁,P<0.05];两组体质量比较,差异无统计学意义(P>0.05)。未停经组血脂异常及糖尿病患者比例明显多于停经组,差异有统计学意义(15.0%vs.0,P<0.05;62.1%vs.42.4,P<0.05);空腹血糖浓度高于停经组,差异有统计学意义[(6.27±2.30)mmol/L vs.(5.40±0.90)mmol/L,P<0.05]。未停经组高密度脂蛋白浓度低于停经组,差异有统计学意义[(1.21±0.31)mmol/L vs.(1.02±0.28)mmol/L,P<0.05],而两组其他血脂成分(血清总胆固醇、低密度脂蛋白、三酰甘油、载脂蛋白A及载脂蛋白B100浓度)比较,差异均无统计学意义(P>0.05)。两组尿蛋白阳性患者比例、血清尿酸及血清肌酐浓度比较,差异无统计学意义(P>0.05)。未停经组患者左前降支及其分支受累率明显高于停经组,差异有统计学意义(76.4%vs.51.5%,P<0.05);发生急性心肌梗死的患者比例也比停经组高,差异有统计学意义(26.4%vs.6.1%,P<0.05)。结论年龄50岁以下女性冠心病患者,未停经患者比停经患者年轻,有血脂异常及糖尿病等冠心病危险因素的患者比已停经患者多。未停经患者比已停经年轻女性冠心病患者高危,需要及时识别并积极诊治。     

砷暴露对大鼠原代星形胶质细胞分泌胶质细胞源性递质的影响

目的 观察砷暴露对大鼠原代星形胶质细胞(astrocyte,AST)分泌胶质细胞源性递质的影响,探讨砷对学习记忆功能损伤的作用机制.方法 出生1～3 d的Wistar大鼠仔鼠,取双侧大脑半球,经处理获得原代培养脑AST,并通过胶质纤维酸性蛋白免疫荧光染色鉴定.AST分别在含0.0、2.5、5.0、10.0μmol/L亚砷酸钠的培养液中培养24h,荧光双波长分光光度计法检测细胞内游离钙离子浓度([Ca2+]i);高效液相色谱(HPLC)法检测细胞培养液谷氨酸、D-丝氨酸、甘氨酸和γ-氨基丁酸含量.结果 胶质纤维酸性蛋白免疫荧光染色,AST纯度＞95％.不同浓度砷暴露组间AST内[Ca2+]i比较差异有统计学意义(F=20.030,P＜0.05),其中10.0 μmol/L砷暴露组AST内[Ca2+]i[(263.27±14.80)nmol/L]明显高于0.0、2.5、5.0μmol/L砷暴露组[(204.24±27.21)、(214.49±21.85)、(232.74±23.14)nmol/L,P均＜0.05].不同浓度砷暴露组间AST分泌的D-丝氨酸、甘氨酸和γ-氨基丁酸比较差异均有统计学意义(F值分别为26.599、33.539、5.599,P均＜0.05),其中2.5、5.0、10.0 μmol/L砷暴露组AST分泌的D-丝氨酸[(21.580±1.313)、(21.936±1.539)、(23.401±1.648)μmol/L]、甘氨酸[(26.353±2.449)、(29.711±1.530)、(29.234±2.057)μmol/L]和γ-氨基丁酸[(27.277±3.421)、(30.213±2.098)、(29.364±2.588) μmol/L]均高于0.0 μmol/L砷暴露组[(16.017±1.046)、(16.763±3.007)、(22.736±4.139) μmol/L,P均＜0.05].结论 砷暴露可引起原代AST分泌胶质细胞源性递质增加,可能会损伤学习记忆功能.     

低剂量长期砷暴露对HaCat细胞增殖及凋亡水平的影响

目的探讨低剂量长期砷暴露对HaCat细胞增殖及凋亡水平的影响。方法 HaCat细胞暴露于浓度为0、0.05、0.10μmol/L的NaAsO215周后,用直接细胞计数法计数对照组及染砷组细胞数,检测细胞增殖水平;用流式细胞仪测定10 000个细胞的细胞凋亡发生水平。结果各染砷组细胞增殖速率与对照组相比均显著增高(P<0.05),且0.10μmol/L组细胞增殖率(245.00±8.66)%显著高于0.05μmol/L组(165.00±15.00)%(P<0.05),细胞增殖水平与染砷剂量间呈显著剂量-效应关系;0.05μmol/L组(0.28±0.08)%及0.10μmol/L组(0.34±0.09)%细胞凋亡率均明显低于对照组(0.74±0.18)%(P<0.05)。结论长期低剂量砷暴露可使HaCat细胞的增殖能力明显增强,并诱导细胞凋亡率显著降低。     

山西省山阴县地方性砷中毒病区饮水砷与皮肤病变间关系调查

目的 分析山西省山阴县地方性砷中毒(简称地砷病)病区居民饮水砷暴露与皮肤病变间的关系,为地砷病防治研究提供流行病学依据.方法 在山西省山阴县地砷病病区抽取17个村的189例地砷病患者和59例非患者(对照)作为调查对象.入户采集所有调查对象饮用水,用水砷快速检测试剂盒半定量检测水砷,并用高效液相色谱一等离子体质谱联用仪(HPLC-ICP-MS)定量检测水砷.地砷病皮肤病变按<地方性砷中毒诊断标准)(WS/T211-2001)进行诊断.结果 在抽取的134份水样中,砷超标率达64.9%(87/134).水砷中位数为91.43μg/L.饮水砷暴露水平(＞50μg/L为高砷暴露,≤50μg/L为低砷暴露)与掌跖角化、色素沉着和脱失间的关联强度OR(95%CI)值分别为2.46(1.22～4.94)、3.34(1.50-7.44)和2.86(1.50-5.46).随着水砷暴露水平(按≤10、≤50、≤200、＞200μg/L分组)升高,患掌跖角化、色素沉着和色素脱失组间OR值呈增加趋势,尤其是水砷＞200μg/L组以≤10μg/L组作为参考,OR值分别为6.15、13.96、11.41,组间差异均有统计学意义(P＜0.05).皮肤色素Ⅲ度脱失患者水砷暴露水平(318.300μg/L)明显高于0、Ⅰ、Ⅱ度脱失患者(86.670、131.800、110.590μg/L,P＜0.05).结论 山阴县属于中度砷暴露地区,水砷暴露是皮肤病变的危险因素.随着水砷暴露量增加,病变程度加重.     

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.