原发性胃肠道恶性淋巴瘤临床分析

目的 探讨原发性胃肠道恶性淋巴瘤(PGIML)的临床及病理特点。方法 回顾性总 结分析PGIML22例资料,所有病例均经内镜活检或手术后病理组织学所证实。结果 腹痛是PCIML 最常见的症状,达68.2％(15／22);胃是最常见的发生部位,达54.5％(12／22)。黏膜表面呈肿块结节 是PGIML最常见的内镜表现,达71.4％(15／21),内镜活检诊断PGIML的阳性率为52.6％(10／19)。 22例均为非何杰金淋巴瘤,20例为黏膜相关淋巴组织(MALT)淋巴瘤,其中13例为MALT型结外边 缘区B细胞淋巴瘤。结论PGIML以腹痛为主要临床表现,胃的发生率最高,主要病理类型为MALT 型结外边缘区B细胞淋巴瘤,其预后与手术方式和术后化疗有关。     

35例原发性恶性胃淋巴瘤临床特点分析

原发性恶性胃淋巴瘤（PMGL）临床表现缺乏特异性，内镜和上消化道钡餐检查确诊率低。目的：了解PMGL的临床特点，以期早期诊断，早期治疗，改善预后。方法：回顾性分析上海仁济医院2000年9月～2006年2月收治的PMGL病例的病史资料。结果：共35例PMGL患者人选。主要消化道症状为上腹痛，伴全身症状者较少。内镜下溃疡型、弥漫浸润型和结节肿块型病变分别占67．7％、22．6％和9．7％，病变主要位于胃窦和胃体。内镜活检病理检查确诊率为54．5％。35例PMGL术后病理诊断均为B细胞性非霍奇金淋巴瘤，其中黏膜相关淋巴组织（MALT）淋巴瘤5例，弥漫性大B细胞淋巴瘤（DLBCL）26例，DLBCL合并MALT淋巴瘤（DLBCML）4例。患者预后与肿瘤病理类型、临床分期和血清乳酸脱氢酶（LDH）水平有关（P〈0．05）。术后3年生存率为81．8％。结论：PMGL患者局部表现严重而全身状况良好。内镜下病变大、范围广且多部位侵犯。多点取材或“挖洞式”活检可提高内镜诊断率。治疗方案的选择应根据肿瘤病理类型、临床分期和是否存在幽门螺杆菌感染而定。     

原发性肠淋巴瘤与克罗恩病的鉴别诊断

背景：原发性肠淋巴瘤的发病率较低，临床表现缺乏特异性，易误诊为其他胃肠道疾病，特别是与克罗恩病（CD）的鉴别诊断较困难。目的：通过分析原发性肠淋巴瘤和CD患者的临床资料，提高原发性肠淋巴瘤与CD的鉴别诊断水平。方法：回顾性分析原发性肠淋巴瘤和CD患者的临床特点、内镜表现和病理检查结果。结果：原发性肠淋巴瘤患者的平均年龄为50岁，CD为35岁。5例（12.2％）CD发生肛周病变，4例（9.8％）内瘘，3例（7.3％）有肠外表现，但仅1例（5.9％）原发性肠淋巴瘤曾有肛瘘。内镜下原发性肠淋巴瘤以回盲部受累多见（41.7％），CD以小肠和结肠均受累多见（48，8％）；原发性肠淋巴瘤以肿块型较多见（41.7％），CD则主要表现为溃疡和铺路石样改变，其中18例伴肠腔狭窄，4例瘘管形成。B细胞性原发性肠淋巴瘤13例，T细胞性4例。12例CD表现为非干酪样坏死性肉芽肿。结论：临床上原发性肠淋巴瘤与CD的鉴别诊断较困难，需综合各种检查手段，特别是内镜检查和内镜下对病变部位多点取活检，以提高诊断率。     

原发性胃肠道恶性淋巴瘤33例临床分析

目的探讨原发性胃肠道恶性淋巴瘤的早期诊断及治疗。方法回顾分析1997—2005年33例原发性胃肠道恶性淋巴瘤（PGIML）患者的临床资料。结果内镜及活检确诊率为44．4％。免疫分型以B细胞为主（90．9％）。全组患者有30例经手术治疗，2例仅行Hp根除术，1例确诊后放弃治疗。术后：单纯手术者21例，2年及以上生存者19例（90．5％）；手术加化疗者9例，2年及以上生存者6例（66．7％）。在11例胃黏膜相关淋巴组织（MALT）淋巴瘤中有2例胃MALT淋巴瘤行抗Hp治疗，肿瘤消退或缩小；9例行手术切除，术后未复发。结论PGIML早期诊断较困难，可采取多种诊断手段综合诊断，手术治疗作用尚未肯定，还需进一步随访观察。     

21例原发性肠道非霍奇金淋巴瘤误诊分析

胃肠道是原发性非霍奇金淋巴瘤最常见的结外累及部位。原发性肠道非霍奇金淋巴瘤临床表现无特异性,内镜活检诊断率较低。目的：回顾性分析原发性肠道非霍奇金淋巴瘤误诊病例,以期提高其诊断准确率。方法：收集上海仁济医院2003年1月-2011年10月所有经手术病理证实、符合Dawson标准的原发性肠道非霍奇金淋巴瘤病例,复习误诊病例,分析可能的误诊原因。结果：共入组误诊病例21例,其中弥漫性大B细胞淋巴瘤10例,原发性肠道T细胞淋巴瘤7例,套细胞淋巴瘤3例,黏膜相关淋巴样组织（MALT）淋巴瘤1例,大多数患者在诊断过程中曾行影像学和内镜检查。弥漫性大B细胞淋巴瘤多误诊为阑尾炎或胃肠炎,原发性肠道T细胞淋巴瘤常误诊为克罗恩病,套细胞淋巴瘤均误诊为结肠息肉,此外尚有误诊为肠道血管炎、淋巴细胞性胃肠炎以及未能明确消化道出血原因者。结论：不同病理类型原发性肠道非霍奇金淋巴瘤在误诊为其他肠道疾病时表现各有其特点,了解这些特点可能有助于正确诊断原发性肠道非霍奇金淋巴瘤。     

胃黏膜相关淋巴组织淋巴瘤的临床和内镜下表现

背量：原发性胃B细胞淋巴瘤发生于黏膜相关淋巴组织(MALT)，与幽门螺杆菌(H．pylori)感染密切相关。内镜检查是早期诊断胃MALT淋巴瘤的重要方法。目的：探讨胃MALT淋巴瘤的临床和内镜下表现。方法：分析总结经术后病理检查证实为胃MALT淋巴瘤的20例患者的临床、内镜和病理资料。20例患者中，男10例，女10例，男女比例为1：1，平均发病年龄为55．6岁(21～78岁)。结果：20例患者的临床表现均无特异性，上腹疼痛最为常见，其次是饥饿痛、腹胀、恶心、呕吐、黑便等。内镜下表现：病变发生于胃窦部5例，胃体部5例，胃角部1例，贲门部1例，多部位8例：形态表现多样，其中溃疡型10例，弥漫浸润型3例，结节型5例，结节溃疡型2例；内镜活检确诊率较低，仅为5％。20例患者中有12例检测了H.pylori，阳性率为83．3％(10／12)。手术标本免疫组化染色结果均为B细胞恶性淋巴瘤。结论：胃MALT淋巴瘤的临床表现无特异性，内镜下表现多样，病变范围较大。H．pylori感染率高可能与胃MALT淋巴瘤的发病有关。     

胃粘膜相关淋巴组织淋巴瘤的内镜和病理特点

目的 探讨胃粘膜相关淋巴组织（MALT）淋巴瘤的内镜和病理特点,以提高其在内镜下的确诊率。方法 回顾性结合部分前瞻性分析28例患者。结果 胃MALT淋巴瘤多见于40－60岁患者,确诊病程的中位数为8．5月。临床症状无特异性,抗酸剂治疗无效,25％可引起上消化道出血。Hp感染率为78．6％,10．7％患者的CA125可升高,17．9％患者的ESR升高。高度恶性者可发生浸润或转移。肿瘤多位于胃体下段和／或胃窦部,占96．4％,75％表现为单个或多人浅表性溃疡,质地偏硬,但大部分患者的粘膜尚可稍提起,少见的病变有稍隆起性、糜烂和坏死性病变。胃镜下形态诊断的误诊率为89．3％。胃镜下常规活检组织病理检查,恶性疾病漏诊率为57．1％,而胃MALT淋巴国漏诊率为82．1％,术后病理检查确诊率达100％。深而大的活检和免疫组织化学检查有助于确诊。B细胞淋巴瘤占88．9％,T细胞淋巴瘤占11．1％。结论 胃MALT淋巴瘤是一类独特的原发性胃淋巴瘤,具有一定的病理和内镜特点。     

肺粘膜相关型淋巴瘤8例报告

目的　肺粘膜相关型淋巴瘤 (MALT型淋巴瘤 )虽是相对少见且临床诊断困难的肺部肿瘤 ,但老年人发病率较高 ,本文旨在引起临床医师对本病的重视。　 方法　利用 8例完整的临床、病理资料 ,结合文献 ,探讨肺MALT型淋巴瘤的诊断、病理特征、预后及治疗等问题。　 结果　①本组 8例均为肺低度恶性MALT型淋巴瘤。②临床上 8例病人均有吸烟、反复肺部感染等超常慢性免疫系统刺激因素存在。③肺MALT型淋巴瘤与肺炎性假瘤关系密切 ,需通过免疫组化等方法加以鉴别。　 结论 　①肺MALT型淋巴瘤的临床症状和影像学表现缺乏特异性 ,极易误诊 ,病理检查是该病确诊的金指标。②临床上凡遇肺部病灶诊断不明或炎性假瘤只要病人能承受手术 ,建议尽早手术切除。     

胃黏膜相关淋巴组织淋巴瘤的临床、病理及内镜下表现探讨

黏膜相关淋巴组织（MALT）淋巴瘤中胃MALT淋巴瘤最为常见,在胃恶性肿瘤中占2%～8%,并有逐年升高的趋势.它有其特殊的组织病理、免疫组化特征,但临床症状、内镜下表现缺乏特异性,早期诊断较困难[1].我们分析总结了我院40例胃MALT型淋巴瘤的病理、临床资料,旨在提高对胃MALT淋巴瘤的认识。     

原发甲状腺淋巴瘤4例临床分析

非霍奇金淋巴瘤（NHL）以淋巴结受累最常见，其次为胃肠道。原发性甲状腺淋巴瘤（PTL）较少发生。1995年5月～2005年10月，我院收治PTL患者4例。现报告如下。临床资料：本组4例PTL患者均为女性，年龄52～72岁、平均66岁．病程2个月～8a，排除系统性淋巴瘤累及甲状腺者。患者均有颈前肿物伴或不伴压迫周围脏器的表现，均为B细胞来源的淋巴瘤，2例为低度恶性B细胞黏膜相关性淋巴组织淋巴瘤（MALT），2例为弥漫大B细胞淋巴瘤（DLBCL）。     

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.