缺血性结肠炎43例临床分析

目的 探讨缺血性结肠炎的临床表现、内镜特征及诊治方法.方法 回顾性分析43例缺血性结肠炎患者的临床资料.结果 缺血性结肠炎多发于60岁以上中老年女性患者,尤其伴有糖尿病以及心、脑血管等基础疾病者.腹痛、腹泻及便血为主要临床表现.结肠镜下以黏膜充血、水肿、糜烂、溃疡等为主要表现,病变主要见于左半结肠,呈节段性分布,病变与正常黏膜分界清楚,多数患者预后良好.结论 中老年人(尤其合并有心脑血管及糖尿病等疾病者)出现不明原因的腹痛、腹泻、便血者应考虑缺血性结肠炎可能,应尽早行结肠镜检查,必要时行血管造影或其他影像学检查.此外,结肠镜检查过程中有诱发缺血性结肠炎的可能.     

缺血性结肠炎37例

目的:探讨缺血性结肠炎的临床特点、内镜特征及诊断和治疗方法.方法:对37例缺血性结肠炎患者的临床表现、易患因素、结肠镜检查、患者的转归等资料进行回顾性分析.结果:缺血性结肠炎多发于老年患者,其中＞60岁者占70.3%(26/37).多伴有高血压、冠心病、糖尿病以及脑血管病等基础疾病.腹痛、腹泻以及便血为主要临床表现.结肠镜下以黏膜充血、水肿、糜烂、溃疡等为主要表现,为非特异性表现,病变主要见于左半结肠,呈节段性分布.多数患者预后良好,27例(72.9%,27/37)患者基本愈合.结论:老年患者出现急性腹痛,腹泻以及便血应注意缺血性结肠炎可能,早期结肠镜检查,综合临床分析可及时明确诊断指导治疗.结肠镜检查时应该小心操作因为肠镜检查本身可以诱发缺血性结肠炎.     

缺血性结肠炎44例临床分析

目的探讨缺血性结肠炎的临床特点、内镜特征和诊治要点。方法回顾性分析2003年1月～2007年6月44例缺血性结肠炎的临床资料．结果缺血性结肠炎好发于老年人，多伴有相关基础疾病，主要临床表现是急性下腹痛和便血。内镜检查提示病变主要发生在左半结肠，呈节段性分布，结肠黏膜高度水肿、充血、糜烂、坏死及溃疡。大多数病例呈一过性表现，如能早期诊断与治疗，预后良好。结论急性腹痛和便血且伴有心、脑血管疾病及糖尿病的老年患者应考虑有缺血性结肠炎可能，病变转归与发病年龄、病变程度及病程长短、伴随的基础疾病及有无并发症可能相关。内镜检查在明确诊断、早期治疗和判断预后上具有重要意义。     

缺血性结肠炎临床特点分析

目的分析缺血性结肠炎的临床资料,探讨其临床特点,提高对该疾病的认识和临床诊治水平。方法对31例缺血性结肠炎患者的临床表现、结肠镜检查、辅助检查、治疗经过以及转归等进行回顾性研究。结果缺血性结肠炎多发于老年患者,其中60岁者占54.8%(17/31)。多伴有高血压、冠心病、脑梗塞、糖尿病等基础疾病。腹痛、腹泻以及便血为主要临床表现。结肠镜下主要表现为黏膜充血、水肿、糜烂、溃疡,病变主要见于左半结肠,呈节段性分布,多数患者预后良好。结论缺血性结肠炎临床症状与体征缺乏特异性,对于不明原因出现腹痛、血便或腹膜刺激征的中老年人应考虑缺血性结肠炎的可能,充分运用相关辅助检查,以明确诊断,指导治疗。     

缺血性结肠炎58例临床及内镜特点分析

[目的]探讨缺血性结肠炎的临床特点、内镜特征和诊治要点。[方法]回顾性分析2015-05—2016-06期间经临床电子结肠镜及病理检查确诊的58例缺血性结肠炎的临床资料、内镜下的表现及治疗情况。[结果]缺血性结肠炎好发于老年人,多伴有相关基础疾病,主要临床表现是急性下腹痛和便血。内镜检查提示病变主要发生在左半结肠,呈节段性分布,结肠黏膜高度水肿、充血、糜烂、坏死及溃疡。大多数病例呈一过性表现,如能早期诊断与治疗,预后良好。[结论]对老年人患者出现急性腹痛和便血且伴有心、脑血管疾病以及糖尿病的应考虑有缺血性结肠炎的可能,病变转归与发病年龄、病变程度及病程长短、伴随的基础疾病以及有无并发症相关。内镜检查对明确诊断、早期治疗和判断预后具有重要意义。     

缺血性结肠炎30例临床表现及内镜特点分析

目的 总结缺血性结肠炎的临床表现及内镜特点,提高对该病的早期诊断和治疗水平.方法 对本院2007年1月-2010年8月诊断为IC的30例患者,其临床表现、内镜特点、治疗和转归进行回顾性分析.结果 IC好发于中老年人,男女比例1:3.3,23例伴有动脉硬化相关性疾病.主要临床表现为突发腹痛及便血,内镜下表现为黏膜充血水肿、糜烂、溃疡、黏膜新鲜出血等,病变黏膜与正常黏膜分界清楚,多位于左半结肠.活血、扩血管及内科综合治疗获得良好效果,均于2周左右好转出院.结论 中老年人突发腹痛及便血时应警惕IC,早期进行结肠内镜检查有助于诊断及治疗.     

缺血性结肠炎34例内镜表现及临床分析

目的总结缺血性结肠炎的临床、内镜表现特点及诊治要点。方法回顾性分析我院34例缺血性结肠炎患者的临床资料。结果缺血性结肠炎好发于中老年人,常合并高血压等基础疾病,以腹痛、腹泻、便血为主要临床表现,内镜检查病变主要位于左半结肠。呈节段性分布,多为一过型,及早诊治后恢复良好。结论具有相关基础疾病的中老年人发生腹痛、便血者,应尽早行结肠镜等检查明确诊断,确诊后及时治疗．提高临床治愈率。     

缺血性结肠炎8例诊治体会

本组缺血性结肠炎 8例 ,男 5例 ,女 3例 ,年龄 5 8～ 73岁 ,平均 6 2岁。其中高血压病 4例次 (下同 ) ,脑血栓后遗症 1例 ,冠心病1例 ,糖尿病 3例 ,习惯性便秘 2例 ,慢性支气管炎、肺气肿 2例。全部病例均有突发性腹痛。其中便血 6例 ,发热 5例 ,腹胀 3例 ,恶心、呕吐 2例。纤维结肠镜检查结果 :乙状结肠粘膜充血、水肿、糜烂 3例 ,结肠脾曲粘膜充血、水肿、散在浅溃疡 2例 ,降结肠粘膜增厚、肠腔狭窄 1例 ,乙状结肠粘膜充血、水肿、溃疡 1例 ,横结肠近脾曲处粘膜散在浅溃疡 1例。病变肠段和粘膜主要表现为肠粘膜轻度弥漫性充血、水肿或散在…     

缺血性结肠炎临床特点分析

目的 探讨缺血性结肠炎的临床表现及内镜下特点以提高对本病的诊治水平.方法 回顾分析我院收治的37例缺血性结肠炎患者的临床资料及内镜下表现.结果 31例患者年龄大于50岁,29例伴有高血压病、心血管疾病、糖尿病、便秘、腹部手术等基础疾病.临床上主要表现为急性起病、腹痛、腹泻及便血.结肠镜下表现为黏膜充血、水肿、糜烂、溃...     

以便血为主要症状的缺血性结肠炎98例临床分析

目的 探讨急诊以便血为主要症状的缺血性肠炎（IC）患者的临床特点、内镜特征和诊治要点.方法 回顾性分析我院2001年1月～2011年9月经临床、结肠镜和病理确诊的98例缺血性结肠炎患者的相关资料,所有病例均在腹痛等症状出现后10天内行全结肠镜检查,76例（77.6％）取病变黏膜活检,观察其病理组织学特点.结果 本病好发于老年女性（年龄＞60岁）,男女之比为1∶2.8.81例（82.7％）伴有基础疾病,包括高血压、糖尿病、高脂血症、血液系统疾病等.临床表现绝大部分伴有腹痛（96.6％）,且以左侧多见（50.0％）.内镜检查发现病变部位主要在左半结肠,主要表现为结肠黏膜高度水肿、充血、出血、糜烂及溃疡.病理多为非特异性表现.绝大多数经过内科保守治疗好转,少数转为慢性.结论 对于老年女性患者出现急性便血伴有腹痛,合并有基础疾病的应首先考虑缺血性结肠炎的可能,应尽早行肠镜检查,明确诊断.     

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.