微探头内镜超声检查在胃窦小隆起病变诊断中的应用价值

[目的]评价微探头内镜超声在胃窦小隆起病变诊断中的应用价值。[方法]回顾性总结分析行微探头内镜超声检查的42例胃窦小隆起病变患者的临床资料,以内镜下黏膜切除术或黏膜下剥离术或手术切除标本病理诊断为最终结果,分析比较微探头内镜超声及内镜下活检对胃窦小隆起病变的诊断符合率。[结果]微探头内镜超声检查在胃窦小隆起病变的诊断符合率为83.3%(35/42),内镜下经活检钳行病理检查对胃窦小隆起病变的诊断符合率为45.2%(19/42),超声内镜的诊断符合率高于胃镜活检,差异有统计学意义(P0.01)。[结论]内镜下活检不能作为诊断胃窦小隆起病变的诊断依据;微探头内镜超声在胃窦小隆起病变有较高的临床诊断价值,对黏膜下病变的治疗方案的选择具有指导意义。     

37例直径大于1.0cm十二指肠隆起性病变的临床、内镜、超声及病理分析

目的探讨十二指肠隆起性病变的临床,内镜、超声及病理特点。方法对37例十二指肠隆起性病变患者均采用Fujion EG-450型胃镜,Olympus UM-2R超声微探头检查及治疗,超声频率为7.5MHz～12MHz,高频电发生器为ERBE-200型。结果常规内镜发现隆起性病变位于十二指肠球部23例,降部14例。常规内镜诊断为十二指肠腺瘤性息肉14例,增生性息肉4例,腺癌2例。17例超声内镜诊断间质瘤11例,黏膜下囊肿4例,脂肪瘤2例。其中有24例病变术后病理诊断为腺瘤性息肉14例,增生性息肉4例,脂肪瘤2例,良性间质瘤3例,平滑肌瘤1例。7例疑为恶性间质瘤(术后确诊为恶性间质瘤4例,良性间质瘤2例,1例不明)。治疗有24例病变行高频电凝切除术,术后处理按我科常规进行;7例超声检查疑为恶性间质瘤,其中6例由外科手术治疗,1例保守观察;4例囊肿采用经内镜下囊肿套扎术治疗;2例十二指肠腺癌采取保守支持对症治疗。对上述所有病例仍在动态观察中。结论对于范围大于1.0cm的十二指肠隆起性病变常规内镜及病理检查、内镜超声检查对隆起性病变的诊断均具有重要价值。     

消化道黏膜下肿物的内镜及超声内镜下特点分析

目的探讨消化道黏膜下肿物的内镜及超声内镜下特点。方法对153例消化道黏膜下肿物进行内镜及超声内镜检查,最终经病理学及免疫组化明确诊断。结果确诊消化道平滑肌瘤51例、胃肠道间质瘤37例、脂肪瘤30例、类癌21例、异位胰腺7例、神经鞘瘤3例、错构瘤3例和血管球瘤1例。超声内镜对平滑肌瘤、间质瘤、脂肪瘤、类癌、异位胰腺、神经鞘瘤、错构瘤和血管球瘤的诊断符合率分别为92%、92%、100%、71%、71%、0、0和100%,其总诊断符合率为86%,明显高于内镜总诊断符合率(70%)。结论超声内镜可明确消化道黏膜下肿物的大小、起源、回声、生长方式,对消化道黏膜下肿物的诊断及鉴别诊断有重要作用。     

上消化道表面光滑型隆起性病变的超声内镜诊断与内镜黏膜切除术、内镜黏膜下剥离术术后病理学比较

目的 探讨超声内镜(EUS)鉴别诊断上消化道表面光滑型隆起性病变的价值.方法 182例患者经胃镜检查发现上消化道表面光滑型隆起性病变,超声内镜检查后行内镜黏膜切除术(EMR)或内镜黏膜下剥离术(ESD),比较超声内镜诊断与术后病理学诊断的符合率.结果 超声内镜诊断食管平滑肌瘤37例,病理学检查符合33例,符合率为89.2％;食管息肉6例,病理学检查符合2例,符合率为33.3％;食管脂肪瘤1例,病理学检查符合1例,符合率为100％;胃息肉106例,病理学检查符合77例,符合率为72.6％;胃间质瘤19例,病理学检查符合16例,符合率为84.2％;胃脂肪瘤7例,病理学检查符合5例,符合率为71.4％;十二指肠息肉6例,病理学检查符合4例,符合率为66.7％.结论 超声内镜检查鉴别诊断上消化道表面光滑型隆起性病变具有一定临床价值,但应结合病理学检查.     

超声内镜对十二指肠降部隆起病变的诊断价值

[目的]探讨十二指肠降部隆起病变的超声内镜诊断价值。[方法]对43例患者的51个十二指肠降部隆起病变行超声内镜检查,判断其病变层次、范围、超声特点,确立诊断;根据不同病变选择内镜下结扎治疗或电切除术,部分病例经手术或病理证实。[结果]51个十二指肠降部隆起病变中,间质瘤16个,平滑肌瘤2个,囊肿24个,囊性淋巴管瘤1个,脂肪瘤3个,血管瘤2个,副乳2个,先天性胆总管囊肿1个,超声内镜的诊断符合率为94.1%(48/51)。根据不同的病变选择结扎治疗或内镜下电切除术,2例副乳及1例先天性胆总管囊肿未行处理,3个月至半年后复查见原病变处已形成瘢痕。[结论]十二指肠降部隆起病变以间质瘤和囊肿多见,在超声内镜指导下的结扎或电切除术对十二指肠降部隆起病变有良好的治疗作用。     

高频超声小探头引导内镜下切除消化道表浅隆起性病变

目的 探讨经内镜高频超声小探头引导内镜下黏膜切除术治疗消化道表浅隆起性病变的安全性、可行性.方法 对普通内镜下发现的67例消化道表浅隆起性病变,经内镜活检钳道插入高频超声小探头进行检查,对其中39例显示病变来源于黏膜层、黏膜肌层及黏膜下层的病变行内镜下黏膜切除术.切除的病变送病理检查.结果 16例消化道息肉、2例异位胰腺、14例间质瘤、3例脂肪瘤,3例类癌,1例早期胃癌共39例病变内镜下完全切除.操作过程顺利,其中一例出现术后迟发性出血,给予内镜下成功止血,无其他严重并发症出现,病理符合率87.1%.结论 高频超声小探头检查可初步明确病变来源及层次,安全有效地指导消化道表浅隆起性病变黏膜切除术治疗.     

内镜超声对消化道黏膜下隆起性病变的应用价值

目的探讨内镜超声(endoscopic ultrasonography,EUS)在消化道黏膜下隆起性病变中的应用价值。方法回顾性分析选取2018年1月至2020年10月徐州医科大学附属徐州市立医院内镜中心EUS初诊消化道黏膜下隆起性病变并同时获取病理结果的患者117例,通过EUS与病理结果比对,探讨EUS对消化道黏膜下隆起病变的应用价值。结果入组研究患者117例,EUS初诊平滑肌瘤37例、间质瘤32例、神经内分泌肿瘤17例、脂肪瘤9例、异位胰腺10例、十二指肠布氏腺(Brunner)腺瘤3例、胃体淋巴瘤1例、十二指肠血管瘤1例,胃壁外病变外压7例。EUS检查结果显示消化道黏膜下隆起性病变以平滑肌瘤及间质瘤居多,表现为起源于黏膜肌层或固有肌层的低回声病变;所有病变均通过活检、内镜微创手术或外科手术获取病理标本。最终EUS和病理诊断符合率为107/117(91.5%),其中10例病例误诊。结论EUS虽对消化道黏膜下隆起性病变存在一定的误诊,但结合病变声像学特点(回声、起源、大小及有无邻近组织浸润等),仍能很好地评判隆起灶病变性质,规范临床诊疗。     

小探头内镜超声在消化道隆起性病变中的诊断价值

目的探讨小探头内镜超声扫查消化道黏膜下病变在管壁的分布特点以及对消化道黏膜下隆起性病变的诊断价值。方法回顾性分析2017年1月—2018年10月在武汉协和医院行小探头内镜超声检查消化道隆起性病变316例,患者均行内镜下治疗切除,组织送病理检查,通过超声检查结果结合病理诊断明确病变的层次和性质。结果316例消化道隆起性病变中黏膜下病变198例,其中平滑肌瘤118例,间质瘤27例,脂肪瘤、囊肿各15例,乳头状瘤4例,神经内分泌瘤7例,异位胰腺9例,颗粒细胞瘤、神经鞘瘤和布氏腺瘤各1例。病变分布在整个消化道管壁,以起源于黏膜肌层最常见,有7例病变在小探头内镜超声下未明确层次。结论小探头内镜超声可以明确黏膜下病变在消化道中的分布,并对病变大小、层次起源提供高准确率的判断,对治疗方案的选择亦有重要指导意义。     

消化系统疾病

20011135内镜超声检查对上消化道病变的诊断价值/张小勇…刀中华消化内镜杂志一2000,l7(5)一291~292 内镜下发现异常病变91例,经内镜超声检查明确诊断86例(94.5%)。而内镜检查明确诊断55例(6 0.4%),其中37例同时进行X线钡餐检查,其诊断符合率为45.9%,均低于内镜超声检查。23例在内镜超声检查后进行手术治疗.二者诊断符合率为82.6%。内镜超声检查诊断的病种有食管平滑肌瘤、食管静脉瘤、胃平滑肌瘤、胃平滑肌肉瘤、胃脂肪瘤、胃淋巴瘤、胃息肉、胃痛、胃溃疡、胃外压迫、胰尾占位变、慢性胰腺炎等,未见明显异常者28例。表1(杨光和)20011136…     

探讨微型超声探头联合内镜窄带成像诊断早期肠癌的价值

[目的]探讨微型超声探头联合内镜窄带成像技术(NBI)诊断早期肠癌的临床价值。[方法]选取126例大肠息肉样病变患者,均行微型超声探头联合NBI进行诊断,以病理检查结果为金标准,分析诊断结果。[结果]病理检查共检出230个息肉样病变,其中炎性及增生性息肉91个,腺瘤118个,腺癌21个。NBI诊断出NICEⅠ型90个,Ⅱ型117个,Ⅲ型23个。NBI对大肠肿瘤性病变的诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为94.24%、90.11%、92.61%、93.57%、91.11%。微型超声探头对肠癌T1、T2、T3期的诊断符合率分别为100.00%、85.71%、80.00%,总体诊断符合率为90.48%。[结论]联合应用微型超声探头和内镜窄带成像技术能有效提高早期肠癌及癌前病变检出率。     

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.