嗜酸粒细胞性胃肠炎1例

患者,男,19岁,外周血白细胞17.14×10~9/L,嗜酸性粒细胞占62%,腹水中嗜酸粒细胞占90%.胃镜可见胃窦黏膜充血,病理提示嗜酸粒细胞浸润.诊断为嗜酸粒细胞性胃肠炎,应用激素治疗后症状消失出院.     

肝硬化合并自发性细菌性腹膜炎112例临床分析

目的：探讨肝硬化合并自发性细菌性腹膜炎（SBP）的临床特点。方法：回顾性分析112例确诊为肝硬化合并SBP患者的临床资料。结果：112例患者均为不同程度发热、腹痛、腹部压痛、反跳痛，从轻微症状到典型腹膜炎表现。其中93例（83．0％）腹水多形核白细胞（PMN）比值≥0．50；57例腹水细菌培养阳性（50．9％），病原菌以革兰氏阴性杆菌为主，其中大肠埃希菌为主要致病菌；药物敏感试验对第三代头孢菌素和第三代氟喹诺酮类药物敏感。结论：肝硬化合并SBP临床表现大多数不典型，腹水PMN比值是诊断SBP重要而可靠的指标；病原菌以大肠埃希菌为主，抗感染治疗首选第三代头孢菌素和第三代氟喹诺酮类药物。     

嗜酸粒细胞性胃肠炎临床特点分析60例

目的分析嗜酸粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、诊断、治疗,降低首诊误诊率.方法回顾性分析确诊的60例患者的临床表现、实验室检查、辅助检查、内镜及病理检查、治疗及预后情况.结果本组患者中首诊误诊率为38.3%,分型以黏膜型(85%)为主,临床表现以腹痛(85%)为主,83.3%患者外周血嗜酸粒细胞增高,75%患者骨髓嗜酸细胞增高,内镜表现无特异性,活检可见大量嗜酸粒细胞浸润;腹水为渗出液,可见大量嗜酸粒细胞;激素治疗与非激素治疗疗效良好,激素治疗组嗜酸粒细胞下降明显.结论 EG临床表现无特异性,过敏史、外周血嗜酸粒细胞计数、骨髓嗜酸粒细胞比例增高对诊断具有提示意义,内镜活组织检查和腹水见大量嗜酸粒细胞是诊断的关键.     

1998－2008年钦州市伤寒、副伤寒86例临床分析

目的了解近10年钦州市伤寒、副伤寒的流行病学、临床特征和预后。方法回顾性分析我科1998年6月至2008年6月10年间收治的经培养确诊为伤寒、副伤寒的住院病例。结果86例病例中,伤寒60例（69．8％）,副伤寒26例（30．2％）。数据表明近年住院病人中伤寒病例的构成比从1998年的2．65％明显下降到2007年的0．69％,副伤寒病例的构成比则从1998年前的0．33％上升刭2007年的0．69％。伤寒、副伤寒在临床上以发热、肝脾肿大、白细胞下降为主要表现;常见的并发症为中毒性肝炎和胆囊炎。86例病人中有61例（70．9％）肥达氏反应阳性,其中伤寒病人的阳性率明显高于副伤寒病人,分别为81．7％与46．2％（P〈0．05）。伤寒、副伤寒沙门氏菌对喹诺酮类、第三代头孢菌素有很好的敏感性。抗生索治疗后体温恢复正常平均时间为（6．3±2．1）d。结论近年来伤寒、副伤寒临床表现多不典型;副伤寒住院病例有上升的趋势,而伤寒有下降的趋势。喹诺酮类和三代头孢菌素药物仍为治疗伤寒、副伤寒的首选药物。     

嗜酸粒细胞性胃肠炎临床分析24例

目的:分析嗜酸粒细胞性胃肠炎的临床特点、诊断要点、治疗及预后.方法:对本院确诊的24例嗜酸粒细胞性胃肠炎患者的病史、临床表现、实验室检查、内镜检查、病理检查、治疗及随访情况进行系统分析.结果:本组资料显示,有过敏史者占37.5%,过敏诱因者占25%.腹痛(87.5%)为最常见的临床表现.83.3%患者外周血嗜酸粒细胞计数升高,为(4.59±3.69)×109/L.内镜下主要表现为黏膜充血水肿、糜烂,以十二指肠最为明显,活检可证实大量嗜酸粒细胞浸润.腹水为渗出液,可见嗜酸粒细胞.激素治疗可在1 wk内迅速缓解症状,并使嗜酸粒细胞恢复正常.病情可有反复,但预后良好.结论:外周血嗜酸粒细胞计数、过敏史对诊断嗜酸粒细胞性胃肠炎有提示作用,内镜下黏膜活检和腹水嗜酸粒细胞增多是诊断的关键.糖皮质激素治疗优于饮食治疗,预后良好.     

氟美松对嗜酸粒细胞凋亡的作用及其机制

目的　探讨氟美松对体外嗜酸粒细胞凋亡的作用及其机制。方法　在不同浓度白细胞介素 (IL) 5和氟美松的条件下体外培养嗜酸粒细胞 ,锥虫蓝拒染法和原位凋亡检测法观察嗜酸粒细胞凋亡的变化及嗜酸粒细胞凋亡抑制基因bcl 2表达的变化。结果　IL 5显著抑制嗜酸粒细胞凋亡 ,氟美松呈浓度和时间依赖性抑制IL 5介导的嗜酸粒细胞存活 ,10 -6mol/L氟美松显著抑制 1× 10 4 U/LIL 5介导的嗜酸粒细胞存活 ,培养 3d嗜酸粒细胞存活率为 (7± 3) % (P <0 .0 1) ,抑制率达 (90± 4) %。IL 5使嗜酸粒细胞bcl 2表达增强 ,氟美松对此具有抑制作用。但高浓度的IL 5 (1× 10 6U/L)可抑制氟美松的凋亡诱导作用。结论　氟美松具有诱导嗜酸粒细胞凋亡的作用 ,其机制可能与抑制嗜酸粒细胞bcl 2表达有关。     

重症急性嗜酸粒细胞性肺炎的诊治经验

重症急性嗜酸粒细胞性肺炎(AEP)临床少见,并发嗜酸粒细胞性张力性血性液气胸休克更少见.浙江省宁波市宗瑞医院1991年1月至2008年1月确诊外周血嗜酸粒细胞消失的重症急性嗜酸粒细胞性肺炎6例,入院前均误诊,其中误诊为重症急性细菌性肺炎5例,癌性张力性血性液气胸1例,现将诊治情况报道如下.     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有"肺水肿反向征",痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有"肺水肿反向征",痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有"肺水肿反向征",痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

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.     

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.