无消化系统症状的肠结核1例

1病例介绍 病人女，35岁。因“消瘦、面色苍白3个月”来诊。3个月前病人无明显诱因地出现消瘦，2个月内体重下降约10kg。伴乏力、发热、咳嗽、无咳痰、无咯血。体温最高达39．0℃，盗汗。已停经3个月。食量无明显变化，无多饮多尿，无怕热多汗，无呕吐腹泻，无腹痛腹胀，无便秘。大便每天1次，为黄色干便。在当地医院就诊，查血常规示Hb56g/L，白细胞及血小板正常，以“贫血原因待查”收入当地医院血液科诊治。经一系列检查及输血、抗感染等治疗后体温下降至正常，     

系统性红斑狼疮并桥本氏病1例报告

患者，女。50岁，因乏力、关节疼痛2个月，发热1个月于2002年7月31日入院。患者于入院前2个月无明显诱因出现乏力，四肢关节疼痛，伴恶心、纳差、消瘦。在当地医院诊断为“甲型肝炎”，给予保肝治疗，病情无好转，并出现持续性右膝关节疼痛，影响日常活动。1月前出现畏寒、高热，体温达40℃，2个月来体重下降约15kg。近2年性格孤僻，少与他人     

胆道隐球菌病一例

患者女，44岁。因“反复上腹痛伴皮肤、眼白黄染4个月，加重3d”入院。患者4个月前无明显诱因出现上腹部隐痛，饥饿时明显，进食后缓解，伴眼白黄染，尿色加深，恶心，无呕吐腹泻，无畏寒发热，无关节疼痛，无咳嗽咳痰，无头痛头晕，大便正常。就诊于多家医院，予熊去氧胆酸等治疗，未见好转。3d前患者突发剑突下绞痛，阵发性，伴腰背部放射，就诊我院，收治于普外科。发病以来，胃纳下降，体重下降10kg。既往体健。否认饲养宠物。[第一段]     

恶心 体重下降 贫血 肾功能不全

1 病史摘要 患者女，33岁。因“水肿3个月，恶心、纳差伴贫血、肾功能不全1个月”于2004—05—21入院。患者于3个月前无明显诱因反复出现双踝部轻度、凹陷性水肿，未引起重视。2个月前患者又突发恶心、呕吐，呕吐物以胃内容物为主，无咖啡样物质，亦未排黑粪。当地医院胃镜检查示“浅表性胃炎”。患者有贫血，血红蛋白（Hb）为65g／L，骨髓检查未见异常。同时发现尿蛋白（＋）[肾功能异常：尿素氮（BUN）5．46mmol／L，肌酐（SCr）192．71μmol／L]，高球蛋白血症（40．3g／L），血清补体正常，自身抗体阴性。经对症与促红细胞生成素治疗后，胃肠道症状缓解，Hb升至88g／L。近3个月，患者夜尿次数多达3次，无肉眼血尿，无明显少尿，无不规则发热、皮疹、关节痛、腹痛、黑粪、脱发、口腔溃疡，无眼干、口干等症状。近2个月体重下降约5kg。精神、睡眠正常。反复追问病史，起病前未服用任何药物，生活及工作中也无毒物接触史。家族史无特殊。     

以"三多一少"起病的糖尿病的诊治

患者女，38岁，因血浆葡萄糖793mg／dl和尿酮2^＋住院。既往无糖尿病史。6个月前测血糖水平正常。8周来体重下降13．6kg，2周来出现多尿和烦渴多饮；2天来明显厌食。入院体重100kg，查体可见黑棘皮症和肥胖。     

胸腺类癌致异位促肾上腺皮质激素综合征手术复发后经米非司酮治疗缓解一例

<正>患者,女,55岁,工人,因“乏力2个月,加重1天”于2016年3月13日就诊于我科。患者2个月前出现乏力,无头晕、胸闷、多尿、口干、多饮,外院查血钾<2.00 mmol/L(3.50～5.30 mmol/L,括号内为正常参考值范围,以下相同),诊断为“低钾血症”,经补钾对症处理后乏力减轻。1天前,患者再次出现四肢乏力,于我院查血钾2.09 mmol/L(3.50～5.50 mmol/L),以“低钾血症原因待查”收住院。自发病以来,患者饮食、睡眠可,大小便无明显异常,近2个月体重较前增加5 kg。既往史：高血压病2年,     

腹茧症一例

患者男，56岁，因腹胀、腹痛伴消瘦7个月入院。患者7个月前无诱因出现右下腹胀，脐周绞痛，稀便1～2次／日，无脓血和黏液；排便后腹痛不缓解。无恶心、呕吐，无发热、盗汗。当地医院查腹部B超及CT提示“少量腹水”；全消化道造影：“空肠上段不全梗阻”；胃镜、肠镜检查未见异常。按“结核性腹膜炎，不全肠梗阻”予异烟肼、利福平、环丙沙星1个月，但腹痛、腹胀无缓解。发病以来体重下降15kg。既往体健。其父患有“结核性胸膜炎”，已故2年。     

第78例——发热、体重下降、双肺弥漫性结节影

临床资料患者男性 ,68岁 ,因发热、体重下降 6个月于 1999年 7月 3 1日入院。患者 6个月前无明显诱因出现发热 ,体温最高达 4 0℃ ,以下午和晚上为甚 ,发热前无明显畏寒 ,伴间断干咳 ,体重下降约 6ｋｇ ,无咯血、盗汗。外院胸片和肺部ＣＴ(图 1)示 :“双肺弥漫性结节影” ,疑为转移性肺癌。曾在多家医院住院 ,经胃镜、全身Ｂ超等检查未发现原发病灶。经多种抗生素抗感染治疗及诊断性抗结核治疗 5 0ｄ病情无好转 ,以“肺多发结节”原因待查收入院。患者既往有胆囊炎病史行胆囊切除术。入院查体 :体温3 9℃ ,慢性面容 ,消瘦 ,皮肤无黄染、出血…     

继发于脑膜瘤的异位促肾上腺皮质激素综合征一例

患者男，61岁。5个月前出现颜面及双下肢水肿，夜尿增多．5～6次／晚，食欲增加，但体重无明显增加，乏力渐明显，生活不能自理，近1个月血压160／100mmHg（1mmHg=0．133kPa)，右跟视力下降，降压利尿浩疗，疗效不佳。无头痛、恶心、呕吐，无毛发增多，无畏寒、发热，无咳嗽、咳痰、腹痛、腹泻。体检：BP150／90mmHg，体重指数21．9kg/m^2，神清，无满月脸、水牛背及向心性肥胖,无皮肤紫纹、痤疮，面部及胸部皮肤发红、全身浅表淋巴结不大，眼睑水肿，眼球活动自如，瞳孔对光反射正常，颈软，甲状腺不大，心肺正常，腹部未扪及包头，肝脾未及，双下肢轻度水肿，四肢肌力、肌张力正常。膝反射减弱，病理征阴性。     

肺癌合并糖尿病、尿崩症一例

患者 男性，60岁。因“多尿、多饮伴体重下降6月，咳嗽，乏力2天入院。入院前6月出现口干，每天饮水量约8—12L，尿量约8～12L，伴体重下降5b，诊断为“糖尿病”，一直未予治疗，2天前出现咳嗽，乏力。发病以来，患者反复下肢及头部疼痛。既往个人及家族史尤特殊。体格检查：体温38．2℃，血压135／85mmHg。神清，神志萎靡，体型消瘦，浅表淋巴结不大，皮肤无瘀斑瘀点及紫纹，无视野缺损，听力正常，甲状腺不大，     

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.     

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.     

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.