川崎病非心血管并发症121例临床特点分析

川崎病（KD）是免疫介导的以全身血管炎为主要病理改变的急性发热性出疹性小儿疾病,是儿童后天性心脏病的常见病因。KD可累及心、脑、肝、肺、肾等脏器,以心血管病变最常见且严重,其中冠脉损害占20％～25％,部分可形成冠脉瘤,晚期发生冠脉狭窄或血栓形成、甚至心肌梗死。目前,临床上对KD导致的非心血管系统损害缺乏足够的重视,     

川崎病病因学研究进展

川崎病是一种以全身血管炎为主要病变的急性发热性出疹性疾病,其严重的并发症是心血管系统损害,可形成冠状动脉扩张和冠状动脉瘤。但川崎病的病因仍不明确,多种细菌、病毒感染可能与川崎病的发生有关,以抗原或超抗原的形式引起机体的免疫激活。流行病学调查研究发现川崎病的发生具有遗传易感性,且冠状动脉损害与炎症基因多态性有关。现主要从感染、免疫和遗传三方面对川崎病的病因学研究进行综述。     

川崎病性冠状动脉瘤

川崎病(皮肤粘膜淋巴结综合征)的心血管并发症发生率很高,约占77～91%,可累及心包、心肌、瓣膜、传导系统及冠状动脉,而在心脏受累者中几乎都要累及冠状动脉。川崎病不仅发生在日本,近年来在美国、澳大利亚、朝鲜、希腊、加拿大、中国(含台湾)等均有报道.川崎病性冠状动脉瘤不仅发生在儿童,现认为成人的冠状动脉瘤也可能与患过川崎病有关。本文对川崎病性冠状动脉瘤综述如下。一、病因及发生率过去认为,冠状动脉瘤的病因主要为动脉粥样硬化、先天性畸形,其次为细菌感染、梅毒、外伤、感染性栓塞,还可见于结     

二维彩色多普勒超声观察川崎病的心脏及冠状动脉改变

二维彩色多普勒超声观察川崎病的心脏及冠状动脉改变吴皎辉，谢道银，陈明哲川崎病是一种以发热、粘膜炎、皮疹、颈淋巴结肿大和肢端改变为特征的原因不明的急性血管炎。其心血管并发症发生率高，可累及心包、心肌、瓣膜、传导系统及冠状动脉，而心脏受累者中几乎都要累及...     

川崎病的诊断与治疗

川崎病(KD)又称皮肤粘膜淋巴结综合征(MCLS)，是一种以全身血管炎病变为主要病理改变的急性发热出疹性儿童疾病。部分患儿可侵犯冠状动脉，甚至形成冠状动脉瘤；部分患儿冠状动脉可发生狭窄或血栓，甚至导致心肌梗死。现将近年来KD的诊治介绍如下。     

金黄色葡萄球菌骨髓炎并脓毒血症继发川崎病合并菊池病1例

<正>川崎病(Kawasaki disease,KD)又被称为皮肤黏膜淋巴结综合征,是一种好发于5岁以下儿童的、以全身血管炎为主要病理改变的急性发热、出疹性疾病,其主要临床特征为发热、不同程度口腔黏膜改变、皮疹、眼结膜充血、手足指端改变等,可累及小血管、中等肌性动脉及全身各个脏器。组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)又称为Kikuchi病或Kikuchi-Fujimoto病(菊池病),好发于年轻女性的淋巴结炎症性     

川崎病患儿32例的超声表现

川崎病(Kawasaki disease)又称为皮肤黏膜淋巴结综合征,是一种以全身血管炎为主要表现的综合征,多发生于婴幼儿的急性发热性出疹性疾病.特异性损害是冠状动脉.本文对3年来我院临床诊断川崎病病例的超声心动图改变进行了回顾性分析,为提高临床对川崎病的早期诊断提供重要信息.     

川崎病的血液学研究

川崎氏病,又称皮肤粘膜淋巴结综合征,是病因不明的急性发热性疾病,主要累及全身血管特别是冠状动脉。造成冠状动脉瘤,是川崎病患儿死亡的主要病因。川崎病存在多样的血液学异常,其改变同心脏损害有较明显的关系。现将有关进展综述如下。川崎病和血小板的关系川崎病的尸解证实血小板参与了动脉内血栓的形成过程。血小板增多本身是非特异性的表现,在伴有或不伴有血管炎的炎性疾病,血小板计数增加是一个常见的实验检查发现。因此,川崎病血小板计数增加是全身性炎症的一种表现,而血小板计数增高对冠状动脉损害无预测作用。继发于冠状动脉瘤的心肌梗塞是川崎病儿死亡的主要原因,故冠状动脉瘤的形成同血小板的关     

川崎病系统损害的临床分析

川崎病是多种原因引起的自身免疫性疾病,可累及全身各个系统,冠状动脉损害是致死的主要原因。我科自1984年5月至1992年7月共收治川崎病人123例,本文将其系统损害作了分析。     

川崎病冠状动脉病变的心电图改变

川崎病可累及全身各个系统 ,以心血管系统受累最为广泛和严重 ,主要为冠状动脉扩张和冠状动脉瘤。川崎病冠状动脉病变是临床防治的核心。修正的 Asai评分法是较完善的预测方法 ,但项目繁多 ,应用欠方便。本文对川崎病冠状动脉病变的心电图改变进行了分析 ,探讨预测川崎病冠状动脉病变的心电图指标。1　临床资料1 998年 8月～ 1 999年 8月间重庆医科大学儿童医院收治住院的川崎病患儿 1 2 0例 ,临床表现均符合《实用儿科学》(人民卫生出版社第 6版 ,1 998年 )川崎病的诊断标准。根据冠状动脉内径≥ 4mm诊断为冠状动脉扩张 ( CAD) ,冠状动脉…     

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.