免疫功能低下患者肺结核的影像诊断

目的探讨几种免疫功能低下疾病并发肺结核患者的X线和CT所见。包括糖尿病、肾病综合症、系统性红斑狼疮（SLE）和获得性免疫缺陷综合症（AIDS）合并肺结核。方法回顾分析合并肺结核糖尿病患者68例，肾病综合症患者20例．SLE患者12例，AIDS患者8例X线及胸部CT所见。结果X线和CT表现，糖尿病合并肺结核：大片浸润病灶45例．浸润病灶内多发空洞40例，散在大小不等浸润病灶可不按肺段分布23例，支气管播散病灶21例；部分病例合并胸水10例。肾病综合症或SLE：急性血行播散性肺结核15例，大小不等浸润病灶17例，合并肺门及纵膈淋巴结肿大4例；AIDS合并肺结核；肺内斑片阴影合并有淋巴结肿大5例，急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病并发肺结核时，肺内结核病灶容易形成大片干酪病灶并合并空洞，结核肺内播散，急性血行播散性肺结核，肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

免疫功能低下疾病患者肺结核的影像分析

目的探讨几种免疫功能低下疾病的肺结核患者的X线和CT所见。方法回顾分析糖尿病患者68例,肾病综合症患者20例,SLE患者12例,8例AIDS患者合并肺结核的X线及胸部CT所见。结果X线和CT表现,糖尿病肺结核:大片浸润病灶45例,浸润病灶内多发空洞40例,散在大小不等浸润病灶可不按肺段分布23例,支气管播散病灶21例;部分病例合并胸水10例。肾病综合症或SLE肺结核:急性血行播散性肺结核15例,大小不等浸润病灶17例,合并肺门及纵膈淋巴结肿大4例;AIDS肺结核:肺内斑片阴影合并有淋巴结肿大5例,急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病患者的肺结核,肺内结核病灶容易形成大片干酪病灶并合并空洞,结核肺内播散,急性血行播散性肺结核,肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。     

AIDS合并肺结核肺部影像学分析

目的探讨AIDS合并肺结核的肺部影像学特征。方法收集89例AIDS合并肺结核患者的临床资料、X线胸片和肺部CT影像学检查资料,并进行分析。结果原发型肺结核5例（5．62％）,以儿童原发综合征为主,表现为肺内原发灶、淋巴管炎和肿大淋巴结组成的哑铃状“双极影”。血行播散型肺结核19例（21．35％）,其中12例为急性血行播散型肺结核,表现为全肺野大小、密度、分布“三均匀”特点,7例为亚急性或慢性血行播散型肺结核,表现为两肺多发大小不等的结节。继发型肺结核65例（73．03％）,病变累及单叶多见,两叶受累次之,三叶以上受累较少;右上肺叶为最易发部位,≥3个肺叶受累患者多伴空洞形成和播散病灶;病变形态多样复杂,但以典型浸润病灶常见（43／65）。结论AIDS合并肺结核主要为继发型肺结核和血行播散型肺结核。     

HIV／AIDS肺部感染的影像学表现

目的探讨HIV／AIDS合并肺部感染的X线及CT表现。方法对已确证(W．B)的HIV／AIDS病人中有胸部影像异常的10例进行分析。结果肺结核5例、军团菌感染2例、卡氏囊虫肺炎1例、非特异性炎症2例。肺结核表现为肺内斑片、大片影，纵隔淋巴结肿大及肺外淋巴结肿大，军团菌肺炎为大片状影像，卡氏囊虫肺炎为弥漫性浸润及间质异常影像。结论HIV／AIDS病人肺内出现斑片、大片或弥漫病变。或有淋巴结肿大时应考虑可能合并肺结核、卡氏肺囊虫肺炎及革兰氏阴性杆菌肺炎。     

AIDS合并肺结核影像学征象研究

目的探讨获得性免疫缺陷综合征（AIDS）合并肺结核患者影像学特征,以提高其诊断水平。方法对确诊的56例AIDS合并肺结核患者与43例单纯性肺结核患者的SCT表现进行对比分析。结果AIDS合并肺结核与单纯性肺结核患者相比,病变累及部位及范围均有统计学差异（P〈0.05）;AIDS合并肺结核患者斑片和（或）大片实变影、多发空洞、多发结节影、纵隔和（或）腋下淋巴结肿大、胸腔积液影出现几率明显高于单纯性肺结核患者。结论AIDS患者胸部影像学征象表现呈多肺叶、大片状、多发空洞、纵隔淋巴结肿大时,应首先考虑结核可能。     

20例艾滋病病人免疫重建中合并结核相关性重建炎性综合征的胸部CT影像特点

目的探讨艾滋病(AIDS)病人在免疫重建过程中,合并与肺结核相关重建炎性综合征的胸部计算机层析成像(CT)影像特点。方法采用回顾性分析的方法,对20例AIDS病人免疫重建过程中,合并结核相关性重建炎性综合征的胸部CT影像进行分析。结果 20例AIDS免疫重建合并肺结核相关重建炎性综合征病人的胸部CT影像,表现为急性血行播散型肺结核与继发型肺结核,急性血行播散型肺结核9例(45.0%,9/20),继发型肺结核11例(55.0%,11/20)。病灶分布3个肺叶及以上者7例(35.0%,7/20),病灶局限于1～2个肺叶者4例(20.0%,4/20)。病变形态为粟粒影、结节影、肺段与亚段实变影,分别为13例(65.0%,13/20)、9例(45.0%,9/20)、5例(25.0%,5/20),肺空洞3例(15.0%,3/20)。胸部CT影像出现纵隔淋巴结肿大伴液化坏死17例(85.0%,17/20),胸腔积液15例(75%,15/20)。结论 AIDS免疫重建合并肺结核相关重建炎性综合征时,胸部CT影像特点是病变呈弥漫、多肺叶分布,粟粒影、结节影、肺段与亚段实变影为肺部病变主要形态,纵隔淋巴结肿大伴液化坏死、胸腔积液常见。其发生机制与重新激活的异常免疫应答相关。在高效抗反转录病毒治疗同时,积极给予抗结核治疗后,病变吸收明显。     

肺结核患者的不典型CT表现

目的 探讨和分析肺结核患者的不典型CT表现特点。 方法 回顾性分析我院2010年1月至2012年9月CT表现不典型的肺结核患者73例,根据其图像特点进行分类并分析。 结果 所有患者按图像特点分为6型,其中多空洞型7例,表现为肺内多发空洞,无结核播散灶;肺间质型20例,表现为肺内大片细网织样密度增高影,与周围正常肺组织分界清晰,病变区内部分病灶融合实变,并可见多发垂直于胸膜的小叶间隔增厚影;雪花型16例,4例合并间质型,表现为多发腺泡样结节沿小支气管及其分支周围分布,受累各级支气管管腔充盈,内形成多发“小树芽征”及小叶性实变;肿块型29例,病灶边缘可见光滑、深分叶、长毛刺及胸膜凹陷征,未见短毛刺征,病灶平扫为等密度,其中3例肿块呈薄壁或厚环形强化,7例有不同程度的强化;肺门及纵隔淋巴结结核并假性动脉瘤型1例,表现为环形强化的淋巴结内出现假性动脉瘤;实变型4例,为多发段、叶实变,段、叶支气管腔内无异常改变。 结论6种肺结核的不典型CT表现中,肺间质型、雪花型和肺门及纵隔淋巴结结核并假性动脉瘤型有一定特异性,但所有类型需结合临床、化验检查等做出诊断。     

儿童肺结核CT影像分析

目的 探讨儿童肺结核的CT平扫及增强的影像表现特征。 方法 回顾性分析2008年7月至2011年8月在我院住院的69例结核病患儿,临床症状、PPD试验及影像学表现均符合结核病特征,经抗结核治疗后复查,患者临床症状及肺部病灶均有所好转。收集患儿的影像学资料,对其进行分析。 结果 69例患儿的CT不同影像表现为：原发性肺结核（8例）包括原发综合征（5例）和胸内淋巴结结核（3例）,原发综合征表现为肺内的原发结核病灶、结核性淋巴管炎及淋巴结炎,此型与胸内淋巴结结核的CT平扫均可见纵隔、肺门及腋窝多发肿大淋巴结,增强扫描不均匀强化或淋巴结中心干酪坏死区无强化,边缘环形强化的特点。原发性血行播散性肺结核（10例）表现为两肺大小、密度、分布均匀一致的粟粒状影合并纵隔淋巴结肿大。原发性肺内浸润性结核病灶和干酪性肺炎（43例）的影像表现为2个肺叶散在分布的结节状、斑片状影,还有甚至双肺多叶多段广泛分布的结核病灶,在结节状、斑片状、大片状结核病灶的基础上形成干酪性肺炎、空洞。结核性胸膜炎（8例）可见不同程度的渗出性胸腔积液及胸膜增厚粘连等表现。 结论 CT平扫及增强对于诊断儿童肺结核,明确肺内各种病灶形态,轻微病灶、隐匿病灶、微结节及干酪性肺炎等具有一定价值,可为临床诊断提供重要依据。     

艾滋病并肺结核临床分析

目的提高艾滋病并肺结核的认识。方法2007年1月～2007年12月间诊断的15例艾滋病并肺结核病患者进行回顾性分析。结果其临床表现为咳嗽（13／15）,咳痰（7／15）,发热（11／15）,盗汗（5／15）,呼吸困难（8／15）和低氧血症（11／15）,平均动脉血氧分压为68mmHg（1mmHg=0．133kPa）,胸痛（4／15）,消瘦（11／15）等。结核病感染率高,合并肺结核时病情较重,胸部X片显示：肺部病灶表现不典型,病灶范围大,肺间质病变多见,或双侧中下肺浸润,可合并肺门,纵膈淋巴结肿大及结核性胸膜炎,易发生粟粒性肺结核及肺外结核。结论艾滋病容易发生肺结核,临床表现复杂多样,病情重,进展快,肺部病灶表现不典型,范围大,中下肺野浸润,呈血行播散型,病变易向其他器官扩散,如结核性脑膜炎,胸腔积液。     

艾滋病合并肺结核患者胸部CT不典型影像表现分析

目的:分析艾滋病(AIDS)合并肺结核患者的胸部CT不典型影像表现，以提高其影像诊断价值。方法:采用回顾性研究方法，收集2017年1月至2020年1月就诊于首都医科大学附属北京地坛医院经病理、实验室检查证实或临床确诊为AIDS合并肺结核且无其他合并感染的171例患者胸部CT影像资料，分析其病变类型、分布、形态及变化情况。结果:171例患者中，多种肺结核类型共存117例(68.4%),以继发性肺结核合并胸内淋巴结结核发生率最高[74例(43.3%)]。117例继发性肺结核患者中，37例(31.6%)病灶只分布于好发部位，25例(21.4%)病灶只分布于非好发不典型部位，55例(47.0%)病灶好发部位与非好发部位均有分布；影像征象以支气管播散[85例(72.6%)]、实变[79例(67.5%)]及多发结节[78例(66.7%)]病变为主，其中31例(39.2%)实变病灶表现为类似肺炎的渗出性实变，周围不伴卫星病灶。53例血行播散性肺结核患者中，45例(84.9%)表现为非“三均匀”粟粒结节。107例胸内淋巴结结核患者中，31例(29.0%)病灶破溃侵及临近肺实质、23例(21.5%)病灶...     

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.