冠状动脉内自体骨髓单个核细胞移植治疗心肌梗死的临床研究

目的探讨冠状动脉内自体骨髓单个核细胞移植治疗急性心肌梗死的安全性和疗效.方法 19例拟行介入治疗的急性心肌梗死患者,11例通过放置于梗死相关动脉内的球囊导管,进行自体骨髓单个核细胞移植.另外8例对照组患者以生理盐水代替细胞进行移植.结果 3个月随访时,在细胞治疗组梗死的范围显著缩小(32.4%±4.8%到16.9%±2.9%,P<0.001),与对照组相比也明显较小(16.9%±2.9% 比28.1%±2.8%,P<0.001).只有在细胞治疗组,梗死的心室壁运动速度明显增加(2.05cm/s±1.08cm/s到4.47cm/s±0.59cm/s,P<0.001).细胞治疗组左心室(左室)射血分数,收缩期室壁增厚率以及梗死区心肌灌注显著提高.结论自体骨髓单个核细胞冠状动脉内移植安全有效.其疗效可能与骨髓细胞引起的心肌再生和血管新生有关.     

细胞因子微球加强骨髓间充质干细胞移植对猪心肌梗死的疗效

目的 通过观察血管内皮生长因子(VEGF)缓释明胶微球与自体骨髓间充质干细胞(MSC)联合移植于猪心肌梗死模型梗死周边区3周后MSC的生存情况,结合磁共振成像(MRI),阐明改善局部微环境对自体MSC移植于缺血心肌后转归的影响,并直观评价MRI对移植MSC在体示踪及半定量分析的可靠性.方法 以乳化冷凝法制备VEGF缓释明胶微球并评价其缓释性能.成年中华小型猪12头,抽取髂骨骨髓并制备自体MSC,以顺磁性氧化铁颗粒(SPIO)和4',6-二脒基-2-苯基吲哚(4',6-Diamidino-2-phenylindole dihydrochloride,DAPI)标记细胞.按照随机化表将动物分为MSC移植组及MSC-VEGF缓释微球联合移植组.开胸结扎冠状动脉左前降支制备小型猪心肌梗死模型后第14天,直视下经心外膜于MSC组动物心肌梗死周边区注射MSC(9×107),于MSC-VEGF缓释微球组注射MSC(9×107)及VEGF缓释明胶微球(含9 μg人重组VEGF165).细胞和(或)微球移植后24 h及21 d,磁共振FGRE序列T2*像检测干细胞移植点低信号区的面积及信号强度.病理组织学检测细胞移植区域心肌组织毛细血管密度及干细胞存活情况.结果 明胶微球平均粒径为(104.0±22.6)μm,体内、外缓释VEGF均可达到10 d以上.小型猪心肌梗死模型建立后第14天,梗死区面积为33.6%±8.9%.细胞移植后24 h,MSC注射点于MRI显示为边界清晰的卵圆形T2*低信号区,细胞移植3周后,两组注射点T2*低信号区面积均减小(P<0.05),其与正常心肌组织间的信号对比度均减低(P<0.05).MSC-VEGF缓释微球组移植点毛细血管密度高于MSC组[(15.2±5.4)个/高倍视野比(10.2±5.0)个/高倍视野,t=2.43,P<0.05].MSC-VEGF缓释微球组MSC注射点移植细胞数多于MSC组[(354±83)个/高倍视野比(278±97)个/高倍视野,t=3.14,P<0.05],而MSC凋亡率则小于MSC-VEGF缓释微球组[(6.4±4.1)%比(11.9±4.8)%,t=2.97,P<0.05].结论 VEGF缓释明胶微球可以改善移植于缺血心肌区3周后MSC的生存情况.移植干细胞所生存的微环境是影响其转归的重要因素.MRI对于移植干细胞位置的在体示踪是可靠的,但不能作为对移植细胞定量或半定量分析的依据.     

自体骨髓间充质干细胞移植对急性心肌梗死后心律失常影响的实验研究

目的 观察自体骨髓间充质干细胞(MSC)移植对小型猪心肌梗死后心律失常的影响,并研究其作用机制.方法 利用介入方法制作小型猪心肌梗死模型并进行自体MSC移植.MSC移植组12头和心肌梗死对照组10头,分别于移植2 h及4周后通过电生理程序刺激,观察室性心动过速(室速)的发生情况.于建模4周后,通过膜片钳技术研究移植后MSC在心肌环境下的离子通道表达和梗死区域心电异质性变化.结果 (1)建模后2 h MSC移植组9头(75%)、对照组9头(90%)诱发出室速,两组间差异无统计学意义(P=0.445).术后4周MSC移植组3头(25%)、对照组8头(80%)可诱发出持续性单形性室速(P=0.012).(2)MSC移植组的心外膜细胞(Epi)、心内膜细胞(Endo)和中层细胞(M)INa峰值电流密度分别为(-12.43±3.04)pA/pF、(-14.04±3.82)pA/pF和(-29.26±5.70)pA/pF,对照组梗死边缘区的Epi、Endo和M层INa峰值电流密度分别为(-8.47±3.34)pA/pF、(-9.71±3.38)pA/pF和(-18.98±4.05)pA/pF;MSC移植组在三层心肌的表达具有异质性,与对照组相比差异具有统计学意义(P<0.05).(3)MSC移植未室速组MSC的Epi、Endo和M层INa失活半数电压分别为(-93.1±13.8)mV、(-95.2 ±15.5)mV和(-103.4±8.7)mV,MSC移植室速组分别为(-126.2±10.9)mV、(-106.7±11.9)mV和(-105.4±11.0)mV,心肌梗死室速组分别为(-129.1±10.9)mV、(-112.2±9.9)mV和(-109.7±9.3)mV,MSC移植室速组和心肌梗死室速组相比各层差异无统计学意义(P>0.05),和MSC移植未室速组相比各层差异有统计学意义(P<0.05).(4)多元logistic回归分析表明INa失活半数电压(RR=1.449,95%CI1.276～2.079,P=0.029)、INa峰值密度(RR=1.092,95%CI1.008～1.917,P=0.012)是影响心肌梗死室性心律失常的独立危险因素.结论 自体MSC移植致心律失常可能性较小,且有抑制梗死后心律失常发生的作用.自体MSC在心肌内可分化成为具有心肌细胞离子通道特性的类心肌细胞,其离子通道分化程度可能是影响室性心律失常发生的主要机制.     

血红素氧化酶-1基因修饰的自体骨髓间充质干细胞移植治疗猪急性心肌梗死

目的 研究骨髓间充质干细胞(MSC)经血红素氧化酶-1(HO-1)基因修饰后移植对急性心肌梗死的治疗作用.方法细胞分为3组,未转染质粒组(MSC组)、转染空载质粒组(LaeZ-MSC组)、转染pcDNA3.1-hHO-1组(HO-1-MSC组),体外实验予缺氧诱导观察HO-1基因转染后MSC的抗凋亡情况,同时收集上清液检测血管内皮生长因子(VEGF)的表达.体内实验建立猪的急性心肌梗死模型,梗死1 h再灌注1 h后分为3组,即生理盐水组、单纯干细胞治疗组(MSC组)及HO-1基因转染干细胞治疗组(HO-1-MSC组).治疗组分别予MSC及HO-1-MSC移植治疗,对照组则注入等量生理盐水.细胞移植后1周及3个月行磁共振检测.3个月后处死动物,取心脏标本行相关检查.结果(1)体外缺氧诱导实验中HO-1-MSC组凋亡率(30.30±7.64)%低于MSC组(56.93±4.68)%(P＜0.001)和LacZ-MSC组(55.88±4.38)%(P＜0.001).同时上清液中VEGF的分泌HO-1-MSC组(768.44±78.38)pg/ml高于MSC组(555.27±67.67)pg/ml(P＜0.001)和LacZ-MSC 组(522.97±71.45)pg/ml(P＜0.001).(2)细胞移植3个月后HO-1-MSC组LVEF(53.50±2.09)%明显高于MSC组(49.54±2.74)%(P=0.017).梗死周边区毛细血管密度(血管数/HPF)HO-1-MSC组14.59±2.39亦大于MSC组11.78±2.48(P=0.033).结论 HO-1基因转染MSC较单纯MSC移植治疗急性心肌梗死疗效明显.     

沉默Nrf2基因的骨髓间充质干细胞移植对大鼠心肌梗死后心室重构和纤维化的影响

目的探讨以si RNA为载体沉默骨髓间充质干细胞(MSC)中核因子E2相关因子2(Nrf2)基因后细胞移植对大鼠心肌梗死后心肌纤维化和心室重构的影响及可能机制。方法建立心肌梗死大鼠模型,随机分为沉默Nrf2基因的MSC移植组(MSCNrf2-/-组)、过表达Nrf2基因的MSC移植组(MSCNrf2+/+组)和生理盐水转染MSC移植组(对照组),每组12只。细胞移植后28天,采用Masson染色检测心肌梗死边缘区胶原沉积含量和纤维化程度,Western blot检测梗死心肌Nrf2和血红素氧合酶1(HO-1)蛋白表达水平,超声心动图评价梗死后心功能。结果 si RNA-Nrf2转染MSC后,Nrf2蛋白表达明显减少。移植后第28天,MSCNrf2-/-组心肌组织纤维化程度较对照组加重,MSCNrf2+/+组心肌组织纤维化程度较对照组减轻(P0.05);MSCNrf2-/-组梗死心肌中Nrf2、HO-1蛋白表达较对照组下降(P0.05),而MSCNrf2+/+组梗死心肌中Nrf2、HO-1蛋白表达较对照组增加(P0.05);超声心动图结果显示,与对照组比较,MSCNrf2-/-组左心室舒张期末内经(LVEDD)和左心室收缩期末内经(LVESD)增大,左心室射血分数(LVEF)下降(P0.05),MSCNrf2+/+组LVEDD和LVESD均减小,LVEF无下降(P0.05)。结论 si RNA-Nrf2可有效干扰MSC中Nrf2蛋白的表达,降低外源性MSC对梗死心脏的修复能力,增加心肌梗死区胶原沉积,进而促进心室重构,降低心功能。由此推测Nrf2信号通路在干细胞移植治疗心肌梗死后心肌重构和纤维化中起了关键作用。     

莱菔硫烷对大鼠移植心脏细胞凋亡的影响

目的探讨莱菔硫烷(SFN)预处理对大鼠心脏移植后心肌缺血再灌注损伤导致的细胞凋亡的影响及可能机制。方法健康雄性SD大鼠30只随机分成A组(假手术组,n=6),B组(缺血再灌注组,n=12),C组(SFN预处理组,n=12)。应用HE染色法、Western印迹法观察心肌组织学及核因子相关因子(Nrf)2、血红素加氧酶(HO)-1、B细胞淋巴瘤/白血病-2(Bcl-2)和Bcl-2相关X蛋白(Bax)的蛋白表达水平。结果与B组比较,C组心肌组织损伤减轻,心肌组织Nrf2、HO-1和Bcl-2蛋白水平升高(P<0.01),并且Bcl-2/Bax也升高(P<0.01),而Bax蛋白水平降低(P<0.01);但与A组比较,心肌组织仍未恢复至正常;心肌组织Nrf2、HO-1、Bcl-2和Bax蛋白水平仍高于正常(P<0.01),Bcl-2/Bax水平无明显变化(P>0.05)。结论SFN可能通过激活Nrf2-ARE通路,上调Bcl-2/Bax比值,提高心肌细胞抗凋亡防御能力,对抗移植心脏冷缺血再灌注损伤。     

移植心肌样细胞对心肌梗死后功能性室壁瘤大鼠心功能的影响

目的 探讨心肌内注射心肌样细胞对心肌梗死(MI)后功能性室壁瘤大鼠心功能的影响。方法 结扎大鼠冠状动脉前降支形成MI,4周后,用超声心动图检测并筛选形成功能性室壁瘤者,并随机分为两组,即移植组（n=10）,在室壁瘤部位及周边点状注射5-氮杂胞苷(5-Aza)诱导骨髓间充质干细胞（MSCs）分化、并用4,6-二脒基-2-苯基吲哚(DAPI)标记的心肌样细胞（106～107个）;对照组（n=10）:注射生理盐水。另取10只健康大鼠作为假手术组,只开胸不做任何处理。4周后,用超声心动图和血流动力学方法测定功能性室壁瘤大鼠的心功能,在荧光显微镜下观察DAPI标记的移植细胞的存活情况。结果 超声心动图的结果显示,对照组和移植组的左室舒张末内径（LVEDD）和左室收缩末内径（LVESD）均较假手术组增高（P<0.01）,而移植组较对照组有所降低［（8.749±0.091）、（5.109±0.171） vs (9.219±0.059)mm、(5.942±0.092)mm,P<0.05］;对照组和移植组的短轴缩短率（△FS）及左室射血分数（LVEF）均较假手术组明显降低（P<0.01）,移植组较对照组两者有所增高［（32.70±1.283）、（45.78±1.796） vs （22.80±0.593）%、（31.92±0.830）%,P<0.05］。血流动力学检测结果显示,移植组、对照组和假手术组的左室舒缩压差（LVDP）和左室正负最大变化速率（±dp/dtmax）,分别为（152.9±0.669）、（4109±33.86）、（-3579±49.09）,（122.5±2.639）、（3823±73.50）、（-2828±60.96）和（183.6±2.348）mmHg、（6 695±80.17）mmHg/s、（-6 294±71.39）mmHg/s,假手术组优于对照组和移植组（P<0.01）,移植组优于对照组（P<0.05）。在荧光显微镜下可以观察到移植组的心肌组织中有存活的标记细胞。结论 移植心肌样细胞能显著改善MI后功能性室壁瘤大鼠的心功能,为治疗功能性室壁瘤提供一种新的治疗思路和为临床研究奠定基础。     

骨髓干细胞移植通过基质金属蛋白酶及其抑制剂降低大鼠缺血性心力衰竭心室重构

目的探讨骨髓干细胞通过调节基质金属蛋白酶2/基质金属蛋白酶抑制剂1(MMP2/TIMP1)系统改善急性心肌梗死后心力衰竭心室重构。方法结扎雌性 SD 大鼠左冠状动脉制作急性心肌梗死模型。4周后随机分为2组:移植组大鼠7只,移植雄性 SD 大鼠来源的骨髓干细胞(5×10~6)到梗死后瘢痕区。对照组大鼠7只,移植等体积的 PBS 到瘢痕心肌。通过 HE 染色和 Masson 染色评价左室形态。免疫组织化学分析心肌 MMP2和 TIMP1和瘢痕区Ⅰ、Ⅲ型胶原表达情况。经Western 杂交检测 MMP2和 TIMP1蛋白变化。结果部分骨髓干细胞在移植后21天呈纤维母细胞样生长。移植后早期有炎症细胞聚集在瘢痕区,移植后7天炎症细胞减少。与对照组相比,移植组大鼠左室射血分数和左室短轴缩短率提高[(63.43±3.97)%与(36.20±3.99)%,(31.71±1.98)%与(18.00±2.07)%,P<0.05],左室压力下降最大值(dp/dt_(min))降低[(-4756.24±270.00)mm Hg/s(1 mm Hg=0.133 kPa)与(-2789.53±624.13)mm Hg/s,P<0.05],左室厚度率增加[(76.34±2.66)%与(64.37±2.36)%,P<0.05],梗死区面积缩小[(36.19±0.83)%与(42.12±1.88)%,P<0.05]。移植组大鼠瘢痕区Ⅰ型胶原表达升高,Ⅲ型胶原降低;心肌 MMP2蛋白水平降低而TIMP1水平升高。结论骨髓干细胞移植通过 MMP2/TIMP1导致胶原网络的动态变化,从而改善急性缺血后衰竭心脏的左室重构。     

骨髓间充质干细胞移植治疗心力衰竭

目的 探讨骨髓间充质干细胞移植对阿霉素诱导的心力衰竭大鼠心功能的影响.方法 无菌条件下取8周龄F344大鼠的股骨和胫骨,获得骨髓间充质干细胞(MSCs),在体外纯化、扩增后 ,用5-溴-2'脱氧尿苷(BrdU)进行标记,然后注射到心力衰竭模型细胞移植组和对照组大鼠的心肌组织内,细胞移植后4周,采用生理记录仪测量3组大鼠的心功能 ,处死动物,心脏切片行免疫组化了解移植细胞在受体心脏的存活情况.结果 细胞移植后4周,细胞移植组大鼠死亡率为6.2%,明显低于假细胞移植组12.5%(P<0.01);在受体大鼠的心脏切片上有BrdU标记的移植细胞存活.心功能测定显示:与对照组相比,细胞移植组最大左室收缩末压(LVSP)、心率(HR)、左室内压最大(最小)变化速率(LV±dp/dtmax)均明显下降(P<0.01),而左室舒张末压(LVDP)明显升高(P<0.01);与对照组相比,细胞移植组大鼠的LVSP、HR、LV±dp/dtmax均有明显升高(P<0.01),而LVDP明显降低(P<0.01);与假移植组相比,细胞移植组大鼠的HR、 LV±dp/dtmax仍有明显下降(P<0.01),而LVDP明显升高(P<0.01).结论 MSCs移植可有效改善阿霉素诱导的扩张型心力衰竭大鼠的心功能,减少心力衰竭大鼠的死亡率.     

组织多普勒联合Tei指数评价右室梗死患者右心功能

目的探讨应用多普勒组织成像(DTI)技术及Tei指数评价右室梗死患者的右心功能。方法急性下壁心肌梗死51例,于心尖四腔观切面以DTI速度模式录取三尖瓣游离壁侧瓣环、室间隔侧瓣环和游离壁中段收缩期、舒张早、晚期峰值运动速度(Sm、Em、Am)及Em/Am;以脉冲多普勒记录三尖瓣关闭至再次开放间期,并于胸骨旁短轴切面记录射血时间,计算右心Tei指数。结果右室心肌梗死组于三尖瓣游离壁侧瓣环及右室游离壁中部Sm、Em较无右室心肌梗死及正常对照组明显减低[游离壁侧瓣环Sm(70±20)cm/s比(87±19)cm/s和(106±21)cm/s,P<001;游离壁侧瓣环Em(63±19)cm/s比(79±18)cm/s和(96±19)cm/s;P<001;游离壁中段Sm(64±19)cm/s比(80±19)cm/s和(94±20)cm/s,P<005;游离壁中段Em(61±20)cm/s比(76±20)cm/s和(92±23)cm/s;P<005];右心Tei指数亦较其他两组普遍增高(065±019比040±015和026±010;P<001)。结论DTI技术检测三尖瓣游离壁侧瓣环及右室游离壁中段运动速度及右心Tei指数可无创、迅速评价右室心肌梗死患者右心室功能。     

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.