功能性便秘患者肛门直肠动力学的临床研究

目的观察功能性便秘(functional constipation,FC)患者的肛门直肠动力学改变.方法采用灌注式测压装置测定20例FC患者和15例健康人的肛门直肠压力、直肠对容量刺激的最低敏感量、最大耐受量及直肠顺应性.结果 FC患者的直肠、肛门内外括约肌静息压力、内括约肌主动收缩压、模拟排便时直肠收缩压、内外括约肌净减压与对照组比较无显著性差异.FC组肛门-直肠屏障压高于对照组.FC组直肠对容量刺激的最大耐受量及顺应性均高于对照组.结论功能性便秘患者存在肛门直肠动力学异常,这种异常可能是导致便秘的原因.     

便秘型和腹泻型肠易激综合征患者肛门直肠运动及直肠感觉功能的检测分析

目的研究便秘型和腹泻型肠易激综合征(IBS)患者肛门直肠运动及直肠感觉改变。方法对2000-01~2004-01广州医学院第二附属医院根据罗马Ⅱ标准入选的便秘型IBS30例,腹泻型IBS20例,正常对照组26例,进行肛门直肠运动功能及直肠感觉测定。结果(1)便秘型和腹泻型IBS肛门括约肌压力、肛门括约肌最大缩窄压和正常对照组相比差异无显著性(P>0.05);增加腹压时,肛门括约肌净增压腹泻型低于正常对照组(P<0.05);模拟大便时直肠和肛门括约肌出现同步收缩发生率便秘型IBS高于正常对照组(P<0.01)。(2)便秘型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显高于正常对照组(P<0.01)。(3)腹泻型IBS直肠对容量刺激的最低敏感量、最大耐受性、顺应性明显低于正常对照组(P<0.01)。结论(1)IBS存在肛门直肠运动异常。(2)便秘型IBS直肠对容量刺激低敏感、高耐受、高顺应性,可能是引起便秘原因之一。(3)腹泻型IBS直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱,可能与腹泻有关。     

便秘型肠易激综合征患者结、直肠肛门动力学的临床研究

目的研究便秘型肠易激综合征患者结肠、直肠动力,直肠感觉功能.方法用结肠传输试验检测结肠传输时间,并用结肠传输指数分型,用肛门直肠测压方法测定便秘型IBS直肠静息压,肛管静息压,肛门括约肌最大缩榨压,模拟排便时,直肠收缩压,肛门括约肌剩余压,直肠对容量扩张刺激的初始感觉阈值,最大耐受容量,直肠顺应性.结果便秘型IBS患者全结肠及各节段结肠传输时间均高于对照组,便秘型IBS患者肛管静息压,直肠静息压与对照组无差异(P＞0.05),肛门括约肌最大缩榨压低于正常对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的便秘型IBS肛门直肠测压表现不同.结论便秘型IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,可体现不同传输类型便秘型IBS肛门直肠动力学病因机制.     

便秘型肠易激综合征肛门直肠动力学的临床研究

目的:观察便秘型肠易激综合征(IBS)患者的肛门直肠动力学改变。方法:采用Pc Polygraf多功能消化道压力检测仪测定18例便秘型IBS患者和21例健康人的肛门内外括约肌、直肠静息压力、肛门内括约肌主动收缩压、直肠对容量刺     

便秘型肠易激综合征肛门直肠动力学的临床研究

便秘型肠易激综合征 (constipation predominantIBS ,IBS C)表现为伴有腹痛或腹部不适的便秘 ,便后腹部不适缓解。我们检测了IBS C的肛门直肠动力学改变 ,以探讨便秘的发生与肛门直肠动力学异常间的关系表 1　两组肛门直肠压力比较 (mmHg)分组直肠静息压肛门内括约肌静息压肛门外括约肌静息压肛门直肠屏障压IBS C 6.0 0± 1.73 88.3 3± 15 .17 3 2 .5 0± 8.0 482 .61± 15 .2 2 对照组 7.5 0± 3 .75 78.2 5± 2 9.2 0 3 6.75± 9.0 0 67.5 0± 2 2 .5 0　　注 :与对照组比较 : P <0 .0 5表 2　两组随意动作时肛门直肠压力比较 (m…     

老年与非老年溃疡性结肠炎患者直肠肛门运动及直肠感觉功能对比分析

目的 探讨老年溃疡性结肠炎(UC)患者肛门直肠运动及直肠感觉变化特点.方法 采用瑞典CTD-SYNECTICS公司生产的PC-Polygraf HR高分辨多道胃肠功能消化道检测仪,对35例非老年UC及19例老年UC患者肛门直肠动力和直肠感觉功能进行检测,并与20例非老年健康人和28例老年健康人进行比较.结果 (1)肛门静息压、括约肌压力、肛门括约肌最大缩窄压,老年UC组与相应对照组比较差异均无统计学意义(t值分别为1.311、1.298、1.401,P＞0.05);增加腹压时,老年UC组肛门括约肌净增压为(2.8±1.1)kPa,低于相应对照组的(3.8±1.2)kPa,差异有统计学意义(t=2.238,P＜0.05).(2)直肠对容量刺激的最低敏感量、最大耐受性和顺应性,老年UC组为(85±30)ml、(180±69)ml和(26.5±8.8)ml/kPa,低于老年对照组的(95±31)ml、(205±78)ml和(32.9±12.9)ml/kPa,差异均有统计学意义(t值分别为3.121、3.135、3.146,P＜0.01).(3)直肠对容量刺激的最低敏感量、最大耐受性、顺应性,老年UC组均高于非老年UC组(t值分别为2.246、2.239、2.240,P＜0.05);直肠最低敏感量、最大耐受性老年对照组高于非老年对照组(t值分别为2.238,2.301,P＜0.05).结论 UC患者存在肛门直肠运动异常,肛门自控能力减弱;UC患者直肠对容量刺激存在高敏感、低耐受、低顺应性现象.健康老年人直肠对容量刺激的感受阈较高,老年UC患者对容量扩张刺激敏感性比非老年UC患者弱.     

肠易激综合征患者肛门直肠感觉阈值和动力学的改变

采用PC Polygraf HR高分辨多道胃肠功能测定仪,检测42例肠易激综合征(IBS)患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标,并与15例健康人做对照.结果发现IBS的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异(P＞0.05),而初始感觉阈值、疼痛阈值、排便阈值腹泻组低于正常对照组(P＜0.05),便秘组高于正常对照组(P＜0.05).排便时IBS便秘组患者的肛管松弛压高于正常对照组(P＜0.05).提示IBS患者排便功能和直肠感觉功能存在异常.     

功能性便秘和便秘型肠易激综合征的结肠运输试验及直肠感觉阈值比较

目的 对功能性便秘和便秘型肠易激综合征（IBS）患者进行肠道转运时间及其肛门直肠运动和直肠容量感觉研究，探讨两类疾病的结肠运动方式有何不同。方法 用不透X线标志物测定全结肠通过时间和结肠分段通过时间并计算转动指数。用电子气压泵研究肛门直肠压力、直肠对容量刺激的感觉和直肠顺应性。结果 便秘型IBS的结肠转动时间延长主要在右半结肠。功能性便秘的各个节段结肠均有延长，结合转动指数研究，发现直肠乙状结肠部位的延长更显著。两种疾病的肛门直肠括约肌静息压、收缩压和松弛压均无明显异常，但两者的顺应性和排便阈值均明显增高，其中功能性便秘的感觉阈值有增加。结论 IBS便秘型结肠运动紊乱主要在右半结肠，功能性便秘的结肠动力改变主要在直肠乙状结肠部为多。说明两者的结肠运动方式改变是不同的，对两者的鉴别诊断有帮助。     

功能性便秘患者直肠肛门压力变化

目的研究功能性便秘患者直肠肛门运动功能,探讨该疾病发生的可能机制。方法测定了35例慢性功能性便秘患者和11例正常对照者的直肠肛门压力及排便功能。结果①直肠静息压、肛门括约肌静息压及其最大缩窄压等在功能性便秘患者和正常人之间无显著差异(P>0.05);②肛管高压带长度在功能性便秘患者显著高于正常人(P<0.0005);③功能性便秘患者直肠壶腹部的感觉阈值和最大耐受量显著高于正常对照组(P<0.05),直肠最大顺应性显著低于正常对照组(P<0.0005),引起直肠肛门抑制反射的直肠扩张容量在便秘组显著高于正常对照组(P<0.05),肛门松弛率在便秘组显著低于正常对照组(P<0.05);④功能性便秘患者排便时肛门内外括约肌松弛反射均障碍,尤以外括约肌明显。结论功能性便秘患者存在直肠肛门运动功能障碍,这在其发病机制中起重要作用。     

肠易激综合征患者直肠肛门压力变化及临床意义

为了研究肠易激综合征（ＩＢＳ）患者直肠肛门运动功能，测定了８０例ＩＢＳ患者和２０例正常人直肠肛门压力及排便功能。发现：①直肠静息压、肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组、便秘组及正常对照组均无显著差异。②肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。③直肠壶腹部的感觉阈值、最大耐受量、直肠顺应性及直肠－肛门抑制反应的直肠扩张容量在ＩＢＳ腹泻组均显著低于正常对照组，肛门括约肌松弛率ＩＢＳ腹泻组与正常对照组无显著差异。④ＩＢＳ便秘组感觉阈值与正常对照组无差异，但其最大耐受量及引起直肠－肛门抑制反射的直肠扩张容量均显著高于正常对照组，其直肠顺应性和肛门括约肌松弛率显著低于正常对照组。     

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.