高分辨CT对结缔组织病所致肺间质病变的诊断价值

目的评价胸部高分辨率CT(HRCT)对早期发现结缔组织病所致肺间质病变的诊断价值。方法选择南京红十字医院及安徽医科大学附属医院2004年7月至2005年6月门诊及住院的系统性红斑狼疮患者20例、类风湿关节炎及干燥综合征患者共16例,行X线胸片及常规螺旋CT全胸扫描,运用HRCT对肺部扫描,进行对比分析。结果肺HRCT示21例(58.3%)患肺间质病变(ILD),常规螺旋CT示11例(30.6%)ILD,而X线全胸片仅4例(11.1%)示ILD。HRCT可见如蜂窝状阴影、胸膜下线影、小叶间隔增厚、毛玻璃样变等常规CT及X线胸片下无法观察到的征象。结论HRCT能充分显示肺间质纤维化的各种征象,对结缔组织病引起的肺间质病变的早期诊断有重要意义。     

结缔组织病肺间质病变的临床特点及治疗效果分析

目的探讨不同结缔组织病肺间质病变（CTD-ILD）的临床特点和治疗效果。方法分析82例CTD-ILD患者的临床特征及胸部高分辨CT（HRCT）特点并观察治疗后HRCT的变化。结果（1）SSc—ILD的发生率最高，为70．0％。其次为pSS—ILD、PM／DM-ILD、RA—ILD、SLE—ILD，系统性红斑狼疮继发的ILD（SLE—ILD）发病年龄（26．2±7．8）较其他CTD-ILD早（P〈0．05）。RA—ILD、SSc—ILD病程较长，pSS—ILD、SLE一[LD和PM—ILl）病程较短。RA．ILD出现活动后气促少见（P〈0．05）。pSS—ILD出现呼吸道症状（40％）和体征（50％）最多见。85．7％SSc-ILD出现雷诺现象，支持雷诺现象与ILD相关。（2）SLE—ILD以磨玻璃影多见，丽蜂窝状改变较少；pSS-ILD以蜂窝状改变和纵隔淋巴结肿大相对较多。（3）大部分患者治疗后肺部间质病变吸收好转（56．7％），其中88．2％SLE—ILD吸收好转，28．4％患者肺部病变处于静止，14．9％患者间质病变较前进展。结论CTD—ILD患者一旦确诊，应尽早用激素联合免疫抑制剂治疗。     

高分辨率CT及积分在结缔组织病并发间质性肺炎及预后中的价值

目的 比较不同结缔组织病(CTD)并发间质性肺炎(ILD)的肺高分辨率CT(HRCT)影像学特征,探讨肺HRCT积分对判断患者预后的预测价值.方法 回顾性收集117例各类CTD 临床资料和影像学资料以及随访结果,对肺HRCT病变进行评分,研究肺HRCT积分与患者预后的关系.结果 117例CTD患者中有95例在肺HRCT上显示有ILD,其中,系统性红斑狼疮(SLE)34%,类风湿关节炎(RA)31%,多发性肌炎/皮肌炎(PM/DM)9%,成人斯蒂尔病(AOSD)9%,干燥综合征(SS)5%,系统性硬化症(SSc)7%,混合性结缔组织病(MCTD)5%.CTD并发ILD肺HRCT最常见的表现是小叶间隔增厚,其次为毛玻璃样变,之后依次为不规则线状影或胸膜下线、网格影、支气管血管束增厚、马赛克灌注、蜂窝肺、薄壁囊肿、结节灶、大片实变病变、肺大泡.AOSD和SSc患者纤维化积分显著高于渗出积分(P＜0.05);CTD并发ILD患者5年生存率为48.5%(95%可信区间为22.4%～67.9%),纤维化积分≥2分是预测患者预后不良的危险因素(P=0.032),其敏感性为82%,特异性为87%.结论 不同CTD并发的ILD有不同的影像学特征,肺HRCT可以较好地发现并鉴别,肺HRCT纤维化积分可以判断患者的预后.     

应用一氧化碳弥散功能检测结缔组织病患者肺间质病变的意义

目的　探讨对结缔组织病 (CTD)患者肺间质病变 (ILD)进行早期、安全、有效且可量化的诊断方法。方法　对 93例CTD患者 ,其中 4 8例系统性红斑狼疮 (SLE)、18例皮肌炎 (DM)、2 1例系统性硬皮病 (PSS)、6例干燥综合征 (SS)进行了一氧化碳弥散功能检测 ,并与X线胸片、肺部高分辨率CT(HRCT)结果相比较 ;同时测定了 5 0名正常人的X线胸片和一氧化碳弥散功能作为对照。结果　X线胸片、肺部HRCT和一氧化碳弥散功能检测 (以一氧化碳弥散吸收率 <80 %为标准 )在SLE中检测到ILD的比率分别是 15 %、36 %和 4 2 % ;在DM中的比率分别是 17%、36 %和 39% ;在PSS中的比率分别是 38%、4 2 %和 5 2 % ;SS的比率分别是 33%、6 7%和 5 0 %。而正常人的X线胸片均正常 ,一氧化碳弥散吸收率均≥ 80 %。结论　X线胸片在检测CTD患者ILD中敏感性最低 ,而HRCT和一氧化碳弥散功能是检测CTD患者ILD的敏感方法。尤其是后者 ,具有敏感性高、不受X线照射、易被患者接受和对其损害程度进行量化等优点 ,既可作为早期了解CTD患者ILD的检测方法 ,又可通过一氧化碳弥散功能的改变对治疗效果进行评价。     

艾滋病合并卡氏肺孢子虫肺炎87例胸部CT影像特点分析

目的通过对艾滋病合并卡氏肺孢子虫肺炎（PCP）患者胸部CT影像特点的分析,以提高对PCP的影像学诊断水平。方法回顾性分析87例艾滋病合并PCP患者的胸部CT影像学表现,分析各型肺炎的发生率。结果87例PCP患者胸部CT均表现为弥漫性病变,其中双肺弥漫性毛玻璃样改变31例占35．63％,渗出性斑片状影（肺泡实变影）34例占39．08％,其他还可表现为间质型性实变影、气囊性病变、粟粒样改变共占26．44％,但以上影像学表现多互相交叉存在而出现影像学上所谓的“四不像”现象。本组病人死亡4例,均是病程长,年龄大的患者。结论PCP各种影像学表现多互相交叉同时存在,即所谓的“四不像”现象,但肺间质损害表现以渗出性毛玻璃状影和渗出性斑片状影为主。     

结核病

CT在成人活动性肺结核诊断中的应用——范崇明等（山东临沂市中医医院276000）；《山东医药》，2006，46（17）：37-38[回顾性分析68例活动性肺结核的CT及HRCT影像表现，其中38例痰菌阳性证实，18例纤维支气管镜活检证实，12例经临床随访观察治疗证实。结果：68例共有121个肺段发现病变，其中肺结核常见部位占69．8％，少见部位占30．2％；40例（58．8％）呈多个肺段病变，28例（41．2％）呈单个病变。以上患者均行常规螺旋CT扫描及HRCT感兴趣区域薄层扫描。认为CT及HRCT在成人活动性肺结核诊断中有重要价值，其特征性表现为肺实变影、毛玻璃影、小空洞、树芽征及绒毛结节等。]     

结缔组织病肺间质病变的临床、影像和病理诊断

目的了解结缔组织病肺间质病变（connective tissue disease-interstitial lung disease,CTD-ILD）的临床、影像及病理学特征,探讨CTD-ILD影像学与病理类型间的相关性。方法通过高分辨计算机体层成像（high-resulution computed tomography,HRCT）技术了解132例弥漫性结缔组织病合并肺间质病变患者的肺间质病变影像学特点及分型,经皮肺穿刺活检技术进行肺间质病变病理分型。结果与系统性红斑狼疮（systemic lupuserythematosus,SLE）、多发性肌炎（polymyositis,PM）、系统性硬化症（systemic sclerosis,SSc）、类风湿关节炎（rheumatoid arthritis,RA）相比,原发性干燥综合征（primary Sj觟gren＇s syndrome,pSS）、皮肌炎（dermatomysitis,DM）、血管炎肺间质病变的呼吸道症状更明显。从影像学上看CTD-ILD表现多种多样：SLE以磨玻璃影多见,pSS以实变影多见,DM、PM、血管炎以实变影及毛玻璃影多见,SSc和RA以网格影多见。不同疾病肺间质病理类型有显著性差异,SLE、pSS、DM以非特异性肺间质炎（nonspecific interstitial pneumonia,NSIP）为主,SSc以寻常型肺间质炎（usual interstitial pneumonia,UIP）为主。病理类型NISP在影像学上多表现为毛玻璃样实变病变,UIP则更多表现为网格样蜂窝样病变,与其他影像学表现比较有统计学差异（P〈0.05）。用力肺活量和一氧化碳弥散能力下降在病种、影像学及病理改变上均无统计学差异。结论HRCT对诊断CTD-ILD有高敏感性及特异性,影像学改变可帮助临床医生推测其组织病理类型,便于随访和疗效的评价,减少肺活检的危险,是目前诊断CTD-ILD的重要手段。     

原发性干燥综合征合并间质性肺病的临床特征

目的探讨原发性干燥综合征（primary Sjogen’s syndrome,pSS）合并间质性肺病（interstitial lung disease．ILD）的临床及影像学特点,以提高对原发性干燥综合征合并间质性肺病（pSS—ILD）的认识。方法回顾性分析本院2004年1月．2007年12月确诊且资料完整的219例pSS患者,对其中47例合并ILD患者的临床特点及影像学检查进行分析。结果（1）pSS组ILD的发生率为21．46％,pSS-ILD组发病年龄晚于pSS一无ILD组,且病程长于pSS．无ILD组（P〈O．01）;（2）pSS-ILD组血沉（erythroeyte sedimentation rate,ESR）明显增快,C反应蛋白（C-reaetive protein,CRP）明显增高,两者与pSS-无ILD组比较差异均具有统计学意义（P〈0．01）;（3）pSS-ILD组抗SSA抗体阳性率高于pSS-无ILD组（P〈0．05）;抗核抗体（antinuclear antibody,ANA）、类风湿因子（rheumatoid factor。RF）、抗SSB抗体、血浆球蛋白〉30g／L、低补体C3和低补体C4在两组间无明显差异;（4）在诊断pSS—ILD病变时,肺高分辨率CT（high resolution computerized tomography,HRCT）明显优于普通X线胸片。结论ILD是pSS常见的系统损害。pSS-ILD的发生与疾病的活动及某些自身抗体有关,肺HRCT有助于pSS—ILD患者的早期诊断及预后判断。     

铝粉尘引起结节病样肺肉芽肿病一例并文献复习

目的 提高对肺肉芽肿病病因诊断的认识.方法 对1例经开胸肺活组织检查(肺活检)证实的结节病样肺肉芽肿病患者的职业史、临床症状、X线胸片、胸部CT、肺活检和矿物分析并结合有关文献进行回顾性分析.结果 50岁女性患者,有15年铝粉尘接触史;间歇性咳嗽、咳泡沫痰和气急3年;肺功能检查显示严重限制性通气功能障碍和弥散功能明显下降;X线胸片和高分辨率CT(HRCT)表现为双肺磨玻璃影,斑片状实变影,弥漫性网状影,条索状影和牵拉性支气管扩张.开胸肺活检病理表现为弥漫性分布非干酪性肉芽肿结节,内有郎格汉斯细胞和异物巨细胞.用扫描电镜和能量弥散X线对肺活检标本进行矿物分析,证实肉芽肿内有大量、主要成分为铝元素的异物颗粒.结论 肺肉芽肿病鉴别诊断中,当患者疑诊结节病时,应寻找可能存在的有关暴露物.     

非特异性间质性肺炎患者的高分辨率CT表现及其病理学特点

目的探讨非特异性间质性肺炎（NSIP）的高分辨率CT（HRCT）影像学特点及其病理学改变。方法对9例经开胸肺活组织检查（简称肺活检）证实为NSIP患者的HRCT与病理表现进行回顾性分析。结果9例NSIP患者HRCT主要表现为两侧斑片状磨玻璃影、实变影、伴或不伴不规则线影和牵拉性支气管和细支气管扩张，分布在中、下肺的外周，但未见蜂窝影。HRCT表现为磨玻璃影伴或不伴不规则线影和牵拉性支气管和细支气管扩张的区域，其相应的病理改变为不同程度的炎性细胞浸润和纤维化引起的肺间质增厚，病变时相基本一致；在HRCT表现为实变影的区域，其病理改变表现为间质纤维化病变程度重于间质炎症；也可表现为闭塞性细支气管炎伴机化性肺炎样改变，肺泡腔内泡沫状细胞聚集，镜下可见蜂窝肺内有黏液潴留等病理改变。结论NSIP患者的HRCT表现有一定的特征性；根据病理特点并结合临床资料及HRCT表现可初步诊断为NSIP。     

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.