原发性肝癌MRI特征

目的探讨原发性肝癌的ＭＲＩ特征，以提高诊断准确性．方法原发性肝癌２９例，全部为男性，年龄３３岁～８０岁，平均５６岁．ＧｄＤＴＰＡ增强扫描１０例共１１个肿块．扫描序列为自旋回波（ＳＥ）、ＦＬＡＳＨ，扫描层厚８ｍｍ～１０ｍｍ．结果肿瘤不规则６９２％（３６／５２），边缘模糊３８５％（２０／５２），长ＴＥ肿瘤的信号强度增高不明显．假包膜征１９例，Ｔ１ＷＩ表现为低信号单环，Ｔ２ＷＩ为低信号或高信号单环，典型表现为外高内低双环．１５例镶嵌征Ｔ１ＷＩ和Ｔ２ＷＩ表现为肿瘤内线样或不规则低信号区．１３例斑征Ｔ２ＷＩ表现为肿瘤内高信号斑块．动态增强扫描肿瘤中心不规则强化３６４％，肿瘤边缘结节样强化４５５％．门静脉或下腔静脉瘤栓是原发性肝癌的辅助征象．结论原发性肝癌ＭＲＩ具有特征性．     

正电子发射型断层扫描在肺癌诊断中的应用

本介绍以＾１８Ｆ－氟代脱氧葡萄糖作为示踪剂的正电子发射型断层显像技术（ＦＤＧ－ＰＥＴ）在肺部肿瘤诊断上的应用，尤其是在肺部孤立性结节（ＳＰＮ）、肺部块影、浸润性阴影、肺门及纵隔淋巴结的良恶性临别以及肺癌治疗后复发、转移性肺癌的诊断上的应用；并把ＰＥＴ与计算机断层扫描（ＣＴ）、核磁共振显像（ＭＲＩ）、经胸针吸肺活检（ＴＴＮＡ）作了比较。ＰＥＴ不仅是一种无创性检测手段，而且在肺部病变良恶性的鉴别诊断     

皮层下动脉硬化性脑病影像学与临床表现（附330例分析）

目的：总结皮层下动脉硬化性脑病（ＳＡＥ）临床、影像学表现及诊断要点。方法：收集分析临床资料完整并有ＣＴ扫描的病例３３０例,其中５４例加磁共振成像。结果：进行性智能障碍是ＳＡＥ的主要临床表现,ＣＴ扫描显示脑内白质区多发低信号灶,ＭＲＩ表现为长Ｔ１、长Ｔ２异常信号灶,同时合并多发腔隙性脑梗塞和脑萎缩。结论：ＣＴ平扫结合临床是ＳＡＥ最简便有效的诊断手段,ＭＲＩ能更敏感地显示合并的脑内细小梗塞灶。     

2.0cm以下肺部结核结节和小肺癌的CT影像研究——附70例对比分析

目的 进一步评价结核结节和小肺癌的ＣＴ影像特点和鉴别要点，方法 对比分析７０例２．０ｃｍ以下结核结节（３０例）和小肺癌（４０例）ＣＴ影像。结果 结核结节以边缘光滑或清楚，无分叶，小空洞，钙化，胸膜增厚粘连，卫星病灶或病灶周围炎多见，并短期内动态形态改变，小肺癌以边缘毛糙，浅分叶，空泡征，空气支气管征，典型胸膜凹陷征多见，并短期动态形态不变，结论 薄层ＣＴ扫描可提供有价值的征象，短期内动态观察是重要     

用巢式PCR检查孤立性肺结节中的结核杆菌

孤立性肺结节(ＳＰＮｓ)早期确诊的临床意义重大,但结核病高发区中的ＳＰＮ的鉴别诊断很困难,作者对从ＳＰＮｓ中的细针吸取物用聚合酶链反应(ＰＣＲ)检查,并就巢式ＰＣＲ检查结核性ＳＰＮｓ中的结核杆菌及对ＳＰＮｓ的鉴别诊断作用进行评价。病人和方法　33例经胸部ＣＴ证实为直径<4ｃｍ、圆或卵圆形、界限清楚的ＳＰＮｓ;结核性ＳＰＮｓ的诊断标准是细菌学肯定或抗结核治疗后Ｘ线下结节消失或缩小;每例均在ＣＴ引导下用21号针从结节中央抽吸2次,吸取物均用ＴＢ1、ＴＢ2、ＴＢ28及ＴＢ29经巢式ＰＣＲ完成结核杆菌检查。结果　33例中,恶性Ｓ…     

甲状腺结节与甲状腺髓样癌

甲状腺结节与甲状腺髓样癌甲状腺结节很常见，而散发性甲状腺髓样癌（ＳＭＴＣ）则很罕见，但在临床上ＳＭＴＣ是以甲状腺结节而表现的。在甲状腺癌中ＳＭＴＣ是唯一对降钙素（ＣＴ）呈高度敏感性，并可作为特异性肿瘤标志物。Ｐａｃｉｎｉ等曾做过一项重要的前瞻性研究，...     

结核分支杆菌重组38 000蛋白的免疫原性特征

目的了解结核分支杆菌重组３８０００蛋白（ｒＭＴ３８）诱发家兔产生抗体的能力及作为血清学诊断试剂的价值。方法将家兔分为６组：ＰＰＤ＋生理盐水（Ａ组）,ｒＭＴ３８＋生理盐水（Ｂ组）ｒＭＴ３８＋佐剂（Ｃ组）,１／２ｒＭＴ３８＋１ｒＭＴ１６＋生理盐水（Ｄ组）,１／２ｒＭＴ３８＋１／２ｒＭＴ１６＋佐剂（Ｅ组）,ｒＭＴ１６＋佐剂（Ｆ组））。用ＥＬＩＳＡ法测Ｃ、Ｅ两组血清是否与分支杆菌ＰＰＤ有效叉反应。双向扩散     

直径<2.0 cm肺部结核结节和肺癌的CT影像研究

目的进一步评价结核结节和肺癌的ＣＴ影像特点和鉴别诊断价值。方法对比分析直径＜２０ｃｍ的结核结节３０例和肺癌４０例的ＣＴ影像。结果结核结节以边缘光滑或清楚、无分叶而有小空洞、钙化、胸膜增厚粘连、卫星病灶或病灶周围炎多见，并有短期内动态形态改变。肺癌以边缘毛糙、浅分叶、空泡征、空气支气管征、典型胸膜凹陷征多见，短期动态形态不变。结论薄层ＣＴ扫描可提供有价值的征象，短期内动态观察是二病重要鉴别手段     

乳果糖氢呼吸试验测定口-盲肠传递时间

目的测定功能性消化不良（ＦＤ）和肠易激综合征（ＩＢＳ）患者口－盲肠传递时间（ＯＣＴＴ）．方法应用乳果糖氢呼吸试验（ＬＨＢＴ）测定了正常人１３例，ＦＤ２０例和ＩＢＳ（其中１５例主诉腹泻，１６例主诉便秘）３１例患者的ＯＣＴＴ．结果正常人ＯＣＴＴ为９５４±１９６ｍｉｎ，ＦＤ患者（９９２±２４５ｍｉｎ）与正常人比较无显著性差异（Ｐ＞００５），但其中５例动力障碍型ＦＤ的ＯＣＴＴ则显著延长（１２９０±１２０ｍｉｎ，Ｐ＜００１），以便秘为主的ＩＢＳ患者ＯＣＴＴ显著延长（１５４４±５５７ｍｉｎ，Ｐ＜００１），以腹泻为主的ＩＢＳ患者ＯＣＴＴ显著缩短（７３１±２２２ｍｉｎ，Ｐ＜００５）．结论ＦＤ和ＩＢＳ患者存在小肠动力学异常，ＬＨＢＴ可作为辅助检查小肠动力学异常的手段之一．     

TSH受体抗体对甲状腺细胞功能的调控及途径

ＴＳＨ受体抗体（ＴＳＡｂ）是Ｇｒａｖｅｓ病的主要病因子，与甲状腺细胞上ＴＳＨ受体结合后，通过不同的信号途径调节甲状腺细胞生长，分化和激素合成及分泌，参与ＴＳＡｂ调节作用的信号途径包括腺苷酸环化酶（ＡＣ）－ｃＡＭＰ，磷脂酶Ｃ－Ｃａ＾２＋和磷脂酶Ａ２－ＡＡ等，其中ＡＣ－ｃＡＭＰ和磷脂酶Ａ２－ＡＡ参与甲状腺细胞生长的调节，磷脂酶Ｃ－Ｃａ＾２＋与甲状腺激素合成密切相关，通过激活不同的信号途径来区分ＴＳＡｂ     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.