冠状动脉造影术与支架置入术对血小板聚集率影响的研究

目的探讨冠状动脉造影与支架置入术对腺苷二磷酸(ADP)诱导的血小板聚集率的影响。方法前瞻性纳入2012年5月1日至2013年4月30日中国医学科学院阜外医院冠心病患者343例,术前至少7 d连续服用阿司匹林100 mg,每日1次;氯吡格雷75 mg,每日1次。根据支架置入情况分为单纯冠状动脉造影组(造影组,173例)和支架置入组(170例)。患者在接受冠状动脉介入操作之前及之后24 h内,分别采集空腹血样本,用光学比浊法测定血小板聚集率,比较两组患者术前、术后血小板聚集率的变化,支架置入组有66例患者自愿参加血小板聚集率复测亚组分析。结果两组患者术前、术后血小板聚集率比较,差异无统计学意义(P0.05);造影组患者术前、术后血小板聚集率比较,差异无统计学意义(P=0.062),而支架置入组患者术后血小板聚集率显著高于术前[(55.59±10.47)%比(52.47±11.97)%,P0.001],差异有统计学意义;支架置入组患者术后血小板聚集率增加大于造影组[(3.12±8.31)%比(1.06±7.40)%,P=0.010],差异有统计学意义。随着患者支架置入数量的增加,术后血小板聚集率呈递增趋势,但差异无统计学意义(P0.05)。支架置入组血小板聚集率复测亚组患者(66例)术后30 d血小板聚集率显著低于术后24 h[(54.71±11.64)%比(56.68±10.21)%,P=0.019],且与术前基线值比较,差异无统计学意义[(54.71±11.64)%比(54.26±12.23)%,P=0.901]。结论冠状动脉支架置入操作可导致术后血小板活性升高,该作用可在术后30 d内消失,而单纯冠状动脉造影则无此影响。     

血栓抽吸联合冠状动脉内注射替罗非班对急性ST段抬高性心肌梗死患者的疗效观察

目的:评价血栓抽吸联合冠状动脉内注射替罗非班,在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的疗效。方法:回顾性分析急性STEMI行直接PCI术患者124例,术中使用血栓抽吸联合冠状动脉内推注替罗非班的56例患者做为观察组,以同期行常规直接PCI术的STEMI患者68例做为对照组。评估PCI术后即刻心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌组织灌注分级(TMPG)及矫正的TIMI帧数(cTFC)、PCI术中无复流的发生率、直接支架置入率、PCI术后90min完全ST段回落率、肌酸激酶同工酶(CK-MB)和肌钙蛋白T(TnT)峰值、PCI术后7d左心室射血分数(LVEF)、住院期间和PCI术后3个月内主要心脏不良事件(MACE)发生率。结果:与对照组比较,观察组PCI术后即刻TIMI 3级及TMPG 3级血流比例更高(分别为94.6%∶80.9%,91.1%∶73.5%,P<0.05);cTFC帧数更少[(44.1±16.7)帧∶(57.1±23.1)帧,P<0.01];无复流发生率低(5.4%∶19.1%,P<0.05);直接支架置入率高(21.4%∶8.8%,P<0.05);PCI术后90min完全ST段回落率高(85.7%∶67.6%,P<0.05);CK-MB和TnT峰值低[分别为(172.4±45.6)U/L∶(201.7±39.5)U/L,(5.46±1.82)ng/L∶(6.59±1.97)ng/L,P<0.01];PCI术后7dLVEF高[(56.3±7.8)%∶(52.7±6.8)%,P<0.01]。观察组住院期间MACE少于对照组(14.3%∶26.5%),但差异无统计学意义,而PCI术后3个月内MACE亦少于对照组(26.8%∶44.1%),且差异有统计学意义(P<0.05)。结论:血栓抽吸联合冠状动脉内注射替罗非班可以增加急性STEMI患者直接PCI术中的冠状动脉血流和心肌组织灌注,减少无复流发生,减少心肌坏死,改善心功能和预后。     

冠心病患者介入治疗前后血清胎盘生长因子水平变化及临床意义

目的:探讨经皮冠状动脉介入治疗(PCI)前后冠心病患者血清胎盘生长因子水平变化及临床意义。方法:选择110例行择期PCI的冠心病患者,分别在术前,术后第1天、3天和5天测定血清胎盘生长因子(PlGF)水平;30例冠状动脉造影正常者作为对照。随访6个月,观察术后心血管事件(MACE)发生与PlGF水平变化之间的关系。结果:冠心病患者术后第1天血清胎盘生长因子水平均较术前增高[(14.49±3.42)∶(13.06±4.05)ng/L,P<0.01],术后第3天明显升高达到峰值[(16.44±3.25)∶(13.06±4.05)ng/L,P<0.01],术后第5天下降接近正常。发生MACE患者术前和术后血清PlGF峰值水平明显高于未发生MACE患者[(15.3±4.07)∶(10.7±2.65)ng/L,P<0.05)和(18.5±4.25)∶(12.3±3.28)ng/L,P<0.01)]。结论:冠心病患者PCI前后血清PlGF水平峰值与MACE相关,PlGF水平升高可能是冠心病患者PCI后发生MACE的危险因素之一。     

不同血流储备分数冠状动脉临界病变的血管内超声特征研究

目的:探讨不同血流储备分数(FFR)冠状动脉(冠脉)临界病变的血管内超声(IVUS)特征。方法:对92例患者的冠脉临界病变行FFR检查,根据不同FFR值将患者分为3组:缺血组(FFR0.75,24例),临界组(0.75≤FFR≤0.80,31例),非缺血组(FFR0.80,37例)。应用gray-IVUS测量3组病变血管外弹力膜横截面积(EEM-CSA)、平均参考血管EEM-CSA、最小管腔面积(MLA)、病变长度、斑块负荷、管腔容积、总斑块体积以及斑块体积百分比(PAV);应用iMAP-IVUS定量分析3组间斑块组织学性质。比较3组间的临床资料与IVUS测量值是否有统计学差异。结果:3组间MLA[(2.6±0.3) mm~2∶(2.8±0.5) mm~2∶(3.3±0.9) mm~2,P0.001]、病变长度[(22.8±7.9) mm∶(21.7±6.7) mm∶(17.3±6.2) mm,P0.001]、斑块负荷[(76.1±9.5)%∶(73.4±7.5)%∶(67.8±9.3)%,P0.001]、斑块体积[(187.1±78.3) mm~3∶(178.4±67.8) mm~3∶(136.6±68.3) mm~3,P=0.015]及PAV[(61.2±7.5)%∶(57.7±6.4)%∶(52.9±7.6)%,P=0.021]具有显著统计学差异;但在组间析因分析中,缺血组和临界组的所有gray-IVUS参数均无显著统计学差异。iMAP-IVUS分析3组的斑块纤维成分[(43.7±8)%∶(44.4±6.5)%∶(48.7±6.4)%,P=0.127]、脂质成分[(13.7±2.5)%∶(11.6±2.6)%∶(11.7±2.8)%,P=0.091]无显著统计学差异,而坏死成分[(37.6±5.6)%∶(32.9±6.6)%∶(29.2±5.1)%,P=0.020]和钙化成分[(3.2±1.4)%∶(2.9±1.4)%∶(2.4±1.2)%,P=0.033]具有统计学差异;组间析因分析中,缺血组和临界组斑块坏死成分和钙化成分仍有统计学差异(均P0.05)。结论:FFR0.75与FFR临界值的冠脉临界病变的形态特征在gray-IVUS上相似,但前者在iMAP-IVUS中的坏死及钙化成分更高。基于iMAP-IVUS的结果,FFR0.75可能仍然是冠脉临界病变行血运重建的合理界值。     

替罗非班对ST段抬高型心肌梗死患者急诊冠状动脉介入治疗后左室功能及临床预后的影响

目的:前瞻性评价替罗非班对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉(冠脉)介入治疗(PCI)后左室功能及临床预后的作用。方法:将145例接受直接PCI治疗的急性STEMI患者,随机分为替罗非班组(73例)和对照组(72例)。比较2组基础临床情况、冠脉造影和PCI结果、住院期及术后第90天左室舒张末期容积(EDV)、收缩末期容积(ESV)、左室射血分数(LVEF)及主要心脏不良事件(MACE,包括死亡、再梗死、再次靶血管重建)发生率。结果:2组基础临床情况、冠脉造影及PCI结果差异均无统计学意义(P>0.05)。替罗非班组住院期的EDV、ESV、LVEF与对照组比较,分别为P>0.05[(134±28)ml∶(146±46)ml]、P<0.05[(67±17)ml∶(81±36)ml]、P<0.05[(49±7)∶(45±9)%];术后第90天的EDV、ESV、LVEF与对照组比较,分别为P>0.05[(147±31)∶(158±62)ml]、P<0.05[(61±20)∶(79±41)ml]、P<0.01[(58±8)∶(51±9)%]。替罗非班组住院期间及术后第90天MACE发生率均显著低于对照组(均P<0.05),分别为5.5%∶15.3%及6.8%∶18.1%。多因素Logistic回归分析表明,替罗非班治疗(OR=0.76,P<0.05)、年龄<65岁(OR=0.83,P<0.01)、住院期LVEF≥0.5(OR=0.49,P<0.05)是降低术后MACE发生率的主要决定因素。结论:急性STEMI患者直接PCI联合替罗非班治疗,能显著改善住院期和术后左室收缩功能及临床预后。     

血管内超声对分叉病变支架置入术后分支闭塞的预测

目的:应用血管内超声(IVUS)分析分支闭塞的预测因素。方法:行冠状动脉介入治疗(PCI)的分叉病变52处,定量分析分叉近端(分支入口平面)和分叉远端(分叉嵴平面)斑块面积、斑块负荷、偏心指数、斑块分布弧度。采用逐步回归法分析PCI术后分支斑块负荷的相关因素。对术前分支斑块负荷>50%(n=15)和<50%(n=37)这2种情况进行术后结果比较。结果:定量分析分叉近端和远端斑块负荷差异无统计学意义[(52.80±13.21)%∶(52.81±12.20)%,P>0.05],分叉近端斑块偏心指数明显低于分叉远端[(1.86±0.64)∶(9.52±2.78,P<0.01],分叉近端斑块弧度明显大于分叉远端[(357.15±12.02)°∶(233.33±45.91)°,P<0.01]。分叉远端斑块与分支的角度为(143.2±33.60)°。逐步回归分析显示,术后分支斑块负荷与术前分支斑块负荷、分叉近端斑块负荷正相关,与分叉角度、分支/主支直径负相关。术后分支斑块负荷在术前分支斑块负荷>50%者明显大于<50%者[(89.20±5.66)%∶(42.60±18.12)%,P<0.01]。结论:血管分叉改变了斑块的分布模式,分叉近端斑块向心性分布,而分叉远端斑块偏心性分布。分叉远端斑块主要分布在分叉嵴的对侧壁。术前分支斑块负荷大、分叉近端斑块负荷大,分叉角度小、分支/主支直径小,分叉病变PCI术后分支闭塞的可能性大。分支开口斑块负荷>50%较<50%术后闭塞的危险性更大。     

缺血后适应在急诊经皮冠状动脉介入治疗中的应用

目的:探讨缺血后适应在急诊经皮冠状动脉介入治疗(PCI)中应用的临床价值.方法:43例急性心肌梗死的患者随机分成2组:后适应组(25例)在行PCI时于血流开通即刻接受后适应治疗,对照组(18例)接受常规PCI.2组患者均于PCI后定时取静脉血测血清肌酸磷酸激酶同工酶(CK-MB)浓度,入院时和术后24 h取静脉血测血清超敏C反应蛋白浓度,入院时和术后2 h行心电图检查,术后第7天行心脏超声和SPECT静息心肌灌注显像.结果:后适应组CK-MB峰值低于对照组[(280.7±120.0)∶(374.9±146.8)U/L,P＜0.05],其CK-MB曲线下面积也较对照组小[(6 125±2 136)∶(8 643±3 779)%,P＜0.05].入院时血清超敏C反应蛋白浓度2组无明显差异[(5.0±2.8)∶(4.8±2.2)mg/L,P＞0.05],但术后24 h后适应组该浓度低于对照组[(6.1±4.8)∶( 9.6±5.0)mg/L,P＜0.05].后适应组术后2 h ST段完全回落者较对照组多(88%∶55.6%,P＜0.05),术后第7天后适应组左室射血分数高于对照组(55.04±11.23%∶47.81±7.78%,P＜0.05),而室壁运动计分指数明显低于对照组(1.27±0.22∶1.44±0.30,P＜0.05).SPECT半定量分析显示术后第7天时后适应组心肌缺血面积、心肌坏死面积和坏死缺血比分别为(27±15)%、(14±11)%、(46±29)%,对照组分别为(37±14)%、(25±11)%、(67±20)%,2组比较,分别为P＜0.05、P＜0.01、P＜0.05.结论:急诊PCI中运用缺血后适应处理能改善心肌灌注,减轻炎症反应,减少心肌坏死.     

细胞色素P450酶2C19基因多态性与血小板高反应性相关性的研究

目的探讨急性冠状动脉综合征患者PCI术后细胞色素P450酶2C19(CYP2C19)基因多态性与血小板高反应性(HTPR)的相关性。方法选择急性冠状动脉综合征并接受PCI术的患者304例,根据二磷酸腺苷诱导的最大血小板聚集率是否大于50%分为HTPR组73例,非HTPR组231例。行CYP2C19*2、CYP2C19*3基因型检测,根据检测结果分为快代谢型、中间代谢型和慢代谢型。并利用最大血小板聚集率评价患者的血小板反应性。统计学分析CYP2C19基因多态性对血小板反应性的影响。结果 HTPR组快代谢型基因比例明显低于非HTPR组(28.8%vs 57.6%,P0.05),慢代谢型基因比例明显高于非HTPR组(13.7%vs 3.9%,P0.01)。慢代谢型患者最大血小板聚集率明显高于快代谢型和中间代谢型患者[(76.3±11.3)%vs(35.4±14.2)%和(45.1±15.8)%,P0.05]。结论 CYP2C19基因多态性对服用氯吡格雷患者的HTPR具有一定影响。慢代谢型患者最大血小板聚集率显著高于快代谢型和中间代谢型患者。     

高危急性冠状动脉综合征介入治疗早期和即刻应用替罗非班改善冠状动脉血流和心肌灌注的临床疗效比较

目的:了解高危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)冠状动脉介入治疗(PCI)时,术前早期和术前即刻应用替罗非班改善冠状动脉血流和心肌灌注的疗效.方法:将2006-07-2007-07入院、备行PCI的160例高危NSTE-ACS患者随机分配到PCI前早期应用组(A组,冠状动脉造影前4～6 h应用替罗非班)和PCI前即刻应用组(B组,导丝通过冠状动脉病变后应用替罗非班).观察2组在常规使用阿司匹林和氯吡格雷基础上,PCI术前和术后即刻靶血管TIMI血流分级和TIMI心肌灌注分级(TMPG),以及血小板聚集率.记录使用替罗非班治疗期间的出血并发症和血小板减少症的发生率.结果:A组冠状动脉造影前的血小板聚集率显著低于B组(8.5%∶42.0%,P<0.05).A组PCI前即刻靶血管TIMI血流2～3级(81%)、TMPG灌注2～3级(62%)的比率以及PCI后TMPG灌注2～3级比率(89%),均显著高于B组(62%、33%、64%),均P<0.05.A、B组PCI后靶血管TIMI血流3级比率差异无统计学意义(99%∶98%,P>0.05),使用替罗非班治疗期间,A、B组重度出血、中度出血及血小板减少症发生率分别为2.5%∶1.25%、1.25%∶1.25%及1.25%∶1.25%,2组比较差异均无统计学意义(P>0.05).结论:在阿司匹林、氯吡格雷抗血小板治疗的基础上,高危NSTE-ACS患者PCI前早期应用替罗非班比PCI前即刻应用,能及早抑制血小板聚集功能,显著改善术前靶血管血流和术前、后心肌灌注.     

氧化低密度脂蛋白和血管内超声预测介入术后支架内再狭窄

目的探讨氧化低密度脂蛋白(oxidized-low density lipoprotein,ox-LDL)和血管内超声在预测经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后支架内再狭窄的价值。方法2006～2008年,佛山市第一人民医院实施PCI180例,随访患者经冠状动脉造影(coronary angiography,CAG)证实支架内再狭窄28例。PCI术前及随访时以酶联免疫法测定ox-LDL,用血管内超声检测病变血管的外弹力膜面积、斑块面积、最小管腔面积和内膜面积。结果无支架内再狭窄患者PCI前后ox-LDL差异无统计学意义;支架内再狭窄患者ox-LDL在PCI术后升高[(70±18)μg/L比(78±19)μg/L,P<0.05)];支架内再狭窄组与支架内无狭窄组比较,两组外弹力膜面积差异无统计学意义、两组斑块面积分别为(6.8±2.4)mm2和(5.1±1.6)mm2,P<0.05;最小管腔面积分别为(4.7±1.9)mm2和(6.2±2.1)mm2,P<0.05;最小管腔的支架面积分别为(1.95±0.33)mm2和(1.49±0.21)mm2,...     

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.     

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.     

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.