长、短节段Barrett食管胃镜表现与病理特征对比分析

目的 探讨长、短节段Barrett食管胃镜表现和病理特征的异同.方法 回顾分析128例经胃镜和病理学诊断确诊的Barrett食管,其中长节段Barrett食管（LSBE）40例,短节段Barrett食管（SSBE）88例,重点分析两者在年龄分布、性别构成、胃镜表现及病理诊断的异同点.数据行t检验及u检验.结果LSBE组与SSBE组在年龄分布、性别构成上无差异（P＞0.05）.胃镜下LSBE组以全周型最多见,占62.5%;SSBE组以岛型最多见,占85.2%.LSBE组特异型肠上皮化生的发生率比SSBE组明显增高,差异有统计学意义（47.5%比14.8%,P＜0.01）.在特异型肠上皮化生中,LSBE组轻、中、重度不典型增生的发生率（15.0%,12.5%,5.0%）较SSBE组（4.5%,3.4%,0.0%）高,差异也具有统计学意义（P值均＜0.05）.结论 LSBE较SSBE更易发生不典型增生,应充分认识胃镜表现结合病理诊断的重要性。     

Distinction between short-segment Barrett＇s esophageal and cardiac intestinal metaplasia

AIM: To investigate the roles of mucin histochemistry, cytokeratin 7/20 (CK7/20) immunoreactivity, clinical characteristics and endoscopy to distinguish short-segment Barrett's esophageal (SSBE) from cardiac intestinal metaplasia (CIM). METHODS: High iron diamine/Alcian blue (HID/AB) mucin-histochemical staining and immunohistochemical staining were used to classify intestinal metaplasia (IM) and to determine CK7/20 immunoreactivity pattern in SSBE and CIM, respectively, and these results were compared with endoscopical diagnosis and the positive rate of gastroesophageal reflux disease (GERD) symptoms and H pylori infection. Long-segment Barrett' s esophageal and IM of gastric antrum were designed as control. RESULTS: The prevalence of type Ⅲ IM was significantly higher in SSBE than in CIM (63.33% vs 23.08%, P<0.005). The CK7/20 immunoreactivity in SSBE showed mainly Barrett's pattern (76.66%), and the GERD symptoms in most cases which showed Barrett' s pattern were positive, whereas H pylori infection was negative. However, the CK7/20 immunoreactivity in CIM was gastric pattern preponderantly (61.54%), but there were 23.08% cases that showed Barrett's pattern. H pylori infection in all cases which showed gastric pattern was significantly higher than those which showed Barrett' s pattern (63.83% vs 19.30%, P<0.005), whereas the GERD symptoms in gastric pattern were significantly lower than that in Barrett's pattern (21.28% vs 85.96%, P<0.005). CONCLUSION: Distinction of SSBE from CIM should not be based on a single method; however, the combination of clinical characteristics, histology, mucin histochemistry, CK7/20 immunoreactivity, and endoscopic biopsy should be applied. Type Ⅲ IM, presence of GERD symptoms, and Barrett's CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-type Ⅲ IM, positive H pylori infection, and gastric CK7/20 immunoreactivity pattern may imply CIM,     

Barrett食管临床及内镜特点与病理关系分析

目的分析Barrett食管（Barrett’s esophagus,BE）临床症状、镜下表现及病理特点,并对BE黏膜发生肠上皮化生（IM）及异型增生的相关因素作初步探讨。方法回顾分析经胃镜下诊断的547例BE患者的临床和镜下特点,其中经病理确诊59例,分析其临床资料、胃镜表现、病理类型与IM及异型增生的关系。结果BE患者以男性居多,随年龄增长有增多趋势。部分患者存在不同程度的胃食管反流症状（GERD）,少数患者镜下有反流性食管炎（RE）表现。黏膜形态以岛状型多见,柱状上皮长度以短段为主。病理类型以胃底型及贲门型多见,显著高于特殊肠化生型。肠化生型BE上皮异型增生发病率显著高于另外两种病理类型。IM及异型增生在两性别间的发病率无统计学差异,30岁以上发病率显著高于30岁以下组。长段BE的IM及异型增生发生率高于短段BE,全周型及舌型发生率高于岛状型,但均无显著性差异。结论BE多发于男性、年长患者,是独立于RE及GERD的疾病。BE镜下以短段、岛状型多见。肠上皮化生少见,但此种类型的异型增生率高,是癌变的危险因素,需提高其检出率。     

贲门癌癌旁肠上皮化生及各亚型的表达及意义

采用阿利新兰-雪夫试剂染色法和高铁二胺-阿利新兰染色法研究195例贲门癌(GCA)癌旁肠上皮化生(IM)及各亚型的表达情况.结果 GCA癌旁IM的检出率为38%,其中完全结肠型27例,多于另外三型(P<0.05),4型IM的检出率有统计学差异(P<0.05).完全结肠型IM表达阳性率与有无淋巴结转移、浸润程度、分化程度之间有统计学差异(P<0.05).完全小肠型IM表达阳性率与TNM分期和临床早中晚期之间差异有统计学意义(P<0.05).结论 GCA癌旁IM以完全型为主,可能是贲门癌前病变的独特组织学类型.完全结肠型IM的表达可能与GCA的发展、浸润和转移相关;完全小肠型IM的表达与GCA的癌变过程相关.     

幽门螺杆菌长期感染对胃粘膜的远期影响——10年随防研究

目的研究Hp长期感染对胃粘膜病变的转归的影响.方法随防了62例10年前Hp感染患者,并分析对比10年前后Hp感染情况、胃镜和病理组织学变化.结果①63例患者16例(25.4%)Hp转阴,47例(74.6%)Hp持续阳性.②Hp持续阴性者10年前后消化性溃疡(PU)的发生率分别为29.78%和53.19%(P＜0.05),Hp转阴者10年前后消化性溃疡(PU)的发生率分别为68.8%和12.5%(P＜0.05)③Hp持续阳性者10年前后慢性炎症严重程度积分分别为1.77±0.43和2.13±0.34(P＜0.01),肠上皮化生(IM)严重程度积分分别为1.13±0.35和1.63±0.52(P＜0.05);Hp转阴者10年前后慢性炎症严重程度积分分别为1.81±0.40和1.31±0.48(P＜0.01),肠上皮化生(IM)严重程度积分分别为1.6±0.55和1.4±0.59(P＜0.05);Hp持续阳性者10年前后胃粘膜糜烂的发生分别为17.02%和38.29%(P＜0.05),IM的发生分别为17.02%和44.68%(P＜0.01);Hp转阴者10年前后IM的发生均为31.25%,胃粘膜糜烂10年后完全消失.结论根除Hp不仅能减轻胃粘膜的炎症程度,而且能阻止肠化的发生和发展.     

BaHett's食管的肠上皮化生研究

目的探讨影响Barrett's食管(Barrett'sesophagus,BE)粘膜中肠上皮化生(intestinalmetaplasia,IM)发生的因素.方法应用胃镜下和组织学染色方法诊断IM,并比较36例存在IM的BE患者与11例不伴有IM的BE患者在年龄、胃镜下表现及食管运动功能方面的特点.结果BE患者的年龄、胃镜下BE粘膜的长度及形态,均与IM的发生率有关(P<0.05);但食管炎的程度及食管运动功能与IM的发生率无关(P>0.05).结论年龄在30岁以上、胃镜下舌型BE及长度3.5em以上与IM的发生率增加,可作为判断BE预后及筛选随访的临床参考指标;食管运动功能障碍在BE发生肠上皮化生的过程中可能不起主要作用.     

Barrett＇s食管的肠上皮化生研究

目的探讨影响Barrett＇s食管(Barrett＇sesophagus，BE)粘膜中肠上皮化生(intestinalmetaplasia，IM)发生的因素。方法应用胃镜下和组织学染色方法诊断IM，并比较36例存在IM的BE患者与11例不伴有IM的BE患者在年龄、胃镜下表现及食管运动功能方面的特点。结果BE患者的年龄、胃镜下BE粘膜的长度及形态，均与IM的发生率有关(P<0．05)；但食管炎的程度及食管运动功能与IM的发生率无关(P>0．05)。结论年龄在30岁以上、胃镜下舌型BE及长度3．5em以上与IM的发生率增加，可作为判断BE预后及筛选随访的临床参考指标；食管运动功能障碍在BE发生肠上皮化生的过程中可能不起主要作用。     

贲门肠上皮化生组织中DAS-1蛋白表达与贲门癌的相关性研究

目的 探讨贲门肠上皮化生(IM)组织中DSA-1表达与贲门癌(GCA)发生的相关性.方法 采用免疫组化法分析65例GCA患者癌组织和距癌组织2 cm贲门IM组织、15例门诊患者贲门(齿状线下2 cm内)IM组织及25例门诊患者贲门炎性组织检测DAS-1蛋白表达.结果 GCA患者贲门IM组织中Ⅲ型占55.4%(36/65),显著高于门诊患者的13.3%(2/15,P<0.01).DAS-1蛋白在GCA癌组织中的表达率为78.5%(51/65),显著高于贲门IM组织[38.8%(30/80),P<0.01].从Ⅰ～Ⅲ型贲门IM组织中,DAS-1蛋白的表达率呈逐渐递增趋势,其中Ⅲ型为71.1%,显著高于Ⅰ型(0%,P<0.01).结论 DAS-1过表达的Ⅲ型贲门IM与GCA的关系密切,可能是GCA癌前病变的重要因素.     

幽门螺杆菌长期感染对胃粘膜的影响

目的为了研究Hp长期感染对胃粘膜病变转归的影响.方法随防了63例10年前Hp感染患者,并分析对比10年前后Hp感染情况、胃镜和病理组织学变化.结果①63例患者中16例(25.4%)Hp转阴,47例(74.6%)Hp持续阳性.②Hp持续阳性者10年前后消化性溃疡(PU)的发生率分别为14例(29.78%)和25例(53.19%)(P＜0.05),Hp转阴者10年前后消化性溃疡(PU)的发生率分别为11例(68.8%)和2例(12.5%)(P＜0.05).③Hp持续阳性者10年前后慢性炎症严重程度积分分别为1.77±0.43和2.13±0.34(P＜0.01),肠上皮化生(IM)严重程度积分分别为1.13±0.35和1.63±0.52(P＜0.05);Hp转阴者10年前后慢性炎症严重程度积分分别为1.81±0.40和1.31±0.48(P＜0.01),肠上皮化生(IM)严重程度积分分别为1.6±0.55和1.4±0.59(P＞0.05);Hp持续阳性者10年前后胃粘膜糜烂的发生分别为8例(17.02%)和18例(38.29%)(P＜0.05),IM的发生分别为8例(17.02%)和21例(44.68%)(P＜0.01);Hp转阴者10年前后IM的发生均为5例(31.25%),胃粘膜糜烂10年后完全消失.结论Hp持续感染可增加消化性溃疡的发生机率,加剧胃粘膜的炎症程度,并促进肠化的形成和发展,根除Hp不仅能减轻胃粘膜的炎症程度,而且能阻止肠化的发生和发展.     

Barrett′s食管(BE)研究进展

Batter’s食管是指食管下段正常复层鳞状上皮被化生的单层柱状上皮所取代的一种病理现象。如受累长度 >3cm称为长段BE(Short segmentBarrett′sesopha gus ,LSBE) ,<3cm称为短段BE(Long segmentBarrett′sesophagus,SSBE)。BE是食管腺癌和部分贲门癌的癌前病变之一 ,近年来Barr     

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.