腰围是代谢综合征最主要的危险成分

目的在代谢综合征(MS)多种成分中,试图发现其中最主要的成分,验证腰围预测中华医学会糖尿病学分会(CDS)建议的MS标准的临床价值。方法收集163例研究对象,以CDS建议的MS为标准,MS患者80例,非MS患者83例,比较MS及非MS患者年龄、腰围、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C),Logistic回归分析预测腰围对MS的危险性,分别建立男性及女性腰围对MS的ROC曲线评价系统,计算ROC曲线下面积,确定腰围最佳诊断界定值,得出灵敏度及特异度。结果MS患者的年龄、腰围、BMI、SBP、DBP、FBG、TG、1/HDL-C均大于非MS患者;控制年龄、吸烟、糖尿病家族史、高血压家族史后,Logistic回归分析示腰围是MS最主要危险因素;男性ROC曲线下面积0.92,腰围界定值为89.5cm时,灵敏度为0.84,特异度为0.93。女性ROC曲线下面积0.93,腰围界定值为80.8cm时,灵敏度为0.97,特异度为0.81;研究发现,吸烟也是MS的危险成分,现仍吸烟者MS的风险是从未吸烟者的6.88倍,曾吸烟者是从未吸烟者的3.96倍。结论证实高腰围是MS最主要危险因素,是预测CDS建议MS标准的可靠指标.吸烟也是MS的危险成分。     

健康体检人群脉搏波传导速度的影响因素分析

目的了解健康体检人群肱踝脉搏波传导速度(ba PWV)的影响因素。方法选取2011年3月~2012年3在武警总医院健康医学中心体检的1579例体检者,检测其血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG),同时测定体质指数(BMI)、收缩压(SBP)、收缩压(DBP)。采用动脉硬化测定仪测定双侧肢体的ba PWV,并以ba PWV≥14 m/s为动脉僵硬度增高。采用多因素Logistic回归分析确定影响动脉弹性的危险因素,采用ROC曲线判断相关影响因素对ba PWV的预测价值。结果 BMI、TG、TC、LDL-C、SBP、DBP、FBG、年龄在ba PWV正常组及升高组有显著差别(P均0.01);多因素Logistic分析显示,年龄、SBP、TG、BMI为ba PWV的独立影响因素(P均0.01);通过ROC曲线分析,AUC曲线下面积最高的为SBP,为0.81,SBP切点选择在135mm Hg时,敏感性为64%,特异性为81%。结论年龄、SBP、TG、BMI为ba PWV的独立影响因素;收缩压对ba PWV最有预测价值。     

青少年腰围与代谢综合征相关性分析

目的 探讨青少年腰围与代谢综合征(MS)之间的关系.方法 选取2006年河北省秦皇岛市流行病学调查中检出的18岁腹型肥胖青少年49例,随机选取同期18岁腹围正常青少年49名,测量所有入选者的身高、体重、腰围、血压、空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),比较两组MS检出率,分析腰围与MS的关系.结果 腹型肥胖组中MS检出6例(12.2%).腹型肥胖组95.9%存在至少1种MS组分.男女腹型肥胖组青少年体重、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、TG明显升高,HDL-C明显下降.超重肥胖、高血压、高SBP、高DBP、高TG和低HDL-C检出率均明显高于对照组.腰围与BMI(r=0.694)、体重(r=0.878)、SBP(r=0.508)、DBP(r=0.391)、LDL-C(r=0.398)呈显著正相关(P＜0.05).结论 腹型肥胖与MS密切相关,腰围测量有助于青少年MS筛查.     

老年代谢综合征人群血尿酸水平及影响因素相关分析

目的探讨老年代谢综合征(MS)合并高尿酸血症的临床特征。方法将258例老年干部人群分为MS高尿酸血症组、MS正常血尿酸组和老年健康对照组,测定其腰围、体重指数(BMI)、血压(SBP,DBP)、血糖(FBG,PBG)、甘油三酯(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血清胰岛素(FINS)、血肌酐(Cr)、血尿酸(UA),游离脂肪酸(FFA),用最小稳态模型计算胰岛素抵抗指数(HOMA-IR)。结果与老年MS正常血尿酸组相比,老年MS高尿酸血症组的BMI、DBP、TG、FINS、HOMA-IR、FFA、Cr水平明显升高,而HDL-C水平降低。血尿酸与FINS、FFA、TG、HOMA-IR、BMI、FBG正相关,与HDL-C负相关。多元逐步回归分析显示:TG、HDL-C、HOMA-IR是老年MS合并高尿酸血症的独立危险因素,结论舒张压、血肌酐、甘油三酯、高密度脂蛋白、胰岛素抵抗与老年MS合并高尿酸血症密切相关,血尿酸水平的升高是代谢综合征的危险因素     

联合测量腰臀围比值(或腰围)和血压可预测代谢综合征

目的代谢综合征(MS)包括多种组成成分,可导致心血管疾病和糖尿病。本研究目的是明确哪一种成分对MS的贡献最大。方法根据1999年WHO的MS工作定义对1994年全国糖尿病防治协作组调查的15 564例年龄≥25岁的中国成人资料进行分析;胰岛素抵抗定义为HOMA-IR指数超过本组糖耐量正常人群(年龄25 ~74岁)的第75百分位数。用logistic逐步回归方法分析MS各组分对MS贡献大小。结果(1)本人群MS患病率为64.35%,标化患病率为59.00%。(2)年龄、性别、收缩压(SBP)、舒张压(DBP)、腰臀围比值(WHR)(或腰围)、体重指数(BMI)与MS独立正相关,相关强度从高至低顺序依次为WHR(或腰围)、SBP、DBP、性别(女>男)、BMI、年龄,这些变量预测本人群MS的一致性达93.8%。WHR、BMI、SBP、DBP预测本人群MS的一致性为90.2%;若以腰围代替WHR,则一致性为86.2%;若去掉BMI,则一致性达86.1%。(3)在其它因素不变时, WHR每增加0.05、腰围每增加5 cm、SBP每增加10mm Hg(1 mm Hg=0.133 kPa)、DBP每增加5 mm Hg、BMI每增加5 kg/m2分别可增加本人群MS风险3.35倍、1.87倍、1.52倍、1.46倍、1.34倍。结论在临床实践中,联合测量腰臀围比值(或腰围)和血压可作为一项快速评估MS的简易指标。     

青少年高血压与代谢综合征的危险因素

目的 探讨青少年高血压与代谢综合征(MS)各组分之间的关系及其危险因素分析.方法 通过分层整群随机抽样,共抽取12～18岁青少年3953人,以12～15岁为青春前期(n=1698),16～18岁为青春期(n=2255),测量身高、体质量、腰围、臀围、血压、空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平.结果 1)总调查人群中高血压患病率为6.2%.2)13～18岁超重肥胖者血压高于体质量正常者(P＜0.05).3)男、女性青春期舒张压(DBP)异常检出率均高于青春期前(P＜0.05),青春期女性收缩压(SBP)异常检出率高于男性(P＜0.05).4)高血压组体质量、体质量指数(BMI)、腰臀比(WHR)、SBP、DBP、FPG、TG及LDL-C均高于正常对照组,HDL-C稍低于对照组(P＜0.05).5)高血压组超重肥胖、高TG、低HDL-C、MS及高血压家族史检出率高于正常对照组(P＜0.05),两组间高FPG、糖尿病家族史检出率差异无统计学意义.6)Logistic多因素回归分析显示,女性高SBP危险性是男性的2.10倍(95% CI为1.47～2.98);年龄每增加1岁,DBP升高的危险性增加1.22倍(95% CI为1.08～1.38);有高血压家族史青少年高SBP的危险性是无家族史的1.64倍(95% CI为1.17～2.30);BMI每增加1 kg/m2,SBP升高的危险性增加1.24倍(95% CI为1.20～1.28),DBP升高的危险性增加1.19倍,(95% CI是1.15～1.23)(P＜0.01).结论 青少年高血压与MS密切相关,家族史、超重肥胖是引发青少年高血压的主要危险因素,要重视青少年心血管疾病的一级预防.     

妊娠期高血压疾病患者妊娠结束后三年慢性高血压的Nomogram预测模型构建

背景妊娠期高血压疾病(HDP)对孕妇的危害不仅限于妊娠期,还可增加妊娠结束后慢性高血压(CH)发生风险,而构建HDP患者妊娠结束后CH的Nomogram预测模型有助于早期筛查、识别CH高风险孕妇。目的构建HDP患者妊娠结束后3年CH的Nomogram预测模型。方法选取2015年1月—2017年1月在六安市第二人民医院进行产前检查、分娩的HDP孕妇324例,均于妊娠结束后随访3年。随访期间主动退出22例,因身体原因退出18例,因失去联系或临床数据不完整剔除10例,最终纳入274例,其中妊娠结束后3年发生CH 68例(CH组)、未发生CH 206例(非CH组)。比较两组患者一般资料(包括年龄、受教育程度、初产妇比例、吸烟情况、高血压家族史)、妊娠前临床资料〔包括体质指数(BMI)、腰围、臀围、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、C反应蛋白(CRP)〕、妊娠期临床资料〔包括最高BMI、最高SBP、最高DBP、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)〕、妊娠结束后6周临床资料(包括BMI、最高SBP、最高DBP);绘制ROC曲线以获取连续变量预测HDP患者妊娠结束后3年CH的最佳截断值;采用多因素Logistic回归分析分析HDP患者妊娠结束后3年CH的影响因素,并构建Nomogram预测模型。结果本研究274例HDP患者妊娠结束后3年发生CH 68例,CH发生率为24.8%。两组患者初产妇比例,妊娠前DBP、FBG,妊娠期最高DBP、TG、TC、LDL、HDL,妊娠结束后6周最高DBP比较,差异无统计学意义(P>0.05);CH组患者年龄、吸烟率、有高血压家族史者所占比例,妊娠前BMI、SBP、CRP,妊娠期最高BMI、最高SBP,妊娠结束后6周BMI、最高SBP高于非CH组,本科及以上学历者所占比例低于非CH组,妊娠前腰围、臀围大于非CH组(P<0.05)。ROC曲线显示,年龄,妊娠前BMI、腰围、臀围、SBP、CRP,妊娠期最高BMI、最高SBP,妊娠结束后6周BMI、最高SBP预测HDP患者妊娠结束后3年CH的最佳截断值分别为28岁、23.0 kg/m2、89.2 cm、98.5 cm、129 mm Hg、1.9 mg/L、26.4 kg/m2、142 mm Hg、24.4 kg/m2、130 mm Hg。多因素Logistic回归分析结果显示,年龄>28岁、本科及以上学历、高血压家族史、妊娠前SBP>129 mm Hg、妊娠期最高BMI>26.4 kg/m2、妊娠结束后6周BMI>24.4 kg/m2是HDP患者妊娠结束后3年CH的独立影响因素(P<0.05)。将HDP患者妊娠结束后3年CH的独立影响因素作为指标构建Nomogram预测模型,内部数据验证结果显示,其一致性指数(CI)为0.811〔95%CI(0.688,0.901)〕。结论本研究成功构建了HDP患者妊娠结束后3年CH的Nomogram预测模型,有助于早期筛查CH高风险HDP患者并有针对性地进行干预。     

高尿酸血症与冠心病及危险因素的相关性分析

目的 通过对高尿酸血症与冠心病及危险因素的横断面研究,分析高尿酸血症与冠心病及危险因素的相关性.方法 入选太原市中心医院心内科符合标准患者150例,依据尿酸水平分为高尿酸血症组(80例)及非高尿酸血症组(70例).记录年龄、性别、身高、体重、腰围、臀围、血压及血生化指标等基本资料,通过横断面研究高尿酸血症与冠心病及危险因素的关系.结果 高尿酸血症组与非高尿酸血症组比较,在吸烟年限、收缩压(SBP)、舒张压(DBP)、腰围、腰臀比、体重指数(BMI)、三酰甘油、总胆固醇、空腹血糖等均有统计学意义(P＜0.05).高尿酸与冠心病间存在相关性.针对高尿酸血症危险因素空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL - C)、BMI以及代谢综合征(MS)四者进行多元Logistic回归分析,并校正年龄、性别、吸烟、饮酒后分析表明,MS(校正前OR=1.110,校正后OR=1.111,P＜0.001)及FBG(校正前OR=2.586,校正后OR=2.685,P＜0.001)是高尿酸血症的独立危险因素,而LDL -C(校正前OR=0.638,校正后OR=0.642,P＜0.05)则是高尿酸血症的保护因素.BMI的Logistic回归分析无统计学意义(校正前OR=0.795,校正后OR=0.757).结论 高尿酸血症与冠心病存在一定的协同作用;在高尿酸血症的危险因素中MS、FBG是高尿酸血症的独立危险因素,LDL -C是高尿酸血症的保护因素.     

杭州城区居民体质指数与慢性病危险因素的关系

目的调查杭州城区居民体质指数(BMI)与慢性病危险因素的关系,为慢性病的早期预防提供依据。方法分析2005~2006年杭州城区1053例18岁及以上居民体检资料,观察BMI、腰围(WC)水平与慢性疾病相关因素-血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)及与脂质代谢紊乱、糖尿病、高血压检出率的关系。结果该人群男性肥胖及超重分别占15.7%及10.9%,女性肥胖、超重分别占2.3%及7.8%。超重及肥胖组脂质代谢紊乱、糖尿病及高血压检出率明显高于BMI正常组。BMI、WC与TC、TG、SBP、DBP呈显著正相关,而与HDL-C呈显著负相关。WC与FBG呈显著正相关。结论杭州城区居民BMI与慢性病危险因素密切相关,早期预防慢性病,应对BMI>24的人群给予充分关注。     

2型糖尿病患者合并代谢紊乱与血管并发症相关性分析

目的观察2型糖尿病(T2DM)患者合并代谢紊乱发生情况及其与血管并发症的相关性。方法采用2004年中华医学会糖尿病学分会(CDS)关于代谢综合征诊断标准,对230例T2DM患者按合并代谢紊乱多少分为单纯T2DM组(T2DM组,n=60)、T2DM合并1种代谢紊乱组(MS1组,n=97)、T2DM合并2种代谢紊乱组(MS2组,n=50)和T2DM合并3种代谢紊乱组(MS3组,n=23)四组,比较四组患者临床及生化检查指标,观察颈动脉内膜-中层增厚(C-IMT增厚)、糖尿病视网膜病变(DR)及糖尿病肾病(DN)发生率,采用多因素Logistic回归模型分析血管并发症与合并代谢紊乱关系。结果 T2DM合并1种代谢紊乱患者占42.2%、合并2种代谢紊乱患者占21.7%、合并3种代谢紊乱患者占10.0%。与T2DM组患者比较,合并其他代谢紊乱组患者的体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)、空腹血糖(FBG)、餐后2小时血糖(2hPG)、血尿酸(UA)、三酰甘油(TG)及总胆固醇(TC)水平显著增高,差异均有统计学意义(P0.05)。与MS1组患者比较,MS2组患者BMI、SBP、DBP、FBG、2hPG、UA、TG、TC及低密度脂蛋白胆固醇(LDL-C)水平增高,高密度脂蛋白胆固醇(HDL-C)水平降低,差异有统计学意义(P0.01);MS3组患者BMI、SBP、DBP、HOMA-IR、FBG、2hPG、UA及TG水平升高,HDL-C水平降低,差异有统计学意义(P0.01)。与MS2组患者比较,MS3组患者SBP、DBP、FBG、2hPG及UA水平升高,差异有统计学意义(P0.01)。随代谢紊乱组份的增加,C-IMT增厚、DR及DN等血管并发症的发生率增加(P0.01)。分别以C-IMT增厚、DR、DN为自变量,以BMI、SBP、DBP、FBG、2hPG、TG及HDL-C为因变量,采用二分类Logistic回归分析,结果显示SBP、DBP及2hPG是C-IMT增厚的独立危险因素;DBP和TG是DR的独立危险因素;SBP和TG是DN的独立危险因素。结论 2型糖尿病合并其他代谢紊乱与C-IMT增厚、DR及DN的发生相关。     

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.