岛叶梗死对心脏自主神经功能的影响

岛叶梗死属大脑中动脉供血区的非腔隙性梗死。岛叶梗死,特别是右侧岛叶梗死易造成自主神经功能紊乱,引起心电图波形改变、心律失常、心肌酶水平升高和心率变异性降低,甚至脑源性猝死。     

急性大脑中动脉供血区卒中时的岛叶皮质梗死

岛叶梗死是大脑中动脉(middle cerebral artery,MCA)供血区卒中的一种早期CT征象,可能影响心血管自主功能。为了确定MCA供血区梗死时的岛叶受累情况及其与MCA供血区其他部分梗死、卒中严重程度和临床有关的心血管病的关系,新西兰克赖斯特彻奇医学和健康科学学院的Fink等于1997年8月1日—2000年6月30日进行了一项病例系列研究。其结果发表在最近的Arch Neurol上。研究共纳入连续150例非腔隙性MCA供血区卒中病例,均在卒中发病48h内行MRI检查。主要转归指标为岛叶梗死与国立卫生研究院卒中量表(National Institutes of Health Stroke…     

不同部位急性脑梗死早期心电图改变的临床意义

目的探讨急性脑梗死患者早期心电图改变的临床意义。方法分析304例急性脑梗死患者的心电图资料。结果①304例患者中发生早期心电图异常占64．47％，表现为ST-T改变、窦性心律失常、Q-T间期延长、起搏点异常和传导异常。②岛叶梗死组早期心电图异常显著多于非岛叶梗死组（81．97％、52．75％，P〈0．01）。⑧中、重型患者在心电图异常组显著多于无心电图异常组（96例、5例，P〈0．01）．岛叶梗死组显著多于非岛叶梗死组（68例、28例，P〈0．01）。④心电图异常的岛叶梗死组死亡率显著高于非岛叶梗死组（17例、2例，P〈0．05）。结论急性脑梗死早期心电图异常与梗死部位、病情严重程度及预后有关，而岛叶梗死患者的心电图异常发生率高、病情重及预后差。     

颈内动脉重度狭窄或闭塞患者侧支循环对脑梗死的影响

目的 探讨颈内动脉重度狭窄或闭塞患者侧支循环的状况与脑梗死的关系。方法 将脑血管造影发现颈内动脉狭窄〉70％的患者62例（6例闭塞）分为有症状组（41例）和无症状组（21例），根据头部MRI上梗死灶的部位、大小和形状，将梗死灶分为小穿支动脉供血区梗死、大穿支动脉供血区梗死、皮质支动脉供血区梗死、大面积梗死及分水岭区梗死。通过观察Willis环的完整性及其他次级侧支循环途径，分析侧支循环与脑梗死的关系。结果 ①有症状组患者在MRI上均有脑梗死灶，表现为小穿支动脉供血区梗死8例、大穿支动脉供血区梗死6例、分水岭区梗死10例，大、小穿支动脉供血区同时梗死9例、穿支动脉供血区梗死合并分水岭区梗死4例、皮质支动脉供血区梗死2例、大面积梗死2例；在无症状组，有分水岭区梗死1例、穿支动脉供血区梗死合并分水岭区梗死7例，其余13例无梗死灶。②有症状组中，Willis环前、后循环均完整5例、前半循环完整12例、后半循环完整8例、前后循环均不完整16例；无症状组中，Willis环前、后循环均完整14例、前半循环完整4例、后半循环完整2例、前后循环均不完整1例。症状组Willis环的开放程度均低于无症状组，差异有统计学意义（P〈0．01）。③症状组次级侧支代偿——眼动脉、大脑前动脉和大脑后动脉的皮质支侧支代偿分别为3、8和5例，无症状组分别为1、6和3例。两组比较，差异无统计学意义（P〉0．05）。结论 颈内动脉重度狭窄或闭塞患者是否出现脑梗死与Willis环开放的程度有关，可能与次级侧支代偿途径无关。     

小脑梗死与后循环血管病变的关系

目的 探讨MRI所示的小脑梗死灶与DSA发现的后循环血管病变的相关性。方法 回顾性分析27例小脑梗死患者的临床资料。将每一例小脑梗死患者头部MRI发现的梗死灶与DSA所见的后循环病变血管进行对照。结果 小脑梗死位于左侧小脑半球17例，右侧10例。DSA发现大动脉狭窄[包括单纯椎动脉近段（V1）狭窄、V1段狭窄伴颅内段椎动脉狭窄及锁骨下动脉＋头臂干狭窄]17例，与之对应的MRI发现的梗死部位为：责任血管区域性小脑梗死7例，多位于小脑下后动脉（PICA）供血区（5／7）；责任血管区不完全性梗死10例，较多位于小脑上动脉（SCA）供血区（4／10）。分支动脉狭窄8例，其中MRI见责任血管区域性小脑梗死4例，均位于PICA供血区；责任血管区不完全性梗死4例，分布于PICA、SCA及小脑下前动脉供血区。2例DSA后循环动脉未见明显异常，头部MRI见PICA和小脑下前动脉供血区有多发性小梗死灶。结论 小脑梗死的MRI表现与后循环动脉狭窄性病变部位具有相关性。大动脉狭窄的病例中，椎动脉V1段狭窄最常见，其梗死部位多位于PICA供血区。     

脑梗死患者心脏自主神经活性变化与心电图异常的关系

目的 探讨不同部位脑梗死与心脏自主神经活性变化和ECG异常的关系。方法 检测156例急性大脑半球梗死患者和206名正常对照组心率变异性和标准12导联ECG，分析不同部位大脑半球梗死对心脏自主神经活性和ECG的影响。结果 与对照组比较，仅右侧岛叶梗死组心率变异性相邻心搏间期差的均方根(RMSSD)、相邻心搏间期差大于50ms的心搏问期数占心搏问期总数的百分比(PNN50)和高频功率谱(HF)明显降低，心脏副交感神经活性降低；低频功率谱(LF)与高频功率谱的比值(LF／HF)明显升高，心脏交感神经活性增强；腔隙性脑梗死组、非岛叶梗死组和左侧岛叶梗死组的心率变异性各项指标均无明显差异；右侧岛叶梗死患者快速心律失常和QTc延长发生率显著增加．左侧岛叶脑梗死患者srr段上升或下降显著增加；快速心律失常组RMSSD、PNN50和HF明显低于非快速心律失常组．LF／HF则明显高于非快速心律失常组。结论 影响脑梗死患者心脏自主神经活性和ECG的主要病变部位为岛叶。     

磁共振弥散加权成像定位氢质子波谱对大脑中动脉供血区超急性期脑梗死的诊断价值

大脑中动脉供血区主干栓塞引起的超急性期脑梗死具有很高的致残率和死亡率,常规CT很难诊断6 h以内的早期脑梗死,本文通过60例大脑中动脉(MCA)供血区超急性期脑梗死的磁共振弥散加权成像(DWI)及氢质子波谱(1H-MRS)分析,旨在寻求诊断超急性脑梗死的有效方法.     

脑梗死患者心电图与血浆肌酸激酶-同工酶活性变化

目的探讨不同部位大脑半球脑梗死患者心电图与血浆肌酸激酶-同工酶(CK-MB)活性的变化.方法检测156例首发急性大脑半球脑梗死患者的心电图和血浆CK-MB活性,分析比较不同部位大脑半球梗死患者的心电图和血浆CK-MB活性变化.结果右侧岛叶脑梗死患者快速心律失常和QTc延长发生率显著增加,左侧岛叶脑梗死患者ST段上升或下降显著增加,其他各种心电图改变各组间无明显区别.血浆CK-MB活性升高亦主要见于岛叶梗死患者,血浆CK-MB活性升高者心电图异常发生率明显增加,预后更差.结论造成心电图异常和血浆CK-MB活性升高的大脑半球脑梗死部位主要是岛叶,对影响到岛叶的脑硬死患者应加强心肌保护和心脏监护.     

进展性脑卒中的临床与影像学研究

目的探讨进展性脑卒中(SIP)发病的相关因素。方法回顾性分析入住我院的SIP患者65例(SIP组),脑梗死患者65例(对照组),对两组患者一般临床资料和头颅CT、MRI进行对比分析。结果 SIP组患者入院前和入院后出现发热者32例(49.2%),对照组11例(16.9%);SIP组患者脉压差<30 mm Hg(1 mm Hg=0.1 33 kPa)者22例(33.8%),对照组5例(7.7%);SIP组患者高血糖43例(66.2%),对照组9例(13.9%),两组比较差异有统计学意义(P<0.01)。SIP组患者头颅CT或MRI检查早期显示病灶者42例(64.6%),大脑中动脉供血区梗死面积>33%者22例,分水岭梗死10例,脑干梗死5例;早期未显示病灶而大脑中动脉呈高密度影8例(12.3%)。对照组早期显示病灶者26例(40.0%),大脑中动脉供血区梗死面积>33%者1例,分水岭梗死2例,脑干梗死1例。SIP组患者大脑中动脉供血区梗死面积>33%、分水岭和脑干梗死以及大脑中动脉高密度影与对照组比较,差异有统计学意义(P<0.01)。结论发热、高血糖、低脉压差、大脑中动脉高密度影、大脑中动脉供血区梗死面积>33%、脑干及分水岭梗死是SIP发病的主要相关因素。SIP是多种因素、多种机制共同作用的结果。     

急性脑梗死患者的动态心电图异常

目的 了解急性脑梗死患者心电图复极改变和心律失常情况及其与岛叶病变的关系。方法 检测７４例急性脑梗死患者和３９例对照的２４小时动态心电图，分析其心电图复极改变和心律失常。结果 右侧大脑半球岛叶梗死患者急性期室上性快速心律失常和房颤发生率明显增高；左侧大脑半球岛叶梗死患者急性期心电图ＳＴ段降低发生率明显增高。结论 左侧和右侧大脑半球梗死对心脏的影响不同，岛叶病变在其中起着主要作用。     

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.