血浆氨基酸浓度与慢性乙型肝炎肝组织病理状态的关系

目的 探讨血浆氨基酸浓度诊断慢性乙型肝炎肝组织病理状态的效能.方法 148例经肝组织病理学检查的慢性乙型肝炎患者入选本研究.血浆氨基酸浓度测定采用Agilent 1100系列高效液相色谱仪,氨基酸标准品及衍生试剂购自Agilent公司.血浆氨基酸浓度诊断肝组织病理状态的效能评价采用ROC曲线法.结果 根据相关分析和方差分析,血浆谷氨酸、丝氨酸、苏氨酸、酪氨酸、蛋氨酸、精氨酸浓度变化可能对肝组织炎症活动度有诊断意义,其诊断轻度炎症(分级≥G2)和中度炎症(分级≥G3)的ROC曲线下面积的95％ CI分别为0.541～0.756、0.512～0.717、0.517～0.719、0.615～0.804、0.535～0.741、0.543～0.756和0.548～0.733、0.635～0.803、0.631～0.801、0.606～0.785、0.523～0.709、0.484～0.671;血浆丝氨酸、酪氨酸浓度可能对肝组织纤维化程度有诊断意义,其诊断显著纤维化(分期≥S2)ROC曲线下面积的95％CI为0.495～0.719、0.477～0.679,诊断严重纤维化(分期≥S3)和肝硬化(分期=S4)ROC曲线下面积的95％CI分别为0.543～0.722、0.548～0.728和0.526～0.733、0.523～0.734.结论 虽然一些血浆氨基酸浓度随肝组织炎症活动度和纤维化程度的增加而出现定向变化,但不能作为诊断慢性乙型肝炎肝组织病理状态的稳定和可靠指标.     

血清铜蓝蛋白水平与慢性乙型肝炎患者临床病理关系的初步研究

目的 探讨慢性乙型肝炎(CHB)患者血清铜蓝蛋白(CP)水平与肝脏炎症活动度分级、纤维化分期的关系,建立肝纤维化分级无创模型并分析其诊断价值.方法 2009年1月至2011年6月于福建医科大学附属第一医院肝病中心确认的CHB患者148例,同步进行肝组织病理学、血清CP及生物化学指标检查.Spearman等级相关分析法判断CP水平与肝脏病理学分级之间的相关性;Logistic回归分析法分析相关指标的诊断意义.构建肝脏纤维化诊断预测模型,受试者工作曲线(ROC)法评价模型的诊断价值.结果 148例CHB患者炎症活动度分级G1、G2、G3、G4的血清CP平均值分别为(212.5±34.9)、(205.5±32.0)、(201.4±37.7)和(172.8±20.4) mg/L,ANOVA分析提示4组炎症活动度分级间CP水平的差异有统计学意义(F=6.309,P＜0.01);纤维化分期S1、S2、S3、S4的血清CP平均水平分别为(217.4±32.3)、(206.0±37.7)、(194.2±29.8)和(179.7±30.4)mg/L,ANOVA分析提示纤维化分期间CP的差异有统计学意义(F=8.608,P＜0.01).Spearman等级相关分析法分析提示,CP与炎症活动度分级(r=-0.316,P＜0.01)以及纤维化分期(r=-0.404,P＜0.01)均呈负相关关系.应用ROC分别建立CP水平对S≥2、S≥3、S=4的诊断曲线,曲线下面积(AUC)分别为0.71、0.70和0.72.经Logistic回归分析,筛选出模型-1(S≥2)、模型-2(S≥3)、模型-3(S=4)组包括CP、甲胎蛋白、胆碱酯酶、PLT、年龄的肝纤维化独立预测因子,最终构建数学模型并计算肝纤维化评分,模型-1、模型-2、模型-3的AUC分别为0.84、0.83和0.87,准确率分别为71.8％、80.3％和79.2％.结论 CHB患者的血清CP水平与肝脏炎症活动度分级、纤维化分期呈负相关关系,随病理分级的增加而呈阶梯状降低.CP水平可作为无创性判断肝脏纤维化状态的一项重要指标,纳入CP而构建的肝纤维化预测模型对CHB肝纤维化肝硬化有较好的诊断价值.     

瞬时弹性成像与实时组织弹性成像评估肝纤维化的比较

目的 对比分析瞬时弹性成像和实时组织弹性成像评估慢性肝病肝纤维化的价值.方法 对92例行肝组织学检查的慢性肝病患者同时行瞬时弹性成像和实时组织弹性成像检查,以肝组织病理学检查结果为金标准,比较瞬时弹性成像和实时组织弹性成像与肝纤维化病理分期的相关系数、诊断肝纤维化的受试者工作特征曲线下面积. 结果 瞬时弹性成像与肝纤维化病理分期的相关系数(r=0.755,95％ CI0.651 ～ 0.831,P=0.000)高于实时组织弹性成像(r=0.481,95％CI0.306 ～ 0.624,P=0.000),Z=3.07,P=0.002.瞬时弹性成像和实时组织弹性成像诊断肝纤维化(S≥2)、肝硬化(S=4)的受试者工作特征曲线下面积分别为0.903和0.740、0.915和0.786,瞬时弹性成像高于实时组织弹性成像(P值分别为0.003和0.020). 结论 瞬时弹性成像诊断慢性肝病肝纤维化效能优于实时组织弹性成像,但后者与二维超声图像融合,具有广泛的应用前景.     

瞬时弹性成像对慢性肝病肝纤维化的诊断价值

目的评价瞬时弹性成像(TE)对慢性肝病肝纤维化的诊断价值。方法分析100例本科就诊的慢性肝病肝纤维化患者,肝组织病理活检确定肝纤维化分期,同时100例患者均行实时组织弹性成像(RTE)与TE检测,比较两者与慢性肝病肝纤维化分期的相关性以及诊断肝纤维化与肝硬化的受试者工作特征曲线(ROC)曲线下面积。结果 TE与肝纤维化病理分期高度相关(r=0.763),RTE与肝纤维化病理分期中度相关(r=0.476),前者相关性显著高于后者(P=0.001);诊断肝纤维化的ROC曲线比较,TE的ROC曲线下面积(0.901)显著高于RTE的曲线下面积(0.738)(P=0.004);诊断肝硬化的ROC曲线比较,TE的曲线下面积(0.923)显著高于RTE的曲线下面积(0.791)(P=0.001)。结论TE较RTE对慢性肝病肝纤维化的诊断效能更高,但由于TE实际操作较RTE要求更高,推广程度低于RTE。     

慢性乙型肝炎肝纤维化患者实时剪切波弹性成像的应用价值分析

目的探讨实时剪切波弹性成像技术(shear wave elastography,S W E)与常规超声检查在评估慢性乙型肝炎患者肝纤维化中的应用价值.方法回顾性分析唐山市传染病医院在2015-08/2017-06收治的慢性乙型肝炎患者87例,分别进行常规超声和S W E检查,以病理穿刺活检结果为金标准,分析常规超声、SWE与肝纤维化病理分期的相关性,评估常规超声、SWE诊断肝纤维化各分期的ROC曲线下面积,比较常规超声与SWE在诊断肝纤维化各分期的诊断效能.结果 (1)常规超声积分在肝纤维化相邻分期之间(S0-S1vs S2,S2 vs S3,S3 vs S4)比较差异无统计学意义(P=0.451,0.639,0.103);但不相邻分期(S0-S1 vs S3,S0-S1vs S4,S2 vs S4)之间常规超声评分比较差异具有统计学意义(P=0.001,0.000,0.000);SWE在不同肝纤维化分期的弹性模量值分别为(S0=5.625 kPa±1.221 kPa,S1=7.172 k Pa±1.818 k Pa,S2=10.295 kPa±3.122kPa,S3=15.541 kPa±4.340 kPa,S4=23.918 kPa±5.697 kPa),肝脏弹性模量在相邻及不相邻分期之间比较差异均具有统计学意义(P均0.05);(2)Spearman相关性分析显示,常规超声积分、SWE弹性模量值与肝纤维化分期之间存在正相关(r=0.529,0.798,P均0.001);SWE弹性模量值与肝纤维化之间相关系数高于常规超声积分;(3)常规超声积分在诊断肝纤维化S≥2、S≥3和S4期的ROC曲线下面积分别为0.766,0.891,0.764;SWE值在诊断肝纤维化S≥2、S≥3和S4期的ROC曲线下面积分别为0.941,0.948,0.952;SWE的诊断效能高于常规超声(P0.05).结论相比于常规超声,SWE技术在评估慢性乙型肝炎患者肝纤维化程度方面具有更高的应用价值,可重复性好,具有较高的潜在临床价值.     

实时组织弹性成像技术对慢性乙型肝炎肝纤维化的诊断价值

目的探讨实时组织弹性成像技术(RTE)对慢性乙型肝炎患者肝纤维化程度的诊断价值。方法选取2013年3-8月于首都医科大学附属北京天坛医院和佑安医院就诊的86例慢性乙型肝炎患者,按照肝纤维化病理分期分组,依次进行RTE检查、血清生化学指标检测、肝穿刺活组织检查,计算肝纤维化指数(LFI)和APRI指数。各纤维化分期之间的比较采用单因素方差分析,进一步两两比较采用LSD-t检验,LFI与肝纤维化病理分期的相关性检验采用Spearman相关分析。计算LFI诊断肝纤维化的灵敏度、特异度,分别以肝纤维化S≥2(显著肝纤维化)、S≥4(早期肝硬化)为判断阳性的标准绘制受试者工作特征曲线(ROC),并与APRI指数进行比较。结果除S0与S1之间LFI差异无统计学意义(P=0.298),其余各期差异均有统计学意义(P=0.000)。LFI与病理分期有明显相关性,相关系数r=0.831,P0.001。LFI诊断显著肝纤维化和早期肝硬化的曲线下面积分别为0.873(P0.001)、0.923(P=0.002),诊断阈值分别为2.74、3.61,敏感度、特异度分别为0.766、0.872和0.833、0.878,明显优于APRI指数。结论 RTE技术对显著肝纤维化和早期肝硬化有较高的诊断价值,是慢性乙型肝炎肝纤维化无创诊断的一种重要方法。     

血清HBsAg和HBV DNA预测慢性乙型肝炎肝组织病理状态的评价

目的 探讨血清乙型肝炎表面抗原（HBsAg）水平和乙型肝炎病毒DNA（HBV DNA）载量预测慢性乙型肝炎（CHB）肝组织炎症活动度和纤维化程度的效能.方法 472例经肝组织活检的CHB患者入选本研究,其中HBeAg阳性279例,HBeAg阴性193例.肝组织病理学分级≥G2、≥G3、≥G4分别被定义为显著炎症、严重炎症和进展期炎症,病理学分期≥S2、≥S3和≥S4分别被定义为显著纤维化、严重纤维化和进展期纤维化.结果 HBeAg阳性患者血清HBsAg在G1与G3、G2与G3、S1与S4、S2与S4、S3与S4之间的差异均有统计学意义（P均＜0.05）,血清HBV DNA载量在S1与S4、S2与S4、S3与S4之间的差异均有统计学意义（P均＜0.05）;HBeAg阴性患者血清HBsAg在肝组织不同病理学分级和分期之间的差异无统计学意义（P＞0.05）,血清HBV DNA载量在G1与G3、S1与S2、S1与S3、S1与S4之间的差异均有统计学意义（P均＜0.05）.HBeAg阳性患者血清HBsAg诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.711 （95％ CI：0.647～0.775）和0.765（95％ CI：0.707～0.823）,血清HBV DNA诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.589（95％ CI：0.519 ～0.659）和0.700（95％ CI：0.632 ～0.769）;HBeAg阴性患者血清HBV DNA诊断非显著炎症和非显著纤维化的ROC曲线下面积分别为0.644（95％ CI：0.565 ～0.723）和0.684（95％ CI：0.606～0.761）.结论 血清HBsAg对HBeAg阳性患者肝组织严重炎症和进展期纤维化有一定的预测价值;血清HBV DNA对HBeAg阳性患者肝组织严重炎症和进展期纤维化和对HBeAg阴性患者肝组织非显著炎症和非显著纤维化有一定的预测价值.     

剪切波弹性成像评估慢性乙型肝炎肝纤维化的价值及影响因素

目的探讨剪切波弹性成像(SWE)评估慢性乙型肝炎(CHB)肝纤维化的诊断效能及影响因素。方法收集2016年1月-2017年9月于中国医科大学附属盛京医院就诊的CHB患者147例,所有患者均行剪切波弹性成像(SWE)检查,SWE检查之后1周内均进行肝穿刺活组织检查。同时收集患者的一般资料及血清学检测结果。不服从正态分布的计量资料组间比较采用MannWhitney U检验;计数资料组间比较采用χ~2检验。绘制受试者工作特征曲线(ROC曲线)评估诊断效能,logistic回归模型分析影响SWE诊断肝纤维化分期准确度的因素。结果以肝组织学诊断肝纤维化分期为标准,SWE诊断肝纤维化≥F1期、≥F2期、≥F3期和≥F4期的ROC曲线下面积分别为0. 824、0. 880、0. 914和0. 986,最佳诊断界值分别为6. 1 k Pa、7. 0 k Pa、8. 1 kPa、10. 0 k Pa,敏感度分别为91. 0%、91. 7%、87. 0%、88. 9%,特异度分别为66. 0%、82. 8%、66. 0%、94. 9%,阳性预测值分别为85. 0%、78. 6%、48. 3%、53. 3%,阴性预测值分别为77. 5%、93. 5%、97. 2%、99. 2%。根据肝穿刺活组织检查结果,147例患者中SWE诊断准确的有94例,不准确者有53例,ALT、AST、肝脏炎症分级在2组间比较差异有统计学意义(Z值分别为-4. 211、-4. 649、-3. 513,P值均0. 01)。肝脏炎症分级是影响SWE诊断肝纤维化分期诊断准确性的独立影响因素[比值比(OR)=0. 552,95%可信区间(95%CI):0. 317~0. 963,P=0. 028],仅在肝纤维化分期为F0期(OR=1. 809,95%CI:2. 305~51. 195)及F2期(OR=1. 345,95%CI:1. 037~13. 647)时肝脏炎症分级对SWE诊断肝纤维化分期的影响明显。结论 SWE测量肝脏弹性值评估肝纤维化分期有良好的诊断效能,评估肝纤维化分期准确性受肝脏炎症分级影响。     

瞬时弹性成像对HIV合并HCV感染者肝纤维化的诊断效能

目的探讨瞬时弹性成像对HIV合并HCV感染者肝纤维化分期的诊断效能。方法选取2013年1月-2018年12月在新疆维吾尔自治区第六人民医院住院的HIV合并HCV感染者,采集所有患者的血常规、肝功能、肾功能、凝血、肝纤维化相关血生化、HIV及HCV病毒载量等指标,计算血清学无创模型(APRI及FIB-4),并且所有患者均接受肝组织病理学检查,活检前3 d内进行瞬时弹性成像检测,结果以肝硬度值(LSM)表示。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H检验,Spearman分析LSM、APRI、FIB-4及肝纤维化相关血生化指标、HCV RNA定量与肝活检纤维化分期的相关性,应用受试者工作特征曲线(ROC曲线)评价LSM对于合并感染者肝纤维化分期的诊断效能,确定其诊断界值。结果共纳入76例肝活检并确诊的HIV合并HCV感染者。相关性分析显示LSM与肝纤维化分期相关性最好(r=0.526,P0.001),优于APRI (r=0.403,P0.001)及FIB-4(r=0.441,P0.001),而肝纤维化相关血生化指标中,仅有Ⅳ型胶原与肝纤维化分期相关(r=0.339,P0.05),而HCV RNA定量与肝纤维化分期无相关性。且对于显著肝纤维化阶段,LSM诊断S2、S3和S4的ROC曲线下面积分别为0.809、0.929和0.906,最佳诊断界值分别为11.6、12.7和14.5 kPa。结论瞬时弹性成像能够较准确的诊断HIV合并HCV感染者肝纤维化分期,在避免肝活检的条件下,对于抗病毒治疗方案的制订及肝纤维化进展的判断提供更加可靠的依据,具有较好的临床应用价值。     

门静脉右支前间隙行磁共振改良测量对肝纤维化和肝硬化的诊断效果

目的探究门静脉右支前间隙行磁共振改良测量对肝纤维化和肝硬化的诊断效果,旨在为临床诊断肝纤维化和肝硬化提供相应的经验。方法选取2016年12月至2018年1月期间在我院接受治疗的病理肝穿刺活检且行MRI检查的患者106例,按照《病毒性肝炎防治方案》将患者分期,将S0期患者作为对照组,S1期-S4期的患者作为实验组,肝硬化患者作为肝硬化组。受试者均进行常规病理穿刺检查及MRI检查,比较三组患者门静脉右支前间隙数据,采用Spearman等级分析门静脉右支前间隙与肝纤维化病理分级的相关性,并采用ROC曲线分析门静脉右支前间隙行磁共振改良测量对肝纤维化和肝硬化的诊断效能。结果随着肝纤维化程度逐渐增加门静脉右支前间隙逐渐加宽,数据差异具有统计学意义(P0.05);S≥3期增宽较S1、S2期更加显著数据差异具有统计学意义;采用Spearman等级分析门静脉右支前间隙与肝纤维化病理分级的相关性,结果显示:门静脉右支前间隙与肝纤维化病理分级成正相关(r=0.736,P0.05)。ROC曲线分析显示:诊断肝纤维化S≥1期、S≥2期的敏感性较低;当门静脉右支前间隙诊断宽度为0.8 cm时,诊断肝纤维化S≥3期效能较高,敏感性为75.8%,特异性为66.7;当门静脉右支前间隙诊断宽度为0.9 cm时,诊断肝纤维化S≥4期效能较高;当门静脉右支前间隙诊断宽度为1.0 cm时,诊断肝硬化效能较高于S≥4期。门静脉右支前间隙S≥3、S≥4期及肝硬化期的ROC曲线下面积分别为0.805、0.822、0.852。结论门静脉右支前间隙与肝纤维化和肝硬化病理分级呈正相关关系,门静脉右支前间隙行磁共振改良测量能够较为准确的诊断S3、S4肝纤维化及肝硬化程度,诊断价值显著。     

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.