平均容积保障压力支持通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭临床研究

目的探讨平均容积保障压力支持通气(AVAPS)治疗慢性阻塞性肺疾病急性加重(AECOPD)呼吸衰竭患者的疗效及其适应证。方法入选2013年10月至2015年10月入住新疆医科大学第一附属医院的120例AECOPD合并呼吸衰竭患者,随机分入不同通气组;每组再分为轻、重症组患者,观察组间血气指标和疗效指标的变化差异。结果两种模式治疗1,3和7 d时,重症患者AVAPS组与双水平气道正压通气(Bi PAP)组比较,p H值显著上升[(7.330±0.075)对(7.359±0.070),P=0.047]、[(7.334±0.061)对(7.371±0.077),P=0.023]和[(7.332±0.083)对(7.372±0.056),P=0.011],PaCO_2显著下降[(59±14)mm Hg对(48±14)mm Hg,P=0.008]、[(53±12)mm Hg对(42±13)mm Hg,P=0.003]和[(52±14)mm Hg对(38±8)mm Hg,P=0.001]。重症患者AVAPS组与Bi PAP组比较,RR、m MRC、NIV通气时间和住院天数显著降低,差异有统计学意义。结论 AVAPS模式较Bi PAP模式在治疗AECOPD呼吸衰竭重症患者显示出一定的优越性。     

无创正压通气治疗不同病因所致急性呼吸衰竭的疗效与安全性研究

目的:探讨无创正压通气(NPPV)对不同病因所致急性呼吸衰竭的疗效与安全性及影响疗效的因素。方法:采用回顾性分析方法,选择2010年1月至2015年12月,入住北京安贞医院呼吸与危重症医学科重症监护室(RICU)的所有诊断为急性呼吸衰竭,经常规氧疗后症状无好转或加重并给予NPPV治疗的患者,并按引起呼吸衰竭的病因分为慢性阻塞性肺疾病组(COPD组)和非COPD组。收集患者的一般情况,包括性别、年龄、APACHE II评分、HGB及白蛋白,记录使用NPPV前、1h后、2~4h的心率、呼吸频率及血气分析测值(pH,PaO_2,PaCO_2,SaO_2),比较各组患者的再插管率、病死率、住重症监护室(RICU)时间。结果:研究期间,共有252例各种类型的呼吸衰竭患者入住RICU,符合研究纳入标准的患者123例(48.8%),男性69例,女性54例,平均年龄(71.0±11.6)岁。其中COPD组79例,非COPD组44例。COPD组APACHE II评分(20.9±4.4)和PaCO_2(73.4±14.0)mm Hg(1mm Hg=0.133KPa),显著高于非COPD组[分别为(18.4±4.6)和(65.9±14.0)mm Hg],呼吸频率[(21.1±4.5)次/min、心率(88.1±17.4)次/min低于非COPD组(分别为(24.9±7.6)次/min、(95.6±19.5)次/min,P<0.05],两组间平均动脉压、pH值、PaO_2和Sa O2差异无统计学意义。NPPV治疗1h、2~4h后两组的pH、PaCO_2和PaO_2均显著改善,心率和呼吸频率减慢(P<0.05或P<0.01)。COPD组再插管率为5.1%,住院病死率5.1%,均明显低于非COPD组(分别为15.9%和27.3%)(P<0.05或P<0.01)。COPD组的成功率为89.9%,显著高于其他病因组的72.7%(P<0.05)。两组住RICU时间相近(分别为15d vs.16d,P>0.05)。结论:NPPV选择性用于COPD所致急性呼吸衰竭患者,可显著降低再插管率,改善患者的预后,疗效优于非COPD所致急性呼吸衰竭患者,且并发症产生少,安全性较好。     

慢性阻塞性肺疾病合并肺动脉高压患者的临床特征与危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者的临床特征及相关危险因素。方法回顾性分析2015年1月至2016年1月自贡市第四人民医院呼吸科住院COPD患者702例,根据是否并发PH分为PH组279例和无PH组423例,PH组患者根据收缩期肺动脉压(SPAP)又分为轻度PH亚组188例和重度PH亚组91例,分别比较PH组和无PH组以及亚组患者间的体质量指数(BMI)、B型脑钠肽(BNP)、红细胞沉降率(ESR)、红细胞压积(HCT)、C-反应蛋白(CRP)、白蛋白(ALB)、氧合指数(OI)、D-二聚体(D-D)、纤维蛋白原(FIB)、乳酸(LA)、第1秒用力呼气末容积(FEV1)和糖类抗原125(CA125)的差异。利用SPSS 18.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。Pearson相关分析SPAP的影响因素,采用多因素logistic回归分析危险因素。结果PH组患者相比无PH组患者FEV1/预计值[(46.4±16.5)%vs(67.6±15.4)%]和OI值[(226.7±56.9)vs(352.0±49.9)mmHg(1 mmHg=0.133 k Pa)]下降,BNP[(575.9±53.2)vs(297.8±84.8)pg/ml]、CA125[(39.9±14.5)vs(15.8±12.2)U/L]和SPAP[(59.2±16.3)vs(30.4±9.1)mmHg]增高,差异具有统计学意义(P0.05)。重度相比轻度PH组患者FEV1/预计值[(37.4±16.7)%vs(59.8±14.1)%]和OI值[(156.0±80.5)vs(267.7±98.9)mmHg]下降,BNP[(698.0±125.6)vs(495.9±118.2)pg/ml]、D-D[(2.9±1.2)vs(1.3±1.2)mg/L]、FIB[(4.9±1.4)vs(3.7±1.5)g/L]、LA[(3.5±1.8)vs(1.8±1.1)mmol/L]、CA125[(52.8±38.2)vs(32.9±17.5)U/L]和SPAP[(68.3±16.1)vs(55.2±14.3)mmHg]增高,差异具有统计学意义(P0.05)。Pearson相关分析结果表明SPAP与OI(r=-0.459,P=0.021)、FEV1/预计值呈负相关(r=-0.442,P=0.035),与BNP(r=0.507,P=0.012)、CA125(r=0.375,P=0.048)和D-D(r=0.401,P=0.030)呈正相关。多因素logistic回归分析结果表明BNP、CA125、D-D、FEV1/预计值和OI是PH的危险因素。结论 PH是COPD患者常见并发症,检测BNP、CA125、D-D、FEV1/预计值和OI等指标有助于临床诊疗。     

慢性阻塞性肺疾病与动脉粥样硬化的相关性分析

目的:探讨慢性阻塞性肺疾病(COPD)与动脉粥样硬化的相关性。方法:以临床好转期的COPD患者为研究对象,测量肺功能1秒率(FEV1%)、体重指数(BMI)和踝肱指数(ABI),观察COPD患者动脉粥样硬化与体重指数之间的相关性、动脉粥样硬化和肺功能受损严重程度之间的相关性。结果:1共纳入70例COPD患者,平均ABI(1.0±0.2),平均BMI(27.1±5.5)kg/m~2,平均腹围(AC)(98.5±12.6)cm;2合并外周动脉疾病(PAD)的COPD患者的年龄偏大[(70.8±10.7)岁vs(68.8±9.7)岁,P0.05)],体型偏瘦[BMI(25.5±4.8)kg/m~2vs(28.4±6.5)kg/m~2,P0.05],腹围偏小[(91.1±9.8)cm vs(103.8±15.2)cm,P0.01],FEV1%更差[(34%±6%vs 49%±10%,P0.05];亚组分析发现,合并PAD的男性COPD患者较无PAD的COPD男性患者,BMI更小[(25.6±5.8)kg/m~2vs(28.9±6.9)kg/m~2,P0.05],腹围更小[(92.2±16.1)cm vs(105.4±15.8)cm,P0.01]。合并PAD的女性COPD患者较无PAD的COPD女性患者,BMI更小[(24.9±4.7)kg/m~2vs(27.5±6.3)kg/m~2,P0.05],但腹围比较无显著性差异[(88.7±13.1)cm vs(93.2±15.6)cm,P0.05)。结论:合并PAD的COPD患者年龄更大、具有更瘦小的体型和腹围以及进展的肺功能损害。     

慢性阻塞性肺疾病对冠心病患者冠脉粥样硬化的影响

目的 观察慢性阻塞性肺疾病(COPD)对冠心病患者冠状动脉粥样硬化、心脏结构和功能的影响,并探讨其可能机制.方法 对86例冠心病合并COPD的患者和76例单纯冠心病患者行冠状动脉造影,确定冠脉病变严重程度,并行血管内皮舒张功能、心脏结构和功能、血气分析检查.结果 冠心病合并 COPD组较单纯冠心病组冠脉三支血管病变比例升高(70.9% vs 48.7%,P<0.01),冠脉Gensini评分升高(46.36±8.15vs 38.75±7.12,P<0.05),动脉血氧分压下降[(74.56±7.93) mmHg vs (87.52±8.11) mmHg,P<0.01],肱动脉内皮舒张功能明显减弱(0.71%±3.39% vs 7.01%±1.90%,P<0.01),二尖瓣反流量增加[(6.29±4.65) ml vs (4.24±3.83) ml,P<0.05].结论 COPD加速了冠状动脉粥样硬化,预后不良,其机制可能与血管内皮功能下降有关.     

慢性阻塞性肺疾病合并心血管疾病的危险因素及预后

目的 探讨慢性阻塞性肺疾病(COPD)合并心血管疾病(CVD)的危险凶素及预后.方法选取2004年至2009年我院因COPD急性加重住院的患者为研究对象,按是否合并CVD进行分组,所有患者均详细记录病史、体格榆查结果,记录血常规、血脂、血糖、心肌酶等化验及肺功能、心电图、超声心动网等检查.对结果采用SPSS 16.0软件进行分析.结果两组患者在年龄、性别、吸烟史方面差异无统计学意义,COPD+CVD组患者体质量指数(BMI)均值(24.29±4.07)kg/m2,高于COPD组(P=0.011);COPD+CVD组合并高血压、高脂血症、糖尿病的比例与COPD组相比[(64.70%vs 58.24%)、(17.65%vs 9.89%)、(26.47%vs 8.79%)],只有合并糖尿病的比例差异具有统计学意义(P=0.023);COPD+CVD组FEV1/FVC、FEV1%pred(吸入支气管扩张剂后)均值低于COPD组[(46.64±8.10)%vs(50.79±10.94)%、(44.62±9.80)%vs(50.21±13.76)%],差异有统计学意义(P值均<0.05),且COPD+CVD组肺功能Ⅲ～Ⅳ级的比例高于COPD组(76.47%vs 49.50%)(P=0.016);COPD+CVD组患者PaO2低于C()PD组[(67.67±10.31)mm Hg vs(73.74±13.67)mm Hg](P=0.038);COPD+CVD组在与炎症相关的指标如白细胞、中性粒细胞比例、C反应蛋白(CRP)、超敏CRP及纤维蛋白原水平上均高于COPD组(P值均<0.05),而在血脂,血糖水平上的差异无统计学意义(P值均>0.05);COPD+CVD组患者平均住院大数、平均再住院次数、死亡患者比例高于COPD组[(21.12±9.83)d vs(17.75±7.37)d、(1.59±1.67)次vs(O.90±1.17)次、20.59%vs 7.69%],且差异有统计学意义(P值均<0.05).Logistic回归分析表明,BMI、是否合并糖尿病、肺功能、血氧水平及与炎症相关的指标都和COPD合并CVD存在一定相关性,但经多因素Logistic回归分析,只有CRP水平与COPD合并CVD 独立相关(P=O.026).结论传统的CVD危险冈素及肺功能的下降都在COPD合并CVD中起一定的作用,这些作用的机制可能与全身炎症和缺氧等因素有关.合并CVD的COPD患者预后差.

Abstract：

Objective To discussion the risk factors and prognosis of chronic obstructive pulmonary disease (COPD) with cardiovascular disease (CVD). Methods We choose the hospitalized patients diagnosis of AECOPD ( n = 125) during 2004-2009 and group them according to the combination of CVD or not. The history, physical examination, laboratory tests, lung function, ECG and echocardiography were recorded. All data were analysis by SPSS 16.0. Results Of the two groups, there are no significant difference in age, sex and smoking history. The BMI of the group COPD+ CVD is (24. 29± 4.07) kg/m2,higher than the group of COPD( P =0. 011). About combined disease, the percentage of hypertension of the COPD+CVD group, hypcrlipidemia, and diabetes, which are higher than the COPD group[ (64.70 %vs 58.24%),(17.65% vs 9.89%),(26.47% vs 8.79%)], but only the differences in the percentage of diabetes is significant statistically( P =0. 023). There are significant differences in lung function and the percentage of GOLD Ⅲ-Ⅳ between the two groups. The PaO2 level of the group COPD+CVD is lower than the COPD group [(67.67±10.31) mm Hg vs (73.74±13.76) mg Hg](P =0.038). About laboratory tests, there are significant differences in the inflammation-related indicators such as the count of white blood cell, the proportion of neutrophils, CRP, high sensitivity CRP and Fib( P<0.05) but no significant differences in blood glucose and lipids. The average length of stay, re-hospitalization and the proportion of patients died of COPD+ CVD group are higher than group COPD[( 21.12±9.83) days vs (17.75±7.3) days, (1.59 ± 1.67) times vs (0.90±0.17) times, 20.59~ vs 7.69%]. Logisticregression analysis showed that BMI, combined with diabetes or not, lung function, blood oxygen levels and inflammation-related indicators are all related with the increase of CVD in COPD. Multivariate Logistic regression analysis show that only CRP level is associated with the increase of CVD in COPD independently( P = 0. 026). Conclusions Traditional cardiovascular risk factors and the decline of lung function are both play a role in the increase risk of CVD in COPD. The mechanisms of these effects may be related to systemic inflammation and hypoxia etc. The prognosis is poor in COPD patients when they combined with CVD.     

右美托咪啶用于慢性阻塞性肺疾病患者机械通气时镇静效果分析

目的 研究右美托咪啶用于COPD患者机械通气时镇静效果.方法 入选病例来自2012年1月至2015年11月在济宁医学院附属医院重症医学科收治的慢性阻塞性肺疾病急性加重期合并呼吸衰竭行机械通气患者60例;采取前瞻随机对照方法分为2组:右美托咪定组和咪达唑仑组,每组30例,记录2组的APACHEⅡ评分、Ramsay评分等指标,比较2组患者机械通气时间,ICU住院时间,血压下降、心动过缓、谵妄发生率.结果 右美托咪啶组机械通气时间[(95.00±5.00) h]与咪达唑仑组通气时间[(126.00±6.00) h]相比,差异有统计学意义(t=16.65,P＜0.01);右美托咪啶组ICU住院时间[(6.10±1.50)d]与咪达唑仑组ICU住院时间[(8.20±1.70)d]相比,差异有统计学意义(t =9.34,P＜0.01).右美托咪啶组谵妄发生率与咪达唑仑组发生率相比,差异有统计学意义(x2=12.17,P＜0.01).血压下降和心动过缓的发生率比较,差异无统计学意义(P＞0.05).结论 右美托咪定用于COPD患者机械通气镇静治疗是有效的,它能缩短机械通气时间及住ICU时间,能降低谵妄发生率.     

慢性阻塞性肺疾病对重症监护病房患者合并呼吸机相关性肺炎病死率的影响

目的 研究慢性阻塞性肺疾病(COPD)对重症监护病房(ICU)患者合并呼吸机相关性肺炎(VAP)病死率的影响.方法 本前瞻性研究是在我院急诊重症监护病房用一年半年时间完成的.患者选择标准为接受机械通气超过48 h并且经过微生物学标准证实罹患VAP.ICU病死率的危险因子通过单变量和多变量分析决定.结果 90例经微生物学证实的VAP患者纳入了研究.84％的VAP患者属于迟发.39％的VAP患者痰液中分离出了铜绿假单胞菌.结果显示,没有合并COPD的患者(n=63)病死率显著低于合并COPD的患者(n=27)[42.9％ vs 59.3％,P=0.038,OR(95％ CI)=1.67(1.04～6.85)].没有合并COPD的患者接受机械通气天数和ICU入住天数的中位数分别是24(16-41)d和31(17 46)d,合并COPD的患者对应是30(18-43)d和37(21-50) d(P＞0.05),没有合并COPD的患者和合并COPD患者(GOLDⅣ期)机械通气时间和ICU入住时间有显著性差异(P值分别为0.001,0.002).多变量分析显示:在VAP[3.70(1.86-7.34)]患者中,COPD[OR (95％ CI)2.52(1.34～5.1 2)]是ICU病死率的独立危险因子.结论 COPD与ICU中VAP患者病死率相关.     

有创-无创序贯机械通气治疗COPD合并Ⅱ型呼吸衰竭患者疗效观察

目的 评价有创-无创序贯机械通气治疗COPD合并Ⅱ型呼吸衰竭的疗效.方法 序贯组30例,对照组28例.序贯组以“肺部感染控制窗”作为有创和无创通气的切换点.结果 序贯组有创机械通气时间缩短[ (5.16±1.23)d比(13.12±3.58)d,P＜0.05];住院时间缩短[(15.35±2.12)d比(24.69±2.78)d,P＜0.05];VAP发生率减少[6.67％比32.14％,P＜0.05];病死率减少[3.33％比10.71％,P＜0.05];总机械通气时间无显著差异.结论 对COPD合并Ⅱ型呼吸衰竭病例,采用有创-无创序贯机械通气可缩短有创机械通气时间,减少住院时间,降低病死率和VAP的发生率.     

老年急性非ST段抬高心肌梗死合并糖尿病患者应用替罗非班的有效性和安全性

目的评价血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班在老年非ST段抬高心肌梗死(NSTEMI)合并糖尿病患者中安全性和有效性。方法随机将168例NSTEMI合并糖尿病的高危患者分为替罗非班组(80例)和常规治疗组(88例)。比较2组患者PCI术后TIMI血流分级及B型钠尿肽(BNP)水平,观察术后7d及30d的LVEF,左心室舒张末内径(LVEDD)和左心室收缩末内径(LVESD)的变化;术后30d内主要不良心脏事件及出血发生率。结果 2组TIMI血流分级(计帧法)比较,替罗非班组优于常规治疗组[(34.2±5.9)帧vs(38.9±8.1)帧,P=0.014]。替罗非班组7d及30d的BNP水平明显低于常规治疗组[(237±192)ng/L vs(282±210)ng/L,P=0.034;(172±85)ng/L vs(218±105)ng/L,P=0.017]。替罗非班组术后7d的LVEF显著高于常规治疗组(P=0.026)。2组术后30d的LVEF、LVEDD、LVESD比较,差异有统计学意义(P=0.037,P=0.021,P=0.028);替罗非班组24h及30d的不良心脏事件发生率明显低于常规治疗组;2组术后出血比较差异无统计学意义。结论老年高危NSTEMI合并糖尿病患者应用替罗非班治疗是安全和有效的,疗效优于常规治疗,并未增加出血事件。     

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.     

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.     

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.     

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.