结肠孤立性溃疡的诊断及治疗

结肠孤立性溃疡是一种可发生在不同年龄阶段的少见结肠疾病。结肠镜及组织学检查是诊断该病的重要手段。本文就结肠孤立性溃疡的相关问题作一综述。     

川芎嗪对离体豚鼠气道平滑肌的效应及机制研究

目的：探讨川芎嗪( ligustrazine,LIG)对离体豚鼠气道平滑肌( airway smooth muscle,ASM)的效应及机制。方法取正常豚鼠支气管,制作成气管螺旋条,随机分成LIG组、LIG+普萘洛尔组、LIG+阿托品组、LIG+硝苯地平组、LIG+格列苯脲组、对照组。分别观察ASM在静息张力下以及组胺所致的高张力下,各组不同LIG浓度对ASM的效应并比较各组间ASM舒张率。结果(1) LIG对离体豚鼠ASM静息张力以及组胺所致的高张力均具有舒张作用。(2)离体豚鼠ASM在静息张力下,与LIG组比较,LIG+普萘洛尔组在LIG浓度10-7~10-6．5 mol/L时,舒张作用明显受到拮抗( P <0．05)。 LIG +阿托品组、LIG+格列苯脲组在LIG浓度10-7．5~10-3 mol/L时,舒张作用没有明显差别(P>0．05)。 LIG+硝苯地平组在LIG浓度10-6~10-4 mol/L时,舒张作用明显加强( P<0．05)。(3)离体豚鼠ASM在组胺所致的高张力下,与LIG组比较,LIG+普萘洛尔组在LIG浓度10-6.5~10-5 mol/L时,舒张作用明显受到拮抗( P<0．05);LIG+阿托品组、LIG+格列苯脲组在LIG浓度10-8~10-3 mol/L时,舒张作用没有明显差别( P>0．05);LIG+硝苯地平组在LIG浓度10-6.5~10-5 mol/L时,舒张作用明显加强(P<0．05)。结论 LIG可对离体豚鼠ASM静息张力以及组胺所致的高张力产生明显的舒张作用,其效应的产生可能与竞争性激动β2受体以及抑制Ca2+内流有关,这为临床应用川芎嗪治疗支气管哮喘提供了理论依据。     

Psoas muscle size,possible sarcopenia and frailty,and long-term survival in elderly patients after isolated surgical aortic valve replacement for aortic stenosis

PurposeThis study investigated the use of psoas muscle area index (PAI) as an indicator of mortality risk in relation to survival in elderly patients after isolated surgical aortic valve replacement (SAVR) for aortic valve stenosis (AS).MethodsBetween January 2005 and March 2015, 140 patients with AS, aged ≥ 70 years, and with preoperative abdominal computed tomography scans, underwent elective, primary, isolated SAVR. PAI showed the ratio of the psoas muscle cross-sectional area at the fourth lumbar vertebral level to body surface area, and PAI less than the gender-specific lowest 20th percentile we called “low PAI” for the purposes of this study. Patients were classified as low PAI (n = 29) or normal PAI (n = 111).ResultsThe mean age in the low-PAI group was significantly older than in the normal-PAI group (81.0 vs. 77.3 years; p = 0.001). The mean follow-up was 4.25 years. The low-PAI group had a lower survival rate than the normal-PAI group at 1 year (89.7 ± 5.7% vs. 96.3 ± 1.8%), at 3 years (71.6 ± 9.3% vs. 91.5 ± 2.7%), and overall (53.0 ± 13.4% vs. 76.0 ± 5.6%; p = 0.039). The prognostic factors of mortality included low PAI (hazard ratio 2.95; 95% confidence interval 1.084–8.079; p = 0.034).ConclusionsPAI was associated with reduced overall survival after isolated SAVR in elderly people. PAI measurement may help to predict patient risks.     

Isolated pancreatic islets of the rat: An immunohistochemical and morphometric study

Although there is a recent increase in the use of the isolated pancreatic islets of the rat in the transplantation and functional studies, there has been no detailed quantitative assessment on the size and cellular constituents of islets after the isolation procedure. The present work was undertaken to study the size classes of the isolated islets and the morphometry of their cellular populations. Islets of the rat pancreas were isolated by using the intraductal collagenase digestion technique, the most commonly used procedure for the isolation of pancreatic islets. Different endocrine cells of the isolated islets were stained by immunoperoxidase staining techniques. The distribution of the cellular constituents of the isolated islets was similar to that of the intact islets of the normal pancreas; A, D, and PP cells were peripherally arranged around the centrally located B cells. However, morphometric quantitative study showed that the percent volume and percent number of A, D, and PP cells of the isolated islets were lower than those of the corresponding intact ones. Further, the mean true diameter of the isolated islets was lower than that of the intact ones. These data indicate loss of islet cells during the process of isolation. Most of the lost cells were from the periphery of islets. This may provide an explanation for the incomplete metabolic control and recurrence of hyperglycemia encountered after isolated islet transplantation in the treatment of diabetes mellitus. It seems that further refinements of the isolation techniques are necessary to obtain islet tissue with total cellular integrity, before a complete success in transplantation could be achieved. © 1993 Wiley-Liss, Inc.     

Comparison of vasoconstrictor actions of norepinephrine and potassium chloride before and after damage of endothelium by saponin

Summary Using isolated and perfused mesenteric arterial preparations of dogs, vasoconstrictor responses to intraluminal norepinephrine and potassium chloride were investigated in the presence and absence of the endothelium. Intraluminal administration of saponin readily removed the endothelium. Saponin (1–3 mg) caused an increase in perfusion pressure, and then approximately 20 min later perfusion pressure became stable at a somewhat higher level than that of the control. A larger dose of saponin (10 mg) caused a tremendous but temporary increase of perfusion pressure. KCl-induced vasoconstriction was significantly enhanced by pretreatment with 0.3, 1, and 3 mg saponin, but norepinephrine-induced constriction was not modified significantly. Moreover, it was demonstrated that diltiazem, a potent Ca antagonist, inhibited the KCl-induced vasoconstriction more readily in the absence than in the presence of the endothelium.     

Ultrastructure of melanocytes in the dark cell area of human vestibular organs: Functional implications of gap junctions,isolated cilia,and annulate lamellae

Background: It is known that melanocytes exist in almost all parts of the inner ear, such as the cochlear duct, stria vascularis, Reissner's membrane, modiolus, vestibular organs in the region surrounding the cristae and maculae, semicircular canals, and pars rugosa of the endolymphatic sac. But there have been few studies using human materials, because of the difficulty of obtaining materials. We attempted to investigate the detailed ultrastructure of melanocytes in the vestibular organs of human inner ear. Methods: Eight surgical specimens obtained from patients with vestibular schwannoma were studied by light microscopy and electron microscopy. Results: Melanocytes were found in the subepithelial layer of the dark cell area. Melanocytes had round or spindle-shaped nuclei and clear cytoplasm with brown pigment granules. Besides melanocytes, there were melanophages, fibroblasts, and small blood vessels. Through electron microscopy we found melanocytes with round-shaped melanosomes in various stages of pigmentation, well-developed Golgi apparatus and endoplasmic reticulum in the cytoplasm, and many cytoplasmic processes. Gap junctions were occasionally found between the cytoplasmic processes. And there were pinocytotic vesicles just under the limiting membrane of melanocytes, and intermediate filaments were abundant in the cytoplasm. Isolated cilia of melanocytes, annulate lamellae, and fusiform banded structures in the connective tissue area around melanocytes were found. Conclusions: Melanocytes in human vestibular organs actively synthesize melanosomes. Frequent findings of isoalted cilia and fusiform banded structures and the incidental existence of annulate lamellae may be an indicator of this metabolically activated state of melanocytes. Moreover, monitoring environmental changes by isolated cilia, melanocytes in the human inner ear could act not only as one cell but also as a group to achieve their physiological functions by means of information transmission through gap junctions. © 1994 Wiley-Liss, Inc.     

Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node: implications for completion axillary node dissection

BACKGROUND: Controversy exists regarding axillary dissection (ALND) for sentinel node (SLN) metastases detected as isolated tumor cells (ITC). We hypothesized that the number of positive non-SLNs is low and ALND is unnecessary for most patients with ITC. METHODS: From 1995 to 1999, 634 breast cancer patients underwent SLND. SLNs were examined using immunohistochemistry if hematoxylin and eosin was negative. ALND was recommended for ITC-positive SLNs. RESULTS: Seventy-eight patients (12.3%) with ITC-positive SLNs were offered ALND. Sixty-one consented, whereas 17 refused. Fifty-eight (95.1%) had negative non-SLNs. Three (4.9%) had non-SLN metastases. One patient (1.6%) had macrometastatic disease, whereas 2 (3.3%) had micrometastases. No ITC-only-positive SLN patient experienced axillary recurrence. CONCLUSIONS: When ALND was performed for ITC, 1.6% of non-SLNs harbored macrometastases and 3.3% had micrometastases. When ALND was not performed, axillary recurrence was not seen. The low risk of non-SLN disease in this study fails to support the routine use of ALND for ITC-positive SLNs.     

Incidence,predictors, clinical profile,management and outcome of patients with isolated left main coronary artery ostial disease

ObjectivesIsolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease.Methods15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients.ResultsThe mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234).ConclusionIn one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.