原发性甲状腺功能减退症继发垂体增生伴高泌乳素血症

目的报告1例原发性甲状腺功能减退症继发垂体增生伴高泌乳素血症患者,探讨其组织形态学、免疫组织化学表型、诊断与鉴别诊断、治疗及预后等临床病理学特点。方法与结果女性患者,29岁,临床表现为月经失调1年,溢乳3个月,头痛1周。MRI提示垂体瘤可能性大。遂行经鼻蝶鞍区占位性病变探查术。组织学形态观察,部分腺泡细胞明显增生,呈局灶性结节状。免疫组织化学染色,增生的腺泡细胞弥漫性表达突触素、促甲状腺激素,部分表达催乳素,不表达甲状腺转录因子-1,淋巴细胞散在表达白细胞共同抗原,Ki-67抗原标记指数约1%。病理诊断为垂体增生,最终临床诊断为甲状腺功能减退症。持续服用左甲状腺素钠(优甲乐)100μg/d,随访13个月,一般状况良好。结论垂体增生诊断困难,明确诊断须依靠临床病史、组织学形态特征和免疫组织化学表型,应注意与垂体腺瘤尤其是垂体微腺瘤相鉴别。     

颅后窝脑膜瘤的诊断与治疗

目的 探讨颅后窝脑膜瘤的诊断和治疗特点。方法 收集同济医院99年以来的颅后窝脑膜瘤25例,分析其在诊断与治疗上的临床特点和影响因素。结果 25例脑膜瘤中女性17例,男性8例,发病年龄多见于24～58岁(22/25),多以头痛起病,病程平均2～3年,增强CT或MRI显示肿瘤位于后颅窝,大小为3cm×3cm×2cm～5cm×5cm×6cm;所有25例经枕下或幕上入路,在显微镜下全切肿瘤。结论 后颅窝脑膜瘤多见于青壮年女性,病程较长且多以头痛起病,没有明显的听觉障碍,增强CT或MRI可明确诊断,按肿瘤生长部位可分为岩骨脊型和横窦型;手术是主要治疗方法,手术入路以枕下入路为主,采取幕上入路时注意Labbe静脉的保护。     

Prolactin secretion in posterior pituitary lobectomized rats: differential effects of 5-hydroxytryptophan and ether

The objective of this study was to determine whether the posterior pituitary mediates the prolactin (PRL) releasing activities of serotonin and ether. Ovariectomized (OVEX) rats were subjected to posterior pituitary lobectomy (LOBEX) or sham surgery (SHAM). Either 1 or 12 days after surgery, rats were injected i.v. with 20 mg/kg b. wt. of 5-hydroxytryptophan (5-HTP), which is a precursor of serotonin. A second group of rats was exposed to ether vapors for 10 min. Blood was collected from a jugular cannula before and after the treatments and analyzed for PRL. On either 1 or 12 days after surgery, injection of 5-HTP increased plasma PRL levels 5–10 fold in both LOBEX and SHAM rats. This was followed by a decline to preinjection levels within 60–90 min. LOBEX and SHAM male rats which were injected i.p. with 50 mg/kg b. wt. of 5-HTP, also showed marked and similar elevations of plasma PRL levels 12 days after surgery. Exposure of OVEX rats to ether elicited a 2–3 fold rise in plasma PRL levels only on day 1, but not on day 12, after LOBEX. The ether-induced rise in PRL was similar in SHAM rats tested on both days. These results indicate that the 5-HTP-induced rise in plasma PRL levels is independent of the posterior pituitary, regardless of the sex, the route of drug administration or the length of time after surgery. In contrast, the PRL response to ether stress is diminished within 12 days after LOBEX. The evidence that the PRL responses to 5-HTP and to ether might be mediated via different neuronal mechanisms is discussed.     

Characterization of LH-RH immunoreactivity in mammalian pituitary neural lobe by HPLC

High performance liquid chromatography was used to characterize luteinizing hormone-releasing hormone (LH-RH) immunoreactivity that was previously identified immunocytochemically in the pituitary neural lobes of bats, ferrets and humans. Extracts of bat posterior lobe and hypothalamus, ferret posterior lobe and hypothalamus and human neurohypophysis were partially purified with C-18 Bond-Elut cartridges. Samples were chromatographed using a C-18 reverse phase HPLC column, and LH-RH-immunoreactive moieties were separated by gradient elution (TFA/acetonitrile solvent system). For bats and ferrets, the major peak of neural lobe LH-RH immunoreactivity eluted with a retention time identical to that of hypothalamic LH-RH. Synthetic mammalian standard added to bat and ferret hypothalamic extracts coeluted as a single peak with the predominant form of LH-RH immunoreactivity present in those tissues. In humans, the peak of LH-RH immunoreactivity in neural lobe extracts coeluted with synthetic standard. These results provide strong evidence that the LH-RH-immunoreactive fibers which terminate within the neural lobe contain authentic LH-RH. Additional minor peaks of LH-RH immunoreactivity were observed in posterior lobe and hypothalamic extracts of both bats and ferrets. Comparisons of posterior lobe content of LH-RH immunoreactivity across species verify that the neural lobe projection is a major component of the LH-RH system in bats, whereas it is represented only minimally in the laboratory rat.     

Further evidence of noradrenergic regulation of rat hypothalamic estrogen receptor concentration: possible non-functional increase and functional decrease

The regulation of estrogen receptors by the alpha 2-noradrenergic system was studied. A single injection of the alpha 2-noradrenergic antagonist, yohimbine, caused a biphasic effect on the concentration of cytosol estrogen receptors in the mediobasal hypothalamus and anterior pituitary gland. A short-latency increase was seen at 1.5-3 h, followed by a longer-lasting decrease at 8-16 h. Scatchard analysis revealed that the apparent, short-latency increase is in the concentration of binding sites, not in the affinity of the receptor for [3H]estradiol. The increase in the concentration of cytosol estrogen receptors is not blocked by pretreatment with the alpha 2-noradrenergic agonist, clonidine. In addition, no increase is detected in the concentration of cell nuclear estrogen receptors accumulating in response to a saturating dose of estradiol. Therefore, the apparent increase in the concentration of cytosol estrogen receptors may not represent a functional increase in receptors. The decrease in the concentration of estrogen receptors, which occurs 8-16 h after yohimbine treatment, is also seen after injection of the alpha 2-adrenergic antagonist, idazoxan, and is not due to a change in the in vitro rate of association of the receptors with [3H]estradiol. Furthermore, the decrease seems to be a functional decrease in the concentration of receptors capable of cell nuclear accumulation in response to estradiol injection, as indicated by the results of experiments in which the concentration of cell nuclear estrogen receptors was assayed after estradiol injection. These experiments provide further support for the hypothesis that the alpha-noradrenergic system, and perhaps specifically the alpha 2-subtype, is involved in decreasing the concentration of estrogen receptors in parts of the brain and pituitary gland. This interaction provides a mechanism by which the environment could regulate the sensitivity of certain neurons to estradiol. However, the finding that the initial increase in the concentration of cytosol estrogen receptors after yohimbine treatment is not followed by the predicted increase in cell nuclear estrogen receptors after estradiol injection raises questions about the physiological relevance of the apparent increase under some conditions.     

内镜下经鼻-蝶窦入路蝶鞍周围解剖学研究

目的研究内镜下经鼻-蝶窦入路的解剖学,为临床内镜经蝶垂体病变手术提供形态学基础。方法选择10具经动脉灌注染料的成人尸体头部标本,男8具,女2具;模拟扩大经鼻-蝶窦手术入路,同时测量海绵窦内重要解剖结构与鞍底的距离。结果根据蝶窦后壁骨性结构特征将蝶窦腔分为中间腔、旁中间腔以及外侧腔等5个部分。扩大经鼻-蝶窦手术入路可清晰地显示鞍底的骨膜、硬脑膜外层、海绵窦内侧壁,海绵窦内的颈内动脉及其分支血管、动眼神经、滑车神经、外展神经及眼神经等重要解剖结构;打开蝶骨平台可显示视神经、视交叉、垂体柄、鞍膈及视丘下部等解剖结构。蝶鞍周围结构与鞍底中线的距离分别为视神经管隆起(5.72±1.56)mm,颈内动脉管隆起(5.42±1.38)mm,鞍膈(10.01±1.46)mm,视交叉(14.96±1.42)mm,海绵窦内颈内动脉(11.02±2.06)mm,海绵窦内动眼神经(13.75±1.79)mm,海绵窦内滑车神经(15.14±1.53)mm,海绵窦内外展神经(12.68±1.52)mm。结论内镜下扩大经鼻-蝶窦手术入路可清晰地显露蝶鞍周围的解剖结构,适用于鞍旁、鞍上病变的手术治疗。     

马来酸桂哌齐特注射液治疗急性脑梗死血液流变学变化及疗效观察

目的 观察马来酸桂哌齐特注射液治疗急性脑梗死的临床疗效和对血液流变学的影响.方法 选择发病72 h内的脑梗死患者152例,按随机数字表法分为观察组(n=88)和对照组(n=64).观察组给予马来酸桂哌齐特注射液320mg.对照组给予复方丹参注射液20mL,均静脉滴注,1次/d,连用14d,观察两组临床疗效和血液流变学指标变化.结果 观察组治疗14d后的中国卒中量表(CSS)评分与对照组比较差异有统计学意义(P<0.05);观察组疗效、显效率(62.5%)优于对照组(35.9%),差异有统计学意义(P<0.05);观察组治疗后的各血液流变学指标下降程度较对照组明显,差异有统计学意义(P<0.05).结论 马米酸挂哌齐特注射液治疗急性脑梗死疗效显著,并能有效降低血液黏度.     

药物洗脱支架在后循环动脉狭窄治疗中的应用

目的 研究在后循环动脉狭窄治疗中应用药物洗脱支架的安全性和疗效性.方法 经常规造影证实椎动脉狭窄者30例,接受支架置入治疗者19例.局麻或全麻下经右股动脉以Seldinger技术置入6 F导管鞘,在相应导丝辅助下使导引导管进入锁骨下动脉或椎动脉,血管造影后沿导引导管插入0.014英寸、300 cm或205 cm导丝至狭窄远端,经此微导丝交换置入相应规格球囊扩张式CypherTM支架(10例)或TAXUSTM支架(9例).结果 19例患者手术均成功,无死亡和并发症,置入支架贴壁良好,血流明显改善,狭窄远端分支血管(小脑后下动脉等)充盈明显改善,狭窄率由原来的平均87.5%降至平均5.2%.15例表现为眩晕症状的患者术后症状消失12例(80%),改善3例.表现为共济失调的6例患者术后共济运动基本正常4例,明显改善2例,表现为小脑性语言障碍的1例患者术后明显改善.完成至少1次造影随访的患者15例,经DSA证实无再狭窄发生.所有患者门诊随访,最长18个月.结论 药物洗脱支架在后循环动脉狭窄的治疗中安全、有效,在短期内能防止术后再狭窄,长期疗效需进一步观察,需要大样本的随机对照研究进一步证实.     

双黄连注射剂不良反应的原因及分析

目的观察、分析和总结双黄连注射剂的不良反应和应对措施。方法通过查阅1994～2008年期间国内公开发行的医药卫生期刊和国家食品药品监督管理局药品不良反应监测中心《信息通报》有关药品不良反应的资料进行分析。结果11083例双黄连注射剂不良反应的病例报告中出现严重不良反应的有306例,涉及158家企业的产品。性别、年龄段没有明显差异;以用药当天出现不良反应为主,严重不良反应的治愈或好转率〉90%,总死亡率高达5.9%,大多数病例对疾病本身影响不大。结论应根据双黄连注射液出现不良反应的可能原因,采取有针对性的安全防治措施。     

Measurement of self-reported HIV risk behaviors in injection drug users: Comparison of standard versus timeline follow-back administration procedures

This study compares the frequencies of retrospective self-reported HIV high-risk drug use and sexual behaviors in 127 out-of-treatment injection drug users using the HIV Risk Questionnaire (HRQ) across two administration methods: (a) a brief standard quantity–frequency approach covering the past 30 days and (b) a lengthier timeline follow-back (TLFB) procedure for improving recall. The two procedures produced similar frequencies of risk behavior across most items (80%) and good intra- and interclass correlation coefficients. The TLFB, however, resulted in higher frequencies for two risk behavior questions—sharing of any drug injection equipment and having any type of unprotected sex. The TLFB is a well-established procedure for retrospective assessment of HIV risk behavior and a good choice when precision in measuring these behaviors is a primary focus of the work. In contrast, the brief HRQ-Standard interview procedure appears to be a reasonable choice for clinical, research, and health-related surveys where the primary focus is broader than HIV risk behavior.