胃癌与煌蓝色素内镜——比较内镜检查与活检结果

本文报告使用普通内镜和煌蓝色素内镜检查36例胃癌患者的结果。其中早期胃癌7人(占19.4％),进行斯胃癌29人。普通胃镜仅发现1例早期胃癌,煌蓝色素胃镜发现7例。煌蓝色素内镜比普通内镜更易发现早期癌(P均<0.05)。煌蓝色素内镜可将胃癌的活检阳性率提高到97.4％,明显优于普通内镜的活检阳性率(P均<0.01)。     

煌蓝色素内镜与胃癌

本文报告３６例胃癌患者普通胃镜和煌蓝色素内镜检查以及活检的结果。其中７例为早期胃癌，早期胃癌的检出率为１９．４％。普通胃镜仅发现１例早期癌，煌蓝色素内镜发现７例，差异有显著意义（Ｐ＜０．０５）。此外煌蓝色素内镜提高胃癌活检阳性率达９７．４％。也明显高于普通胃镜的活检阳性率（Ｐ＜０．０１）。作者认为在胃癌前病变的随访中应提倡使用煌蓝色素内镜。     

色素内镜对早期胃癌及癌前病变的诊断价值

研究内镜下美蓝染色对早期胃癌及癌前病变的诊断价值。内镜下有黏膜异常表现的120例患者，54例予以美蓝染色后活检，66例单纯活检。美蓝染色组病检证实有肠化萎缩者占23例，不典型增生15例，早期胃癌4例（均经手术病理证实）；单纯活检组（对照组）病理证实有肠化萎缩者占18例，不典型增生10例，未检出早期胃癌。染色组早期胃癌及癌前病变检出率为77．78％，对照组为40．90％，两组差别有显著性差异（P〈0．05）。结果表明，应用色素内镜指导黏膜活检，可显著提高早期胃癌和癌前病变的检出率。     

内镜下美蓝染色对早期胃癌及癌前病变的诊断价值

[目的]探讨内镜下直接喷洒低浓度美蓝染色对早期胃癌及癌前病变的诊断价值.[方法]对常规内镜检查发现胃黏膜有以下至少1项异常者:①微隆起,②糜烂,③小溃疡,④粗糙不平,⑤色泽改变,将其随机分为2组,各58例,染色组内镜下直接喷洒0.2%美蓝染色后活检;对照组不作染色按肉眼判断常规活检.[结果]染色组中检出早期胃癌3例、不典型增生15例、肠上皮化生17例;对照组中分别检出0、6、0例.2组检出率差异有统计学意义(P＜0.01).[结论]内镜下直接喷洒低浓度美篮染色可显著提高早期胃癌和癌前病变的检出率.     

色素内镜对早期胃癌的诊断价值

背景: 胃癌是最常见的消化道恶性肿瘤之一,早期诊断是治疗的关键。目的: 探讨色素内镜在胃癌早期诊断中的价值。方法: 纳入2008年1月～2009年7月普通内镜检查示可疑胃黏膜病变者115例,比较普通内镜和色素内镜的总体诊断符合率和早期胃癌检出率。结果: 病理检查示,炎性增生27例(23.5%),胃溃疡57例(49.6%),早期胃癌15例(13.0%),进展期胃癌15例(13.0%),胃黏膜相关淋巴组织(MALT)淋巴瘤1例(0.9%)。色素内镜的总体诊断符合率和早期胃癌检出率均略高于普通内镜,但差异无统计学意义(92.1%对86.8%,P0.05;80.0%对66.7%,P0.05)。结论: 色素内镜可增加病灶清晰度,有提高总体诊断符合率和早期胃癌检出率的趋势,其临床应用价值还有待大样本研究证实。     

内镜下醋酸联合靛胭脂染色对胃黏膜病变的诊断价值

目的 探讨内镜下醋酸联合靛胭脂染色对胃黏膜病变的诊断价值.方法 选择常规内镜下发现胃黏膜异常的门诊患者272例,随机分为对照组和醋酸联合靛胭脂染色组,每组各136例.对照组患者采取肉眼判断病灶并内镜下活检,染色组采取染色后活检,对比两组一般情况、镜下表现、活检病理、安全性等.结果 对照组检出早期胃癌4例(2.9％)、重度不典型增生3例(2.2％)、轻中度不典型增生11例(8.1％)、肠上皮化生35例(25.7％)、胃炎83例(61.0％),染色组分别为13例(9.6％)、12例(8.8％)、22例(16.2％)、54例(39.7％)及35例(25.7％).染色组对早期胃癌、重度不典型增生、肠上皮化生、胃炎的检出率高于对照组(P＜0.05).结论 醋酸联合靛胭脂染色可提高普通胃镜下黏膜异常的早期胃癌及癌前病变等的检出率.     

高清放大胃镜联合内镜窄带成像技术及靛胭脂染色对早期胃癌诊断的价值

[目的]评估高清放大胃镜联合内镜窄带成像技术及靛胭脂染色(ME-NBI联合靛胭脂染色)在早期胃癌诊断中的价值。[方法]选择2014年1月~2014年12月于我院行普通胃镜检查发现黏膜糜烂、僵硬、红晕或褪色,皱襞变平、凹陷及聚集,溃疡边界不规则等可疑病灶的437例患者,采用ME-NBI联合靛胭脂染色对其进行进一步的观察及镜下诊断,并于病变区取活检行常规病理组织学检查。以病理学诊断为金标准,检验该检查与病理诊断的一致性,并比较其与普通胃镜检查诊断早期胃癌的检出率。[结果]纳入病例中有61例患者经病理诊断确诊为早期胃癌,经普通内镜检查及ME-NBI联合靛胭脂染色诊断为早期胃癌的病例数分别为116例、79例。普通胃镜检查诊断早期胃癌的敏感性、特异性、假阳性率、假阴性率分别为55.74%、78.19%、22.81%、44.26%。ME-NBI联合靛胭脂染色检查诊断早期胃癌的敏感性、特异性、假阳性率、假阴性率分别为91.8%、93.88%、6.12%、8.2%。两者与病理诊断进行一致性检验的Kappa值分别为0.246、0.763(P0.05)。两者的检出率分别为7.78%、12.815%(P0.05)。[结论]高清放大胃镜联合内镜窄带成像技术及靛胭脂染色能够明显提高早期胃癌的镜下检出率,与病理诊断有较好的一致性。     

内镜在胃癌筛查的应用和价值

胃癌为我国常见的消化道恶性肿瘤,早期发现、早期治疗是胃癌治疗的关键.胃癌的筛查主要依靠内镜检查结合病理活检确诊.我国人口基数众多,在健康人群中实施胃镜筛查具有一定难度.因此,应首先锁定胃癌高危人群,随后对其定期进行内镜筛查.早期胃癌内镜下表现多种多样,目前胃镜筛查仍以白光内镜检查结合病理活检为主.随着内镜技术的进步,染色内镜、窄带内视镜、放大内镜及共聚焦内镜先后应用到胃癌的内镜筛查中,早期胃癌的检出率也随之得以提高.     

早期胃癌内镜诊断进展

胃癌的死亡率位居全球肿瘤死亡率的第二位.早期胃癌(EGC)预后较好,而进展期胃癌预后较差,因此胃癌的早期诊断成为决定患者预后的关键.因目前胃癌的诊断主要依赖于胃镜下活检行组织病理学检查,所以胃镜下如何发现病灶并准确活检是胃癌早期诊断的关键.随着染色内镜、放大内镜、窄带成像内镜、共聚焦显微内镜等检查手段投入临床使用,EG...     

色素内镜在早期胃癌诊治中的分析应用

[目的]分析色素内镜在早期胃癌的诊治和活检符合率情况。[方法]选取400例胃黏膜病变者,随机分为色素内镜组、普通内镜组,每组200例,分别对2组的早期胃癌的镜检结果与病理活检的结果进行比较。[结果]色素内镜组、普通内镜组的早期胃癌活检符合率分别为97%、60%,色素内镜组的活检符合率明显高于普通内镜组(P0.05)。[结论]色素内镜对早期胃癌诊断率高于普通内镜。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.