前臂后皮神经营养血管远端蒂复合瓣的应用解剖

目的:为前臂后皮神经营养血管远端蒂复合瓣设计提供解剖学基础。方法:30侧动脉灌注红色乳胶成人上肢标本,解剖观测前臂后皮神经营养血管的来源、分支、吻合及其与尺、桡骨膜血管的关系。结果:前臂后皮神经营养血管来自:桡侧副动脉皮支2～6支,外径(0.6±0.3) mm;骨间后动脉皮支6～9支,外径(0.7±0.3) mm;骨间前动脉腕背支皮支3~5支,外径(0.8±0.2) mm;尺、桡动脉腕背支皮支2~6支,外径(0.6±0.1) mm。尺骨中上段骨膜血管来自骨间后动脉的肌骨膜支6～8支,外径0.3～1.0 mm;骨间后动脉桡侧骨皮支与桡骨中段裸区骨膜血管吻合。上述支发出皮支、筋膜支、骨膜支和神经营养血管,形成皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂后皮神经营养血管与肌、骨、皮营养血管同源,其远端蒂复合瓣,旋转轴点在腕关节平面,适宜手背远处的组织缺损修复。     

带蒂股后皮神经营养血管皮瓣的解剖与临床应用

目的：报道股后皮神经营养血管带蒂皮瓣的解剖特点与临床应用疗效。方法：在10侧经动脉灌注红色乳胶成人新鲜下肢标本上，解剖观测股后皮神经血供及其筋膜皮支的分布范围，设计股后皮神经营养血管岛状皮瓣转移修复腘窝、髋关节周围软组织缺损6例。结果：股后皮神经营养血管主要来源臀下动脉、穿动脉和腘动脉后侧穿支的升皮支，并在股后区形成网状吻合营养股后侧皮肤。皮瓣5例全部成活，1例皮瓣远端少量坏死，换药后愈合。经12～44个月随访，皮瓣无破溃，膝、髋关节功能活动良好。结论：股后皮神经营养血管岛状皮瓣转位是一种修复腘窝、髋关节周围软组织缺损良好的方法。     

Primary cutaneous B-cell lymphoma in Japanese patients

Primary cutaneous B-cell lymphoma (PCBCL) is a rare group of lymphoproliferative disorders. There have been few reports of Japanese patients with PCBCL, so the present study investigated the clinicopathological and immunological features and Bcl-2 gene rearrangement and protein expression in 28 Japanese patients with PCBCL. According to the Revised European-American Lymphoma (REAL) classification, there were 25 diffuse large B-cell lymphomas (DLBCL), one Burkitt type lymphoma, one lymphoblastic lymphoma and one marginal zone cell lymphoma. Of the 25 DLBCL, 17 were in males and eight in females, with an average age of 69.4 years. Follow-up data were available in 19 cases of DLBCL of which seven died and 12 were alive. The overall 5-year survival rate was 61%. Cases of DLBCL involving the legs were found to have poorer clinical outcomes; two of four cases with leg lesions died, with a mean survival of 13 months. Of 14 cases with non-leg lesions, four died, and the mean survival was 38.9 months. Only one case of Burkitt type lymphoma was CD10 positive. Bcl-2 rearrangement was not observed in 13 cases studied by polymerase chain reaction. Bcl-2 expression was observed in nine of 13 cases studied. All five cases with leg lesions exhibited Bcl-2 expression, but four of six cases with non-leg lesions also expressed the protein. These results show that DLBCL is the most frequent subtype of PCBCL in Japanese patients and that the prognosis of Japanese patients with DLBCL is worse than that of reported European cases. The study also found that PCBCL was frequently associated with Bcl-2 expression, which was not site-confined, and that there was no evidence for a follicular center origin of PCBCL.     

Monoclonal anti-human IgG antibodies for quantitation of allergen-specific IgG in human sera

Eight monoclonal anti-human IgG antibodies were fully characterized and evaluated as possible reagents in solid phase radioimmunoassay for quantitating allergen-specific IgG antibody. Four monoclonal antibodies (HG24D, HG2-14, HG2-18, and HG2-25) recognize CH2 domain of human IgG and bind to human IgG fixed to microtiter plate with high affinities. These monoclonal antibodies were more suitable than polyclonal rabbit anti-human IgG antibody in Phadebas RAST for honey bee venom-specific IgG antibody. Nonspecific binding was much lower, and the slopes of standard curves were much steeper. In contrast to polyclonal antibody, the standard curve was hardly influenced by human serum IgG in sample diluent. These advantages of monoclonal antibodies that recognize CH2 domain of human IgG made it possible to quantitate egg white- and Dermatophagoides pteronyssinus-specific IgG antibodies with use of allergen disks prepared for IgE RAST. This property allows a single system to be used for measurement of IgG and IgE antibodies against clinically relevant allergens.     

Impairment and recovery of visual functions after bilateral lesions of superior colliculus

Adult, male hooded rats were tested on a six-choice jumping stand apparatus designed to study their ability to perform visually guided orientation movements with a brightness discrimination task. Upon reaching criterion, the rats suffered either one- or two-stage, bilateral electrolytic lesions of the superior colliculi and then, after a brief recovery period, were retested for their ability to retain the preoperatively learned task and, in addition, perform a more difficult task. Although both brain damaged groups evidenced an impairment in comparison to sham-operated controls, the rats with two-stage lesions were less disabled than their simultaneously operated counterparts.     

Local immune responses and systemic cytokine responses in zoster: relationship to the development of postherpetic neuralgia

Varicella zoster virus (VZV) causes varicella (chickenpox) as the primary infection and zoster (shingles) on reactivation from latency, often many years later. One of the most common and most severe sequela of zoster is postherpetic neuralgia (PHN). Apart from age, factors which predispose towards PHN are unknown. In the present study, the concentration of a variety of Th1 and Th2 cytokines in the serum of 30 zoster patients at the time of the acute disease were correlated with the subsequent development of PHN in nine of these patients, but no association was found. In addition, although some cytokines such as IFN-gamma, IL-6 and IL-8 were slightly raised in the zoster group compared with a group of normal healthy subjects of a similar age distribution, these differences only verged on significance. Antibody titres to VZV were raised in the zoster group compared with the controls but these did not differ between the patients who developed PHN and those who did not. Biopsies of zoster lesions were collected from nine patients. There were significantly fewer infiltrating lymphocytes in the lesions of the three patients who subsequently developed PHN compared with the six who did not, although the expression of the neuropeptide, substance P, did not differ between the two groups. It is possible that the poor inflammatory response at the time of the acute zoster may result in less effective containment of the VZV and more damage in the dermatome, thus contributing to the persistence of the neuralgia.     

Early atherosclerotic lesions in infancy: role of parental cigarette smoking

Cigarette smoking is associated with an increased incidence of atherosclerotic diseases. The aim of this study was to examine the progression of the preatherosclerotic lesions previously observed by us in coronary arteries of fetuses of smoker mothers and in infants with smoker parents. We examined the coronary arteries of 34 infants, aged 1–36 months, and the histological and biological [c-fos, proliferating cell nuclear antigen (PCNA), and apoptosis] features of the early atherosclerotic lesions. In 17 infants (50%), at least one parent smoked, generally more than five cigarettes a day. In 18 cases (53%), we observed variable thickening of the coronary walls from preatherosclerotic lesions to juvenile atherosclerotic plaques, related to parental smoking habit. This morphological progression of the lesions was accompanied by a sequence of biological changes in the smooth muscle cells of the tunica media. We suggest that the oxidants present in the gas phase of the parental cigarette smoke pass through the endothelium and induce at first the c-fos gene activation and subsequently the PCNA positivity, that is, a proliferative process.     

Women with endometriosis have increased levels of placental growth factor in the peritoneal fluid compared with women with cystadenomas

BACKGROUND: To assess the release of placental growth factor (PlGF) into peritoneal fluid in women with and without endometriosis, we measured its concentration with reference to disease stage, the presence of red endometriotic lesions and the phase of menstrual cycle. METHODS: Surgery was scheduled in the proliferative or secretory phase of the menstrual cycle for 59 women with (n = 35) or without (n = 24) endometriosis. The latter group comprised women undergoing surgery for ovarian cystadenomas. PlGF concentrations in the peritoneal fluid were measured using an enzyme-linked immunosorbent assay. RESULTS: PlGF concentration in the peritoneal fluid was markedly elevated in the endometriosis patients (median 189 pg/ml, interquartile range 84-475 pg/ml) as compared with the controls (88 pg/ml, 41-213 pg/ml; P < 0.001), especially in women with red lesions. Significantly greater values during the secretory phase of the menstrual cycle as compared with the proliferative phase were observed in both the control (cystadenoma) group (P < 0.05) and the endometriosis group (P < 0.001). CONCLUSIONS: Our findings suggest that production of PlGF is sensitive to the cyclic changes in ovarian steroids and may contribute to the pathogenesis of endometriosis, especially that of red lesions, by promoting neovascularization.     

Serotonin-depleting midbrain lesions fail to mitigate hyperphagia and obesity in the Zucker fatty rat

Previous research has shown that damage to the dorsal and median raphe nuclei of rats can impede the subsequent development of hypothalamic hyperphagia and obesity as well as impair the defense of established hypothalamic obesity in response to food deprivation. The present study sought to determine if raphe injury might alter the development of another form of obesity, namely that which occurs spontaneously in the Zucker fatty rat. Subjects were 20 obese females (fafa; mean weight of 200 g) and 20 lean littermate controls (FaFa females; mean weight of 150 g). Following 10 days of baseline intake and weight recordings, half of each group received radio-frequency heat lesions of the dorsal and median raphe nuclei while the other half received sham surgery. Except for a mild suppression of food intake and weight gain during the first few days after lesioning, raphe injury did not alter the hyperphagia or obesity shown by fatties over the 7 week ad lib feeding period studied. Additional 24-hr intake tests of varying sucrose and quinine solutions revealed reduced sucrose acceptance and enhanced quinine rejection by fatties much as has been seen in previous studies of hypothalamic obese rats. Terminal assays of forebrain monoamine levels confirmed that raphe lesions were effective in depleting serotonin (-71% compared to controls) without producing major changes in norepinephrine or dopamine (-14% and +2%, respectively). The inability of raphe lesions to mitigate this form of hyperphagia and obesity suggests that earlier observations of their attenuating effects on hypothalamic obesity were not due to non-specific impairments of behavioral or metabolic factors necessary to permit overeating and weight gain.     

Cystic lesions of the salivary glands: cytologic features in fine-needle aspiration biopsies

A variety of neoplastic and nonneoplastic lesions of the salivary glands have a predominantly cystic architecture. Fine-needle aspirates of these lesions yield watery or mucoid material, frequently of low cellularity. Such aspirates may be obtained from mucus retention cysts, lymphoepithelial cysts, cystadenomas, Warthin's tumors, cystic pleomorphic adenomas, low-grade mucoepidermoid carcinomas, cystadenocarcinomas, and examples of polycystic disease of the parotid gland. The cellular component within the fluid obtained from these lesions may be exceedingly scant or absent, making cytologic diagnosis difficult and, at times, impossible. We studied a series of 56 cystic lesions of the salivary glands, including 38 Warthin's tumors, 6 benign cysts, 2 lymphoepithelial cysts, 5 low-grade mucoepidermoid carcinomas, 1 cystic pleomorphic adenoma, 2 cystadenomas, and 2 cystadenocarcinomas. Careful attention to the cellular elements present often allowed definitive cytologic diagnosis, with an overall accuracy rate of 84%. The presence of atypical squamous metaplasia in oncocytic lesions was a significant cause of false-positive diagnoses of carcinoma (4 cases, 7%). Aspirates of low-grade mucoepidermoid carcinoma may contain no epithelial cells and result in false-negative diagnoses (1 case, 2%).