Widenings of the myelin lamellae in a typical Guillain–Barré syndrome

The so-called “widenings of the myelin lamellae” are thought to be specific ultrastructural features of peripheral nerve myelin in patients with peripheral neuropathy associated with a monoclonal dysglobulinemia of IgM type and antiglycolipid activity. We report here a case of Guillain–Barré syndrome with no evidence of serum monoclonal dysglobulinemia, presenting the typical widenings of the myelin lamellae in small-diameter myelinated fibers from a sural nerve biopsy. In view of the positive reaction with anti-C3d complement on direct immunofluorescence, an immunological mechanism may be involved in the widenings of the myelin lamellae. © 1994 John Wiley & Sons, Inc.     

Identifying incident cases of parkinsonism among veterans using a tertiary medical center.

To better understand the impact of incident Parkinson's disease (PD) on the Veteran's Health Administration (VHA) and to develop methods applicable to future epidemiological research, we performed a medical record review study at a tertiary referral VHA medical center. Searching the local data base, we identified 782 veterans with diagnostic codes for PD or secondary parkinsonism (SP) between 1998 and 2000. Based on structured medical record review, a movement disorders specialist confirmed diagnoses for incident parkinsonism cases. Among the 782, 191 incident parkinsonism cases were identified (100 PD, 75 SP, and 16 Parkinson's Plus). Incident PD cases were older at diagnosis (74.5 vs. 70.4 yr; P < 0.05) and more likely to be white (81% vs. 62; P < 0.07) than incident SP cases. Diagnostic codes were insufficient to distinguish between incident PD and SP (positive predictive value, 57% and 39%, respectively), and VHA sources failed to identify 21% of confirmed deaths among the incident PD cohort by November 2004. Although the large number of incident cases identified suggests PD is an important cause of disability among elderly VHA users, observed limitations of VHA sources for identifying incident PD cases and determining their vital status should be considered when designing future studies.     

潮汕地区健康青年H9、H6、H5亚型甲型流感病毒血清抗体调查

目的：调查潮汕地区健康青年中H9、H6、H5三种甲型流感病毒亚型的隐性感染情况，以期了解上述三种禽类甲型流感病毒亚型是否能够或已经从禽类直接或间接传染给人。方法：潮汕地区健康青年血清946份，通过HI实验进行抗体检测。结果：H9亚型抗体阳性率达37．2％；同时发现有三份血清存在H5抗体；未见H6亚型抗体的存在。结论：H9亚型在健康青年中的隐性感染率非常高；H5亚型抗体的存在也应值得注意。     

联合检测CEA、CA19-9在结直肠癌诊断中的应用

目的探讨用化学发光法检测CEA和CA19-9在结直肠癌诊断中应用价值。方法用化学发光法测定29例结直肠癌患者、46例良性疾病患者和20例健康人群血清CEA和CA19-9含量。结果癌变组CEA和CA19-9含量明显高于良性对照组和健康对照组,差异具有显著性(P<0.05),其中敏感性、特异性、有效性分别为65.5%、92.4%、84.2%和51.7%、95.4%和82.1%,联合检测的敏感性、特异性、有效性分别为82.8%、90.9%、88.4%。结论联合检测CEA和CA19-9有利于结直肠癌临床诊断,可提高其敏感性和有效性。     

Détermination de la tortuosité pour la détection des rétinopathies vasculaires sur les images d''angiographie rétinienne

Les rétinopathies vasculaires peuvent être accompagnées d'une modification de la forme des vaisseaux. Les patients atteints courent le risque de perdre la vue. Jusqu'ici, les méthodes utilisées par les ophthalmologistes pour analyser ces modifications sont qualitatives. Nous proposons une méthode nouvelle d'analyse de la tortuosité des vaisseaux de la rétine en vue d'élaborer par la suite un outil d'aide au diagnostic des rétinopathies vasculaires. La première étape de la méthode est une représentation symbolique de la structure vasculaire de la rétine. La deuxième étape appelée reconstitution 2D est la classification des entités vasculaires en gros vaisseaux (artères ou veines) et en petits vaisseaux (artérioles ou veinules) en utilisant la moyenne du diamèetre et du niveau de gris des segments de vaisseau comme paramètres discriminants. La dernière étape consiste à calculer l'excentricité des vaisseaux pour décrire leur tortuosité. Pour s'assurer de la capacité de l'excentricitéà décrire les petites modifications de forme, un second paramètre a été défini à titre comparatif. Les résultats obtenus permettent de quantifier les modifications de forme des vaisseaux.     

The surfaces of the parasitic nematodes Trichinella spiralis and Toxocara canis differ in the binding of post-C3 components of human complement by the alternative pathway

The binding of human complement components C3, C5 and C9 to the surface of the infective larvae of the nematode parasites Toxocara canis and Trichinella spiralis, by the alternative pathway, was examined by direct and indirect immunofluorescence on the intact parasites. This showed that although C3 bound to both nematodes, they differed markedly in the binding of C5 and C9; C5 bound only minimally to T. spiralis, and C9 binding to this parasite was barely detectable. In contrast, both early and late components bound to T. canis to a high density, comparable to, or in excess of, the binding of these components to the infective larvae of the trematode Schistosoma mansoni. The lack of binding of the post-C3 components to T. spiralis did not correlate with enhanced binding of the control protein, Factor H.     

多种肿瘤标志物联合检测肺癌的临床意义

目的 评价血清肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原50(CA50)、糖类抗原19—9(CA19—9)、铁蛋白(SF)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFlRA21—1)水平对肺癌诊断的临床价值。方法 测定72例肺癌患者和40例良性肺病患者的血清AFP、CEA、CA50、CA19—9、SF、NSE、CYFRA21—1水平，比较两组的差异。结果 肺癌组患者CEA、CA50、CA19—9、SF、NSE、CY—FRA21—1水平高于良性肺病组，AFP对肺癌的诊断价值不大。NSE CYF、RA21—1的联合检测具有良好的阳性和阴性预测值。六项联合检测的敏感性和准确性最高，但与两项联合检测的敏感性和准确性差异无统计学意义。结论 NSE CYFRA21—1的联合检测具有良好的临床应用前景。     

Œdème cérébral aigu mortel chez un enfant diabétique

A case is reported of fatal acute cerebral oedema occurring in a 15-year-old child suffering diabetic ketoacidosis. He had severe gastro-enteritis, with a weight lose of 8 kg over a period of 8 days (initial weight = 50 kg). He was admitted in a stupor with pH 7.15, 129 mmol.l-1 natraemia, and 31 mmol.l-1 blood glucose concentration. Blood osmolaity was calculated to be 310 mosmol.l-1. He was rehydrated with 416 ml.h-1 normal saline and 416 ml.h-1 of 1.4% sodium bicarbonate. At the same time a total dose of 75 i.u. of ordinary insulin was given. After 2 h, the patient's condition suddenly worsened with unreactive coma, bilateral fixed mydriasis, respiratory pauses, and impairment of haemodynamic state (heart rate 150 b.min-1, blood pressure 80/50 mmHg). The diagnosis of cerebral oedema with severe intracranial hypertension was confirmed by different investigations. Despite ventilatory support and continued intensive care, the patient died a few hours later. It is concluded that some degree of subclinical brain swelling could be common occurrence during diabetic ketoacidosis, present maybe even before the start of treatment. Such cases of cerebral oedema are often reported, but the pathophysiological mechanisms remain unclear. However, unlike this case, rehydration must be moderate (less than 41.m-2.day-1), especially in case of hyponatraemia. Insulin and sodium bicarbonate must be used with care. Early rigorous clinical and biological monitoring is essential. Treatment should aim at a progressive correction of the metabolic disturbances.     

MMP-2、TIMP-2、VEGF和bFGF在血管瘤增生及消退过程中的变化

目的 探讨基质金属蛋白酶-2（MMP-2）及其抑制剂（TIMP-2）、血管内皮生长因子（VEGF）和碱性成纤维细胞生长因子（bFGF）在血管瘤增生、消退过程中的变化。方法 采用免疫组织化学链霉亲和素-过氧化酶（SP）法，检测增生期血管瘤32例、消退期血管瘤10例、血管畸形17例及小儿正常皮肤10例标本中MMP-2、TIMP-2、VEGF及bFGF的表达。结果 MMP-2、VEGF及bFGF在增生期血管瘤中的表达明显高于消退期血管瘤、血管畸形和正常皮肤，其差异有统计学意义；TIMP-2在消退期血管瘤中的表达明显高于增生期血管瘤、血管畸形和正常皮肤，其差异有统计学意义。结论 MMP-2、VEGF及bFGF可能促进血管瘤血管生成，从而促进血管瘤增生，而TIMP-2可能促进血管瘤消退。