Hypokalemic paralysis and osteomalacia secondary to renal tubular acidosis in a case with primary Sjögren's syndrome

A 39-year-old Japanese woman was admitted to our hospital for severe weakness owing to potassium deficiency caused by type 1 renal tubular acidosis (RTA1). Sicca complex, serological tests, and lip biopsy revealed that she had Sjögren's syndrome (SS). Acidosis was corrected by alkali supplement treatment. She also had an impaired renal function with proteinuria, and high absorbance on Ga scintigram was recognized in both kidneys. She was taking warfarin potassium after aortic valve substitution due to aortic regurgitation, therefore renal biopsy was not performed. Prednisone (20?mg/day) was administered for renal inflammation. One month later, she suffered severe chest wall pains with some local tender points over the costae of both sides, which was presumed to be due to pseudofractures based on osteomalacia. Hypokalemic paralysis and osteomalacia should be taken into consideration in the diagnosis of SS with RTA1.     

大黄素对脂多糖所致肾脏炎症的抑制作用

目的探讨大黄素对脂多糖（LPS）诱导的肾小管上皮细胞（TECs）免疫炎症的抑制作用。方法原代培养的BALB/C小鼠肾小管上皮细胞,模型组用100 ng/mL的LPS诱导,干预组在LPS诱导的同时,分别用0.1、0.2、0.4μg/mL浓度的大黄素干预,于24 h后分别提取细胞总RNA及蛋白。用流式细胞术检测TEC TLR4膜蛋白水平,逆转录-聚合酶链反应（RT-PCR）检测样受体（TLR）、肿瘤坏死因子-α（TNF-α）及白介素-6（IL-6）mRNA的表达。结果正常肾小管上皮细胞可见TLR4表达,用100 ng/mL LPS刺激后TLR4 mRNA的表达由（0.25±0.22）上调至（0.62±0.11）,且TNF-α、IL-6因子表达亦分别上调6.4倍和2.1倍,与正常组比较,差异有统计学意义（P〈0.05）。不同浓度大黄素干预后则TLR4、TNF-α、IL-6 mRNA表达较模型组下降2.0～5.7倍,与模型组比较,差异有统计学意义（P〈0.05）,下降程度与大黄素浓度相关,部分存在一定的量效依赖关系。结论大黄素能够下调LPS诱导的肾小管上皮细胞TLR4的表达,并减少下游炎症因子TNF-α及IL-6的激活,从而减轻肾脏局部免疫炎症反应、保护肾功能。     

管状胃治疗老年食管癌的安全性、有效性观察及其对患者生活质量的影响

目的探讨管状胃治疗老年食管癌的安全性、有效性及其对患者生活质量的影响。方法选择本院收治的老年食管癌患者54例,随机分为研究组和对照组,研究组患者给予管状胃治疗,对照组患者给予全胃代食管治疗,根据食管癌患者生活质量测定量表（QLQ—OES24）测定患者术后1、3、6、12个月的生活质量情况,并统计患者不良反应发生情况。结果两组手术时间、术中出血量、输血量差异无统计学意义：术后随访屁示研究组心律失常、胸部并发症、反流性食管炎、胸胃综合征发生率明显少于对照组（P〈0．05）,而两组吻合口瘘、吻合口狭窄发生率无明显差异（P〉0．05）;两组术后1个月生活质量评分差异无统计学意义,术后3、6、12个月,研究组生活质量评分明显高于对照组（P〈0．05）。结论管状胃代食管治疗老年食管癌患者,并发症少,安全性高,患者生活质量改善明显．值得应用。     

小切口配合管状胃对食管癌患者呼吸功能的影响

目的探讨经左胸小切口配合管状胃对食管癌患者呼吸功能的影响。方法 84例食管癌患者随机分为两组,观察组42例,对照组42例,对照组采用常规开胸手术,观察组采用经左胸小切口配合管状胃手术。测定患者术前和术后2月呼吸功能。结果两组患者均顺利完成手术,在胸腔胃综合征和胃食管反流的并发症方面,观察组少于对照组（P〈0.05）。术后2月比较,两组患者的呼吸功能均有明显改善（P〈0.05,P〈0.01）;与对照组比较,观察组呼吸功能改善更明显（P〈0.05）。结论经左胸小切口配合管状胃更有利于食管癌患者呼吸功能的改善。     

经左胸小切口结合管状胃治疗对食管癌患者呼吸功能和血清血管内皮生长因子水平的影响

目的 探讨经左胸小切口结合管状胃治疗对食管癌患者呼吸功能和血清血管内皮生长因子(VEGF)的影响.方法 选择食管癌患者78例,采用随机数字表法分为两组,观察组42例,对照组36例.对照组采用传统开胸治疗,观察组采用经左胸小切口结合管状胃治疗.分析术前和术后3个月患者生活质量,并测定血清VEGF.结果 两组患者手术后生活质量均较术前有所提高,并且观察组较对照组提高更明显(t =4.36,P＜0.05).两组治疗后血清VEGF均有明显下降(t=26.11、12.28,均P＜0.01),并且观察组降低更明显(t =14.94,P＜0.05).结论 经左胸小切口结合管状胃可以明显提高食管癌患者的生活质量和血清VEGF.     

Expression of cathepsin D and galectin 3 in tubular carcinomas of the breast

Tubular carcinoma (TC) is a distinctive type of grade I (G1) ductal carcinoma with particularly favourable outcome and low rate of axillary metastases. To the best of our knowledge, few data are available in the literature concerning the expression of molecules mediating intercellular and cell-matrix interactions in TC. We examined with immunohistochemical methods the expression of galectin 3 and cathepsin D in 17 TC and in 33, 31 and 28 ductal carcinomas of G1, grade II (G2) and grade III (G3), respectively. Results were compared using Chi-square test. Galectin 3 expression was higher in TC than in G1 carcinomas (p<0.05). The pattern of immunostaining was also different with a focal cytoplasmic apical reinforcement in TC. However, cathepsin D stromal and epithelial expression was similar in TC and G1 cases (p>0.05), and lower than in G2 and G3 patients at a stromal level. The higher expression of galectin 3 in TC and its focal staining (apical) pattern suggests that within the group of G1 carcinomas, galectin 3 expression varies according to histological type, and may correlate with prognosis and metastatic potential. We also suggest that cathepsin D could not be involved in neoplastic progression and metastasis in low-grade (G1) ductal breast carcinomas.     

Acute renal failure — An integrative discussion of morphologic and functional findings

Summary The ultrastructural alterations at the nephron established in animal experiments, were also confirmed, by means of an electron-microscopic examination, in eight cases of human acute renal failure (ARF). Special consideration was given in this study to single cell alterations, particularly in proximal tubular cells, with emphasis being placed on alterations due to single cell damage in the region of the renal fluid compartments. The ultrastructural alterations of the tubular cells in ARF, suggest serious impairment of the cellular capacity for electrolyte transport and metabolic processes. The shunt paths between the tubular fluid compartment and the functional interstitium, arising from necrosis of the tubular cells or dissolution of the gap or tight junctions, were discussed in terms of their significance for the directional, active transport processes of the tubular cells for sodium chloride and the passive water flow. The morphologic findings were reviewed in light of recent findings on cellular membrane processes and electrolyte transport. A reinterpretation of the morphologic and functional findings in ARF is suggested. This takes into consideration single cell function and the integrity of the renal fluid compartments.This study was supported by the Deutsche Forschungsgemeinschaft (Gi 117/2-2 and Bo 216/22-2)     

Microdissection study of the length of different tubular segments of rat superficial nephrons

Summary Anatomical investigations have been carried out on rats of two different strains. The kidney weight was shown to be linearly dependent upon body weight. Microdissections of superficial nephrons revealed that there is a significant correlation between kidney weight and the length of the proximal convolution, loop of Henle and distal convolution. The mean length of the proximal convolution in a 1 g kidney was 5.91 mm, and of the loop of Henle (pars recta of the proximal tubule included) 6.50 mm. The bend of loops of Henle belonging to superficial nephrons was always situated in the outer medulla.

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Zusammenfassung An den Nieren von Ratten zweier unterschiedlicher Stämme wurde die Länge oberflächlich gelegener Nephrone mit der Mikrodissektionsmethode bestimmt. Dabei war eine direkte Korrelation zwischen dem Nierengewicht und den einzelnen Abschnitten des Nephrons (proximales Konvolut, Henlesche Schleife, distales Konvolut) nachweisbar. Die mittlere Länge des proximalen Konvoluts betrug für ein Nierengewicht von 1 g 5,91 mm und für die Henlesche Schleife einschließlich der pars recta des proximalen Tubulus 6,5 mm. Die Umbiegungsstelle von Schleifen oberflächlich gelegener Nephrone lag immer im äußeren Nierenmark. Diese Längenvariationen in Abhängigkeit vom Nierengewicht sind auch auf das Körpergewicht beziehbar, da sich eine annähernd lineare Beziehung zwischen Nierengewicht und Bruttokörpergewicht ergab.

     

Modultion of the Golgi apparatus in stimulated and nonstimulated prolactin cells of female rats

The three-dimensional structure of the Golgi apparatus and its compartments in prolactin cells has been examined in lactating rats in which secretion of prolactin was suppressed by removing the litter or stimulated by allowing the pups to suckle again. As soon as 2 hr after removal of the litter, large irregular progranules and numerous large pale vesicles accumulated in the trans-Golgi area together with vesicular or tubular fragments. The cis-tubular network was no longer recognizable on the cis-face of the Golgi ribbon; the saccules of the midcompartment were partitined by narrow fissures and also became perforated in register by numerous fenestrations of various sizes and irregular contours. The concomitant appearance of numerous vesicles in the cavities thus formed as well as in the surrounding cytoplasm indicated that they probably arose by the progressive cavitation and fragmentation of saccules of the mid compartment. Such a process, which reached a maximum between 4 and 6 hr after removal of the litter from the mother, was no longer observed at 8 and 12 hr, at which time intervals the Golgi apparatus was reduced in size with no cis-tubular elements and progranules on its trans-aspect and few vesicles in its surroundings. When mothers, separated from their litters for a period of 12 hr, were returned to their pups for 20 min, the cis-tubular network reappeared on the cis-aspect of the Golgi stacks and presumably formed by fusion of vesicles and anastomosed tubules located next to the cisternae of the rough endoplasmic reticulum. In addition, the structure of the midsaccules returned to the stimulated condition, and early progranules were again segregated within the trans-most saccules of the Golgi stack. Hence, the Golgi apparatus of prolactin cells was rapidly and deeply modified in the presence or absence of stimulation. © 1993 Wiley-Liss, Inc.     

Tubular apocrine adenoma of the eyelid – A case report and literature review

Tubular apocrine adenoma is a rare benign adnexal neoplasm most commonly identified in the scalp, composed of a dermal proliferation of apocrine tubules in a background of hyalinized stroma. Tubular apocrine adenoma can be a component of various sweat gland tumors and can also morphologically overlap with other sweat gland neoplasms. Isolated tubular apocrine adenoma arising in the glands of Moll is exceedingly rare, with only 4 previously reported cases. We present a 63-year-old male with tubular apocrine adenoma of the left upper eyelid, which recurred following initial incomplete excision. Although the lesion showed focal morphologic similarity to the apocrine variant of pleomorphic adenoma (chondroid syringoma), the diagnosis of tubular apocrine adenoma was supported by fluorescence in situ hybridization studies, which demonstrated absence of PLAG1 and HMGA2 gene rearrangements seen in pleomorphic adenoma. This case illustrates the clinical, microscopic and immunohistochemical features of tubular apocrine adenoma. The recent advances in our understanding of the molecular genetics of tubular apocrine adenoma and related tumors, and how these advances shape the evolving classification of sweat gland tumors are reviewed.