实时超声造影技术诊断肝脏微小局灶性病变的价值

目的:探讨肝脏微小局灶性病变(最大径≤2cm)的实时超声造影诊断价值。材料和方法:对205个≤2cm肝脏局灶性病变分别进行实时超声造影及常规超声检查,将诊断结果分为良性、恶性和不能确定,最终诊断经病理学、同期其他影像及实验室检查证实,并随访10~30个月。结果:恶性肿瘤65个病灶,良性病灶140个。与病理诊断比较,超声造影诊断的敏感性、特异性及准确性分别为85.0%、90.5%及88.5%,常规超声分别为40.0%、47.6%及42.6%。病灶动脉期高增强及门静脉期或延迟期低增强为诊断恶性的重要指标。结论:实时超声造影技术对鉴别诊断肝脏微小(≤2cm)局灶性病变具有重要的临床应用价值。     

Bilateral perioral sensory symptom after unilateral stroke: Does it have a localizing value?

Bilateral perioral sensory dysfunction due to unilateral cerebral lesion is rare, and has been thought to be caused by midline brainstem lesions. Six patients are described herewith, with bilateral perioral sensory symptoms due to unilateral strokes that do not involve the mid-brainstem region. Brain-computed tomographic scan and magnetic resonance imaging demonstrated unilateral cerebral strokes in the thalamus, posterior limb of the internal capsule, basal ganglia, fronto-parietal cortex and the insular-frontal subcortical area. This observation suggests that bilateral perioral sensory symptoms do not have a localizing value. Possible pathogenetic mechanisms for this sign are discussed.     

损毁双侧蓝斑区引起血尿的实验研究

用电解损毁方法损毁Ｗｉｓｔａｒ成年雄性大鼠的双侧蓝斑区。结果出现膀胱扩张、尿液潴留和血尿等，膀胱和输尿管尿液有大量红细胞和血红蛋白，膀胱粘膜和肾脏充血．结果表明：损毁双侧蓝斑区后不仅有膀胱出血，还有肾脏出血。这个实验可用作研究“特发性”血尿的动物模型。     

Expression of human T-cell lymphotropic virus type-1 gene products in the short-term cultured skin tissues of an adult T-cell leukemia/lymphoma patient with cutaneous manifestations.

Adult T-cell leukemia/lymphoma (ATLL) is recognized as a disease etiologically associated with human T lymphotropic virus type-1 (HTLV-1) infection, but, neither viral replication nor specific virus antigen expression have been detected on ATLL cells distributed in organs, including skin. To examine the latent expression of HTLV-1 in the cutaneous lesions of ATLL patients, we cultured the lesional skin tissues in vitro and applied immunofluorescence staining with mouse monoclonal antibodies Lt-4, GIN-14, and F10, which react with p40tax, p19 and gp21, respectively. We recognized HTLV-1 specific antigens on clustered ATLL cells only in the deeper dermis of the skin after 24 hrs cultivation of the lesional skin tissue from an ATLL patient in RPMI-1640 medium supplemented with 20% fetal calf serum. In the electron microscope, we observed HTLV-1 like particles, 80-140 nm in diameter with envelope and core structures, in the same tissue specimen. These findings suggest that HTLV-1 gene products may be expressed in the skin lesions of ATLL patients and involved in the pathogenesis of skin eruptions in cutaneous type ATLLs. To our knowledge, this is the first report that envisages the potency of intracutaneous HTLV-1 expression in vivo.     

A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin

Calcific tendinitis is a common condition with characteristic clinical and radiological findings. Although we do not know which condition initiated the pathologic cascade, we present a rare case of calcific tendinitis of the long head of the biceps brachii at its origin, associated with a SLAP lesion. The calcium deposit was removed and the SLAP lesion was repaired with a suture anchor arthroscopically.     

良性淋巴上皮病、淋巴上皮癌、MALT淋巴瘤的关系

良性淋巴上皮病(benign lymphoepithelial lesion)、淋巴上皮癌(lymphoepithelial carcinoma)、黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(MALT淋巴瘤)(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT lymphoma)是3种性质不同但又存在某些关联的病变,本文对3种病变的病因、组织病理学表现及三者之间的关系进行了介绍,并结合叶为民等论文中的一些内容进行了简要探讨。     

Noonan syndrome associated with central giant cell granuloma

We report a case of Noonan syndrome associated with central giant cell granuloma. The patient was a 101/2-year-old boy with the chief complaint of proptosis of the right eye. He also had various malformations such as short stature, webbed neck, pectus excavatum, cubitus valgus, pulmonary valve stenosis and patent foramen ovale, a characteristic face appearance and cryptorchidism and so on. Chromosome analysis showed a 46, XY karyotype. A computed tomographic scan and magnetic resonance imaging showed a mass originated from the lateral wall of the right maxillary sinus. The patient underwent Caldwell-Luc operation. Histological examination of the mass showed the characteristics of central giant cell granuloma. This case report describes a patient with the features of the recently described Noonan-like/multiple giant cell lesion syndrome.     

食管癌高低发区人群食管粘膜组织病理学研究

目的探讨食管癌高、低发区人群食管粘膜上皮组织学改变，为癌前病变防治提供依据。方法高（林州市）、低发区（范县、清丰县）分别取无症状居民食管活检２２９人和１８７人，均分为４组，２５岁～３４岁、３５岁～４４岁、４５岁～５４岁及≥５５岁，常规石蜡ＨＥ制片，按标准诊断归类。结果高、低发区食管上皮萎缩、棘层肥厚、炎细胞浸润相应年龄组比较无显著差异，基底细胞增生高发区３５岁～４４岁、４５岁～５４岁组显著大于低发区相应组（Ｐ＝０．０３１２，Ｐ＝０．０２７３），非典型增生４５岁～５４岁、≥５５岁组高发区显著大于低发区相应组（Ｐ＝０．０１９６，Ｐ＝０．０２６３）。高、低发区总体人群比较除棘层肥厚、炎细胞浸润无差异外，余各病变间均有极显著差异（Ｐ＜０．０１）。结论食管上皮萎缩、基底细胞增生应作为较狭义的癌前病变对待，食管上皮棘层肥厚、炎细胞浸润似与食管癌变无关。     

Radiofrequency Current Ablation of Porcine Right Atrium: Increased Lesion Size with Bipolar Two Catheter Technique Compared to Unipolar Application In Vitro and In Vivo

Interruption of atrial flutter and fibrillation by RF catheter ablation may be favored by large, elongated lesions. We administered RF current in unipolar and bipolar mode in porcine right atrium. Bipolar ablation was performed between the tip electrodes of two serially coupled catheters. With 4-mm tip electrodes in vitro, lesion length increased from a mean (SD) of 7.9 (1.2) mm at 3 mm-interelectrode distance (IED) to 13.3 (3.3) mm at 9-mm IED, but decreased at 12-mm IED due to nonconfluent lesions (P < 0.0001), With 4 mm distal electrodes and 8 mm IED, bipolar lesions were 65% longer than corresponding unipolar ablations. Switching to bipolar mode increased the lesion length more than increasing electrode tip length to 6 mm in unipolar mode. Power and temperature controlled ablation created equally sized lesions. Twelve anesthetized pigs were randomized to unipolar or two catheter bipolar temperature controlled ablation of the right atrial free wall. Bipolar ablation created confluent lesions with endocardial length × width of 13.5 (5.8) × 7.3 (3.7) mm, unipolar ablation 6.4 (2.8) × 4.6 (1.4) mm (P < 0.001 when comparing length and P = 0.013 for lesion width). The atrial lesions in both groups were transmural and extended into hilar lung lesions with maximal depth of 3.0 (1.1) and 2.6 (1.0) mm, respectively (P = 0.44). Five bipolarly and four unipolarly ablated pigs developed right diaphragmal paresis. We conclude that bipolar ablation may be preferable in situations where large, elongated lesions are favorable. The two catheter technique is feasible in porcine right atrium. Both bipolar and unipolar ablation of the porcine right atrial free wall may frequently be complicated by injury to the phrenic nerve and adjacent lung tissue.     

Enhanced tyrosine phosphorylation of striatal NMDA receptor subunits: effect of dopaminergic denervation and l-DOPA administration

Sensitization of striatal N-methyl- -aspartate receptors (NMDAR) has been linked to events leading to the motor response changes associated with the administration of dopaminomimetics to parkinsonian animals and patients. To determine whether tyrosine phosphorylation of NMDAR subunits contributes to the apparent long-term enhancement in synaptic efficacy of these receptors, we examined the effect of unilateral nigrostriatal dopamine system ablation with 6-hydroxydopamine followed by twice-daily treatment with -DOPA on the phosphorylation state of rat striatal NR2A and NR2B subunits. Three weeks of intermittent -DOPA administration produced a shortening in the duration of the rotational response to dopaminergic challenge and other changes mimicking those occurring in patients with Parkinson's disease. Concurrently, tyrosine phosphorylation of NR2A and especially of NR2B subunits increased ipsilateral to the lesion (20±5% and 46±7% of intact striatum, respectively; p<0.01) without attendant changes in subunit protein levels. Selective blockade of NR2B subunits with ACEA 10-1244, but not of NR2A subunits with MDL 100,453, reversed the -DOPA-induced response alterations. The intrastriatal injection of a tyrosine kinase inhibitor, genistein, at a dose (2.0 μg) that normalized the response shortening, attenuated the NR2A and NR2B phosphorylation increase by about 12% and 24%, respectively (p<0.01). Taken together, these results suggest that augmented tyrosine phosphorylation of NR2B subunits, alone or in combination with the smaller rise in NR2A subunit phosphorylation, contributes to the apparent enhancement in striatal NMDAR sensitivity and thus to the plastic alterations in dopaminergic responses in -DOPA-treated parkinsonian rats.