T Cell Receptor Vβ Repertoires of Angioimmunoblastic Lymphadenopathy-like T Cell Lymphoma

To elucidate the pathogenesis of angioimmunoblastic lymphadenopathy-like T cell lymphoma (AILD-T) we investigated the T cell receptor Vβ gene repertoires of four AILD-Ts and compared them with those of other histological types of lymphomas and three cases with reactive disorders. All lymphoma patients had rearrangement bands detected by Southern blot analysis. Only 1 of the 4 cases of AILD-T showed a single predominant usage of Vβ 20 gene by PCR with 20 different Vβ specific primers and the others had repertoires somewhat restricted but similar to reactive lesions. Subsequent sequencing of this PCR product revealed that only 2 of 7 clones were identical. These results suggest the monoclonal malignant cells in AILD-T are scant and that the infiltrating T cells show a reactive pattern. In the only AILD-T case with a single dominant Vβ usage, the relationships of this repertoire and lymphoma cells seems to be of some consequence.     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

An analysis of paediatric diagnostic decision-making: how should students be taught?

This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out-patient Department of the Central Middlesex Hospital, London, by means of a questionnaire-based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety-one per cent of cases were diagnosed without recourse to investigations. Forty-two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history-taking skills and the subsequent purpose of examination.     

多发伤中四肢骨折早期处理

1997- 2 0 0 0年 10月我科收治多发性损伤有四肢骨折 10 2例 ,早期作内固定的有 4 5例 ,现对其中4 5例诊治过程进行回顾性分析 ,以期探讨多发伤中四肢骨折早期内固定的必要性。1　临床资料　　本组 4 5例 ,其中男 30例 ,女 15例 ,年龄 7～ 70岁 ,平均 37 5岁。受伤原因 :交通伤 2 2例 ,高处坠落伤 13例 ,压砸伤 5例 ,机器伤 5例。按肢体大骨折计算 ,胫腓骨骨折 2 8例 ,股骨骨折 13例 ,尺桡骨骨折2 0例 ,肱骨骨折 7例 ;开放性骨折 2 0例。合并伤 :合并颅脑损伤 2 5例 ,胸部损伤 17例 ,腹部脏器损伤 6例 ,血管神经损伤 2 1例 ,并发休克 2 0例…     

A genetic progression model of oral cancer: current evidence and clinical implications

Based on recent genetic studies, we propose a progression model for the development of oral squamous cell carcinoma. In the initial phase, a stem cell acquires a genetic alteration; subsequently a patch is formed, a clonal unit consisting of the stem cell with its daughter cells that all share the DNA alteration. The next critical step is the conversion of a patch into an expanding field as a result of additional genetic alterations. This mucosal field replaces the normal epithelium and in the oral cavity such fields have been detected with dimensions of over 7 cm in diameter. Sometimes these fields are visible as leukoplakia. Ultimately, clonal selection leads to the development of carcinoma within this contiguous field of pre-neoplastic cells. An important clinical implication of this model is that fields often remain after surgery of the primary tumor and may lead to new cancers, presently designated by clinicians as second primary tumors or local recurrences.     

阻塞性睡眠呼吸暂停低通气综合征和肥胖及正常体重人群血清瘦素水平的研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、肥胖和正常体重人群的血清瘦素水平。方法:将经PSG检测的患者分为OSAHS组(53例)和单纯肥胖组(41例),另选正常体重者(正常体重组)62例,用放射免疫法测定3组的血清瘦素水平,同时测量每例受检者的身高、体重、颈围、腰围和臀围。结果:①无论男性还是女性,OSAHS组和单纯肥胖组的血清瘦素水平均比正常体重组高(均P<0.05);OSAHS组血清瘦素水平[男(8.06±2.58)μg/L,女(12.83±2.67μg/L)]均高于单纯肥胖组[男(5.75±1.27)μg/L,女(9.83±1.99μg/L)](均P<0.05)。②单纯肥胖组及OSAHS组血清瘦素水平分别与体质指数(BMI)呈显著正相关(均P<0.01),OSAHS组血清瘦素水平与AHI、颈围及腰臀围比(WHR)也呈显著正相关(均P<0.01)。结论:单纯性肥胖患者血清瘦素水平升高与机体内发生瘦素抵抗有关;OSAHS患者的血清瘦素水平与AHI呈正相关,说明OSAHS本身可能是引起血清瘦素升高的因素之一,瘦素可能有兴奋呼吸中枢的作用。     

Treatment time analysis for extensive amalgam restorations

The treatment times for the fabrication of Extensive Amalgam Restorations (EAR) as recorded in a longitudinal clinical trial at the Dental School in Nijmegen were analyzed. 269 EAR's with different retention methods were made on molars by three operators. A mean total treatment time of 60 min was found. The factor operator had a significant influence on all treatment phases resulting in a 26% difference in total treatment time between operators. Also significant influences were found in some treatment phases for the factor retention, side location of the tooth and extension of the restoration. The results of this study with regard to treatment times must be considered from the perspective of the quality of the care provided.