Endometrial cancer patients have a significant risk of harboring isolated tumor cells in histologically negative lymph nodes

In this study, we examine the prevalence of finding isolated tumor cells (ITCs) in negative lymph nodes of endometrial cancer patients using immunohistochemistry. Seventy-six endometrial cancer patients with lymph nodes histologically negative for metastatic disease were examined. Nodal tissue sections were stained with anticytokeratin antibodies AE-1 and CAM 5.2. Nodes with single or groups of cells (two to four cells) < or =0.2 mm and showing cytokeratin reactivity were positive for ITCs. Findings were compared to features of the primary tumor and patient outcome. ITCs were present in 31 of 1712 lymph nodes. Fifteen (19.7%) patients had ITC-positive nodes. ITCs involved only pelvic nodes in nine cases, only para-aortic nodes in five cases, and pelvic and para-aortic in one case. Tumor in adnexa was the only pathologic feature associated with nodal ITCs (P= 0.0485). All 15 patients with nodal ITCs were alive at follow-up. One (6.7%) patient suffered recurrent disease but was alive at last encounter. Disease recurred in 5 (8.8%) of 57 patients without nodal ITCs. Two are alive without disease, two alive with disease, and one died from her cancer. In summary, a significant proportion of endometrial cancer patients have ITCs detected by immunohistochemistry in histologically negative regional lymph nodes.     

Osteochondral Fracture of the Fourth Metatarsal Head Treated by Open Reduction and Internal Fixation

Fracture of the metatarsal head is uncommon, and reports of isolated osteochondral fracture of the metatarsal head are rare. Because of the distal location of the fracture, it is difficult to achieve and maintain reduction, and potential complications include avascular necrosis and subchondral fatigue fracture. The authors present a case of an osteochondral fracture in a 40-year-old man, which was treated by open reduction and internal fixation with a single twist-off screw, with good results 12 months postoperatively.     

5-单硝异山梨酯缓释剂治疗老年单纯收缩期高血压疗效观察

目的 观察5-单硝异山梨酯缓释剂（ISMN）对老年单纯收缩期高血压（ISH）患者降压治疗的疗效。方法 80例ISH患者随机分为对照组39例和治疗组41例，对照组给予氨氯地平5mg，吲达帕安2．5mg每日1次口服，治疗组在上述治疗的基础上给予5-单硝异山梨酯缓释剂40mg每日1次口服，疗程4周。结果 （1）治疗组从第一周开始收缩压（SBP）下降幅度即大于对照组，先于对照组于第二周降至正常，差异有显著性（P〈0．05）；（2）从第一周开始治疗组舒张压（DBP）下降幅度即小于对照组（P〈0．05），第三周开始差距加大，差异有非常显著性（P〈0．01），整个观察期内治疗组DBP下降幅度始终小于对照组，且从第二周开始处于相对稳定状态；（3）第一周开始治疗组脉压（PP）下降幅度即大于对照组（P〈0．05），第二周开始差距进一步加大，差异有非常显著性（P〈0．01）。结论 硝酸酯类药物能降低ISH患者的SBP,而对DBP影响不大，使PP减小，对ISH患者降压治疗有益。     

异搏定对胰腺腺泡细胞内游离钙离子浓度的影响

目的:探讨细胞内钙超负荷在急性胰腺炎(AP)发生发展中的作用.方法:使用140只SD大白鼠胆胰管逆行加压注射4.5%牛磺胆酸钠制成AP模型,用荧光指示剂Fura-2/Am测定游离胰腺腺泡细胞内游离钙离子浓度([Ca~(2 )]i).结果:注射后2小时和3小时胰腺呈急性出血坏死性炎症早期改变,制AP模型后AP组[Ca~(2 )]i较对照组明显增高(P<0.001),AP组胰腺腺泡细胞内[Ca~(2 )]i增高值与胰腺病理变化程度呈正相关关系(r_s=0.9727,P<0.001),异搏定治疗可明显提高病鼠生存率和改善胰腺组织出血坏死程度和腺泡细胞超微结构损害.结论:胰腺腺泡细胞内钙超负荷在胆汁性急性水肿性胰腺炎向出血坏死性胰腺炎转变中起明显作用,钙通道阻滞剂异搏定可明显阻止胰腺细胞内钙离子超负荷,是其治疗急性胰腺炎的主要机理之一.     

HEPATIC ZONATION OF CARBOHYDRATE METABOLISM

Periportal cells synthesize twice as much glucose from lactate than do cells from the perivenous zone.     

新型双球囊导管在经皮选择性隔离肝脏灌注化疗中的应用

目的探讨自制双球囊导管在经皮选择性肝脏隔离灌注化疗(PSIHP)中的应用效果。方法实验猪12头,利用介入放射学方法进行双球囊导管选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显,肝细胞凋亡指数(51.82%±5.34%)明显高于未灌注区域肝细胞凋亡指数(4.12%±0.84%)(P<0.01)。结论自制新型双球囊导管能有效隔离肝脏,对未灌注区域肝组织有良好的保护作用,是一种理想的隔离肝脏灌注化疗的球囊导管。     

Isolated tricuspid valve stenosis caused by infective endocarditis in an adult: Report of a case

We report herein the case of a 42-year-old man in whom dyspnea on exertion was found to be caused by isolated tricuspid stenosis. Two-dimensional echocardiogram showed thickening of the tricuspid valve with a markedly enlarged right atrium. A color-flow Doppler examination-revealed severe tricuspid stenosis without regurgitation and a Doppler-derived tricuspid diastolic pressure gradient of 23 mmHg. At the time of surgery, the patient was noted to have a stenotic tricuspid valve with thickened leaflets, fused commissures, and almost normal chorda tendineae. The valve leaflets were teased apart to the scattered specimen, and tricuspid valve replacement was successfully performed. Microscopic examination of the specimen demonstrated infective endocarditis. Isolated acquired tricuspid stenosis is extremely rare and, to our knowledge, this is the first case of infective endocarditis being involved as the primary cause.     

离体灌流鼠心胞浆游离钙——fura—2测定

本实验建立了一种浮动基点式ｆｕｒａ－２测定离体灌流心脏细胞内游离钙浓度的新模型，本模型中游动基点式测定地克服目前ｆｕｒａ－２技术中受细胞内某些物质产生的自身荧光变化干扰的缺点，实现了自动消除细胞自身荧光变化对实验结果的影响，并在此基础上将广泛用于测定游离状态的细胞内游离钙的ｔｕｒａ－２技术推广到离体灌流心脏，实现了在更接近心肌生理状态的条件下测定其胞浆游离钙。     

经皮局部隔离肝脏灌注化疗合并血液灌流方法学实验研究

目的　探讨经皮局部隔离肝脏灌注化疗的方法及可行性。方法　 12只实验用犬 ,对照组 4只 ,进行常规经肝动脉灌注化疗 ;实验组 8只 ,利用介入放射学方法进行经皮局部隔离肝脏灌注化疗结合血液灌流。化疗药物选用阿霉素 ,分别检测肝静脉及外周血液中的血药浓度。结果　实验组介入操作全部成功 ,1例死于血液灌流的血路管漏气 ,平均操作时间 ( 132 .3± 15 .3)min。血药浓度测定显示 ,对照组肝静脉血和外周静脉血浓度峰值分别为 ( 370 9.676± 385 .72 3)ng/ml、( 15 76.14 0± 2 2 6.933)ng/ml;实验组为( 465 3.42 0± 430 .2 0 4)ng/ml、( 433.612± 40 .5 0 1)ng/ml。统计学处理 ,两组相差非常显著。结论　经皮局部隔离肝脏灌注化疗结合血液灌流是一种可行的技术 ,具有简单、创伤小、可保护正常肝脏、便于重复治疗的优点。与常规经肝动脉灌注化疗相比 ,不仅可以增加局部血药浓度 ,更可以降低外周的血药浓度 ,降低毒副作用     

Long-term follow-up of patients with persistent/recurrent,isolated haematuria: A Hungarian multicentre study

A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least 6 months at the beginning of observation. The duration of follow-up was 2–5 years in 201, 5–10 years in 119, 10–15 years in 19, and over 15 years in 2 cases. Of these patients 47.8% became symptom-free. In 18.4% the haematuria remained isolated; in 13.8% it was combined with proteinuria over 250 mg/day more than 2 years later. The occurrence of associated proteinuria increased progressively with time. It was 8.6% between the 3rd and 5th years, and 37.0% after the 5th year. Renal biopsy was performed because of the symptoms of glomerular disease in 47 cases at an average time of 12 months following the appearance of proteinuria. Proteinuria appeared after a 2–5, 5–10, 10–15 and more than 15 years follow-up period in 16, 23, 6, and 2 patients respectively; 14 of them had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (creatinine clearance: 10–50 ml/min per 1.73 m²) and 0.3 (creatinine clearance: < 10 ml/min per 1.73 m²). Mortality was 0.58%. Most of the patients who developed severe azotaemia had persistent microscopic haematuria at the beginning. The prevalence of hypertension was only 1.2%. The time of its appearance was above 5 years in 2 and below 5 years in 2 cases. All these patients had chronic glomerulonephritis. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2–15 years after onset. All of these had hypercalciuria. Our findings suggest that symptoms of isolated haematuria may last for a longterm period and need systematic control. When proteinuria and/or hypertension is associated with haematuria a worse prognosis can be expected.Participating paediatric hospitals and university departments: Second Department of Paediatrics, I. Semmelweis Medical University of Budapest (M. Visy); Department of Paediatrics, University Medical School of Pécs (V. Jászai); Department of Paediatrics, A. Szent-Györgyi Medical University of Szeged (I. Haszon, S. Túri); County Children's Hospital, Miskolc (Á. Vissy); P. Heim Children's Hospital, Budapest (Z. Czirbesz); County Children's Hospital, Györ (Zs. Szelid); Buda-Children's Hospital, Budapest (I. Ferkis); I. Apáthy Hospital, Budapest (J. Kisbán); János Hospital, Budapest (I. Marosváry); Hospital of Hungarian State Railway, Budapest (J. Fehér); L. Madarász Hospital, Budapest (F. Kalmár); South Pest Hospital, Budapest (G. Halász); County Children's Hospital, Pécs (E. Kolman); County Children's Hospital, Gyula (P. Sipos); County Children's Hospital, Szolnok (I. Jaksics); County Children's Hospital, Debrecen (Á. Miskolczi); County Children's Hospital, Tatabánya (I. Kiss); County Children's Hospital, Eger (M. Frank, E. Ladányi); County Children's Hospital, Nyíregyháza (E. Bujdosó); County Children's Hospital, Szombathely (M. Andics); Kerepestarcsa Hospital, Budapest (M. Marcell); Komárom Hospital, Komárom (J. Kecskés)