Determination of lung volumes from chest films

The results obtained from two radiological methods of determining total lung capacity (TLC) (Kovach's parabo oid and Barnhard's ellipsoid) were compared with those obtained with the body plethysmograph. Determinations of TLC were made in four groups of subjects: group 1 consisted of 26 miners most of whom had simple pneumoconiosis; group 2 consisted of 12 normal subjects; group 3 consisted of eight subjects who had a variety of chest disease, but with no demonstrable parenchymal or pleural opacification; and group 4 consisted of 19 subjects with miscellaneous diseases, all showing demonstrable infiltration or opacification.     

Reversibility from delayed hyperacute rejection in ABO-incompatible renal transplantation: histopathological findings of renal allograft biopsy

ABO-incompatible renal transplantation (ABOIRTx) tend to lead to blood type antibody-mediated rejection, the so-called delayed hyperacute rejection (DHAR), which results in short-term graft loss. To clarify the accurate incidence and prognostic value of DHAR among ABOIRTx, we reviewed biopsy specimens obtained from ABOKTx allografts with abrupt dysfunction during the early period after transplantation. Among 74 ABOIRTx patients, 34 patients displayed allograft dysfunction within 14 days following transplantation. The biopsy specimens were classified based on the Banff schema. The pathological diagnosis of ABO blood type antibody-mediated humoral rejection (ABO-AMHR) was made by the following 3 findings: Specimens with all of above-mentioned findings were categorized as severe ABO-AMHR; those with at least one findings, were categorized as mild ABO-AMHR. All patients were treated with steroid pulse therapy and/or modification of other immunosuppressants. Group 1 consisted of severe ABO-AMHR (n = 6); group 2 consisted of mild ABO-AMHR (n = 5); group 3 consisted of acute cellular rejection (n = 3); group 4 consisted of recovery phase of ATN (n = 11); group 5 consisted of calcineurin inhibitor toxicity (n = 2); and group 6 consisted of normal histology (n = 5). One of 6 patients (16%) in group 1 lost the graft because of DHAR irreversible by antirejection and anticoagulation therapy. However, there has been no clear definition of histpathological criteria for DHAR after ABO-incompatible kidney transplantation. The definition must prognosticate whether the rejection process is reversible.     

Familial pheochromocytoma

A familial pheochromocytoma disease is described on the basis of two siblings and a cousin. The main symptoms consisted of troubles with the eyes, inclination to perspire and high blood pressure. Special in this family disease was the marriage between relatives. The method of surgery consisted in a transverse upper abdominal incision with excellent surgical exposure.     

Effects of Ginko Biloba and caspase inhibitors on brain ischemia in the Mongolian Gerbil

AIM: Data reported in previous studies and our own previous experience have led us to explore the mechanism of and the degree of protection afforded by Ginko Biloba in a model of cerebral ischemia in the Mongolian Gerbil evaluating histological and neurological effects in this rodent. METHODS: Mongolian Gerbils were divided into experimental groups: Group A consisted of animals subjected only to experimental ischemia; 5 minutes occlusion of the carotid arteries. Group B consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately before the surgical procedure. Group C consisted of animals subjected to experimental ischemia and to a dose of Ginko Biloba, given intraperitoneally immediately after the surgical procedure. Group D consisted of animals subjected to experimental ischemia and to a dose of the caspase inhibitors z-VAD.FMK and z-DEVD.FMK injected intracerebroventricularly through the right hemisphere before the surgical procedure. Group E consisted of animals subjected to experimental ischemia and to a dose of caspase inhibitors injected after the surgical procedure. Group F consisted of Sham-operated animals. Histological controls were done by H and E and the TUNEL method in the frontal cortex and caudate-putamen. RESULTS: The percentage of normal cells was not statistically significant at analysis with H and E, whereas the TUNEL method showed good protection with Ginko Biloba and caspase inhibitors, when the latter is given in the reperfusion phase. These data were in agreement with data obtained at neurological examination. CONCLUSION: We could say that cellular morphology is in itself an untrustworthy tool for judging the effects of ischemia and protective drugs; the TUNEL method may add important information about the different components of cellular death; the reperfusion phase may be critical for apoptotic phenomena; Ginko Biloba might protect neurons of the frontal cortex from both necrotic and apoptotic death in this model of ischemia.     

Relationship between the prognosis and the morphology of stromal invasion of the breast cancer

I studied on the relationship between the prognosis and the invasion of the breast cancer clinicopathologically. Eight hundred and thirty-nine cases which had invasive cancer foci and mastectomized between 1950 and 1964 at the Cancer Institute Hospital were analyzed. The largest length of the invasive focus was measured histologically as the invasion size. To evaluate quality of the invasion, all invasive foci were analyzed about the composition of 5 morphological types of invasion, which consisted of one type with tubular formation (papillotubular-cribriform) and 4 types without tubular formation (medullary, small nest, pure scirrhous and mucinous). With proportion to the invasion size, 10-year survival rates were gradually diminishing. Cases with 20mm or less invasion size had better prognosis than cases with more than 20mm invasion size. Between tumors consisted with only one morphological type of invasion and tumors consisted of more than one types, the former had better prognosis than the latter. Cases with tubular formation had better prognosis than cases without tubular formation. In conclusion, the invasion size was the most valuable prognostic factor. About quality of the invasion, invasion focus consisted of only one histological type of invasion or of tubular formation was the indicator for better prognosis.     

低白细胞血症肠瘘病人细菌感染危险因素分析

目的 分析导致低白细胞血症的肠瘘病人发生细菌感染的危险因素。方法 对2007年1月至2008年6月南京大学医学院临床学院南京军区南京总医院诊治98例肠瘘病人的临床资料进行回顾性分析。98例病人分为研究组和对照组,研究组由25例发生细菌感染的低白细胞血症肠瘘病人组成,对照组由73例细菌感染阴性的低白细胞血症肠瘘病人组成。结果 导致低白细胞血症肠瘘病人发生细菌感染的唯一独立危险因素是中心静脉置管,在研究组的置管率为40%,在对照组的置管率仅为5.48%。其他危险因素包括：肝功能不全、机械通气和导尿管留置。导致细菌感染阳性的低白细胞血症肠瘘病人发生死亡的危险因素为肾功能不全和导尿管留置。 结论 中心静脉置管是导致低白细胞血症肠瘘病人发生细菌感染的最主要危险因素。这一结论有助于临床医师采取更有效的针对性治疗措施以降低细菌感染的发生率,改善肠瘘病人的预后。     

Management of dislocation of the hip in Down syndrome

Six patients with Down syndrome were treated for dislocation of the hip (10 hips). Follow-up averaged 49 months. Group I consisted of three patients (six hips) with dislocatable hips and normal acetabula treated with capsular plication and/or proximal femoral osteotomy. Group II consisted of three patients (four hips) with dislocatable hips and dysplastic and insufficient acetabula treated with capsular plication, Salter osteotomy, and proximal femoral osteotomy. Results were rated as satisfactory in four patients (seven hips) and unsatisfactory in two patients (three hips).     

Immunohistochemical localization of proteoglycans in interstitial elements of human bladder cancer

The immunohistochemical localization of glycosaminoglycan side chains and core protein of proteoglycan was observed, using monoclonal antibodies, on 8 specimens of non-tumor bladder tissues and 26 specimens of bladder tumors obtained from total cystectomy or transurethral resection of bladder tumor (TUR-Bt). In non-tumor tissues of human bladder examined, the surface of urothelial epithelium consisted of heparan sulfate as revealed with antibody HepSS-1, and submucosal interstitial elements consisted mainly of small proteoglycan having chondroitin 4-sulfate side chains as revealed with antibodies 6B6 and 9A2, respectively. On the other hand, in bladder tumors examined, the interstitial fibrous elements, the so-called "specific stroma" in cancer cell nests, consisted mainly of large proteoglycans having chondroitin 4-sulfate or 6-sulfate side chains as revealed with antibodies 2B1, 9A2 and 3B3, respectively. Antibodies 2B1 and 3B3 are considered to be useful to demonstrate the involvement by invasive growth of bladder tumor cells.     

Role in acute urinary retention

The relationship between prostatic infarction and acute urinary retention was studied. Serial sections of two groups of 100 prostates each were studied for evidence of infarction. One group consisted of patients with acute urinary retention while the other group consisted of patients with benign prostatic hypertrophy. Eighty-five per cent of the retention group had prostatic infarcts while only 3 per cent of the patients with benign prostatic hypertrophy had infarcts. Despite the close association of acute urinary retention with infarction of the prostate, the exact mechanism in the production of acute retention is as yet undetermined.     

Does implant selection affect outcome of revision knee arthroplasty?

We reviewed 139 consecutive femoral or tibial revision knee arthroplasties to determine if the outcome of revision knee arthroplasty using revision implant systems was superior to revisions using primary implant systems. Group 1 (n = 42) consisted of revisions performed with implants designed for primary total knee arthroplasty. Group 2 (n = 42) consisted of revisions performed with modified primary components. Group 3 (n = 55) consisted of revisions performed with components specifically designed for revision arthroplasty. The implant status was known in 123 of 139 knees at a mean follow-up of 7 years (range, 5-12 years). The implant-related failure rate, defined as reoperation requiring component revision or removal, was 26% for group 1, 14% for group 2, and 6% for group 3 (P<.05). Revision implants exhibited superior performance and durability despite their use in more difficult reconstructions. The improved longevity of revision implants justifies the evolution of modular revision components.     

Floating knee injuries treated with single-incision technique versus traditional antegrade femur fixation: a comparative study

Forty-three patients with floating knee injuries were treated from January 1994 through March 1999. The study group consisted of 25 patients treated with retrograde nailing of the femur and antegrade nailing of the tibia through a single incision, and the control group consisted of 18 patients treated with traditional femoral and tibial antegrade intramedullary nailing. The femoral retrograde technique required less set-up time, anesthesia time, and surgical time than did the traditional femoral antegrade technique and was associated with less estimated blood loss. We conclude that the single-incision technique is a safe and faster alternative procedure for type I floating knee injuries.     

Histopathology of compression of the superficial radial nerve in the forearm

A histologic assessment of the radial sensory nerve from a patient with nerve compression is reported. Histologic changes were confined to the region of the nerve compression. Connective tissue changes consisted of an increased thickness of the epineurium and perineurium. Nerve fiber changes consisted of Schwann cell pathology with marked thinning of the myelin noted in the myelinated fibers and evidence of degeneration and regeneration noted in the unmyelinated fiber population. Nerve fiber pathology was not uniform but varied from fascicle to fascicle in the compressed area.     

Trillium-coated oxygenators in adult open-heart surgery: a prospective randomized trial

This randomized, prospective clinical trial examines the impact of the use of Trillium biopassive surface coating on clinical outcomes after cardiopulmonary bypass (CPB) that may be induced by contact of blood elements with foreign surfaces. The study consisted of 98 consecutive patients randomly assigned to either a CPB circuit that consisted of a Trillium-coated Affinity open reservoir oxygenator or a CPB circuit with an uncoated Affinity open reservoir oxygenator. The operative procedure performed on all 98 patients consisted of either coronary artery bypass graft (CABG), valve, or a combination of the two. Exclusion criteria consisted of patients who presented to the operating room in circulatory arrest. Trillium biopassive surface coating resulted in improved clinical outcomes and fewer adverse events when compared to the control group. Significantly, fewer patients required no blood products (18.3% in the control group vs. 32.7% in the treatment group), even though the control group had a significantly higher pre-bypass hematocrit. Postoperative atrial fibrillation (24.5% vs. 16.3%) and reoperation for bleeding (10.2% vs. 4.1%) showed a much lower incidence in the Trillium group. Significance was not reached because of the small sample size resulting in low power. Trillium circuits result in improved patient outcomes in the treatment group when compared to the control circuit group.     

The Essex-Lopresti lesion: a variant with a bony distal radioulnar joint injury

The Essex-Lopresti lesion is an unusual injury, consisting of a radial head or neck fracture, distal radioulnar joint (DRUJ) injury and interosseous membrane rupture. To date, all reported Essex-Lopresti lesions have consisted of soft tissue injuries at the DRUJ. We present a case of an Essex-Lopresti lesion with a bony variant, in which the DRUJ injury consisted of an ulnar head fracture associated with radial head fracture and acute proximal migration of the radius. The management involved plating of the ulnar head fracture and titanium replacement of the radial head.     

PCEA和尼莫地平防治不稳定膀胱的疗效观察

目的：比较硬脊膜外腔自控镇痛术（PCEA）与尼莫地平防治良性前列腺增生（BPH）术后不稳定膀胱的疗效。方法：61例耻骨上经膀胱前列腺切除术后BPH患者，分为A组（PCEA治疗组）、B组（尼莫地平治疗组）、C组（对照组），观察并比较防治不稳定膀胱的疗效。结果：临床症状评分显示有效率A组92％、B组65％、C组21％，A组与C组各症状总评分差异有极显著性意义（P＜0.01)，B组与C组各症状总评分差异有极显著性意义（P＜0.01)，A组与B组各症状总评分差异有显著性意义（P＜0.01)，A组与B组各症状总评分差异有显著性意义（P＜0.05)。结论：PCEA和尼莫地平微泵治疗不稳定膀胱均有疗效，其中PCEA疗效较显著。     

Pseduarthrosis of a tibial plateau fracture: report of a case

In an elderly woman a tibial condylar pseudarthrosis was angulated with disabling pain, significant deformity, and progressive articular deterioration. The treatment of this non-union consisted of arthrotomy, mobilization of the ununited medial condyle, slight over-elevation of the tibial plateau, iliac bone grafting to reconstitute loci of bone loss, and rigid interfragmentary and buttress plate fixation. Postoperative management consisted of early knee motion and delayed weight-bearing to facilitate functional restoration of the extremity. Within 3 months, union occurred in anatomic position.     

The use of daclizumab as induction therapy in combination with tacrolimus and mycophenolate mofetil in recipients with previous transplants

Clinical trials using daclizumab as induction therapy in combination with tacrolimus (TAC) and mycophenolate mofetil (MMF) have been shown to reduce the incidence of acute rejection episodes in solid organ transplantation. In an attempt to obtain a low rejection rate we proceeded with the use of daclizumab as induction therapy, in combination with TAC and MMF for recipients with previous transplants. In this study, we analyzed patients who received previous transplants, treated with the above immunosuppressive regimen. Group A consisted of four patients with previous liver transplants, group B consisted of 16 recipients with previous kidney transplants and group C consisted of three patients with previous simultaneous pancreas-kidney transplants. All patients underwent cadaveric kidney transplants except one patient in group B, who underwent a pancreas transplant. At 12 months, patient and graft survival for all groups was 100 and 100%, respectively. Acute rejection rate was 0% for group A, 12.5% for group B, and 0% for group C. Daclizumab induction therapy is effective for patients with previous transplants and does not appear to increase the risk of acute rejection.     

高敏肾移植受者的二硫基苏糖醇—群体反应性抗体测定及其意义

为了进一步解释群体反应性抗体(PRA)的免疫球蛋白性质及其对异基因肾移植的潜在威胁。方法 借助二硫基苏糖醇(DTT)具有断裂Ig的二硫键,解聚大分子量的IgM分子的原理,将DTT引进PRA实验中,建立DTT-PRA分析方法,以分辨高PRA患者血清中的Ig类型。结果 发现在标准PRA阳性的701例受者中DTT-PRA阳性率为33.1％,依靠患者血清对DTT敏感与否可将PRA阳性患者分为单纯IgM、单纯IgG和IgG、IgM混合类型3种。结论 单纯IgM抗体与移植后排斥反应无关,而单纯IgG和IgC、IgM混合类型的HLA抗体将介导急性甚至超急排斥反应的发生。     

Debridement for osteoarthritis of the elbow in athletes

The results of surgical treatment for osteoarthritis of the elbow in athletes were investigated. Athletic activities consisted mainly of judo wrestling and baseball; and included 26 elbows. The mean age was 32 years. The radiological changes were mild in most cases. Debridement consisted of resecting osteophytes and removing loose bodies. Pain scores were improved, and the range of movement was improved by an average of 24 degrees with an average follow-up of 4 years and 2 months. Recurrence of mild symptoms occurred in most cases.     

Bladder and urethral recordings in acute and chronic spinal cord injury patients.

Three groups of patients with upper motor neuron lesions were studied. A first group consisted of 19 patients with complete lesions and 3 patients with incomplete lesions. All had an unbalanced bladder function which required surgical interventions. A second group consisted of 9 patients with chronic complete lesions who achieved balanced bladder function spontaneously. A third group consisted of 11 patients in the acute stage of injury. Polygraph recordings of pressure within the bladder, urethra, rectum and external anal sphincter were carried out with the help of video-tape monitoring and radiographic image intensification. Special catheter ballons with radiopaque markings were employed for pressure measurements. The behavior of the external urethral sphincter during spinal shock and the sequence of return of sacral somatic and visceral motor reflexes during recovery from spinal shock were investigated. It was shown that in spinal shock, the majority of patients retained sacral segment somatomotor reflex activity, in the absence of visceromotor activity, and that resistance values at the external urethral sphincter remained high. The highest resistance recorded in the membranous urethra was found to be located at the distal external sphincter, just before the bulb of the urethra.