Pericardial effusion in renal disease: to tap or not to tap

The natural history of pericardial effusions attributable to renal disease is variable. Although aggressive hemodialysis may lead to the resolution of some effusions, some reports suggest that prompt drainage is optimal. We describe a case of a 49-year-old woman who presented with end-stage renal disease and a large pericardial effusion. Although she was hypertensive on presentation and had no pulsus paradoxus, transthoracic echocardiography revealed stigmata of cardiac tamponade, including right atrial and ventricular collapse, as well as a plethoric inferior vena cava. Because of the lack of certain clinical signs of tamponade and due to concern about excess bleeding risk in the setting of uremia, the effusion was initially managed with serial dialysis rather than pericardiocentesis. The effusion did not decrease in size despite 1 week of hemodialysis, and the patient developed acute dyspnea, relative tachycardia and hypotension after an increase in the blood flow rate during hemodialysis, all of which resolved with a decrease in the blood flow rate. The onset of dyspnea during a session of dialysis as a symptom of tamponade physiology has not been reported previously. We believe that this case supports early pericardiocentesis in patients with any degree of echocardiographic evidence of tamponade. We discuss this in the context of existing literature, which suggests that pericardiocentesis, rather than dialysis, is the preferred management strategy for large uremic pericardial effusions, even in the absence of evidence of clinical signs of pericardial tamponade.     

Human Tumour Immunology

Summary: Many human cancer cells appear to differ from their normal counterparts in ways that are recognisable by the immune system of the host or patient. The specificities of these differences, however, and the nature, extent and significance of the host responses to them are often not very clear. Disturbances of the immune system generally contribute little to the occurrence, progression and clinical features of common malignant diseases. The present value of immunological monitoring of cancer patients is rather limited. Immunotherapy remains an experimental mode of treatment, the results of which are often disappointing. Current studies of the host-tumour relationship in experimental animals and man suggest, however, that a wholly pessimistic view is not justified.     

Phagocytic Tumour Cells

In two patients, one with carcinoma of the lung and the other with carcinoma of the breast, bone marrow aspirates contained tumour cells in the cytoplasm of which were red cells. Special stains were used to confirm this observation. A review of 99 other bone marrow aspiates containing metastatic tumour cells failed to reveal other examples of this phenomenon.     

Erythrocytosis and Wilms' Tumour

A Wilms' tumour was diagnosed in an 18-year-old male patient with erythrocytosis. After radical excision of the tumour and postoperative irradiation and chemotherapy, the erythrocytosis disappeared and did not recur during a 2-year observation period. The levels of erythropoiesis-stimulating activity in serum and in the renal mass suggest the tumour as the source of this activity. The rarity of the association is discussed and a review of the literature is given.     

瘤苗主动免疫疗法的实验研究

采用Ｃ５７ＢＬ小鼠和Ｌｅｗｉｓ肺低分化癌细胞株进行瘤苗主动免疫疗法的实验研究。结果表明：（１）单纯瘤苗注射组１０只动物的瘤苗注射区及各脏器均未见肿瘤生长。各脏器也未见明显病理改变；（２）瘤苗注射治疗Ｄ组植入１×１０５癌细胞，植入区与各脏器均未见癌生长。而治疗Ｃ组植入２×１０７癌细胞，植入区均有瘤结生长，但瘤结体只明显小于对照组（０．０４１ｃｍ３：０．４３１ｃｍ３），肺只有１只动物有一个转移瘤结（对照组９只肺有１～２个转移瘤结）；（３）从Ａ组瘤苗注射区及其他组瘤结印片观察显示有巨噬细胞吞噬活跃，癌细胞周围有许多巨噬细胞、淋巴细胞侵蚀癌细胞现象。表明瘤苗的抑瘤作用可能主要通过细胞免疫来完成。     

Tumour invasion and matrix metalloproteinases

Matrix metalloproteinases (MMPs) are proteolytic enzymes which play a major role in tumour invasion. They are mainly produced by host stromal cells in most carcinomas and their expression implies a close co-operation between tumour and stromal cells. Increasing data also demonstrate that, in association with a process of epithelial-to-mesenchymal transition, many MMPs can be expressed by tumour cell themselves. Their most well-known role is the degradation of extra-cellular matrix macromolecules which in turn may regulate tumour invasion in some conditions. This ECM degradation generates some matrikins which are also implicated in tumour invasion and angiogenesis. Moreover, MMPs are also implicated in the degradation of cell adhesion molecules and release and activation of growth factors.