Primary gastrointestinal stromal tumor of the esophagus in an HIV-positive patient

We describe a rare case of malignant gastrointestinal stromal tumor (GIST) of the esophagus presenting in an HIV-positive man. Not only did the tumor arise from an unusual anatomic site for GIST, namely, the esophagus, but it also had a predominant epithelioid cell morphology that is uncommon and preferentially associated with aggressive behavior. Exhaustive immunohistochemical studies showed strong reactivities to the classic GIST marker, CD34, and to the current more sensitive and more specific GIST marker, CD117/ c-kit protein. This immunophenotype corresponded to that of stromal tumors arising in the more common sites like stomach and small intestine as well as to that of a reported series of esophageal GISTs in the general population. Mutations of the c-kit protein was detected in the tumor, confirming previous observations. This further documents that esophageal GIST and the more common benign esophageal spindle cell lesions are pathologically distinct entities and despite its rarity, esophageal GIST should be recognized by pathologists and clinicians. The occurrence of this tumor in an HIV-positive patient is coincidental, and it resulted in an extremely unusual metastatic site that has not been reported for GISTs.     

煤尘抽提物诱发BALB/3T3A31-1-13细胞系形态转化的研究

本文用 BALB/3T3 A31-1-13细胞系研究了煤尘抽提物的转化活性。亚硝化和未亚硝化的煤尘抽提物都能诱发细胞发生转化且有剂量反应关系.但亚硝化煤尘抽提物的转化活性比未亚硝化者高。从转化集落分离出来的细胞具有赘生转化的一些特征,如细胞生长迅速、接触抑制消失和停泊不依赖性生长等.本文结果看来支持煤矿工胃癌高发原因的煤尘假说。     

广州市12~13岁儿童牙龈炎与恒牙龋患病关系的调查分析

【目的】 探讨儿童牙龈炎与恒牙龋的相关关系,为儿童牙龈炎防治工作提供理论依据。 【方法】 采用多阶段分层整群随机抽样的方法共调查广州市12~13岁儿童1 115人。检查方法和标准参考1997年WHO推荐的《口腔健康调查基本方法》,牙龈炎检查六颗指数牙,龋病检查全口恒牙,分别采用牙龈指数(GI)和DMFT记录检查结果。Logistic回归分析儿童牙龈炎与恒牙龋病的关系。 【结果】 广州市12~13岁儿童牙龈炎患病率72.65%,中、重度牙龈炎患病率分别为28.16%和5.83%。恒牙龋患病率为25.83%,其中未充填龋占龋齿的73.73%。Logistic回归分析显示未充填龋是广州市12~13岁儿童牙龈炎患病的危险因素。 【结论】 广州市12~13岁儿童牙龈炎患病率较高,有未充填龋存在的儿童是广州市儿童牙龈炎重点防治人群。     

Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study

OBJECTIVE: Magnetic resonance imaging (MRI) showed that subacromial/subdeltoid bursitis is the most frequent shoulder lesion in polymyalgia rheumatica (PMR). We evaluated whether shoulder ultrasonography (US) was as effective as MRI in the detection of this lesion and assessed the sensitivity and specificity of bilateral subacromial/subdeltoid bursitis in the diagnosis of PMR. METHODS: A case-control study of 57 consecutive case patients with untreated PMR and 114 controls seen over a 6 month period in 3 secondary referral rheumatology centers. Control patients consisted of the next 2 consecutive patients with bilateral shoulder aching and stiffness observed after the case patient. In all case and control patients the glenohumeral joint space, bursae, and long head biceps tendon were assessed by bilateral shoulder US. The first 24 case patients were also examined by bilateral shoulder MRI. RESULTS: US showed subacromial/subdeltoid bursitis in 55/57 (96%) patients with PMR and in 25/114 (22%) controls (p < 0.001). The lesion was bilateral in 53/55 (96%) case patients and in 1/25 (4%) controls (p < 0.001). The frequency of glenohumeral joint synovitis and biceps tenosynovitis did not differ significantly between case patients and controls. In 100% of case patients MRI showed subacromial/subdeltoid bursitis confirming US findings. The sonographic evidence of bilateral bursitis had a sensitivity of 92.9%, specificity of 99. 1%, and positive predictive value of 98. 1% for the diagnosis of PMR. CONCLUSION: US and MRI were equally effective in confirming bilateral subacromial and subdeltoid bursitis in PMR. This finding, in view of its high sensitivity and specificity, could be used as a new diagnostic criterion for PMR.     

Increased myocardial methionine‐enkephalin with reduced arterial oxygenation in congenital heart disease

Background: Cardiac opioid peptides have been identified to exert important adaptive metabolic signalling for cardioprotection against ischaemia or hypoxia‐related injury. Aims: To determine myocardial methionine‐enkephalin content in children with hypoxemic congenital heart defects and to correlate myocardial content of methionine‐enkephalin with the extent of arterial oxygen desaturation. Methods: Children (n= 20, median age of 16 months), undergoing cardiac surgical repair (tetralogy of Fallot, 17/20), were included in this study. Arterial oxygen saturation was measured on admission. Myocardial samples obtained during surgery were assayed via radioimmunochemistry for methionine‐enkephalin content. Results: Greater methionine‐enkephalin content was measured in the right ventricles of the patients suffering from recent cyanotic spells compared with those with no recent spells (cyanotic spells: 2418 ± 844 pg/g wet weight tissue, n= 6; no spells: 1175 ± 189 pg/g wet weight tissue, n= 14, P= 0.04). An inverse correlation was evident between the arterial oxygen saturation and myocardial methionine‐enkephalin content. Conclusion: Myocardial methionine‐enkephalin levels increase with the severity of hypoxic stress in congenital cardiac disease and may play an important adaptive role in countering adrenergic over‐activity and related excess demand on myocardial metabolic capacity.