N终端脑钠尿肽激素原诊断早期心力衰竭的优势分析

目的 :分析慢性心力衰竭 (心衰 )患者心衰程度与N终端脑钠尿肽激素原 (Nt proBNP)血浆浓度的相关性 ,并与血浆肾素 血管紧张素 醛固酮系统 (RAS)的激素水平及内皮素 (ET)浓度比较 ,了解心衰发生发展过程中神经内分泌方面的变化 ,以探讨心衰的早期诊断和治疗的理论依据。方法 :38例心脏病患者根据纽约心脏病协会分级标准分为A组 (心功能Ⅰ级 )、B组 (Ⅱ级 )、C组 (Ⅲ级及Ⅳ级 )三组 ,正常对照组 2 2例。分别用ELISA法检测Nt proBNP血浆浓度 ,放射免疫法检测RAS的激素水平、ET血浆浓度 ,心脏彩色B超检测其射血分数(EF)。结果 :B组和C组患者的Nt proBNP、ET血浆浓度、RAS的激素水平与正常对照组比较 ,差异均有统计学意义 (P <0 .0 5 ) ;B组与C组比较 ,Nt proBNP、ET血浆浓度的差异仍然具有统计学意义 (P <0 .0 5 ) ,而RAS的激素水平虽升高 ,但差异无统计学意义 (P >0 .0 5 )。在无症状性心衰患者 (EF <5 0 %但无心衰症状 )则仅Nt proBNP浓度升高有统计学意义 (EF≥ 5 0 %∶EF <5 0 % ,P <0 .0 5 )。结论 :慢性心衰患者均存在神经内分泌的过度激活 ,而以Nt proBNP血浆浓度升高更为敏感 ,可望作为评价心衰严重程度和早期心功能受损的指标。     

Octreotide therapy for pancreaticopleural fistula

Abstract Pancreaticopleural fistula is a rare but remediable complication of pancreatitis. Hitherto, treatment by means of total parenteral nutrition and thoracocentesis had resulted in an overall success rate of 40% only. Surgical obliteration of persistent fistulae is required in many cases, as the underlying pancreatic duct lesion often prevents spontaneous closure of the fistula. We report a patient suffering from pancreaticopleural fistula with a tightly strictured pancreatic duct. The fistula was successfully obliterated with the use of octreotide addition to thoracocentesis and total parenteral nutrition. Pancreatic bypass surgery was later performed only for pain relief. We believe that octreotide can effectively suppress pancreatic secretion and promote closure of pancreaticopleural fistula even in the presence of severe pancreatic duct lesions. Thus the risk of infection and early surgery for persistent fistula can be minimized.     

Rhabdomyomatous Mesenchymal Hamartoma of the Vagina

Abstract: Rhabomyomatous mesenchymal hamartoma (RMH) is a rare hamartomatous lesion in the dermis and subcutaneous tissue. We report a case of solitary RMH occurring on the vagina of a newborn infant.     

Ventricular Tachycardia and Ventricular Fibrillation in Patients with Short P-R Intervals and Narrow QRS Complexes

Eleven patients with short P-R Intervals and narrow QRS complexes had ventricular tachycardia due to organic heart disease: mitral valve prolapse with mitral insufficiency (2 patients); alcoholic (?) cardiomyopathy (2 patients); and coronary artery disease (7 patients). Intracardiac studies showed short A-H intervals during sinus rhythm in all cases. The onset of ventricular fibrillation (which, to our knowledge, has not been observed in patients having short P-R and A-H intervals coexisting with narrow QRS complexes) was documented in 4 cases. Only 1 patient (with quinidine syncope) had been premedicated. In the 3 other patients the episodes of ventricular fibrillation appeared during bouts of atrial fibrillation with rapid ventricular rates which could have been an expression of the “enhanced A-V conduction” that had been manifested in sinus beats by short P-R and A-H intervals. In clinical settings and physiological conditions proven to be hemodynamicaliy unstable (such as transient ischemia or acute myocardial infarction) these rapid ventricular rates could have led to ventricular fibrillation; directly because of the R-on-T phenomenon, and/or indirectly due to decreased coronary perfusion. Ventricular tachycardia and ventricular fibrillation due to organic heart disease probably occur more often than suggested by the few reported cases in the literature. Its significance, however, has to be clarified by further prospective studies     

Metabolic and histological features of non-alcoholic fatty liver disease patients with different serum alanine aminotransferase levels

Background  Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in affluent countries. Serum alanine aminotransferase (ALT) level is commonly performed to monitor NAFLD patients, but its clinical relevance is unclear.
Aim  To evaluate the metabolic and histological features of NAFLD patients with different ALT levels.
Methods  A total of 173 consecutive patients with biopsy-proven NAFLD were studied. Patients with persistently normal ALT and those with abnormal ALT were compared.
Results  Patients with persistently normal ALT had lower steatosis grade than patients with abnormal ALT, but they had similar degree of lobular inflammation, ballooning and fibrosis. Among 19 patients with ALT below 0.5 times the upper limit of normal (ULN) at the time of liver biopsies, 8 (42%) and 3 (16%) had steatohepatitis and significant fibrosis respectively. The within-patient coefficient of variance was similarly high in patients with simple steatosis and steatohepatitis (33.5). Age and glucose, but not ALT, were independent factors associated with significant fibrosis.
Discussion  Metabolic factors, but not ALT, are associated with histological severity. Patients with ALT < 0.5 × ULN may still have non-alcoholic steatohepatitis (NASH) and significant fibrosis. Evaluation of NAFLD patients should be based on metabolic risk factors, but not ALT level.     

Long-Term Clinical Outcomes and Stent Thrombosis of Sirolimus-Eluting Versus Bare Metal Stents in Patients with End-Stage Renal Disease: Results of Korean Multicenter Angioplasty Team (KOMATE) Registry

Background: There are still controversies about long-term clinical outcomes of sirolimus-eluting stents (SES) versus bare metal stents (BMS) implantation in patients with end-stage renal diseases (ESRD).
Objective: To compare long-term outcomes in patients with (ESRD) following SES versus BMS implantation.
Methods: Between March 2003 and July 2005, a total of 54 patients (80 lesions) with ESRD undergoing SES implantation [SES-ESRD] were enrolled and compared with 51 patients (54 lesions) with ESRD receiving BMS during the same periods [BMS-ESRD] in the Korean Multicenter Angioplasty Team Registry. The primary outcome was the composite of death, myocardial infarction (MI), or any stent thrombosis (ST) according to the Academic Research Consortium definition during a 3-year follow-up.
Results: The cumulative 3-year rate of composite of death, MI, or ST of the SES-ESRD group (24%) was nearly similar with that of the BMS-ESRD group (24%, P = 1.000). The 3-year rates of death (26% vs. 24%, P = 0.824) or MACE (37% vs. 43%, P = 0.331) in the SES-ESRD did not differ significantly from those in the BMS-ESRD. However, the SES-ESRD showed a sustained lower 3-year TVR rate (9%), compared with BMS-ESRD (24%, P = 0.042). The rate of any ST in SES-ESRD was not significantly higher than that in the BMS-ESRD (17% vs. 14%, P = 0.788). There was no significant difference in the rate of late or very late ST between SES-ESRD (15%) versus BMS-ESRD group (10%, P = 0.557).
Conclusions: SES did not increase the risks for death, MI, or any ST in patients with ESRD during the long-term follow-up, compared with BMS.     

Multiple Subepidermal Calcified Nodules on the Thigh Mimicking Molluscum Contagiosum

Abstract: Subepidermal calcified nodule (SCN) is a rare form of calcinosis cutis that presents as a solitary verrucous nodule on the face. Here, we report an unusual case of SCN. A healthy 2‐year‐old boy presented with multiple, round, hard, yellow‐white to erythematous lesions on his right thigh. Histopathologic examination of a punch biopsy specimen revealed deposition of calcium in the dermis.     

Anti‐angiogenic factor endostatin in osteosarcoma

Neoplastic neovascularization is regulated not only by stimulators, but also by inhibitors of angiogenesis and might be the result of a net balance between the positive and negative regulators. Endostatin (ES) is a potent inhibitor of angiogenesis. The expression of ES has not been investigated in patients with osteosarcomas (OSAs). The aim of this study was to determine whether there is a correlation between the expression of ES and clinicopathologic parameters and/or outcomes in patients with OSAs. We made tissue microarrays from 46 cases of OSA and analyzed the expression of ES using immunohistochemistry. Staining was assessed in a semi‐quantitative manner by scoring the proportion of positive tumor cells over the total number of tumor cells. A sample was defined as ES‐positive when 10% or more of the tumor cells were stained positively throughout the tumor core. ES was localized to the cytoplasm of the tumor cells. 32.6% (15/46) of the patients were ES‐positive. The expression of ES was positively correlated with tumor size (p = 0.011), histologic grade (p = 0.034), stage (p = 0.025), and distant metastasis (p = 0.036). Our results suggest that the expression of ES is increased in OSA, and ES may be used as a prognostic marker in patients with OSAs.     

Immunohistochemical analysis of NF‐κB signaling proteins IKKε, p50/p105, p52/p100 and RelA in prostate cancers

Seo SI, Song SY, Kang MR, Kim MS, Oh JE, Kim YR, Lee JY, Yoo NJ, Lee SH. Immunohistochemical analysis of NF‐κB signaling proteins IKKε, p50/p105, p52/p100 and RelA in prostate cancers. APMIS 2009; 117:623–8. Activation of nuclear factor‐kappa B (NF‐κB) signaling is considered an important mechanism in the development of prostate cancers. A recent study revealed that IκB kinase epsilon (IKKε), an activator of NF‐κB, was overexpressed in breast cancers and acted as an oncogene. Expression of NF‐κB members has been reported in prostate cancer tissues, but expression of IKKε has not yet been studied in prostate cancers. In this study, we attempted to explore as to whether expressions of IKKε and NF‐κB members p50/105, p52/p100 and RelA are altered in prostate cancers. We analyzed the expression of IKKε, p50/105, p52/p100 and RelA in 107 prostate adenocarcinoma tissues by immunohistochemistry using a tissue microarray (TMA) method. In the TMA, IKKε is expressed in basal cells, but not in alveolar cells in normal prostate glands. IKKε is expressed in 60.0% of prostate intraepithelial neoplasm (PIN) and 70.1% of the prostate cancers in the cytoplasm. Nuclear immunostainings of NF‐κB members p50/105, p52/p100 and RelA, which are considered activation of NF‐κB signaling, were observed respectively in 28.0%, 18.7% and 37.4% of the cancers. Nuclear staining was detected neither in normal alveolar cells nor in PIN. However, none of the expression of p50/105 nor p52/p100 nor RelA nor IKKε was associated with pathologic characteristics, including size of the cancers, age, Gleason score and stage. The increased cytoplasmic expression of IKKε as well as the increased nuclear expressions of p50/105, p52/p100 and RelA in the prostate cancers compared to normal alveolar cells suggested that overexpression of these proteins may be related to activation of the NF‐κB pathway and might play a role in tumorigenesis of prostate cancers.