Combined hepatocellular-cholangiocarcinoma: A clinicopathological study

Combined hepatocellular-cholangiocarcinoma (HCC-CC) is an uncommon form of primary liver cancer having features of both hepatocellular and biliary epithelial differentiation. We reviewed 21 cases of this tumour diagnosed between 1972 and 1996 (patient age range 16–79 years; mean patient age 49.7 years; 18 male and three female patients). Histologically, the majority (n= 18) of tumours were ‘mixed’ tumours, in which areas of hepatocellular and biliary epithelial differentiation were intimately mixed within the same tumours. Two patients had separate tumours in which discrete nodules of HCC and CC occurred in the same livers. One patient had a ‘fibrolamellar’ tumour that histologically simulated the fibrolamellar variant of HCC, but some of the tumour cells were mucin-producing cells. Of the 21 cases, mucin was demonstrable in 16 and, in the few mucin-negative tumours, electron microscopic studies confirmed the presence of the dual differentiation. The tumours frequently exhibited an invasive character with frequent venous permeation, direct invasion into adjacent liver parenchyma and tumour microsatellite formation, similar to that of ordinary HCC. Histological evidence of cirrhosis or chronic hepatitis was present in 77.8% of patients and 75% of patients were hepatitis B surface antigen positive. Raised serum α-fetoprotein (AFP) levels (above 300 ng/mL) were present in 61.5% of patients and AFP was detected immunohistochemically in 55% of tumours. The overall survival times of patients with HCC-CC were short. In conclusion, HCC-CC showed clinical and pathological features more akin to those of ordinary HCC than to CC.     

Hormonal changes related to reduced renal blood flow and low urine output under prolonged increased intra-abdominal pressure in pigs.

OBJECTIVE: To investigate effects of prolonged increased intra-abdominal pressure (IAP) on diuresis, renal blood flow, and hormones that influence renal function, in particular endothelin. DESIGN: Experimental study. SETTING: Haukeland University Hospital, Norway. ANIMALS: 21 domestic pigs. METHODS: The TAP was maintained at normal (n = 7) or at 20 mmHg (n = 7) or 30 mmHg (n = 7) for three hours. MAIN OUTCOME MEASURES: Urine output, renal venous pressure, renal artery blood flow (transit-time flowmetry), renal cortex blood flow (microspheres), and renin, aldosterone, atrial natriuretic factor (ANF), adrenaline, noradrenaline, cortisol, and endothelin-1 (ET-1) in renal venous blood. RESULTS: An IAP of 20 mmHg was followed by no significant changes in the variables studied. An IAP of 30mmHg was associated with anuria, considerably reduced renal blood flow and increased renal vascular resistance. The renin activity and the blood concentrations of ET-1, aldosterone, noradrenaline, adrenaline, and cortisol increased during the three hours that IAP was at 30 mmHg. CONCLUSION: An IAP of 20 mmHg did not influence renal haemodynamics or diuresis. The low renal blood flow observed at an IAP of 30 mmHg probably results from reduced arteriovenous pressure difference and vasoconstriction. Increased concentrations of endothelin, angiotensin II, and noradrenaline may account for the vasoconstriction. The anuria can be explained by low renal blood flow and increased reabsorption of sodium in renal tubules caused by aldosterone.     

Plasma concentrations and transperitoneal transport of native insulin and C-peptide in patients on continuous ambulatory peritoneal dialysis

The insulin and C-peptide response to glucose (50 g), given intraperitoneally or enterally, and the elimination rate of these compounds has been studied in five nondiabetic patients on continuous ambulatory peritoneal dialysis (CAPD). The fasting C-peptide concentrations were three to ten times the normal values, whereas the fasting plasma insulin concentrations were within normal limits. After intraperitoneal glucose administration, a more marked hyperglycemia (P less than 0.05) and a more long lasting hyperinsulinemia (P less than 0.05) were found than after the enteral glucose load. The relative change in plasma C-peptide was slower and less pronounced in both experiments. Estimated total body clearance (Kt) for insulin was higher than for C-peptide (P less than 0.01), but dialysis clearance (Kd) for C-peptide was higher than for insulin in both experiments (P less than 0.01). The markedly elevated fasting C-peptide concentrations in plasma can be explained only partly by the absence of normal kidney function and suggests a continuously increased production of C-peptide during CAPD treatment. This was not reflected by the fasting plasma insulin concentrations. C-peptide measurements in plasma and dialysate during CAPD could be helpful in evaluating the beta-cell function in patients in need of exogenous insulin.     

Atrial natriuretic factor in cats subjected to acute myocardial ischaemia.

Eighteen anaesthetized open chest cats were subjected to 10, 30, or 50 min occlusion of the left anterior descending coronary artery (LAD). Heart rate, left ventricular end-diastolic (LVEDP) and systolic pressure (LVSP), and dp/dt were continuously recorded during the experiments. Prior to LAD-occlusion, and just before termination of the experiments, blood samples were collected from the left femoral artery for measurements of atrial natriuretic factor (ANF), catecholamines, electrolytes, urea, and creatinine. Simultaneously, biopsies were collected from the right auricular wall. The tissue was embedded in Lowicryl K4M, and ultrathin sections were incubated with anti-ANF antibodies and secondary antibodies conjugated to gold particles. The density of ANF-containing atrial-specific granules labelled with gold particles was morphometrically calculated. LVEDP increased significantly in all three time groups, and when pooling the pre- and postocclusion values, there was an increase from 5.1 +/- 0.4 to 10.3 +/- 1.2 mmHg (p < 0.05). The noradrenaline level increased from 0.93 +/- 0.18 to 2.34 +/- 0.75 nmol l-1 (p < 0.05) after LAD-occlusion. Similarly, the mean plasma level of ANF in the 18 cats increased from 57.6 +/- 11.9 to 98.9 +/- 22.6 pmol l-1 (p < 0.05). Atrial granular density appeared to decline after 10 min of occlusion (from 0.141 +/- 0.017 to 0.127 +/- 0.022 granules-1 microns 2 sarcoplasm), and after 30 min there was a significant decrease (0.080 +/- 0.012 granules/microns 2, p < 0.05). However, after 50 min occlusion the granular density was almost restored (0.133 +/- 0.017 granules/microns 2). Plasma ANF showed a positive linear correlation to LVEDP and to the noradrenaline level.(ABSTRACT TRUNCATED AT 250 WORDS)     

ACR-NEMA digital imaging and communications standards: minimum requirements

The purposes, implications, and history of development of the American College of Radiology-National Electrical Manufacturers Association (ACR-NEMA) Digital Imaging and Communication Standard and its contents are briefly described, and the minimum requirements of the ACR-NEMA Digital Imaging and Communication Standard are described with a concise introduction of each layer. The usefulness, validity, current status, and future development of the standard are also discussed.     

The Bergen Blood Pressure Study: Sodium Intake and Ambulatory Blood Pressure in Offspring of Hypertensive and Normotensive Families

Sodium intake, estimated by the 24-h urine sodium excretion, was assessed in 39 offspring of hypertensive families and 37 offspring of normotensive families. The family history of hypertension or normotension was defined according to parental BP data from two surveys conducted 27 years apart. Urine sodium excretion was similar in offspring of hypertensive and normotensive families, averaging 136 and 137 mmol/24 h, respectively. Monitored by non-invasive methodology in the urine sampling period, the average 24-h ambulatory blood pressure (BP) was approximately 10/10 mmHg higher in offspring of hypertensive than normotensive families. The clinically and statistically significant differences in BP between groups could not be explained by differences in sodium intake. After adjustment for confounding variables, the BP was not associated with the sodium excretion in the material as a whole or in either offspring group.     

Thymectomy and anti-muscle autoantibodies in late-onset myasthenia gravis

Thymectomy is still widely carried out in myasthenia gravis (MG) patients, but its role, especially in late-onset MG patients, is not established. These patients are immunologically heterogeneous, some with thymoma-like and others with early onset-like features. We evaluated whether any therapeutic effects of thymectomy correlate with the presence of non-acetylcholine receptor (AChR) muscle antibodies. The severity of MG, and titin and ryanodine receptor (RyR) antibodies, were assessed yearly starting from MG onset in 21 thymectomized and 22 non-thymectomized AChR antibody positive late-onset MG patients, who were followed for 2, 3 and 5 years. Clinical or pharmacological remission were seen in six of 11 titin antibody negative but none of the 10 titin antibody positive thymectomized patients, however, the non-thymectomized cases showed an opposite trend. The three MG-related deaths were all in patients with titin antibodies. There was no significant difference in MG severity between thymectomized and non-thymectomized patients; 2 years after MG onset, both groups were significantly improved. This study showed no dramatic benefit from thymectomy in late-onset MG in general. Any limited improvement appeared less likely in cases with titin and/or RyR antibodies.     

Wert der transtrachealen Aspiration bei bronchopulmonalen Infektionen im Erwachsenenalter

Zusammenfassung Es wurde eine bakteriologische Untersuchung des Trachealaspirates und des Sputums bei 341 Patienten mit 1. Pneumonie oder Bronchopneumonie, 2. Asthma, chronischer Bronchitis oder Emphysem (ABE), 3. Lungenembolie und 4. anderen, nicht pulmonalen Erkrankungen durchgeführt. Bei 47% der Pneumoniepatienten wurden im Trachealaspirat Bakterien mit einer für die Luftwege anerkannten Pathogenität isoliert, überwiegend in Monokultur. In der ABE-Gruppe wurden pathogene Bakterien bei 21% der Patienten gefunden, meistens in Mischkultur. In den wenigen Fällen, wo bei einer Lungenembolie oder nicht pulmonalen Erkrankung ein bakteriologischer Befund vorlag, handelte es sich fast stets um apathogene Bakterien. In den Sputumproben aller Patientengruppen fanden sich überwiegend Mischkulturen mit zwei bis fünf Keimarten, wobei die Häufigkeit von Enterobakterien auffallend war.Eine vergleichende Untersuchung zweier Transportmedien ergab, daß die Gefahr des Verlustes der Nachweismöglichkeit vonHaemophilus influenzae selbst nach kurzer Transportzeit besteht. Von den 145 Patienten, deren Nasopharynx vor der transtrachealen Aspiration mitSerratia marcescens kontaminiert wurden, konnte nur bei einem Patienten Serratia unterhalb der Stimmbänder wiedergefunden werden. Die transtracheale Aspiration bot eine bessere Grundlage für eine genaue ätiologische Diagnose als die Sputumuntersuchung. Die technische Ausführung ist einfach, es traten keine ernsthaften Komplikationen auf.

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The value of transtracheal aspiration in bronchopulmonary infections in adults

Summary The bacteriological findings in transtracheal aspirate and sputum are reported in 341 patients with 1. pneumonia or bronchopneumonia, 2. asthma, chronic bronchitis or emphysema (ABE), 3. pulmonary embolism and 4. non-pulmonary diseases. In 47% of the patients with pneumonia or bronchopneumonia pulmonary pathogens were isolated from the tracheal aspirate — usually in pure culture, whereas aspirates from patients in the ABE-group yielded pulmonary pathogens in 21% — mostly in mixed culture. Bacteria — predominantly non-pathogenic organisms — could be demonstrated in the aspirate from only a small number of patients with pulmonary embolism or nonpulmonary diseases. In all patient groups, sputum yielded mainly mixed cultures with two to five different species of bacteria and a striking frequency of enterobacteria. Evaluation of two different transport media showed that the possibility of demonstratingHaemophilus influenzae may be lost even after a short-lasting transport. In 145 patients whose nasopharynx had been contaminated withSerratia marcescens prior to the transtracheal aspiration, the marker was recognized in the tracheal aspirate from one patient only. The tracheal aspirate provided a better basis for the bacteriological diagnosis than did sputum cultures. The procedure is simple and easy to perform, and no serious complications occurred.

     

Balloon cell melanoma mimicking clear cell carcinoma

Balloon cells may occur in both benign nevi and malignant melanomas. Sometimes they dominate the histological appearance and cause difficulties in biopsy interpretation. There are no specific clinical characteristics. We report a metastatic balloon cell melanoma where the primary tumour was not identified and the histological appearance mimicked that of a clear cell renal carcinoma.