Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation

CT scans of 47 patients who had peripheral bronchogenic carcinoma contiguous to the pleural surface and who had undergone thoracotomy were retrospectively reviewed. The CT features of the primary neoplasm that were analyzed included the angle and amount of contact with the adjacent pleural surface, associated pleural thickening, fat plane between the tumor and chest wall, rib destruction, and chest wall mass. CT was of limited predictive value in separating those patients who had parietal pleural/chest wall involvement from those who did not. The combination of two or three CT findings (obtuse angle, greater than 3 cm contact with pleural surface, associated pleural thickening) resulted in a sensitivity of 87% and a specificity of 59%. The clinical symptom of focal chest pain, while not as sensitive (67%) as CT, was much more specific (94%) for parietal pleura/chest wall invasion.     

Gallbladder bile in cholecystitis: in vitro MR evaluation

Fifty-three samples of gallbladder bile were obtained at the time of cholecystectomy from patients with the clinical diagnosis of acute or chronic cholecystitis. Five bile samples from patients with clinically normal gallbladders also were obtained. Proton magnetic resonance (MR) relaxation times, protein content, and water content were determined for the bile samples, and the data were grouped according to pathologic diagnosis, which disclosed 11 cases of acute cholecystitis, 41 cases of chronic cholecystitis, and six normal gallbladders. There was no significant difference in the mean T1 and T2 values between the groups with acute and chronic cholecystitis. Patients with chronic cholecystitis were found to have more concentrated bile than those with acute cholecystitis. Protein content varied widely within both groups of patients. We conclude that T1 and T2 relaxation times do not reliably differentiate acute from chronic cholecystitis.     

The bile ducts after a fatty meal: further sonographic observations

The sonographic appearance of the response of the common hepatic duct to physiologic stimulation by a fatty meal was assessed in 131 patients referred because of right upper quadrant symptoms or abnormal liver chemical studies. In the determination of the presence or absence of biliary obstruction, the sensitivity of the examination was 84%, the accuracy of a positive test was 84%, and the accuracy of a negative test was 93%. This test proved helpful in several circumstances: equivocal duct caliber (6-10 mm); abnormal caliber (6-14 mm) with normal laboratory values; normal caliber duct with abnormal laboratory values; persistent question of cholelithiasis or asymptomatic pancreatic duct dilatation. Measurements of bile duct caliber alone may be insufficient to ascertain the presence of bile duct obstruction and fatty meal stimulation significantly improves diagnostic accuracy.     

Obstructed calycocystostomy site in association with a transplanted kidney: percutaneous management

We have used advanced endourologic techniques in the treatment of an obstructed lower-pole calycocystostomy site. The unusual clinical course that led to this problem and the interventional treatment used are discussed.     

人类免疫缺陷病毒感染细胞的Rer蛋白依赖性凋亡引导

目的:以人类免疫缺陷病毒(HIV)调节蛋白Rev与Rev反应区(RRE)的高亲和性建立引导HIV感染细胞凋亡的结构。方法:用分子克隆技术合成含RRE和肿瘤坏死因子受体-1(TNF-R1)的Rev依赖性凋亡引导质粒,流式细胞仪检测质粒表达。结果:新质粒pDM128-TNF-R1(pT128)HindIII内切有3.1、2.7、1.0和0.87kb片段;聚合酶链反应(PCR)法检测示TNF-R1的1360bp片段。DNA测序法确认其准确性。单纯Hup60TNF-R1在pDC302(pT60)转染Hela,TNF-R1表达可明显杀伤Hela(P<0.01),Rev存在时,pT128也能表达TNF-R1杀伤Hela(P<0.01),但不及pT60的作用(P<0.01);无Rev时,pT128不表达TNF-R1,不杀伤Hela(P>0.01)。单纯Rev不杀伤Hela(P>0.01)。pT128与pRev共转,TNF-R1表达较pT60慢(P<0.01),40h后才接近单纯pT60。结论:新质粒具有Rev依赖性表达作用,进而引导Rev表达细胞凋亡。     

Image-guided pleural biopsies: indications, technique, and results in 23 patients

Twenty-six pleural biopsies were performed on 23 patients over a 3-year period. Twenty-three biopsies were performed guided with ultrasound; one, with computed tomography; and two, with fluoroscopy. Indications for an image-guided pleural biopsy were (a) pleural masses or thickening that were either not seen on chest radiographs or seen only on one view and (b) small or loculated pleural effusions of unknown cause with no mass seen. If only pleural fluid was present, reverse bevel needles were used for biopsy (n = 15). If a discrete pleural mass or thickening was seen with cross-sectional imaging, standard (16-20 gauge) biopsy needles were used (n = 11). In the 23 patients, biopsy results were true positive in ten (nine with malignancy, one with tuberculous pleurisy), true negative in ten (confirmed either at subsequent thoracotomy or clinical follow-up), and false negative in three. Complications were few, with a significant pneumothorax occurring in two patients (8.7%). Image-guided biopsy of small pleural lesions and small pleural effusions can be performed by the radiologist who understands the special needles and techniques involved.     

腹腔镜胆囊切除术后腹壁肌间囊肿1例

1　病例报告　女 ,38岁 . 1 998- 1 0 - 2 0因右腰部包块逐渐增大 1 a入院 . 1 a前患者洗澡时发现右腰部核桃大小包块 ,逐渐增大且隐痛 ,不伴发热、盗汗及消瘦 ,饮食及大、小便正常 .患者于 3a前曾因胆囊结石在某院行腹腔镜胆囊切除术 ,术中经腹壁戳创口取出胆囊时 ,胆囊破裂 ,术后并发腹壁戳创口感染 ,并从戳创口夹出数枚米粒大小结石 ,经换药治愈 .查体 :T 36℃ ,肥胖 .于右腰区见 1 5 cm× 1 0 cm× 5 cm包块 ,皮色如常 ,皮温不高 ,包块质软 ,有囊性感 ,边界欠清 ,基底部固定 ,活动度差 ,无明显压痛 .B超 :右侧腹壁囊性包块 ,壁不规则增…