Vernarbendes Pemphigoid mit Autoantikörpern gegen Laminin-5 (Epiligrin) bei einer Patientin mit metastasierendem Endometriumkarzinom

Zusammenfassung Berichtet wird über eine 71j?hrige Patientin mit erosiver Stomatitis, Vulvitis und Konjunktivitis, jedoch ohne Hautbeteiligung, bei der ein Jahr vor dem Auftreten der Schleimhautl?sionen ein metastasierendes Adenokarzinom des Endometriums diagnostiziert worden war. Die Histologie zeigte eine junktionale Spaltbildung, die direkte Immunfluoreszenz peril?sionaler Haut lineare Ablagerungen von C3 und IgG entlang der BMZ. Mit Hilfe der indirekten Immunfluoreszenz lie?en sich niedrigtitrige anti-BMZ-Antik?rper nachweisen, die in der Spalthautanalyse am Boden der artifiziellen Blase banden. Die Autoantik?rper der Patientin pr?zipitierten ein Spektrum an Proteinen, das für Epiligrin/Laminin-5 typisch ist, und banden im Immunoblot spezifisch die alpha-Kette des Heteropeptids. Aufgrund dieser Ergebnisse stellten wir die Diagnose eines vernarbenden Pemphigoids vom anti-Epiligrin-Typ. Unter Behandlung mit Methylprednisolon und Dapson konnte eine rasche Remission erzielt werden, trotz Progression des metastasierenden Adenokarzinoms. Bisher wurden weltweit nur 8 Patienten mit vernarbendem Pemphigoid vom anti-Epiligrin-Typ beschrieben; unsere Patientin stellt den ersten in ?sterreich diagnostizierten Fall dar und gleicht sowohl klinisch als auch immunpathologisch den bisher beschriebenen F?llen. Eingegangen am 23. Januar 1997 Angenommen am 25. Juni 1997     

The economic considerations in laparoscopic surgery

There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589±$223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient. Instrument cost was evaluated, showing that the surgeons who used disposable instruments had an average instrument cost of $806±$63 per case, whereas those using reusable products had an average cost of $303 per case. (A reprocessing cost of $200 was also added when reusable instruments were used. This included the cost of cleaning, repairs, and labor costs for this equipment.) The cost of disposable and reusable products was evaluated in terms of the initial purchase price, replacement charges, equipment maintenance charges, and labor costs for cleaning, repackaging and inspection, sterilization, and quality control. A second factor identified was that patients directed to an inpatient nursing unit incurred an average direct nursing labor cost of $124, whereas the cost was only $54 when the patient went to an out-patient unit. A third observation demonstrated that the operating room time averaged 203 min±31 min, and the length of the operative procedure accounted for only 96 min±20 min of the total operating room time. From this data it appears that, in hospitals with more than 300 laparoscopic cholecystectomy cases per year, the costs of using reusable and disposable instruments is similar. Time/motion studies in the operating room have also been instituted, along with changes in postoperative physician orders, to decrease the cost of the hospitalization.     

Distal limb deficiency following chorionic villus sampling?

We have reviewed the follow-up of almost 3000 completed pregnancies in the Münster CVS Program and identified 4 children with distal limb deficiencies. Two cases involved only minor anomalies of distal digital phalanges. One child had a Hanhart anomaly (hypoglossia hypodactylia). We also reviewed 24 cases of limb defects following CVS reported previously. With the exception of a single series, neither the overall incidence of affected children nor cases reported from larger series provide unambiguous evidence of an increased risk of distal limb deficiency caused by CVS.     

Oral Leukoplakias Show Numerical Chromosomal Aberrations Detected by Fluorescence in Situ Hybridization

To examine at which stage in the multistep process of head and neck tumorigenesis numerical chromosomal alterations can be detected by fluorescence in situ hybridization (FISH), biopsies and cell smear preparations of clinically healthy oral tissue, premalignant lesions (leukoplakias), and tumors were analyzed by FISH using chromosome-specific centromeric probes. Aberrations found in tumor biopsies and in tumor cell smears consisted of trisomy of chromosomes 1, 7, 10, and 17 and monosomy of chromosomes 1, 7, 9, 10, and 17. In five of eight dysplastic oral leukoplakia biopsies, aberrations were seen consisting of trisomy of chromosome 1, 7, and 17, and monosomy of chromosome 9. No aberrations were found in biopsies of hyperplastic lesions (n = 8), or in oral cell smears of persons at risk. Because numerical chromosomal aberrations seem to be highly specific for malignant cells, FISH may help to identify leukoplakias that have a high risk of malignant conversion.     

嵩乙醚的抗血吸虫作用

实验感染日本血吸虫的小鼠,用蒿乙醚或蒿甲醚100～200mg·kg^-1·d^-1×2d灌胃治疗,显示两药对小鼠体内不同发育期血吸虫的减虫率相仿。特别是d7童虫和d35成虫组的减虫率较高,分别达77.5～87.2%和51.7～61.3%。经蒿乙醚作用后,d7童虫和d35成虫的糖原明显减少或消失,虫的皮层和实质组织中的碱性磷酸酶活力亦明显受抑制,表明蒿乙醚具有抗日本血吸虫童虫和成虫的作用。     

Molecular characterization of a glycosylphosphatidylinositol-linked ADP- ribosyltransferase from lymphocytes

Mono ADP-ribosyltransferases catalyze the transfer of the ADP-ribose moiety of nicotinamide adenine dinucleotide (NAD) to proteins. It was reported by Wang et al (J Immunol 153:4048, 1994) that incubation of mouse cytotoxic T lymphocytes (CTL) with NAD resulted in the ADP- ribosylation of membrane proteins and inhibition of cell proliferation and cytotoxicity. Treatment of CTL with phosphatidylinositol-specific phospholipase C (PI-PLC) before incubation with NAD prevented the inhibitory effects of NAD on the cells, consistent with the removal of a glycosylphosphatidylinositol (GPI)-anchored ADP-ribosyltransferase on the lymphocyte surface. We have identified and cloned a GPI-linked ADP- ribosyltransferase from Yac-1 mouse T-cell lymphoma cells. The deduced amino acid sequence of the Yac-1 transferase was 70% and 41% identical to those of the rabbit skeletal muscle and chicken heterophil, respectively. It contained three noncontiguous sequences similar to those found in several of the bacterial toxin and vertebrate ADP- ribosyltransferases. Based on crystallography of the bacterial toxins, these regions are believed to form, in part, the catalytic site consistent with a common mechanism for the ADP-ribose transfer reaction. In rat mammary adenocarcinoma (NMU) cells transformed with the Yac-1 transferase cDNA, transferase activity was present on the cell surface and was released into the medium by treatment of cells with PI-PLC. Thus, we have cloned a novel gene that has properties identical to the transferase detected in CTL, and may be involved in the NAD-dependent regulation of proliferation and cytotoxicity.     

滨蒿内酯对离体大鼠主动脉平滑肌作用的研究

目的 :研究滨蒿内酯 (scoparone ,Scop)对离体大鼠主动脉平滑肌张力的影响。方法 :通过测定离体血管环张力变化 ,观察Scop对主动脉平滑肌的舒张作用及与苯肾上腺素 (PE)、普萘洛尔 (Prop)和氯化钾 (KCl)之间的相互作用。结果 :Scop舒张离体主动脉平滑肌 ,并且对内皮完整 (EC +)标本的舒张作用明显大于去内皮 (EC - )标本 ,半抑制浓度 (IC50 )分别为 (10 0± 0 4 ) μmol/L(CE +)与 (83 2± 0 8) μmol/L(EC - ) (P <0 0 1) ;Scop使PE量效曲线下移 ,呈非竞争性抑制 ,亲和力指数 (PD2 )分别为 4 93± 0 0 5 (EC +)与 2 94± 0 14 (EC - ) ;Prop(1μmol/L)对Scop舒张血管平滑肌作用无影响 ;Scop不能抑制Prop所致血管平滑肌收缩 ;Scop对血管平滑肌的依内钙及依外钙性收缩均有明显抑制作用。结论 :Scop可舒张离体大鼠主动脉平滑肌 ,此作用与内皮细胞的功能有一定关系。Scop抑制血管平滑肌依内钙与依外钙性收缩可能是Scop舒张血管平滑肌的主要机制     

In-plane vascular imaging: pulse sequence design and strategy

Magnetic resonance (MR) angiography is a noninvasive method of obtaining images without contrast agents. Recent developments in sequence design have allowed images of moving spins to be obtained without a loss of signal by rephasing the spins with three or four gradient pulses to compensate for constant velocity or acceleration, respectively. At longer echo times (TE), this approach allowed for low readout gradients and high signal-to-noise ratios. Angiograms with a resolution of 300 micron were obtained. With additional sequences that allow some dephasing but minimal signal loss, separate images of arteries and veins were obtained. Phase information was used to estimate flow velocity. Application of the rephasing scheme to gradient-echo sequences allowed for ungated, fast MR angiograms. Acceleration correction was important for long TE sequences, but velocity-corrected, gradient-echo sequences with a very short TE were comparable to velocity- and acceleration-corrected, gradient-echo sequences with slightly longer TEs. With ungated three-dimensional, gradient-echo sequences, susceptibility artifacts were minimized and excellent contrast-to-noise ratios were obtained.