Do normal leucocyte count and C‐reactive protein value exclude acute appendicitis in children?

The present study aimed to determine the role of leucocyte count and C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis in children. In particular, children with acute appendicitis but normal leucocyte count and CRP level were sought. The present study protocol was identical to those used in earlier studies on adult patients with suspected acute appendicitis. The mean preoperative leucocyte count and CRP value in 100 consecutive children with an uninflamed appendix at appendicectomy (group A) and in 100 consecutive patients with acute appendicitis (group B) were calculated. The numbers of patients with (i) both values normal, (ii) only leucocyte count raised, (iii) only CRP level raised, and (iv) both values raised were calculated in both groups A and B. Leucocyte count effectively (p     

杭州市3岁儿童乳牙龋齿患病情况调查

为早发现、早预防儿童龋齿的发生和发展 ,了解我市儿童早期的乳牙龋齿患病情况 ,于 1998年 ,对杭州市幼儿园进行随机抽样 ,在 3岁儿童中作龋齿调查 ,现报道如下。对象与方法1　对象　对杭州市所有的幼儿园分 5个城区 (拱墅、上城、下城、西湖、江干 )随机抽样 ,每个城区随机抽取 2～3所幼儿园 ,对纳入的幼儿园中所有过了 3岁生日 ,尚未到4岁生日的幼儿进行口腔检查。2　方法　口腔检查由一位副主任医师在自然光线下 ,使用标准器械 ,严格按照ＷＨＯ (1997)龋齿诊断标准[1 ] 进行检查。另一位医师配合 ,按每个牙齿龋蚀情况、龋齿类型(分四型 :…     

Melanoma associated with subacute primitive fibrinolysis

BACKGROUND: Surgery is the first treatment of a pigmented skin lesion when a melanoma is suspected. This excision is most of the time realized by the dermatologist as well as the second time surgery. Bleeding at the surgical site may have numerous aetiologies. Fibrinolysis is a rare but dramatic event. CASE REPORT: We report a case with delayed bleeding after excision of a melanoma. The patient was re-operated and a major haemorrhage followed so that a transfusion of blood and fresh frozen plasma was necessary. The biological investigations concluded to a subacute primitive fibrinolysis associated with the melanoma. The patient was first considered to have completely recovered when a blood-borne liver metastasis diffusion rapidly occurred. The patient deceased within a few months from a hepatic encephalopathy with hepatic metastases. DISCUSSION: We find only a few published cases of melanoma with fibrinolysis. Its association with other abnormalities, like a partial factor XIII deficiency, made these abnormalities even more difficult to identify. The relation between the subacute fibrinolysis, the melanoma and the liver infiltrative metastasis is difficult to establish.     

T cells discriminate between differentially phosphorylated forms of alphaB-crystallin, a major central nervous system myelin antigen

Factors such as developmental stage or physiological and infectious stress may change patterns of post-translational protein modification. In order to determine whether such regulated types of modification may influence T cell responsiveness to self proteins we examined the T cell response of SJL (H-2s) mice to alphaB-crystallin, a small heat shock protein that can exist in differentially phosphorylated forms. Epitope mapping revealed the presence of two T cell epitopes that are presented by I-As. One major epitope including residues 41-56 contains an amino acid residue (Ser45) that can be phosphorylated as the result of aging or stress. Accordingly, T cells from SJL mice discriminate between preparations of alphaB-crystallin that differ in their extent of phosphorylation at the level of whole protein as well as at the level of determinant-specific responses. Phosphorylation at Ser45 does not prevent binding of the peptide 41-56 to I-As and computer-assisted modelling of the peptide-MHC complex suggests that the phosphate group of the bound peptide extends outwards from the peptide-binding cleft and may thus be available for direct contact with TCR. Together, our data provide evidence that stress-inducible phosphorylation of alphaB- crystallin creates neo-determinants for T cells and, therefore, may contribute to the breakdown of peripheral tolerance to this self protein.      

CD4+/CD56+ haematodermic neoplasm: a preculsor haematological neoplasm that frequently first presents in the skin

CD4+/CD56+ hematodermic neoplasm, formerly known as blastic NK cell lymphoma, is an aggressive and rare preculsor hematologic neoplasm recently recognized by the WHO-EORTC classification consensus for cutaneous lymphomas. The neoplasm tends to affect elderly patients, who usually present with skin lesions but often have a disseminated disease, including bone marrow involvement. Although the lesions are composed of cells with a lymphoblast-like morphology and an NK-cell phenotype, exhibiting a CD4+, CD56+ positive immunophenotype, recent studies support a relationship to plasmacytoid dendritic cells. Because of the rarity of this disease, we describe two patients suffering a CD4+/CD56+ hematodermic neoplasm.