Polycythemia vera. II. Hypersensitivity of bone marrow erythroid, granulocyte-macrophage, and megakaryocyte progenitor cells to interleukin-3 and granulocyte-macrophage colony-stimulating factor.

Polycythemia vera (PV) is a clonal disease of the hematopoietic stem cell characterized by a hyperplasia of marrow erythropoiesis, granulocytopoiesis, and megakaryocytopoiesis. We previously reported that highly purified PV blood burst-forming units-erythroid (BFU-E) are hypersensitive to recombinant human interleukin-3 (rIL-3). Because these cells may be only a subset, and not representative of marrow progenitors, we have now studied partially purified marrow hematopoietic progenitor cells. Dose-response experiments with PV marrow BFU-E showed a 38-fold increase in sensitivity to rIL-3 and a 4.3-fold increase in sensitivity to recombinant human erythropoietin (rEpo) compared with normal marrow BFU-E. In addition, PV marrow colony-forming units-granulocyte-macrophage (CFU-GM) and CFU-megakaryocyte (CFU-MK) also showed a marked hypersensitivity to rIL-3 and to human recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF). Dose-response curves with rGM-CSF and blood BFU-E showed a 48-fold increase in sensitivity. No effect of rIL-4, rIL-6, human recombinant granulocyte-CSF (rG-CSF), or macrophage-CSF (rM-CSF) was evident, nor was there any effect of PV cell-conditioned medium on normal BFU-E, when compared with normal cell-conditioned medium. Autoradiography with 125I-rEpo showed an increase in Epo receptors after maturation of PV BFU-E to CFU-E similar to that shown with normal BFU-E, but no increase of specific binding of 125I-rIL-3 by PV CD34+ cells was seen compared with normal CD34+ cells. These studies show that PV marrow hematopoietic progenitor cells are hypersensitive to rIL-3 and rGM-CSF, similar to PV blood BFU-E. While the mechanism does not appear to be due to enhanced binding of rIL-3, the hypersensitivity of PV progenitor cells to IL-3 and GM-CSF may be a key factor in the pathogenesis of PV.     

环丙沙星滴耳液对内耳影响的研究

豚鼠中耳（听泡）内滴入０．５％、１％、２％环丙沙星与庆大霉素滴耳液７天或２１天，借助光镜和扫描电镜观察内耳的显微和超微结构变化。结果证明环丙沙星对内耳没有明显的毒性作用。庆大霉素则使耳蜗明显受损，以底回为重，Ｃｏｒｔｉ’ｓ器外毛细胞坏死较多，内毛细胞及支持细胞病变较轻。位觉斑耳石脱落，毛细胞纤毛粘连、脱落。壶腹嵴中央区纤毛也缺失。本实验对客观评价环丙沙星对内耳的作用及临床使用提供了形态学资料。     

Hodgkin disease: CT of the thymus

The computed tomography (CT) scans in two groups of patients with Hodgkin disease were reviewed to determine the frequency of thymic enlargement. In 50 CT scans from 50 patients with evidence of thoracic disease on CT scans who were examined for primary staging, the thymus was enlarged in 15 of 50 (30%). Fifty CT scans were obtained from 44 patients at the time of 50 separate episodes of known or suspected relapse. Relapse occurred in the mediastinum in 12 episodes, lung parenchyma in five, and both sites in one. Thymic enlargement thought to be due to involvement by disease was present in seven of 18 (38%). Mediastinal disease was associated with thymic enlargement in all but one patient in whom a thymic cyst developed after radiation therapy. Differentiation of thymic enlargement from enlarged superior mediastinal lymph nodes was easily made in all but two patients. Thymic enlargement in the absence of lymph node enlargement may indicate a different disease, since isolated Hodgkin disease of the thymus is uncommon. Primary thymic tumor should be considered initially, whereas after treatment, rebound hyperplasia of the thymus may be the cause of enlargement.     

Solid and papillary epithelial neoplasms of the pancreas: CT findings

Five female patients and one male patient with solid and papillary epithelial neoplasms of the pancreas were examined with computed tomography (CT). The mean age of the patients was 27 years (range, 13-46 years). All cases showed well-encapsulated, round or lobulated masses consisting of both cystic and solid areas. Cystic portions showed CT numbers that suggested hemorrhagic necrosis. There were no internal septations within the masses. In three tumors located in the head of the pancreas, dilatation of the biliary tree was absent or minimal, although the masses were large. Two tumors contained calcifications. One tumor demonstrated metastatic deposits in liver and lymph nodes. Metastatic masses appeared similar to the primary pancreatic mass. Solid and papillary neoplasm of the pancreas should be the primary diagnostic consideration when characteristic CT findings are detected in a young female patient.     

彩色多普勒超声血流图在心脏手术中的应用(附19例病例分析)

在心脏手术中应用多普勒彩色超声心动仪直接探测和观察19例患者,其中风湿性心瓣膜病11例、先天性心脏病7例、左心房粘液瘤1例。风心病及左房粘液瘤患者手术前、中检查的结果基本一致;先心病术前诊断符合率为84.2％(5/7),术中诊断符合率为100％。本文对检查结果作了分析讨论,并提出符合我国情况的有关检查设想。     

长沙地区孕妇CMV感染状况及其临床追踪观察

研究了７７例长沙地区孕、产妇的宫颈排毒（ＣＭＶ）情况及母、婴的免疫状态，并对宫颈排毒及ＣＭＶ一ＩｇＭ阳性的母亲所生小孩进行临床追踪。结果显示：孕妇宫颈排毒率为４．５％，抗ＣＭＶ－ＩｇＧ和抗ＣＭＶ－ＩｇＭ阳性率分别为７７％和１３％，５９例脐血ＣＭＶ－ＩｇＭ阴性。宫颈排毒的３例其抗体检测抗ＣＭＶ－ＩｇＧ均阳性，抗ＣＭＶ－ＩｇＭ仅一例阳性。作者认为，对妊娠期活动性ＣＭＶ感染的诊断，仅检测抗ＣＭＶ－ＩｇＧ和抗ＣＭＶ－ＩｇＭ抗体滴度仍不足，尚须结合病毒分离和其它检测手段。     

弥漫性轴索损伤病人的护理

弥漫性轴索损伤（diffuse axonal injury，DAI）是以胼胝体、脑十等中线部位局灶性病变及脑白质广泛性轴索损伤为主，以原发昏迷时间长而又缺乏神经定位体征为其临床特征的一组原发性弥散性脑损伤。在重型颅脑损伤中占20％，病死率高达42％～62％。最常见于车祸颅脑损伤病人，也可见于高处坠落伤者。病人多合并其他部位损伤，特点为伤情重、变化快、并发症和休克发生率高，且病死率高。护理时矛盾多，易顾此失彼，影响临床治疗效果。为更好地总结对该类损伤病人的救治，     

经胸门奇静脉断流术的外科解剖学基础(附52例临床疗效分析报告)

观测了１００例成年尸体胃底、贲门及食管区静脉。结果显示：胃左、右静脉的出现率是９６％和９２％，胃小弯侧的静脉分布可归纳为５型：胃左静脉型、胃右静脉型、胃左静脉优势型、胃右静脉优势型和胃左右静脉均衡型。胃后静脉出现率为７３．６％，胃左静脉与左膈下静脉间有相对恒定的吻合，此种情况占４８％。在此基础上作者于１９７６年３月至１９９２年３月对５２例因门脉高压症大出血患者行经胸门奇静脉断流术，急症手术死亡率为４．９％，急症手术止血率为９２．６％，远期再出血率为１１．４％。作者认为彻底断流的关键是识别胃小弯侧静脉分型、胃左静脉汇入部位及属支变化；胃后静脉及门腔吻合。阐述了经胸门奇静脉断流的优越性。