Percutaneous vertebroplasty: a special syringe for cement injection

Percutaneous vertebroplasty is an effective treatment for many focal vertebral lesions. Methyl methacrylate is too viscous to be handled without difficulty in the conventional way because injection time is short. The operator is left with little time and must fumble with multiple syringes. We describe a special screw-system syringe that decreases the effort needed to inject the cement. In addition, it can standardize the injection pressures and control the injected volume because the threaded plunger affords greater control of injection pressure and volume delivered than does the conventional method.     

Treatment of chronic anal fissure

Current treatment of chronic anal fissure continues to be based on conventional conservative measures in a high percentage of cases. What is known as chemical sphincterotomy aims to achieve a temporary decrease of anal pressures that allows fissures to heal. There are various alternatives such as nitroglycerine or diltiazem ointment and botulinum toxin injections. However, because of collateral effects and recurrences in the medium term, the definitive role of these treatments remains to be elucidated. Nevertheless, chemical sphincterotomy should be the first option in patients with a high risk of incontinence. "Open" or "closed" lateral internal sphincterotomy performed in the ambulatory setting with local anesthesia can currently be considered the ideal treatment of chronic anal fissure refractory to conservative measures so long as the patient is informed about the risk of minor incontinence. This procedure provides rapid and permanent recovery in more than 95% of patients. There is evidence demonstrating that the incontinence rate is related to the extent of the lateral internal sphincterotomy and consequently the extent of this procedure should be reduced to the length of the fissure.     

Urinary CD80 Excretion Increases in Idiopathic Minimal-Change Disease

CD80 is expressed on all antigen-presenting cells and is present on podocytes in a number of experimental models of nephrotic syndrome. We tested whether urinary soluble CD80 increased with idiopathic minimal-change disease (MCD). We collected urine and serum samples from patients with MCD in relapse and in remission, patients with nephrotic syndrome resulting from other glomerular diseases (FSGS, membranoproliferative glomerulonephritis, IgA nephropathy, and membranous nephropathy), patients with systemic lupus erythematosus, and normal control subjects. Urinary concentrations of soluble CD80 in patients with relapsed MCD were significantly higher compared with those observed in patients with MCD in remission, other glomerular diseases, and systemic lupus erythematosus with and without proteinuria and healthy control subjects. Urinary concentrations of soluble CTLA-4, which is a negative regulator of CD80, were not statistically different in patients with relapsed MCD compared with those in remission. The urinary soluble CD80/CTLA-4 ratio was >100-fold higher in patients with relapsed MCD compared with those in remission (P < 0.008). In contrast, serum concentrations of soluble CD80 and CTLA-4 did not distinguish patients with MCD in relapse and in remission. In conclusion, urinary soluble CD80 is elevated in idiopathic MCD, which could be relevant to both diagnosis and pathogenesis.Idiopathic minimal-change disease (MCD) is the most common nephrotic syndrome in children and adolescents.¹ The disease is considered a disorder of T cell function.^2,3 Although the mechanism of the proteinuria is unknown, a circulating cytokine has been postulated as the link between proteinuria and the T cell dysfunction.^2–4Podocytes are specialized and highly differentiated epithelial cells that form a layer between the glomerular basement membrane and the urinary space. In a series of experiments, Reiser et al.⁵ found that these cells could acquire dendritic cell–like functions, in which they can be induced to express CD80, a transmembrane protein that provides a co-stimulatory signal for T cell activation. Mice administered LPS developed podocyte CD80 expression and proteinuria; when LPS was administered to the CD80^−/− knockout mouse, no increase in urinary protein excretion was observed.⁵ The authors further showed that podocyte CD80 activation by LPS could occur in SCID mice that lack T cells.⁵ Furthermore, CD80 expression could be shown in both experimental models of nephrotic syndrome (e.g., aminonucleoside nephrosis) and human lupus nephritis.⁵ These findings led the authors to propose that podocyte CD80 expression might be involved in the pathogenesis of MCD.⁶Some podocyte antigens are known to be shed, where they can be found in the urine.⁷ This led us to hypothesize that soluble CD80 (sCD80) might be detected in the urine in patients with MCD. Furthermore, T regulatory cells are known to secrete soluble CTLA-4 (sCTLA-4), which can bind CD80 and block the co-stimulatory activation of T cells.^8–10 If T cells are releasing a cytokine that can induce MCD, such as IL-13,¹¹ then one might postulate that an inadequate release of sCTLA-4 might lead to continued activation of the T cells and possibly persistent CD80 expression by dendritic cells. We therefore measured urinary sCD80 and urinary sCTLA-4 levels in children with MCD and compared the findings with healthy children and children with other glomerular diseases.Clinical characteristics of the patients with MCD and control groups are shown in

彩色多普勒对亚临床型精索静脉曲张不育患者的诊断价值

目的:探讨彩色多普勒(CDFI)对亚临床型精索静脉曲张(SVC)不育患者的诊断价值。方法:采用CDFI检测56例精液异常不育患者的精索静脉,观察蔓状静脉血管内径及血液返流时间,并行X线选择性精索内静脉造影对照分析。结果:平静状态下蔓状静脉内径为(2.24±0.16)mm;Valsalva运动时内径为(2.67±0.26)mm;返流时间为(1 487±203.66)m s,CDFI检测SVC的准确性为92.8%。结论:在男性不育的病因筛选中,CDFI检测对SVC的诊断比临床型精索静脉曲张更有意义。     

肝尾状叶原发性肝细胞肝癌的外科治疗

目的 探讨尾状叶原发性肝癌手术切除的方式及其影响。方法 自1995年至2003年,对39例尾状叶原发性肝癌进行了手术切除,其中单独尾状叶切除19例,联合切除20例。并对两组病例中可能影响术后肝功能的指标进行了比较。结果 39例患者均被成功切除肿瘤,1例于术后30d因肾功能衰竭死亡,3例并发胸腔积液,4例并发腹水,1例并发胆漏,其余病例均顺利恢复。术后30例获得随访,1年、3年、5年生存率分别为53％、50％、39％。结论 尾状叶切除是治疗原发于尾状叶肝癌的有效手段,若肿瘤原发于肝尾状叶而又无其他肝叶侵犯时,单独尾状叶切除该是外科治疗的最佳选择。     

Molecular subtypes of breast cancer: metabolic correlation with 18F-FDG PET/CT

Purpose

To determine whether the metabolic features of breast tumours differ among molecular subtypes.

Methods

This prospective study included 168 women diagnosed with locally advanced breast cancer. PET/CT was requested in the initial staging before neoadjuvant treatment (multicentre study, FISCAM grant). All patients underwent an ¹⁸F-FDG PET/CT scan with a dual time-point acquisition. Both examinations (PET-1 and PET-2) were evaluated qualitatively and semiquantitatively with calculation of SUVmax (SUV-1 and SUV-2, respectively), and the percentage variation in the SUVs and retention indexes (RI) between PET-1 and PET-2 in the breast tumour were calculated. Biological prognostic parameters, including the steroid receptor status, HER-2 expression, proliferation rate (Ki-67) and grading, were determined from primary tumour tissue. Tumour subtypes were classified following the recommendations of the 12th International Breast Conference, by immunohistochemical surrogates as luminal A, luminal B-HER2(?), luminal B-HER2(+), HER2(+) or basal. Metabolic semiquantitative parameters and molecular subtypes were correlated.

Results

Of the 168 tumours, 151 were classified: 16 were luminal A, 53 were luminal B-HER2(?), 29 were luminal B-HER2(+), 18 were HER2(+) and 35 were basal. There were significant differences between SUV-1 and SUV-2 and the different subtypes, with higher SUVs in HER2(+) and basal tumours. No significant differences were found with respect to RI.

Conclusion

Semiquantitative metabolic parameters showed statistically significant differences among the molecular subtypes of the tumours evaluated. Therefore, there seems to be a relationship between molecular and glycolytic phenotypes.     

雌二醇对去势前列腺癌患者LH脉冲分泌的抑制作用

３例前列腺癌施行双侧睾丸节除术后２－１２周的患，每天肌注苯甲酸雌二醇１ｍｇ，ｄ。治疗前后分别每１０ｍｉｎ采血一次，作７ｈ ＬＨ脉冲分析。结果表明，３例患平均血清ＬＨ水平分别由１７７．５８±３．２０，１３８．３０±５．８３和１４５．８８±３．８２ＩＵ／ＬＧＨＢＴＧＣ １７４．９０±７．６０，１３２．０２±５．７７和１４２．８０±３．６５ＩＵ／Ｌ（Ｐ均＜０．０１），但ＬＨ脉冲幅度和频率无明显变化（     

Performance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit

There is a growing interest in ultrasound evaluation of bone status as an alternative to the measurement with dual X-ray absorptiometry (DXA), due to its low cost, portability, and nonionizing radiation. The aim of our study was to investigate the relation among DXA, QUS, clinical, anthropometric, and lifestyle factors, and to determine QUS cutoff values in order to discriminate fractures in patients referred to the Bone Metabolic Unit at an Endocrinology Service. We studied 300 patients (281 females and 19 males; age 58 +/- 11 years) referred for evaluation of osteoporosis. In all cases we determined basic anthropometric parameters, a clinical history including previous osteoporotic fractures and risk factors for osteoporosis, and QUS parameters in calcaneus (Hologic Sahara), and BMD in lumbar spine (LS) and femoral neck (FN), by DXA (Hologic QDR 1000). Using the WHO densitometric criteria, 37, 46.7, and 16.3% of our population were osteoporotic, osteopenic, and normal, respectively. A QUI T-score 相似文献   

Klippel-Trenaunay综合征血管内硬化治疗的临床探讨

目的探讨Klippel-Trenaunay(KT)综合征血管内硬化治疗的疗效及安全性。方法6例KT综合征患者行顺行静脉造影、多普勒超声后行患肢动脉造影,并经动脉主干注入碘油平阳霉素乳剂,随访观察疗效及术后并发症。结果顺行静脉造影和多普勒超声显示单纯异常扩张浅静脉6例,深静脉无异常;动脉造影显示动脉二、三级分支增多,软组织内见染色影。术后并发症主要有肢体肿胀和感觉异常。随访8～40个月,5例肢体症状明显好转,1例症状反复。结论碘油平阳霉素乳剂血管内硬化治疗KT综合征能有效改善患肢症状。