Radiotherapy for metastatic melanoma presenting in pregnancy

We describe the study of a patient with metastatic melanoma to axillary nodes presenting during pregnancy. The factors considered in her management are discussed, including issues related to staging, the decision not to terminate the pregnancy and the relative efficacy and fetal toxicity of the available treatment options. An overview of the known effects of radiotherapy on the fetus is presented and the technical alterations that were used to decrease the toxicity of radiotherapy are discussed.     

Percutaneous pulmonary valvuloplasty with a double-balloon technique

Percutaneous pulmonary valvuloplasty with a double-balloon technique was used in eight patients, aged 10-40 years, in whom valvuloplasty with a single 20-mm balloon resulted in inadequate dilatation of the stenosis. The diameters of the additional balloon varied from 10 to 20 mm. Balloons were inflated manually at about 30-45 psi (206.7-310.1 kPa) and deflated immediately after disappearance of the balloon waist. The mean peak systolic pressure gradient was 85 mm Hg +/- 37 before valvuloplasty, and it decreased to 38 mm Hg +/- 28 afterward (P less than .05). Double-balloon dilation and simultaneous computed tomography were done in two cardiac specimens from adult cadavers. At inflations at 30 and 45 psi (206.7 and 310.1 kPa), the outflow tract was elongated, and the balloons also deformed into ovoid shape at the lower pressure. The double-balloon technique appears to be safe and effective for relief of pulmonary valvular stenosis in those cases in which single-balloon technique is inadequate, especially in older children and adults.     

Rearrangements of the BCL6 gene in diffuse large cell non-Hodgkin's lymphoma

The pathogenesis of non-Hodgkin's lymphoma (NHL) with a large cell component (DLLC, including diffuse large cell, DLCL; diffuse mixed cell, MX-D; and immunoblastic, IMB) is unknown. A novel candidate proto- oncogene, BCL6, that is involved in chromosome band 3q27 aberrations in NHL has been recently identified. We have investigated the incidence and disease-specificity of BCL6 rearrangements in a large panel of lymphoid tumors, including acute and chronic lymphoid leukemias (96 cases), various NHL types (125 cases), and multiple myelomas (23 cases). BCL6 rearrangements were found in 16/45 (35.5%) DLLC, more frequently in DLCL (15/33, 45%) than in MX-D (1/10, 10%), in 2/31 (6.4%) follicular NHL, and in no other tumor types. BCL6 rearrangements represent the first genetic lesion specifically and recurrently associated with DLLC and should prove useful for understanding the pathogenesis as well as for the clinical monitoring of these tumors.     

黄毛忽木皂甙A的分离和结构测定

黄毛木(Aralia decaisneana Hance)为五加科木属植物。从其根的甲醇提取物中分离得到一个皂甙化合物(I),根据光谱(IR,¹HNMR,¹³CNMR,MS,Longrange ¹H-¹HCOSY和¹H-¹³cHETCOR)解析和化学反应(酸水解,乙酰化和碱水解)证明,化合物1的结构确定为3-O-[β-D-吡喃木糖1→3)]-β-D-吡喃葡萄糖(1→2)-β-D-吡喃葡萄糖-28-O-β-D-吡喃葡萄糖(1→6)-β-D-吡喃葡萄糖酯甙。该化合物是一个新的三萜皂甙,命名为黄毛木皂甙A(aradecoside A)。     

Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up

The clinical natural history of renal arterial fibromuscular dysplasia (FMD) in patients with normal blood pressure is unknown, to the authors' knowledge. The authors reviewed the results of 1,862 renal angiograms obtained in potential renal donors. FMD was present in 71 patients (3.8%). The average age at which FMD was discovered was 50.8 years. Seventy-five percent of the patients with FMD were female. Of 30 patients who did not undergo nephrectomy, eight (26.6%) developed hypertension over a mean followup interval of 7.5 years. Of 19 patients who underwent nephrectomy, despite the presence of FMD, five (26.3%) developed hypertension over a mean follow-up interval of 4.4 years. In comparison, three subjects (6.1%) (from a randomized control group of 49 age- and sex-matched healthy individuals) developed hypertension over a mean follow-up period of 7.1 years. The authors conclude that asymptomatic middle-aged individuals with renal FMD develop hypertension at a rate greater than that of age-matched control subjects with normal blood pressure.     

Heparin-induced thrombocytopenia: studies with a new low molecular weight heparinoid, Org 10172

Studies were performed to determine the cross-reaction rate of the heparin-dependent antibody with Org 10172, a new low molecular weight heparinoid, and to investigate the effect of Org 10172 on platelet activation induced by the antibody. The plasmas of 17 patients with thrombocytopenia induced by standard heparin were shown, by platelet aggregation studies, to contain the heparin-dependent antibody. Of these 17 patient plasmas, only three cross-reacted with the heparinoid, producing a cross-reaction rate of 18%. When Org 10172 was added to a reaction mixture containing normal platelet-rich plasma, patient plasma, and standard heparin with non-cross-reacting plasmas, it inhibited platelet aggregation and thromboxane B2 production induced by the antibody, provided that the ratio of Org 10172 concentration (anti- Xa U/mL) to standard heparin concentration (IU/mL) exceeded 2.5 to 5.0. This inhibitory effect was observed only with platelet activation mediated by the antibody, but not by collagen (2 micrograms/mL) or ADP (5.0 mumol/L). Additionally, three of 17 patients with serious thrombosis, whose plasma showed no cross-reaction with the heparinoid, received Org 10172 treatment with a good response in each case. These findings suggest that Org 10172 may be a useful drug for the treatment of heparin-induced thrombocytopenia.     

Proximal fallopian tube occlusion: diagnosis and treatment with transcervical fallopian tube catheterization

Transcervical fallopian tube catheterization (TFTC) was performed in 22 infertile patients with bilateral fallopian tube obstruction and a mean duration of infertility of 3.3 years. A high prevalence of previous ectopic pregnancy (n = 8, 36%), tubal ligation and/or reconstruction (n = 5, 23%), spontaneous or therapeutic abortion (n = 6, 27%), and previous intrauterine device use (n = 14, 64%) was noted. The authors successfully catheterized 40 (98%) of 41 tubes without serious complication and visualized the distal tube in 36 (88%) of 41 tubes. Free spill in at least one tube was seen in 17 (77%) of 22 patients. Nineteen patients had a history of previous laparoscopy or laparotomy for tubal disease, in 16 of whom laparoscopic results were available for review. Retrospectively, in 15 (94%) of 16 patients all clinically relevant abnormalities would have been detected by means of TFTC alone. Five patients conceived, three with intrauterine and two with ectopic pregnancies. Patients with intrauterine pregnancies had normal-appearing tubes after TFTC, while those with ectopic pregnancies had residual tubal abnormalities after recanalization. TFTC is a safe, accurate diagnostic procedure that provides more information than hysterosalpingography and, in most cases, as much or more information about the fallopian tubes than laparoscopy.