Pulmonary lymphangitic carcinomatosis: CT and pathologic findings

The authors retrospectively reviewed the computed tomographic (CT) scans, biopsy specimens, autopsy results, and lobectomy specimens of 21 patients who had lymphangitic carcinomatosis. Ten-millimeter collimation CT scans were obtained from all patients, and selected 1.5-mm CT scans were obtained from ten patients. In five patients, the diagnosis was established with open lung biopsy, lobectomy, or autopsy; in nine, with bronchial biopsy or transbronchial biopsy; and in seven, with clinical and radiologic criteria. Certain characteristic findings on CT scans were evident: uneven thickening of bronchovascular bundles, thickening of isolated interstitial lines, and the presence of polygonal lines. These findings may be seen on CT scans even if the findings on chest radiographs are normal or nonspecific. The pathologic basis for these characteristic CT findings may relate to tumor thrombi in lymphatic vessels rather than edema and fibrosis, at least in the early stages of disease.     

心房扑动患者的下腔静脉-三尖瓣环峡部和房间隔缓慢传导的电生理意义

目的　用电 解剖标测方法标测右心房 ,然后比较心房扑动 (AFL)和房室结折返性心动过速(AVNRT)患者在下腔静脉 三尖瓣环峡部 (CTI)和心房间隔部 (AS)的电冲动传导速度 ,以便确定AFL患者除了解剖结构上的异常外 ,是否伴有心房电生理方面的异常变化。方法　 1 0例AFL患者 ,男性 7例 ,女性 3例 ,平均 (53± 1 0 )岁 ;1 3例AVNRT患者 ,男性 5例 ,女性 8例 ,平均 (51± 1 1 )岁。对这两组患者进行了详细的电 解剖标测、电生理检查和射频消融术。分别以周长为 60 0、40 0、和 30 0ms在冠状静脉窦 (CS)起搏的情况下测量AFL和AVNRT患者的CTI和AS的冲动传导速度 ,并将两组患者在CTI和AS的冲动传导速度进行比较。结果　与AVNRT患者相比 ,AFL患者在各个起搏周长 (PCL)时CTI和AS的冲动传导速度都明显减慢 (P <0 0 5)。另外 ,在AFL组 ,AS的冲动传导速度在起搏周长 60 0、40 0ms时低于CTI,但在 30 0ms时差异无显著性 (P >0 0 5)。因为在AFL组 ,PCL为 30 0ms时的冲动传导速度明显低于 60 0和 40 0ms时的冲动传导速度 ,致使PCL为 30 0ms时CTI和AS的冲动传导速度差异无显著性。结论　与CTI相比 ,AS的冲动传导速度在所有患者都较慢 ,而AFL患者在CTI和AS的冲动传导速度减低更明显 ,并且在CTI的冲动传导速度减慢具有频率依     

Pulmonary alveolar proteinosis: CT findings

In pulmonary alveolar proteinosis (PAP), a proteinaceous material accumulates in the alveolar air spaces, causing hypoxemia, restrictive lung disease, and dramatic abnormalities on chest radiographs. Complications are unusual, but of the ones that do occur, infection, particularly with Nocardia asteroides, and fibrosis are the most common. Few computed tomographic (CT) studies of this condition have been reported. The CT scans of nine patients with PAP were reviewed. Varying combinations of air-space and interstitial patterns were seen. The CT appearance of air-space disease ranged from ill-defined nodules to patchy consolidation to large regions of confluence. Air-space consolidation was sometimes sharply demarcated from surrounding normal lung tissue, which created a geographic pattern. Despite the predominance of air-space patterns, air bronchograms were not a prominent feature. CT showed the interstitial component of disease and the extent of disease more clearly than did plain radiography. In two cases, CT demonstrated focal pneumonia that was not visible on the radiographs.     

Analysis of a linear peristaltic infusion device for the transfusion of red cells to pediatric patients

A linear peristaltic infusion device was evaluated for red cell (RBC) transfusion in the pediatric and neonatal setting. CPDA-1 RBC units (n = 24) divided into six groups of 4 units each underwent simulated transfusion. Blood was infused by using manufacturer-provided administration sets with either a 21-gauge needle or a 24-gauge catheter. Filters were used in two groups to evaluate the effect of negative pressure on filter function. Two groups of RBCs less than 1 week old were washed, irradiated, and infused at 5 mL per hour, by using a standard administration set, or at 10 mL per hour, by using a syringe set. Four-week-old RBCs (washed and irradiated, irradiated and filtered, filtered only, or unmanipulated) were infused at 100 mL per hour. Paired samples from 0 and 2 hours before and after infusion were analyzed for hemoglobin, hematocrit, RBC count, plasma hemoglobin, lactate dehydrogenase, potassium, alanine aminotransferase, and aspartate aminotransferase. Hausser and Nageotte hemocytometers were used to perform white cell (WBC) counts when a filter was used. By analysis of variance and percentage of change, data from 0 and 2 hours before and after infusion were compared. No clinically or statistically significant differences were seen for hemoglobin, hematocrit, or RBC count. The difference in preinfusion and postinfusion plasma hemoglobin levels in washed RBCs at 2 hours was statistically but not clinically significant (14.5 +/− 6.8 vs. 19.3 +/− 7.1 mg/dL). No clinically significant differences were noted for the remaining analytes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Genetic and environmental influences on expression of recurrent headache as a function of the reporting age in twins.

Neurology. 2002;58(9 suppl 6):S3-S9.
That migraine is significantly underdiagnosed in the United States and other countries is well established. New data from a follow-up survey to the American Migraine Study II reveal that the presence of concomitant headache types and co-morbid conditions significantly affects the ability to detect and diagnose migraine. This article describes these data and explores the contribution of concomitant headache types and co-morbidities to the problem of underdiagnosis of migraine. Migraine continues to be underdiagnosed because of failure to recognize it (missed diagnosis) and because of misdiagnosis of migraine as another headache type. First, a diagnosis of migraine may be missed in the presence of other headache types that occur proportionally more frequently than migraine and thereby overshadow migraine. Second, migraine may be misdiagnosed when health-care providers inappropriately interpret specific symptoms and co-morbid conditions as indicators of the presence of a non-migraine headache type such as sinus or tension. By becoming aware of these diagnostic pitfalls and being more judicious and deliberate in diagnosing migraine and other headache types, health-care providers can improve the diagnosis of migraine and patients to receive appropriate therapy.
Comment: The diagnosis of migraine is less likely to be made if the patient has several types of headache presentations over time. Thus, a patient with the full spectrum of migraine, from episodic tension-type through migrainous (probable migraine) headache and on to migraine per se is far less likely to receive a diagnosis of migraine than a patient who experiences attacks of "pure" migraine. SJT     

胰岛干细胞来源及诱导分化与分子标记物

目的:胰岛干细胞移植是治疗糖尿病的一条新途径,可避免胰腺供体匮乏及长期使用免疫抑制剂的问题。本文对有关胰岛干细胞的来源、诱导分化及其分子标记物等研究进展做一综述。资料来源:应用计算机检索PUBMED 1997-06/2006-06期间的相关文章,检索词为“pancreatic,stem cell,differentiate,marker”,并限定文章语言种类为English。同时计算机检索万方数据库1997-06/2006-06期间的相关文章,检索词为"胰岛干细胞,诱导分化,分子标记物",并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与胰岛干细胞的来源、诱导分化及其分子标记物研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到82篇相关文献,31篇文献符合纳入标准,排除的51篇文献为内容陈旧或重复。符合纳入标准的31篇文献中,6篇涉及主要概念,15篇涉及胰岛素分泌细胞的来源及其诱导分化,9篇涉及胰岛干细胞的分子标志,2篇涉及目前存在的问题。资料综合:干细胞是具有自我更新能力的多潜能细胞,分为胚胎干细胞和成体干细胞两大类。胰腺干细胞属于成体干细胞,能在体内分化成导管细胞、胰岛素分泌细胞、外分泌腺胞等特定胰腺组织细胞型,并具有无限分裂和永久自我更新能力。胰岛干细胞的来源、诱导分化及其分子标记物等研究对糖尿病治疗有非常重要的意义。近年研究表明:胰岛素分泌细胞主要来源于胚胎干细胞和成体干细胞,如胰腺导管上皮细胞、巢蛋白阳性胰岛前体细胞、骨髓间充质干细胞、肝脏干细胞等的诱导分化,也可利用基因工程获得。胰岛干细胞的分子标志对基础和临床研究均有重要意义,目前所使用的主要分子标志主要有PDX-1、巢蛋白、角蛋白19、角蛋白20、神经原素3、9.5蛋白基因产物等,可用于胰岛干细胞鉴定、分离及纯化。结论:胰岛细胞及干细胞移植的研究发展迅速,胰岛干细胞的来源及鉴定取得了突破性进展,但还有很多问题急需解决。随着干细胞研究的深入发展和技术的不断完善,必将能够在体外培育出数量充足的胰岛细胞供移植之用。