Granulocyte macrophage colony-stimulating activity production by cultured human thymic nonlymphoid cells is regulated by endogenous interleukin-1

Supernatants of cultured human thymic nonlymphoid cells were assayed for granulopoietic factors using cultures of low density bone marrow mononuclear cells (LD-BMMC). Thymic nonlymphoid cell-conditioned medium (TNLC-CM) supported vigorous myeloid colony growth of LD-BMMC, and of LD-BMMC depleted of T lymphocytes and/or monocytes. Colony stimulating activity (CSA) in TNLC-CM was abrogated by a highly specific neutralizing antiserum against recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF). TNLC-CM also enhanced colony growth in LD-BMMC stimulated by colony stimulating activity from a giant cell tumor culture (GCT). The enhancing activity of TNLC-CM, unlike its CSA activity, required the presence of adherent cells in the marrow cell culture. The addition of anti-interleukin-1 (anti-IL-1) antibody to TNLC-CM inhibited the GCT-enhancing activity, but not the CSA. When the anti-IL-1 immunoglobulin was added directly to cultures of thymic nonlymphoid cells, GM-CSF production was completely inhibited, and the GCT enhancing activity was neutralized. We conclude that an intercellular regulatory network exists in cultured thymic explants in which GM-CSF expression is induced by IL-1. In this system, the granulopoietic effect of IL-1 derives not from a direct effect on myeloid progenitors, but from its ability to recruit CSA production by other cells.     

小切口开胸39例体会

1 临床资料小切口开胸39(男24,女15)例,年龄16～75(平均50.5)岁. 肺癌12,其中中央型肺癌3例,周围型肺癌9例;肺结核瘤2例;恶性胸水8例;自发性气胸肺大疱10例;食管裂孔疝3例,贲门失弛缓症4例. 术前准备同常规开胸手术. 采用单腔或双腔管气管内插管、全身静脉复合麻醉. 采用标准开胸的健侧卧位. 切口自锁骨中线至肩胛下线之间的范围沿肋间走行,长约8～12 cm,以病变的部位选择锁骨中线至腋中线或腋前线至腋后线或腋中线至肩胛线的相应肋间,依次切开皮肤、皮下组织,将背阔肌及胸大肌游离而不切断,沿欲切开之肋间将前锯肌纤维钝性分开,紧贴下位肋骨上缘切断肋间肌及壁层胸膜,用两副开胸器交叉撑开即可暴露术野进行操作. 关胸时,用10号丝线绕切口上下肋骨间隙缝合3针,关闭胸腔,逐层缝合切口各层组织,其中皮肤层以可吸收线行皮内连续缝合. 应用小切口进行肺叶切除11例;取活检1例;肺楔形切除2例;胸膜固定术8例;肺大疱切除10例;食管裂孔疝修补3例,贲门失弛缓症贲门胃底肌层切开膈肌瓣成形术4例. 开胸时间8～12(平均10)min. 关胸时间15～20(平均17.5)min. 开胸过程中出血量10～20 mL. 术后胸腔引流量70～200(平均130)mL/d. 术后伤口疼痛较标准开胸切口者明显减轻,均不用止痛剂. 术后术侧上肢活动无明显受限,肩关节活动在1 wk内均恢复正常,可耐受大范围的活动. 本组病例中,患者切口7～9 d拆线,全部I期愈合.     

Migration and lymphatic spread of calcified paraffinomas after breast augmentation

A 62 year old Chinese woman presented 25 years after having both breasts augmented with paraffin injections. Development of paraffinomas and multiple episodes of paraffin-related mastitis eventually resulted in bilateral mastectomies. The unusual distribution of migrated calcified paraffinomas in the thoracic wall and its lymphatic system is documented on computed tomography.     

Immunodeficiency and infantile bone and joint infection

Fifteen patients with infantile bone and joint infections were studied immunologically and clinically, 3 at the time of illness and 12 later. Abnormality of immunoglobulins, or complement, or phagocytes was found in 9 patients; 6 were within normal limits for the tests undertaken. Immunodeficiency is probably responsible for the subdued clinical signs of infection and for delayed diagnosis in some patients. It was also related to the extent of femoral head damage in infective arthritis of the hip and to the incidence of wound infection in late elective surgery.     

Parental and primary care physicians'views on the management of chronic diseases: a study in Italy

A survey on the burden and quality of care and the parental and primary care physicians'views on management of eight chronic illnesses and disabilities was conducted from 1990 to 1993. Data were collected on 993 children and adolescents from family interviews and physicians'postal questionnaires. Approximately 70% of patients used two or more services for care management and 149 children were treated outside their region. Only 36% of the physicians were case managers and half of these agreed that better communication with other care providers could facilitate their role. A wide difference in parental satisfaction was found between medical and disabling conditions. Approximately 90% of the parents expressed satisfaction with care for children with coeliac disease (112/120), asthma (80/89) and diabetes (98/111), whereas approximately one-third of parents of children with cerebral palsy and Down's syndrome were dissatisfied (88/242 and 72/189, respectively). Primary care physicians expressed similar satisfaction with case management. Distance from hospital, the need for more information on disease management and financial aid were the sources of greatest dissatisfaction. Children with disabling diseases had more problems integrating at school than children with other chronic disorders. Closer interaction between health services, providers and families is necessary to manage the needs of disabled (Italian) children better. Chronic illness, disability, family, primary care, quality of care, special needs