The Role of Surgical Resection in the Management of Small Cell Carcinoma of the Lung

To assess the role of surgical resection in the management ofsmall cell carcinoma of the lung, experience with 118 patientswho were treated between 1973 and 1985 was reviewed. Twenty-fivepatients underwent surgical resection followed by combinationchemotherapy in all except one. The remaining 93 pa tients weretreated by combined chemotherapy and radiation therapy. The 5-year survival rate for patients with stage I disease undergoingsurgical resection was 50.8%. For all 25 patients operated on,the 5-year survival rate was 30.7%. In the patients not operated on, only those with complete responsehad long-term survival, for whom the 5-year survival rate was11.9% We consider that surgical resection is definitely indicatedin patients with stage I disease. If the response to initialchemotherapy is very good, patients with stage 11 or T3N0M0disease also probably should receive resection. Patients withN2 disease are not candidates for resection, unless distantmetastases are controlled completely by intensive chemotherapy.     

Weber-Christian disease with benign cytophagic histiocytes in the skin lesion

We describe an 8 year old female with Weber-Christian disease who manifested erythema on her legs and an intermittent high fever. A wedge skin biopsy revealed lobular panniculitis and bean-bag cells, which were characteristic to cytophagic histiocytic panniculitis (CHP). However, she showed no evidence of liver dysfunction, hyperlipidemia, or coagulation disorders usually seen in CHP. Moreover, she responded well to oral corticosteroids therapy with resultant advanced subcutaneous fat atrophy.     

Epidemiologic Study of Neonatal Subcutaneous Gangrene Caused by Multi-Resistant Staphylococcus aureus

ABSTRACT. Forty-five cases of neonatal subcutaneous gangrene were admitted between Nov. 1985 and Feb. 1987, with a mortality of 6.6%. This paper presents the first epidemiologic study of 20 cases of this disease caused by multi-resistant Staphylococcus aureus. Eight of 20 cases were caused by an epidemic strain belonging to phage 29 (group I) and carrying 2.8, 3.3, 4.2 and 28.5–34.0 kb plasmid DNA. The restriction endonudease analysis confirmed that the plas-mid DNA of approximately similar size in different isolates were identical or highly homologous. According to the results of an epidemiologic study the source of infection of one patient who died was her grandmother and the other one was her mother, so the family members can also be the source of neonatal infection caused by multi-resistant S. aureus.     

Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging

AIM: To analyse the differences in the patterns between clear and papillary renal cell carcinomas using magnetic resonance imaging (MRI) and dual-phase helical computed tomography (CT). METHODS: We examined seven patients with papillary renal cell carcinoma, and six with clear cell carcinoma. The highest attenuation value of tumors in the corticomedullary phase (CMP) and the excretory phase (EP) was measured using the observer-defined region of interest (ROI). MRI consisted of T1-weighted and T2-weighted spin-echo imaging. RESULTS: All five tumors except for one with papillary renal cell carcinoma showed homogenous hypointensity, but all six tumors with clear cell carcinoma showed heterogeneous hyperintensity on their T2-weighted images. In the CMP, the mean CT numbers of the papillary renal cell carcinomas were significantly lower than those of the clear cell carcinomas. The mean enhancement of the papillary renal cell carcinomas in the CMP and the EP was significantly lower than that of the clear renal cell carcinomas. The mean CT numbers of the clear cell carcinomas in the CMP were markedly increased from those on the unenhanced CT; those in the EP were decreased gradually. But the mean CT numbers of the papillary renal cell carcinomas in the EP were still slightly more increased than those in the CMP. The enhancement patterns of the papillary renal cell carcinomas in the CMP and the EP were homogenous, but those of the clear cell carcinomas were heterogeneous. CONCLUSIONS: We can speculate the differential diagnosis from clear to papillary renal cell carcinoma using MRI and dual-phase helical CT.     

Efficacy of Intracytoplasmic Sperm Injection (ICSI) Treatment in the Immunological Infertile Patients

PROBLEM: To evaluate the efficacy of intracytoplasmic sperm injection (ICSI) treatment in the immunological infertile patients. METHODS: The subjects were 60 cycles of 44 immunological infertile patients and these clinical data were analysed, retrospectively. They were classified into female and male immunological infertility group and were treated with conventional IVF, ICSI, and half-ICSI. RESULTS: The fertilization rate of ICSI (60.3%) and half-ICSI (60.7%) cycles were significantly (P<0.01) higher than conventional IVF (42.6%) cycles. In the male immunological infertility group, fertilization rate was significantly (P<0.01) higher in ICSI (60.7%) and half-ICSI (66.7%) cycles than in conventional IVF (27.4%) cycles and clinical pregnancy rate was higher in ICSI (54.5%) and half ICSI (33.3%) than in conventional IVF (25.0%) cycles. CONCLUSIONS: We suggest that ICSI treatment is highly effective method to improve fertilization and pregnancy rate in IVF-ET program of male immunological infertility.     

Intracellular sodium modulates the state of protein kinase C phosphorylation of rat proximal tubule Na+,K+‐ATPase

The natriuretic hormone dopamine and the antinatriuretic hormone noradrenaline, acting on α‐adrenergic receptors, have been shown to bidirectionally modulate the activity of renal tubular Na⁺,K⁺‐adenosine triphosphate (ATPase). Here we have examined whether intracellular sodium concentration influences the effects of these bidirectional forces on the state of phosphorylation of Na⁺,K⁺‐ATPase. Proximal tubules dissected from rat kidney were incubated with dopamine or the α‐adrenergic agonist, oxymetazoline, and transiently permeabilized in a medium where sodium concentration ranged between 5 and 70 mM . The variations of sodium concentration in the medium had a proportional effect on intracellular sodium. Dopamine and protein kinase C (PKC) phosphorylate the catalytic subunit of rat Na⁺,K⁺‐ATPase on the Ser23 residue. The level of PKC induced Na⁺,K⁺‐ATPase phosphorylation was determined using an antibody that only recognizes Na⁺,K⁺‐ATPase, which is not phosphorylated on its PKC site. Under basal conditions Na⁺,K⁺‐ATPase was predominantly in its phosphorylated state. When intracellular sodium was increased, Na⁺,K⁺‐ATPase was predominantly in its dephosphorylated state. Phosphorylation of Na⁺,K⁺‐ATPase by dopamine was most pronounced when intracellular sodium was high, and dephosphorylation by oxymetazoline was most pronounced when intracellular sodium was low. The oxymetazoline effect was mimicked by the calcium ionophore A23187. An inhibitor of the calcium‐dependent protein phosphatase, calcineurin, increased the state of Na⁺,K⁺‐ATPase phosphorylation. The results imply that phosphorylation of renal Na⁺,K⁺‐ATPase activity is modulated by the level of intracellular sodium and that this effect involves PKC and calcium signalling pathways. The findings may have implication for the regulation of salt excretion and sodium homeostasis.     

PBL教学法在口腔正畸研究生教学中的应用

目的提高临床医学研究生的思维和综合应用知识的能力.方法以研究生为对象,采用PBL教学法,探讨临床医学教学改革的途径和方法.结果所有参与者都认为PBL教学法新颖,是一种高效率的教学模式.结论 PBL教学法可提高研究生的综合素质.     

苦参素对感染性休克大鼠肺损伤防治作用的实验研究

目的观察苦参素(Oxymatrine,OMT)对感染性休克大鼠肺损伤的防治作用。方法采用大鼠盲肠结扎穿孔法(cecal ligation and puncture,CLP)复制大鼠感染性休克模型,将56只大鼠随机分为假手术组、OMT对照组、模型(CLP)组、CLP OMT 52、26、13 mg/kg剂量组、阳性对照(CLP 地塞米松)组。通过观察血气、肺组织W/D比值、肺系数及肺含水量、肺病理学检查(大体改变及肺病理组织切片)等指标,对肺损伤进行评估。结果CLP组较假手术组比较PaO2、SaO2及BE值均降低(P<0.01);PaCO2、HCO3、W/D比值、肺系数及肺含水量均升高(P<0.05)。CLP OMT 522、6、13 mg/kg剂量组及CLP 地塞米松组较CLP组比较PaO2、SaO2及BE值均升高;PaCO2、HCO3、W/D比值、PWI及肺含水量均降低(P<0.01或P<0.05);CLP OMT 52、26、13 mg/kg剂量组及大鼠双肺肉眼观察与CLP组相比,体积膨大程度有所减轻,淤血较轻,颜色较浅。结论OMT 13、26、52mg/kg对感染性休克大鼠肺损伤性病变有明显的抑制作用。     

上皮性卵巢癌ERCC1表达与顺铂化疗耐药的关系

目的探讨切除修复交叉互补基因（ERCC1）在原发性上皮性卵巢癌顺铂化疗耐药中的意义。方法用组织芯片仪制备组织芯片并结合免疫组织化学技术,检测56例上皮性卵巢癌病人癌组织中ERCC1蛋白的表达情况,并以38例正常卵巢组织作为对照,分析其与顺铂化疗耐药的关系,同时分析ERCC1在原发性上皮性卵巢癌中的表达与临床手术-病理分期（FIGO,2000）、病理学类型、分化程度、发病年龄、发生部位以及疾病发生的相关性。结果38例正常卵巢组织中ERCC1阳性表达者17例（44.74%）,56例上皮性卵巢癌组织ERCC1阳性表达者31例（55.36%）,二者比较差异无显著性（χ^2=1.022,P〉0.05）。上皮性卵巢癌中ERCC1的表达与临床手术-病理分期、病理学类型、分化程度、发病年龄、发生部位及发病率均无明显的相关性（P〉0.05）。上皮性卵巢癌顺铂化疗耐药组ERCC1的阳性表达率为76.67%,明显高于敏感组的30.77%,差异有显著性（χ^2=11.87,P〈0.05）。结论上皮性卵巢癌ERCC1表达与顺铂化疗耐药相关。     

Impact of Occluded Culprit Arteries on Long‐Term Clinical Outcome in Patients with Non‐ST‐Elevation Myocardial Infarction: 48‐Month Follow‐Up Results in the COREA‐AMI Registry

Background

The prognostic impact of occluded culprit arteries in non‐ST‐elevation myocardial infarction (NSTEMI) patients beyond 12 months has not been investigated.

Objectives

The impact of occluded culprit arteries on a composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) in patients who presented with NSTEMI was investigated during a 48‐month follow‐up using propensity‐score (PS) matching.

Methods

A total of 2,878 NSTEMI patients in the COREA‐AMI (COnvergent REgistry of cAtholic and chonnAm university for Acute MI) Registry were classified according to the angiographic flow of culprit arteries (occlusion [OC], n = 1,070; nonocclusion, n = 1,808). After PS matching, the incidence of the primary end‐point, a composite of CD, RMI, and TVR was compared.

Results

The median follow‐up duration was 47.3 months (IQR 32.7–66.2). In the PS‐matched population, the 48‐month cumulative rates of the primary end‐point (27.5% vs. 17.9%, P < 0.001) and each event were higher in the OC group (CD: 9.0% vs. 5.4%, RMI: 16.3% vs. 9.4%, TVR: 10.5% vs. 5.6%, respectively, P < 0.05). In multivariate Cox regression analysis, occluded culprit arteries showed the significant statistical impact on the primary end‐point (HR 1.689 [1.385–2.059], P < 0.001) and each event (CD: 1.736 [1.218–2.475], RMI: 1.918 [1.468–2.505], TVR: 2.042 [1.453–2.869], respectively, P < 0.05). Furthermore, in the 12‐month landmark analysis, occluded culprit arteries were still associated with higher risk of primary end‐point beyond 12 months (P < 0.001).

Conclusions

Occluded culprit arteries were independently associated with the higher risk of CD, RMI, and TVR in NSTEMI patients during the 48‐month follow‐up. (J Interven Cardiol 2014;27:12–20)