原发性颅内恶性淋巴瘤的CT诊断

原发性颅内恶性淋巴瘤的ＣＴ诊断郭凡樊长姝北京铁路总医院ＣＴ室１０００３８提要对６例经手术病理证实的原发性颅内恶性淋巴瘤的ＣＴ表现进行分析后，认为对发生在中线区表现为均匀高密度，边缘清楚具有分叶征象的病灶，可作为ＣＴ的表现的特点。在放、化疗过程中出现肿...     

Moraxella catarrhalis sepsis in a patient with juvenile spinal muscle atrophy

Moraxella catarrhalis rarely causes severe infections or bacteraemia in healthy subjects. In the literature only four cases of clinical sepsis with M. catarrhalis have been described, mostly in immunocompromised patients. We describe a case of a 34-year-old patient with Kugelberg-Welander disease and low body weight (28 kg) who developed clinical sepsis due to M. catarrhalis bacteraemia. A review of the literature is given.     

CD38 expression on CD8(+) T cells as a prognostic marker in vertically HIV-infected pediatric patients

Increased expression of CD38 on CD8(+) T cells is associated with activation of the immune system, progression of HIV disease, and death in adults. The prognostic significance of these cells in HIV-infected children, where the picture is complicated by age-related differences in CD38 expression, remains controversial. Measuring the unimodal expression of CD38 on CD8(+) T cells in adults and children by flow cytometry is best accomplished by quantitating the antigen on the cell surface. To our knowledge, this technique has not previously been reported in a pediatric population. Vertically HIV-infected children were age matched for mild (n = 26) and severe (n = 23) clinical disease. Eleven age-matched HIV-negative controls were included for comparison. Quantitation of CD38 on CD8(+) T cells was performed at baseline and 1 y later. The ages of the children in the three clinical groups did not differ significantly (p = 0.6004). HIV-infected children had significantly increased CD38 measurements in comparison with the HIV-negative controls (p = 0.0131), and the severe disease group tended to have higher measurements than the mild disease group. Increased CD38(+)CD8(+) T cells were significant predictors of death within the first year (p = 0.043). These findings support the view that increased CD38 expression on CD8(+) T cells has the same prognostic significance in pediatric as in adult HIV disease.     

Persistence of the lactate paradox over 8 weeks at 3,800 m

The arterial blood lactate [La] response to exercise increases in acute hypoxia, but returns to near the normoxic (sea level, SL) response after 2 to 5 weeks of altitude acclimatization. Recently, it has been suggested that this gradual return to the SL response in [La], known as the lactate paradox (LP), unexpectedly disappears after 8 to 9 weeks at altitude. We tested this idea by recording the [La] response to exercise every 2 weeks over 8 weeks at altitude. Five normal, fit SL-residents were studied at SL and 3,800 m (Pbar = 485 torr) in both normoxia (PIO2 = 150 torr) and hypoxia (PIO2 = 91 torr approximately air at 3,800 m). Arterial [La] and blood gas values were determined at rest and during cycle exercise at the same absolute workloads (0, 25, 50, 75, 90, and 100% of initial SL-VO2Max) and exercise duration (4, 4, 4, 2, 1.5, and 0.75 min, respectively) at each time point. [La] curves were elevated in acute hypoxia at SL (p < 0.01) and at 3,800 m fell progressively toward the SL-normoxic curve (p < 0.01). On the same days, [La] responses in acute normoxia showed essentially no changes over time and were similar to initial SL normoxic responses. We also measured arterial catecholamine levels at each load and found a close relationship to [La] over time, supporting a role for adrenergic influence on [La]. In summary, extending the time at this altitude to 8 weeks produced no evidence for reversal of the LP, consistent with prior data obtained over shorter periods of altitude residence.     

Duration of Sample Storage Dramatically Alters Expression of the Human Immunodeficiency Virus Coreceptors CXCR4 and CCR5

Expression of the chemokine receptors CXCR4 and CCR5 was monitored using EDTA-anticoagulated whole blood held for different time periods prior to fluorescent-antibody staining. When left overnight CXCR4 expression on leukocytes was substantially increased, whereas CCR5 expression was reduced. The results were similar when heparin and acid-citrate-dextrose were used as anticoagulants.     

BD focalpoint slide profiler performance with atypical glandular cells on SurePath Papanicolaou smears

BACKGROUND:

The FocalPoint Slide Profiler is an automated cervical cytology screening system that is approved for primary screening. It identifies up to 25% of slides as requiring No Further Review. However, few studies have evaluated FocalPoint performance with glandular abnormalities.

METHODS:

Sixty‐six SurePath Papanicolaou (Pap) tests with a diagnosis of atypical glandular cells were identified. A total of 172 Pap tests with a diagnosis of “endometrial cells present” were included as controls. Follow‐up histology was abnormal if diagnosed as high‐grade squamous intraepithelial lesions, adenocarcinoma in situ, carcinoma, or complex endometrial hyperplasia. The FocalPoint software ranked each case into 1 of 7 categories: quintiles 1 (high risk) through 5 (low risk), No Further Review, and Process Review.

RESULTS:

A total of 215 slides were qualified for review; 38 (57.6%) atypical glandular cells cases were abnormal on follow‐up biopsy, and 27 (71.1%) atypical glandular cells with abnormal follow‐up qualified for review; no cases were classified No Further Review, and 9 (33%) were ranked in quintile 1. Twenty‐three (82.1%) atypical glandular cells with benign follow‐up were qualified for review; 3 (11%) cases were classified No Further Review, and 4 (17%) were ranked in quintile 1. There was a statistically significant difference between the ranking of benign atypical glandular cells cases, abnormal atypical glandular cells cases, and control cases (P = .03). However, when collapsed into No Further Review versus all other quintiles, the differences were not significant (P = .20).

CONCLUSIONS:

The FocalPoint Slide Profiler did not classify glandular lesions with abnormal follow‐up in the No Further Review category. However, these cases were not preferentially ranked in quintile 1. FocalPoint‐screened slides need to be carefully reviewed for glandular abnormalities, regardless of the quintile ranking. Cancer (Cancer Cytopathol) 2010. © 2010 American Cancer Society.     

Current concepts in teaching and learning in surgery

Modern surgical teaching is evolving at speed. The environment in which we learn and teach is subject to a number of extrinsic pressures. These are influencing ways in which medical students and trainees learn and are taught the discipline of surgery. As a surgical educator it is useful to understand the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.