Renal allograft rejection: evaluation by Doppler US and MR imaging

A prospective study compared the efficacy of Doppler ultrasonography (US) and magnetic resonance (MR) imaging in evaluating 38 renal allografts, with specific attention to transplant rejection. Forty-three Doppler US and 42 MR examinations were performed and interpreted. Histologic correlation was obtained from 22 biopsy or nephrectomy specimens. Clinical correlation or a response to instituted therapy was used as confirmation in the remaining allografts. Accuracy in identifying cyclosporine toxicity or acute tubular necrosis could not be evaluated because there were few such cases, with concomitant rejection in most. The ability to predict and identify presence or absence of rejection was not affected by different serum creatinine values. Doppler US was significantly superior to MR imaging in identifying allograft rejection, demonstrating a higher sensitivity (95% vs. 70%), specificity (95% vs. 73%), and accuracy (95% vs. 71%). Because of its low cost and accessibility, Doppler US should become the primary modality for renal transplant screening.     

In vitro and in vivo antileukemic activity of B43-pokeweed antiviral protein against radiation-resistant human B-cell precursor leukemia cells

B-cell precursor (BCP) leukemia is the most common form of childhood cancer and represents one of the most radiation-resistant forms of human malignancy. In this study, we examined the antileukemic efficacy of the B43 (anti-CD19)-pokeweed antiviral protein (B43-PAP) immunotoxin against radiation-resistant BCP leukemia cells. B43-PAP caused apoptosis of radiation-resistant primary BCP leukemia cells, killed greater than 99% of radiation-resistant primary leukemic progenitor cells from BCP leukemia patients, and conferred extended survival to severe combined immunodeficiency (SCID) mice xenografted with radiation- resistant human BCP leukemia. Furthermore, the combination of B43-PAP and total body irradiation (TBI) was more effective than TBI alone in two SCID mouse bone marrow transplantation models of radiation- resistant human BCP leukemia. Thus, B43-PAP may prove useful in the treatment of radiation-resistant BCP leukemia.     

非限制性肩关节置换术

目的：作者对２９例肩关节炎和肱骨近端骨折患者的３６侧肩关节，采用非限制性假体做全肩关节置换术２４个、半肩（即人工肱骨头）置换术１２个。方法：所有３６个肱骨头假体和１３个肩盂假体为骨长入型非骨水泥假体，余１１个肩盂假体为骨水泥假体。患者术时平均年龄６３岁，术后平均随访６．２年（３．３～１０．４年）。结果：术后肩关节疼痛缓解率达９１．３％，主动活动度增加：前屈４７°、外展４３°、外旋３０°、内旋４个节段。６个日常生活动作能力平均评分由术前０．８分增加到术后３．１分。术后Ｘ线片示肱骨头假体上移８例，其中６例伴有肩袖撕裂甚或缺损。１例肱骨头假体和９例肩盂假体周围可见Ｘ线透亮线。肱骨头假体松动１例；肩盂假体松动２例。结论：显示非限制性肩关节置换术是一种疗效可靠满意的手术方法     

Inhibitory effects of okadaic acid on rat uterine contractile responses to different spasmogens

Summary— In the present study, we examined the effects of okadaic acid, a selective inhibitor of type 1 and 2A protein phosphatases, on the mechanical responses evoked by oxytocin, K⁺- and Na+-modified solutions and ouabain in estrogen-primed rat myometrium. Oxytocin elicited a rapid, phasic contraction followed by rhythmic oscillations. The phasic response was partially resistant to the absence of external Ca²⁺. Okadaic acid (1 μM) and the L-type calcium channel blocker nifedipine (1 μM) abolished the oscillatory component and reduced the initial, phasic response to about 80% of the control response. High K⁺ (60 mM) solution, ouabain (1 mM), K⁺-free medium and low Na⁺ (25 mM) solution induced extracellular Ca²⁺-dependent biphasic responses composed by an early rapid (KCl, ouabain and K⁺-free solution) or slower developed (25 mM Na⁺ solution) phasic contraction followed by a sustained increase in tension. Okadaic acid and nifedipine, alone or in combination, abolished or decreased similarly the contractile response evoked by these stimulants. The okadaic acid- and nifedipine-insensitive responses to ouabain, K⁺-free and low Na⁺ solution were enhanced by increasing the extracellular concentration of Ca²⁺ in the medium and were inhibited in a dose-dependent manner by amiloride (0.05–0.5 mM). These data suggest that, in estrogen-primed rat uterus, dephosphorylating mechanisms by OA-sensitive protein phosphatases play an important role in regulating myometrial contractions elicited by Ca²⁺ entry through voltage-sensitive Ca²⁺ channels.     

Thoracic spine: percutaneous trephine biopsy

Forty-one percutaneous trephine biopsies of thoracic vertebral bodies or disks from T-3 to T-12 were performed under fluoroscopic guidance without complications. Biopsy technique was improved by a new set of trephine needles using a procedure similar to vascular catheterization and specific prone-oblique positioning of the patient. On a 35 degrees prone-oblique view, the heads (dorsal extremities) of the ribs determine the direction of puncture. Both pleura and spinal canal are easily recognized and avoided. Of 40 cases, there were 31 true-positive results, six contributory results, and three false-negative results. Percutaneous biopsy of the thoracic spine with this technique is a safe, rapid, and reliable procedure.     

Gianturco expandable metallic biliary stents: results of a European clinical trial

Eleven patients with benign strictures (after choledochojejunostomy, n = 10; chronic pancreatitis, n = 1) and 16 with malignant biliary strictures (cancer of the pancreas, n = 7; cholangiocarcinoma, n = 5) were treated with a self-expanding metallic biliary stent. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilation. All patients had immediate relief of jaundice and cholangitis. In a follow-up period of 6-21 months, nine of the 11 patients with benign disease had no difficulties with infection, pruritus, or recurrent jaundice. In patients with malignant strictures, the stent produced relief of biliary obstruction unless recurrent tumor invaded the bile ducts. With careful patient selection, this stent appears to be useful in the management of biliary obstruction, particularly in benign disease.