兔肝脏及附属管道的应用解剖学研究

目的　对兔肝脏及其附属管道进行应用解剖学研究。 方法　对20只日本大耳兔分别进行活体和离体形态学观察,制作门静脉和肝静脉管道铸型标本观察其分支与走行,测定各肝叶质量及其所占肝脏百分比。 结果　兔肝肝裂明显,依据肝叶形态、肝裂走行和门静脉主干分支形式将兔肝脏分为五叶,分别为尾状叶、左外叶、左中叶、右中叶、右外叶,各肝叶质量分别为(g)：3.93±1.13、15.93±3.50、14.83±3.31、15.08±4.34、12.08±3.55。左中叶和右中叶根部肝组织融合,其余各肝叶相对独立,尾状叶包括相对独立的乳头突和尾状突两部分。各肝叶有相对独立的Glisson系统和肝静脉走行于肝蒂内。 结论　兔肝解剖学特点与多数哺乳类实验动物肝脏解剖相似,同时又具有其自身特点,适合于肝脏外科疾病动物模型的制作。     

Does preoperative needle localization lead to an increase in local breast cancer recurrence?

Between 1978 and 1981, 74 women with nonpalpable breast cancer underwent surgery after localization guides were placed. In 72 patients, guides were introduced parallel to the chest wall; in two the needle was positioned anteroposteriorly under computed tomographic guidance. Fifty-six cases (76%) were infiltrating cancer; 13 (17%), intraductal cancers; two (3%), inflammatory; and three (4%), lobular carcinoma in situ. Surgery was not used to treat the latter five patients. In the remaining 69 women, 42 (61%) were treated by means of modified radical mastectomy; six (9%), total mastectomy; 12 (17%), local excision and radiation therapy; and seven (10%), local excision alone; exact therapy for two women (3%) was unknown. At a minimum follow-up of 5 years, none of the 67 women in whom the parallel approach was used had a local recurrence. The authors conclude that preoperative placement of guides parallel to the chest wall does not appear to increase the risk of local breast cancer recurrence.     

Sclerosing cholangitis: CT findings

The value of computed tomography (CT) in the detection of primary sclerosing cholangitis (PSC) in the intrahepatic and extrahepatic biliary systems was assessed by comparing CT scans of 20 cases of PSC with cholangiographic findings. In 16 of 19 cases of extrahepatic duct disease demonstrated with cholangiography, CT demonstrated abnormalities of the common hepatic duct, or bile duct, including duct stenosis, mural nodularity, duct dilatation, wall thickening, and mural enhancement. CT demonstrated intrahepatic disease in all 20 cases, including duct dilatation, duct stenosis, pruning, and beading. CT was superior to cholangiography in characterization of the status of the intrahepatic duct system in 11 of 20 cases. In addition, CT demonstrated extrabiliary complications of PSC in 12 cases and superimposed cholangiocarcinoma in three cases. While cholangiography remains the standard for diagnosis and follow-up of PSC, CT can provide valuable information about the extent and complications of the disease.     

Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.     

Cytomegalovirus-seronegative blood components for the prevention of primary cytomegalovirus infection after marrow transplantation. Considerations for blood banks

The authors report 2.5 years' experience with the use of cytomegalovirus (CMV)-seronegative blood components for the prevention of primary CMV infection after allogeneic marrow transplantation from seronegative marrow donors to 104 CMV-seronegative patients. Patients and blood donors were screened for CMV-seronegativity by a combination of passive latex agglutination, complement fixation, and indirect hemagglutination CMV antibody screening methods. Changes in blood banking procedures necessary to provide CMV-seronegative components are detailed. Providing CMV-seronegative components was a considerable undertaking; a mean, per patient, of 19 units of red cells and 105 units of platelets was required. Twenty percent of the platelet support was provided by family members and 80 percent by volunteer donors. CMV-infection was eliminated in all but one patient not considered infected at the time of transplantation. The capability to provide CMV-seronegative components depends on an adequate supply of seronegative donors, a sensitive and practical screening method for CMV antibody, a major commitment by the blood bank, and close communication between the blood bank and the patients' physicians.     

Computed tomography of the anterior cruciate ligament

The anterior cruciate ligaments of 20 patients with suspected pathology in one ligament were studied by thin-section computed tomography (CT) and reformating techniques. In 19 patients, the suspect anterior cruciate ligament was abnormal and this was confirmed by subsequent arthroscopy or arthrotomy in thirteen. Thin-section CT and reformatting techniques provide a useful means of non-invasively imaging the anterior cruciate ligament.     

Prospective randomized controlled trial of acute normovolaemic haemodilution in major gastrointestinal surgery

Background. The efficacy of acute normovolaemic haemodilution(ANH) remains uncertain because of a lack of well-designed prospectiverandomized controlled trials. The aim of this study was to assessthe effects of ANH on allogeneic transfusion, postoperativecomplications, and duration of stay. Methods. Consecutive patients undergoing major gastrointestinalsurgery were randomized to a planned 3-unit ANH, or no ANH.Both groups underwent identical management including adherenceto a transfusion protocol after surgery. Outcome measures includedthe number of patients receiving allogeneic blood, complications,and duration of stay. Results. 380 patients were screened of which 160 were includedin the study, median age was 62 yr (range 23–90), ‘ANH’n=78, ‘no ANH’ n=82. There was no significant differencebetween groups in the number of patients receiving allogeneicblood 22/78 (28%) vs 25/82 (30%), the total number of allogeneicunits transfused (90 vs 93), complication rate, or durationof stay. Haemodilution significantly increased anaesthetic time,median 55 (range 15–90) vs 40 min (range 17–80)(P<0.001). Significantly fewer patients in the ANH groupexperienced oliguria in the immediate postoperative period 37/78(47%) vs 55/82 (67%) (P=0.012). The most significant factorsaffecting transfusion were blood loss, starting haemoglobin,and age. When compared with ASA-matched historical controls,the introduction of a transfusion protocol reduced the transfusionrate in colorectal patients from 136/333 (41%) to 37/138 (27%),P=0.004. Conclusions. In this large pragmatic study, ANH did not affectallogeneic transfusion rate in major gastrointestinal surgery.Preoperative haemoglobin, blood loss, and transfusion protocolare the key factors influencing allogeneic transfusion.     

High-dose intravenous gammaglobulin in alloimmunized platelet transfusion recipients

High-dose intravenous gammaglobulin (polyvalent immunoglobulin G) has been shown to be of benefit in some patients with immune thrombocytopenic purpura (ITP), possibly by producing reticuloendothelial system blockade. We studied this approach in patients refractory to random donor platelet transfusion using an IV IgG preparation manufactured by the Swiss Red Cross. Eleven adult patients with acute leukemia received either 0.4 g IgG/kg/d intravenously X five days (four patients) or 0.6 g/kg/d X five days (seven patients). All patients had high levels of lymphocytotoxic antibody and poor responses to random donor platelets. Except for mild headaches in two patients, there were no side effects related to the IgG infusions. All patients had significant elevations of serum IgG on the day after completion of treatment. Either random donor or partially HLA-matched platelet transfusions were administered the day after and, in some cases, during the IgG therapy. No patient had an improvement in one hour posttransfusion platelet count increments. Two additional patients received pooled platelet concentrates incubated for 30 minutes at 37 degrees C with IgG at a final concentration of 3 g% prior to transfusions. These results indicate that high-dose IgG, an extremely expensive treatment, cannot be recommended for alloimmunized adults with leukemia.     

Monocyte-mediated antibody-dependent cell-mediated cytotoxicity: the role of the metabolic burst

Human monocytes respond to opsonized microorganisms with a "metabolic burst" composed of an increase in oxygen consumption, an increase in hexose monophosphate shunt (HMPS) activity, and the generation of reactive oxygen species (ROS). We investigated the role of the metabolic burst in antibody-dependent cell-mediated cytotoxicity (ADCC) by human monocytes toward anti-D coated erythrocyte target cells because recent studies suggested a role for oxygen-dependent bactericidal mechanisms in ADCC. In normal monocytes, we found that ADCC was nearly halved under hypoxic conditions. Several agents known to impair activation of the burst, such as vincristine, cation chelators, and a sulfhydryl reagent, all decreased cytotoxicity if added before initiation of contact between target and effector cells. Cytotoxicity was inhibited by 2-deoxyglucose but not fluoride, suggesting a nonglycolytic role for glucose in ADCC, perhaps in the HMPS pathway. Although these data suggested a role for the metabolic burst in ADCC, scavengers of ROS did not impair cytotoxicity, and monocytes from chronic granulomatous disease (CGD) patients who had a defective metabolic burst had normal levels of ADCC. We conclude that ADCC toward anti-D coated erythrocyte target cells was the result of at least two independent but closely related cytotoxic pathways. Although one of these pathways appeared to involve the metabolic burst, the potentially cytotoxic reactive oxygen species did not appear to play a role in this system.