The amount of white pulp in the spleen; a morphometrical study done in methacrylate-embedded splenectomy specimens

This report deals with a morphometrical study on 92 surgically removed human spleens, to investigate the composition of spleens which are considered to be normal, i.e. spleens which had ruptured in traffic accidents or which had been incidentally removed during abdominal operations. A comparison was made with 16 spleens with hypersequestration of platelets and to 11 with hyper-sequestration of erythrocytes. Methyl-methacrylate embedding was used because of the superiority of this technique over conventional paraffin embedding. Significant differences were found between both 'normal' groups as to the absolute and relative amount of white pulp as well as the perifollicular red pulp zone. Based also on the few morphometrical reported studies in the literature, spleens removed during abdominal surgery form the best control group. Traumatic rupture of the spleen in traffic accidents might specifically occur in spleens which already contained a stimulated lymphatic compartment. A probably non-specific increase of white pulp was found in splenomegaly of varied aetiology. An expected influence of age on weight and composition of the spleen was not found in our study. The spleen changes in weight and composition only up to 5 years of age. Significant involution at older age was not found in ours nor in other reported larger series.     

复方氢氧化钙糊剂在根尖诱导成形术中的疗效观察

目的：观察复方氢氧化钙糊剂在根尖诱导成形术中的疗效。方法：选择52颗根尖未发育完成的年轻恒牙,根管预备、消毒后,用复方氢氧化钙糊剂进行根尖诱导。定期复查,随访3年,观察临床疗效。结果：复方氢氧化钙糊剂在根尖诱导成形术中有效率为90.38%。结论：复方氢氧化钙糊剂对根尖诱导有良好的效果。     

YAP和Caspase在恶性肿瘤中的作用机制及其关联的研究进展

正常情况下细胞增殖与凋亡之间保持着动态平衡,维持着机体的生理状态,细胞异常增殖或凋亡抑制时细胞过度增殖组织异常生长导致肿瘤的发生。Hippo通路是最近发现的一条细胞信号传导通路,主要功能有调控器官体积、保持细胞增殖凋亡平衡、细胞接触性抑制的调节等。YAP是Hippo通路上的重要因子,YAP表达异常可导致Hippo通路不能正常发挥作用而细胞异常增殖导致肿瘤的发生。Caspase是与细胞凋亡密切相关的蛋白水解酶家族,一般以酶原形式存在,在凋亡信号的作用下激活启动型Caspase引发Caspase级联反应导致细胞凋亡,其功能异常导致各种相关疾病的发生。本文将介绍Hippo通路的主要组成及其作用机制,YAP和Caspase基因的作用机制及其与肿瘤发生发展的相关性。     

CT定位下肺大泡减容术前后的CT肺功能分析

目的:研究定量CT肺功能对肺大泡减容术前及术后的肺功能评估。方法:18例肺大泡病例进行CT定位下肺大泡减容术,分别在术前、术后1个月及6个月行CT扫描,利用CT肺功能定量分析软件分析图像数据并得出相应CT肺功能参数值:CT值、像素指数(PI,分为-1024～-980,-980～-910,-910～-800,-800～-700,>-700五区)、容积,比较各组参数的差异。结果:①CT肺定量能检出介入术前肺大泡病灶的大小、数目及位置,并能顺利地用Volume软件测出欲减容的肺大泡容积;②CT肺功能术后与术前比较,肺总容积、PI-1024～-980明显减少,平均CT值、PI-910～-800明显增加(P<0.01)。结论:CT定位下肺大泡减容术是治疗肺大泡的途径之一,定量CT肺功能可对肺大泡减容术前及术后的肺功能进行评估。     

Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study

Elevated serum phosphorus is a predictable accompaniment of end-stage renal disease (ESRD) in the absence of dietary phosphate restriction or supplemental phosphate binders. The consequences of hyperphosphatemia include the development and progression of secondary hyperparathyroidism and a predisposition to metastatic calcification when the product of serum calcium and phosphorus (Ca x PO4) is elevated. Both of these conditions may contribute to the substantial morbidity and mortality seen in patients with ESRD. We have analyzed the distribution of serum phosphorus in two large national, random, cross-sectional samples of hemodialysis patients who have been receiving dialysis for at least 1 year. Data were obtained from two special studies of the United States Renal Data System, the Case Mix Adequacy Study (1990) and the Dialysis Morbidity and Mortality Study Wave 1 (1993). The relative risk of death by serum phosphorus quintiles is described after adjusting for age at onset of ESRD, race, sex, smoking status, and the presence of diabetes, the acquired immunodeficiency syndrome, and/or neoplasm. Logistic regression analysis is then used to describe the demographic, comorbid, and laboratory parameters associated with high serum phosphorus. Serum phosphorus was similar in these two study populations and averaged 6.2 mg/dL. Ten percent of patients had levels greater than 9 mg/dL and at least 30% of each group had serum phosphorus levels greater than 7 mg/dL. The adjusted relative risk of death by serum phosphorus level was not uniform across all quintiles, being constant below a level of 6.5 mg/dL and increasing significantly above this level. The relative risk of death for those with a serum phosphorus greater than 6.5 mg/dL was 1.27 relative to those with a serum phosphorus of 2.4 to 6.5 mg/dL. This increased risk was not diminished by statistical adjustment for coexisting medical conditions, delivered dose of dialysis, nutritional parameters, or markers of noncompliance. Evaluation of predictors of serum phosphorus greater than 6.5 mg/dL revealed in multivariate analysis that younger age at onset of ESRD, female sex, white race, diabetes, active smoking, and higher serum creatinine levels were all significant predictors. Analysis of serum calcium revealed no correlation with relative risk of death. The Ca x PO4 product, however, showed a mortality risk trend similar to that seen with serum phosphorus alone. Those in the highest quintile of the Ca x PO4 product (>72 mg2/dL2) had a relative mortality risk of 1.34 relative to those with products of 42 to 52 mg2/dL2. The relative mortality risk by log parathyroid hormone (PTH) level was elevated for patients with higher levels, but the mortality risk associated with hyperphosphatemia was independent of PTH. For hemodialysis patients who have been receiving dialysis for at least 1 year, we conclude that a large percentage have a serum phosphorus level above 6.5 mg/dL and that this places them at increased risk of death. This increased risk is independent of PTH. The mechanism(s) responsible for death is unknown, but may be related to an abnormally high Ca x PO4 product. Although mechanisms are not clearly established, this study supports the need for vigorous control of hyperphosphatemia to improve patient survival.     

Observations of sexually transmitted disease consultations in India

Objectives: To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment.Methods: Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management.Results: With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndromic approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactorily managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations.Conclusions: Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.     

Pretreatment tumor mass, cell kinetics, and prognosis in multiple myeloma

One-hundred fifty patients with multiple (plasma cell) myeloma had pretreatment tumor mass staging, and 79 also had measurement of the pretreatment labeling index (LI%). There were clear differences in survival by pretreatment stage of disease. The pretreatment LI% of bone marrow plasma cells was an independent prognostic factor both in single factor and multivariate regression analyses, including myeloma stage (p less than 0.02). Other important prognostic factors (multivariate) included performance status, serum creatinine, presence of Bence Jones protein, age, and kappa/lambda subtype. A LI% of less than 1% was associated with long survival in each patient group. Patients with benign gammopathy had excellent survival and very low labeling indices. A pretreatment LI% of greater than 3% in high cell mass patients with a high total number of DNA synthesizing cells (S) conferred a very poor prognosis (p = 0.002). This subgroup of patients with high S values also had a high incidence of central nervous system relapse (27%), Bence Jones proteinuria, and elevated serum uric acid levels. We conclude that the pretreatment labeling index provides helpful prognostic information in addition to tumor mass staging.