Intraparenchymal pulmonary lymph node: case report and literature review

Summary A case of a 44-year-old woman with a solitary pulmonary coin lesion is presented. Histologic study of this nodule revealed a normal intraparenchymal pulmonary lymph node. A review of the literature discusses the incidence and characteristics of this entity.

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Nud lymphatique intrapulmonaire: revue de la littérature. A propos d'un cas

Résumé L'observation d'un cas de lésion nodulaire du poumon est rapportée chez une femme de 44 ans. L'étude histologique du nodule a révélé un nud lymphatique intrapulmonaire normal. La revue de la littérature apprécie l'incidence et les caractéristiques de cette localisation.

     

The floating cardiac fat pad—sign of occult pneumothorax

Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.     

急性脑出血患者卒中相关性肺炎发病的危险因素分析

目的探讨急性脑出血患者卒中相关性肺炎(SAP)发生的危险因素,以便早期干预。方法选择急性脑出血患者196例为研究对象,其中发生SAP 82例为病例组,未发生SAP 114例为对照组。对两组的年龄、性别、心肺疾病史、GCS评分、吞咽困难、心率、血压、白细胞计数、脑出血量、鼻饲、使用胃黏膜保护剂和手术等共计23项予以比较分析。所得资料在单因素分析的基础上,又作多因素Logistic回归分析。结果急性脑出血SAP的患病率为41.837%。收缩压升高(优势比1.072,95%可信区间1.007~1.141,P=0.029)、白细胞计数增加(优势比1.331,95%可信区间1.009~1.756,P=0.043)、脑出血量增多(优势比1.079,95%可信区间1.019~1.142,P=0.010)、有心肺疾病(优势比12.275,95%可信区间1.210~124.545,P=0.034)、吞咽困难(优势比12.937,95%可信区间1.918~87.250,P=0.009)和鼻饲(优势比19.217,95%可信区间1.307~282.651,P=0.031)均促进发病。而使用胃黏膜保护剂(优势比0.157,95%可信区间0.031~0.790,P=0.025)和实施手术(优势比0.012,95%可信区间0.000~0.294,P=0.007)阻止发病。结论收缩压、白细胞计数增加、脑出血量增高、有心肺疾病、吞咽困难和鼻饲是急性脑出血发生SAP的危险因素;而使用胃黏膜保护剂和实施手术为其保护因素。     

The kidneys in paroxysmal nocturnal hemoglobinuria

Long-term study of 21 PNH patients revealed an unexpectedly high incidence of functional and anatomic renal abnormalities. Most patients demonstrated varying degrees of hematuria and proteinuria distinct from hemoglobinuria. Evaluation of renal function revealed hyposthenuria, abnormal tubular function, and declining creatinine clearance. Radiologically these patients had enlarged kidneys, cortical infarcts, cortical thinning, and papillary necrosis which were confirmed by autopsy studies. Hypertension developed in eight patients. Urinary tract infection was uncommon. The renal findings bear striking similarity to those of sickle cell anemia. Contrary to the usual opinion, out studies clearly showed evidence of widespread renal pathology in PNH most likely due to repeated microvascular thrombosis similar to the venous thrombosis involving other organs in this disorder.     

Effects of monoclonal antibody therapy in patients with chronic lymphocytic leukemia

A phase I clinical trial was initiated to treat patients with stage IV B-derived chronic lymphocytic leukemia (CLL) with the IgG2a murine monoclonal antibody T101. This antibody binds to a 65,000-mol wt (T65) antigen found on normal T lymphocytes, malignant T lymphocytes, and B- derived CLL cells. All of the patients had a histologically confirmed diagnosis of advanced B-derived CLL and were refractory to standard therapy, and more than 50% of their leukemia cells reacted with the T101 antibody in vitro. The patients received T101 antibody two times per week, over two to 50 hours by intravenous administration in 100 mL of normal saline containing 5% human albumin. Twelve patients were treated with a fixed dosage of 1, 10, 50, or 100 mg, and one patient was treated with 140 mg of antibody. It was demonstrated that patients given two-hour infusions of 50 mg developed pulmonary toxicity, with shortness of breath and chest tightness. This toxicity was eliminated when infusions of 50 or 100 mg of T101 were prolonged to 50 hours. All dose levels caused a rapid but transient decrease in circulating leukemia cell counts. In vivo binding to circulating and bone marrow leukemia cells was demonstrated at all dose levels with increased binding at higher dosages. Antimurine antibody responses were not demonstrated in any patients at any time during treatment. Circulating free murine antibody was demonstrated in the serum of only the two patients treated with 100 mg of antibody as a 50-hour infusion and the patient treated with 140 mg of antibody over 30 hours. Antigenic modulation was demonstrated in patients treated at all dose levels but was particularly apparent in patients treated with prolonged infusions of 50 and 100 mg of antibody. We were also able to demonstrate antigenic modulation in lymph node cells, which strongly suggests in vivo labeling of these cells. Overall, T101 antibody alone appears to have a very limited therapeutic value for patients with CLL. The observations of in vivo labeling of tumor cells, antigenic modulation, antibody pharmacokinetics, toxicity, and antimurine antibody formation may be used in the future for more effective therapy when drugs or toxins are conjugated to the antibody.     

新疆家畜蠕形蚤病病原研究

本文详细介绍了在新疆发现的花蠕形蚤、叶氏蠕形蚤、北山羊蠕形蚤、羊长喙蚤和狍长喙蚤的形态学特点、地理分布和某些生物学特性。     

带蒂腹直肌包绕阴茎增强犬尿道压力的研究

目的探讨采用带蒂腹直肌包绕球部尿道治疗男性尿失禁的可行性。方法成年雄性比格犬10条,游离阴茎周围组织,建立类似尿失禁模型。取长8．0cm,宽2．5cm全层带蒂的腹直肌。包绕球部尿道处阴茎1周。术前,术中,术后1个月、2个月分别测定尿道压力变化。结果术前平均最大尿道压力为(48．9±11．0)cm H_2O,使用带蒂腹直肌包绕阴茎后,平均最大尿道压力为(78．3±20．5)cmH_2O,与术前相比,差异有统计学意义(t=4．995,P＜0．01)。术后1个月和术后2个月复查时,平均最大尿道最大压力分别为(92．2±31．6)cm H_2O和(88．3±22．4)cm H_2O,与术前相比差异均有统计学意义(t=4．011,P＜0．01和t=6．058,P＜0．01)。结论采用带蒂腹直肌包绕球部尿道能明显提高尿道压力,为采用此法治疗男性尿失禁提供了实验依据。     

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.     

直视下尿道内切开术治疗尿道狭窄20年经验总结

目的 总结直视下尿道内切开术(direct vision internal urethrotomy,DVIU)治疗尿道狭窄的经验.方法 回顾性分析1990年6月至2010年6月20年间DVIU治疗尿道狭窄或闭锁患者361的临床资料.年龄16～72岁,平均38岁.病程3～78个月,平均16个月.狭窄或闭锁长度0.2～2.0 cm,平均1.1 cm.狭窄长度≤1.0 cm 238例,其中≤0.5 cm 63例(组1),0.6～1.0 cm 175例(组2),瘢痕厚度≤1.0 cm 148例,＞1.0 cm 90例;狭窄长度1.1～2.0 cm 123例,其中1.1～1.5cm 85例(组3),1.6～2.0 cm 38例(组4),瘢痕厚度≤1.0 cm 44例,＞1.0 cm 79例.结果 361例中手术失败3例.320例获随访,随访时间12～120个月,平均42个月.因狭窄复发而接受开放手术174例(54.4%),4组中转开放手术率分别为3.3%、49.7%、83.3%和97.1%.狭窄长度≤1.0cm者获随访207例,其中瘢痕厚度≤1.0 cm转开放手术27.2%(37/136),瘢痕厚度＞1.0 cm转开放手术60.6%(43/71).狭窄长度＞1.0 cm者获随访113例,其中瘢痕厚度≤1.0 cm转开放手术78.6%(33/42),瘢痕厚度＞1.0 cm转开放手术84.5%(60/71).结论 当尿道狭窄长度≤0.5 cm时,DVIU术后转开放手术的比例明显减少;狭窄长度≤1.0 cm,瘢痕厚度≤1.0 cm者,DVIU也可获较好疗效.

Abstract：

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.