Embolisation of Angio-Seal™ device: an unusual case of post-cardiac catheterisation limb ischaemia

We present the case of a 67-year-old male presenting with critical limb ischaemia following cardiac catheterisation. Immediately after deployment of an arterial closure device, the patient reported severe lower limb pain with impalpable pulses. Magnetic resonance angiography revealed an abrupt disruption of flow in the tibioperoneal trunk. Subsequent surgery revealed embolisation of the arterial closure device. The patient went on to make an unremarkable recovery.     

梗阻型急性胆源性胰腺炎的治疗方式及手术时机的选择

目的 探讨梗阻型急性胆源性胰腺炎的治疗方式及手术时机的选择.方法 回顾分析广州医学院第三附属医院2000年至2010年76例梗阻型急性胆源性胰腺炎的临床资料.结果 全组手术治疗36例,两周内手术20例,延期手术16例,死亡1例,术后随访无复发.内镜治疗15例,其中ERCP/EST 11例,ERCP/ENBD 1例,ERCP 3例,均获痊愈,随访1例复发.非手术治疗25例,死亡1例,随访6例复发.结论 外科手术在胆源性胰腺炎治疗中具有重要地位.对梗阻型急性胆源性胰腺炎患者应在经短期积极的非手术治疗后早期手术或内镜治疗解除胆道梗阻.

Abstract：

Objective To investigate the management and timing of operation in obstructive acute biliary pancreatifis.Methods A etrospective review was performed of seventy-six consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with obstructive acute biliary pancreatitis.Results Of the seventy-six patients,thirty-six patients underwent operations,with early(after onset within 2 weeks)operations in twenty cases,delayed operationsin sixteen cases and one case dead,no one experienced recurrent pancreatitis during follow-up.Fifteen patients were treated by endoscopy,ERCP/EST in eleven cases,ERCP/ENBD in one case and ERCP only in three case.All patients were cured,only one patient experienced recurrent pancreatitis.Twenty-five patients received conservative treatment,one patient died,six patients experienced recurrent panereatitis.Conclusions Surgery is essential in the management of acute biliary pancreatitis.In cases of obstructive acute biliary pancreatitis,early operation or endoscopic therapy should be performed to remove biliopancreatic obstruction after aggressive conservative treatment.     

水溶性脂聚体介导NR2B siRNA治疗神经病理性痛的实验研究

目的 探讨水溶性脂聚体(WSLP)介导含2B亚基的N-甲基-D-天冬氨酸受体小干扰RNA(NR2B siRNA)治疗大鼠神经病理性痛的可行性.方法 健康雄性SD大鼠100只,周龄6周,体重180～200 g,采用随机数字表法,将大鼠随机分为5组(n=20):对照组(C组)、假手术组(S组)、神经病理性痛组(NP组)、WSLP-NR2B siRNA组(W组)、WSLP-阴性对照NR2B siRNA(WN组).采用坐骨神经分支部分结扎法制备大鼠神经病理性痛模型.C组不予任何处理;S组仅暴露坐骨神经,不牵拉和损伤神经;NP组于制备模型后即刻鞘内注射生理盐水20μl;W组和WN组于制备模型后即刻分别鞘内注射相应的siRNA 20μl.于模型制备前1 d及制备后3、7、14和21 d时测定机械缩足反应阈值(MWT)及热缩足反应持续时间(TWD),模型制备后3 d,痛阈测定结束后,每组取10只大鼠,取L4-6节段背根神经节,测定NR2B mRNA及其蛋白的表达水平.结果 与S组比较,NP组、W组和WN组MWT降低,TWD延长,NR2B mRNA及其蛋白表达上调(P＜0.05或0.01),C组上述指标差异无统计学意义(P＞0.05);与NP组比较,W组MWT升高,TWD缩短,NR2B mRNA及其蛋白表达下调(P＜0.01),WN组上述指标差异无统计学意义(P＞0.05).结论 WSLP不仅成功介导NR2B siRNA,抑制NR2B的表达,还可减轻大鼠神经病理性痛.

Abstract：

Objective To investigate the feasibility of NR2B small interference RNA(NR2B siRNA)carried by water-soluble lipopolymer(WSLP)for treatment of neuropathic pain in rats.Methods One hundred healthy male SD rats weighing 180-200 g were randomly divided into 5 groups(n=20 each):normal control group (group C),sham operation group(group S),neuropathic pain group(group NP),group WSLP-NR2B siRNA (group W)and group WSLP-negative NR2B siRNA(group WN).Neuropathic pain was induced by partial ligation of sciatic nenre.WSLP-NR2B siRNA complex was formed by binding WSLP and NR2B siRNA.Normal saline.WSLP-NR2B siRNA complex and WSLP-negative NR2B siRNA 20μl were injected intrathecally after operation in NP,W and WN groups respectively.Mechanical withdrawal threshold(MWT)and thermal withdrawal duration (TWD)were measured before(baseline)and at 3,7,14 and 21 days after operation.Ten animals in each group were sacrificed on the 3rd day after operation and the lumbar segment(L4-6)of the dorsal root ganglia was removed for determination of the expression of NR2B mRNA and protein using RT-PCR and Western blot analysis.Results Sciatic nerve ligation significantly decreased MWT and prolonged TWD and increased NR2B mRNA and protein expression in group NP as compared with group C.WSLP-NR2B siRNA complex significantly reduced sciatic nerve ligation-induced hyperalgesia and decreased NR2B mRNA and protein expression in group W as compared with group NP.Conclusion WSLP not only mediates NR2B siRNA successfully and inhibits the expression of NR2B,but also reduces neuropathic pain in rats.     

睾丸混合性生殖细胞肿瘤临床病理分析

目的:探讨原发性睾丸混合性生殖细胞肿瘤(MGCT)的临床病理特征。方法:对我院13例原发性睾丸MGCT患者的临床病理资料进行回顾性分析,并结合相关文献进行讨论。结果:睾丸MGCT占我院同期睾丸生殖细胞肿瘤的24.1%(13/54),患者年龄2~53岁,平均28.3岁。全部病例均发生于单侧睾丸,左侧6例,右侧7例,左右侧比为0.86∶1。睾丸MGCT病理形态多样,肿瘤成分包括胚胎性癌(11例,84.6%)、精原细胞瘤(8例,61.5%)、畸胎瘤(6例,46.2%)、绒毛膜癌及卵黄囊瘤(均为4例,23.1%)。其中9例(69.2%)包含2种不同的生殖细胞肿瘤成分,3例(30.8%)包含3种不同的肿瘤成分,1例(7.7%)包含5种不同的肿瘤成分。结论:睾丸MGCT非常少见,好发于青壮年男性,不同的肿瘤成分其生物学行为、临床治疗和预后不同,因此准确的病理诊断非常必要,免疫组化标记对病理诊断与鉴别诊断具有重要作用。     

用SSH方法构建BTCC患者尿脱落细胞差异表达基因的cDNA消减文库

目的:应用抑制性消减杂交(SSH)方法构建膀胱移行细胞癌(BTCC)患者与正常人尿脱落细胞差异表达基因cDNA消减文库。方法:分别从BTCC患者与正常人尿液中提取总mRNA,用SMART技术反转录成cDNA,经过HaeⅢ酶切后将BTCC尿脱落细胞cDNA分为两组并接上接头,再与过量正常膀胱尿脱落细胞cD-NA进行两轮消减杂交及两轮抑制性聚合酶链反应(PCR),使得差异表达的DNA片段得以富集。PCR产物与T/A载体连接并转化大肠杆菌JM109构建成差异表达基因的cDNA消减文库。文库扩增后,随机挑取克隆进行酶切、测序及同源性分析。结果:PCR鉴定有317个克隆载有主要在200～900bp之间呈随机分布的插入片段,片段插入率达82.6%,证实建库成功。对20个质粒测序结果经同源性比对分析,其中20个片段源于17个已知基因,1个克隆在GenBank中未检索到与其有相似性的基因序列,表明它们可能为BTCC差异表达的新基因。结论:该消减杂交文库质量可靠,其成功构建为进一步筛选、克隆BTCC差异表达基因提供了依据。     

Pyogenic liver abscess complicated by endogenous endophthalmitis

Background: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. Methods: Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. Results: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. Conclusion: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.     

ACHN人肾癌裸鼠移植瘤模型的生物学特性及放射治疗观察

目的观察ACHN人肾癌裸鼠皮下移植瘤模型的生物学特性及其对放射线的敏感性。方法分别利用瘤细胞悬液接种法、瘤块包埋法获得ACHN人肾癌裸鼠移植瘤模型，观察移植瘤的生长情况、成瘤率、肝肺转移率及病理形态。ACHN皮下荷瘤鼠14只，随机分为空白对照组和放疗组，6MV X直线加速器对放疗组移植瘤局部单次照射12Gy，观察裸鼠的耐受性及肿瘤生长抑制情况；透射电镜观察瘤细胞超微结构变化。结果瘤块包埋法成瘤稳定，成瘤率92．5%，肝转移率43％，未见肺转移。裸鼠对12Gy射线局部照射耐受良好，放疗组移植瘤与空白对照组比较生长明显受抑制（P〈0．01）；放疗组瘤细胞凋亡现象明显。结论ACHN人肾癌裸鼠移植瘤模型可作为肾癌放疗实验研究的有效工具。     

Surveillance neuroimaging in childhood intracranial ependymoma: how effective, how often, and for how long?

OBJECT: The authors examined images obtained in 52 children with intracranial ependymomas to determine risk factors for tumor recurrence and to assess the impact of surveillance imaging on patient outcome. METHODS: Data obtained in all children with intracranial ependymomas were prospectively entered into a database from January 1987 to June 2000. The imaging and clinical details in all patients were reviewed. Fifty-two children with histologically proven intracranial ependymomas were treated at the authors' institution; recurrences developed in 28 (54%) of them, with a median time from surgery to first recurrence of 14.5 months (range 3-65 months). Of these tumor recurrences, 43% were asymptomatic and were noted on surveillance imaging. Seventeen children died, all of whom had recurrences. Incomplete excision of the primary tumor was significantly associated with reduced time to recurrence (p = 0.0144) and time to death (p = 0.0472). The age of the patient, location of the primary tumor, histological findings, and the presence or absence of spinal metastases on preoperative imaging were not significantly associated with outcome. The risk of death at any given time was 12-fold greater in patients in whom a recurrence was identified due to symptoms rather than on surveillance images (p = 0.016). CONCLUSIONS: Recurrent childhood ependymoma has a poor prognosis. The extent of the initial local tumor resection is the factor most closely associated with outcome. Surveillance imaging reveals a substantial number of asymptomatic recurrences, and survival appears to be improved in these patients compared with those identified by symptoms. The improvement in survival is thought to be greater than that expected just from earlier diagnosis.     

Analysis of loss of heterozygosity on chromosomes 10q, 11, and 16 in medulloblastomas

OBJECT: The loss of genetic material from specific chromosome loci is a common feature in the oncogenesis of tumors and is often indicative of the presence of important tumor suppressor genes at these loci. Recent molecular genetic analyses have demonstrated frequent loss of chromosomes 10q, 11, and 16 in medulloblastomas. The aim of this study was to localize the targeted deletion regions on the three aforementioned chromosomes in medulloblastomas. METHODS: Loss of heterozygosity (LOH) was examined on chromosomes 10q, 11, and 16 in a series of 22 primary and two recurrent medulloblastomas by using polymerase chain reaction-based microsatellite analysis. The DNA extracted from the tumors and corresponding normal blood samples were amplified independently in the presence of radioactively labeled microsatellite primers, resolved by denaturing gel electrophoresis and processed for autoradiography. The DNA obtained from control blood samples that displayed allelic heterozygosity at a given microsatellite locus were considered informative. Loss of heterozygosity was inferred when the allelic signal intensity of the tumor sample was reduced by at least 40%, relative to that of the constitutional control. The LOH analysis demonstrated that deletions of chromosomes 10q, 11p, and 16q are recurrent genetic events in the development of medulloblastomas. Three subchromosomal regions of loss have been identified and are localized to the deleted in malignant brain tumors 1 [DMBT1] gene site on chromosomes 10q25, 11p13-11p15.1, and 16q24.1-24.3. CONCLUSIONS: These results indicate that DMBT1 is closely associated with the oncogenesis of medulloblastomas and highlight regions of loss on chromosomes 11p and 16q for further fine mapping and cloning of candidate tumor suppressor genes that are important for the genesis of medulloblastoma.     

The interaction of 'occupant factors' on the lower extremity fractures in frontal collision of motor vehicle crashes based on a level I trauma center

BACKGROUND: To advance occupant protection through the improvement of safety countermeasures, it is necessary to understand the factors that affect human injury tolerance. This study investigated the effect of 'occupant factors' i.e. age, gender, height, weight, and body mass index (BMI) on the pattern of lower extremity injury after motor vehicle crashes (MVCs). The second objective was to identify factor(s) (including restraint systems and Delta V) that influence the severity of fractures (open versus close fractures) within the lower extremity area. The outcome of this study may have implications toward secondary prevention in MVCs. METHODS: One-hundred and thirty-seven front-seat occupants involved in MVCs with frontal impact admitted to the University of Michigan trauma center as part of the Crash Injury Research and Engineering Network (CIREN) project were evaluated. Injuries were classified according to location (knee, thigh, hip [KTH]; lower leg [LL], foot and ankle [FA]). All the relevant variables mentioned above were analyzed. RESULTS: KTH fractures were the most common region (49.5%) affected, followed by fractures to the FA (38.4%) and LL region (12.1%). Female occupants, being generally shorter than their male counterpart, sustained a significantly higher percentage of FA fractures (44% vs. 29.5%, p < 0.05). Male occupants sustained more KTH fractures (58.3% vs. 44%, p < 0.05). Results demonstrated that there were significantly higher percentages of 'open' fractures in the below knee area (FA [53.8%], LL [24.4%], and KTH [21.8%]; p < 0.05). Of all those variables tested (age, gender, height, weight, BMI, restraint systems, and Delta V), occupant's height had a significant effect on the severity of fractures sustained. CONCLUSION: The interactive effect observed for height and gender on the pattern of lower extremity fracture is principally related to the body habitus and that gender may be a 'proxy' variable. The 'human factor' plays a vital role in influencing the pattern of injury in a MVC. This study strongly supports the fact that occupants with dissimilar body habitus interact differently with the interior cabin of the vehicle, thus, the performance of the active and passive safety systems.