Adnexal and cul-de-sac abnormalities: transvaginal sonography

Sixty-seven patients selectively chosen from 354 undergoing conventional transabdominal (TA) sonography for evaluation of a clinically suspected adnexal mass subsequently underwent transvaginal (TV) sonography either because the TA sonograms were technically suboptimal or because it was not possible to characterize with certainty an abnormality identified with TA sonography. TV sonography added diagnostically useful information in 25 of 28 patients with cystic pathologic changes in the adnexa uteri. Eight of 12 patients with tuboovarian abscess and nonspecific adnexal masses visualized with TA sonography had tube-shaped fluid collections characteristic of pyosalpinx identified with TV sonography. TV sonography added diagnostically useful information in all seven patients with diseases of the cul-de-sac (rectouterine fossa) and allowed differentiation of adnexal from primary uterine disease in three patients with TA sonograms on which findings were equivocal. It also expedited the diagnosis of a tubal pregnancy in ten of 14 patients and was useful in the detection of adhesions and perforated intrauterine devices. These results indicate that adjunctive TV sonography can provide important diagnostic information.     

Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway calibre

Features of asthma include increases in both bronchial responsiveness and variability of airflow rates. We examined the relationship between bronchial responsiveness to histamine and the variation of peak expiratory flow rate (PFR) during the day and in response to salbutamol (200 μg), and the initial FEV₁ at the time of the histamine test and FEV₁ response to salbutamol. Bronchial responsiveness to histamine was expressed as the provocation concentration causing a fall in FEV₁ of 20% (PC₂₀). PC₂₀ ranged between 13·9 and 130 mg/ml in nonasthmatic subjects, between 10·5 and 59·9 mg/ml in five asymptomatic asthmatics, and between 0·03 and 20·8 mg/ml in 27 asthmatics with symptoms controlled by medication. The lower the PC₂₀ (the greater the bronchial responsiveness) the lower the morning PFR (r = 0·79), the greater the increase in PFR after salbutamol (morning r = −0·75, evening r = −0·80), and the greater the difference between the highest and lowest PFR each day (r = −0·81). Measurements of PFR were abnormal, compared with those in nonasthmatic subjects, in all subjects with a PC₂₀ less than 2 mg/ml—that is, moderate or severe increase in nonspecific bronchial responsiveness—and in none with a PC₂₀ greater than 21 mg/ml—that is, normal responsiveness; five of nine asthmatics with controlled symptoms had abnormal PFR measurements when PC₂₀ was between 2 and 21 mg/ml—that is, mild hyperresponsiveness. In contrast, FEV₁ at the time of the histamine test was greater than 80% predicted in all subjects with a PC₂₀ greater than 2 mg/ml and was not less than this in 10 of 18 subjects with a PC₂₀ less than 2 mg/ml. When improvement in FEV₁ was 20% or more after salbutamol, the PC₂₀ was usually moderately or severely increased (less than 0·4 mg/ml). The results identify a close relationship between nonspecific bronchial responsiveness to histamine and the variability in flow rates which occurs spontaneously and after bronchodilator. In addition, they raise the possibility that increased airflow obstruction in asthma may be a consequence of increased responsiveness.     

The human corpus luteum: reduction in macrophages during simulated maternal recognition of pregnancy

It has been shown that immune cells, particularly macrophages, accumulate in the corpus luteum during luteolysis. This study aimed to investigate the effect of maternal recognition of pregnancy on the localization and numbers of macrophages in the human corpus luteum. Corpora lutea (n = 12) were obtained from normally cycling women at the time of hysterectomy and were dated on the basis of serial urinary luteinizing hormone (LH) estimation. In addition, corpora lutea (n = 4) were collected from women who had received daily doubling doses of human chorionic gonadotrophin (HCG) to mimic the hormonal changes of early pregnancy. Macrophages were localized by immunohistochemistry using an anti-CD68 antibody. Steroidogenic cells, steroidogenic cells of thecal origin and endothelial cells were identified on serial sections by immunohistochemistry for 3beta-hydroxysteroid dehydrogenase, 17alpha-hydroxylase and von Willebrand factor, respectively. The luteal cells capable of responding directly to HCG were identified by isotopic in-situ hybridization for messenger RNA encoding LH/HCG receptors. Macrophages were localized primarily to the vascular connective tissue and theca-lutein areas of the corpus luteum, although some were found in the granulosa-lutein cell layer. Macrophage numbers increased throughout the luteal phase to a maximum in the late- luteal phase (P < 0.05). Luteal 'rescue' with HCG was associated with a marked reduction in the numbers of tissue macrophages when compared with those of the late-luteal phase (P < 0.001). One of the effects of HCG during maternal recognition of pregnancy is to prevent the normal influx of macrophages into the corpus luteum. As LH/HCG receptors localized to the steroidogenic cells, this implies a fundamental role for steroidogenic cell products in the control of macrophage influx into the human corpus luteum.      

Interdisciplinary treatment of necrotizing enterocolitis and spontaneous intestinal perforations in preterm infants

From January 1986 to December 1992, 13 patients with necrotizing enterocolitis (NEC) (Grade II-III; Bell) were treated. The incidence was highest in the very immature infants with birth weight < 1000 g: 6/148 (4%). From onset, NEC was associated with clinical symptoms such as abdominal distension, bloody stools, retained gastric contents and septicemia. Indications of inflammation were seen in only 6 out of 13 patients at the time of diagnosis. No complications were seen in 10 patients during the acute phase. Two infants developed a bowel perforation and another one a gangrene. Immediate surgery was performed. In three other infants, elective surgery was performed because of colonic strictures. Twelve (92%) patients survived NEC. Five other VLBW infants developed spontaneous perforations of the bowel. The clinical presentation, laboratory and radiological findings differed greatly from those with NEC. Four infants survived. A primarily conservative therapeutic regime with close cooperation between the surgeon and pediatrician may be an alternative to early surgical intervention in NEC.     

Cyclin H expression is increased in GIST with <Emphasis Type="Italic">very-high</Emphasis>risk of malignancy

Background  

Risk estimation of gastrointestinal stromal tumours (GIST) is based on tumour size and mitotic rate according to the National Institutes of Health consensus classification. The indication for adjuvant treatment of patients with high risk GIST after R₀ resection with small molecule inhibitors is still a controversial issue, since these patients represent a highly heterogeneous population. Therefore, additional prognostic indicators are needed. Here, we evaluated the prognostic value of cyclin H expression in GIST.     

9例γδT细胞淋巴瘤/白血病患者的临床及实验室特征

目的 报告9例γδ T细胞淋巴瘤/白血病患者的临床及实验室特征.方法 对2007至2010年住院诊治的患者,常规询问病史,进行体检及实验室检测.对有异常细胞的骨髓或脾组织用流式细胞分析技术(FCM)行免疫分型,同时用PCR法检测TCRγ、TCRδ基因克隆性重排,用G显带技术分析染色体,用多重筑巢式PCR技术筛查急性白血病基因及1-8型人类疱疹病毒基因,并行形态学及细胞化学染色.根据表达TCRγδ链来确定γδT细胞,根据T细胞抗原表达异常确定恶性γδT细胞,根据γδT细胞表达CD34、CD99、TDT、CD1a及急性白血病基因等确定为前体γδT细胞.结果 共9例患者经FCM分析诊断为γδT细胞淋巴瘤/白血病,初诊时8例患者骨髓中检测出大量恶性细胞,细胞形态同原始细胞.5例患者诊断为急性T淋巴细胞白血病(T-ALL)或淋巴母细胞淋巴瘤(LBL)(γδT型),4例患者诊断为肝脾γδT细胞淋巴瘤(HSγδTCL).行TCR基因克隆重排检测的6例患者均检测出有克隆性TCRγ和(或)TCRδ基因重排.全部患者化疗难以完全缓解(CR)或CR后很快复发,5例接受异基因造血干细胞移植(allo-HSCT)的患者4例持续CR,CR时间分别为2、2、3、12个月;1例TALL(γδT型)患者在allo-HSCT后1个月内复发.结论 γδT细胞淋巴瘤/白血病的发病率可能比既往报道的高,部分T-ALL/LBL也为γδT细胞型;FCM是快速可靠的诊断方法,克隆性TCRγ和(或)TCRδ基因重排阳性有助于诊断;患者预后差,allo-HSCT可能是唯一可治愈的方法.

Abstract：

Objective To analyze the clinical and laboratory features of 9 cases of γδT cell lymphoma or leukemia.Methods From 2007 to 2011, 9 patients with γδT-cell lymphoma/leukemia were diagnosed in our hospital.The immunophenotype of the abnormal cells were detected by flow cytometry, clonal gene rearrangement of IgH,TCRγ,TCRδ by PCR, chromosome karyotype analysis by G banding, acute leukemia gene and the DNA of type 1-8 human herpes virus by mulplex nested PCR, The γδT cells were determined by T cell with TCR γδ chain, the malignant γδ T cells by the abnormal expression of T cell antigens and the precursor malignant γδ T cells by the expression of CD34, TDT ,CD99, CD1a or acute leukemia genes.Results In the 9 patients with γδT cell lymphoma leukemia, significant malignantγδT cells infiltration of bone marrow were found in 8 with blast morphology.5 were diagnosed as T-ALL/LBL(γδT type) and 4 HSγδ TCL.The clonal gene rearrangement of TCRγ and/or TCRδ were detected in 6/6 patients.Patients either did not achieve complete remission (CR) after induction therapy or relapsed quickly after CR.Only 4/5 patients remained continuous CR(CCR) at 2,2,3,12 months respectively, after allogeneic hematopoietic stem cell transplantation(allo-HSCT), the fifth T-ALL(γδT) relapsed 1 month after allo-HSCT .Conclusion s The incidence of γδ T cell lymphoma or leukemia may be higher than reported, part of them were T-ALL/LBL with poor prognoses.FCM and clonal gene rearrangement of TCRγ and/or TCRδ are helpful to diagnosis.Allo-HSCT may be the only curative approach.     

部分睡眠剥夺对大鼠糖代谢的影响

1材料和方法 1.1材料血糖仪(Accu-CHEK Softclix(R)2 LANCING DEVICE)及大平台水箱由第四军医大学教学实验中心提供.小平台水箱由第四军医大学航天航空医学系心理教研室提供.INS试剂盒,购自中国人民解放军总医院科技开发中心放免研究所.