The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

Modern management of Barrett’s oesophagus and related neoplasia essentially focuses upon surveillance to detect early low‐risk neoplastic lesions and offering organ‐preserving advanced endoscopic therapies, while traditional surgical treatments of oesophagectomy and lymph node clearance with or without chemoradiation are preserved only for high‐risk and advanced carcinomas. With this evolution towards figless invasive therapy, the choice of therapy hinges upon the pathological assessment for risk stratifying patients into those with low risk for nodal metastasis who can continue with less invasive endoscopic therapies and others with high risk for nodal metastasis for which surgery or other forms of treatment are indicated. Detection and confirmation of neoplasia in the first instance depends upon endoscopic and pathological assessment. Endoscopic examination and biopsy sampling should be performed according to the recommended protocols, and endoscopic biopsy interpretation should be performed applying standard criteria using appropriate ancillary studies by histopathologists experienced in the pathology of Barrett’s disease. Endoscopic resections (ERs) are both diagnostic and curative and should be performed by clinicians who are skilled with advanced endoscopic techniques. Proper preparation and handling of ERs are essential to assess histological parameters that dictate the curative nature of the procedure. Those parameters are adequacy of resection and risk of lymph node metastasis. The risk of lymph node metastasis is determined by depth invasion and presence of poor differentiation and lymphovascular invasion. Those adenocarcinomas with invasion up to muscularis mucosae (pT1a) and those with superficial submucosal invasion (pT1b) up to 500 µ with no poor differentiation and lymphovascular invasion and negative margins may be considered cured by endoscopic resections.     

Complications in tunneled CVL versus PICC lines in very low birth weight infants.

OBJECTIVE:Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g. STUDY DESIGN:A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99. A retrospective review of these infants' medical record was done to review associated complications of catheter placement. RESULTS:Both groups had similar weights and gestational ages. The duration of catheterization was 28 days in TCVLs and 11 days in PICCs (p<0.05). Total, infectious, and mechanical complications between the two groups were similar. Survival function estimates showed no difference between the two groups up to the 15th day of catheterization. CONCLUSION:There is no difference in efficacy or associated complications between the two groups. If one could anticipate needing a catheter longer than 15 days, then a TCVL might be the better choice.     

Benign prostatic hyperplasia--video image analysis and its relationship to androgen and epidermal growth factor receptor expression.

Androgens are essential for the development and maintenance of the prostate. However, prostatic growth may be mediated by epidermal growth factor (EGF) and the expression of the EGF receptor (EGFR) may be influenced by the androgenic milieu. We have characterized the expression of cytosolic androgen receptor (ARc), nuclear salt extractable androgen receptor (ARn) and EGFR in 89 consecutive cases of benign prostatic hyperplasia, 84 of which were treated by transurethral prostatic resections. Image analysis morphometry was performed on the histological sections to determine the epithelial content of the gland. Our results indicate that there is a vast heterogeneity of receptor expression in benign prostatic hyperplasia. Expression of ARc ranged from zero to 1312 fmol/gm. tissue (mean +/- SD 265 +/- 290), ARn ranged from zero to 531 fmol/gm. tissue (mean +/- SD 145 +/- 98) and EGFR ranged from zero to 316 fmol/gm. tissue (mean +/- SD 121 +/- 76). A statistically significant association was found between expression of ARn and EGFR, and these were both significantly correlated with the epithelial content of the gland.     

Human immunodeficiency virus seroprevalence among blood product recipients in San Francisco before transfusion

To determine the incidence of transfusion-associated human immunodeficiency virus (HIV) infection after routine screening of donated blood, a pilot study estimated the pretransfusion prevalence of HIV infection among blood product recipients in San Francisco. Among the 911 nonduplicate pretransfusion specimens from recipients without a clinical history of acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC), the overall prevalence of antibody to HIV was 2.9 percent (5.2% among males and 0.6% among females; p = 0.00002). If recipients in specifically defined or possible high-risk groups (n = 348) were excluded, a seropositivity rate of 1.8 percent (10/563) was detected, with all the positives occurring in men (10/242, 4.1%) and none in women (0/321, 0%). This demonstrated prevalence of HIV infection among blood product recipients in San Francisco before transfusion was substantially higher than the known 0.02 to 0.04 percent prevalence in the donor population. Therefore, the population of women without known risk for AIDS is the best in which to assess the risk of HIV infection in patients who are currently receiving seronegative blood transfusions.     

傣药小灯台中的吲哚生物碱

从傣药小灯台(Winchia catophylla A. DC.)中分到4个吲哚生物碱,经理化常数测定,光谱分析和化学转化,分别鉴定为echitamine chloride(Ⅰ),echitamidine(Ⅱ),N_B-demethyl-echitamine(Ⅲ)和22-O-acetyl-N_b--demethyl-echitamine(Ⅳ),其中Ⅳ为新的吲哚生物碱。     

Improved reproducibility in measuring LV volumes and mass using multicoil breath-hold cine MR imaging

There is a generally recognized need for improvement in quality of fast cardiac MR images. Consequently, breath-hold cine MR images were obtained with multiple surface coils connected to phased array receivers, and C/N, intra-observer and inter-observer variabilities for LV volumes and mass were evaluated. Two sets of short-axis images of the LV, one with multiple surface coils and another with a body coil, were acquired in eight subjects with a fast cine MR sequence using k-space segmentation (TR/TE=7/2.2 msec, temporal resolution=56 msec). C/N with multicoil imaging was 32.2 ± 7.6 (mean ± SD), significantly higher than that with a body coil (11.0 ± 3.3, P < .01). The mean percentage differences in intra-observer and inter-observer measurements with multicoil imaging were significantly better than those with a body coil. In conclusion, multicoil imaging provides significant gain in C/N on breath-hold cine MRI of the heart. In addition, intra-observer and inter-observer reproducibilities are improved with multicoil imaging.     

HPLC定量分析制剂中雷公藤氯内酯醇含量

雷公藤氯内酯醇(T_4)是从雷公藤中分离得到的一个新化合物,但含量很低,因此进行了以雷公藤内酯醇(To)为原料合成T_4的研究。T_4具有较强的免疫抑制活性,且毒性低于雷公藤内酯醇,有希望开发成新药在临床应用。为了控制T_4制剂的质量,本文系统地研究了反相高效液相色谱法分离和测定T_4的条件,结果以甲醇-水(1:1)作流动相,能满意地分离和测定T_4的含量,最小检测量为10 ng,采用内标法定量,方法快速、准确。     

A rare anatomical variation of the C7 pedicle and intraspinal course of the C7 nerve root

We report a 58 year old man who presented with severe C7 radiculopathy which failed to respond to conservative measures. Subsequent CT and MR imaging of his cervical spine demonstrated C6/7 foraminal stenosis as well as unusual low take-off of the C7 nerve root in relation to a congenital low-set C7 pedicle, findings which were subsequently confirmed intra-operatively. The relevance of the bony and neural anatomy is described and its implications for surgical management are discussed. To our knowledge, this anatomical anomaly has not been previously highlighted in the published English literature.     

Acute haemorrhagic conjunctivitis in Hong Kong 1971-1975.

Acute haemorrhagic conjunctivitis occurred in epidemic in Hong Kong in 1971 and 1975 respectively. Two picornaviruses, the Enterovirus type 70 and an antigenic variant of Coxsackie virus type A24, were isolated during the 1971 outbreak, while only the latter virus was detected in the 1975 outbreak. In 1972 and 1974, sporadic cases of conjunctivitis associated with Enterovirus type 70 were observed. Serological survey in late 1975 showed a high proportion of the population might still be susceptible to both viruses. Recrudescence of the disease is conceivable when environmental condition is favourable for the spread of these viruses.