Peripheral pulmonary lesions: ultrasonography and ultrasonically guided aspiration biopsy

Twenty-five patients, each of whom had peripheral intrathoracic lesions that were smaller than 5.0 X 5.0 cm in size and not diagnosed by conventional methods, underwent real-time sonography and ultrasonically guided aspiration biopsy. The lesions included 18 nodules, two infiltrates, and five cavitary lesions. Sonography showed homogeneous hypoechoic or isoechoic density with well-defined margins in 16 of the nodules, and heterogeneous echogenicity with irregular margins in infiltrates. The cavitary lesions showed a hyperechoic ring with a central sonolucent area. Biopsy specimens were successfully obtained by percutaneous aspiration under ultrasound guidance in 24 (96%) of the patients, and a positive diagnosis was established in 21 (84%) by cytology and/or histology. All 17 malignant lesions were diagnosed by aspiration biopsy, while only four of seven benign lesions were diagnosed by this method. Two patients (8%) experienced minimal pneumothorax after aspiration biopsy. We conclude that real-time sonography, including ultrasonically guided aspiration biopsy, is a useful and safe method for examination of peripheral intrathoracic lesions and has a high diagnostic yield.     

Facilitated diagnosis of the contiguous gene syndrome: tuberous sclerosis and polycystic kidneys by means of haplotype studies

Tuberous sclerosis (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are genetically heterogeneous diseases. The major gene for ADPKD (PKD1) lies adjacent to the TSC2 gene on chromosome 16p13. Some reports in the literature referred to an unusual presentation of TSC with enlarged cystic kidneys at birth, but it was not until the localization of the TSC2 and PKD1 genes that it was possible to analyze the interaction between both genes. We describe a case of a child with TSC and enlarged cystic kidneys. The study of genetic marker segregation in the family pointed to the presence of a deletion involving the 3' region of PKD1. A further study of the region showed a deletion of 40 kb involving both PKD1 and TSC2. We suggest that an additive or synergistic effect between PKD1 and TSC2 may cause this renal phenotype. A contiguous gene syndrome involving PKD1 and TSC2 should be suspected in children with TSC and enlarged polycystic kidneys at birth. The first approach to identify a deletion of both genes could be the analysis of the segregation of PKD1 and TSC2 markers in the family.     

A Randomized, Double-Blind, Multicenter Comparison of the Efficacy and Tolerability of Restylane Versus Zyplast for the Correction of Nasolabial Folds

BACKGROUND: Bovine collagen is extensively used for facial soft tissue augmentation but provides only temporary correction and can cause hypersensitivity reactions. Hyaluronic acid derivatives potentially offer improved longevity of correction and a reduced risk of immunogenicity and hypersensitivity. OBJECTIVE: To compare the efficacy and safety of nonanimal stabilized hyaluronic acid gel (Restylane; Q-Med, Uppsala, Sweden) with that of bovine collagen (Zyplast) for treatment of nasolabial folds. METHODS: One hundred thirty-eight patients with prominent nasolabial folds were randomized to treatment with hyaluronic acid gel and bovine collagen on contralateral sides of the face. Treatments were repeated at 2-week intervals, as required, to achieve "optimal cosmetic result" (baseline). Outcomes were evaluated by a blinded investigator at 2, 4, and 6 months after baseline. RESULTS: Less injection volume was required for "optimal cosmetic result" with hyaluronic acid gel than with bovine collagen, and patients and investigators judged hyaluronic acid gel to be more effective in maintaining cosmetic correction. The investigator-based Wrinkle Severity Rating Scale and Global Aesthetic Improvement Scale assessments at 6 months after baseline indicated that hyaluronic acid gel was superior in 56.9% and 62.0% of patients, respectively, whereas bovine collagen was superior in 9.5% and 8.0% of patients, respectively. The frequency, intensity, and duration of local injection-site reactions were similar for the two products. CONCLUSION: Nonanimal stabilized hyaluronic acid provides a more durable aesthetic improvement than bovine collagen and is well tolerated.     

An orally bioavailable oxime ether capsid binder with potent activity against human rhinovirus

A series of capsid-binding compounds was screened against human rhinovirus (HRV) using a CPE based assay. The ethyl oxime ether 14 was found to have outstanding anti-HRV activity (median IC(50) 4.75 ng/mL), and unlike the equivalent ethyl ester compound 3 (Pirodavir), it has good oral bioavailability, making it a promising development candidate. Compound 14 illustrates that an oxime ether group can act as a metabolically stable bioisostere for an ester functionality.     

脂肪肝病人血液流变学的临床观察

目的：目前临床对脂肪肝病人的诊断，实验室没有理想的检测手段。我们对临床确诊的脂肪肝病人，同时伴有甘油三酯增高86例，对血液流变学各参数的变化进行了比较，以观察临床对脂肪肝诊断的实用价值。方法：取空腹静脉血3mL注入肝素抗凝管混合，先测全血粘度，然后分离血浆测其血浆粘度。甘油三酯取空腹肘静脉血2mL，分离血清进行检测。结果：86例脂肪肝病人全血粘度：高切、低切、红细胞电泳时间及甘油三酯同时增高61例，占70．9％。全血粘度：高切、中切、低切，血浆粘度，全血还原粘度，红细胞聚集指数，红细胞电泳时间，甘油三酯同时增高19例，占22．1％。单纯全血粘度低切增高6例，占7％。结论：脂肪肝病人血液流变学各参数的影响主要是全血粘度及红细胞电泳时间有明显的改变，甘油三酯的增高对血浆粘度及全血还原粘度影响不太明显。可作为临床对脂肪肝病人辅助诊断检查的一项重要参考指标。     

Work in progress. Intra-arterial digital subtraction angiography: evaluation in 150 patients

As part of an ongoing study comparing digital subtraction angiography (DSA) with conventional film-screen angiography, 150 patients were examined with arterial contrast material injections and digital filming techniques alone or combined with conventional angiography. Of 247 injections, the DSA study was good or excellent in 236, approaching the quality of conventional angiography for visualization of vessels greater than 1 mm in size. Advantages included improved vascular detail in selected areas such as the skull base, visualization of minimal contrast concentration in diseased vessels or postoperatively, and imaging of vessels distal to stenoses without the hazards of selective catheterization. DSA permitted rapid positioning under fluoroscopic control, instantaneous viewing of subtracted images, and reduced technologist time and film costs. Contrast material volume was reduced by 40 to 60%, allowing multiple studies in one sitting and study of patients with renal compromise.