Retrospective review of outcome after surgical treatment of enchondromas in the hand

Background  Tumours of the skeleton of the hand are rare. While the majority of bone tumours are benign (89.4%), a small number show signs of malignancy (4.4%). Among the benign bone tumours of the skeleton of the hand, enchondromas are the most common, at 35–65%. Methods  In the period from 1998 to 2005, a total of 35 enchondromas on the hand were diagnosed at the Trauma Center Lorenz Boehler. These were 16 women and 19 men with an average age of 36 years (age range 16–66). The most common site of an enchondroma was the proximal phalanx in 17 cases, followed by the metacarpal bone in 8 cases and the middle phalanx in 5 cases. In five patients, an enchondroma was found in the carpal bones. Twenty-nine patients underwent surgery. Results  The follow-up findings (average follow-up time, 47 months) were assessed in accordance with the formula outlined by Wilhelm and Feldmaier. Twenty-five of 27 patients who underwent follow-up examination showed an excellent result. In two patients, the result was assessed as good on account of restricted mobility caused by increased scar formation. No recurrence was detected in X-ray controls. Conclusion  Enchondromas of the hand are usually detected after a bagatelle trauma. For accurate diagnosis, conventional X-ray examination and if necessary, a contrast medium MRI should be performed. Histological investigation is compulsory due to the risk of malignancy. Depending on its spread, the defect in the extirpation cavity should be filled with autogenous spongy bone.     

Audit of Two-Week Rule Referrals for Suspected Testicular Cancer in Cornwall, 2003–2005

INTRODUCTION

The objective was to evaluate the two-week wait referral system for suspected testicular cancer and to compare waiting times from referral to treatment before and after the introduction of the two-week wait process.

PATIENTS AND METHODS

We reviewed 241 case notes for patients referred under the two-week wait system with suspected testicular tumour during a complete 3-year period (2003–2005) and recorded information from the referral letter, findings in the urology clinic, results of ultrasound and final outcomes. We also identified 42 cases of testicular tumour treated during a complete 3-year period (1997–1999) just before the two-week wait system was introduced. The journey from referral to treatment for tumour cases was compared during these two periods.

RESULTS

Testicular cancer was only found in 8% of patients referred by the two-week wait system. We judged the referral to be inappropriate in 48% of cases. Of referred cases, 78% required no surgical treatment. There was a significant improvement of 9 days in the average time from general practitioner (GP) referral to urology clinic attendance but all other journey intervals remained the same.

CONCLUSIONS

The performance of GPs in examining scrotal swellings and applying the two-week wait guidelines was very poor, resulting in many unnecessary urgent clinic visits. The referral system speeds up the visit to a urology clinic but the overall effect is probably not of clinical significance. We suggest that it would be much more cost-effective for all these patients to have an ultrasound scan within 2 weeks instead of a urology clinic appointment.     

胰岛素样生长因子-1对小鼠T，B淋巴细胞分泌功能的影响

目的：观察胰岛素样生长因子-1（IGF-1）对T,B细胞分泌功能的影响,以探究IGF-1治疗应激机体免疫功能低下的可能性．方法：用酶联免疫吸附试验（ELISA）分析体外免疫应答中IGF-1对小鼠T细胞分泌白介素-2（IL-2）和B细胞分泌免疫球蛋白（Ig）的影响．结果：小鼠T,B细胞在给予80μg/L IGF-1的条件下培养3d,其上清的IL-2活性比对照组增加了366．74nkat／mL（P〈0．01）,培养6d后正常小鼠T,B细胞培养上清和应激小鼠T,B细胞培养上清中的IgG含量均比对照组高,尤其是应激小鼠T,B细胞培养上清的IgG含量比对照组增加了41μg／L（P〈0．01）。结论：抗原刺激后的小鼠T,B细胞进行体外培养时,在IGF-1存在下T细胞分泌IL-2和B细胞分泌IgG的能力增强,提示IGF-1对机体的免疫应答有调节作用．     

雷帕霉素体外促进小鼠调节性T细胞的分化和增殖

目的:观察雷帕霉素体外对小鼠调节性T细胞(regulatory T cells,Treg)分化和增殖的影响,为进一步探讨其可能的免疫耐受诱导机制奠定基础.方法:无菌条件下取C57BL/6小鼠脾脏,分离单个核细胞,免疫磁珠阴性分选获得CD4+T细胞,分别与0.1 μmol/L雷帕霉素(RAPA组)、0.5 μmol/L环孢素(CsA组)进行共培养7 d,并以正常培养细胞作为空白对照.流式细胞仪检测各组CD4+CD25+Treg细胞比例;RT-PCR检测各组T细胞Foxp3 mRNA表达水平.结果:与空白对照[(7.42±0.82)%]相比,CsA组CD4+CD25+Treg细胞[(3.72±0.74)%]所占比例明显降低(P<0.01);RAPA组CD4+CD25+Treg细胞[(11.47±1.08)%]所占比例明显升高(P<0.01).RAPA组T细胞Foxp3 mRNA表达明显高于CsA组和空白对照(P<0.01);CsA组Foxp3 mRNA表达低于空白对照(P<0.05).结论:雷帕霉素体外可促进CD4+CD25+ Treg细胞的分化和增殖,有利于免疫耐受的形成,其免疫抑制机制不同于CsA.     

Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort

Objective

To investigate if early treatment of primary HIV-1 infection (PHI) reduces viral set point and/or increases CD4 lymphocytes.

Methods

Analysis of two prospective multi-centre PHI cohorts. HIV-1 RNA and CD4 lymphocytes in patients with transient treatment were compared to those in untreated patients. Time to CD4 lymphocyte decrease below 350/μl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses.

Results

156 cases of PHI were included, of which 100 had received transient HAART (median treatment time 9.5 months) and 56 remained untreated. Median viral load (563000 cop/ml vs 240000 cop/ml; p < 0.001) and median CD4 lymphocyte (449/μl vs. 613/μl; p < 0.01) differed significantly between treated and untreated patients. Median viral load was 38056 copies/ml in treated patients (12 months after treatment stop) and 52880 copies/ml in untreated patients (12 months after seroconversion; ns). Median CD4 lymphocyte change was +60/μl vs. -86/μl (p = 0.01). Median time until CD4 lymphocytes decreased to < 350/μl (including all patients with CD4 lymphocytes < 500/μl during seroconversion) was 20.7 months in treated patients after treatment stop and 8.3 months in untreated patents after seroconversion (p < 0.01). Cox-PH analyses adjusting for baseline VL, CD4 lymphocytes, stage of early infection and symptoms confirmed these differences.

Conclusions

Treatment during PHI did not lower viral set point. However, patients treated during seroconversion had an increase in CD4 lymphocytes, whereas untreated patients experienced a decrease in CD4 lymphocytes. Time until reaching CD4 lymphocytes < 350/μl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes < 500/μl during seroconversion.     

白血病T淋巴细胞核仁形成区嗜银蛋白的检测及临床意义

目的探讨白血病患者外周血T淋巴细胞核仁形成区嗜银蛋白（Ag-NORs）测定的临床意义。方法采用KL型肿瘤免疫图像分析系统及配套试剂对32例白血病患者、20例良性血液病、20例正常对照者进行外周血Ag-NORs检测。结果T淋巴细胞Ag-NORs水平白血病为（6．1±0．9）I．S％,良性血液病为（8．3±0．8）I．S％,正常对照组为（8．4±0．7）I．S％,三组比较差异有统计学意义（F=66．734,P=0．000）,其中白血病组低于对照组和良性血液病组,差异有统计学意义（P〈0．01）,良性血液病组与对照组比较差异无统计学意义（P〉0．05）。结论Ag-NORs检测不仅能准确地反映白血病患者的免疫状态,对白血病的诊断、鉴别诊断和预测病情发展有一定的意义。     

EB病毒感染与宿主细胞恶性转化的关系

EB病毒(EBV)是一种与多种肿瘤发生密切相关的DNA肿瘤病毒。EBV基因表达产物有潜伏膜蛋白(LMP1、LMP2A、LMP2B),6种核抗原(EBNA1、EBNA2、EBNA3A、EBNA3B、EBNA3C、EBNA-LP),以及EBER1、EBER2和TP等。EBV通过影响和调控宿主细胞基因的表达,干扰细胞信号转导系统,使宿主细胞产生细胞因子表达失衡。EBV能上调IRF-4、IL-6、Bcl-6、Bcl-2、A20等细胞生长因子、抗凋亡因子,还能抑制p53和PTPPK等肿瘤抑制基因,促使宿主细胞转化为肿瘤细胞。     

鼻咽黏膜上皮内淋巴细胞在鼻咽癌时的变化

目的：研究鼻咽黏膜上皮内淋巴细胞（mucosa intraepithelial lymphocyte,mIEL）在鼻咽癌时的变化,初步探讨局部上皮增生活跃程度对mIEL的影响。方法：（1）收集可见黏膜上皮的51例鼻咽慢性炎症（NPi）和90例鼻咽癌（NPC）石蜡标本。（2）在HE切片上计数黏膜上皮内淋巴细胞、癌巢内淋巴细胞,判定巢间淋巴细胞浸润程度。（3）对部分病例用CD3、CD4、CD8（Npi20例,NPC33例）和PCNA抗体（Npi48例,NPC80例）进行免疫组化染色。结果：（1）NPC组mIEL数量明显少于NPi组[（4.53±3.87）vs（6.33±7.20）,P=0.017],但其在NPC各期和有无淋巴结转移之间变化不明显（P〉0.05）。（2）NPC组mIEL与其巢内、癌巢间淋巴细胞数量（P=0.011,P=0.018）和组织中T细胞数量变化（P=0.037）均呈正相关。（3）NPC组黏膜上皮PCNA表达强度与mIEL数量变化呈正相关（P=0.007）。结论：（1）NPC组mIEL明显减少,但在其肿瘤进展过程中变化不显著;（2）NPC组mIEL变化与其组织中淋巴细胞浸润情况和T淋巴细胞变化一致;（3）NPC组mIEL数量随黏膜上皮增生活跃程度而增加。     

CXCL12 and CCL20 play a significant role in mucosal T-lymphocyte adherence to intestinal microvessels in mice

OBJECTIVE: Although it is known that the chemokines CXCL12 and CCL20 are expressed in the intestine, their contribution to lymphocyte homing has not been investigated in detail. The authors investigated whether the CXCL12-CXCR4 and CCL20-CCR6 systems are involved in T lymphocyte-endothelial interaction in microvessels of the small and large intestines. METHODS: Labeled lamina proprial lymphocytes (LPLs) were administered to mice, and their adhesion to microvessels of normal and TNF-alpha -induced inflamed intestinal mucosa was observed under an intravital microscope. Antibodies against CXCL12, CCL-20, or CCL-25 were administered prior to lymphocyte administration, and in some experiments CXCR4 or CCR6 on LPLs was desensitized with an excess amount of chemokine. RESULTS: LPLs adhered to microvessels of the ileum and colon, and TNF-alpha induced a significant accumulation at both sites. Blocking of the CXCL12-CXCR4 system significantly inhibited the LPL adhesion in the ileum and colon under both normal and TNF-alpha -treated conditions. However, blocking of the CCL20-CCR6 system significantly attenuated LPL adhesion only under a TNF-alpha -treated condition. There was an additive inhibitory effect on LPL adherence by CXCL12 and CCL20 blocking in TNF-alpha -induced inflamed intestines. There was also an additive function of the CCL25-CCR9 system in LPL accumulation in the small intestine. CONCLUSION: Several chemokine systems may play significant roles cooperatively in vivo in LPL adherence to microvessels of intestinal mucosa.