强直刺激后计数在妇科腹腔镜手术应用的可行性研究

目的 探讨在妇科腹腔镜手术中,将强直刺激后计数(PTC)作为肌松药物增药指标的可行性.方法 选择30例择期行妇科腹腔镜手术的患者,美国麻醉医师协会(ASA)麻醉风险分级Ⅰ～Ⅱ级,年龄＞18岁.麻醉诱导时给予顺式阿曲库铵0.1 mg/kg (2ED95).记录顺式阿曲库铵的起效时间t0[注药毕至首个肌颤搐(T1)抑制至0的时间],t1(最后1次注药毕至PTC出现的时间),t2(最后1次注药毕至T1出现的时间),t3(PTC开始出现至T1出现的时间),T1恢复时PTC的值(PTC at T1),以及PTC恢复之前出现呛咳的患者例数,T1恢复之前出现呛咳的患者例数.结果 t0为(3.67±0.79)min,t1为(26.61±6.54)rain,t2为(39.44±5.94)min,t3为(12.83±5.26)min,PTC at T1为(11.8±2.6)次,PTC恢复之前无患者出现呛咳,T1恢复之前3例出现呛咳.经Pearson相关性检验,PTC与T1恢复时间呈显著负相关(r=-0.807,P＜0.0001),回归方程可表示为t=13.085-0.629 PTC.结论 妇科腹腔镜手术中,采用顺式阿曲库铵肌松阻滞,PTC与T1恢复时间具有良好相关性,可通过PTC数值初步估计T1出现的时间,PTC是深度神经肌肉阻滞程度的监测指标,作为妇科腹腔镜手术肌松药的增药指标具有一定的可行性.     

先天性胆总管囊肿(附30例分析)

复习30例先天性胆总管囊肿的X线所见，24例做了内窥镜逆行性胰胆管造影（ERCP）检查，6例进行了经度肝穿刺胆道造影（PTC），4例做了CT检查，2例做了消化道造影（GI）。30例均做了超声。每一种检查方法的敏感性如下：超声72％，ERCP87.5％，CT50％，PTC83.3％，上GI50％。其中ERCP和PTC是唯一的能够准确显示囊肿扩张程度以及异常胰胆管连接的方法。ERCP和PTC对手术方式和治疗方案的选择是必不可少的。     

A nonsense mutation in exon 3 results in the HLA-B null allele B*5127N

A new HLA-B null allele has been identified within the B*51 group by combined serological and molecular typing of an Italian Caucasoid family. Serological data indicated that the proband typed homozygous for A2 and B60. Confirmatory typing using sequence specific oligonucleotide hybridization (SSPOH) detected a second B allele within the B*51 group. Allele specific typing (SSP) for B*51 subtypes, including the known B*5111N allele, was performed, and typing results were consistent with B*5101, suggesting the presence of a new null variant. Cloning and sequencing of this allele identified a B*5101 variant with a nonsense mutation in exon 3. This new null allele has been designated B*5127N. The combined use of serologic and DNA-based typing methods facilitates the identification of null and low-expression alleles. An overview of null alleles of class I HLA is presented.     

Type and prevalence of BRAF mutations are closely associated with papillary thyroid carcinoma histotype and patients’ age but not with tumour aggressiveness

A high prevalence of the BRAF^V600E somatic mutation was recently reported in several series of papillary thyroid carcinomas (PTC). This mutation appears to be particularly prevalent in PTC with a predominantly papillary architecture. Another BRAF mutation (K601E) was detected in a follicular adenoma and in some cases of the follicular variant of PTC. The few studies on record provided controversial data on the relationship between the occurrence of BRAF mutations and clinicopathologic parameters such as gender, age and tumour staging. In an attempt to clarify such controversies we decided to enlarge our previous series to 315 tumours or tumour-like lesions diagnosed in 280 patients, including a thorough analysis of several clinicopathologic features. The BRAF^V600E mutation was exclusively detected in PTC with a papillary or mixed follicular/papillary architecture both of the conventional type (46%) and of other histotypes, such as microcarcinoma (43%), Warthin-like PTC (75%) and oncocytic variant of PTC (55%). The BRAF^K601E mutation was detected in four of the 54 cases of the follicular variant of PTC (7%). The mean age of patients with conventional PTC harbouring BRAF^V600E (46.7 years) was significantly higher (P<0.0001) than that of patients with conventional PTC without BRAF^V600E (29.5 years). The BRAF (BRAF^V600E) mutated PTC did not exhibit signs of higher aggressiveness (size, vascular invasion, extra-thyroid extension and nodal metastasis) and were in fact less often multicentric than PTC without the mutation.V. Trovisco and P. Soares contributed equally to this workFundação para a Ciência e Tecnologia POCTI/FEDER (POCTI/NSE/48171/2002)     

Clinical significance of RET/PTC and p53 protein expression in sporadic papillary thyroid carcinoma

AIMS: Rearranged during Transfection (RET)/papillary thyroid carcinoma (PTC) and p53 are two genes involved in the pathogenesis of PTC. It has been suggested that RET/PTC expression is associated with higher rates of local extension and lymph node involvement, whereas p53 mutations are more frequent in poorly differentiated and anaplastic carcinomas. In addition, experimental studies have shown that p53 activity can modify the behaviour of PTC carrying RET/PTC. The aim of this study was to investigate the expression of both RET/PTC and p53 in order to evaluate their usefulness as prognostic factors. METHODS AND RESULTS: Resected specimens of 61 cases of PTC were studied immunohistochemically using a polyclonal antibody to RET and a monoclonal antibody to p53 protein. RET/PTC expression was associated with extrathyroid extension of PTC, at diagnosis (P < 0.05). In contrast, no relationship between p53 immunoreactivity and clinical status was found. In addition, p53 expression was more prevalent among RET/PTC+ patients, and significantly influenced the relationship observed between RET/PTC and extrathyroid extension of the disease. CONCLUSION: Our results suggest that immunohistochemistry for both PTC/RET and p53 could be useful in the clinical evaluation of patients with PTC.     

Percutaneous Transjejunal Biliary Access in 60 Patients with Bilioenteric Anastomoses

Purpose

To determine success and complication rates of percutaneous transjejunal biliary access (PTJBA) in patients with bilioenteric anastomoses.