Fine-needle aspiration biopsy of hepatic papillary cystadenocarcinoma in Caroli's disease.

A case of papillary adenocarcinoma arising in Caroli's disease (CD) in a 25-yr-old woman is reported. The diagnosis of malignancy was made by ultrasound-guided, fine-needle aspiration biopsy (FNAB). As there were no metastasis, a liver transplant was performed and the diagnosis was histologically confirmed. Only 22 cases of malignant transformation of CD have been reported to date, all among middle-aged subjects (mean age: 52 yr) of both sexes. Most of these reported cases (83%) were found to be bile duct adenocarcinomas with occasional reports of hepatocellular and undifferentiated carcinomas. Our case is the youngest reported to date and the first to be diagnosed cytologically.     

Intraductal shock-wave lithotripsy in complicated common bile duct stones

Summary Intracorporeal shockwave lithotripsy was performed in 36 patients with problematic common bile duct stones. All of the patients had undergone unsuccessful mechanical lithotripsy prior to this procedure. In 29 patients (80.6%), the stones were fragmented under cholangioscopic control and subsequently extracted with a Dormia basket. In seven patients, the procedure failed due to stone impaction or failure to intubate the common bile duct with a nasobiliary tube. No complications were observed. Cholangioscopically guided intracorporeal shockwave lithotripsy is a highly effective and safe procedure for the conservative treatment of complicated common bile duct stones.Abbreviations ESWL extracorporeal shock-wave lithotripsy - ISWL intracorporeal shock-wave lithotripsy Dedicated to Prof. Dr. med. Ludwig Demling on the occasion of his 70th birthday     

Immunohistochemical detection of p53 homolog p63 in solid cell nests, papillary thyroid carcinoma, and hashimoto's thyroiditis: A stem cell hypothesis of papillary carcinoma oncogenesis

Most models suggest that the cell of origin of papillary carcinoma is the mature thyroid follicular epithelial cell. In a recent study, p63 was detected in papillary carcinoma, Hashimoto's thyroiditis, and in squamoid aggregates and solid cell nests (SCNs), embryonic remnants found sporadically in the fully developed thyroid. In the present study, the relationship between solid cell nests and papillary carcinoma was investigated further. Four-micrometer sections from 88 routinely fixed and processed archival thyroidectomy specimens were pretreated with citric acid pH 6.0 for antigen retrieval, then incubated overnight with anti-p63 monoclonal antibody 4A4. Slides were stained with a streptavidin-biotin kit and diaminobenzidine as chromogen and were counterstained with hematoxylin. Squamoid aggregates or SCNs were noted in 21 specimens. Several morphologic variants of SCNs were found, all of which displayed p63 positivity. These included undifferentiated SCNs and those displaying commitment toward squamoid and ciliated glandular differentiation. Small, morphologically inconspicuous aggregates of p63-positive cells were commonly found in Hashimoto's thyroiditis. Commitment of p63-positive undifferentiated cells toward thyroid follicular epithelial differentiation was occasionally noted. One SCN variant, also associated with Hashimoto's thyroiditis, was a floretlike arrangement of p63-positive cells with fusiform nuclei. p63 staining was strong and uniform in some SCNs, but in other SCNs it was compartmentalized and homologous to stem cell-staining patterns in normal squamous or bronchial epithelia. Stem cell-like staining, associated with compartmentalized p63 staining or p63-positive undifferentiated cells, was noted in 7 of 27 papillary carcinomas. p63 immunostaining is a highly sensitive means of detecting SCNs. p63 expression patterns in SCNs and a subset of papillary carcinomas are closely homologous to stem cell-associated p63 staining patterns that have been described elsewhere in squamous and bronchial epithelia. We propose a stem-cell-associated model of papillary carcinoma oncogenesis that suggests that (1) p63-positive embryonal remnants rather than mature follicular cells are the cells of origin of a subset of papillary carcinomas; (2) these p63-positive cells are pluripotent and may stay undifferentiated or undergo benign squamoid or glandular maturation, may undergo thyroid follicular epithelial differentiation, may undergo oncogenic change leading to papillary carcinoma, or may trigger an immune reaction, resulting in lymphoid infiltration and Hashimoto's thyroiditis; and (3) Hashimoto's thyroiditis and papillary carcinoma may therefore be linked etiologically, because both disorders may be initiated by the same population of pluripotent p63-positive embryonal stem cell remnants.     

左肝管全程剖开胆肠吻合术的应用解剖学研究

左肝管全程剖开手术,必须熟悉左肝管与邻近血管的局部解剖关系.为此我们用 ABS 丙酮溶液灌注塑型了6具新鲜成人尸肝脏,解剖40例(成人30,儿童10)肝脏标本,测量了左肝管长度和管径,左肝管与肝总管夹角。全程剖开左肝管与右肝管,并观察左肝管与右肝管、左肝动脉、门静脉左干和肝圆韧带的关系,提出了右肝管全程剖开手术方法和注意事项。     

Arterial and lymphatic supply of the knee integuments

Summary The surgical approach to the anterior knee region carries a risk for postoperative integument infection and skin necrosis. A hypothesis is that surgical approach may damage integumental blood supply and additionally the lymphatic drainage from the foot and leg. The goal of this study was to describe the arteries and lymphatics directly affected by the antero-medial approach. Injection of the femoral a. was used to identify the femoral and popliteal aa. and their branches distributed to the integument of the anterior, medial and lateral aspects of the knee. Lymphatic injection into the plantar aspect of the first toe was also performed to identify the subdermal lymphatics traversing the area. Our results showed that most of the blood supply arises from the medial aspect of the knee integuments. However, subcutaneous arterial anastomoses provide a significant blood-supply when there is interruption of the medial vessels as seen in the medial surgical approach to the knee. Most of the lymphatic drainage originating from the foot crosses the knee region on the medial side, opposite or below the tibial tuberosity. Because the subdermal arterial network is well-developed, the medial approach for knee surgery does not endanger the anterior knee integuments as long as the lateral vascular supply is preserved. However, this approach may interrupt the lymphatic circulation, particularly in the case of an extended incision, which could explain postoperative edema and an increased rate of wound infection.

---

Vascularisation artérielle et lymphatique des téguments du genou

Résumé L'abord chirurgical du genou présente un risque d'infection post-opératoire et de nécrose cutanée. Une hypothèse serait que la voie d'abord peut détruire la vascularisation artérielle et lymphatique qui draine la jambe et le pied. Le but de notre étude était de décrire la circulation artérielle et lymphatique impliquée dans la voie d'abord antéromédiale du genou. Des injections ont été utilisées pour identifier les aa. fémorale et poplitée et leurs branches qui se distribuent aux téguments de la région médiale et latérale du genou. Des injections lymphatiques ont été également utilisées pour localiser le réseau subdermique lymphatique de la région du genou. Nos résultats montrent que la majorité de l'apport artériel des téguments du genou provient de la partie médiale. Des anastomoses sub-cutanées entre les systèmes artériels latéral et médial permettent un apport artériel suffisant pour les téguments en cas d'interruption de l'apport médial. La plupart des vaisseaux lymphatiques provenant du pied et de la cheville croisent la région dorsale du pied de dehors en dedans à une distance variable de la tubérosité tibiale. Du fait du bon développement du réseau artériel sub-cutané, la voie d'abord médiale ne présente pas de risque de nécrose des téguments de la face antérieure du genou tant que l'apport latéral est préservé. Toutefois, elle peut être responsable de l'interruption des conduits lymphatiques, en particulier lorsque l'incision s'étend vers le bas, exposant aux lésions des collecteurs lymphatiques, ce qui expliquerait un dème post-opératoire et un taux accru d'infection.

     

Autoimmune hepatitis associated with bile duct injury resembling chronic non-suppurative destructive cholangitis

Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) are representative autoimmune liver diseases in which hepatocytes and intrahepatic bile ducts, respectively, are selectively damaged by autoimmune mechanisms. Bile duct injury and loss is characteristic of PBC and chronic non-suppurative destructive cholangitis (CNSDC), in particular, is a histological hallmark of PBC. In this report, we present an unusual case of AIH accompanied by CNSDC-like bile duct injury in a 46-year-old woman. The patient's serum aminotransferase level was abnormally high. The serum levels of alkaline phosphatase, gamma-GTP and IgG were also elevated, but the IgM level was within normal limits. The titer of antismooth muscle antibody (SMA) was 1:80, while antinuclear autoantibody (ANA) and the M2 fraction of antimitochondrial antibody (AMA) were both negative. Liver biopsy disclosed CNSDC-like bile duct injuries and severe interface hepatitis and lobular hepatitis with perivenular zonal necrosis were observed. The aggregate score of the International Autoimmune Hepatitis Group corresponded to the category of probable AIH. Immunohistochemically, histocompatibility leukocyte antigen-DR, which is aberrantly expressed in the damaged bile ducts of PBC, was not found in the injured bile ducts of this case. Laboratory data were much improved by treatment with prednisone, but ursodeoxycholic acid was not effective. Although the possibility of an overlapping syndrome of AIH- and AMA-negative PBC could not be excluded, this case was diagnosed as AIH with CNSDC-like bile duct lesions.     

Manumycin诱导细胞凋亡抑制乳腺癌细胞SK-BR-3活性

目的:研究manumycin对乳腺癌腹腔转移癌细胞株SK-BR-3的抑癌效应及其诱导凋亡。方法:用MTT法检测manumycin对SK-BR-3细胞的抑癌作用。免疫印迹方法检测p38 MAPK蛋白表达。用caspase-3活性检测试剂盒定量检测manumycin诱导细胞凋亡的水平及评估特异性的p38 MAPK抑制剂SB203580对凋亡的影响。结果:经6 μmol/L、18 μmol/L、54 μmol/L manumycin处理SK-BR-3细胞24 h时,其抑制率分别为(7.4±3.9)%、(21.0±4.4)%和(64.7±4.1)%,呈量效关系。其中后2者的细胞活性与对照组比有显著差异(P<0.01)。用药24 h的IC₅₀为42.5 μmol/L。同时此药物可明显增加caspase-3的活性,且这一效应可部分地被p38抑制剂SB203580阻断。免疫印迹结果显示manumycin促进p38的磷酸化。结论:manumycin可通过诱导SK-BR-3细胞凋亡而产生抑癌作用,p38 MAPK是manumycin诱导细胞凋亡的通路之一。     

The SLC14 gene family of urea transporters

Carrier-mediated urea transport allows rapid urea movement across the cell membrane, which is particularly important in the process of urinary concentration and for rapid urea equilibrium in non-renal tissues. Urea transporters mediate passive urea uptake that is inhibited by phloretin and urea analogues. Facilitated urea transporters are divided into two classes: (1) the renal tubular/testicular type of urea transporter, UT-A1 to -A5, encoded by alternative splicing of the SLC14A2 gene, and (2) the erythrocyte urea transporter UT-B1 encoded by the SLC14A1 gene. The primary structure of urea transporters is unique, consisting of two extended, hydrophobic, membrane-spanning domains and an extracellular glycosylated-connecting loop. UT-A1 is the result of a gene duplication of this two-halves-structure, and the duplicated portions are linked together by a large intracellular hydrophilic loop, carrying several putative protein kinase A (PKA) and -C (PKC) phosphorylation sites. UT-A1 is located in the apical membrane of the kidney inner medullary collecting duct cells, where it is stimulated acutely by cAMP-mediated phosphorylation in response to the antidiuretic hormone vasopressin. Vasopressin also up-regulates UT-A2 mRNA/protein expression in the descending thin limb of the loops of Henle. UT-A1 and UT-A2 are regulated independently and respond differently to changes in dietary protein content. UT-A3 and UT-A4 are located in the rat kidney medulla and UT-A5 in the mouse testis. The widely expressed UT-B participates in urea recycling in the descending vasa recta, as demonstrated by a relatively mild "urea-selective" urinary concentrating defect in transgenic UT-B null mice and individuals with the Jk_null blood group.     

The fine structure and histochemistry of human bile duct in obstruction and choledocholithiasis

Biopsies from the common bile ducts from seven patients undergoing surgery for biliary obstruction due to stones or malignancy were studied histochemically and electron microscopically. The surface of the bile duct is lined by a tall epithelium which extends into diverticula. Apically, they contain some neutral and sialated mucosubstances. Fucosyl residues were found in the Golgi apparatus and along the apical cell membrane. The latter is lined by microvilli. There was a well-developed rough endoplasmic reticulum and Golgi apparatus and a small number of apical secretory droplets. Large numbers of lipid droplets were present basally in some cells. Lipid-containing macrophages were also seen intra-epithelially and in the lamina propria. This suggests a possible pathway for lipid transport. The glands were lined by cuboidal cells, some containing much mucus--sulphated, sialated, and neutral with a basal nucleus. A well-developed endoplasmic reticulum and Golgi apparatus were found with abundant secretory droplets. The glandular epithelium contained lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. These may play a protective role. The lamina propria contained scattered smooth muscle cells amongst the fibroblasts and inflammatory cells.     

Inhibition of sodium transport by angiotensin II in the main duct of the rabbit mandibular gland isolated and perfused in vitro

Summary The effect of angiotensin II on nett electrolyte transport by the main duct of the rabbit mandibular gland was investigated in vitro using a perfused duct preparation bathed in a Haemaccel^®-nutrient salt solution. In a bath concentration of 4×10^–10 M, angiotensin reduced nett absorption of Na⁺ and Cl^– by about 8% and depolarized the transepithelial electrical potential difference (P.D.) by about 13%; the drug had no effect on ductal transport of K⁺ and HCO ₃ ^– . In both lower (4×10^–11 M) and higher (4×10^–9 M) concentrations, angiotensin had qualitatively similar effects. After exposure to the hormone for about 30 min, Na⁺ transport and P.D. became unstable and gradually fell away towards zero. It is concluded that angiotensin in physiological concentrations has a specific inhibitory effect on Na⁺ absorption by salivary duct cells which could arise either from a change in the Na⁺ pump rate or from a conductance change in the apical or basal membrane of the epithelial cell.