Leflunomide-related lung injury in patients with rheumatoid arthritis: imaging features

Imaging findings of 26 cases of leflunomide (Arava)-related acute lung injury were analyzed. Thirteen cases had pre-existing interstitial pulmonary disease on chest X-ray or computed tomography. The main features of clinically determined leflunomide-induced acute lung injury were similar to those caused by other drugs: diffuse or widespread patchy ground-glass opacities and/or consolidation, frequently accompanied by septal thickening and intralobular reticular opacities. We categorized these findings into four patterns: diffuse alveolar damage (DAD), acute eosinophilic pneumonia, hyperreaction, and cryptogenic organizing pneumonia. The DAD group had a higher mortality rate, but statistically not a significant one. It is impossible to exclude infectious disease such as pneumocystis carinii pneumonia based on imaging findings, and detailed correlation of imaging findings with clinical and laboratory findings is essential in order to make a correct diagnosis.     

Deficiency in endogenous modulation of prolonged heat pain in patients with Irritable Bowel Syndrome and Temporomandibular Disorder

Females with Irritable Bowel Syndrome (IBS) and Temporomandibular Disorder (TMD) are characterized by enhanced sensitivity to experimental pain. One possible explanation for this observation is deficiencies in pain modulation systems such as Diffuse Noxious Inhibitory Control (DNIC). In a few studies that used brief stimuli, chronic pain patients demonstrate reduced DNIC. The purpose of this study was to compare sensitivity to prolonged heat pain and the efficacy of DNIC in controls to IBS and TMD patients. Heat pain (experimental stimulus; 44.0–49.0 °C), which was applied to left palm, was continuously rated during three 30-s trials across three separate testing sessions under the following conditions: without a conditioning stimulus; during concurrent immersion of the right foot in a 23.0 °C (control); and during noxious cold immersion in a (DNIC; 8.0–16.0 °C) water bath. Compared to controls, IBS and TMD patients reported an increased sensitivity to heat pain and failed to demonstrate pain inhibition due to DNIC. Controls showed a significant reduction in pain during the DNIC session. These findings support the idea that chronic pain patients are not only more pain sensitive but also demonstrate reduced pain inhibition by pain, possibly because of dysfunction of endogenous pain inhibition systems.     

Epstein-Barr Virus–associated Lymphoproliferative Disorders in the Skin

Epstein-Barr virus (EBV)–associated lymphoproliferations involving the skin are a rare but important group of diseases with a broad spectrum of behavior, ranging from self-limiting spontaneously resolving disorders to highly aggressive malignancies. They may be of B, T, or natural killer (NK) cell type and include EBV-positive mucocutaneous ulcer, lymphomatoid granulomatosis, EBV-positive diffuse large B-cell lymphoma, hydroa vacciniforme–like lymphoproliferative disorder, and extranodal NK/T-cell lymphoma of nasal type. Recognition and distinction of these entities is important in view of their differing prognoses and treatments. An association with EBV may be the first indication that a patient is immunosuppressed.     

Hereditary diffuse gastric cancer and E-cadherin: description of the first germline mutation in an Italian family.

AIMS: Germline mutation of the E-cadherin gene (CDH1) accounts for the Hereditary Diffuse Gastric Cancer (HDGC) syndrome. Fourteen pedigrees with Diffuse Gastric Cancer that fulfilled the International Gastric Cancer Linkage Consortium (IGCLC) criteria were selected and screened for CDH1 germline mutations. METHODS: The entire coding region of the CDH1 gene and all intron-exon boundaries were analyzed by direct sequencing in the 14 families fulfilling the IGCLC criteria. E-cadherin immunohistochemical expression was evaluated on tumour as well as normal formalin-fixed paraffin embedded tissues. RESULTS: A novel germline missense mutation was found. It was a single C-->T substitution in exon 8, resulting in a transition of CCG-->CTG (C1118T; Pro373Leu) demonstrated in the proband and her brother. At immunohistochemical analysis, the staining intensity was reduced and considered weakly positive (15%). CONCLUSIONS: The first CDH1 germline mutation of an Italian family is herein reported. The present missense mutation has never been described so far.     

弥漫性轴索损伤研究进展

弥漫性轴索损伤(DAI)是用于描述头部伤后以脑深部神经轴索肿胀、断裂为特征的脑损伤类型。本文就近年来对DAI研究进展包括发生机制、病理特征、临床表现、诊断及其治疗综述如下。     

脑弥漫性轴索损伤的影像诊断价值

目的 探讨CT、MR对脑弥漫轴索损伤(DAI)的诊断价值及与临床、预后关系.方法 回顾性分析经临床确诊的DAI 32例,患者均做了CT检查,其中22行CT及MR检查.结果 32例中共发现237个病灶,其中胼胝体12个,脑干3个,基底节区8个,大脑白质211个,小脑半球3个.85.2%病灶为非出血性病灶,T1W低信号,T2W高信号.损伤部位与患者临床预后、GCS评分有统计学差异(P＜0.05).结论 MR为DAI的临床诊断、预后判断提供了可靠的影像学依据.     

磁共振弥散成像在弥漫性轴突损伤诊断中的应用

磁共振弥散成像是通过水分子弥散差异成像,反映水分子弥散运动状态。由于成像原理不同于传统磁共振,故弥散成像对中枢神经纤维束的解剖结构改变较为敏感,从而成为弥漫性轴突损伤诊断的重要技术。弥散加权成像能通过突出弥散效应显示损伤灶;弥散张量成像能反映各向异性矢量,更加敏感地显示损伤灶,并可通过神经纤维束成像显示轴突损伤。弥散成像不仅提高了弥漫性轴突损伤的诊断,还有利于判断伤情及预后。该作者对以上问题作一综述。     

Haemorrhagic shock-encephalopathy syndrome: plasmapheresis as a therapeutic approach

We present the case of a 4.5-week-old boy with acute encephalopathy, shock, intestinal bleeding and disseminated intravascular coagulation. The clinical course and typical laboratory parameters were compatible with a diagnosis of haemorrhagic shock-encephalopathy syndrome (HSE). Immediate shock treatment, repeated haemodialysis and plasmapheresis did not prevent a fatal outcome 4 days after the onset of clinical symptoms.Abbreviations HSE haemorrhagic shock-encephalopathy syndrome - HUS haemolytic uraemic syndrome     

弥漫性脑损伤大鼠脑组织细胞间粘附分子-1的表达与神经元损伤

目的观察细胞间黏附分子-1(ICAM-1)在大鼠弥漫性脑损伤不同时程的表达与脑组织神经元损伤。方法荧光实时定量RT-PCR和免疫组化分别测定ICAM-1mRNA和蛋白在大鼠弥漫性脑损伤不同时程的表达,光镜和电镜观察神经元的变化。结果外伤后6h脑组织中ICAM-1蛋白的表达开始升高(阳性微血管数4.8±0.8),72h达高峰(17.2±2.4),高于假手术对照组(0.4±0.5)(P<0.05)。ICAM-1mRNA表达3h即明显升高(△Ct:13.48±3.93),72h达最高(20.59±0.97),7d(15.60±0.01)仍高于假手术对照组(4.66±1.11)(P<0.01)。光镜及电镜下可见弥漫性神经元变性水肿和坏死,72h损伤最重。结论大鼠脑外伤后ICAM-1表达升高,介导了粒细胞与脑血管内皮黏附增强,ICAM-1可能参与了外伤后炎症反应和神经元损伤的病理过程。