New modification of deep biliary cannulation using endoscopic–radiologic rendezvous technique for palliative treatment of malignant obstructive jaundice

Aim

To describe a new simple modification of deep biliary cannulation using combined endoscopic–radiologic technique and evaluate its technical and clinical success for palliative treatment of malignant obstructive jaundice.

Patients and intervention

We used this technique in 25 patients with inoperable malignant biliary obstruction and failed endoscopy procedures alone. Using angiographic methods, an introducer of long arterial sheath, over a guide wire was passed to overcome the site of obstruction. Our amendments lie in using a stiff introducer to allow support of the guide wire during its navigation through the obstruction site, followed by passage of the introducer together with the guide wire to the duodenum, while the introducer in place; the hydrophilic guide wire with its slippery end should be replaced with a long ordinary guide wire which is used in ERCP because it could be easily grasped with the dormia basket.

Results

Technical success rates were 100%, internal biliary stents were successfully placed in a one-step procedure at the appropriate position in all patients with adequate duct drainage. Clinical success rates were 92% within 48–72 h and 8% within 7 days. Minor complications occurred in 4/25 (16%) patients, with no reported major complication. The median procedure time was 40 min.

Conclusion

This simple modification was technically and clinically successful for palliative treatment of inoperable malignant biliary obstruction with failed endoscopy procedures alone.     

Some milestones in in vitro organ Toxicity Assessment. The Kidney as a Case Study

The expression of target organ toxicity ranges from subtle abnormalities of cellular organelles to permanent loss of organ function. The selective targeting of chemicals for discrete regions and cell types of a given organ is frequently due (besides some pharmacodynamic mechanisms) to the fact that target cells may express unique biochemical or functional characteristics predisposing them to chemically induced injury. In vitro models commonly used in target organ toxicity tests include perfused organ preparations, isolated tissue preparations, single-cell suspensions and tissue culture systems. Although these systems have proved their usefulness for acute toxicity tests, there is still a great need for in vitro models to be used for chronic toxicity tests. Among the systems listed above, the single-cell culture technique may be adapted to long-term study requirements. The example of kidney proximal tubules is taken to illustrate the necessity for extensive characterization of the actual capacities of the models in term of phenotypic profiling, energy status, drug detoxication activities, specific transport systems and organ-specific differentiated functions. LLC-PK1, LLC-RK1, NRK and OK cell lines are compared with primary cultures of rat, rabbit and human proximal tubule cells. The importance of the cell culture environment on the cell phenotypic profile, and its subsequent response pattern to toxicant exposure, are described using gentamicin and platinum derivatives as examples. In terms of experimental strategy, choice of cell type, choice of species of origin, choice of doses, choice of duration, continuous or discontinuous exposure, and whether to study the recovery phase, are crucial issues for designing models mimicking more closely the in vivo situation. The identification of relevant endpoints, allowing discrimination between general cell toxicity and specific organ toxicity, has not been sufficiently explored in vitro. Scientifically based endpoints referring to the background studies conducted by biochemists or physiologists should be selected and included in experimental designs dealing with organ toxicology in vitro. Conceptually, relevant specific target-organ toxicity could be investigated by the use of multiple cell types and by analysis of the difference in concentration between the cytotoxic concentration threshold and the specific endpoint alteration threshold.     

影象学在胆管癌诊断中的价值：35例报告

本文分析了35例梗阻性黄疸病人,均经B型超声波、ERCP/PTC检查而明确胆管癌的诊断,并经手术证实。病理结果表明大部分为腺癌。通过分析认为B型超声波检查可作为首选方法,ERCP/PTC则能比较准确地描绘出胆管肿瘤的性质、所在部位及其形态,本文并进行了形态学方面的分型。     

甲状腺乳头状癌24例临床病理分析

目的：探讨甲状腺乳头状癌的临床病理特征，对其病理诊断、病理组织学分型和鉴别诊断进行讨论。方法：对24例甲状腺乳头状癌的活检标本进行病理组织学观察与分析。结果与结论：甲状腺乳头状癌组织学形态复杂，依据主要诊断要点、鉴别诊断及组织学分型，做出正确的病理诊断，对估计预后有帮助。     

甲状腺乳头状癌颈部淋巴结转移特点及清扫策略

背景与目的：目前,在甲状腺癌颈淋巴结清扫方面存有较大分歧。该研究总结甲状腺乳头状癌淋巴结转移的特点,为择区淋巴结清扫提供理论依据。方法：回顾性分析2006年7月—2014年8月收治的462例甲状腺乳头状癌患者病历资料,分析其淋巴结转移规律及其影响因素,评判cN0标准的准确性。结果：全组患者均行患侧中央区(Ⅵ区)淋巴结清扫,320例行侧颈区淋巴结清扫术(Ⅱ～Ⅴ区)或择区淋巴结清扫(Ⅱ～Ⅳ区中的部分或全部),90例行对侧中央区淋巴结活检。73.2%(338/462)符合cN0标准,病理证实其中有184例淋巴结转移,cN0标准误诊率达60.9%。颈部淋巴结总转移率为65.4%(302/462),侧颈区淋巴结转移率为42.6%(197/462),“跳跃转移”率为13.1%(42/320),对侧中央区淋巴结转移率为50%(45/90)。男性、肿瘤累及腺叶上1/3、肿瘤T3或T4、多中心病灶是淋巴结转移的危险因素。肿瘤累及腺叶上1/3是喉前淋巴结转移及“跳跃转移”的危险因素。喉前淋巴结转移及中央区淋巴结2个以上转移者侧颈区淋巴结转移率显著增加(分别为85.7%和83.3%, P＜0.05)。结论：现行cN0标准不能作为确定淋巴结清扫范围的依据;甲状腺乳头状癌易发生淋巴结转移,其中Ⅵ区淋巴结转移率最高,依次为Ⅲ区、Ⅱ区、Ⅳ区、Ⅴ区;初次手术应常规清扫患侧中央区淋巴结,建议将Ⅵ区淋巴结送冰冻病理;当喉前淋巴结有转移或Ⅵ区2个以上淋巴结转移时,或肿瘤累及腺叶上1/3者,有必要行侧颈区(或择区)淋巴结清扫;对侧中央区淋巴结转移率较高,需予以重视;中央区淋巴结再分亚区具有重要意义,应深入研究。     

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.     

Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers

Purpose

Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers.

Diffuse intrahepatic bile duct abscesses — Diagnosed by percutaneous transhepatic cholangiography

Multiple intrahepatic abscesses are associated with a very high mortality rate. We believe that percutaneous transhepatic cholangiography (PTC) is the definitive diagnostic procedure in this condition. Two patients with biliary duct obstruction who developed hepatic abscesses are presented. The value of early diagnosis by PTC is stressed.     

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。     

Botulinum Neurotoxin A Complex Recognizes Host Carbohydrates through Its Hemagglutinin Component

Botulinum neurotoxins (BoNTs) are potent bacterial toxins. The high oral toxicity of BoNTs is largely attributed to the progenitor toxin complex (PTC), which is assembled from BoNT and nontoxic neurotoxin-associated proteins (NAPs) that are produced together with BoNT in bacteria. Here, we performed ex vivo studies to examine binding of the highly homogeneous recombinant NAPs to mouse small intestine. We also carried out the first comprehensive glycan array screening with the hemagglutinin (HA) component of NAPs. Our data confirmed that intestinal binding of the PTC is partly mediated by the HA moiety through multivalent interactions between HA and host carbohydrates. The specific HA-carbohydrate recognition could be inhibited by receptor-mimicking saccharides.