Immunization-induced inflammatory infiltration of the central nervous system in transgenic mice expressing a microbial antigen in astrocytes

Transgenic mice expressing a defined microbial antigen from central nervous system (CNS) cell type-specific promoters can be utilized to investigate the consequences of induction of peripheral immune responses to foreign antigens produced by different CNS cell types. Immunization of mice expressing β-galactosidase (β-gal) in astrocytes with this protein resulted in antigen-dependent infiltration of the CNS by mononuclear cells, principally CD4⁺ T lymphocytes and monocyte/macrophages. The perivascular and intraparenchymal infiltrates, which were located predominantly in the hippocampal formation and cerebellum, the areas of highest β-gal expression, were associated with astrocytosis, microgliosis, and a generalized increase in blood-brain barrier permeability. The resemblance of these pathological changes to aspects of human immune inflammatory CNS disorders e.g. multiple sclerosis, suggests that an initiating step in the process by which such complex diseases are produced could be the induction of peripheral immune responses to antigens expressed in astrocytes.     

损伤性肝外胆管狭窄45例临床分析

目的：分析损伤性肝外胆管狭窄发生的原因和损伤后狭窄的修复术式选择。方法：损伤性肝外胆管狭窄45例，诊断方法以B超，PTC、ERCP为主，全组分别行胆管空肠吻合术，胆管十二指肠吻合术，肝门胆管整形术等手术治疗。结果：随访36例，末次手术行胆管空肠吻合术33例，优良87.9%。结论：可见性损伤和隐性损伤所致的瘢痕收缩是胆道狭窄的主要原因，损伤性肝外胆管狭窄的治疗方法以胆管空肠Y形吻合术较为理想。     

射精管异位开口于苗勒管囊肿

报告２例射精管异位开口于苗勒管囊肿。均以血精、血尿就诊，通过经皮输精管穿刺造影及染色尿道镜检查确诊。经抗炎及窥视下纵行剪开苗勒管囊肿前壁。１例治愈，１例好转。对本病的病因、临床表现、诊断、治疗及预后进行了讨论。     

BILIARY HYPERPRESSURE IN RAT EXTRAHEPATIC CHOLESTASIS ALTERS HORSERADISH PEROXIDASE BILIARY EXCRETION

1. The authors investigated the effect of two extrahepatic cholestasis models (one by bile duct ligation and the other by choledocho-jugular fistula) on the hepatic clearance of horseradish peroxidase in male Sprague-Dawley rats divided into four groups. 2. In groups A (n = 5 rats) and B (n = 5), bile duct ligation was performed, while a choledocho-jugular fistula was created in groups C (n = 5) and D (n= 7). A 10 mg intravenous bolus of horseradish peroxidase was injected after 24 h (groups A and C), 48 h (groups B and D) or 1 h (Group E; five sham-operated rats). Serum and bile samples were then serially collected for 2 h. 3. In all groups, serum horseradish peroxidase levels increased soon after injection and then rapidly decreased, the curves being similar. Biliary excretion increased for 30 min and then slowly decreased. The highest horseradish peroxidase biliary concentrations and outputs were found in Group B followed by Group A; both groups had significantly higher levels than Group E. No difference was found between horseradish peroxidase biliary excretion of groups C and D and that of sham-operated rats. 4. When each group was considered separately, sampling times correlated with the corresponding ratios of bile/ plasma HRP. Significant differences were found between the relative slopes of groups A, B and E, but not between those of groups C, D and E. 5. In conclusion, bile duct obstruction greatly affects the plasma-bile transfer of fluid phase markers, such as horseradish peroxidase, while single retention, caused by choledocho-jugular fistula, has no influence. The increased biliary hyperpressure related to the duration of cholestasis may account for the degree of horseradish peroxidase transfer which, in turn, probably depends on an enhanced paracellular passage.     

共同管综合征———胆、胰管异常汇合

对我院14年来2322例直接胆管造影所发现的27例AJPBD进行研究，27例中胆总管囊肿8例，胆石症9例，慢性胰腺炎4例，胆管炎3例，胆囊癌2例，胰体癌1例。临床表现为上腹痛（92．6％），黄疸（70．4％），发热（48．1％）或Charcot三联症（44.4％）。发病年龄3～60岁（36．9士17．8）。共同管长15～44mm（20.2士5．9）。据胆、胰管汇合形式作者将AJPBD分为三型。值得注意的是本组3例复杂型患病年龄均＜15岁。本组以胆、肠内引流手术效果满意。AJPBD与胆、胰疾病发生、发展密切相关，作者建议用“共同管综合征”来表述这一复杂病理现象。     

Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.     

门脉高压性胃病患者的胃壁血气变化

作者观测了４３例门脉高压症患者股动脉血ＰＯ２、胃网膜有动静脉胃壁支血ＰＯ２、胃壁支静脉及肘静脉血ｐＨ、ＨＣＯ３－和胃网膜右静脉压力，其中２３例并有非出血期门脉高压性胃病。结果表明：①门脉高压症患者的股动脉血ＰＯ２低于对照组；②门脉高压症患者胃网膜右动静脉胃壁支血氧分压差低于对照组，胃网膜右静脉压力高于对照组，胃壁支静脉血ｐＨ和ＨＣＯ３－低于对照组和同组肘静脉血。并有门脉高压性胃病者这些变化更为显著。提示门脉高压性胃病的发病机制在于门脉系压力增高、胃粘膜下动静脉短路开放、胃粘膜缺血缺氧和胃壁局部酸中毒。     

Efficacy of an air-cleaning device equipped with a high efficiency particulate air filter in house dust mite respiratory allergy

The efficacy of an air-cleaning device equipped with a high efficiency particulate air (HEPA) filter (without further avoidance measures) was studied in patients allergic to house dust mite. The effects of the air-cleaner on indoor Dermatophagoides sp. levels, symptom score and bronchial hyperresponsiveness in nine mite-allergic patients were assessed using a cross-over controlled study. No significant effect was demonstrated on indoor Dermatophagoides sp. levels when comparing the period of air-cleaner activity (2 months) with the control period (2 months). The Dermatophagoides sp. levels in the houses studied were lower than the risk level for asthmatic attacks, making it difficult to assess any effect on asthma; however, neither bronchial hyperresponsiveness nor rhinitis symptom score were changed by air-cleaner activity. During the trial period, however the mean level of Dermatophagoides sp. allergen in the houses changed spontaneously from 4.4 micrograms/g (mean level in the first 2 trial months) to 1.75 micrograms/g of dust (second 2 months) (P less than 0.05). Owing to this change, the mean rhinitis symptom score also decreased (P less than 0.05), even if no significant correlation was demonstrated (r = 0.4 P = 0.089). HEPA filter air-cleaners appear insufficient as substitutes for standard avoidance measures in mite allergic patients.     

Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy

Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration. Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach proved impossible or unsuccessful. Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited biliary leak. Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital stay. Received: 29 March 1996/Accepted: 12 June 1996