16层螺旋CT检测肠系膜下静脉回流部位的临床意义

目的探讨16层螺旋CT血管重建对肠系膜下静脉（IMV）回流部位及形态的应用价值。方法采用16层螺旋CT对120例患者腹部三期增强扫描的静脉期图像进行最大密度投影（MIP）重建,统计肠系膜下静脉的回流部位。结果肠系膜下静脉的显示率为90%,其中回流到脾静脉（SV）起始处占6.7%;回流到脾静脉占40%;回流到肠系膜上静脉（SMV）起始处占6.7%;回流到肠系膜上静脉占28.3%;回流到肠系膜上静脉与脾静脉汇合处占8.3%.结论16层螺旋CT的MIP重建可以清楚、直观显示肠系膜下静脉。     

黄芪甲甙对大鼠离体肠系膜动脉血管舒缩功能的影响

目的：观察黄芪甲甙对大鼠离体肠系膜动脉舒缩功能的影响，并探讨其可能机制。方法：分离肠系膜动脉1—2级分支制备离体肠系膜血管环固定于微血管张力测定仪，观察黄芪甲武对血管环舒缩功能的影响。结果：①不同浓度的黄芪甲甙（30mg／L和100mg／L）孵育后，苯肾上腺素引起的血管收缩较对照组明显下降（尸〈0．05或P〈0．01）。②累积浓度的黄芪甲甙对苯肾上腺素（2×10^-6mol／L）预收缩的内皮完整或去内皮肠系膜动脉血管环均产生浓度依赖性的舒张作用，中高浓度的黄芪甲甙（10mg／L、30mg／L和100mg／L）对内皮完整组的舒张作用明显强于去内皮组（P〈0．05或P〈0．01）。③累积浓度的黄芪甲甙对KCl预收缩的肠系膜动脉血管环张力无明显影响（P〉0．05）。④L-NAME（10^-4mol／L）预处理能显著减弱黄芪甲甙的舒血管作用（P〈0．05或P〈0．01）。结论：黄芪甲甙具有一定的内皮依赖性舒张血管作用，且主要通过NO途径发挥作用。     

Pediatric precursor T lymphoblastic leukemia and lymphoblastic lymphoma: Differences in the common regions with loss of heterozygosity at chromosome 6q and their prognostic impact

Deletions on chromosome 6q are frequently reported in hematological malignancies. However, their biological or prognostic impact has not yet been clarified. This study analyzed loss of heterozygosity (LOH) at chromosome 6q and compared the LOH findings in pediatric precursor T lymphoblastic lymphoma (T-LBL) with the LOH findings in precursor-T lymphoblastic leukemia (T-ALL). For LOH analyses, a set of 25 microsatellite-markers on 6q14-q24 were examined. All patients were treated uniformly according to ALL-BFM-type treatment-strategy. A total of 1671 markers were successfully analyzed from 108 T-LBL patients. LOH was detected in 21 T-LBL patients. There was clear association between LOH at 6q and an increased risk of relapse. In comparison, 3109 markers were successfully analyzed from 127 T-ALL-patients. LOH was detected in 16 patients, but was not associated with increased relapse-rate. The localization of the common LOH regions identified for T-LBL and T-ALL samples did not overlap. Therefore patterns of LOH at 6q and the prognostic impact of LOH differ between T-ALL and T-LBL. These results hint at biologic differences between the two diseases.     

Burkitt's Lymphoma in a Child with Aids

Few systemic lymphomas have been reported in children with AIDS. We report a case of disseminated Burkitt's lymphoma with lung involvement occurring in a 33-month-old child with acquired immunodeficiency syndrome. Lymphoid interstitial pneumonia was diagnosed by lung biopsy at 23 months of age, but lymphoma was not diagnosed before autopsy.     

Secondary syphilis of the tonsil

Summary An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.     

Lymphadenopathic Kaposi'S Sarcoma in a Pediatric PatienT with Acquired Immune Deficiency Syndrome

A six-year-old Hispanic female with acquired immune deficiency syndrome (AIDS) and multiple opportunistic infections was found to have disseminated lymphadenopathic Kaposi's sarcoma at autopsy. She was presumed to have been infected via maternal transmission, although both HIV antibody positive parents were asymptomatic. Kaposi's sarcoma is rarely reported in pediatric AIDS, and children may not have the typical aggressive cutaneous lesions found in adults with AIDS-associated Kaposi's sarcoma.     

Microdissection Study of the Myentric Plexus in Acardia, Ataxia-telangiectasia, Cystic Fibrosis, Extrahepatic Biliary Atresia, Pediatric Aids and Werdnig-Hoffmann Disease

Microdissection-point count morphometric study of the myenteric (Auerbach) plexus or esophagus, small intestine, and colon was done for infants and children with acardia (2), ataxia-telangiectasia (5), cystic fibrosis of the pancreas (CFP) (25), extrahepatic biliary atresia (EBA) (17), pediatric AIDS (10), and Werdnig-Hoffmann disease (WHD) (8). Values for fractional area of neural tissue in the plane of the plexus were compared to those of control patients in same age range as those in each disease category by t-test. Statistically abnormal values included low values for small intestine and colon in Werdnig-Hoffmann disease, high values for small intestine and colon in biliary atresia, and high value for colon but a low value for small intestine in cystic fibrosis. Values for all three loci were within the normal range for ataxia telangiectasia and pediatric AIDS. The mechanisms of the low value for small and large intestines in WHD, which causes chronic constipation as a result of skeletal muscle weakness, and of the high values for colon in CFP and EBA, both causing malabsorption with bulky stools, are unclear. The value for small intestine in acardia was normal for term but lower than expected for fetal bowel of the same size, possibly because of reduced neural crest inflow to the fetal bowel.     

Intensive short-course chemotherapy in pulmonary tuberculosis

One hundred and twenty children with possible diagnosis of pulmonary tuberculosis were admitted in this study for evaluating the efficacy of short course chemotherapy regimens in childhood pulmonary tuberculosis and are under follow up. In only three patients smear was positive for AFB. In 74 cases culture for AFB was done of which 18 cases (24·3%) were found to be positive. Fortyone patients were put on a standard one year regimen consisting of streptomycin, isoniazide and ethambutol as a control group and seventy nine patients were put on short-course regimens, consisting of isoniazid, rifampicin and pyrizinamide. Out of these 79 patients, 39 were in a biweekly regimen consisting of isoniazid and rifampicin after initial intensive therapy with three drugs for two months. In majority of patients clinical improvement and in all patients bacteriological improvement was observed at the end of two months period. Marked radiological improvement at the end of therapy was seen in only about two-third patients. Relapse after stopping therapy occurred in one patient with associated tubercular cervical lymphadenitis.     

Current treatment of thalamic gliomas in children

Historically, the outcome of children with thalamic gliomas has been poor. Because of the potential for severe perioperative mortality, conservative approaches toward these lesions have been commonly instituted. However, recent improvements in therapeutic approaches have been numerous. These refinements have most importantly centered on improving the neurosurgical technique of tumor resection by integrating computerassisted, stereotactic approaches. In so doing, perioperative mortality has dropped from as high as 40% to as low as 0–1%. Gross total resection confirmed with postoperative imaging is becoming an expectation. However, because of anatomical limitations or malignant histology, incomplete resections will undoubtedly occur in an effort to preserve neurological function. At the same time, not all residual disease implies a poor outcome. Indolent, low-grade gliomas of childhood are not limited to the cerebellum or optic/hypothalamic regions, and histologically similar lesions in the region of the thalamus occur with some frequency. In this case scenario, incompletely resected low-grade lesions should be followed sequentially with routine imaging; further therapy, be it surgical or adjuvant, is instituted only if disease progression is documented. Children found to have malignant gliomas of the thalamus should undergo surgical resection in an effort to relieve them of any existing mass effect. Subsequently, adjuvant therapy is utilized depending on the exact histopathology and the child's age. Thus, what evolves from recent data and current surgical techniques is an aggressively directed therapy based upon anatomical considerations and tumor type.     

Recent trends in the radiotherapy of pediatric gliomas

The management of pediatric gliomas is controversial, and is greatly influenced by the site of origin of the tumor. For example, cerebellar low grade tumors are often cured by surgery alone. This is in contrast to the hypothalamic and optic system tumors which are usually not amenable to complete resection. For the low grade astrocytomas, the usual indications for adjuvant treatment include: recurrent tumors after initial complete resection or symptomatic tumors that have been incompletely excised. In addition, treatment is generally indicated in tumors with growth on follow-up imaging, even in the absence of symptoms. In selecting the optimal treatment, the relative efficacies of surgery, chemotherapy and irradiation must be balanced by the potential complications of therapy. The potential risks of delayed intervention include irreversible neurologic impairment and potential lower probability of tumor control. This chapter reviews recent trends in the radiotherapeutic management of pediatric low-grade and malignant astrocytomas, particularly the new more conformal techniques that hold the promise of reduced toxicity in children requiring irradiation.