环孢菌素A阻断人HL－60抗药性细胞于G_1期而诱导敏感细胞凋亡

进一步研究了抗三尖杉酯碱的ＨＬ－６０细胞（ＨＲ２０）抗细胞凋亡的机制及该抗性和抗药性的关系。结果表明，环孢菌素Ａ（ＣｓＡ）２０，１０μｇ·ｍｌ￣（－１）诱导ＨＬ－６０细胞发生凋亡，而阻断ＨＲ２０细胞于Ｇ＿１期，就不能诱导细胞发生凋亡。低浓度的ＣｓＡ明显增加柔红霉素在ＨＲ２０细胞内的积聚，其逆转抗药性作用与阻断细胞周期运行无关。ＣｓＡ１０μｇ·ｍｌ￣（－１）处理ＨＲ２０细胞，可引起５０ｋＤａ的蛋白质高度磷酸化。结果提示：环孢菌素Ａ阻断抗三尖杉酯碱的ＨＬ－６０细胞于Ｇ＿１期，而诱导敏感的ＨＬ－６０细胞发生凋亡，其阻断作用与抗药性无关     

Microsurgical anatomy of VII and VIII cranial nerves and related arteries in the cerebellopontine angle

Summary The relationships of VII and VIII cranial nerves and related arteries are reviewed in 26 preparations by microdissection techniques. These vessels may be grouped in large (AICA, PICA), medium (LA, SA, CSA, RPI) and small calibre (vasa nervorum, radicullar and medullar branches). The importance of these structures in acoustic neuroma surgery, vestibular neurectomy and cross-compression syndromes is discussed. Vascular loops and elongated arteries are normal structures present at birth.This work was supported by a grant from the AJ Roemmers Foundation     

Osteosarcomatosis

A review of the 690 cases of osteosarcoma in the radiographic file of the Armed Forces Institute of Pathology revealed 29 cases of "osteosarcomatosis" (multiple skeletal sites of osteosarcoma). Fifteen of these patients were 18 years old and under and manifested rapidly appearing, usually symmetric, sclerotic metaphyseal lesions. The remaining 14 patients were more than 18 years old and had fewer, asymmetric sclerotic lesions. In most patients (28 of 29), a radiographically dominant skeletal tumor was seen. Pulmonary metastases occurred in the majority of patients and were detected at the same time as the bone lesions. These 29 patients were studied with regard to demographic data and skeletal distribution and radiographic appearance of their lesions. As a result of the findings, a metastatic origin from a primary dominant osteosarcoma is favored over a multifocal origin as the basis for osteosarcomatosis. Osteosarcomatosis is more commonly encountered in the mature skeleton than has been previously recognized.     

The effect of transfusions on renal allograft survival in the cyclosporine era: a single center report

The potential efficacy of prior transplant transfusions on graft survival in the cyclosporine era has been reported from several centers which are reconsidering their transfusion policy. The purpose of this study has been to evaluate the results obtained in a large series of first kidney transplant patients (N=284) treated with cyclosporine. Our past experience showed a beneficial effect of blood transfusions in cadaveric renal transplants on conventional immunosuppression. Forty-eight patients never received blood transfusions, 85 patients received 1-2 transfusions, 72 patients received 3-5 transfusions and 79 patients received more than 5 transfusions in their pre-transplant periods. We did not show an obvious beneficial effect of prior blood transfusions in improving 1- and 2-year patient and graft survival. In fact, no statistically significant differences were found among any of the groups depending upon the transfusion status. In the transfused group, graft survival rates were 81.4% (1 year) and 77.8% (2 years) while in the non-transfused group they were 81.2% (1 year) and 78.4% (2 years)(p=n.s.). The patients who rejected had a significantly lower graft survival in the transfused group as compared to the non-transfused group. On the other hand, the transfused patients without rejection episodes experienced the best graft survival, suggesting a beneficial transfusion effect. We conclude that since it is impossible to determine which patients will not reject, pre-transplant transfusions under certain circumstances might be harmful, or at least not beneficial. We would recommend restricting transfusions in cyclosporine-tested patients only in cases of therapeutic necessity.     

Quality of life in diabetic recipients of kidney transplants is better with the addition of the pancreas

The present study is an evaluation of the quality of life of 32 patients following successful pancreatic transplantation. These patients were studied at from 6 months to 5 years post-transplantation. Over one-half of them were beyond the 21/2-yr mark. A questionnaire was developed that focused on symptoms of neuropathy, enteropathy, and retinopathy. All of the patients evaluated had completely normal carbohydrate metabolism, as evidenced by normal fasting blood sugars and hemoglobin A1C levels. Twenty-one of the 32 patients had symptomatic neuropathy pre-operatively, and 11 of these reported substantial subjective improvement. Eight remained unchanged and 2 became worse. Twenty-four patients had symptoms of enteropathy and 23 noted improvement post-transplantation. Retinopathy symptoms were not improved, but there was a suggestion that after 3 or 31/2 yr progression did not occur as rapidly as earlier. Virtually all of the patients had mood improvements and considerably less fatigue. We have determined that the risk of the procedure when receiving simultaneous renal and pancreas grafts is not significantly greater than that associated with a kidney transplant alone. Patients who are not uremic, either those with a successful kidney graft or those preuremic patients, are better candidates if symptoms are present. The risk of immunosuppression is insignificant in those patients who already have a successful renal transplant and are already on immunosuppressant drugs. Pancreatic transplantation can substantially improve the quality of life in diabetic patients, and should be considered as a therapeutic measure.     

Clonality of Campylobacter sputorum bv. paraureolyticus determined by macrorestriction profiling and biotyping, and evidence for long-term persistent infection in cattle

Eighteen strains of Campylobacter sputorum bv. paraureolyticus (isolated over a 12-month period from seven dairy cows contained in a single herd) were examined by resistotyping, and macrorestriction profiling using pulsed field gel electrophoresis (PFGE). The resistotypes of these strains were identical, although repeat testing indicated resistance to metronidazole was not a reliable trait for typing purposes. Five SmaI-derived genotypes were identified among the 18 strains. In 5 of 7 cows, isolates obtained from the same animal, but from different time periods, were genotypically indistinguishable, indicating persistence of infection. Macrorestriction profiles of 5 strains representing the 5 SmaI genotypes and 8 other strains of C. sputorum from various sources, were prepared using 4 endonucleases (SmaI, SalI, BamHI and KpnI). The only other strain of C. sputorum bv. paraureolyticus examined (a Canadian isolate from human faeces), was found to have a SmaI macrorestriction profile identical with one of the five clones isolated from the cattle. Moreover, SalI and BamHI profiles of all bv. paraureolyticus strains were similar, while digestion with KpnI was not observed. By contrast, the seven strains of C. sputorum bv. sputorum yielded various macrorestriction profiles with all the enzymes used, and features distinguishing the two biovars studied could be identified. This study indicates that C. sputorum can persist in cattle for at least 12 months and exhibits a clonal population genetic structure.     

Cytomegalovirus cecal erosion causing massive hemorrhage in a bone marrow transplant recipient

A 24-year-old male underwent bone marrow transplantation for severe aplastic anemia. Posttransplantation complications included severe graft-versus-host disease and cytomegalovirus (CMV) infection manifested by gastrointestinal bleeding and apparent pneumonitis. Massive rectal bleeding necessitated exploratory laparotomy at which time a right colon resection was performed. Fifteen cecal ulcers were present which on histologixc examination revealed numerous cells containing characteristic intranuclear inclusions. Life-threatening gastrointestinal lesions associated with CMV infection will be seen with increasing frequency as more patients undergo the severe immunosuppression associated with bone marrow and organ transplantation. Prompt recognition and expeditious surgical management will result in improved survival in this high-risk population.

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Résumé Chez un sujet de 24 ans qui avait subi une transplantation de moelle osseuse sort survenues des complications de rejet et une infection à cytomégalovirus qui s'est manifestée par une hémorragie digestive et une atteinte pulmonaire. L'abondance de l'hémorragie a imposé une laparotomie exploratrice qui a conduit à une hémicolectomie droite. Sur la pièce de résection on a découvert quinze ulcérations. L'examen histologique a montré qu'elles contenaient de nombreuses cellules dont le noyau présentait de nombreuses inclusions caractéristiques.Ce type de lésions digestives allant de pair avec une infection a cytomégalovirus devrait devenir de plus en plus fréquent chez les malades qui présentent des phénomènes immuno-dépressifs après transplantation d'organes ou de moelle osseuse. Il sera nécessaire de les reconnaitre rapidement pour les traiter chirurgicalement sans retard. C'est à ce prix que le risque d'évolution fatale pourra être réduit chez ces sujets à haut risque.