IFN-γ和糖皮质激素对哮喘病人T淋巴细胞中的TGF-β的作用

目的:探讨C D4 TG F-β,C D8 TG F-β在哮喘发病机制中的作用,了解IFN-γ和糖皮质激素对其的影响。方法:采用Ficoll-H ypague密度梯度离心及贴壁培养法对18例哮喘患者和10例健康对照者外周血单个核细胞进行分离,纯化后,加入地塞米松及IFN-γ培养24h,加入PM A,莫能菌素,艾罗霉素培养4.5h,促使细胞内细胞因子聚集于高尔基体,取培养上清中的淋巴细胞经流式细胞仪检测分析C D4 T、C D8 T淋巴细胞及其细胞内细胞因子TG F-β表达率。结果:C D4 TG F-β、C D8 TG F-β及C D4、C D8细胞内总TG F-β检测结果的比较,哮喘组C D4 TG F-β(15.50±0.15)%、C D8 TG F-β(19.34±0.18)%,与正常对照组(9.57±0.16)%、(13.49±0.26)%比较,显著增高(均P<0.05);加入地塞米松培养的哮喘组C D4 TG F-β,C D8 TG F-β无显著变化(P>0.05),加入IFN-γ培养的哮喘组C D4 TG F-β(7.61±0.09)%、C D8 TG F-β(9.82±0.19)%的变化显著降低(均P<0.05),C D4、CD8细胞内总TG F-β哮喘组(32.42±1.17)%比正常组(20.53±1.02)%显著增加(P<0.05),加地塞米松后无显著变化(P>0.05),加IFN-γ后(16.85±0.14)%,显著降低(P<0.05)。结论:哮喘急性发作期有C D4 TG F-β、C D8 TG F-β升高;地塞米松不能降低哮喘气道重塑;IFN-γ可通过抑制TG F-β的分泌治疗哮喘,降低哮喘气道重塑。     

Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum.

Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to squamous-cell carcinoma is unknown. Bowenoid papulosis, erythroplasia of Queyrat, and Bowen's disease are histologically identical to in situ carcinoma. Although the first is consistently benign, the latter two regularly evolve into invasive cancer. Malignant scrotal lesions include squamous-cell carcinoma, liposarcoma, leiomyosarcoma, basal-cell carcinoma, extramammary Paget's disease, erythroplasia of Queyrat, malignant melanoma, and metastases. Hemangioma can be confused with carcinoma.     

Spontaneous Regression of Budd-Chiari Syndrome (Hepatic Venous Occlusion) in a Young Female

ABSTRACT. Hultcrantz R, Angelin B, Einarsson K, Friman L (Departments of Internal Medicine and Roentgenology, Serafimer Hospital, and Department of Internal Medicine, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden). Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female. Acta Med Scand 1987; 221:503–7. A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparo-centesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.     

Is chronic inflammatory change in the prostate the major cause of rising serum prostate‐specific antigen in patients with clinical suspicion of prostate cancer?

AIM: To evaluate the cause of elevated prostate-specific antigen (PSA) in patients with transrectal needle biopsy negative for prostate cancer. METHODS: Serum PSA concentration, prostate volume, and pathologic findings were examined in 223 patients with negative biopsy for prostate cancer. The degree of prostate inflammation was determined by the extent and degree of inflammation shown by biopsy specimens and is expressed as an inflammation score (range: 0-36). RESULTS: A significant correlation was found between PSA concentration and prostate total volume (P=0.0001). Prostate chronic inflammation showed no correlation with PSA concentration (P=0.485, F=0.488). After allocating patients to normal PSA (4 ng/mL) groups, we found that serum PSA concentrations in both groups were predominantly affected by prostate total volume. CONCLUSIONS: An increase in prostate volume appears to be the major contributor to a high serum PSA concentration in patients with negative biopsy for prostate cancer. However, in contrast to previous reports, there was no correlation between the degree of prostate chronic inflammation and serum PSA concentrations.     

NATURE AND HEALING OF TIBIAL SHAFT FRACTURES IN ALCOHOL ABUSERS

Alcohol abuse is associated with an increased risk of osteopeniaand fractures. Previous histomorphometric studies on iliac crestbone have found decreased bone formation and increased boneresorption in alcohol abusers but it has not been establishedwhether alcohol abuse has any effect on the anatomical locationor the healing time of tibial shaft fractures. We studied, retrospectively,199 adult male patients hospitalized for isolated tibial shaftfracture in the city of Malmö, Sweden, between 1980 and1990. Forty-nine of the patients had earlier been registeredat the Department of Alcohol Diseases and were judged to beproblem drinkers. Abusers sustained their tibial shaft fracturesmore often by falling at ground level (P<0.0001) or froma higher level (P=0.009) and the fractures were more often obliquethan transverse (P=0.002) as compared with non-abusers. Healingtime was impaired in abusers who had sustained a transversefracture (P=0.035), but no difference was observed in healingtime in those with an oblique fracture. We found no differencebetween the abusers and the non-abusers regarding duration ofhospital stay, fracture location, amount of displacement, occurrenceof open fractures or the rate of complications.     

国产法莫替丁治疗消化性溃疡的近期疗效观察

本文报告应用国产法莫替丁治疗消化性溃疡45例的近期疗效。治疗组法莫替丁20mg,早晚各服一次;对照组甲氰咪胍400mg,早晚各服一次,两组疗程皆为6周。以胃镜检查为诊断和评价疗效的依据,两组愈合率分别为97.8%,89.9%,上腹疼痛用药后三日缓解率分别为60.9%,30.2%。两组均未出现明显毒副作用,由于抗溃疡新药疗效高,提示今后治疗无合并症消化性溃疡将以药物治疗为主。     

Evaluation of Tissue-Engineered Skin (Human Skin Substitute) and Secondary Intention Healing in the Treatment of Full Thickness Wounds after Mohs Micrographic or Excisional Surgery

BACKGROUND: Human Skin Substitute (Apligraf, Organogenesis, Inc., Canton, MA) is a bi-layered tissue-engineered living biological dressing developed from neonatal foreskin. It consists of a bovine collagen matrix containing human fibroblasts with an overlying sheet of stratified human epithelium containing living human keratinocytes. Human Skin Substitute (HSS) appears to be immunologically inert, and has shown usefulness in the treatment of chronic and acute wounds. OBJECTIVE: Primary objectives were to evaluate the safety and efficacy of HSS in the treatment of full-thickness wounds in a prospective case series. Secondary objectives were to determine the rate of complete wound reepithelialization, incidence of complete wound healing, pain at wound site, overall cosmetic outcome, and patient satisfaction. METHODS: Fourteen patients were enrolled in the study, of which 12 were evaluable. HSS was applied in a blinded fashion to 6 of the patients immediately following Mohs or excisional surgery for skin cancer. The remaining 6 patients were allowed to heal by secondary intention. Both groups were evaluated at weekly appointments until complete reepithelialization occurred. During each evaluation, wound quality was assessed through the Vancouver Burn Scar Assessment Scale by the investigator and an independent blinded dermatologist. The investigator, blinded observer, and patient further evaluated the cosmetic outcome of the wound through the use of a Visual Analog Scale over a 6-month period. RESULTS: HSS patients and secondary intention patients were equivalent in comorbid factors such as pain, erythema, edema, exudate, infection, or hematoma between the groups. The incidence of complete wound healing at 6 months was 100% for both groups. Both groups also appeared to heal at similar rates, as defined by the complete reepithelialization of the wound. HSS patients ultimately resulted in more pliable and less vascular wounds as defined by the Vancouver Burn Scar Assessment Scale. Patient satisfaction with cosmetic outcome in both groups was positive at 6 months. CONCLUSIONS: HSS appears to be a safe, well-tolerated biological dressing with equivalent comorbid factors to secondary intention healing. HSS, however, seems to produce a more pliable and less vascular scar than those developed through healing by secondary intention. HSS also appears to produce more satisfactory cosmetic results when compared to secondary intention healing.     

Dural sinus thrombosis: study using intermediate field strength MR imaging

The magnetic resonance (MR) images of six patients with thrombosis of a dural sinus were reviewed. The diagnosis had been verified by computed tomographic scans in three patients and arteriograms in two; in the sixth patient, only MR imaging was used to confirm the clinical syndrome. In all patients, high-intensity signal was seen from the thrombus within the affected dural sinus on all echoes. This persistent signal intensity allowed intravascular clot to be distinguished from normal causes of increased signal such as flow-related enhancement (entry phenomenon) and even-echo rephasing. MR imaging demonstrated the cause of the thrombosis in three patients: two were secondary to adjacent tumors, and one was secondary to unsuspected mastoiditis. Complications such as infarction were also demonstrated. Using MR imaging, one can easily and safely diagnose thrombosis of a dural sinus. MR should be the imaging method of choice in patients suspected of having thrombosis of a dural sinus.     

The Impact of Small Bowel Resection on the Incidence of Stomal Stenosis and Marginal Ulcer After Gastric Bypass

Background: Stomal stenosis (SS) and marginal ulcer (MU) are reported to occur in 9-20% and 2-13%, respectively, of patients undergoing gastric bypass for morbid obesity. It is hypothesized that decreasing tension on the gastrojejunostomy by performing limited small bowel resection (SBR) would decrease ischemia, thereby decreasing the likelihood of SS and MU. Methods: A retrospective review of 150 consecutive gastric bypass patients operated by one surgeon from 1993 to 1996 was performed. The incidence of SS and MU was compared in patients with and without SBR. Results: The overall rate of SS was 24.0% and that of MU was 9.3%: the incidence of both was 2.0%. The incidence of SS in patients without SBR was 26.9% and with SBR was 19.6%. The incidence of MU in patients without SBR was 8.9% and with SBR was 9.8%. Neither result was statistically significant by Fisher's exact test. Conclusion: There is a trend towards a decrease in the incidence of SS in gastric bypass patients with concomitant SBR although this did not reach clinical significance.     

The role of definitive radiation therapy in squamous cell carcinoma of the oral tongue

Between 1968 and 1985, 114 patients with squamous cell carcinoma of the tongue were evaluated in the Department of Radiation Oncology at the University of Virginia (Charlottesville, VA); of these, 86 received treatment with curative intent. The majority were treated with radiation therapy alone, whereas the remainder were treated with radiation therapy with preoperative or postoperative surgery. There were 17 T1 primary malignancies, 40 T2, 27 T3, and 2 T4. Clinically positive adenopathy was present in 48% of the patients overall and ranged from 35% in the T1 group to 100% in the T4 group. Twenty-six percent of patients either presented with or later had second malignancies. At 36 months, the patient status was evaluated as dead of disease (37%), dead of intercurrent disease (23%), alive with disease (1%), and alive without evidence of disease (38%). Seventy-five patients received external beam therapy and 32 patients received an implant as either all or part of their treatment. Average doses were in the range of 6000 Gy. Adjusted local control rate at 3 years was not statistically different for different treatment techniques used on either T1 or T2 primary malignancies. The rates were 89% versus 88% for T1 lesions treated with definitive radiation therapy versus postoperative radiation therapy. For T2 primary malignancies, the rates were 67%, 71%, and 83% for the definitive, preoperative, and postoperative radiation therapy groups, respectively. For T3 lesions, there was close to statistical significance with the corresponding rates being 47%, 50%, and 100%, respectively. When the effect of implants was examined for T1 and T2 lesions, no difference in local control rate at 3 years was noticed with or without an implant. Survival was improved for the group presenting with positive neck disease when compared with the N0 group. The external beam severe complication rate was less than 5%, and the implant complication rate was 6%.