Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.     

Merkel Cell Carcinoma Arising from the Subcutaneous Fat of the Arm with Intact Skin

BACKGROUND: Merkel cell carcinoma is a rare malignant neuroendocrine neoplasm characteristically arising from the dermis of sunlight-exposed skin. It rarely arises outside the skin. OBJECTIVE: We present a patient with primary Merkel cell carcinoma arising from subcutaneous fat, with no involvement of the overlying skin. We describe the clinical manifestations and magnetic resonance imaging (MRI) findings. METHODS: We report a 63-year-old woman with a primary lesion of Merkel cell carcinoma that arose from the subcutaneous fat layer of the left arm. The lesion presented as a subcutaneous nodule with intact overlying skin. MRI showed that the nodular lesion was located entirely in the subcutaneous fat layer, with no involvement of the dermis. Peritumoral infiltration around the lesion and enlarged lymph nodes deep to the lesion were noted. The patient received wide excision of the lesion with dissection of the regional lymph nodes and adjuvant radiotherapy and chemotherapy. RESULTS: Histopathologic examination confirmed the diagnosis of Merkel cell carcinoma with local lymphatic metastasis, and the lesion was completely located in the subcutaneous fat, with no involvement of the dermis. These findings were well correlated with MRI findings. CONCLUSION: Primary Merkel cell carcinoma may arise from the subcutaneous fat and present as an entirely subcutaneous lesion with intact skin. MRI is helpful to evaluate the local extension of the lesion and regional lymphatic metastasis.     

表小檗碱对α受体的作用

表小檗碱(epiberberine,EB)是从湖北产黄连(Coptis chinensis Franch)中提取的一种生物碱,属苯喹嗪类原小檗碱,对其药理作用的研究资料甚少,未见其对α肾上腺素体作用的报道。资料表明,许多原小檗碱类化合物有α受体阻滞作用,为从该类化合物中选择     

Pain and faulty breathing: a pilot study

The purpose of this pilot study was to observe both relaxed and deep breathing patterns in a convenience sample to determine the incidence of normal versus faulty patterns of respiration. These observations were then combined with respondent answers to a survey on pain history to determine if there is any correlation between faulty breathing and musculo-skeletal pain patterns. If such a correlation can be made, then we propose that clinicians working with chronic pain patients may have improved outcomes if they address and correct faulty breathing patterns. Based on this study, it is suggested to include the evaluation and treatment of faulty respiration in the rehabilitation of chronic musculo-skeletal conditions, most notably cervical pain.     

36例踝关节骨折合并下胫腓联合分离的治疗体会

0 引言 踝关节骨折是临床上较常见的关节内骨折,包含了腓骨骨折,内踝骨折,后踝骨折和下胫腓联合的损伤. 处理不当可导致踝穴的变形,下胫腓联合分离后期出现创伤性关节炎.     

The effect of pH and nucleophiles on complement activation by human proximal tubular epithelial cells.

BACKGROUND: Activation of urinary complement proteins in situ by proximal tubular epithelial cells (PTEC) may contribute to the mediation of tubulointerstitial injury in patients with significant proteinuria. However, the mechanism involved is unclear, and the role of changes in urinary pH and in the concentrations of urea or ammonia requires further clarification. METHODS: The protein fraction of urine samples from nine patients with proteinuria >1.5 g/day was purified. A cell ELISA involving cultured HK-2 PTEC was used to investigate the capacity of urinary protein to promote the deposition of both C3 and C9 on the cell surface. The effect of variations in pH (5.5-8.0) and in the concentration of urea and ammonia was also examined. C3 was purified and used to further investigate the mechanism of complement deposition. RESULTS: Urine samples from the majority of patients induced deposition of C3 and C9 on the surface of HK-2 cells via the alternative pathway. This process was maximal at acidic pH values. Preincubation of urinary complement or serum with urea or ammonia inhibited C3 deposition. Purified C3 incubated with HK-2 cells showed no evidence of activation in the absence of other complement components. CONCLUSIONS: These data suggest that bicarbonate protects against complement-mediated damage in the lumen by increasing the local pH, rather than by inhibiting the generation of ammonia. PTEC appear to activate complement through provision of a 'protected site' on their surface, rather than by the activation of C3 by convertase-like protease(s).     

Aortic-iliac occlusive disease

This article is divided into 4 sections which deal with changes in the management of short stenoses in the iliac arteries, the management of aorto-iliac disease and the effects of concomitant myocardial ischemia, changes in the design of prostheses, and multisegmental disease. Myocardial ischemia may be apparent from clinical or electrocardiogram evidence, or it may be covert. The mortality rate after aortic bifurcation grafting may improve if patients with severe coronary artery disease are either refused operation or have a coronary bypass first. It was postulated over 10 years ago that increased porosity would encourage the formation of a functioning intima on the inner surface of a prosthesis. Since then, the fashion has been to use porous prostheses, and recent developments to offset the loss of blood at implantation are described. Methods of predicting which patients with multisegmental disease will require combined aorto-iliac and femoropopliteal reconstructions are discussed in the light of the problem of early occlusion of aortobifemoral grafts.

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Resumen El presente artículo está dividido en 4 secciones relativas al manejo de las estenosis cortas de las arterias iliacas, al manejo de la enfermedad aortoiliaca con isquemia miocárdica concomitante, a los cambios en el diseño de las prótesis vasculares, y a la enfermedad arterial multisegmentaria. La isquemia miocárdica puede resultar aparente por evidencia clínica o electrocardiográfica, o puede permanecer inadvertida. La tasa de mortalidad de los injertos de la bifurcación aórtica puede ser mejorada si aquellos pacientes con enfermedad coronaria severa son rechazados para operación, o bien sometidos primero a una derivacíon coronaria. Hace más de 10 años fue postulado que la mayor porosidad de una prótesis estimula la formación de una íntima funcional en la superficie interna. Desde entonces se ha preferido utilizar prótesis porosas; aquí se describen recientes avances para lograr la pérdida de sangre en el momento de la implantation del injerto. Se discuten métodos para predecir qué pacientes habrán de requerir reconstrucciones aortoiliacas y femoropoplíteas una vez que se presenta el problema de la oclusión temprana de un injerto aortobifemoral.

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Résumé Dans cet article nous envisageons 4 sujets: les tendances therapeutiques actuelles des sténoses courtes des artères iliaques, celles des arteriopathies aorto-iliaques lorsqu'existe une ischémie myocardique concomitante, les changements dans la fabrication des prothèses, et le traitement en cas de maladie artérielle multisegmentaire. Une ischémie du myocarde peut être évidente à partir des données de la clinique ou d'après l'électrocardiogramme; ailleurs elle est latente. Pour réduire la mortalité après remplacement du carrefour aortique chez le patient présentant une maladie ischémique du coeur, on peut soit refuser d'opérer ces patients, soit les faire opérer au préalable de leurs artères coronaires. Il y a plus de 10 ans on a supposé que si on augmentait la porosité, on favoriserait la formation d'une couche d'intima fonctionnelle à l'intérieur de la prothèse. Depuis qu'on utilise des prothèses poreuses, les pertes sanguines au niveau des anastomoses tendent à se minimiser. Les méthodes destinées à choisir quels patients avec une maladie multisegmentaire pourront bénéficier d'une recontruction aorto-iliaque et fémoropoplitée combinée sont discutées à la lumière du problème que pose la thrombose précoce des prothèses aortobifémorales.

     

Lymphocytotoxins in infectious mononucleosis: a non-cytotoxic effect on their cytotoxicity in vitro

The lymphocytotoxic activity (LCA) of sera from patients with infectious mononucleosis (IM) was tested against lymphocytes under various experimental conditions. Firstly, lymphocytes from 11 healthy donors were preincubated with pools of normal human sera (NHS) or IM sera at 37°C and then tested for (a) reactivity with the same IM sera in a standard lymphocytotoxin assay at 15°C; (b) rosetting with various sheep erythrocyte (E) preparations (E, EA and EAC) and (c) stimulation by non-specific activators (phytohaemagglutinin, pokeweed mitogen and concanavalin A). These experiments showed that preincubation of normal cells with IM sera caused significant reduction in subsequent lymphocyte killing at 15°C (P<0·01) compared to unincubated cells or those preincubated with pooled NHS. There was no change in the binding of E, EA and EAC or mitogen stimulation following incubation. Culture of preincubated lymphocytes in lymphocytotoxin-free medium for 24 hr did not restore LCA at 15°C. Secondly, a pool of normal lymphocytes was incorporated into media containing either 2,4-dinitrophenol or sodium azide and tested for LCA against 11 acute IM sera and two NHS at both 15 and 37°C. No significant change in cell killing was observed at 15°C in the presence of these inhibitors, but there was a significant return of LCA at 37°C. Finally, normal lymphocytes and cells from two patients with IM were cultured at 37°C in lymphocytotoxin-free medium to determine the role of down-regulation of lymphocyte surface receptors in reducing autolymphocytotoxicity during the acute phase of the illness. There was no change in cell killing by IM sera after culture for 24 hr. These experiments show that lymphocytotoxic sera from patients with infectious mononucleosis interact with normal lymphocytes at 37°C without causing cell killing. This interaction caused a change in surface-binding characteristics that was not reversed by culture in ligand-free medium for 24 hr. Studies using metabolic inhibitors suggested that the failed lymphocytotoxicity at 37°C resulted, at least in part, from lymphocyte metabolism, although this did not inhibit the reaction between cytotoxic material and the lymphocyte surface.