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A distinctive glomerular lesion complicating placental site trophoblastic tumor: report of two cases 总被引:1,自引:0,他引:1
Renal disease with distinctive pathologic features developed in two young women who had placental site trophoblastic tumors. The renal abnormalities were manifested by proteinuria in both cases and by hematuria in one case; blood pressure was elevated in one of the patients. Pathologic examination of the kidneys showed distinctive glomerular abnormalities, characterized mainly by the presence of occlusive eosinophilic deposits in many of the glomerular capillary lumina, most of which stained for fibrinogen-related antigens and IgM by immunohistochemical techniques. Ultrastructural examination showed the deposits to consist mainly of granular material that contained packets of fibrillar material with the appearance of fibrin. The uterine tumors were composed of mononucleated and multinucleated cells with abundant cytoplasm that infiltrated between the muscle bundles of the myometrium; in both tumors there was prominent deposition of eosinophilic material that had the tinctorial properties of fibrin and that stained for fibrinogen and IgM in immunoperoxidase studies. The renal abnormalities disappeared after hysterectomy in one case; the other patient, who was receiving chemotherapy and had disseminated intravascular coagulation, died with leukopenia and sepsis. The clinical and pathologic features in these cases suggest that the renal abnormalities were related to the uterine tumors and that the production of immune complexes and/or the activation of intravascular coagulation by the tumors were pathogenetic mechanisms. 相似文献
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Eye hospitals, originally founded to care for the poor, have developed into academic centers and tertiary "hospitals of last resort." Inexorable economic pressures, especially price competition, are likely to close many of them, particularly those which are marginal in quality or management. Survival of the remainder may further depend on their ability to adapt to a rapidly changing environment and to fulfill, better than anyone else, the special mission of basic and clinical research and training. Society must be convinced that some of these complex, highly differentiated, relatively expensive eye hospitals are significant national resources, serve the public welfare, and are worth preserving. 相似文献
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Objective
To determine the relationship between high-altitude retinopathy (HAR) and other altitude-related illnesses and establish a classification system for HAR.Design
Observational case series.Participants
All 40 climbers among 3 Himalayan expeditions who ascended to altitudes between 16,000 and 29,028 feet above sea level (summit of Mt. Everest) were examined for signs of HAR and altitude illness (AI).Methods
All subjects had dilated fundus examinations before the ascent, intermittent fundus, and medical examinations during the climb and a dilated fundus and medical examination within 2 days after attaining their highest altitude.Main outcome measures
Careful fundus drawings or fundus photography or both were obtained for all participants. All subjects gave a subjective assessment of their symptoms of acute mountain sickness (AMS) and were assessed clinically for signs of high-altitude cerebral edema (HACE).Results
Nineteen of 21 climbers who ascended above 25,000 feet developed HAR. Fourteen of 19 climbers who attained altitudes between 16,000 and 25,000 feet were found to have retinopathy. A grading system for HAR describing the severity of the retinopathy was developed. Correlation of the retinopathy with other AI showed that AMS was endemic and that a statistically significant correlation exists between HAR and HACE (P = 0.0240).Conclusion
Recognizing advancing grades of HAR may allow physicians to recommend initiating empiric treatment with oxygen, steroids, diuretics and immediate descent to prevent HAR progression, macular involvement, or potentially fatal HACE. High-altitude retinopathy is both a significant component of and a predictor of progressive AI. 相似文献6.
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