Radiologic methods in the diagnosis of diseases of the spleen]

Ultrasonic and computer-aided tomographic examinations of 2457 patients with suspected diseases of the abdominal cavity organs have revealed splenic involvement in 48. The sensitivity of ultrasonic technique for the detection of splenic diseases has made up 70.8%, that of computer-aided tomography--95.8%. Invasive interventions monitored by these two methods were carried out in 26 patients; in 10 of these transcutaneous puncture drainage was carried out for cysts (2), hematoma (1), and abscesses of the spleen (7). In one patient with multiple abscesses of the spleen the drainage was found insufficient for complete cure and he had to be subjected to splenectomy, in the rest cases surgery did not have to be resorted to. Therefore, ultrasonic and computer-aided tomographic examinations of the spleen, used together with various invasive interventions, result not only in correct diagnosis and differential diagnosis of this organ's disease, but permit various therapeutic measures and help achieve cure without laparotomy.     

The effect of triisopropyl phosphate on the mobility of surface concanavalin a receptors and on the locomotion of polymorphonuclear leucocytes

The non-phosphorylating organophosphorus compound triisopropyl phosphate, which is known to inhibit rabbit leucocyte locomotion, can stimulate the locomotion of guinea pig leucocytes under certain conditions. Different methods of preparing guinea pig leucocyte monolayers can give preparations with different proportions of motile cells. With preparations that contain relatively slowly moving cells triisopropyl phosphate increases the number of stationary cells without significantly affecting the speed of the cells that remain motile. Most rabbit leucocytes labelled with fluorescein-labelled concanavalin A form caps within 5–10 min at 37 °C. In contrast the rate of cap formation in guinea pig leucocytes is much slower and after 20 min many cells have only random patches. Triisopropyl phosphate accelerates cap formation in guinea pig leucocytes but not in rabbit leucocytes. The local anaesthetic nupercaine inhibits cap and patch formation in rabbit and guinea pig leucocytes. Inhibition of rabbit leucocyte locomotion is induced by concanavalin A at 1 μg/ml. These results are briefly related to the known effects of triisopropyl phosphate on the isolated leucocyte plasma membrane.     

腹部超声检查对新生儿坏死性小肠结肠炎的临床应用价值研究

目的:探究腹部超声检查对新生儿坏死性小肠结肠炎(NEC)的临床应用价值。方法:选取2009年1月-2016年12月我院收治116例患有NEC的新生儿作为本次研究的对象,依据修正Bell-NEC分级标准将之分为确诊组(n=50)和疑似组(n=66),再依据临床转归分为手术组(n=37)和内科治愈组(n=79),对比确诊组和疑似组的腹部超声与X线检查结果,以及内科治愈组和手术组的腹部超声与X线检查结果。结果:在确诊组和疑似组中,腹部超声对肠壁积气、门静脉积气的检出率均高于X线摄片(P0.05)。腹部超声还发现了肠道蠕动缓慢、肠道蠕动消失和腹腔积液;内科治愈组腹部超声对肠壁增厚、肠管扩张和腹腔积液的检出率低于手术组(P0.05);内科治愈组X线摄片对肠管扩张的检出率低于手术组(P0.05)。结论:腹部超声能够提高NEC的检出率,且对NEC的临床转归有较好的预测作用。     

CT 扫描在食管癌淋巴结转移患者预后评估中的应用价值

目的:探讨CT扫描对食管癌淋巴结转移诊断的准确率及CT扫描对预测淋巴结转移患者预后的价值.方法:选择我院收入的行食管癌根治术患者共146例,患者均行CT及腹部彩超,检查者CT及腹部彩超对食管癌淋巴结转移检测的准确率及漏诊率,检测CT淋巴结转移数、CT三分区转移情况及CT最大病变直径等CT检测与食管癌淋巴结转移相关因素.结果:CT淋巴结总检出率显著高于彩超检出率,两组对比差异有统计学意义,P＜0.05.CT检测中胸上段、胸中段总检出率显著高于彩超检出率,结果对比差异有统计学意义,P＜0.05.所有患者自手术日起计算术后1、3年生存率分别为73.3％(107/146)、47.9％( 70/146),CT 转移数≥2枚、CT三分区转移＜2区、CT最大病变直径≤3cm患者术后生存率较高,结果对比差异有统计学意义,P＜0.05.结论:CT对食管癌淋巴结转移诊断率较高,CT转移数、CT三分区转移及CT最大病变直径检测可用于评估患者术后生存率情况.     

Successful antimicrobial therapy of hepatic,intra-abdominal and intrapelvic abscesses.

Antimicrobial therapy without surgical drainage or therapeutic aspiration was effective in the management of four patients with deep abscesses ranging in diameter from 1.3 to 10.0 cm. Two of the patients had multiple hepatic abscesses, one had hepatic, intra-abdominal and intrapelvic abscesses, and one had an intrapelvic abscess alone. Anaerobic bacteria were isolated from the blood or abscesses in all four patients, and an aerobic-anaerobic infection was present in one patient. The patients were treated with metronidazole, alone or in combination with other antibiotics, for 3 to 6 weeks. Therefore, in selected patients with deep abscesses, a therapeutic trial of antimicrobial agents instead of surgery may be justified.     

Postoperative Depression of Tumour-directed Cell-mediated Immunity in Patients with Malignant Disease

Leucocytes from 46 melanoma patients, 45 breast carcinoma patients, and 95 control donors were tested by the leucocyte migration test against the supernatants of homogenates of malignant melanomas, breast carcinomas, simple breast tumours, and breasts showing simple cystic disease. By comparison with controls inhibition of migration occurred significantly more frequently when tumour patients'' leucocytes were exposed to extracts of histogenetically similar tumours.Cell-mediated immunity to tumour-associated antigens was measured in 12 patients with breast carcinoma and 12 with malignant melanoma immediately before surgical operation and in the postoperative period. All patients tested before operation showed significant inhibition of migration on contact with extracts of histogenetically similar tumours. Postoperatively the degree of leucocyte migration inhibition was reduced in all patients with melanoma and breast carcinoma. Significant inhibition of leucocyte migration returned in most patients 6-22 days after operation.     

Optimal Surgical Options for Descending Necrotizing Mediastinitis of the Anterior Mediastinum

The mortality rates from descending necrotizing mediastinitis (DNM) are between 25 and 40 % mainly because of delayed diagnosis and inappropriate surgical treatment. This study was undertaken to examine two surgical options for DNM and determine the optimal surgical option for DNM of the anterior mediastinum. Fifteen cases of DNM of the anterior mediastinum, January 2001 and October 2010, were retrospectively reviewed. Eleven were anterosuperior mediastinitis, with infection located above the tracheal bifurcation and four had infections involving the entire anterior mediastinum. Depending on the location of mediastinitis, open drainage of the submandibular and neck abscesses, in addition to other surgical treatments, was performed. If the infection was anterosuperior, transcervical mediastinal drainage or thoracotomy was performed. If the entire anterior mediastinum was involved, necrotic tissue was removed with thoracoscopic via subxiphoid incision, the bilateral pleurae were opened for drainage, and a tunnel connecting the neck incision and the subxiphoid incision through the whole anterior mediastinum was made for drainage. The anterosuperior mediastinitis cases were treated with either transcervical mediastinal drainage (n = 8) or thoracotomy (n = 3). Patients healed after an average of 24.5 and 20.0 days in the hospital, respectively. For the four other cases, one patient died of septic shock, while the other three patients were healed after and an average of 43.3 days in the hospital. Mortality rate was 6.7 %. The surgical procedure used to treat DNM should be selected according to the location of the infection. DNM involving the anterosuperior mediastinum can be treated by transcervical mediastinal drainage. If anterosuperior mediastinitis spreads to the side of the trachea, open thoracotomy is a suitable therapy. If the entire anterior mediastinum is involved, debridement and drainage of the anterior mediastinum should be performed with a thoracoscope via the subxiphoid incision.     

阴道彩超对宫角妊娠的诊断运用评价

目的：探究阴道彩超对宫角妊娠的诊断价值,为宫角妊娠的临床诊断提出有效方法。方法：对我院2010年4月～2013年4月收治的80例初诊宫角妊娠患者进行回顾性分析,对比其经腹彩超和经阴道彩超的的诊断结果与术后病理确诊差异。结果：阴道彩超下宫角妊娠共分三种表现,包括胚囊型、包块型和破裂型;阴道彩超显示,所有初诊宫角妊娠患者均可见孕囊与子宫内膜相连,其肌层厚度在7．5-11.3mm间,平均（10．5±1．7）mm;二次检查中,经腹超声确诊59例宫角妊娠,经阴道超声确诊51例,病理诊断共确诊宫角妊娠48例。经腹超声诊断准确率为81．4％,明显低于经阴道超声的94．1％,两组数据对比存在显著统计学差异。经腹超声两次检查符合率为73．8％,显著低于经阴道超声的96．2％,两组数据对比存在显著统计学差异。结论：阴道彩超较经腹彩超对宫角妊娠具有更高的诊断准确率,通过图像判断,能够有效对宫角妊娠、输卵菅间质部妊娠进行有效鉴别诊断,可作为指导临床早期干预方案、制定跟踪随访措施的关键依据。     

Scintigraphy,Ultrasound and CT Scanning of the Liver ,

Isotope examination of the liver depends on the functional activity of the liver phagocytes, while ultrasound and CT scanning display the anatomical structure. Cold areas on an isotope scan may be due to impaired function or space-occupying lesions. The method is nonspecific and does not differentiate between cysts, abscesses and metastases. Both ultrasound and CT scanning can differentiate space-occupying lesions with a high degree of accuracy so that both techniques can be used to improve the accuracy and specificity of the radioisotope examination. CT scanning of the liver is limited by relatively slow data acquisition and the small differences in X-ray absorption within soft tissues unless contrast agents are used. In comparison, ultrasonic data are rapidly collected and displayed and liver consistency is imaged without contrast media or ionizing radiation. Diffuse abnormalities of the liver, such as cirrhosis, cannot be detected by CT scanning but are apparent on ultrasound examination. In addition, equipment purchase and maintenance costs for ultrasound are a fraction of those for CT scanning. Experience to date at Yale indicates that ultrasound and CT scanning are complementary and supplementary to isotope examination of the liver but that ultrasound in most patients produces better resolution and enhanced tissue differentiation at considerably less cost.     

超声引导下穿刺置管引流治疗肝脓肿的疗效分析

目的:探讨超声引导下穿刺置管引流治疗肝脓肿的临床疗效。方法:回顾性分析本院2012-2013年56例肝脓肿住院患者超声引导下穿刺置管引流治疗的临床资料。结果:56例患者行超声引导下穿刺置管引流治疗,其中3例多发脓肿行2次穿刺置管治疗,其余均一次穿刺置管成功,未出现出血、胆漏、周围脏器损伤等并发症,本组患者手术前后体温、白细胞数及脓肿面积比较均有统计学意义(P0.01)。24例体温升高患者中,21例术后3天内恢复正常,3例仍有升高;41例白细胞数升高患者中,29例术后3天内恢复正常,12例仍有增高;56例患者术后脓肿面积均明显减小,该组患者腹痛、肝区叩痛等临床症状均明显缓解。结论:超声引导下穿刺抽吸及置管引流治疗肝脓肿是一种简单方便、安全可靠、创伤小、明显有效的局部治疗方法,操作者需要充分作好术前准备,严格把握适应症,严谨操作步骤并结合全身抗生素治疗可以明显改善患者发热症状,有效降低患者白细胞及中性粒细胞,明显缩短治疗周期,提高治愈率。     

Renal abscess due to Aspergillus fumigatus as the only sign of disseminated aspergillosis in a patient with AIDS

BackgroundAspergillus fumigatus can cause a wide variety of clinical syndromes, especially in the three largest immunocompromised groups, such as HIV-infected patients. Primary renal aspergillosis is an extremely rare entity.AimsWe report an unusual case of renal abscess due to Aspergillus fumigatus in a patient with AIDS.MethodsWe review clinical and laboratory records, and provide follow up of the patient.ResultsA 38-year-old man, HIV seropositive, was admitted to our hospital with fever, lumbar pain and respiratory symptoms. Abdominal ultrasound and computerised tomography showed a single and large lesion consistent with an abscess located in the left kidney. Aspergillus fumigatus was isolated from clinical sample obtained by ultrasound-guided needle aspiration. Despite a correct treatment based on amphotericin B and drainage of the abscess, surgery was necessary and nephrectomy was carried out. Histopathological examination of the surgical specimen confirmed the diagnosis of renal aspergillosis. Systemic antifungal therapy based on intravenous and oral voriconazole and highly active antiretroviral therapy was started after surgery. The patient had a good response to the established treatment and he remains in a good clinical condition at one year of follow up.ConclusionsCombined medical and surgical treatment is the elective therapy for renal abscesses due to Aspergillus when percutaneous drainage and the administration of systemic antifungal drugs, such as amphotericin B and/or oral voriconazole or itraconazole, fail. This case emphasizes renal fungal infections should be included in the differential diagnosis of kidney abscesses in AIDS patients.     

Inhibition by quercetin of activation of polymorphonuclear leucocyte functions Stimulus-specific effects

The effect of some bioflavonoids on the activation of polymorphonuclear leucocyte respiration and exocytosis was examined. At 10^?5–10^?4 M concentration, quercetin, but not morin and rutin, was found to inhibit the concanavalin A-induced enhancement of oxygen consumption markedly, without impairing leucocyte viability and concanavalin A binding. The inhibition could be reversed by either washing the leucocytes or adding a 10-fold molar excess of 1-anilino-8-naphthalene sulphonate. Concanavalin A-dependent cell secretion of lysozyme was also totally inhibited by 30 μM quercetin.The effect of quercetin on the activation of leucocyte respiration appeared to be stimulus specific. In fact, at a concentration of the flavonoid (75 μM) which provided a 95% inhibition of the concanavalin A-induced stimulation, the respiratory activation produced by phospholipase C was inhibited by about 50% and that caused by myristic acid and by the antibiotic Br-X537A by less than 25%.These data suggest that quercetin exerts its activity at specific sites of the plasma membrane of the leucocytes, and that this compound might be used to identify the membrane domain whereon different stimuli act to originate the initial stimulatory signal.     

Mixed Leucocyte Reaction in Multiple Sclerosis

Astorga and Williams¹ have demonstrated that leucocytes from some patients with rheumatoid arthritis (RA) have an impaired one-way mixed leucocyte reaction² (MLR) when stimulated with leucocytes from other such patients. No definite explanation of this phenomenon is given. We have investigated other diseases in which auto-immune aetiology is suspected to see whether similar phenomena are associated with them. Here we report our investigations of multiple sclerosis (MS).     

Isolation of leucocytes from the anterior kidney and spleen of rainbow trout in a self-generating density gradient

Separation of leucocytes from tissues and enrichment of specific types of leucocytes are essential first steps in studies of leucocyte function. We describe a simple and rapid method for separating and enriching leucocytes from the anterior kidney and spleen of rainbow trout. Leucocytes were separated on self-generating density gradients of Sepracell-MN, a colloidal silica-based medium. Recovery of leucocytes from the gradients was near 100% and was not affected by procedural variables such as cell suspension: Sepracell-MN ratio (separation ratio), initial temperature, centrifugation time, or number of cells per gradient. Two bands of leucocytes formed at separation ratios of 1 : 1, 1:1.5, 1:2 and 1 : 3. Recovery of selected leucocyte types could be maximized, and contamination by other cell types reduced, by selection of the appropriate separation ratio and cell band. Recovered leucocytes were responsive in assays of functional capability (adherence, phagocytosis, superoxide anion production). Leucocyte populations that adhered to glass were enriched for macrophages, but some neutrophils and lymphocytes (paricularly spleen lymphocytes) were also adherent. The most abundant leucocytes in the anterior kidney and spleen of the experimental fish were lymphocytes (respectively, 47 and 88%, including thrombocytes), neutrophils (35 and 7%), and macrophages (11 and 3%).     

The effect of phagocytosis of Candida albicans blastospores on alkaline phosphatase levels in rat polymorphonuclear leucocytes

Summary The phagocytic function of young polymorphonuclear leucocytes with high levels of leucocyte alkaline phosphatase, which are present in the peripheral blood during an inflammatory response, was compared with that of normal polymorphonuclear leucocytes.Candida albicans blastospores were used as phagocytic targets. The phagocytic index of polymorphonuclear leucocytes with low levels of leucocyte alkaline phosphatase was higher than that of cells with high levels of enzyme.Monitoring of leucocyte alkaline phosphatase levels with increasing times of incubation of leucocytes with the blastospores showed a progressive decline in the level of the enzyme. Thus loss of the enzyme is linked to the phagocytic function, although the mechanism of this dynamic process is unclear.     

Indium-111 autologous leucocyte scanning: comparison with radiology for imaging the colon in inflammatory bowel disease.

Indium-111 autologous leucocyte scanning was compared with barium enema for assessing the extent of colonic disease in Crohn''s colitis and ulcerative colitis. Scanning was shown to be as accurate as conventional radiology in colitis, reliably distinguishing active from inactive disease. The results suggest that 111In-leucocyte scanning is an accurate, non-invasive, alternative technique for imaging the extent of disease in colitis.     

Potential for improvement in clinical decision-making: tumor imaging with in-111 labeled liposomes results of a phase ii-iii study

Abstract

Liposome scanning using In- 111 labeled VS102 liposomes (VesCan^R) has previously been shown to image a wide variety of common human tumors, probably related to tumor neovascular capIIIary fenestrations and binding of liposomes to tumor cells. We further tested In-III VS102 liposomes in a Phase II trial (27 patients) and a Phase III trial (38 patients). The sensitivity for detecting tumors in primary sites was 82% and in metastatic sites was 65% at the recommended lipid dose of 100 mg. There was 1 false positive scan (specificity 98%). Tumors which have been imaged include carcinomas of the breast, lung, head-neck, prostate, colon, ovary, cervix, thyroid, kidney, testes, melanoma, sarcoma and lymphoma. Sites imaged have included soft tissue, breast, mediastinum, bone, lung, lymph node, liver and pelvis. We also describe five patients in whom a In-111 liposome scan was performed in addition to standard tests, and in whom therapy plans were changed by use of liposome scan results. In two instances, no therapy would have been given without In-III liposome scan, but chemotherapy or radiotherapy were used based on liposome scan results and confirmatory tests. In one patient, surgery would have been used in the absence of In-III liposome scans, versus radiotherapy with In-III liposome scan results. In two other patients, palliative radiotherapy or chemotherapy would have been given without In-111 liposome scan. One of the patients would have required further therapy and the other needed curative surgery after liposome scan evaluation. These results suggest In-111 liposome scans may be useful to complement standard diagnostic tests in cancer patient management.     

Maternal leucocyte zinc deficiency at start of third trimester as a predictor of fetal growth retardation.

Leucocyte zinc concentrations were measured in 70 mothers at the beginning of the third trimester of pregnancy and compared with the weight centiles of their subsequently delivered babies. The median maternal leucocyte zinc concentrations rose progressively with weight centile. Thus the median leucocyte zinc concentration of the mothers delivering babies weighing below the 10th centile was 112 nmol/10(9) leucocytes and that of the mothers with babies weighing above the 90th centile was 229.5 nmol/10(9) leucocytes. A maternal leucocyte zinc concentration less than 120 nmol/10(9) leucocytes strongly predicted a baby weighing below the 10th centile (positive predictive value = 71.9%, negative predictive value = 91.5%, sensitivity = 64.3%, specificity = 81.8%). These findings suggest that maternal zinc concentration might have a role in antenatal screening, but larger studies are required.     

乳腺癌超声征象与ER、PR、连环蛋白p120、癌基因CerbB-2、原癌基因Her-2/neu表达的关系研究

目的:探讨乳腺癌超声征象与雌激素受体(ER)、孕激素受体(PR)、连环蛋白p120、癌基因CerbB-2、原癌基因Her-2/neu表达的关系。方法:将2014年10月至2017年10月我院收治的50例乳腺癌患者纳入本研究,术前获得患者完整乳腺超声图像资料,术后通过免疫组织化学法检测ER、PR、CerbB-2、Her-2/neu和p120的表达情况。记录超声检查与组织标本检测结果,比较不同乳腺癌超声征象中ER、PR、CerbB-2、Her-2/neu和p120的表达情况。结果:p120阴性表达率为62.00%,ER阳性表达率为50.00%,PR阳性表达率为36.00%,CerbB-2阳性表达率为74.00%,Her-2/neu阳性表达率为30.00%。病灶边缘有毛刺征、周边有高回声晕征、无淋巴结转移患者的ER阳性表达率高于病灶边缘无毛刺征、周边无高回声晕征、淋巴结转移者(P0.05);病灶边缘有毛刺征、周边有高回声晕征患者的PR阳性表达率高于病灶边缘无毛刺征、周边无高回声晕征者(P0.05);内部有微小钙化、血流显像分级2-3级、淋巴结转移患者的p120阴性表达率高于内部无微小钙化、血流显像分级0-1级、无淋巴结转移者(P0.05);内部有微小钙化、血流显像分级2-3级、淋巴结转移患者的CerbB-2阳性表达率高于内部无微小钙化、血流显像分级0-1级、无淋巴结转移者(P0.05);内部有微小钙化、淋巴结转移患者的Her-2/neu阳性表达率高于内部无微小钙化、无淋巴结转移者(P0.05)。结论:乳腺癌超声征象与ER、PR、CerbB-2、Her-2/neu和p120的表达有紧密联系,可为治疗方案拟定提供参考。     

Cross-reactivity of lung cancer patients' leucocytes in the leucocyte migration inhibition test

Summary Panels of 3 M KCl extracts of squamous-cell carcinomas, adenocarcinomas and oat-cell carcinomas of the lung were used for a comprehensive analysis of cross-reactivity in the leucocyte migration test. Lung cancer patients' leucocytes showed positive reactivity in 69%–100% of cases (n=353). No significant differences were observed when data were grouped with respect to the histological type of the tumours used for extraction or of the tumours of the leukocyte donors. Leukocytes of patients bearing tumours of nonpulmonary origin exposed to lung cancer extract panels and leukocytes of lung cancer patients exposed to gastrointestinal cancer extract panels were definitely less reactive (35%–47% and 6%–38%, respectively). However, a high reaction frequency was found in patients with lung metastases from different nonpulmonary tumours. This group of patients also frequently showed reactivity (52%) with normal lung tissue extracts. Patients with benign lung diseases reacted positively with lung tumour extracts in 25%–39% of cases, but donors with other benign disease and healthy controls were virtually nonreactive (0–14%).Hence, a high degree of cross-reactivity occurs in the lung cancer system and restricted cross-reactivity occurs with tumours of other organs. Possible explanations for the lung-oriented reactivity of patients with lung metastases are discussed.Abbreviations LMI leucocyte migration inhibition - MI migration index - LMT leucocyte migration test - SCC squamous-cell carcinoma - OCC oat-cell carcinoma - AC adenocarcinoma