Percutaneous Aspiration Lung Biopsy

A total of 182 percutaneous trans-thoracic aspiration biopsies were performed in 164 patients over a three-year period. In malignant neoplasms arising in the lung the diagnostic accuracy rate was 84%. In the non-malignant localized parenchymal lesions the accuracy drops considerably unless the lesion is cystic or cavitary. Some patients with non-parenchymal lesions were selected to assess further the value of this procedure. It proved much less rewarding in lesions of the chest wall, diaphragm and also in diffuse parenchymal disease. These lesions may be more accurately identified by other methods of biopsy. Lesions presenting as a mediastinal mass are an intermediate group and in selected cases helpful information can often be obtained by small-bore needle aspiration, particularly if a pericardial, bronchogenic or thymic cyst is suspected. Recent reports have shown that the aspiration of pulmonary lesions can be utilized to obtain viable tumour cells for chemosensitivity testing. The aspiration of nodular pulmonary lesions should be considered when a diagnosis is not forthcoming from the usual investigative means, since there has been little morbidity and no mortality in the series.     

经支气管镜气管插管与常规气管插管救治呼吸衰竭对比分析

目的：回顾性分析呼吸机辅助呼吸救治危重呼吸衰竭患者气管插管方式对于救治成功率的影响。方法：我科收治的各种呼吸衰竭患者94例,回顾分析插管方式对于救治成功率、引发心跳骤停及其对心肺复苏效果的影响。结果：经纤维支气管镜经口气管插管（35例）与经直接喉镜经口（59例）引发心跳骤停有明显统计学差异（X^2=11．5,v=1,t〈0．001）。经直接喉镜经口气管插管在术前用药与否对引发心跳骤停并无统计学意义,但是对于引发心跳骤停后心肺复苏成功率确有明显统计学意义。结论：经纤维支气管镜气管插管具有较高的安全性,在经直接喉镜气管插管是选择镇静药或浅麻醉药物应慎重,尽力避免心跳骤停和心肺复苏失败。     

USE OF THE ROCKING BED TO AUGMENT VENTILATION IN PATIENTS WITH POLIOMYELITIS

As the first step in an attempt to clarify criteria for use of the rocking bed rather than the respirator as an aid to breathing for patients with weakness of respiratory muscle function caused by poliomyelitis, ventilation studies were done on seven patients with pronounced weakness or paralysis of the respiratory muscles. Average tidal air volume was considerably less when the patient was on the rocking bed than when he was in the respirator. Since the tidal air volume with the patient on the rocking bed represents the maximum that can be produced with the apparatus, whereas the volume in the respirator represents the patient''s usual tidal air and the respirator is capable of a greater volume if necessary, it is apparent that in cases of complete paralysis of the respiratory muscles the respirator has a large margin of safety, the rocking bed none.From clinical observations made on 51 patients who were put upon the rocking bed—23 of them early in the course of the disease and 28 after they had been ill three months or more—it was concluded that the rocking bed is contraindicated for patients who are febrile and in whom the disease is progressing rapidly, and for those with atelectasis or urinary or pulmonary infection. It must be used with extreme care in the case of patients early in the course of the disease who are not tracheotomized, because of a tendency toward increased accumulation of mucus and the danger of atelectasis.General guides were developed with regard to use of the rocking bed for patients with post-acute poliomyelitis, and somewhat different rules were drawn for use of the apparatus in cases in which there is a chronic respiratory problem.The rocking bed will give artificial respiration in cases of respiratory weakness, but will not provide enough tidal air for the patient with paralysis of the muscles of respiration.     

Letter: PGE2 as a vaginal abortifacient - diaphragm effect.

Schulman et al reported reduction in interval-abortion time and decreased side effects when prostaglandin (PG) E2 vaginal suppositories were administered within a contraceptive diaphragm. The authors conducted a study to confirm Schulman et al' finding. 2 groups of 20 patients with gestational ages ranging from 13 to 20 weeks were matched. 1 group (non-diaphragm) had a 20 mg. suppository inserted every 4 hours high in the vaginal fornix. The other group (diaphragm) had a contraceptive diaphragm containing the suppository inserted at 4-hour intervals. The authors' protocol differed from that of Schulman's in that oxytocin sensitivity was not sought and PGE2 alone was used. Oxytocin, however, was used to promote placental expulsion following fetal delivery in 4 cases. There were no statistically significant differences observed between the groups with respect to total drug dose (84 mg. for diaphragm group and 80 mg. for non-diaphragm), abortion-interval time (15.2 hours vs. 14.3 respectively), or frequency of side effects (vomiting, diarrhea). Schulman's reduced side effects may have followed the decreased absorption rate of PGE2 and avoidance of plasma peaks secondary to reduction in drug-mucosal interface. Schulman also reported onset of uterine activity in the diaphragm group (mean, 41 minutes) versus the control group's mean of 79.4 minutes. There is no known physiologic explanation for such findings.     

Unilateral agenesis of the diaphragm

Summary A brother and sister with congenital agenesis of the diaphragm are described and the literature reviewed with respect to the familial incidence of congenital diaphragmatic lesions. Although unilateral agenesis of the diaphragm is infrequent, four comparable reports of familial occurrence were found.Based on anatomic and genetic considerations, the hypothesis is advanced that agenesis of the diaphragm may be etiologically different from other lesions of the diaphragm. The possibility exists that a rare recessive gene in some cases might cause this developmental failure of the diaphragm anlage.This investigation was supported in part by USPHS International Postdoctoral Research Fellowship Grant No. FO 5-TW-1129, and by Public Health Service Research Grant No. HD-00635-04, from the National Institute of Child Health and Human Development.     

Negative Pressure Artificial Respiration: Use in Treatment of Respiratory Failure of the Newborn

Ninety-one infants with respiratory failure secondary to primary pulmonary disease and with a birth weight of 1000 g. or over have been managed in a negative-pressure respirator (Air-Shields) over a three-year period. Of these the failure in 87 was due to respiratory distress syndrome (RDS) and in four it resulted from massive meconium aspiration. Respiratory failure was indicated initially by arterial blood gas tensions (while breathing 100% O₂) of Po₂ <40 mm. Hg, pH <7.10 and Pco₂ >75 mm. Hg in the initial 47 cases; these levels were subsequently raised to Po₂ < 50 mm. Hg, pH <7.20 and Pco₂ >70 mm. Hg for the remainder. Fifty-four (59.3%) of the infants survived the use of the respirator and 47 of these (51.6%) were subsequently discharged alive and well. Mean time in hours to normalization of blood gas values while on the respirator were as follows: for Po₂, 10.5; for pH, 11.6; and for Pco₂, 22.6. These values indicate that the respirator is more efficient in promoting oxygenation (raising Po₂) than ventilation (lowering Pco₂). They also suggest that the observed acidosis is in large part secondary to the hypoxia rather than the result of co₂ retention. For the survivors the average time of total respirator dependency before commencement of weaning was 53.7 hours. All the infants were managed without the use of endotracheal tubes although the use of the respirator and/or administration of 100% oxygen were either continuous or intermittent for periods of up to two weeks. There have been no instances of so-called respirator lung disease in the survivors or in those who died, which suggests that the use of high oxygen concentration by itself is not the major factor in the pathogenesis of this complication.     

Lung function in diaphragm pacing.

Electric stimulation of the diaphragm via the phrenic nerve to induce ventilation has recently been used for the long-term management of chronic ventilatory insufficiency. Since 1973 three patients with inadequate alveolar ventilation have been treated with diaphragm pacing at the Toronto Western Hospital. Two, who had quadriplegia due to lesions of the spinal cord in the upper cervical region and a severe restrictive ventilatory defect, were treated with continuous diaphragm pacing. The third patient required assisted nocturnal ventilation because of primary alveolar hypoventilation. All three patients tolerated the diaphragm pacing well, and pulmonary function tests showed satisfactory gas exchange with the patients breathing room air. This form of therapy seems to be a practical clinical method of managing chronic ventilatory failure in patients with lesions of the upper cervical cord or primary alveolar hypoventilation.     

Severe muscle dysfunction precedes collagen tissue proliferation in mdx mouse diaphragm.

After extensive necrosis, progressive diaphragm muscle weakness in the mdx mouse is thought to reflect progressive replacement of contractile tissue by fibrosis. However, little has been documented on diaphragm muscle performance at the stage at which necrosis and fibrosis are limited. Diaphragm morphometric characteristics, muscle performance, and cross-bridge (CB) properties were investigated in 6-wk-old control (C) and mdx mice. Compared with C, maximum tetanic tension and shortening velocity were 37 and 32% lower, respectively, in mdx mice (each P < 0.05). The total number of active CB per millimeter squared (13.0 +/- 1.2 vs. 18.4 +/- 1.7 x 10(9)/mm(2), P < 0.05) and the CB elementary force (8.0 +/- 0.2 vs. 9.0 +/- 0.1 pN, P < 0.01) were lower in mdx than in C. The time cycle duration was lower in mdx than in C (127 +/- 18 vs. 267 +/- 61 ms, P < 0.05). Percentages of fiber necrosis represented 2.8 +/- 0.6% of the total muscle fibers, and collagen surface area occupied 3.6 +/- 0.7% in mdx diaphragm. Our results pointed to severe muscular dysfunction in mdx mouse diaphragm, despite limited necrotic and fibrotic lesions.     

原发性血小板减少性紫癜合并侵袭性真菌感染2例报告附文献复习

目的 报道2例难治性原发性血小板减少性紫癜（ITP）患者用大剂量激素和（或）免疫抑制剂后发生侵袭性真菌感染（IFI）,其治疗经过及相关文献复习。方法 2例难治性ITP患者用大剂量激素和（或）免疫抑制剂后发生IFI,用大扶康、两性霉素B,降颅压,辅助呼吸等治疗。结果 例1发生隐球菌脑膜脑炎、例2出现肺曲酶菌感染,均经抗真菌治疗无效死亡。结论 长期应用激素及免疫抑制剂是难治性ITP患者发生IFI的危险因素,治疗困难,确诊后用药应足量、足疗程。     

TRACHEOTOMY IN BULBAR POLIOMYELITIS

Tracheotomy was performed on 181 of 351 patients with bulbar poliomyelitis. The essential indication for tracheotomy was secretional obstruction of the respiratory tract that could not be relieved by postural drainage and aspiration.Comparison of mortality rates in this series with those of previous series in which tracheotomy was not done in the presence of similar indications, suggests that the procedure may be life-saving in a considerable percentage of cases.Outside the respirator the tracheotomy can be done with or without the aid of the bronchoscope or endotracheal anesthesia tube. When done inside the opened respirator the Bennett flow-sensitive positive pressure machine should be used to supply oxygen to the patient while the respirator is not operating.     

脑弥漫性轴索损伤的MRI征象及与GCS计分及预后的关系

目的：探讨脑弥漫性轴索损伤（DAI）的磁共振成像（MRI）征象及其与格拉斯哥昏迷量表评分（GCS）计分和预后的关系。方 法：回顾性分析2012 年1 月-2014 年7 月我院收集的30 例DAI 患者的临床病历资料,根据病灶累及部位分析其与GCS 计分和 临床预后的关系。结果：30 例患者共53 个病灶,17例多发病灶,13 例单发病灶;42 个病灶T1WI显示出低信号或者是等信号,11 个病灶T1WI显示为高信号;T2WI显示为高信号,FLAIR 序列以及弥散加权像（DWI）上表现出的信号更高,范围更清晰;病灶形 态呈条索状27 例,斑片状11 例,卵圆形8 例,不规则斑点状7 例;病灶未累及脑中线部位的患者临床预后优于病灶累及脑中线 部位的患者,差异有统计学意义（Z=-2.636,P=0.008）,病灶累及脑中线部位的患者GCS 计分情况比未累及组严重,计分更低,差 异有统计学意义（Z=-2.519,P=0.012）。结论：DAI病灶累及脑中线部位的患者GCS计分较低、预后差,MRI检查是诊断DAI 首选 的影像学方法,临床有重要的参考价值。     

Applicability of different endovascular methods for treatment of refractory Budd-Chiari syndrome

The study’s objective was to evaluate the applicability of different endovascular methods for treatment of refractory type of Budd–Chiari syndrome (BCS) under specific scenarios frequently encountered in patients. The treatment methods were evaluated in 197 patients with the following four types of refractory BCS: lesions of the inferior vena cava (IVC) including a special shape diaphragm (e.g., a knife- or a vertically shaped diaphragm, etc.), occlusion of the long segment of IVC, IVC obstruction combined with thrombosis, and occlusion of the hepatic vein. The choice of endovascular treatment depended on the degree of difficulty to puncture the membrane after spatial orientation. There was a need to adjust the curvature of the device to fit the natural angle of IVC. When IVC lesions were combined with thrombosis, the treatment was adjusted depending on the freshness of the thrombus. Different routes were used to rupture the membrane and expand the lesion. The majority of patients recovered without complications. The few complications observed were the following: 1 case of death due to a postoperative stress ulcer, 1 case of a successfully treated pericardial tamponade, 1 case of stent migration, and 3 cases of failure to stent and re-occlusion that occurred in the follow-up period. To conclude, BCS is preferably treated via endovascular intervention; however, the particular choice depends on individual circumstances.     

Early glomerular filtration defect and severe renal disease in podocin-deficient mice

Podocytes are specialized epithelial cells covering the basement membrane of the glomerulus in the kidney. The molecular mechanisms underlying the role of podocytes in glomerular filtration are still largely unknown. We generated podocin-deficient (Nphs2-/-) mice to investigate the function of podocin, a protein expressed at the insertion of the slit diaphragm in podocytes and defective in a subset of patients with steroid-resistant nephrotic syndrome and focal and segmental glomerulosclerosis. Nphs2-/- mice developed proteinuria during the antenatal period and died a few days after birth from renal failure caused by massive mesangial sclerosis. Electron microscopy revealed the extensive fusion of podocyte foot processes and the lack of a slit diaphragm in the remaining foot process junctions. Using real-time PCR and immunolabeling, we showed that the expression of other slit diaphragm components was modified in Nphs2-/- kidneys: the expression of the nephrin gene was downregulated, whereas that of the ZO1 and CD2AP genes appeared to be upregulated. Interestingly, the progression of the renal disease, as well as the presence or absence of renal vascular lesions, depends on the genetic background. Our data demonstrate the crucial role of podocin in the establishment of the glomerular filtration barrier and provide a suitable model for mapping and identifying modifier genes involved in glomerular diseases caused by podocyte injuries.     

2型糖尿病患者血糖波动与心律失常和下肢血管病变的关系及其影响因素分析

目的:探讨2型糖尿病(T2DM)患者血糖波动与心律失常和下肢血管病变的关系,分析影响T2DM心律失常和下肢血管病变的因素。方法:选择2019年7月到2020年6月我院收治的82例T2DM患者,根据是否合并心律失常分为心律失常组28例和无心律失常组54例,根据是否合并下肢血管病变分为下肢血管病变组31例和无下肢血管病变组51例。所有患者均通过72 h监测血糖获得日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、全天血糖标准差(SDBG)、全天血糖波动次数(NGE)。比较组间差异,分析影响T2DM患者心律失常和下肢血管病变的因素。结果:心律失常组MAGE、MODD、SDBG、NGE、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、T2DM病程、同型半胱氨酸(Hcy)、丙二醛(MDA)高于无心律失常组(P<0.05)。下肢血管病变组T2DM病程、Hcy、MDA、HOMA-IR、MAGE、MODD、SDBG、NGE均高于无下肢血管病变组(P<0.05)。Logistic回归分析结果显示MDA、HOMA-IR、MAGE、MODD是T2DM患者心律失常的危险因素(P<0.001),MAGE、MODD、SDBG是T2DM患者下肢血管病变的危险因素(P<0.001)。结论:T2DM患者血糖波动与心律失常和下肢血管病变均有关,血糖波动增加是T2DM心律失常和下肢血管病变的危险因素。     

Adenosine A2A receptors mediate GABAergic inhibition of respiration in immature rats.

Adenosine is a known inhibitor of respiratory output during early life. In this study we investigated the developmental changes in adenosine A2A-receptor activation on respiratory timing, as well as the relationship between adenosine and GABA. The specific adenosine A2A-receptor agonist CGS-21680 (CGS) or vehicle control was injected into the fourth ventricle of 14-day (n = 9), 21-day (n = 9), and adult (n = 5) urethane-anesthetized rats while diaphragm electromyogram was monitored as an index of respiratory neural output. CGS injection resulted in a decrease in frequency and/or apnea in all 14-day-old rats and in 66% of 21-day-old rats. There was no effect of CGS injection on respiratory timing in adult rats. Prior injection of the GABA(A)-receptor blocker bicuculline at 14 and 21 days eliminated the CGS-induced decrease in frequency and apnea. We conclude from these studies that the inhibitory effect of A2A-receptor activation on respiratory drive is age dependent and is mediated via GABAergic inputs to the inspiratory timing neural circuitry. These findings demonstrate an important mechanism by which xanthine therapy alleviates apnea of prematurity.     

生长抑素受体亚型SSTR2、SSTR3 在淋巴瘤中的表达 及临床意义

目的:探讨生长抑素受体亚型SSTR2和SSTR3在不同类型、不同部位淋巴瘤中的表达情况并分析其临床意义.方法:采用RT-PCR法检测105例4种不同淋巴瘤石蜡标本中SSTR2和SSTR3的基因表达情况.结果:SSTR2及SSTR3在粘膜相关性淋巴瘤阳性表达率分别为(8/27),(6/27),弥漫大B细胞型淋巴瘤(14/36),(12/36),NK/T细胞淋巴瘤(9/22),(6/22),伯基特淋巴瘤(6/20),(7/20),SSTR2的总阳性率为(37/105),SSTR3的总阳性率为(31/105).其中病变位于膈上的SSTR2的总阳性率为(24/105),膈下的总阳性率(14/105),而SSTR3在膈上的总阳性率为(19/105),膈下的为(11/l0S).结论:部分淋巴瘤组织中至少表达一种生长抑素受体,且表达率较低,但淋巴瘤是对放射性敏感的肿瘤,低表达的生长抑素受体对淋巴瘤的诊断及靶向治疗方面是否有意义,还需要进一步研究.     

Cytophotometric analysis of cervical intraepithelial neoplasia grade III, with and without synchronous invasive squamous cell carcinoma

Cytophotometric analysis was performed in nuclei retrieved from paraffin-embedded cervical tissue from 57 cases of CIN III. CIN III lesions of patients without invasive squamous cell carcinoma (N = 37) were regarded to represent a mixture of progressive and nonprogressive lesions. The CIN III lesions of patients with a synchronous invasive squamous cell carcinoma (N = 20) were regarded as representing truly progressive precursor lesions (CIN.INV). Twenty-one photometric features describing geometrical, density, and texture characteristics were extracted from the digitized nuclear images. Statistical analysis of cytophotometric data indicated significant differences between the group of CIN III lesions and CIN.INV lesions. A cluster analysis, using one co-occurrency texture feature (S-HOMOG), one density feature (S-DI), and two geometrical features (S-AREA and M-CIRC), showed that two clusters (C1 and C2) were present in the total group of CIN III and CIN.INV lesions. The vast majority of CIN.INV lesions was member of one and the same cluster C1. The CIN III group appeared to consist of a mixture of two clusters, 54% C1 and 46% C2 lesions. Of patients 45 years or younger, the majority (62%) of CIN III lesions had feature values, corresponding with those of cluster C1, and as such possibly with a potentially progressive course. In patients older than 45 years the percentage of CIN III lesions with C1 feature values was 27%.     

Midtrimester abortion induced by serial intravaginal administration of prostaglandin E2 suppositories in conjunction with a contraceptive diaphragm.

Midtrimester abortion was successfully induced in 68 of 69 patients with serial intravaginal administration of prostaglandin E2 suppositories behind a contraceptive diaphragm. The mean abortion time for the successful inductions was 13.07 hours; multiparous patients aborted somewhat faster, mean 12.72 hours, as compared to nulliparous patients, mean 14.22 hours. In 36 patients the PGE2 suppositories were placed behind an intact diaphragm and the mean abortion time was 14.89 hours. In 33 patients the PGE2 suppositories were placed behind a diaphragm modified by having an opening incised in the center, the mean time in these patients was 11.96 hours. Of the 68 successful abortions 59% of the patients aborted in 12 hours or less and 88% aborted within 24 hours. The most frequently encountered side effect was temperature elevation of 2 degrees F or higher which occurred in 68% of the patients. Temperatures returned to normal levels within 4 to 6 hours after the last adminstration of PGE2. Gastrointestinal side effects occurred in 45% of patients, but these side effects were well tolerated and did not require termination of drug administration in any of the patients. Intravaginal administration of PGE2 suppositories is a very effective abortifacient technque during the midtrimester, however the use of PGE2 in conjunction with a diaphragm did not appreciabley improve the technique although the amount of drug administered and the incidence of side effects was somewhat lower than when the PGE2 suppositories are used alone. If a diaphragm is to be used, a modified diaphragm is indicated since it simplifies the clinical management of the abortion, eases administration of the suppositories and permits a more accurate estimation of cervical changes, vaginal bleeding and abortion.     

Distribution frequency of pathogenic bacteria isolated from cutaneus leishmaniasis lesions

Cutaneous leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infections are one of the complications that can increase the tissue destruction and the resulting scar. To better determine the incidence of real secondary bacterial infections in CL, we designed the current study. This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. A total of 1,255 patients with confirmed CL enrolled in the study. Sterile swaps were achieved for ulcer exudates and scraping was used for non-ulcerated lesions. All samples were transferred to tryptic soy broth medium. After 24 hr of incubation at 37 degrees C they were transferred to eosin methylene blue agar (EMB) and blood agar. Laboratory tests were used to determine the species of bacteria. Among 1,255 confirmed CL patients, 274 (21.8%) had positive cultures for secondary bacterial infections. The bacteria isolated from the lesions were Staphylococcus aureus in 190 cases (69.3%), coagulase negative Staphylococcus in 63 cases (23.0%), E. coli in 10 cases (3.6%), Proteus sp. in 6 cases (2.2%), and Klebsiella sp. in 5 cases (1.9%). The results show that the overall incidence of secondary bacterial infections in the lesions of CL was 21.8%, considerably high. The incidence of secondary bacterial infections was significantly higher in ulcerated lesions compared with non-ulcerated lesions.     

Correlation of immunochemical detection of HPV L1 capsid protein in pap smears with regression of high-risk HPV positive mild/moderate dysplasia

OBJECTIVE: To immunostain Pap smears of high-risk (hr) HPV DNA-positive early squamous lesions for detecting HPV L1 protein. STUDY DESIGN: Routinely stained archival slides from 84 mild and moderate hrHPV DNA-positive dysplasias were immunostained using a panreactive HPV L1 antibody. Follow-up smears were taken from women with remission for a mean period of 22.8 months (range, 6-46). Conization was done in patients with persistence or progression (3 and 48 patients, respectively) after a mean time of 12 months (range, 9-48). RESULTS: Twenty-nine of 84 smears (34.5%) had positively stained squamous epithelial cell nuclei. In 9 of 29 (31%) women progressive disease occurred (2 cervical intraepithelial neoplasia [CIN] 2 and 7 CIN 3 lesions on conization) 20 (69%) had remission. Of the 55 L1-negative cases, 13 (23.6%) had remission, 42 (76.4%) progressed (3 CIN 2, 38 CIN 3, 1 microinvasive carcinoma). The difference in follow-up between L1 positive and negative cases was statistically significant (chi2 test, p< or =0.001). CONCLUSION: Low and moderate dysplastic squamous lesions without immunochemically detectable HPV L1 protein are significantly more likely to progress than are L1-positive cases. Immunochemical L1 capsid detection in routine Pap smears thus offers prognostic information about early dysplastic lesions.