Use of Intravenous Urography

Studies on 1,476 intravenous urographic examinations done in a 15-month period showed that the proportion of abnormal results varied widely—from 20% in patients with abdominal pain other than renal colic to 92% of those in prostatism. Patients with the strongest clinical evidence of haematuria were the most likely to have abnormal urograms, and to undergo cystoscopy with abnormal findings on this examination. All six patients with renal hypertension showed abnormalities other than on the urogram. Prior use of other tests may increase the effectiveness of urography.     

阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者外周血ROCK2激酶活性及肺动脉压力的影响

目的：探讨口服阿托伐他汀片对慢性阻塞性肺疾病（chronic obstructive pulmonary Disease,COPD）合并肺动脉高压（pul-monary hypertension,PH）患者外周血ROCK2激酶活性及肺动脉压力的影响。方法：选取COPD合并PH患者60例为研究对象,并将其随机分为对照组（给予吸氧、抗感染、化痰、平喘等基础治疗）和阿托伐他汀治疗组（在基础治疗的基础上给予阿托伐他汀片20mg／d治疗）;随访观察周期12周,于试验开始前和结束后检测外周血ROCK2的活性,利用彩色多普勒检测肺动脉压力的变化,肺功能变化（测定FEV1,FVC）。结果：与对照组比较,阿托伐他汀治疗可显著降低患者血浆中ROCK2的水平（P〈0．01）;降低患者的肺动脉压力,改善患者的肺功能（FEV1,FVC）,P均〈0．05。结论：在常规吸氧、抗感染等治疗的基础上,联合应用阿托伐他汀可显著降低ROCK2激酶的活性和肺动脉压力,从而改善肺功能。     

SPORADIC ACUTE GLOMERULONEPHRITIS IN ADULTS

Nineteen adults who had acute glomerulonephritis were reviewed with respect to the clinical course and long-term follow-up. The age range was from 17 to 55 years. Only one patient died during the acute episode. In 11 cases, onset occurred between November and January and 15 of the patients had a known respiratory tract infection three to 30 days before the onset. The most important symptoms noted were weight gain, edema, dyspnea, oliguria and red or smoky urine. The most prominent physical signs were elevated blood pressure, edema, abnormalities in the chest and fever of over 100° F. Fifteen patients showed roentgen evidence of pulmonary vascular congestion, pleural effusion, cardiomegaly, pneumonia or a combination of these abnormalities. All the patients had proteinuria and red blood cells in the urine, and half of them had red blood cell casts. Azotemia, when present, subsided in 9.4 days. The average diastolic pressure was 105 mm. of mercury and the mean fall was 26 mm. in 23.5 days. At six months, nine of the 13 patients still being observed continued to show proteinuria or microscopic hematuria (seven showed both). A late follow-up of ten patients showed one to have significant hypertension and one to have early functional impairment and inconstant proteinuria. In these cases the average blood pressure was 140/91 mm. as compared with 119/74 mm. at the time of discharge.Sporadic glomerulonephritis in adults presents essentially the same pattern as it does in children. Urinary abnormalities may persist for months or even years, and neither the present series nor those reported by others clearly reveal the ultimate prognosis.     

Chromosome 22q11 deletions in patients with selected outflow tract malformations

The incidence of 22q11 deletions and its effect on the phenotype were established in 170 patients with selected outflow tract malformations and transposition of the great arteries (conotruncal defects). Cases were seen both prospectively and retrospectively. All patients had a dysmorphological evaluation by the clinical geneticist and a cytogenetic analysis including FISH analysis for 22q11 deletions. A chromosomal abnormality was present in 29 patients, including a 22q11 deletion in 22/170 patients (13%). The 22q11 deletion was found in 11% of tetralogy of Fallot, in 11% of pulmonary atresia and VSD, in 44% of pulmonary atresia. VSD and collateral arteries, in 20% of truncus arteriosus, in 60% of interrupted aortic arch and in 25% patients with aberrant subclavian artery. They were absent in double outlet right ventricle or in transposition of the great arteries. No parental deletion was found. All patients had clinical characteristics of the velocardiofacial syndrome. This study confirms a high incidence of chromosome 22q11 deletions in patients with selected outflow tract malformations, with great clinical impact for further management and genetic counseling.     

Atrial Septal Defect in Infancy

The case histories of seven infants with atrial septal defect are presented to draw attention to certain features and possible dangers of this defect in infancy. Four infants were asymptomatic but one failed to thrive and two died suddenly. Five had ejection murmurs and two, with pulmonary hypertension, had loud pan-systolic murmurs with a thrill. In two infants murmurs were noted at birth, but in five they were first heard between the ages of 1 and 6 months. The second pulmonary sound was initially narrowly split in all, but became widely split between the ages of 12 and 20 months. Electrocardiograms and chest roentgenograms were of little help at the outset but later showed findings characteristic of the defect after one year. All infants were catheterized; a left-to-right atrial shunt was detected in each instance. Pulmonary hypertension was present in two infants, one of whom died.     

Pulmonary circulation and right ventricular function in primary arterial hypertension]

Selected parameters of the pulmonary circulation and right ventricular performance were studied in 30 patients with primary arterial hypertension. Four patients belonged to the WHO class I, four to class I/II, 18 to class II and the remaining four to class III. Patients were eligible, if they were in sinus rhythm, without symptoms of left ventricular failure and diseases that night influence pulmonary pressures, and if drugs affecting cardiac performance could be withdrawn safely for 3 days. Ten healthy subjects served as control group. The mean pulmonary capillary wedge pressure and mean pulmonary artery pressure were similar in both groups. In contrast, the systolic pulmonary arterial pressure exceeded 30 mm Hg in 6 patients. Mean pulmonary vascular resistance was higher in examined patients than in the control group. Right ventricular end-diastolic pressure was above 5 mm Hg in as much as 50% of patients. Mean systolic ejection rate showed a tendency to decrease. The results indicate that part of patients with primary arterial hypertension exhibits disorders in the pulmonary circulation and right ventricular performance.     

High-resolution studies in patients with aniridia-Wilms tumor association,Wilms tumor or related congenital abnormalities

Summary We attempted to determine wheter all cases of AWTA (anirida-Wilms tumor association) or any of the following groups of patients show 11p deletion: cases of Wilms tumor with congenital abnormalities other than aniridia, those without any congenital abnormalities, tumor itself in cases of Wilsm tumor without constitutional 11p deletion and cases of aniridia or hemihypertrophy without Wilms tumor. We studied a total of 29 index patients including five cases of AWTA, four cases of Wilms tumor with various congenital abnormalities, 16 cases of Wilms tumor without other abnormalities, three cases of aniridia in one of which Wilms tumor developed later and a case of hemihypertrophy.In all five cases of AWTA and in a case of aniridia who later developed Wilms tumor, 11p deletion involving the p13 band was detected. The mother of the latter also showed an identical 11p deletion. The common segment of deletion was the middle part of the p13. Two possible hypotheses on the mechanism through which Wilms tumor might develop were evaluated, based on the distribution of break points. All other cases, including five with tumor culture, showed a normal karyotype.     

机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响

目的探讨机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响。方法随机抽取86例ICU肺动脉高压伴呼吸衰竭患者分为两组,观察组43例患者应用面罩呼吸机予以辅助呼吸治疗,对照组43例患者行气管插管呼吸机辅助治疗,并对两组患者治疗前后脑钠肽、肺动脉压水平以及并发症发生率进行比较分析。结果治疗后,观察组脑钠肽、肺动脉压力均高于对照组(均P0.01);观察组并发症发生率为6.98%,低于对照组的23.26%(P0.05)。结论 ICU肺动脉高压伴呼吸衰竭患者行气管插管机械通气治疗的临床效果肯定。     

Pulmonary vascular dysfunction in preterm lambs with chronic lung disease

Chronic lung injury from prolonged mechanical ventilation after premature birth inhibits the normal postnatal decrease in pulmonary vascular resistance (PVR) and leads to structural abnormalities of the lung circulation in newborn sheep. Compared with normal lambs born at term, chronically ventilated preterm lambs have increased pulmonary arterial smooth muscle and elastin, fewer lung microvessels, and reduced abundance of endothelial nitric oxide synthase. These abnormalities may contribute to impaired respiratory gas exchange that often exists in infants with chronic lung disease (CLD). Nitric oxide inhalation (iNO) reduces PVR in human infants and lambs with persistent pulmonary hypertension. We wondered whether iNO might have a similar effect in lambs with CLD. We therefore studied the effect of iNO on PVR in lambs that were delivered prematurely at approximately 125 days of gestation (term = 147 days) and mechanically ventilated for 3 wk. All of the lambs had chronically implanted catheters for measurement of pulmonary vascular pressures and blood flow. During week 2 of mechanical ventilation, iNO at 15 parts/million for 1 h decreased PVR by approximately 20% in 12 lambs with evolving CLD. When the same study was repeated in eight lambs at the end of week 3, iNO had no significant effect on PVR. To see whether this loss of iNO effect on PVR might reflect dysfunction of lung vascular smooth muscle, we infused 8-bromo-guanosine 3',5'-cyclic monophosphate (cGMP; 150 microg. kg(-1). min(-1) iv) for 15-30 min in four of these lambs at the end of week 3. PVR consistently decreased by 30-35%. Lung immunohistochemistry and immunoblot analysis of excised pulmonary arteries from lambs with CLD, compared with control term lambs, showed decreased soluble guanylate cyclase (sGC). These results suggest that loss of pulmonary vascular responsiveness to iNO in preterm lambs with CLD results from impaired signaling, possibly related to deficient or defective activation of sGC, the intermediary enzyme through which iNO induces increased vascular smooth muscle cell cGMP and resultant vasodilation.     

x线断层容积成像技术在肺动脉畸形中的应用

目的：通过与常规x线胸片比较,探讨胸部x线断层容积成像技术在肺动脉畸形中的应用价值。方法：对20例临床及x线平片怀疑肺动脉畸形者,进一步进行胸部x线断层容积成像检查。其中11例被明确诊断为肺动脉畸形。以CT或超声心动结果为标准,对比两种图像对肺动脉畸形的明确诊断率,分析对比该11例患者的胸部x线断层容积成像图片和普通x线胸片,评价两种方法所获得的图像质量和图片优秀率。结果：20例疑似患者中,11例被CT或超声心动确诊为肺动脉畸形,其x线断层容积成像图片和普通x线胸片经主管技师和副主任医师双盲判读,x线断层容积成像11例均获明确诊断（100％）,普通x线胸片明确诊断2例（18％）,诊断准确率有明显差异（P=0．O001）。容积断层成像优质图像为10例,占总数的90．91％;良好1例,差为0例。11例x片中优秀7例,占总数的63．63％,其中良好3例,差1例。两种图像优秀率比较差异有统计学意义（P=0．0001）。结论：x线断层容积成像技术对肺动脉畸形的图像优秀率和诊断准确率均高于x线平片,对病变的显示更加清晰、立体,提高诊断准确率和客观性,具有重要的临床诊断价值。     

Temperature-induced abnormalities in sheep oocytes during maturation

The susceptibility of sheep oocytes to temperature changes during maturation in vitro was tested by reducing the incubation temperature to 20 degrees C at various stages of meiosis. Cooling induced chromosomal abnormalities including disorganized metaphase plates and multipolar spindles in 28-54% of oocytes cooled at all stages of meiosis from germinal vesicle breakdown (GVBD) to metaphase II. The time of GVBD (8-11 h after the start of culture) was the most sensitive to cooling, whereas fewest abnormalities were found in oocytes cooled in late metaphase I (16-19 h). In addition to the chromosomal abnormalities, unusual vesicles appeared in the cytoplasm of oocytes cooled at 8-11 h and 12-15 h. No abnormalities in protein synthesis were detected by one-dimensional SDS gel electrophoresis. The consequences of the abnormalities for the developmental potential of the cooled oocytes were tested by transfer to recipient ewes and fertilization in vivo. After 12 days of development only 6% and 11% oocytes cooled at 12-15 h and 20-23 h respectively had developed to expanded blastocysts, compared with 44% of control oocytes. The results demonstrated that maturing sheep oocytes are very sensitive to a drop in temperature.     

幽门螺杆菌感染与门脉高压性胃病的发病关系

为了解门脉高压性胃病 (portalhypertensivegastropathyPHG)与幽门螺杆菌 (HP)感染的关系 ,选门脉高压性胃病胃窦粘膜 30例 ,免疫组化SP法 (链霉菌抗生物素蛋白—过氧化酶法 ,Streplavidin Peroxidase,SP)抗HP抗体染色 ,并以慢性乙型肝炎并胃病 2 0例及非肝病胃病 2 1例胃窦粘膜作对照。结果显示 ,30例门脉高压性胃病阳性2 2例 ,占 73.3% ;2 0例慢乙肝组阳性 11例 ,占 5 5 % ;2 1例非肝病组阳性 11例 ,占 5 2 .38%。门脉高压组HP感染阳性率与慢乙肝组、非肝病组相比差异无显著性 (P >0 .0 5 )。可见HP感染虽不是门脉高压性胃病的发生原因 ,但在治疗中短期加用杀HP的药物是必要的。     

Thromboxane inhibition reduces an early stage of chronic hypoxia-induced pulmonary hypertension in piglets.

The pulmonary vasoconstrictor, thromboxane, may contribute to the development of pulmonary hypertension. Our objective was to determine whether a combined thromboxane synthase inhibitor-receptor antagonist, terbogrel, prevents pulmonary hypertension and the development of aberrant pulmonary arterial responses in newborn piglets exposed to 3 days of hypoxia. Piglets were maintained in room air (control) or 11% O(2) (hypoxic) for 3 days. Some hypoxic piglets received terbogrel (10 mg/kg po bid). Pulmonary arterial pressure, pulmonary wedge pressure, and cardiac output were measured in anesthetized animals. A cannulated artery technique was used to measure responses to acetylcholine. Pulmonary vascular resistance for terbogrel-treated hypoxic piglets was almost one-half the value of untreated hypoxic piglets but remained greater than values for control piglets. Dilation to acetylcholine in preconstricted pulmonary arteries was greater for terbogrel-treated hypoxic than for untreated hypoxic piglets, but it was less for pulmonary arteries from both groups of hypoxic piglets than for control piglets. Terbogrel may ameliorate pulmonary artery dysfunction and attenuate the development of chronic hypoxia-induced pulmonary hypertension in newborns.     

血清PCT、IL-17与CRP在AECOPD合并肺动脉高压患者中的表达及诊断价值

目的:探讨降钙素原(PCT),白介素17(IL-17)与C反应蛋白(CRP)在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压患者外周血中的表达水平,探究联合检测的诊断价值。方法:收集2015年8月至2017年2月我院收治的AECOPD患者120例,纳入研究患者根据是否合并肺动脉高压分为分为单纯AECOPD组60例及AECOPD合并肺动脉高压(AECOPD+PH)组60例,另选取20例健康志愿者作为对照组。采用化学发光法检测PCT水平,双抗夹心酶联免疫吸附试验法(ELISA)检测IL-17水平及生化分析仪检测CRP水平,采用受试者工作特征曲线(ROC)评估PCT,IL-17与CRP对AECOPD合并肺动脉高压的诊断价值。结果:AECOPD+PH组及AECOPD组的PCT,IL-17,CRP水平较健康对照组均明显升高,而AECOPD+PH组的各指标水平也均高于单纯AECOPD组,差异均有统计学意义(P0.05)。通过Pearson相关性分析发现,AECOPD合并肺动脉高压的PCT与IL-17之间存在表达正相关性(r=0.733,P0.05),PCT与CRP表达存在正相关性(r=0.817,P0.05)。此外,针对AECOPD合并肺动脉高压的诊断中PCT的ROC曲线下面积为0.83,IL-17为0.71,CRP为0.77,联合三者的ROC曲线下面积为0.94。结论:PCT、IL-17和CRP可能与AECOPD患者肺动脉高压的形成有关,各指标存在一定的相关性,联合以上三项生物学指标对诊断AECOPD合并肺动脉高压患者具有一定的临床参考价值。     

Unilateral radiation pneumonitis in sheep: physiological changes and bronchoalveolar lavage

Radiation pneumonitis is a life-threatening result of therapeutic thoracic irradiation, yet its mechanisms are poorly understood. We studied the effects of unilateral lung irradiation (3,000 rad) in sheep from the immediate response to the later development of radiation pneumonitis. We defined radiation pneumonitis by its diagnostic clinical feature, radiographic infiltration of the irradiated zone with a straight margin corresponding to the radiation port. The immediate response in the few hours after irradiation was characterized by cough, labored respiration, hypoxemia (arterial PO2 decreased 19 Torr), mild pulmonary hypertension (pulmonary arterial pressure increased 20%), and lymphopenia. Hemodynamics and gas exchange returned to normal by day 2 but became abnormal again before or during radiation pneumonitis at 32 +/- 2 days. Respiratory distress, hypoxemia, and pulmonary hypertension recurred during radiation pneumonitis. Bronchoalveolar lavage during radiation pneumonitis contained increased neutrophils (19 +/- 4%, control = 7%), increased protein (0.27 +/- 0.1 g/dl, control = 0.12 +/- 0.03), and severely impaired ability to lower surface tension. Alveolar macrophages from both lungs during unilateral radiation pneumonitis exhibited impaired generation of superoxide after phorbol myristate (only a 30% increase). Normal control alveolar macrophages increased superoxide production after stimulation greater than 400%. We conclude that unilateral lung irradiation in sheep causes a mild immediate response followed by radiation pneumonitis at 1 mo. Unilateral radiation pneumonitis in this model is associated with ipsilateral neutrophilic alveolitis, increased bronchoalveolar lavage protein, and impaired surfactant function, as well as bilateral functional abnormalities of alveolar macrophages.     

Analysis of CD38 and ZAP70 mRNA expression among cytogenetic subgroups of Iranian chronic-lymphocytic-leukemia patients

Chromosomal abnormalities and ZAP70 expression profile are two major independent prognostic markers in B-cell chronic lymphocytic leukemia. We investigated a possible correlation between these two markers. ZAP70 expression using real-time RT-PCR was examined in 20 B-cell chronic lymphocytic leukemia patients with del13q14, 13 patients with del11q22, 15 patients with trisomy 12, and 16 patients with no detected chromosomal abnormalities. Molecular analysis revealed that ZAP70 expression in the del13q subgroup was the same as in the control group, while it increased 2.78-fold in the del11q subgroup and 2.95-fold in the trisomy 12 subgroup, compared to the 15 cases in the control group. Comparison of the mean and standard deviation of the ZAP70 expression profile within the subgroups showed it to be highly variable among the individuals of the del11q and trisomy 12 subgroups, versus tight clustering for the del13q subgroup. Therefore, there is a correlation between del13q aberration, which has good prognosis with normal levels of ZAP70 expression. Due to a high degree of variation, no conformity is seen for del11q and trisomy 12 subgroups, making this grouping poor for prognostic discrimination. As a result, neither of these markers can serve as sole discriminators to determine the course of the disease; the use of both markers improves prognostic assessment.     

Histological and cytological evidence of viral infection and human papillomavirus type 16 DNA sequences in cervical intraepithelial neoplasia and normal tissue in the west of Scotland: evaluation of treatment policy

Biopsy samples from 27 patients referred to a colposcopy clinic in Glasgow for cervical abnormalities were assessed for the relations among colposcopic appearances, cytological and histological diagnosis, expression of papillomavirus antigen, and the presence of human papillomavirus (HPV) types 6, 11, 16, and 18 deoxyribonucleic acid (DNA) sequences. Specimens were from colposcopically abnormal areas of the transformation zone and from colposcopically apparently normal areas of the zone in the same patients (paired matched internal control tissue). All 27 women referred for abnormal smears had colposcopic abnormalities.HPV-16 or 18 DNA sequences were detected in 20 of the 27 colposcopically abnormal biopsy samples and 13 of the 27 paired normal samples. Twelve samples of colposcopically normal tissue contained histological evidence of viral infection but only four of these contained HPV DNA sequences. The other nine samples of colposcopically normal tissue which contained HPV DNA sequences were, however, histologically apparently normal. HPV-6 and 11 were not detected.Integration of the HPV-16 genome into the host chromosome was indicated in both cervical intraepithelial neoplasia and control tissues. In two thirds of the HPV DNA positive samples the histological grade was classed as normal, viral atypia, or cervical intraepithelial neoplasia grade 1. Papillomavirus antigen was detected in only six of the abnormal and three of the normal biopsy samples, and HPV DNA was detected in all of these.The detection of HPV DNA correlates well with a combination of histological and cytological evidence of viral infection (20 of 22 cases in this series). A poor correlation between the site on the cervix of histologically confirmed colposcopic abnormality and the presence of HPV DNA sequences implies that a cofactor other than HPV is required for preneoplastic disease to develop.A separate study in two further sets of biopsy samples examined the state of HPV DNA alone. The sets were (a) 43 samples from cervical intraepithelial neoplasia and nine external controls and (b) 155 samples from cervical intraepithelial neoplasia, cervical cancer, vulval intraepithelial neoplasia, and vulval cancer and external controls. HPV-11 was found in only two (4·7%) of the 43 specimens from cervical intraepithelial neoplasia, whereas HPV-16 was found in 90 (58%) of the other 155 specimens. These results also suggest that HPV subtype is subject to geographical location rather than being an indicator of severity of the lesion or of prognosis.     

Impact of L-arginine on hydrogen sulfide/cystathionine-gamma-lyase pathway in rats with high blood flow-induced pulmonary hypertension

The present study was designed to explore the possible effect of L-arginine on endogenous hydrogen sulfide/cystathionine-gamma-lyase (H(2)S/CSE) pathway in the pathogenesis of pulmonary hypertension and pulmonary vascular structural remodeling induced by high pulmonary blood flow. Thirty-two male Sprague-Dawley rats were randomly divided into control group (n=11), shunt group (n=11) and shunt with L-arginine group (n=10). Rats in the shunt and shunt with L-arginine group underwent an abdominal aorta-inferior cava vein shunt operation. After 11 weeks of shunting, the plasma level of H2S and lung tissue H2S production rate in the shunt with L-arginine group were much higher than those in the shunt group (P<0.01). Meanwhile, the expression of CSE mRNA in the lung tissues of rats in the shunt with L-arginine group was increased significantly (P<0.01), and in situ hybridization showed that CSE mRNA expression was obviously up-regulated in the smooth muscle cells (SMCs) of the pulmonary arteries of shunted rats treated with L-arginine when compared with shunted rats without the treatment of L-arginine (P<0.01). In conclusion, H2S/CSE pathway was up-regulated by L-arginine in pulmonary hypertension induced by high blood flow with the attenuation of pulmonary hypertension and pulmonary vascular structural remodeling.     

Cytogenetic investigations in a family with ataxia telangiectasia

Summary Cytogenetic findings on a family with ataxia telangiectasia (A-T) in which three of four sibs were affected are described. The affected individuals had approximately twice the level of spontaneous chromosome breakage of a normla control, while the parents and the normal sib had no significant increase. Lymphocytes from all three A-T homozygotes showed specific stable chromosomal rearrangements involving chromosomes 7 and 14. All of these abnormalities involved breakage at the usual four sites associated with A-T (7p14, 7q35, 14q12, and 14q32). Two rearrangements detected in the eldest and most severely affected patient were clones, one of which [t(14;14)(p11;q12)] is not commonly found in A-T cells. No chromosomal rearrangements were encountered in lymphocytes from the control, the parents, or the normal sib. Lymphocytes from the A-T patients also were found to be 7–11 times more sensitive to the induction of chromatid aberrations by X-irradiation than control cells. Lymphocytes from the parents and normal sib showed a moderately increased frequency of X-ray induced aberrations compared with that of the control.     

Chromosomes in acute nonlymphocytic leukemia

Summary The karyotype of leukemic cells was studied in 88 acute nonlymphocytic leukemia (ANLL) patients. Chromosome abnormalities were discovered in 78.4% of all patients and in 72.5% of the 69 patients studied before treatment. Characteristic abnormalities: translocations 8;21, 15;17, 9;22 or 6;9, rearrangements of 11q, gain of chromosomes 8 or 21, and loss or deletion of chromosomes 5 or 7 were detected in 56 of 69 patients with abnormal karyotypes. Translocation 8;21 was revealed in 27 patients; 20 of them had M2 FAB-form, four had M1, and three had M4. In patients with t(8;21) the incidence of complete remission was higher and the duration of first remission and survival longer than in patients with other abnormalities or with a normal karyotype.