Biloma: An unusual complication in a patient with pancreatic cancer

The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic （secondary to hepatobUiary surgery）, trauma or complications due to choledocho- lithiasis. A few cases have been reported as complica- tions of cholangiocarcinoma or acute cholecystitis. We report the case of a 64-year-old man initially diagnosed with a non-obstructive malignancy of the pancreas, who developed a spontaneous intrahepatic biloma 8 mo later. This was identified following a 1-wk history of fever, rigors and icterus. The biloma was identified on computed tomography and subsequently drained under ultrasound guidance. Forty-eight hours later, a stent was inserted endoscopically into his common bile duct and he made an uneventful in-hospital recovery. We believe this is the first documented case of spontaneous intrahepatic biloma to occur secondary to pancreatic malignancy.

神经外科夹闭和血管内弹簧圈栓塞治疗2143例颅内动脉瘤破裂患者的国际蛛网膜下腔动脉瘤试验(ISAT):一项对生存情况、依赖性、癫痫发作、再出血、亚组和动脉瘤阻塞影响的随机对比试验

Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.

花斑发毛囊中细胞角蛋白的表达

Pili annulati is a rare autosomal inherited hair shaft abnormality of unknown pathogenesis in which clinical examination reveals alternating light and dark bands leading to a shiny appearance of the hair due to cavities within the cortex of the hair shaft. This is the first investigation of the proposed cytokeratin defect in pili annulati hair follicles. Four cryopreserved pili annulati and four control scalp specimens were analysed using immunohistochemistry for different ‘hard’trichocytic and ‘soft’epithelial cytokeratinsincludingK1,K6,K10,K14,K16,K17,K18,K19, Ha1 and Hb1. There was no difference in staining intensity and quality of staining pattern seen in pili annulati and control scalp specimens. These results suggest that pili annulati is not caused by a defect of the cytokeratins investigated in this study.

Excision margins in squamous cell carcinoma of the tongue: A retrospective audit and review of the literature

The incidence of close and involved tongue resection margins for squamous cell carcinoma (SCC) were reviewed with the aim to identify any possible need for change in the surgical approach to glossectomies. The histopathological reports of 101 partial glossectomies for SCC between 2006 and 2012 were retrospectively reviewed. Results: Overall 52 (51.5%) patients had one or more close or involved margin and 9 (8.9%) had both close and involved margins. 42 (41.5%) patients had close margins and 11 (10.9%) had involved margins. The inferior/lateral muscoal margin was most frequently close/involved (32%) followed by deep margin (27%). The anterior margin was least close/involved (5%). The posterior and superior/medical margins were close/involved in 12% and 11% of cases respectively. Conclusions: 52.5% of patients had close or involved margins following surgery, potentially requiring further treatment to avoid an increased risk of tumour recurrence and the associated increase in morbidity and mortality. The inferior/lateral and deep margins were most frequently involved possible due to the anatomical difficulties visualising and dissecting these margins. The potential explanations for these disparities and possible solutions are discussed.

肾移植受者的黑色素瘤

Background: It is well documented that renal transplant recipients are at increased risk of developing skin cancers, in particular squamous cell carcinomas. Less extensively reviewed in the literature is the increased incidence of malignant melanoma. We have reviewed 10 patients in the Oxford renal transplant population who developed 12 melanomas following transplantation. Objectives: To determine the incidence and characteristics of melanoma in renal transplant recipients. Methods: We reviewed the case notes and pathology of all patients who developed melanoma within the Oxford Renal Transplant Unit. The clinical details were recorded including date of transplant, immunosuppressive therapy, interval between transplant and melanoma, site of occurrence, history of sun exposure, type of clinician diagnosing the melanoma, history of other skin malignancies and outcome. From the histopathology we documented various prognostic factors. Results: Ten patients developed 12 melanomas (one patient had three melanomas) from a population of 1874 transplanted patients. The total number of transplant years was 11 942.2. The incidence of melanoma in our population was 12 per 11 942.2 transplant years, which is approximately 8 times greater than the standardized rate for this region. We found that the mean interval between transplant and melanoma was ～11 years (median 8.5). A dermatologist was the diagnosing clinician in at least 67%of cases. Melanomas occurred on the trunk in the majority of cases (58%), followed by the upper limb (25%). All patients apart from one are alive with no recurrence of their melanoma. One patient died as a result of metastatic melanoma. The mean follow-up period following melanoma was 3.7 years. In all patients apart from the patient who died, the melanomas were < 1 mm Breslow thickness. That patient’s melanoma was 4.5 mm thick. There was no precursor naevus in eight of the 12 melanomas. In two there was a precursor dysplastic naevus. In the cases in vertical growth phase the tumour-infiltrating lymphocyte response was absent in four cases and non brisk in one patient. Conclusions: In the Oxford transplant population studied melanomas occurred at approximately 8 times the rate in the general population. This is the highest rate reported in the literature. The patients had a better outcome than reported previously. This may be due to detection at a relatively early stage. Renal transplant recipients attend dedicated dermatology clinics in Oxford, which may have contributed to the early diagnosis and good outcome.

系统性红斑狼疮患者非皮损皮肤中补体活化经典途径的激活与失活

Background: The link between the lupus band and pathogenesis remains controver sial, because immunoglobulins and complement components, including the membrane attack complex, can be found in both lesional and non-lesional skin of patients with systemic lupus erythematosus (SLE). The expression of proteins that regula te complement has not been previously investigated in the skin of patients with SLE. Aim: The aim of this study is to compare the expression of protectin (CD59) , which demonstrates the activation of the classical pathway of complement, in n on-lesional skin obtained from patients with SLE with its expression in normal skin. This may help us explain the link between the lupus band and pathogenesis of cutaneous lupus erythematosus. Methods: An indirect immunofluorescence techni que was performed in order to provide unequivocal evidence for the activation of complement via the classical pathway and to compare the expression of CD59 in n on-lesional skin from patients with SLE with normal skin samples obtained from healthy people. Results: The activation of the classical pathway of complement w as demonstrated in non-lesional skin inmore than 90%of SLE patients investigat ed in this study. Staining intensity of the complement regulatory proteinCD59was markedly increased in themajority of non-lesional skin samples obtained from p atientswith SLE, compared to that from normals. Conclusions: CD59 is overexpress ed in non-lesional skin in which complement activation has occurred. It seems l ikely that an increased and continuous CD59 expression may be important for main taining the integrity of the skin BMZ during inflammatory responses involving co mplement activation in SLE skin.

多发性阴囊表皮松解性棘皮瘤:继发于外伤?

Epidermolytic hyperkeratosis (EH) is an abnormality of epidermal maturation, most commonly due to mutations in keratins 1 and 10, which may be a congenital or an acquired defect. The term epidermolytic acanthoma was applied to a solitary discrete epidermal proliferation characterized by EH. Subsequently there have been several reports of disseminated epidermolytic acanthomas. We report a rare case of multiple epidermolytic acanthomas localized to the scrotum. With the aetiology of epidermolytic acanthoma unknown, trauma has been postulated as a possible cause. Our patient repetitively scratched his scrotum for 5 years and we believe that this action triggered his multiple scrotal epidermolytic acanthomas.

Extracellular vesicles and reproduction-promotion of successful pregnancy

Extracellular vesicles （EVs） are membrane-bound complexes secreted from cells under both physiological and pathological conditions. They contain proteins, nucleic acids and lipids and act as messengers for cell-cell communication and signalling, particularly between immune cells. EV research is a rapidly evolving and expanding field, and it appears that all biological fluids contain very large numbers of EVs; they are produced from all cells that have been studied to date, and are known to have roles in several reproductive processes. This review analyses the evidence for the role of EVs throughout human reproduction, starting with the paternal and maternal gametes, followed by the establishment and continuation of successful pregnancies, with specific focus, where possible, on the interaction of EVs with the maternal immune system. Importantly, variations within the EV populations are identified in various reproductive disorders, such as pre-term labour and pre-eclampsia.

科研道德委员会面临的挑战:一些实际建议

本文要点地方性科研道德委员会面临几个挑战:研究的规模、类型和复杂性不断增加;建立一个多中心科研道德委员会系统;缺乏对研究结果的汇总;发现科研失误和欺骗。面对这些挑战,地方性委员会必须有受过良好训练、具备多种技能的会员,充足的人力及财力资源,以及一个监督已批准的研究项目进程的体系。在多中心研究中,道德评估由多中心委员会和地方性委员会共同承担,后者只保留本地承认的决定权。假如地方性和多中心科研道德委员会采用共同的道德审查标准,其效果和效率将得到提高。

合理的影像学检查 妊娠期疑诊肺栓塞的研究

知识点妊娠期的生理变化可以产生类似肺栓塞的症状,从而使临床诊断不可靠影像学检查可以避免不恰当的治疗,并且不增加胎儿任何的特殊风险。均应接受 X 线胸片检查以排除其他病因半剂量的肺灌注显像检查可以应用于大多数患者由于 CTPA 可使母亲乳房组织暴露于高剂量照射,因此,此项检查应该仅用于合并肺部疾病如哮喘的患者,肺灌注显像对这些患者的诊断价值不大。