婴幼儿牛奶过敏162例临床分析

牛奶过敏(cow's milk allergy)是小儿最常见的食物过敏之一,在欧美发达国家,婴儿牛奶过敏发生率约2%～7.5%.牛奶过敏的婴儿还可能对其它食物过敏,如蛋类、豆类、花生仁等,50%牛奶过敏婴儿以后可能出现对吸人性过敏原,如尘螨、花粉等过敏,同时,牛奶过敏婴儿还存在着发生哮喘、湿疹、过敏性鼻炎等特应性疾病的风险.     

Carcinoma of the supraglottic larynx. A review of 221 cases

Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.     

Prognostic factors for adenocarcinoma of the gallbladder: an analysis of 162 cases

We experienced a case with sudden unexpected death caused by rupture of an intracranial aneurysm, which was confirmed by autopsy. Depending on this case, we reported the significance of the cerebellar tonsillar herniation on the cause of sudden death of ruptured cerebral aneurysm. A 58-year-old man was admitted to us for treatment of subarachnoid hemorrhage (SAH). The CT scanning showed diffuse SAH in the whole cistern. Cerebral angiography on admission revealed an aneurysm at the bifurcation of the left middle cerebral artery in association with bleb like configuration. The aneurysmal neck was clipped on the day of admission. The postoperative course was uneventful. In the early morning of postoperative 23rd day, he was found being expired. To clarify the cause of death, an autopsy was done, disclosing diffuse SAH in association with tonsillar herniation more marked on the left. Thus, the distortion of the spinomedullary junction due to asymmetrical herniation was considered to be responsible for unexpected sudden death in this case. Examination of the major cerebral artery disclosed a ruptured anterior communicating artery aneurysm.     

Torsion of the palatine tonsil

Torsion of a pedunculated part of the palatine tonsil is extremely rare. This paper discusses the clinical presentation, differential diagnosis, treatment of such a case and reviews the existing literature.     

Polypoid lipoma of the palatine tonsil

A polypoid, pedunculated tumour of the left palatine tonsil was incidentally detected in a 42-year-old female. It was composed of mature fat and was covered by a nonkeratinizing squamous epithelium with an underlying rim of fibrous tissue. The literature on tonsillar lipoma is reviewed and the differential diagnosis of polypoid lesions of the tonsil is discussed.     

Analysis of the validity of vaginal-cervical cytologic examination in 162 pre- and post-menopausal patients

The authors examine 162 cervico-vaginal smears of women in peri-menopause presenting cellular alterations (ASCUS). These patients were treated with a local topic therapy as the persistence of these alterations in 23 cases (14.2%) second level analyses were performed: gynecological visit, colposcopy and biopsy. In addition to inflammatory aspects 2 in situ carcinomas and 2 moderate dysplasias were recorded. We believe therefore that cytology could be a valid aid also in pre-menopausal women in the cervico-vaginal pathology.     

Extramedullary plasmocytoma of the larynx. Analysis of four cases

Four cases of solitary extramedullary plasmocytoma of the larynx (3 men, 1 women) treated with radiotherapy are presented. Laboratory and X-ray examinations showed no evidence of systemic plasmacytoma. One patient was treated with conventional X-ray therapy and 3 patients with telegammatherapy Co-60. All patients survived 10 years with no evidence of disease.     

Hemorrhagic disease of the newborn. Analysis of 50 cases

The study included 50 cases with this disease which were divided into 2 groups: above and under 2,500 g. A relationship was established among weight and bleeding site, type of delivery, prothrombin activity and lethality. It was found that those under 2,500 g. bled earlier than those above 2,500 g. With higher percentage, the bleeding site was the digestive tract in both groups. Most of both groups bled between the 2nd and 6th day and a group of special interest was made up of 8 patients who bled between the 10th and 28th day of life and that we included as hemorrhagic disease of the newborn because bleeding appeared within the neonatal stage; these patients fell within the group showing the lowest prothombin activity. Bleeding within the central nervous system was frequent and showed the highest lethality.     

Sacral agenesis. Analysis of 22 cases

Sacral agenesis is a rare congenital anomaly of the spine and is usually associated with urologic abnormalities. Twenty-two patients are reviewed. Twenty-one had other congenital and developmental abnormalities in addition to sacral agenesis. Physical examination showed flattening of the buttocks, loss of the gluteal cleft, widely spaced buttock dimples, and a palpable sacral defect. Lateral views of the spine are essential when anteroposterior views suggest an absence of sacral segments. Seven patients had a significant familial history of diabetes mellitus. All patients with involvement of more than one sacral segment had neurogenic bladder dysfunction with incontinence. The degree of neurologic deficit could not be predicted from the radiologic appearance of the sacrum.     

Neurotrophins and their receptors in the pigeon caecal tonsil. An immunohistochemical study

Neurotrophins are growth factors which bind to signal-transducing receptors called Trk proteins. The neurotrophins and their receptor proteins are present in the mammalian and avian lymphoid organs, thus suggesting that these factors could act upon cells of the immune system. Nevertheless, little is known about the cellular distribution of neurotrophins and their receptor proteins in avian lymphoid tissues. In this study we use immunohistochemistry to detect the cellular localisation of neurotrophins and their receptor proteins in the pigeon caecal tonsil, used as a model for avian secondary lymphoid organs. Rabbit polyclonal antibodies against neurotrophins (nerve growth factor -NGF-, brain-derived neurotrophic factor -BDNF- and neurotrophin -3 NT-3-) and against specific epitopes of TrkA, TrkB and TrkC proteins were used. Cytokeratins, vimentin, S-100 protein and chromogranin A were studied in parallel to identify cells which seemed to express neurotrophins and Trk proteins. TrkA-like protein was seen in the intestinal epithelium, whereas TrkB-like and TrkC-like proteins was found in cells which we identified as dendritic cells and macrophages. BDNF-like and NT-3-like reactivity was localised in intestinal epithelial cells, especially endocrine cells. Present results add further evidence to the presumptive immune role of neurotrophins and their receptors and the possible functions of these peptides in the caecal tonsil are discussed.     

Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases

OBJECTIVE: Lymphoproliferative lesions of the ocular adnexa were analyzed to examine (1) the suitability of the Revised European-American Lymphoma (REAL) classification for the subtyping of the lymphomas in these sites; (2) the predictive value of the REAL classification for the evolution of these tumors; and (3) the frequency and prognostic impact of tumor type, location, proliferation rate (Ki-67 index), p53, CD5 positivity and the presence of monoclonality within these tumors. DESIGN: Retrospective review. METHODS: The clinical, histomorphologic, immunohistochemical, and molecular biologic (polymerase chain reaction [PCR]) features of lymphoid proliferations of the ocular adnexa were studied. STUDY MATERIALS: The ocular adnexal lymphoproliferative lesions were located as follows: orbit in 52 patients (46%), conjunctiva in 32 patients (29%), eyelid in 23 patients (21%), and caruncle in 5 patients (4%). RESULTS: Reactive lymphoid hyperplasia was diagnosed in 12 cases and lymphoma in 99 cases; 1 case remained indeterminate. The five main subtypes of lymphoma according to the REAL classification were extranodal marginal-zone B-cell lymphoma (64%), follicle center lymphoma (10%), diffuse large cell B-cell lymphoma (9%), plasmacytoma (6%), and lymphoplasmocytic lymphoma (5%). Age, gender, and anatomic localization of the lymphomas did not have prognostic significance during a follow-up period of 6 months to 16.5 years (mean, 3.3 years). Extent of disease at time of presentation was the most important clinical prognostic factor: advanced disease correlated with increased risk ratios of having persistent disease at the final follow-up and with lymphoma-related death (P < 0.001). Histomorphologic features and immunohistochemical markers positively correlating with disseminated disease at presentation, stage at final follow-up, and occurrence of lymphoma-related death included cytologic atypia (P < 0.001), MIB-1 proliferation rate (P < 0.001), and tumor cell p53 positivity (P < 0.001). The MIB-1 proliferation rates greater than 20% in extranodal marginal-zone B-cell lymphoma corresponded to at least stage II lymphoma (P < 0.05). CONCLUSION: The REAL classification is suitable for the subdivision of the ocular adnexal lymphomas. The MIB-1 proliferation rate and p53 positivity may aid the prediction of disease stage and disease progression, whereas PCR can support the diagnosis and reduce the number of histologically indeterminate lesions.     

Radiation therapy for squamous cell carcinoma of the tonsil

We presented the coexistence of the severe aortic insufficiency and the systemic lupus erythematosus with antiphospholipid syndrome in 33-years old woman. She was qualified for the operation of the prosthesis aortic valve replacement after she was treated with steroids. During the operation, the heart infarct of the inferior wall had been observed, but finally in the postoperation period the heart efficiency improvement was observed. We have discussed same theories and clinical experiences of lupus erythematosus with antiphospholipid syndrome and clinical sequels.     

Cavernous sinus syndrome. Analysis of 151 cases

OBJECTIVE: To characterize lesions causing cavernous sinus syndrome. DESIGN: Review of 26 years of personal experience in a large city hospital. RESULTS: Among 151 patients, tumors (45 patients, 30%) were the most frequent cause of cavernous sinus syndrome. However, when surgical causes (17 patients, 11%) were included, trauma (36 patients, 24%) became most common. Self-limited inflammation was the third frequent cause (34 patients, 23%), while carotid aneurysms and fistulas, infection, and other causes composed the remaining 12%. The age at onset varied with the cause, and patients with aneurysms (average age, 52 years) and patients with tumors (average age, 47 years) were older than those with self-limited inflammation (average age, 35 years) and trauma (average age, 29 years). Spontaneous remissions defined "self-limited inflammation" but were also seen following an acute onset of symptoms due to aneurysms and pituitary apoplexy. CONCLUSIONS: In an unselected series from a city hospital, tumor, trauma, and self-limited inflammation were the predominant causes of cavernous sinus syndrome, and classic causes such as aneurysm, meningioma, and bacterial infection were uncommon. Contrast-enhanced magnetic resonance imaging and watchful waiting proved the most effective diagnostic procedures.     

Severe parachuting accident. Analysis of 122 cases

Based on a population of 122 severely injured patients the causes of paragliding accidents and the patterns of injury are analyzed. A questionnaire is used to establish a sport-specific profile for the paragliding pilot. The lower limbs (55.7%) and the lower parts of the spine (45.9%) are the most frequently injured parts of the body. There is a high risk of multiple injuries after a single accident because of the tremendous axial power. The standard of equipment is good in over 90% of the cases. Insufficient training and failure to take account of geographical and meteorological conditions are the main determinants of accidents sustained by paragliders, most of whom are young. Nevertheless, 80% of our patients want to continue paragliding. Finally some advice is given on how to prevent paragliding accidents and injuries.     

DNA synthesis in tonsil lymphocytes. I. Changes in cell population during culture

Allergic asthma-like attacks were induced in guinea pigs by intraperitoneal injections of Ovalbumin and following inhalation of Ovalbumin aerosol. The animals were narcotized, tracheotomized and a small catheter was placed in mid-oesophagus. The quantities: oesophageal pressure, respiratory flow and tidal volume were measured and recorded on magnetic tape during spontaneous breathing. A technique was applied for automated computation of the parameters of respiratory mechanics using a digital computer. The parameters compliance, resistance, work of breathing and power of breathing showed typical pathological variances and characteristic response-curves in the experimental phases during and after the asthma attacks. These parameters became normal after the injection of Alupent.     

Peripartum cardiomyopathy. Analysis of 3 cases and review of the literature

A patient with hypogammaglobulinemia is presented with a primary cutaneous B-cell lymphoma. Diagnosis requires clinical and histologic criteria as well as phenotyping and genotyping. The cause, differential diagnosis, staging criteria, and treatment of the cutaneous B-cell lymphoma are reviewed.     

Atelectasis of the maxillary sinus. Analysis of progression stages. Apropos of 4 cases

Evaluation of the diphtheria protection in 764 healthy volunteers before and after the vaccination showed that 56.3% had a reliable immunity, 22.8% a doubtful and 20.9% had no immunity. A high risk is in the age group 41-50 years. Young medical personal and alcoholics also have insufficient diphtheria immunity. The results of 41 healthy volunteers with a basic immunisation of more than 10 years ago prove that one booster shot is sufficient irrespective of the moment of the last vaccination.