Foliate Lymphoid Aggregates as Novel Forms of Serous Lymphocyte Entry Sites of Peritoneal B Cells and High-Grade B Cell Lymphomas.

The cellular homeostasis of lymphoid tissues is determined by the continuous interactions of mobile hematopoietic cells within specialized microenvironments created by sessile stromal cells. In contrast to the lymph nodes and mucosal lymphoid tissues with well-defined entry and exit routes, the movement of leukocytes in the peritoneal cavity is largely unknown. In this study, we report that, in addition to the omental milky spots and fat-associated lymphoid clusters, in mice, the serous surface of the mesenteric adipose streaks contains lymphocyte-rich organoids comprised of a highly compacted leaf-like part connected to the adipose tissue that can also efficiently bind B cells and high-grade B cell lymphoma (diffuse large B cell lymphoma) cells. Denoted as foliate lymphoid aggregates (FLAgs), these structures show incomplete T/B segregation and a partially differentiated stromal architecture. LYVE-1-positive macrophages covering FLAgs efficiently bind i.p. injected normal B cells as well as different types of diffuse large B cell lymphoma cells. Within FLAgs, the lymphocytes compartmentalize according to their chemokine receptor pattern and subsequently migrate toward the mesenteric lymph nodes via the mesenteric lymphatic capillaries. The blood supply of FLAgs includes short vascular segments displaying peripheral lymph node addressin, and the extravasation of lymphocytes to the omental and mesenteric adipose tissues is partly mediated by L-selectin. The appearance of i.p. injected cells in mesenteric lymph nodes suggests that the mesentery-associated lymphatics may also collect leukocytes from the fat-associated lymphoid clusters and FLAgs, thus combining the mucosal and serous exit of mobile leukocytes and increasing the range of drainage sites for the peritoneal expansion of lymphoid malignancies.

[Focal nodular hyperplasia]. / Fokal nodulaer hyperplasi.

INTRODUCTION: Focal nodular hyperplasia (FNH) is a benign lesion of the liver and is most commonly seen in women in the reproductive age. This article is a retrospective study of FNH. MATERIAL AND METHOD: Patients with histologically verified FNH were included. The relationship between tumor size, sex and estrogen was investigated. RESULTS: 24 patients were included. In 19 cases, the diagnosis was made coincidentally during the investigation or treatment of another disease. There was no difference in average tumor-size between sexes, but estrogen-treated women had larger tumors. Biopsies were needed in order to establish the diagnosis and to rule out malignancy. In most cases, the chosen strategy of management was expectancy rather than surgery. CONCLUSION: FNH is a benign liver disease and is often diagnosed coincidentally. An association between tumor size and estrogen treatment remains elusive. Diagnostic Imaging with contrast enhancement may produce characteristic features of FNH. However, biopsy remains the best option to diagnose FNH and to rule out malignancy.

[Appropriate use of hospital days in medical wards]. / Hensigtsmaessig anvendelse af sengedage på medicinske afdelinger.

INTRODUCTION: This study evaluated the incidence of inappropriate use of bed days in Danish medical wards using the European Appropriateness Evaluation Protocol (AEP). Several European countries have used the AEP to assess the appropriateness of hospitalisation days. MATERIALS AND METHODS: The study was carried out in four Danish medical wards from October 2004 to January 2005. On pre-selected days a doctor and nurse performed case record analyses of all hospitalised patients with registration of the AEP criteria. To assess activities during the entire day, the screening comprised activities from the previous day. RESULTS: Altogether, 738 patients were reviewed. On average, 32.1% of hospitalisation days on the four wards were assessed as inappropriate (range 19.2-39.2%). Lack of alternative facilities (different outpatient services, rehabilitation, home nursing, etc.) and internal waiting time for diagnostic tests were the most common causes of inappropriate bed use. 6.4% of bed days were considered appropriate from a clinical point of view even though no AEP criteria were met. CONCLUSION: In order to reduce the number of inappropriate hospital days, it is necessary to optimise the cooperation with the primary health care sector and ensure immediate availability of diagnostic tests.