Kinetic analysis of impaired work-cost performance in jaundiced rabbit liver

Impairment of energy metabolism was studied in jaundiced rabbit liver by kinetic analysis of energy transfer function. Free cytosolic ADP (ADP_f), as calculated from the measured components of the glyceraldehyde-3-phosphate dehydrogenase and 3-phosphoglycerate kinase/lactate dehydrogenase reactions, decreased from the control value of 48.1 to 37.0 μM at 24 h after bile duct ligation. The maximal velocity (V_max) of ATP synthesis, as measured by state 3 respiration of isolated mitochondria, decreased from the control value of 62.1 to 38.3 nmol ATP synthesized per min per mg mitochondrial protein, while the Michaelis constant for ADP (K _m) decreased from the control value of 19.2 to 12.8 μM. ATP synthesis velocity in vivo {v:V_max/[1+(K _m/[ADP_f])]}, as calculated by V_max,K _m and ADP_f, decreased from the control value of 44.4 to 28.5 nmol ATP synthesized per min per mg mitochondrial protein. Δv/ΔADP_f (Δv/ΔADP_f: V_max·K _m/(K _m+[ADP_f])²), which indicates work-cost performance of the liver, decreased from the control value of 0.263 to 0.198. Biochemical output of the liver, as measured by hippurate synthesis from benzoate, decreased from the control value of 98.4 to 32.7 mg/h. These results indicate that synergistic decreases in ADP_f, V_max, v and Δv/ΔADP_f take place in the course of deterioration of mitochondrial ATP synthesis and work output in jaundiced liver     

Peribiliary cysts in cirrhotic liver: observation on computed tomography

Background: To analyze the frequency and number of suspected peribiliary cysts in cirrhotic liver on computed tomography (CT). Methods: Three hundred forty-six cases with clinically diagnosed liver cirrhosis (LC) and 307 cases with clinically diagnosed non-LC were subjected to the study. The frequency and number of suspected peribiliary cysts on CT were compared between the two groups. The existence of peribiliary cysts was suggested when a cyst was observed around the second- to fourth-order branches of the intrahepatic portal vein. Results: Peribiliary cysts were suggested on CT in 31 of 346 cirrhotic livers (9.0%) and 10 of 307 noncirrhotic livers (3.3%). This difference in the frequency of peribiliary cysts was statistically significant (χ², p < 0.01). Multiple peribiliary cysts were seen in 71% of cirrhotic patients with peribiliary cyst. The size of peribiliary cysts was smaller than 1.5 cm in diameter. Conclusion: Peribiliary cyst is radiologically observed more frequently in cirrhotic liver than in noncirrhotic liver and is occasionally multiple. Received: 1 November 1994/Accepted after: 24 February 1995     

Fibronectin is related to prealbumin in plasma of decompensated cirrhotics

Summary In a group of 23 patients with advanced liver cirrhosis we have found a statistically significant positive correlation (r=0.746; p<0.0001) between fibronectin and prealbumin levels measured in plasma by immunonephelometric methods and found significantly lower than in healthy controls (p<0.001). On the contrary, no correlation of fibronectin neither to albumin nor to the presence of an enlarged spleen was observed. Since the sensitivity of prealbumin as an index of liver function is believed to be higher than that of albumin, our results support the view that the decreased fibronectin in advanced cirrhotics is mainly due to their liver failure, an enlarged spleen playing only a minor role. This work was supported by grants from theAssessorato alla Sanità, Regione Veneto, and theConsiglio Nazionale delle Ricerche (CNR), Roma, Italy (contract n^o 84.00857.04).     

Schistosomiasis of the liver

Schistosomiasis is an infection of trematodes, Schistosoma, causing periportal fibrosis and liver cirrhosis due to deposition of eggs in the small portal venules. In schistosomiasis caused by S. mansoni, sonography shows echogenic thickening or fibrotic band along the portal veins. CT shows low-attenuation bands or rings around the large portal vein branches in the central part of the liver with marked enhancement. Hepatoplenomegaly, liver cirrhosis, portal hypertension and gastroesophageal varies are commonly associated. In schistosomiasis caused by S. japonicum, sonography shows echogenic septae in the liver, utlining the polygonal liver lobules, mimicking “fish-scale” network appearance, reflecting fibrosis. CT shows periportal septae in the peripheral part of the liver parenchyma, producing “turtle-back” appearance, representing calcified eggs along the portal tracts. The portal tracts and hepatic capsule are enhanced on contrast-enhanced CT images. The size and shape of the liver are relatively preserved. MR images show fibrous septae as low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and these fibrous septae are enhanced. CT images of the lungs show multiple scattered nodules with halo of ground-glass opacities. Exudative granulomatous inflammation of the colonic wall may produce inflammatory polyps, fibrous thickening or stenosis of the colonic wall.     

磁共振R2* mapping评估大鼠急性放射性肝损伤模型早期肝纤维化

目的 探讨MR R2^* mapping技术评估SD大鼠急性放射性肝损伤模型早期肝纤维化的可行性。方法 将30只SD大鼠随机平均分为3组,以固定剂量对大鼠右半肝进行单次放疗,制备急性放射性肝损伤大鼠模型。于放疗前、放疗后1个月（A组）、2个月（B组）和3个月（C组）,分别行T1WI、T2WI及R2^*扫描。扫描后处死大鼠行病理学检查、评估肝纤维化分期。测定大鼠左、右半肝的T1WI和T2WI的信号强度及R2^*值,分析R2^*值与大鼠肝纤维化病理分期的相关性。结果 最终7只大鼠死亡,A组8只、B组8只、C组7只纳入研究。A、B、C组大鼠肝左叶及右叶相对T1、T2值差异无统计学意义（P均>0.05）。放疗后3组肝右叶R2^*值均高于肝左叶（P均<0.05）。3组组间两两比较,肝右叶R2^*值随放疗后时间延长而升高（P均<0.05）,肝左叶的R2^*值差异均无统计学意义（P均>0.05）。放疗前大鼠肝右叶R2^*值为（38.42±5.69）Hz,S0期大鼠肝右叶R2^*值为（50.75±6.12）Hz,S1期为（58.73±6.40）Hz,S2期（64.34±5.87）Hz。肝右叶R2^*值与病理分期呈高度正相关（r_s=0.819,P<0.05）。结论 R2^*值可用于准确反映SD大鼠急性放射性肝损伤模型早期纤维化程度。     

Jaundice in critical illness: promoting factors of a concealed reality

Objective In critical illness, liver dysfunction (LD) is associated with a poor outcome independently of other organ dysfunctions. Since strategies to support liver function are not available, a timely and accurate identification of factors promoting LD may lead to prevention or attenuation of its consequences. The aim of this study was to assess risk factors for LD in critically ill patients. Design Prospective, observational study. Setting A multidisciplinary intensive care unit (ICU) of a university hospital. Patients All patients consecutively admitted over a 6-month period. Intervention None. Measurements and results LD was defined as serum bilirubin levels ≥ 2 mg/dl and lasting for at least 48 h. Out of 283 patients, 141 matched inclusion criteria. Forty-four patients (31.2%) showed LD (LD group), while 97 (68.8%) were included in control group (C group). A binomial analysis showed that LD occurrence was associated with moderate (odds ratio [OR] 3.11; p = 0.04) and severe shock (OR 3.46; p = 0.05), sepsis (OR 3.03; p = 0.04), PEEP ventilation (OR 4.25; p = 0.006), major surgery (OR 4.03; p = 0.03), and gram-negative infections (OR 3.94; p = 0.002). In stepwise multivariate analysis, the single independent predictive factors of LD resulted in severe shock (p = 0.002), sepsis (p = 0.03), PEEP ventilation (p = 0.04), and major surgery (p = 0.05). Conclusions In critically ill patients jaundice is common, and severe shock states, sepsis, mechanical ventilation with PEEP and major surgery are critical risk factors for its onset. Since there is no specific treatment, prompt resuscitation, treatment of sepsis and meticulous supportive care will likely reduce its incidence and severity.     

Carbohydrate-binding proteins (plant/human lectins and autoantibodies from human serum) as mediators of release of lysozyme,elastase, and myeloperoxidase from human neutrophils

Analysis of cell surface glycosylation not only provides information about cell properties such as their state of differentiation or histogenetic lineage. The carbohydrate chains also provide potentially functional binding sites to endogenous carbohydrate-binding proteins. This interaction can elicit consequent signalling processes. Because of the importance of neutrophils in the host defence system, we monitored the effect of the binding of such sugar receptors to their cell surface on the release of the enzymatic activities of lysozyme, elastase, and myeloperoxidase. Besides the mannose-binding lectin concanavalin A and the immunomodulatory α/β-galactoside-binding lectin fromViscum album L., three preparations of human sugar receptors—β-galactoside-binding lectin (M _r 14 kDa) and two affinity-purified polyclonal IgG fractions from serum with the capacity to recognize α- or β-galactosides, respectively—were used. Two animal lectins from chicken liver and intestine that bind β-galactosides, as well as the lectin-like human serum amyloid P component, were included in order to assess the importance of slight differences in ligand recognition. Cytochalasin B-enhanced enzyme release was invariably seen with the two plant lectins and the chicken liver β-galactoside-binding lectin, but the related intestinal lectin did not increase enzyme release. The mammalian homologue of these avian lectins triggered lysozyme secretion, and the lactoside-binding IgG fraction enhanced the amount of extracellular elastase activity slightly but significantly. Thus, the actual lectin, not the nominal specificity of sugar receptors, is crucial for elucidation of responses. Due to the highly stimulatory activity of the two plant lectins, neutrophils from patients with non-cancerous diseases and from patients with lung cancer were monitored for the extent of lectin-mediated enzyme release. Only the concanavalin A-mediated reactivity of the neutrophils was associated with the type of disease.     

Echinococcosis of the liver

Echinococcosis, also known as hydatid disease, is an infection of larval stage animal tapeworm, Echinococcus. The larvae reside in the liver and lungs, producing multiloculated fluid-filled cysts. Imaging findings of Echinococcosis caused by E. granulosus are single, unilocular cyst or multiseptated cysts, showing “wheel-like”, “rosette-like” or “honeycomb-like” appearances. There may be “snow-flakes” sign, reflecting free floating protoscoleces (hydatid-sand) within the cyst cavity. Degenerating cysts show wavy or serpentine bands or floating membranes representing detached or ruptured membranes. Degenerated cysts show heterogeneous, solid-looking pseudotumor that may show “ball of wool sign”. Dead cysts show calcified cyst wall. Echinococcosis caused by E. multilocularis produces multilocular alveolar cysts with exogeneous proliferation, progressively invading the liver parenchyma and other tissues of the body. Imaging findings are ill-defined infiltrating lesions of the liver parenchyma, consisting of multiple small clustered cystic and solid components. On sonography, lesions are heterogeneous with indistinct margins, showing “hailstorm appearance” or “vesicular or alveolar appearance”. CT and MR imaging displays multiple, irregular, ill-defined lesions. Multiple small round cysts with solid components are frequent. Large lesions show “geographical map” appearance. Calcifications are very frequent, appearing as peripheral calcification or punctuate scattered calcific foci. Invasion into the bile ducts, portal vein or hepatic vein may occur. Direct spread of infected tissue may result in cysts in the peritoneal cavity, kidneys, adrenal gland or bones.     

Comparative effects of α, β and γ human interferons on a HBsAg-producing human hepatoma cell line

Summary The effects of all the three types of human interferons (α, β and γ) on a human hepatoma cell line with hepatitis B virus (HBV)-DNA sequences integrated into the host DNA and producing hepatitis B surface antigen (HBsAg) in culture medium were assayed. The aim of the present research was to test human interferon preparations in anin vitro system for hepatitis B virus, and to compare the observed effects. The results evidenced both the antireplicative activity principally showed by preparations of β and γ human interferons and the inhibition of HBsAg production by high concentrations of γ human interferon. This work was supported in part by a grant from theConsiglio Nazionale delle Ricerche (CNR), Roma, Italy (contract № 83.00631.52).     

Bioavailability of beta-aescin from horse chestnut seed extract: comparative clinical studies of two Galenic formulations

The bioavailability of β-aescin—the main active constituent of horse chestnut seed extract—in a nonretarded test medication in comparison with that in a retarded reference formulation was evaluated in 2 randomized crossover clinical trials involving 18 healthy volunteers each. Serum concentration/time curves derived under steady-state conditions and pharmacokinetic parameters measured during both studies showed no significant difference between absorption rates for the retarded versus nonretarded preparation. In the first study, investigators found a test-to-reference ratio of 1.06 (90% confidence interval [CI] range: 99–113) for the area under the curve (AUC; the primary outcome measure). Absorption rates were diminished during the night compared with daytime rates for both study preparations. In the second study, using AUC and maximum concentration (C_max) as the primary characteristics, investigators analyzed bioavailability based on the mean of 2 consecutive daytime periods and obtained estimates of 1.07 for AUC (90% CI range: 0.96–1.19) and 1.05 for C_max (90% CI range: 0.90–1.21). Bioequivalence of the test and reference drug preparations was thus established according to theNote for Guidance on the Investigation of Bioavaiiability and Bioequivalence. Both treatments were equally well tolerated.     

Methodological assessment of combined spiral CT angiography and CT arterial portography

Background: To assess an optimal methodology of combined spiral computed tomographic (CT) angiography (CTA) and CT arterial portography (CTAP) for detection and characterization of liver tumors. Methods: We performed spiral CTAP only in five patients with 30–32% contrast (subset A), CTAP combined with preceding spiral CTA using 30–32% contrast in 19 (subset B), and CTAP combined with preceding spiral CTA with 60–64% contrast in seven (subset C). The CT numbers of the aorta immediately before preceding CTA and subsequent CTAP and the CT numbers of malignant tumor and liver parenchyma with CTAP were measured. Results: The differences of the CT number between the malignant tumor and liver parenchyma on CTAP were 61.1–161.8 (mean ± SD, 114.5 ± 39.3) HU, 50.7–164.8 (104.2 ± 31.2) HU, and 101.2–368.3 (219.5 ± 90.5) HU in subsets A, B, and C, respectively. Two cavernous hemangiomas showed pathognomonic findings with preceding CTA. Conclusion: Combination of preceding spiral CTA and subsequent spiral CTAP using 30% contrast with a 5-min interval is an optimal method for detection and characterization of liver tumors. Received: 14 December 1995/Accepted after revision: 13 February 1996     

模拟器训练显著缩短腹腔镜肝左外叶切除术学习曲线

目的:腹腔镜技术在肝脏外科中应用日趋广泛,腹腔镜下肝切除术对腔镜技术具有较高要求,年轻医师需经历较长的学习曲线才能掌握并熟练运用。方法:本研究对肝脏外科具有三年以上工作经验、且无腹腔镜基础的年轻医师进行基于腹腔镜模拟器的训练,并评估技术改善情况。同时观察受训者独立开展腹腔镜下肝左外叶切除术的情况。结果:经过腹腔镜模拟器培训120 h后,受训者完成缝合打结所需时间较训练前显著缩短[受训对象A为(141.5±17.6) s vs(342.5±24.7) s;受训对象B为(127.5±3.5) s vs(319.5±43) s;受训对象C为(132.5±3.5) s vs(310±14.1) s]。自2016年3月至2018年9月,受训对象共独立完成93例腹腔镜下肝左外叶切除术,术中平均出血量为(61±42) mL,无中转病例,术中均未阻断第一肝门,术后并发症发生率(按照Clavien-Dindo分级)为23.6%,未出现围手术期死亡病例。中位手术时间为98 min,三位受训者达到中位手术时间所需要的病例数分别为10例、8例、23例。结论:腹腔镜模拟训练可有效提高肝脏外科腹腔镜操作者的熟练程度,能有效地缩短学习曲线,并顺利开展腹腔镜下肝左外叶切除术。     

磁共振定量测定儿童及青少年戈谢病肝脾脏体积及脂质含量

目的 探讨MRI定量分析儿童及青少年戈谢病患者肝脏、脾脏体积及脂质含量的价值。方法 对经骨髓穿刺证实的42例戈谢病患者（其中12例已行脾脏切除）行腹部MR检查,序列为冠状位三维梯度回波Dixon水脂分离（3D FFE mDIXON）和T2WI-STIR序列。所有患者均正在接受酶替代治疗。评估患者肝脏、脾脏脂质含量的差异及相关性。结果 42个肝脏校正的体积值为25.15~48.99 ml/kg,平均（33.66±6.03）ml/kg,脂质含量4.63%~10.09%,平均（5.90±1.10）%;30个脾脏校正的体积值为4.48~56.04 ml/kg,平均（16.36±10.65）ml/kg,脂质含量4.78%~19.39%,平均（6.63±2.62）%。同一患者脾脏脂质含量高于肝脏（t=2.16,P=0.04）。结论 采用MRI测量肝脾脏体积及脂质含量具有一定的可行性,可用于监测儿童及青少年戈谢病患者的病情及治疗效果。     

Partial inefficiency of T cell receptors γ/δ composed of a heavy (55-kD) γ chain to mediate cell activation upon binding to specific monoclonal antibodies

Summary We analyzed CD8⁺ T cell receptor (TCR) γ/δ⁺ (δ-TCS-1 reactive) cell clones expressing the 55-kD γ chain for their susceptibility to triggering by monoclonal antibodies (mAbs) specific for TCR or CD3 molecules. Clones were derived by limiting dilution from CD3⁺, WT31⁻ FACS-purified peripheral blood populations or CD4⁻CD8⁻ thymocytes (a fraction of the latter cells expressingde novo CD8 surface antigen upon culture in IL-2). Clones were screened according to their reactivity with both anti-CD8 and δ-TCS-1 mAbs. Analysis of CD3-associated molecules immunoprecipitated by anti-Leu-4 (anti-CD3) mAb under conditions which preserve the CD3/TCR association (1% digitonin) showed a predominant 55–60-kD molecule both under reducing and non-reducing conditions. All clones expressing the δ-TCS-1⁺ CD8⁺ surface phenotype derived from either thymus or peripheral blood lysed the Fcγ receptor-bearing P815 target cells in the presence of anti-CD3 mAb. On the other hand, δ-TCS-1 mAb was poorly efficient in triggering the lytic machinery of these clones, while it induced target cell lysis by δ-TCS-1⁺ CD8⁻ clones. This work was supported by grants from theConsiglio Nazionale delle Ricerche (CNR), Roma, Italy,Progetto Finalizzato ‘Oncologia’ to M. C. M. and A. M., and from theAssociazione Italiana per la Ricerca sul Cancro (AIRC).     

Computer-aided image analysis of focal hepatic lesions in ultrasonography: preliminary results

Purpose  To develop a computer-aided image analysis (CAIA) algorithm for analyzing US features of focal hepatic lesions and to correlate the feature values of CAIA with radiologists’ grading. Materials and methods  Two abdominal radiologists, blinded to the final diagnosis, independently evaluated sonographic images of 51 focal hepatic lesions in 47 patients: hemangiomas (n = 19), hepatic simple cysts or cystic lesions (n = 14), hepatocellular carcinoma (n = 11), metastases (n = 6), and focal fat deposition (n = 1). All images were graded using a 3- to 5-point scale, in terms of border (roundness, sharpness, and the presence of peripheral rim), texture (echogenicity, homogeneity, and internal artifact), posterior enhancement, and lesion conspicuity. Using a CAIA, texture and morphological parameters representing radiologists’ subjective evaluations were extracted. Correlations between the radiologists and the CAIA for assessing parameters in corresponding categories were computed by means of weighted κ statistics and Spearman correlation test. Results  A good agreement was achieved between CAIA and radiologists for grading echogenicity (weighted κ = 0.675) and the presence of hyper- or hypoechoic rim (weighted κ = 0.743). Several CAIA-derived features representing homogeneity of the lesions showed good correlations (correlation coefficient (γ) = 0.603∼0.641) with radiologists’ grading (P < 0.05). For internal artifact (γ = 0.469–0.490) and posterior enhancement (γ = −0.516) of the cyst and lesion conspicuity (γ = 0.410), a fair correlation between CAIA and radiologists was obtained (P < 0.05). However, parameters representing lesions’ border such as sharpness (γ = 0.252–0.299) and roundness (γ = −0.134–0.163) showed no significant correlation (P > 0.05). Conclusion  As a preliminary step in US computer-aided diagnosis for focal hepatic lesions, a CAIA algorithm was constructed with a good agreement and correlation with human observers in most US features. In addition, these features should be weighted highly when a computer-aided diagnosis for characterizing focal liver lesions on US is designed and developed.     

Central venous cannulation in patients with liver disease and coagulopathy – a prospective audit

Objective: To determine the incidence of vascular complications associated with central venous cannulation in patients with liver disease and coagulopathy. Design: A prospective audit of all cannulation episodes in patients with liver disease and a prothrombin (INR) more than 1.5 and/or platelet count of 150 × 10⁹/l or less. Setting: A specialist liver unit between January 1996 and September 1997. Patients: Patients with acute or chronic liver diseases and patients undergoing liver transplantation or other hepatobiliary surgery. Measurements and results: Vascular complications of central venous cannulation were classified as major (any haemodynamically significant haemorrhage) or minor (superficial oozing or haematoma). We recorded 658 cannulations (subclavian, 352, and internal jugular, 306). The median INR was 2.4 (range 1–16) in the subclavian group and 2.7 (1–17) in the internal jugular group (p < 0.05); median platelet counts were 81 × 10⁹/l (range 9–1088) and 83 × 10⁹/l (10–425), respectively (difference not significant). One patient developed a haemothorax after accidental subclavian artery puncture (INR was 1.5, platelets 68 and regional prostacyclin therapy was being given for haemofiltration). There were no other major vascular complications. Risk factors for minor vascular complications included internal jugular cannulation, more than one needle pass into the vein, failure to pass any guidewire, a high INR and low platelets for haematoma formation, and low platelets and heparin therapy for superficial oozing. Conclusions: The incidence of major vascular complications following central venous cannulation in patients with liver disease and coagulopathy was low in this audit. In liver disease the presence of a raised INR alone should not be considered a contra-indication to central venous cannulation. Received: 18 September 1998 Final revision received: 4 January 1999 Accepted: 24 February 1999     

MSCT增强延迟扫描定量评估肝细胞外间隙的可行性

目的 探讨MSCT增强延迟扫描定量评估肝细胞外间隙(fECS)的可行性。方法 选取经病理证实的肝纤维化患者20例(肝纤维化组)和因接受尿路造影检查、既往无肝疾病史的成年人20名(正常组)。对所有受检者注射对比剂10 min后行延迟扫描,分别测量并比较两组fECS大小。结果 肝纤维化组、正常组fECS分别为为(34.83±5.81)%、(28.73±4.42)%,差异有统计学意义(t=5.04,P<0.001)。结论 MSCT增强延迟扫描定量评估fECS可行,能够有效地区分肝纤维化和正常者。     

Dual-Time-Point FDG-PET/CT for the Detection of Hepatic Metastases

Purpose  To prove the sensitivity of dual-time-point imaging with 18F-flourodeoxyglucose-positron emission tomography (18F-FDG-PET) of the liver to evaluate possible changes in the tumor-to-background ratio considering an improved detection rate of liver lesions. Procedures  Image acquisition for the first whole-body scan started at a mean time point of 69 min (55–110 min). The mean time interval between the injection of 18F-FDG and the second delayed scan was 100 min (85–166 min). Results  Of 90 proven liver metastases in 34 patients, the first scan detected 53 (59%) liver lesions correctly, whereas in the second, delayed scan 81 (90%) lesions were diagnosed correctly (p<0.001). The mean Standardized uptake values in the first and second delayed scan were 6.59 g/ml versus 8.09 g/ml, respectively (p<0.001). Tumor-to-background ratio of the first and second delayed scan were 2.0 and 2.7, respectively (p = 0.04). Conclusions  Dual-time-point-imaging of the liver showed a significant increase of tumor-to-background ratio and hypermetabolic lesion diameter. Although, 30% of all verified liver lesions could only be detected in the second delayed scan 10% of all malignant liver lesions were missed with FDG-PET.     

肝脏上皮样血管内皮瘤MRI征象

目的 观察肝脏上皮样血管内皮瘤（EHE）的MRI表现。方法 回顾性分析经病理证实的18例肝脏EHE患者的MRI资料,观察肿瘤分布、大小、形状、边界、信号强度、强化方式等,探讨其MRI特征,并测量病变及周围正常肝组织的ADC值。结果 18例EHE均为多发病灶,其中结节型10例,融合型8例。病变于平扫T1WI均呈低信号,16例T2WI呈"靶征"（边缘稍高信号伴中央更高信号）,2例呈混杂信号;DWI均呈高信号,病灶ADC值为（1.58±0.25）×10^-3 mm²/s,高于周围正常肝组织ADC值[（1.34±0.12）×10^-3 mm²/s,t=4.014,P=0.001]。增强扫描10例结节型中7例呈环形渐进性向心强化,其中3例见"双环征",3例呈持续环形强化;8例融合型中,7例呈云絮状渐进性强化,1例呈环形渐进性向心强化。16例病灶内见血管穿行,13例血管止于病灶边缘或病灶内,15例伴肝包膜回缩。结论 肝脏EHE的MRI表现具有一定特征性,有助于诊断和鉴别诊断。     

Preventing surgical-site infections after colorectal surgery

Surgical-site infection (SSI) is a major contributor to patient mortality rates and health care costs. Due to the high risk of bacterial contamination, colorectal surgery is associated with a particularly high risk of postoperative infection. The surveillance reported here was conducted at Aichi Medical University Hospital on 304 patients who underwent elective colorectal resection—total or partial—from June 2006 to May 2009. To determine risk factors for SSI, multivariate analysis was used. Forty-six (15.1%) patients were diagnosed with SSI. Patients who received cefotiam for prophylaxis showed the highest incidence of SSI (26.6%), and patients who were administered flomoxef showed the lowest incidence (8.1%). Patients who developed SSI were more likely to intraoperative blood loss (308.1 ± 29.8 vs. 153.9 ± 12.2; p < 0.05), longer postoperative antimicrobial administration (5.3 ± 2.2 vs. 4.5 ± 1.5; p < 0.05), and longer operative time (3.3 ± 1.6 vs. 2.7 ± 1.2; p < 0.05). Intraoperative bleeding, antimicrobial choices to cover both anaerobic and aerobic bacteria, and length of antimicrobial administration were independently predictive of SSI development according to multivariate logistic regression analysis. These results suggest that the degree of operative invasion and anaerobic bacteria contribute to SSI following colorectal surgery.