产褥期脑病62例临床分析

目的研究产褥期脑病的临床特征、治疗方法及预后。方法选择62例产褥期突发精神症状并有全脑受累体征病人的临床资料进行回顾性分析。结果发现产褥期脑病的临床表现酷似病毒性脑炎,但病前无明显感染灶,病程较长,疗效和预后较差。结论对产褥期精神异常病人应进行神经病学方面检查,尽早诊治。病初要控制和缩短脑水肿期,防止和减轻脑细胞的变性和脱鞘;恢复期要耐心而持久地进行各种康复治疗,以便病人恢复到最佳健康水平。     

HO-1、HO-1 mRNA在肝硬化病人肝组织中的表达及与门静脉压力的关系

目的　观察HO CO系统在肝硬化病人肝组织中的表达及与门静脉压力的关系 ,以探讨其在肝硬化门脉高压中的作用。方法　随机选取 2 0例正常志愿者及 2 0例肝硬化患者 ,在B超引导下经皮经肝穿刺分别测定门静脉压力、抽取门静脉血和外周血并留取肝组织 ,测定血液中CO浓度 ,用免疫组化和RT PCR方法观察肝组织HO 1及其HO 1mRNA的表达。结果　肝硬化病人下腔静脉及门静脉血中CO浓度、肝组织HO 1、HO 1mRNA的表达及门静脉压力均分别显著高于正常对照组 ,正常对照组的外周血和门静脉血中CO浓度水平接近 ,无明显差异 ;但肝硬化患者的门静脉血CO浓度显著高于外周血CO浓度。结论　门脉血CO浓度、肝组织中HO 1以及HO 1mRNA表达与门静脉压力密切相关     

肝钳与肝门阻断的肝损害及其防治的实验研究

本实验观察不同阻断时刻肝钳与肝门阻断的肝损害以及预防性应用抗氧化剂的缓解作用。结果表明：（１）ＳＧＰＴ、ＴＢ在肝钳组的变化比肝门阻断组表现得更为一过性。而肝门阻断给药组的改变要比非给药组的轻微且恢复得快。（２）肝门阻断时，ＭＤＡ含量显著升高，机体的Ｔ－ＡＯＣ和ＳＯＤ下降。而给药组可明显减轻上述改变。（３）随着肝门阻断时间的延长，肝组织损害也相应加重，抗氧化剂的给予缓解了肝缺血和再灌注造成的组织损害。肝钳组由于健肝血供未受干扰，因此，不同阻断时刻肝组织学形态与对照组相似无甚改变。结论：（１）肝钳较肝门阻断的肝损害轻，且实用安全。（２）肝门阻断预防性使用抗氧化剂，可明显减轻肝缺血再灌注损害。（３）肝门阻断时经门静脉较外周静脉输注抗氧化剂，其保护作用更直接、明显     

The Effects of Serum from Patients with Acute Liver Failure on the Growth and Metabolism of Hep G2 Cells

In many bioartificial liver systems currently being designed and evaluated for use in fulminant hepatic failure, direct contact is required between the patient's blood and the liver cells in the device. The efficacy of such devices will be influenced by the interaction of fulminant hepatic failure (FHF) patient serum with the cells. We have found that FHF serum inhibits the growth rate and the synthesis of DNA, RNA, and protein; disturbs glutathione homeostasis; and induces morphological changes in cultured human Hep G2 cells. These interactions should influence the design of bioartificial liver devices based on proliferating cell lines and indicate the requirement to pretreat FHF patient plasma to reduce the toxin load.     

大鼠颌下腺切除对CCl4所致肝损伤修复的影响

实验大鼠分为颌下切除＋ＣＣｌ４组，假手术＋ＣＣｌ４对照组及正常对照组，结果假手术＋ＣＣｌ４第２ｄ时Ⅲ带细胞轻度受损，第４ｄ、８ｄ时受损面积略大，第１２ｄ时大部分细胞恢复，而颌下腺切除＋ＣＣｌ４组则损伤明显，第８ｄ时胞质极度稀疏，１２ｄ时大部分细胞尚未恢复，与假手术组比较，该组Ｆｅｕｌｇｅｎ反应略弱，ＰＡＳ反应减弱，第４～８ｄ时较明显，Ｇ－６－Ｐ，ＳＤＨ活性均减弱。结果表明颌下腺切除导致内源性表皮生     

Treatment strategies for hepatic metastasis from colorectal cancer

Hepatic micrometastases of the parenchyma adjacent to a macroscopic lesion were detected in 17 of 31 resected liver metastases. Fifty-nine micrometastatic lesions were detected in total; 26 lesions were situated in the portal vein (PV), 22 in the central vein (CV), 5 in the bile duct (BD), and 6 in the sinusoid (SS). A histological study confirmed the direct invasion of the macrometastatic cancer cells into the adjacent PV, CV, BD, and SS. According to the tumor doubling time, the mean diameter of the macrometastases in 19 remnant livers was calculated to have been 0.57±0.87 cm at the time of the primary resection. The calculated diameter of 3 of these 19 macrometastases was found to be less than 0.01 cm, the minimum implantable size, indicating that the cancer recurrence in these specimens may have developed from macroscopic metastatic lesions as a satellite, and not from the primary tumor. In 13 patients who received doses of 5250 mg or more of 5 fluorouracil (FU) via the hepatic artery, the cumulative disease-free rate 2 years postoperatively was 100%; this value was 47.6% in 11 patients who received less than 5250 mg of 5 FU via the hepatic artery, and 0% in 39 patients who received no chemotherapy (P<0.005). These results suggest that anatomical hepatic resection for satellite lesions, combined with prophylactic hepatic arterial chemotherapy for micrometastases, decreases the recurrence rate of hepatic metastases in the remnant liver.     

肝胆管结石并高位胆管狭窄的外科治疗

治疗肝胆管结石并高位胆管狭窄７４例。术中通过高位胆管的充分暴露，１～３级胆管切开整形、肝切除的正确应用，纤维胆道镜检及取石，大口胆肠内引流等多种手术的联合使用，提高了手术疗效，降低了残石率．认为术前详细的路道影像学检查、对手术难度的充分预测、术式的正确选择等非常重要．强调术中病肝切除的重要性．     

Schistosoma mansoni infection in a recently exposed community in Senegal: lack of correlation between liver morphology in ultrasound and connective tissue metabolites in serum

Summary Four hundred and seventy villagers of Ndombo, a village with recently established intensive transmission of Schistosoma mansoni in the Senegal River Basin, were enrolled in a study with the intention to assess hepatosplenic morbidity. All patients were examined parasitologically and by ultrasound. Hepatic fibrosis serum markers were determined in 153 adult patients (aminoterminal propeptide of procollagen type III, hyaluronan and laminin). By ultrasound, about 60% of the patients showed early stages of hepatic involvement, 3% of the patients unequivocally showed severe hepatosplenic pathology (grade 3 according to the Managil classification), whereas in another study performed in the same village 3 years earlier, no patients with severe hepatosplenic pathology had been found. No correlation between the aminoterminal propeptide of procollagen type III, hyaluronan or laminin and the ultrasound findings could be established. These hepatic fibrosis serum markers do not seem to be a sensitive method to detect early hepatic fibrosis in schistosomiasis.     

Percutaneous hepatic venous isolation and extracorporeal charcoal hemoperfusion for high-dose intraarterial chemotherapy in patients with colorectal hepatic metastases

The results of treating 12 consecutive patients with unresectable colorectal hepatic metastases with a hepatic arterial infusion of high-dose Adriamycin, 100–120 mg/m², using hepatic venous isolation (HVI) and charcoal hemoperfusion (CHP) are reported herein. Adriamycin was administered over 5–15 min under extracorporeal drug elimination by HVI-CHP. HVI was percutaneously accomplished by either the double-balloon technique using a Fogarty occlusion catheter (8/22F) or a balloon-tipped catheter (16F). During the infusion, isolated hepatic venous blood was filtered by CHP and pumped into the left axillary vein. There were no lethal complications, and good hemodynamic tolerance to HVI-CHP was confirmed. Tumor liquefaction accompanied by a sharp decrease in serum carcinoembryonic antigen levels by more than 50% of pretreatment levels was observed in 6 of the 12 patients 1 month after treatment. Apart from chemical hepatitis, which developed in 11 (92%) of the patients, the Adriamycin toxicities were well controlled following the development of nausea and vomiting in 2 patients (17%), leukopenia <2,000/mm³ in 3 (25%), and gastric ulcer in 1 (8%). These results indicate that this method is a safe and useful procedure for otherwise hazardous high-dose intraarterial chemotherapy in patients with unresectable hepatic tumors.     

Hepatic angiomyolipoma developing during the follow-up of ulcerative colitis: Report of a case and review of the literature

Hepatic angiomyolipoma is a rare tumor composed of spindle-shaped and epithelioid smooth muscle cells, adipose tissue, and proliferating blood vessels. We report the first documented case of this tumor developing in a patient with ulcerative colitis. A solitary tumor (7.5×7.5×7cm) was detected in the left lateral segment of the liver and a left hepatic lobectomy was performed. The diagnosis of angiomyolipoma was confirmed by a pathological examination. We also review the literature on previously reported cases of hepatic angiomyolipoma.