门静脉高压症患者脾内血管病变及其发病机制的研究

探讨门静脉高压症患者脾内血管病变及其机理。方法对２８例门静脉高压脾脏和１０例正常脾破裂脾脏切除标本,行ＨＥ染色和ＭＡＳＳＯＮ染色,观察血管形态学改变;免疫组织化学法检测增殖细胞核抗原（ＰＣＮＡ）、血管内皮生长因子受体１（Ｆｌｔ－１）的蛋白质表达;原位杂交法检测血管内皮生长因子、碱性成纤维细胞生长因子的ｍＲＮＡ表达。     

脾脏原发性恶性肿瘤

报告原发性脾脏恶性肿瘤7例。临床以左上腹不适，左上腹肿块及体重下降、发热、贫血、白细胞减少及血小板减少为主要特点。病理以淋巴系统及血管源性恶性肿瘤多见。治疗以手术和化疗等手段为主。早期发现、早期手术对提高疗效是非常重要的。     

补肾益气方对流产大鼠胎盘孕酮生成通路的影响

目的:探讨补肾益气方对流产大鼠胎盘孕酮生成通路中相关重要上游因素低密度脂蛋白受体(LDLR)、细胞色素P450链裂解酶(P450scc)、3β-羟基类固醇脱氢酶(3β-HSD)的影响及其与孕酮(P)分泌的关系。方法:溴隐亭皮内注射法建立流产大鼠模型,分别于孕1-8 d、1-11 d灌服补肾益气方药,黄体酮肌注作为阳性对照组,采用放免法测定大鼠血清P水平;RT-PCR技术检测LDLR、P450scc、3β-HSD在不同组动物胎盘中的mRNA表达。结果:模型组LDLR、P450scc、3β-HSD mRNA表达较正常对照组明显降低;中药组及黄体酮组不同程度提高模型大鼠胎盘LDLR、P450scc、3β-HSD mRNA表达,表达强度随孕天和给药时间逐渐升高,与血P有显著相关性。结论:补肾益气方清热益气、固肾安胎,能调控胎盘滋养细胞LDLR、P450scc、3β-HSD基因表达,促进孕激素合成分泌增加,从而达到保胎维持妊娠的目的。     

温针灸和电针治疗脾虚型单纯性肥胖症的对照研究

目的:比较温针灸与电针治疗脾虚型单纯性肥胖症的疗效.方法:将68例脾虚型单纯性肥胖症(包括脾虚湿阻、肺脾气虚、脾肾阳虚3型)患者随机分成温针灸组(36例)、电针组(32例).两组取穴均以中脘、水分、气海、中极、天枢、水道等为主,对其疗效及体重指标进行观察.结果:温针灸组总有效率为88.9%,电针组为71.9%,两组比较差异有显著性意义(P<0.05);温针灸组与电针组肥胖体重下降差异亦有显著性意义(P<0.05).结论:温针灸治疗脾虚单纯性肥胖疗效确切且持久,值得推广.     

益气除痰法延长非小细胞肺癌中位生存期的作用

目的:观察益气化痰法延长Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)生存期的作用.方法:采用前瞻性、多中心、随机、对照的临床流行病学方法,将符合标准的病例按肺郁痰瘀型、脾虚痰湿型、阴虚痰热型及气阴两虚型四型辨证施治,辨病治疗以益气化痰法为主,辨证治疗分别以宣肺除痰、益气除痰、滋阴化痰、益气养阴法为主.用乘积极限(K-M)法分析不同证型的中位生存期及中位疾病进展时间.结果:肺郁痰瘀型、脾虚痰湿型、阴虚痰热型及气阴两虚型肿瘤总缓解率分别为9.1%、23.6%、11.5%、13.2%(P<0.05);瘤体总稳定率分别为69.7%、77.8%、69.2%、78.9%(P>0.05);中位生存期分别为308天、401天、300天和326天(P>0.05);1年累积生存率分别为45.63%、51.53%、41.95%、46.01%(P>0.05).结论:益气化痰法可使Ⅲ、Ⅳ期NSCLC的中位生存期达到9个月,与化疗配合应用可达到12个月,是晚期非小细胞肺癌的一种有效治法.其中,脾虚痰湿型患者中位生存期达到13个月,有可能进一步提高疗效.     

扶正活血解毒中药治疗小儿病毒性肺炎临床观察

目的:观察扶正活血解毒中药治疗小儿病毒性肺炎的临床治疗效果.方法:用扶正活血解毒中药组方,并结合雾化吸入辨证治疗小儿病毒性肺炎42例,并随机设对照组30例,观察肺部体征及临床症状改善情况.结果:治疗组临床治愈率高,时间缩短,明显优于对照组(P＜0.05).结论:扶正活血解毒中药口服结合雾化吸入治疗小儿病毒性肺炎是临床有效疗法.     

Effect of Soothing Gan (Liver) and Invigorating Pi (Spleen) Recipes on TLR4-p38 MAPK Pathway in Kupffer Cells of Non-alcoholic Steatohepatitis Rats

Objective: To investigate the mechanism of inflammatory-mediated toll-like receptor 4(TLR4)-p38 mitogen-activated protein kinase(p38 MAPK) pathway in Kupffer cells(KCs) of non-alcoholic steatohepatitis(NASH) rats and the intervention effect of soothing Gan(Liver) and invigorating Pi(Spleen) recipes on this pathway. Methods: After 1 week of acclimatization, 120 Sprague-Dawley male rats were randomly divided into 8 groups using a random number table(n=15 per group): normal group, model group, low-dose Chaihu Shugan Powder(柴胡疏肝散, CHSG) group(3.2 g/kg), high-dose CHSG group(9.6 g/kg), low-dose Shenling Baizhu Powder(参苓白术散, SLBZ) group(10 g/kg), high-dose SLBZ(30 g/kg) group, and low-and highdose integrated recipe(L-IR, H-IR) groups. All rats in the model and treatment groups were fed with a high-fat diet(HFD). The treatments were administrated by gastrogavage once daily and lasted for 26 weeks. The liver tissues were detected with hematoxylin-eosin(HE) and oil red O staining. Levels of liver lipids, serum lipids and transaminases were measured. KCs were isolated from the livers of rats to evaluate the mRNA expressions of TLR4 and p38 MAPK by real-time fluorescence quantitative polymerase chain reaction, and proteins expressions of TLR4, p-p38 MAPK and p38 MAPK by Western blot. Levels of inflammatory cytokines including tumor necrosis factor α(TNF-α), interleukin(IL)-1 and IL-6 in KCs were measured by enzyme-linked immunosorbent assay. Results: After 26 weeks of HFD feeding, HE and oil red O staining showed that the NASH model rats successfully reproduced typical pathogenesis and histopathological features. Compared with the normal group, the model group exhibited significant increases in body weight, liver weight, liver index, serum levels of total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol, and aspartate aminotransferase as well as TC and TG levels in liver tissues, and significant decrease in serum level of high-density lipoprotein cholesterol(P0.05 or P0.01), while those indices were significantly ameliorated in the H-IR group(P0.05 or P0.01). Higher levels of TNF-α, IL-1 and IL-6 in KCs were observed in the model group compared with the normal group(P0.01). Significant decreases in TNF-α, IL-1 and IL-6 were observed in the H-SLBZ, H-IR and L-IR groups compared with the model group(P0.05 or P0.01). The m RNA expressions of TLR4 and p38 MAPK and protein expressions of TLR4, p38 MAPK and p-p38 MAPK in KCs in the model group were significantly higher than the normal group(P0.01), while those expression levels in the L-IR and H-IR groups were significantly lower than the model group(P0.05 or P0.01). Conclusions: Inflammation in KCs might play an important role in the pathogenesis of NASH in rats. The data demonstrated the importance of TLR4-p38 MAPK signaling pathway in KCs for the anti-inflammatory effect of soothing Gan and invigorating Pi recipes.     

Spontaneous rupture of splenic hematoma in a malaria patient: Case report and review of literature

IntroductionBlunt abdominal trauma is the most common cause of splenic rupture. Malaria is the most frequent tropical infectious cause of spontaneous splenic rupture. The exact mechanism is not well-defined.Case reportWe report a case of thirty-year-old male patient known to have malaria who presented with spontaneous splenic rupture. A trial of conservative treatment failed and splenecomy was done to control bleeding.ConclusionSpontaneous splenic rupture should be kept in mind in malaria patients presenting with left upper quadrant pain and signs of hypovolemia. Early diagnosis and treatment is essential.     

Primary Malignant Fibrous Histiocytoma of the Spleen-an Extremely Rare Entity

Malignant fibrous histiocytoma (MFH) is a frequently occurring soft tissue tumour with aggressive biological behaviour. Primary MFH of the spleen, however, is an exceedingly rare occurrence. Herein, we report a case of such a neoplasm in a 66-year-old female. The tumour was well localised within the spleen and the patient remains alive and well 34 months after splenectomy without any adjuvant therapy. A brief discussion and review of the few cases of primary splenic MFH previously reported in the English language literature is included.     

Right sided spleen laying retro-duodenal: A case report and review of the literature

IntroductionUnlike left sided accessory spleen that are seen in 10–30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis.Presentation of caseWe present the case of a patient whose CT scan of the abdomen showed a large mass, 11 × 8 cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher’s incision and immunohistological examination showed that it was a right sided accessory spleen. The patient’s left sided spleen appeared normal.DiscussionEfforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration.ConclusionThis case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.