Splenic involvement in lymphomas. Evaluation on serial CT examinations

Purpose: To prospectively evaluate changes in splenic volume (SV) on serial CT of patients with lymphoma and correlate them with other indicators of the disease process.Material and Methods: SV was calculated in 290 abdominal CT examinations of 58 consecutive adults with lymphoma (42 non-Hodgkin's lymphoma, 16 Hodgkin's disease). Each patient had one CT investigation before, 2 during chemotherapy and 2 post-chemotherapy. The changes in SV were correlated with clinical, laboratory and other imaging indicators of the disease process.Results: Three groups of patients were identified. Group A (n=20) presented no changes in SV, showed no splenic parenchymal abnormalities and had normal SV and serum lactic dehydrogenase (S-LDH). Group B (n=25) presented a decrease in SV during treatment suggesting response to therapy. Splenic parenchymal abnormalities (n=5) and other subdiaphragmatic sites of involvement (n=20) underwent remission during treatment. Eighteen patients with high S-LDH at presentation showed normal values during therapy. Group C (n=12) showed an increase in SV post-therapy associated with manifestations of disease recurrence. The S-LDH levels were elevated in 10 patients at the same time.Conclusion: Quantitatively assessed splenic size on CT may serve as an indicator of splenic involvement in the course of lymphomas.     

Cystic lymphangioma of the spleen: US-CT-MRI correlation

A case of a surgically confirmed cystic lymphangioma of the spleen is presented. Preoperative imaging consisted of US, contrast-enhanced CT and MRI, all showing a multiloculated lesion with small cystic cavities divided by thin septa, corresponding to dilated lymphatic spaces. Preoperative studies correlated well with the pathologic findings. Cystic lymphangioma of the spleen is a very rare condition and is usually solitary and asymptomatic. Large lymphangiomas may be an indication for splenectomy, since the risk of rupture is high even from minor abdominal trauma. Preoperative diagnosis may be achieved with correlated noninvasive imaging.     

Radiology of the spleen

The spleen is generally not considered a challenge to the radiologist. Most often it poses a problem by anomalies or an irregular but normal contrast enhancement; however, a variety of inflammatory, infectious and neoplastic diseases may involve the spleen. CT and ultrasonography are screening modalities for the spleen. For problem solving, MR imaging can be helpful, especially due to its free choice of the imaging plane and because of the high resolution in contrast MR imaging. Splenic angiography as a diagnostic tool has generally been replaced by CT, ultrasound, or MR and is now used as an interventional method, e. g., in non-surgical management of patients with chronic idiopathic thrombocytopenia or in patients with splenic trauma. This article reviews the radiology of the spleen, including anatomy, embryology, splenomegaly, splenic injury, infarction, cysts, tumors, abscesses, sarcoidosis, and AIDS. Knowledge about the use of different imaging modalities and underlying gross and microscopic pathologic features leads to a better understanding of the radiologic findings. Received: 4 November 1999 Revised: 12 May 2000 Accepted: 16 May 2000     

健脾宣浊方对2型糖尿病胰岛素抵抗的影响

目的:观察健脾宣浊方对2型糖尿病胰岛素抵抗的改善作用。方法:将60例2型糖尿病患者随机分为两组各30例,两组基础治疗相同,治疗组加用健脾宣浊方治疗,2个月为一疗程。结果:治疗组血糖、血脂、胰岛素值均有下降,胰岛素敏感性指数升高,与治疗前比较有显著性差异(P<0.05),与对照组比较也有显著性差异(P<0.05)。结论:健脾宣浊方有明显改善2型糖尿病糖、脂代谢紊乱,提高胰岛素敏感性的作用。     

外伤性延迟性脾破裂11例诊断与治疗

目的探讨外伤性延迟性脾破裂的临床特点、诊断和治疗方法。方法回顾性分析我院自2000年12月至2005年12月收治的11例外伤性延迟性脾破裂病例的临床特点、诊断和治疗结果。结果明确诊断7例,误诊为肝破裂3例、宫外孕出血1例。11例病人均行手术治疗,其中行脾切除8例,脾部分切除术2例;术中死亡1例。结论本病由于受伤间隔时间长,腹腔内出血症状隐匿,故误诊率高(本组误诊率36%)。诊断依靠询问病史、临床表现,及时进行腹腔穿刺、B超及CT检查,治疗以脾切除术为主。     

益肾活血方对家兔血瘀模型纤溶指标与血液流变学影响的研究

目的:研究益肾活血方对家兔血瘀模型纤溶指标与血液流变状态的影响,并探讨其机制。方法:兔30只,随机分为正常组、模型组、益肾活血方大、小剂量组、血栓宁组,各组相应处理后分别取静脉血检测组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活剂抑制物(PAI)、纤维蛋白原(Fbg)、D-二聚体(DD),血黏度。结果:t-PA,PAI,Fbg,DD,红细胞压积(H)、全血表观黏度(η_а)、血浆黏度(η_р),正常组、益肾活血大、小剂量组与模型组比有非常显著性差异(P<0.01);血栓宁组与模型组比有显著性差异(P<0.05,P<0.01);益肾活血大、小剂量组与血栓宁组比有显著性差异(P<0.05);益肾活血大剂量组与小剂量组比无显著性差异(P>0.05)。结论:益肾活血大、小剂量组及血栓宁组对血瘀模型纤溶指标与血液流变状态均有影响,且均强于血栓宁组。     

从炎症发病机制探讨急性冠脉综合征的中医治法

通过分析急性冠脉综合征(ACS)发病中的炎症机制,探讨ACS炎症机制与中医脾虚毒损血脉的关系,阐明健脾解毒通络法是治疗ACS的重要方法之一。     

健脾补肾、化瘀泄浊法对慢性肾功能衰竭患者脂质代谢及肾功能的影响

目的观察健脾补肾、化瘀泄浊法对慢性肾功能衰竭(CRF)患者脂质代谢及肾功能的影响。方法选择CRF患者58例,随机分为2组。对照组28例,予低蛋白饮食、控制高血压及对症治疗;治疗组30例,在对照组治疗的基础上加服健脾补肾、化瘀泄浊中药。治疗2个月后,观察两组临床疗效、肾功能、血脂的变化。结果治疗组治疗后TC、TG、APOB水平明显下降(P<0.01),HDL-C、APOAⅠ明显升高(P<0.01),与对照组治疗后比较有显著性差异(P<0.01),而对照组治疗前后血脂水平无明显改变(P>0.05),治疗组在总有效率和改善肾功能方面亦优于对照组(P<0.01)。结论在常规西医治疗基础上加用健脾补肾、化瘀泄浊中药能改善CRF患者的脂质代谢紊乱,提高临床疗效和更好地改善肾功能。     

养阴益气活血方药不同配伍对VSMC的影响

目的:探讨养阴益气活血方药不同配伍对高胰岛素、高脂血清诱导血管平滑肌细胞(VSMC)增殖的拮抗作用。方法:通过MTT比色测定及形态学方法观察养阴益气活血方药各组药物血清的作用效果。结果:人参与麦冬组药物血清有较明显的抗VSMC增殖作用,形态学观察显示各组药物血清可不同程度缓解高胰岛素、高血脂造成的形态学改变。结论:养阴益气活血方药物各药物血清治疗瘀血的机制与血管平滑肌细胞有密切联系。     

补脾法对脾虚证大鼠59Fe代谢的药代动力学变化的影响

目的:通过建立脾虚证大鼠模型,从药代动力学方面运用放射性示踪技术动态观察脾虚证大鼠以及运用补脾法后对铁吸收和/或转运代谢过程的影响的实验,研究脾主运化/脾失健运与铁代谢的关系,探讨脾主运化生物学意义,揭示脾主运化、脾为后天之本等重要中医理论的科学内涵,并为脾的功能和/或脾虚证本质研究提供实验依据。方法:雄性SD大鼠40只,随机分为正常组、正常补脾组、脾虚组、脾虚补脾组4组,按运动模型规范化的要求造模后,4组一次性灌服59FeCl3水悬液0.2ml/220g/只,同时依照人和鼠体重换算,正常补脾组、脾虚补脾组两组即时灌服1:1四君子汤药液1.5ml±,其它两组用1.5ml±生理盐水灌胃,日1次。分别在0.5h、1h、1.5h、3h、6h、12h、24h大鼠尾部取血0.2ml,用γ放射免疫计数器测量其放射性59Fe计数,观测放射性铁经大鼠胃肠道进入全身循环系统的药代动力学变化。结果:实验研究4组对59FeCl3经大鼠胃、大、小肠消化吸收进入全身循环系统的药代动力学变化,主要比较在脾虚状态下和在补脾状态下对59FeCl3的吸收存在明显差别,补脾法促进了大鼠对59FeCl3的吸收。结论:脾虚证大鼠降低了59FeCl3的生物利用度,不能有效促进精微物质吸收,补脾法提高了大鼠铁的生物利用度,促进了59FeCl3的吸收。显示脾虚降低了大鼠铁的生物利用度,或是降低了生物利用程度,或是降低了生物利用速度,这和脾失健运,不能有效促进精微物质吸收或转运密切相关;而补脾法在很大程度上改善了这种状态,通过调理脾而调节机体物质转运系统的功能,提高了大鼠铁的生物利用度,促进了铁的吸收。