中医外治法治疗肝癌晚期常见并发症的新思路

肝癌晚期患者常见癌性疼痛、肝性腹水、顽固性呃逆等并发症,临床上通常采用对症治疗,但往往无法收获满意的效果。回顾了近年运用中医外治法治疗肝癌晚期常见并发症的相关报道,剖析中医外治法如膏药贴敷、肿瘤热疗法、介入与中药结合、超声导入中药等治疗手段对肝癌晚期常见并发症的治疗效果及可行性。     

尾状叶肝癌的介入治疗

尾状叶肝癌是一种特殊部位肝癌,少见且治疗困难,既往其主要的治疗手段是手术切除。近年来尾状叶肝癌的介入治疗已取得显著进展,并获得较好疗效。简述了肝脏尾状叶的解剖特点和尾状叶肝癌的动脉血供特点,总结了经肝动脉化疗栓塞术和局部消融术治疗尾状叶肝癌的进展,认为联合应用介入方法治疗尾状叶肝癌的优势仍需进一步的临床验证。     

肝癌的中西药结合介入治疗进展

随着介入放射学和介入超声学迅速发展,动脉内灌注药物(TAI)和栓塞(TAE)及瘤体内注射药物治疗肝癌已有不少报道.实践证明,对中晚期肝癌,中西药介入治疗是目前最好方法,现将近年有关文献综述如下:1.中西药结合介入治疗肝癌的理论依据与适应症:通过介入治疗,瘤体内给药或动脉给药可使肝癌组织内保持高浓度,较静脉给药高5倍,由于单纯抗癌西药有一定毒性及疗效局限性,而中药有肯定的抗癌效果,用中药提取物配合抗癌药物局部用     

消瘀养肝汤对肝癌介入化疗后的作用

用消瘀养肝汤对66例肝癌介入化疗后患者进行治疗,并设西药组60例作对照。结果,中药组在症状改善,肝功能、AFP好转,癌块缩小及提高3年以上生存率等方面明显优于对照组。经统计学处理两组各项指标均有非常显著性差异(P<0.01)。表明消瘀养肝汤是治疗肝癌介入化疗后患者的一个实用而有效的手段,值得研究应用。     

华蟾素注射液治疗中晚期肝癌临床研究进展

原发性肝癌是世界范围内高发的恶性肿瘤之一,其死亡率排名第三,每年有约50万新发患者,其中50％发生在中国。手术切除是治疗肝癌的首选方式,但由于肝癌发病特点,大多数患者确诊时已失去手术机会,此时以肝动脉化疗栓塞术为基础的综合介入治疗方法成为主要的治疗手段,然而,中晚期肝癌患者,受肝脏肿瘤负荷、肝功能、门脉癌栓的影响,部分患者存在肝脏介入术禁忌症,因此中医中药治疗中晚期肝癌凸显独特优势。     

介入化疗联合复方苦参注射液治疗中晚期肝癌30例

目前对于不能手术切除的中晚期肝癌通常采用动脉栓塞并介入化疗 ,但在其治疗过程中常常出现骨髓抑制 ,肝功能损害加重 ,造成化疗延迟、减量或中断。如何减少介入治疗的副作用和提高疗效 ,近年来提出了多途径序贯治疗。中西医结合治疗为其中的一个重要环节。我们 1998年 6月 -2 0 0 3年 2月 ,与放射科导管室合作 ,采用肝动脉介入化疗结合中药复方苦参注射液 ,治疗中晚期原发性肝癌 60例 ,取得了较满意的疗效 ,总结如下。1　资料与方法1 1　诊断标准　①症状 :肝区不适或疼痛 ,或原有肝病症状加重 ,伴全身不适、胃纳减退、乏力、发热、体重减…     

张玮教授治疗原发性肝癌的辨治思路

<正>原发性肝癌(以下简称肝癌)是全球常见的癌症死因，现代医学对于肝癌的治疗除了手术治疗外，还有化疗、消融、放疗、介入等。研究表明，中西医结合治疗肝癌5年复发率约为47%，明显低于单纯西医治疗患者;同时无复发生存期较西医治疗延长12个多月^[1],15年内生存率更是远高于单纯西医治疗患者^[2]，肝癌患者联合中药治疗可以巩固手术疗效，提高放化疗等治疗的耐受性，减轻副作用，防治肿瘤复发转移，提高生存率，整体提高患者生存质量^[3,4]。张玮教授，系上海中医药大学附属龙华医院感染科主任，上海市中医领军人才，浦东新区名中医，从医三十三载，     

射频消融在早期肝癌治疗中的应用进展

目前早期肝癌常选择的治疗方式有射频消融术(RFA)、肝动脉介入化疗栓塞术(TA-CE)以及根治性肝切除术.近年来的研究表明,RFA有着有效、并发症少、可重复操作、住院时间短及花费少等优势,被认为是早期局灶性肝癌的首选治疗方式.但在相当长的一段时间内,RFA有着较高的肿瘤复发率.本文总结了近年来RFA在局灶性肝癌治疗中的...     

各种介入治疗肝癌方法临床评价

<正>介入治疗作为治疗中晚期肝癌的主要手段[1],可分为经血管介入技术和非血管介入技术。1经血管介入技术1.1经肝动脉介入技术可分为选择性肝动脉灌注(TAI)、选择性肝动脉栓塞(TAE)、选择性肝动脉化疗栓塞(TACE)。目前,临床应用以TACE为主,在治疗不能手术切除和术后复发的肝癌患者中已被公认为首选疗法,其治疗原发性和转移性肝癌,尤其是局限性肝癌可获得较好的疗效[2]。传统观念认为,TACE可应用于外科手术前和术     

中药治疗原发性肝癌介入术后发热的疗效分析

目的：观察中药对原发性肝癌（HCC）患者肝动脉灌注化疗栓塞（TACE）术后出现发热、腹水的治疗效果。方法：采用随机入组的方式,将拟行TACE初治的原发性肝癌患者随机分为中药加常规治疗组和常规治疗组,观察两组患者的体温变化及腹水发生情况。结果：两组患者的最高体温及发热持续时间比较差异有统计学意义,腹水发生率无统计学差异。结论：中药可以减轻肝癌患者介入术后出现的发热症状。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.