EFFICACY OF LAPAROSCOPIC RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA COMPARED TO PERCUTANEOUS RADIOFREQUENCY ABLATION WITH ARTIFICIAL ASCITES

Aim: Hepatocellular carcinoma (HCC) nodules close to the liver surface exhibit high recurrence compared to those in distal parts of the liver. Moreover, when nodules remain adjacent to the gastrointestinal tract or gallbladder, severe complications such as perforation of those organs may occur due to invasive therapy. Percutaneous radiofrequency ablation (PRFA) with artificial ascites or laparoscopic radiofrequency ablation (LRFA) are used to treat these patients to avoid complications. The purpose of the present study was to assess the efficacy and safety of these two methods. Methods: Subjects comprised 74 patients (48 men, 26 women; mean age, 68.5 ± 8.0 years; range, 46–89 years) with 86 HCC nodules. PRFA with artificial ascites was carried out for 37 patients (44 nodules) and LRFA was used for 37 patients (42 nodules). Clinical profiles were compared between groups. Results: No significant differences in clinical profiles were found between patients treated by PRFA or LRFA. Mean number of treatments was significantly lower for LRFA (1.0 ± 0.0) than for PRFA (2.1 ± 1.0, P < 0.001). Mean number of PRFA treatments was 2.2 ± 1.0 in patients with HCC nodules >2 cm in diameter, whereas all tumors were completely ablated with only one session of LRFA. The safety margin was significantly wider for LRFA than for PRFA. Conclusion: LRFA is a better treatment option for ablation of HCC nodules >2.0 cm in diameter.     

顺铂鱼肝油酸钠配伍治疗胃癌的实验研究

用ＭＴＴ法观察顺铂（ＣＤＤＰ）与鱼肝油酸钠（ＳＭ）配伍对人胃癌细胞ＳＧＣ－７９０１的体外杀伤效果。人胃癌细胞ＳＧＣ－７９０１被接种于裸鼠皮下以建立荷瘤裸鼠。ＣＤ－ＤＰ每次３ｍｇ·ｋｇ~（－１）·ｔｉｍｅ~（－１），ＳＭ：５０ｍｇ·ｋｇ~（－１）·ｔｉｍｅ~（－１），容量：５０μｌ，肿瘤组织中心注射。配伍组肿瘤ＳＭ和ＣＤＤＰ交叉给药，两药间隔３０分钟，每３天１次，共３次。ＳＭ在体外对胃癌细胞有很强的杀伤作用；局部注射后，配伍组的抗癌作用明显高干各单一药物组，肿瘤细胞全部坏死，周围有纤维组织包绕，血管内皮细胞坏死。ＳＭ与ＣＤＤＰ协同抗肿瘤作用明显。     

用Sephadex G200层析血清对4种弓形虫病免疫诊断方法的评价

弓形虫感染小鼠血清经Sephadex G 200柱层析后,各层析峰(紫外线OD_(280)吸收峰)用染色试验(DT)、乳胶凝集试验(LAT)、间接荧光抗体试验(IFA)和酶联免疫吸附试验(ELISA)分别检测总抗体、IgM和IgG抗体。结果显示,两类抗体分别存在于第Ⅰ峰和第Ⅱ峰,第Ⅲ峰无抗体活性。ELISA和IFA用于弓形虫病早期诊断(检测IgM)具有高度特异性和敏感性;LAT操作简便、经济快速、但敏感性稍差。IFA可取代DT用于常规个例诊断。     

甲苯咪唑与阿苯达唑连续3年群体化疗控制人体肠道线虫的效果观察

1994～ 1996年 ,在 117万 2周岁以上的居民中 ,每年 1次用甲苯咪唑或阿苯达唑每人 40 0 m g,2 d分服 ,人群平均年服药率为 6 0 .41% ,按整群分层随机抽样 ,用 Kato- Katz法比较服药前后人群肠道线虫感染率 ,结果总感染率下降了 80 .5 6 % ( 1989年为 79.97% ,1997年为 15 .5 5 % ) ;钩虫、蛔虫、鞭虫的感染率分别下降了 78.76 %、93.5 8%和 89.0 4% ;多虫感染率下降了 96 .93%。表明在肠道线虫重感染区 ,采用甲苯咪唑或阿苯达唑定期群体化疗驱虫 ,是一项方便、安全、有效良好的控制措施     

重庆地区病毒性肝炎患者血清病毒标志分析

目的 探讨重庆地区病毒性肝炎患者的病原感染状况。方法 采用EIA法对295例各型肝炎患者血清进行了甲～庚型肝炎病毒12种血清标志的检测。结果 甲～庚型肝炎病毒血清标志阳性共234例(79.32％)。其中抗-HAV IgM阳性71例(24.07％),HBVM58.98％(174例),抗-HCV8.13％(24例),HDVM29.15％(86例),抗-HEV和抗-HGV分别为22.37％(66例)和16.95％(50例)。在234例甲～庚型肝炎病毒感染者中,仅71例(30.34％)检出一种肝炎病毒血清标志,其余均为重叠感染。两种肝炎病毒血清标志阳性者85例(36.32％),三种重叠感染者50例(21.37％),四种阳性的21例(8.97％),还有两例可同时检出五种肝炎病毒标志。结论 重庆地区病毒性肝炎患者中以HBV感染最多,HCV最少,HDV占相当比例。但仍可能存在甲～庚型以外的其他肝炎病毒感染者。几种肝炎病毒重叠感染可能是造成肝炎慢性化和重型化的重要因素之一。     

银染法观察胶体金标记的恶性疟原虫裂殖子表面主要蛋白与人红细胞的结合作用

恶性疟原虫裂殖子表面主要蛋白－１，又称Ｐ１９５，与人红细胞膜具有结合作用，这种结合是裂殖子识别红细胞的基础。为了确定Ｐ１９５蛋白与人红细胞的结合位点，我们在大肠杆菌中分８段表达了Ｐ１９５蛋白。各段表达蛋白经过提纯与复性后，用胶体金标记。标记后的各段蛋白分别与人红细胞共孵育。然后将此红细胞加入到银显影液中。结果发现，红细胞在与一段Ｐ１９５蛋白（Ｍ６，氨基酸序列为３８４－５９５）共孵育并加入到银显影液中后，红细胞表面出现黑色银沉淀。而红细胞在与其它各段Ｐ１９５蛋白进行同样操作后，红细胞表面没有出现黑色银沉淀。这表明经胶体金标记后的Ｍ６与人红细胞具有结合作用。Ｍ６所对应的区域可能就是Ｐ１９５蛋白的红细胞结合区域。     

100例~(99m)Tc-MIBI心肌灌注断层显像与冠状动脉造影的对比

本文报道100例~(99m)Tc-甲氧异丁异腈(MIBI)心肌灌注断层显像(SPECT)与冠状动脉造影对比的结果。~(99m)Tc-MIBI心肌SPECT对冠心病诊断敏感性为96%,特异性为83%,如排除心肌梗塞病例,对单纯心绞痛患者诊断的阳性率为88%,对左前降支的诊断阳性串为86%,左回旋支为69%,右冠状动脉86%,总的阳性预测值96%。阴性预测值84%。此外,对6例左冠状动脉主干病变,分析了核素显像特点。总之,~(99m)Tc-MIBI心肌SPECT对冠心病的诊断有较大价值。     

EVALUATION OF TSH RECEPTOR ANTIBODY BY ''NATURAL IN VIVO HUMAN ASSAY'' IN NEONATES BORN TO MOTHERS WITH GRAVES'' DISEASE

Neonatal thyrotoxicosis induced by transferred TSH receptor antibody (TRAb) is the ideal human in-vivo experimental system for the evaluation of TRAb. The clinical significance of circulating TRAb in Graves' disease was evaluated by this 'natural in-vivo human assay'. TRAb activity in vitro was measured by radioreceptor assay (thyrotrophin-binding inhibitor immunoglobulin, TBII) and sensitive cAMP accumulation assay using FRTL-5 cells (thyroid-stimulating antibody, TSAb). Further, the binding-stimulation index (B-S index) was newly introduced, which was the most useful indicator for prediction of neonatal thyrotoxicosis, calculated as the product of TBII and TSAb (Tamaki et al., 1988a). Maternal serum TRAb indices showed highly significant correlations with the serum free T4 index (FT4I) and free T3 index (FT3I) in neonates (5-10 days after birth) born to 20 mothers with Graves' disease who had positive TBII and/or TSAb (FT4I: r = 0.825 for TBII, r = 0.908 for TSAb, r = 0.944 for the B-S index, P less than 0.001; FT3I: r = 0.622 for TBII, P less than 0.01, r = 0.812 for TSAb, r = 0.791 for the B-S index, P less than 0.001; n = 20). In contrast, in 57 untreated adult patients with hyperthyroid Graves' disease, the FT4I and FT3I levels were not correlated with any of the TRAb indices. The linear regression relationship between the B-S index and FT4I found in neonates was applied to values in adult patients with Graves' disease, and the patients were divided into three groups on the basis of the 95% confidence limit: high, normal, and low responders of thyroid hormone (FT4I) secretion to the B-S index. FT4I and the ratio of FT4I to the B-S index were highest and the TRAb indices were lowest in the high responders, while FT4I and the FT4I/B-S index ratio were lowest and the TRAb indices were highest in the low responders. The FT4I/B-S index ratio was inversely correlated with the titres of antithyroid microsomal antibody in all the adult patients with untreated Graves' disease (r = -0.288, P less than 0.05). The results suggest that in-vitro assays using animal thyroid cells and cAMP as an index of response are suitable for detecting circulating thyroid stimulating activity in vivo. Secretion of thyroid hormones in Graves' disease may be regulated not only by circulating thyroid-stimulating antibodies but also by intrathyroidal stimulatory factors or by inhibitory or destructive factors.     

庚型肝炎病毒抗体在不同人群中的检测及意义

为了解庚型肝炎病毒(GBV-C/HGV)在我国人群的感染状况,应用ELISA法对277例各种肝病及103例肝炎高危人群血清进行了抗-GBV-C/HGV-IgG的检测。结果:急性肝炎、慢性肝炎、重型肝炎、肝炎肝硬变和肝癌患者抗-GBV-C/HGV检出率分别为20.3％(13/64)、15.6％(19/122)、26.7％(12/45)、28.2％(11/39)和28.6％(2/7);在HAV、HBV、HCV、HAV+HBV、HBV+HCV、HBV+HDV和HAV+HBV+HCV肝炎病人中检出率分别为15.6％(5/32)、26.1％(31/119)、20.7％(6/29)、26.1％(6/23)、28.6％(4/14)、18.2％(2/11)、33.3％(1/3)和在非甲-戊型肝炎中的检出率为12.1％(4/33);献血员、血液透析者、静脉毒瘾者抗-GBV-C/HGV检出率分别为14.7％(5/34)、6.3％(2/32)和8.1％(3/37),以上结果组间均无显著差异(P>0.05)。研究表明,在我国部分肝病及肝炎高危人群中存在庚型肝炎病毒感染,GBV-C/HGV与HAV、HBV、HCV、HDV之间存在多种形式的同时或重叠感染,非甲-戊型肝炎中存在GBV-C/HGV感染,但感染率并不高,提示GBV-C/HGV可能是非甲-戊型肝炎的一种病原体,但并非是非甲-戊型肝炎的主要致病因子。     

PREDICTION OF RECURRENCE AFTER ENDOSCOPIC TREATMENT FOR ESOPHAGEAL VARICES: WITH SPECIAL REFERENCE TO ESOPHAGEAL VARICEAL PRESSURE

Background : We investigated the factors influencing esophageal variceal recurrence after endoscopic treatment on the basis of 25 variceal patients who were measured for esophageal variceal pressure, which had been reported to have a close relationship to variceal rupture. Method : Six patients (24.0%) showed variceal recurrence during follow‐up periods of up to 60 months. Clinical, biochemical, endoscopic and portal hemodynamic parameters were analyzed by univariate analysis in order to determine variceal recurrence. Results : The cumulative risk of variceal recurrence was greater in patients with F3 varices (P = 0.027), and esophageal variceal pressure (EVP) ≥ 15 mmHg (P = 0.021). It was not significantly related to any clinical, biochemical parameter. Large portosystemic collaterals, which were not concerned with esophageal varices, were demonstrated in five patients who had never showed variceal recurrence; all of their EVP were under 15 mmHg. Conclusion : It is suggested that the form of varices and EVP, which may reflect a part of portal hemodynamics, are the most reliable factors for predicting variceal recurrence.     

THE RESPONSE OF NORMAL SUBJECTS AND PATIENTS WITH IDIOPATHIC GROWTH HORMONE DEFICIENCY TO CONTINUOUS INFUSION OF HUMAN PANCREATIC GROWTH HORMONE RELEASING FACTOR 1–44

The GH response to a prolonged continuous infusion of human pancreatic growth hormone releasing factor (hpGRF 1–44), 0.3 μg/kg/h was evaluated in seven patients with severe idiopathic GH deficiency, one patient with partial deficiency and in seven normal controls. Normal controls had a multiphasic response with a first peak between 15 and 90 min of 13.6 to 88.5, mean 45.6 mU/l and a second peak between 105 and 195 min of 8.8 to 73.1, mean 33.8 mU/l. However, the magnitude and pattern of response were highly variable. Six of the seven patients with severe GH deficiency had a response with a maximum level between 30 and 90 min of 3.3 to 7.5, mean 4.8 mU/l. Mean levels remained greater than 2.0 mU/l throughout the infusion but further peaks were absent or minimal. The patient with partial GH deficiency responded in a normal manner. hpGRF 1–44 by continuous infusion thus induced GH release in seven of eight patients with idiopathic GH deficiency though the response was impaired and the pattern of secretion abnormal in severely deficient patients.