超声引导下冷循环射频治疗肝脏肿瘤30例分析

20 0 2年以来 ,我院应用美国冷循环超能射频治疗系统治疗不能切除或拒绝手术的肝脏肿瘤患者 30例 (4 5个病灶 ) ,临床效果满意。现报告如下。临床资料 :本组男 2 6例 ,女 4例 ;年龄 2 9～ 71岁 ,平均5 8.5岁。治疗前均行穿刺活检明确病理诊断 ,其中原发性肝癌 2 6例 (32个病灶 ) ,转移性肝癌 4例 (13个病灶 )。肿瘤直径1.3～ 9.6 cm,平均 4 .83cm。单发 2 0例 ,多发 10例。术前行肝动脉插管化疗栓塞治疗 5例 ,合并门静脉癌栓 5例 ,胆管癌栓3例。肝、肾功能正常 2 8例。肝功能 child分级 A级 2 5例 ,B级 3例 ,C级 2例。 AFP升高 9例。方法…     

经皮集束电极射频毁损治疗肝脏恶性肿瘤67例

我院于 1999年 6月～ 2 0 0 3年 1月采用经皮射频毁损治疗法 (PRFA)治疗肝癌 67例 ,取得较好疗效。对象与方法1.对象 :肝癌患者 67例 ,年龄 3 5～ 83岁 ,平均年龄 5 4岁 ,男性 49例 ,女性 18例。原发性肝癌 5 9例 ,转移性肝癌 8例。伴肝硬化者 42例 (62 .7% ) ,肝功能Child分级A级 3 9例、B级2 8例 ,无C级病例。均无肝性脑病病史。少量腹水 9例(13 .4% )。67例患者共有 85个结节 ,平均 1.2 7个 ,其中 1个结节者 5 4例 ,2个结节者 8例 ,3个结节者 5例。结节直径 1.1cm～ 15 .5cm ,其中结节直径 <3cm 2 6个 ,结节直径 3～ 5cm2 4个 ,结节…     

双途径介入疗法治疗原发性肝癌疗效评价

目的　探讨双途径介入疗法 (下称双介入法 )治疗原发性肝癌的临床价值。方法　选择原发性肝癌患者 6 5例 ,对其中 34例单纯行肝动脉化疗栓塞 (TACE,对照组 ) ,31例行 TACE和分次多点经皮肝穿刺注射无水乙醇 (双介入法 ,观察组 )。全部病例定期做 CT检查和 AFP测定 ,观察肿瘤客观疗效。结果　对照组及观察组肿瘤客观有效率 (CR+PR)分别为 35 .3%、6 4 .4 % (P<0 .0 5 ) ;AFP下降幅度分别为 5 6 .1%、78.6 % (P<0 .0 5 ) ;2年存活率分别为 5 0 %、6 1.3% (P<0 .0 5 )。结论　双介入法治疗原发性肝癌疗效肯定 ,优于单纯应用 TACE。     

老年人原发性肝癌临床特点分析

目的　探讨老年人原发性肝癌 (PL C)临床特点及疗效。方法　对 36例老年治疗组、30例老年未治疗组及 74例非老年治疗组患者进行对比分析。结果　老年治疗组及未治疗组的肿瘤类型、肝功能分级与非老年组相近。老年组无症状或症状不典型者明显高于非老年组 (P<0 .0 5) ,AFP升高者低于非老年组 (P<0 .0 5) ,且并存疾病多 (P<0 .0 1 )。老年治疗组半年、1年、2年生存率与非老年组相似 ,但显著高于老年未治疗组 (P<0 .0 5)。结论　老年人 PL C临床表现不典型者居多 ,积极采用以手术或 TACE为主的综合治疗可获得与非老年人相似的治疗效果。     

T淋巴细胞Ag—NORs的检测在原发性肝癌诊断中的价值

目的 :研究T淋巴细胞核仁形成区嗜银蛋白 (Ag NORs)在原发性肝癌免疫学诊断中的意义。方法 :采用KL型肿瘤免疫计算机图像分析系统 ,测定 38例正常人和 2 5例原发性肝癌患者外周血T淋巴细胞Ag NORs的含量 ,以细胞核仁银染面积与细胞核面积比值 (I .S % )作为检测评估指标 ,以了解原发性肝癌患者Ag NORs的变化情况。同时 ,检测 2 5例原发性肝癌患者血AFP含量 ,以比较Ag NORs和AFP诊断原发性肝癌的灵敏性。结果 :2 5例原发性肝癌的平均I .S %值为 5 5 1%± 0 85 % ,明显低于正常人的 7 12 %± 0 78% ,二者差异显著 (P <0 0 5 ) ;Ag NORs的检测阳性率达 88% ,高于AFP的检测阳性率的 84% ,但差异无显著性 (P >0 0 5 )。 4例AFP正常的原发性肝癌患者中有 3例Ag NORs检测为异常。结论 :T淋巴细胞Ag NORs与原发性肝癌的诊断呈良好的相关性和较高的灵敏性 ,可望成为一种原发性肝癌免疫学诊断的指标     

IEF分离硷性磷酸酶同工酶对肝细胞癌诊断价值的研究

本文观察95例原发性肝癌患者用等电聚焦电泳法(IEF)分离血清碱性磷酸酶(ALP)同工酶对原发性肝癌的诊断效果,其结果见ALP_(1～5)五条区带,其中ALP_3对肝癌有特异性,阳性率在原发性肝癌组为71.6%;良性肝病组均小于15%;肝硬化组仅3.4%。用IEF检测肝癌特异性区带(ALP_3)的阳性率(71.6%)较目前通用的电泳方法(25%左右)明显提高,同时,也有较高的特异性(77.0%)和准确率(8.0%);ALP_3与AFP无相关,对AFP阴性的原发性肝癌也有诊断价值。     

老年人肝癌介入治疗50例体会

老年肝癌患者因各组织、器官的解剖、生理状况不同于中青年人 ,故在介入治疗上有其特殊性。我们选择 1995年2月至 1998年 2月 5 0例资料完整者进行分析 ,就治疗中的体会报告如下 :　　一、材料方法　　 1.对象 :老年肝癌患者 (老年组 ) 5 0例 ,男 42例 ,女 8例 ,年龄 6 0～ 88岁 ,平均年龄 78岁 ;其中右肝巨块型 2 2例、弥散型 8例、结节型 8例、左肝巨块型 7例、结节型 5例 ,门静脉右支癌栓 6例、左支癌栓 1例 ;肝功能Ｃｈｉｌｄ分级 :Ａ级8例、Ｂ级 32例、Ｃ级 10例 ,中青年肝癌患者 (中青年组 ) 32例 ,男 2 6例 ,女 6例 ,年龄 32～ 5 8岁…     

经肝动脉化疗栓塞术联合射频消融治疗巴塞罗那B期原发性肝癌的效果及预后影响因素分析

目的探讨经肝动脉化疗栓塞术(TACE)联合肝癌射频消融(RFA)治疗巴塞罗那(BCLC) B期原发性肝癌患者的疗效及其预后影响因素。方法选择2007年1月-2012年1月在首都医科大学附属北京佑安医院住院行TACE联合RFA治疗的BCLC-B期原发性肝癌患者154例。收集所有患者基线实验室及影像检查资料,通过门诊、住院或电话随访所有病例。采用KaplanMeier法绘制生存曲线,采用log-rank检验生存曲线,将单因素分析中P 0. 05的指标纳入多因素Cox回归分析。结果 154例BCLC-B期肝癌患者,中位生存期37个月,1、2、3、5年生存率分别为82. 5%、59. 7%、50. 6%和36. 1%。将患者按照BCLC-B期亚分期分为B1、B2、B3、B4期,B1期患者生存率明显高于B2～B4期,差异有统计学意义(χ~2=16. 881,P=0. 001); RFA后1个月达到完全消融、年龄60岁、术前AFP 400 ng/ml、胆碱酯酶≥4000 U/L、TBil≤21μmol/L、Child-Pugh A级,肿瘤数目≤3个、肿瘤最大直径3 cm组患者生存率分别高于不完全消融、年龄≥60岁、AFP≥400 ng/ml、胆碱酯酶4000 U/L、TBil 21μmol/L、ChildPugh B级、肿瘤数目 3个、肿瘤最大直径 5 cm组,差异均有统计学意义(χ~2=173. 002,P 0. 001;χ~2=6. 336,P=0. 012;χ~2=10. 765,P=0. 001;χ~2=6. 933,P=0. 008;χ~2=4. 624,P=0. 032;χ~2=5. 570,P=0. 018;χ~2=6. 761,P=0. 009;χ~2=7. 430,P=0.024)。Cox多因素回归分析显示消融评价[P 0. 001,比值比(OR)=21. 950,95%可信区间(95%CI):11. 817～40. 772]、ChildPugh分级(P=0. 002,OR=2. 190,95%CI:1. 329～3. 609)、AFP水平(P=0. 014,OR=1. 760,95%CI:1. 122～2. 760)、B期亚分期(P=0. 004,OR=2. 178,95%CI:1. 284～3. 694)是BCLC-B期肝癌患者RFA治疗后生存期的影响因素。结论 TACE联合RFA治疗BCLC-B期肝癌安全有效,不完全消融、AFP≥400 ng/ml、Child-Pugh B级、BCLC-B期亚分期越晚是影响BCLC-B期肝癌RFA治疗后生存期的独立危险因素。     

三维适形放射治疗不能手术的原发性大肝癌35例报告

目的观察三维适形照射对不能手术的原发性大肝癌治疗效果。方法收集1997年10月至2008年6月不能手术的原发性大肝癌35例。肿瘤直径8～12 cm。根据Child-Pugh肝功能分级,A级26例,B级9例。采用三维适形放疗,每次照射剂量4～5 Gy,每周3次,总剂量50～55 Gy。结果放疗后2～3个月CT复查,CR 17.1%,PR 65.7%,NC 11.4%。1、2、3年生存率分别为71.4%、42.9%、20.0%,30例复查AFP,21例明显下降,其中8例恢复至正常水平。结论三维适形放疗对原发性肝癌有肯定的治疗效果,特别是对不能手术的大肝癌是一种有效的局部治疗手段。     

CT引导下射频消融术治疗肝癌效果观察

目的观察CT引导下射频消融术（RFA）治疗肝癌的效果。方法对27例肝癌患者共33个肿瘤病灶行CT引导下RFA治疗,治疗前后均行AFP、CEA及CT、MRI等瘤灶检查,并定期随访。结果本组手术顺利,术后血压较低3例、出现胆瘘1例,对症处理后好转。术后均随访4～18个月,复查CT或MRI示,肿瘤灶完全损毁21个（均为原发性肝癌）,肿瘤直径均〈4cm;瘤灶部分损毁8个（其中原发性肝癌5个,转移性肝癌3个）,肿瘤直径4—6cIn;瘤灶局部复发4个（其中原发性肝癌1个,转移性肝癌3个）,肿瘤直径6～8．5cm。AFP由术前的平均1646ng／ml降至术后的254ng／ml,CEA由术前的平均6．62ng／ml降至术后的2．31ng／ml,P均〈0．05。患者ALT、AST均有不同程度升高,给予保肝治疗,1个月时基本恢复到术前水平。结论CT引导下RFA治疗原发性及转移性肝癌安全、有效。     

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.     

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.     

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.     

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.