Critical management decisions in patients with acute liver failure

Few admissions to the ICU present a greater clinical challenge than the patient with acute liver failure (ALF), the syndrome of abrupt loss of liver function in a previously unaffected individual. Although advances in the intensive care management of patients with ALF have improved survival, the prognosis of ALF remains poor, with a 33% mortality rate and a 25% liver transplant rate in the United States. ALF adversely affects nearly every organ system, with most deaths occurring from sepsis and subsequent multiorgan system failure, and cerebral edema, resulting in intracranial hypertension (ICH) and brainstem herniation. Unfortunately, the optimal management of ALF remains poorly defined, and practices are often based on local experience and case reports rather than on randomized, controlled clinical trials. The paramount question in any patient presenting with ALF remains defining an etiology, since specific antidotes can save lives and spare the liver. This article will consider recent advances in the assignment of an etiology, the administration of etiology-specific treatment to abate the liver injury, and the management of complications (eg, infection, cerebral edema, and the bleeding diathesis) in patients with ALF. New data on the administration of N-acetylcysteine to patients with non-acetaminophen ALF, the treatment of ICH, and assessment of the need for liver transplantation will also be presented.     

Loading technique comparison in permanent I prostate implants

Treatment of prostate cancer utilizing iodine 125 (¹²⁵I) interstitial seed implants has become an accepted and widely used modality. Numerous variations in ¹²⁵I seed implant loading distribution techniques have developed as a result of the preferences of individual institutions implementing the modality. No particular universal standard is currently used for ¹²⁵I seed implants. A major concern with ¹²⁵I seed implants is coverage of the prostate with the desired dose and the minimization of dose to the urethra. A variation of seed distribution per individual anatomy is desirable. Historically, brachytherapy relied on dosimetry systems, such as the Paris, Quimby, and Manchester systems to achieve the desired dose distribution. Use of various peripherally loaded ¹²⁵I seed implant distributions to accommodate anatomic variations within the same institution prompted the interest of how the results compare to the Manchester system.     

NO,iNOS与胃癌关系的研究进展

幽门螺杆菌(H.pylori)感染造成的炎症反应,可刺激诱导型NO合酶(inducible NO synthase,iNOS)产生大量的NO,对胃癌的启动和发展起重要作用.进入20世纪90年代以来,一氧化氮(NO)研究跨入了迅猛发展的阶段,许多调节功能及其在病理生理过程中所起的重要作用被逐渐认识,特别是NO在致癌和致突变过程中表现的双重性,更是近年的研究热点之一[1,2].本文就NO、iNOS与胃癌关系的研究进展作一综述.