Hepatopancreatoduodenectomy for advanced hepatobiliary malignancies: a single-center experience

BACKGROUND: Hepatopancreatoduodenectomy is a com-plicated and challenging procedure but necessary for curative resection for advanced hepatobiliary malignancies. This ret-rospective study was to examine the safety and survival out-comes of hepatopancreatoduodenectomy in our center. METHODS: Prospectively collected data of 12 patients who underwent hepatopancreatoduodenectomy for advanced hepatobiliary malignancies in our hospital from January 1998 to December 2014 were analyzed. The primary endpoints are treatment-related morbidity and mortality and the secondary endpoints are overall survival and disease-free survival. RESULTS: Curative resection was achieved in 11 (91.7%) pa-tients. Complications developed in 10 (83.3%) patients. Three hospital deaths resulted from multiorgan failure secondary to postoperative pancreatic fistula or hepaticojejunostomy leak-age. Six of the nine remaining patients had disease recurrence. The nine patients had a median survival of 39.8 (5.3-151.8) months. The 1-, 3- and 5-year overall survival rates were 66.7%, 55.6% and 27.8%, respectively. The corresponding disease-free survival rates were 55.6%, 44.4% and 29.6%, respectively. CONCLUSIONS: Morbidity and mortality after hepatopan-creatoduodenectomy were significant. With R0 resection, the 5-year overall survival and disease-free survival rates were 27.8% and 29.6%, respectively.     

Pigmented eccrine poromas: expression of melanocyte-stimulating cytokines by tumour cells does not always result in melanocyte colonization

Background Although eccrine poroma (EP) occurs preferentially in palmoplantar areas, pigmented variants of EP have not been documented on the palms and soles. Objectives We seek to confirm the notion regarding lack of pigmented EP on palmoplantar areas and determine whether the absence of pigmentation in palmoplantar EPs is due to lack of expression of melanocyte‐stimulating cytokines by tumour cells. Methods We searched the PubMed and Web of Science databases (1966–2006) for reports of pigmented EPs. In addition, a total of 17 EPs were collected from our pathology department. The presence of melanin was examined with haematoxylin‐eosin sections, and melanocyte colonization was shown by immunohistochemical stains for tyrosinase. In addition, immunohistochemical staining with antibodies to melanocyte‐stimulating cytokines, including endothelin‐1, stem cell factor, and nerve growth factor, was done on these tumours. Results A review of the literature revealed 15 pigmented EP reports, none of which were located in palmoplantar areas. Among 17 EPs collected from our pathology department, 7 occurred in palmoplantar areas and 10 in non‐palmoplantar areas. Three of the palmoplantar EPs and three of the non‐palmoplantar EPs showed positive staining with melanocyte‐stimulating cytokines. However, none of the palmoplantar EPs contained melanocytes or melanin pigment, wheras the three non‐palmoplantar EPs that stained positively with melanocyte‐stimulating cytokines were colonized with melanocytes and showed pigmentation clinically. Conclusions The expression of melanocyte‐stimulating factors by tumour cells is associated with melanocyte colonization in non‐palmoplantar EPs but not palmoplantar EPs. Therefore, the presence of melanocyte‐stimulating cytokines per se is not sufficient by itself to induce melanocyte colonization. Certain characteristics of palmoplantar skin, such as the dermal components of these anatomical sites, may play a role in inhibiting melanocyte colonization of EPs.     

应用弹性测量仪和超声波评价烧伤后增生瘢痕的粘弹性

目的：研究应用弹性测量仪和超声波测量评价烧伤后增生瘢痕的变化。方法：自1995年1月起，长期随访18例随机选择的烧伤患者（年龄为1－60岁），应用皮肤弹性测量仪及超声波影像对患者每月测量一次皮肤在负压吸引作用下的最大变形度（R0）和粘弹性指数（R8），比较增生瘢痕与身体对侧相应部位测量的区别，并将检查结果与传统临床分度方法进行比较分析。同时也对皮肤弹性值与临床观察的瘢痕硬度进行相关性分析。结果：烧伤后增生瘢痕的R8＞0．193时，临床硬度分度也较高（9％为0度，14％为1度，30％为2度，46％为3度，83％为4度）。结论：R8＞1．93被定为预后数值，大于该数值者需要密切随访。     

构建肠系膜微淋巴管内皮细胞培养技术并观察休克淋巴液环境中内皮细胞的形态变化

目的:建立肠系膜微淋巴管内皮细胞的培养技术,观察不同体积分数的休克淋巴液对大鼠肠系膜微淋巴管内皮细胞形态的影响。方法:实验于2004-02/07在河北北方学院病理生理学教研室及实验中心细胞培养室完成。选择健康雄性Wistar大鼠,体质量分别为220～300g和50～80g。实验方法:①无菌条件下制备大鼠重症失血性休克模型,引流肠系膜淋巴液或收集门静脉血;同时另取大鼠,引流正常淋巴液或正常门静脉血。②从动物种类、培养基、植块方法、胎牛血清浓度等方面对植块培养法进行改良,进行肠系膜微淋巴管内皮细胞原代培养并传代。实验分组:分为6组:胎牛血清组:培养液为DMEM 体积分数为0.1的胎牛血清;正常淋巴液组:培养液为DMEM 正常淋巴液;休克淋巴液组:培养液为DMEM 体积分数为0.04,0.06,0.08,0.10的休克淋巴液;正常血浆组:培养液为DMEM 正常血浆;休克血浆组:培养液为DMEM 休克血浆;无血清对照组:培养液为DMEM。实验评估:①光镜下观察大鼠肠系膜微淋巴管内皮细胞原代培养及传代情况。②光镜、扫描电镜及透射电镜下观察不同体积分数的休克淋巴液及不同作用时间(4,8,12h)对肠系膜微淋巴管内皮细胞形态及超微结构的影响。结果:①光镜下肠系膜微淋巴管内皮细胞原代培养及传代情况:内皮细胞呈扁平的梭形或多边形,大小均匀,胞核清晰,呈卵圆形。细胞生长融合形成单层后,呈典型的鹅卵石或铺路石样镶嵌状排列生长。②光镜下在休克淋巴液中肠系膜微淋巴管内皮细胞形态:体积分数为0.04的休克淋巴液作用4h时细胞逐渐收缩、变圆直至脱落漂浮,随着休克淋巴液体积分数增加及作用时间延长,细胞损伤逐渐加重,体积分数为0.08的休克淋巴液作用4h时核旁出现空泡,体积分数为0.10的休克淋巴液作用12h时细胞裂解成碎片。其他各组作用12h肠系膜微淋巴管内皮细胞形态无显著改变。③扫描电镜下在休克淋巴液中肠系膜微淋巴管内皮细胞形态:体积分数为0.04的休克淋巴液作用4h部分细胞逐渐收缩离壁,细胞间隙增大、细胞边缘的突起拉长、缩短、断裂,作用8,12h可见凋亡小体。其他各组作用12h肠系膜微淋巴管内皮细胞形态无显著改变。④透射电镜下在休克淋巴液中肠系膜微淋巴管内皮细胞形态:体积分数为0.04的休克淋巴液作用4h细胞膜形态不规整,胞浆内质网等膜性细胞器扩张,核形态不规则,作用8h线粒体呈球形扩张,细胞核逐渐出现固缩、似细胞凋亡改变,核周腔变宽;体积分数为0.08的休克淋巴液作用时间8h细胞内出现囊泡,内质网不同程度扩张,线粒体主要表现为浓缩、深染等改变,细胞膜边界不清,出现起泡、破碎等现象。其他各组作用12h肠系膜微淋巴管内皮细胞形态无显著改变。结论:成功建立了肠系膜微淋巴管内皮细胞的培养技术;休克淋巴液可导致肠系膜微淋巴管内皮细胞形态及超微结构损伤。     

辽西地区农村汉族青少年体型发育规律的Heath-Carter体型法分析

目的:分析辽西地区农村汉族青少年的体型发育规律和特点,为体质人类学补充必要的数据。对象:按整群分层抽样法,抽取2001-07/2003-09辽西地区锦州、盘锦、葫芦岛、义县和绥中的农村13所中小学7～19岁经学校正常体质检查证明身体健康的汉族学生为调查对象,按性别分两大组,每大组按年龄分12小组,7～18岁每岁为1个年龄组,18～19岁为1个年龄组,每小组44～82人,共分24组,搜集完整资料1280名(男666名,女614名)。采用Heath-Carter体型法,每项指标测量2次,取平均值,10项指标由专人负责,测试数据按年龄和性别在微机中建立数据库,依次计算出各年龄组的内因子、中因子和外因子,体型图上的X,Y坐标值,身高/体质量1/3,样本中平均体型点到所有体型点空间距离的均数,三维空间中两个体型点间的差异,体脂百分比和各类体型分布频数。结果:参加调查1280名,均进入结果分析。①7～17岁青少年身高、体质量随年龄的增加而增长。平均身高、体质量男生大于女生。身高/体质量1/3指数除7、8、10、12和13岁外,各年龄组男生>女生,平均值男生>女生。体脂含量除8岁外,其他年龄组女生>男生,平均值女生>男生。②男生的体型均值3.6-2.5-3.7,属外胚层-内胚层均衡体型,女生平均体型值为4.3-2.2-3.3,属于偏外胚层的内胚层体型。体型频数的变化提示辽西农村汉族男生体型分布在内胚层和外胚层的体型较多,女生分布较集中,主要在内胚层体型。③内因子男生在3.0～4.0,女生在3.5～5.2,各年龄组女生>男生;中因子男生在1.6～3.9,女生在0.8～3.4,除7、11和17岁女生>男生外,其他年龄组男生>女生或男女相等,平均值男生>女生。外因子男生在3.0～5.0,女生在3.0～4.1,7、8、10、12、13岁女生>男生,11、14、15、16、17、18岁男生>女生。因此,女生的内因子占优势,皮下脂肪更发达,体态丰满,男生中因子占优势,骨骼粗壮,肌肉发达,随着年龄的增长,男生的身体相对瘦高程度增长,身材修长。④男女各年龄组间体型比较,7,8,9,10,11,12,13,14,15,16,17,18～19岁三维空间中两个体型点间的差异值分别为0.45,0.67,1.03,0.56,0.76,0.30,0.93,2.60,1.86,1.37,1.21,1.47,8～11岁年龄组男女间体型差异有显著性(t=2.66,2.75,2.95,3.58,P<0.05)。⑤与城市青少年相比,农村青少年身高低5～6cm(男女分别为u=6.24,5.90,P<0.01),体质量低3～6kg(男女分别为u=6.93,4.60,P<0.01)。结论:辽西地区农村男生较女生骨骼粗壮,肌肉发达,女生的皮下脂肪更发达,体态丰满,随着年龄的增长,男生的身体相对瘦高,身材修长。与城市青少年相比,农村青少年仍矮瘦,与国外资料和国内少数民族相比,辽西地区农村汉族青少年骨骼肌肉欠发达,身材修长。