Is 18F-fluorodeoxyglucose positron emission tomography meaningful for estimating the efficacy of corticosteroid therapy in patients with autoimmune pancreatitis?

Background

Autoimmune pancreatitis (AIP) is often misdiagnosed as pancreatic cancer (PC). Both conditions accumulate ¹⁸F-fluorodeoxyglucose (FDG), so FDG positron emission tomography (FDG-PET) is not discriminatory. This study aimed to evaluate the pattern of FDG accumulation, and the change in FDG uptake after steroid treatment in AIP and PC.

Methods

We compared FDG-PET patterns between 18 patients with AIP and 20 patients with PC, and also evaluated the short-term changes in FDG uptake after steroid therapy.

Results

FDG uptake was observed in 88.9% in AIP and 90.0% in PC. FDG uptake in extra-abdominal lymph nodes was seen more frequently in AIP, and uptake in salivary glands, eyes and biliary ducts was seen only in AIP. Follow-up PET was performed in 6 AIP patients and in 3 PC patients. Changes in SUV_max after steroid therapy were estimated within 1 week in 5 AIP patients and in all 3 PC patients, retrospectively. In 4 AIP patients, the change in SUV_max was more than 10%. On the other hand, in PC, SUV_max increased or remained almost unchanged (within 10%).

Conclusions

FDG-PET pattern at baseline, and a decrease in FDG uptake after a short steroid trial can be useful for discriminating AIP from PC.     

慢性乙型肝炎病毒感染者中黄曲霉毒素暴露与肝癌发生关系的纵向研究

目的 研究慢性乙型肝炎病毒(HBV)感染者中黄曲霉毒素(AF)暴露与肝癌发生的关系.方法 在肝癌高发现场,对515例感染HBV的肝癌高危人群进行了21年定群纵向研究.结果 (1)观察人群肝癌人年发生率为1437.25/10万,极显著地高于相应自然人群的184.53/10万(P=0.000,RR=7.79),其他肿瘤两组问差异无统计学意义(P=0.576).(2)定期观察人群中发现的肝癌患者平均年龄较相应自然人群提前了1.4年,治后平均生存期延长了6.42个月.(3)AF暴露对象的肝癌人年发生率为2784.96/10万,极显著地高于非暴露人群的1251.02/10万(P=0.008,RR=2.23),其他肿瘤的发生率与AF暴露与否无关.(4)AF暴露人群肝癌发生率随着尿中AFM1排出量增加而上升,当24 h尿中AFM1排出量＞100 ng时,肝癌的人年发生率高达4717.82/10万.尿中AFM1排出量与肝功能异常明显相关(P=0.035),与HBeAg无明显相关性(P=0.812).(5)HBV感染同时伴有AF暴露人群的人年肝癌发病率(2784.96/10万)极显著地高于观察人群(P=0.001)和相应自然人群(P=0.000,RR=15.09).(6)诊断乙肝到肝癌发生的平均时间为14.65年,中位时间13.68年;诊断肝硬化到肝癌发生的平均时间为7.38年,中位时间6.40年.结论 HBV是肝癌发生的主要病因因素,AF暴露在肝癌的发生中具有明显的协同作用;定期观察肝癌高危人群能有效地实现早诊早治,提高疗效;防治肝炎和AF污染是预防肝癌的有效途径.     

肝移植术后间质性肺炎的诊治经验

目的总结诊治肝移植患者术后间质性肺炎的经验。方法回顾分析2001年4月至2009年6月期间诊治的8例同种异体肝移植术后间质性肺炎病人的临床资料。结果8例肝移植术后间质性肺炎患者的发病时间为术后17～117 d,平均84 d,其中7例发生于术后2～4个月。8例均有发热,其中抗巨细胞病毒(CMV)特异性抗体CMV-IgM阳性及CMV-DNA阳性4例,胸部CT均有明显间质性肺炎表现。经调整抗排斥药物用量、使用更昔洛韦及呼吸支持治疗后,4例患者临床症状明显好转,胸部CT恢复正常;4例患者病情进展,继发细菌或真菌感染,死于呼吸衰竭。结论肝移植后间质性肺炎临床表现无特异性,病死率高,应及时予胸部CT检查,同时加强病原体的监测。确诊后予调整免疫抑制剂用量、早期抗病毒治疗及对症支持治疗,以提高治愈率。     

肝脏原发性类癌的诊断及治疗

目的探讨肝脏原发性类癌（PHCT）的诊断及治疗方法。方法报告2004年2月收治的1例巨大PHCT病例,并检索1994年1月至2006年12月国内文献报告的19例PHCT患者的临床资料,对该病的临床表现、病变特点、诊断及治疗进行临床分析。结果PHCT的症状以腹胀、腹疼等上腹不适（8例）和腹部肿块（7例）为主,少数表现为类癌综合征（3例）。病灶免疫组织化学染色显示神经元特异性烯醇化酶、嗜铬颗粒蛋白A和突触素的阳性率较高。16例接受手术治疗,其中13例完全切除病灶;4例接受介入栓塞化疗。结论PHCT的确诊依赖于术后病理学及免疫组织化学检查,手术切除是最佳治疗手段,预后较好。介入栓塞化疗是有效的非手术治疗方法。     

First-line liver resection and salvage liver transplantation are increasing therapeutic strategies for patients with hepatocellular carcinoma and child a cirrhosis

AIM: The present study focused on nine patients with hepatocellular carcinoma (HCC) associated with Child A liver cirrhosis undergoing first-line liver resection and salvage liver transplantation (SLT) for liver tumor recurrence. PATIENTS AND METHODS: Forty-six patients with HCC underwent liver transplantation (OLT); 37 (80.5%) were primary liver transplantations (PLTs) and 9 (19.5%) were SLTs. All patients who underwent SLT received minor transabdominal liver resections. RESULTS: The posttransplant 1-, 3-, and 5-year overall survival rates for SLT (88.9%, 88.9%, and 88.9%) were similar to those for PLT (78%, 62.7%, and 62.7%). Four (10.8%) patients in the PLT group had HCC recurrence, while there was zero recurrence in the SLT group. The 1-, 3-, 5-year disease-free survival rates for PLT (89%, 74%, and 74%) were similar to those for SLT (100%, 100%, and 100%). The 1-, 3-, 5-year disease-free survival rates after PLT were 89%, 74%, and 74%, and after SLT were 100%, 100%, and 100%, respectively. The operative mortality, intraperioperative bleeding, operative time, intensive care unit stay, in-hospital stay, and overall incidence of postoperative complications were similar in the two groups. CONCLUSIONS: In our experience, SLT for HCC is a feasible procedure with similar results in terms of overall survival, disease-free survival, and postoperative complications to those reported for patients who underwent PLT at our institute. An important role exists for SLT as shown by the fact that such a strategy has been used in the 20% of the patients undergoing OLT for HCC.     

Immunogenicity and Safety of Human Papillomavirus (HPV)-16/18 AS04-Adjuvanted Vaccine in Healthy Boys Aged 10–18 Years

PurposeThe human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (Cervarix?) has been shown to be well-tolerated and immunogenic in females aged 10 to 55 years, and up to 100% effective for the prevention of HPV-16/18 infection and associated precancerous cervical lesions in females aged 15 to 25 years. This study is the first to evaluate the immunogenicity and safety of the vaccine in males.MethodsHealthy males aged 10 to 18 years were randomized (2:1 ratio) to receive HPV-16/18 AS04-adjuvanted vaccine (n = 181) or hepatitis B virus (HBV) control vaccine (n = 89) at 0, 1, and 6 months, and were followed for 7 months.ResultsAll initially seronegative subjects in the HPV-16/18 group seroconverted for HPV-16 and 18 (ELISA) at month 2. At month 7, all subjects were seropositive, and the HPV-16 and -18 antibody levels were, respectively, four- and twofold higher than at month 2. The anti-HPV-16 and -18 antibody responses for males aged 10 to 18 years and 10 to 14 years, respectively, were higher than those reported for females aged 15 to 25 years and 10 to 14 years, respectively, in a previous study. The reactogenicity profiles of the HPV-16/18 AS04 and HBV vaccines were similar, except that pain and swelling at the injection site were more common in the HPV-16/18 group. However, vaccine-related symptoms did not affect compliance with the three-dose course, which was equally high (97%) in both groups.ConclusionsThe HPV-16/18 AS04-adjuvanted vaccine is immunogenic and well tolerated in boys aged 10 to 18 years. However, further data on the potential public health benefits of vaccination of boys are required before any recommendations can be made.     

乙型肝炎病毒感染标志物与肝癌关系的前瞻研究

目的:探讨患者携带乙型肝炎表面抗原(HBsAg)与发生肝癌的关系.方法:在肝癌高发的启东地区,对515例20～60岁男性HBsAg携带者作乙型肝炎病毒感染标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb(HBVM 1、2、3、4、5)检测,进行连续20年的队列研究.结果:队列发生肝癌111例,肝癌发生率为1 340.90/10万人年,肝癌发生中位年龄为43岁,平均生存期为1年3个月,41-50岁年龄组的肝癌发生率高于其他年龄组(P＜0.05).队列HBVM以15、135、145为主要模式,分别占队列的38.83%(200/515)、15.92%(82/515)、44.08%(227/515),此3种模式的肝癌发生率分别为1 433.69/10万人年、2 284.71/10万人年、984.10/10万人年,135模式显著高于145模式(P＜0.01).肝癌中15、135、145模式分别占39.64%(44/111)、23.42%(26/111)、35.14%(39/111),15模式显著多于135模式(P＜0.01).肝硬化死亡率分别为195.50/10万人年、966.61/10万人年和277.57/10万人年,135模式显著高于15、145模式(P＜0.01).结论:HBsAg携带者是发生肝癌的高危人群,对其进行定期随访,能早期发现肝癌患者,给予早期治疗后可延长肝癌患者生存期.HBV复制程度与肝癌发生有关,通过抗病毒治疗等手段可能会延缓或解除肝癌的发生.     

中国女性乳腺癌的发病和死亡现况——全国32个肿瘤登记点2003-2007年资料分析报告

目的:描述2003-2007年中国女性乳腺癌的发病和死亡情况.方法:从经审核合格的全国32个肿瘤登记点收集2003-2007年女性乳腺癌发病、死亡和相应的人口数据,对数据进行汇总和描述分析.结果:2003-2007年全国32个肿瘤登记点女性乳腺癌合计发病率为41.64/10万,居女性癌症发病的第1位;合计死亡率为9.63/10万,居女性癌症死因的第6位.女性乳腺癌在全国城市地区的发病率和死亡率均高于农村地区,城市地区发病率是农村地区的3.04倍,城市地区死亡率是农村地区的1.92倍.肿瘤登记点合计女性乳腺癌发病率在GLOBOCAN 2008统计的184个国家中排位第110位,死亡率排位第172位.结论:女性乳腺癌已经成为中国女性最常见的癌症之一,中国城市女性乳腺癌的发病率和死亡率水平显著高于农村,但中国女性乳腺癌的发病率和死亡率在世界范围仍处于中低水平.