Increased intercellular adhesion molecule-1 serum concentration in cholestasis

Background/Aims: Increase of serum levels of the soluble intercellular adhesion molecules in patients with the cholestatic liver diseases primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are known and have been thought to indicate activation of the immune system and the grade of the inflammatory process. In hepatitis and cholestatic diseases, expression of adhesion molecules was found on the surface of bile duct epithelia and hepatocytes.Materials and Methods: Serum levels of sICAM-1 in patients with intrahepatic cholestasis in PBC (n=42) and extrahepatic cholestasis (n=18) due to choledocholithiasis were investigated. sICAM-1 levels and “classical” cholestasis parameters as alkaline phosphatase (ALP), γ-glutamyl-transpeptidase (γ-GTP) and bilirubin levels were compared. Furthermore, sICAM-1 concentrations and “classical” cholestasis parameters were analysed before and after therapy with ursodeoxycholic acid (UDCA). In addition, sICAM-1 was detected in serum and bile fluid of four patients with cholestasis due to choledocholithiasis. Soluble ICAM-1 levels in sera and, if accessible, in bile fluids were determined using a commercially available ELISA system. Statistics were done by Wilcoxon's signed rank exact test and Spearman's rank correlation test. Sensitivity and specificity of cholestasis parameters and sICAM-1 concentrations was analysed by receiver operating characteristic (ROC) curves.Results: Increased sICAM-1 serum concentrations in a similar range were found in patients with PBC (range 251–2620 μg/l; median 966 μg/l) as well as in patients with extrahepatic cholestasis (257–2961 μg/l; median 760 μg/l) compared to healthy controls (n=12; 220–500 gmg/l; median 318 μg/l). sICAM-1 levels correlated significantly to histological stage I to IV (p<0.001), ALP (range 107–1877 U/l; median 545 U/l; r=0.496, p=0.0008), bilirubin (range 0.3–26 mg/dl; median 0.8 mg/dl; r=0.52; p<0.0004) and γ-GTP levels (range 43–705 U/l; median 221 U/l; r=0.36; p=0.02) in PBC patients. In PBC patients a histological stage III or IV (n=21) could be predicted with high sensitivity (95%) and specificity (85%) if sICAM-1 levels were above 840 μg/l. After treatment of PBC patients with UDCA, sICAM-1 levels decreased significantly with decline of other “classical” cholestasis parameters. Increased sICAM-1 levels (range 257–2961, median 745 μg/l) in extrahepatic cholestasis correlated also significantly with serum concentrations of bilirubin (r=0.8; p<0.01; range 0.3–19.7, median 1.6 mg/dl), γ-GTP (r=0.55; p=0.03; range 33–1401, median 179 U/l) and ALP (r=0.61; p=0.1; range 110–1378, median 562 U/l). sICAM-1 2as detectable in bile fluid (264–919 μg/l) of four patients with extrahepatic cholestasis and nose-biliary catheterisation.Conclusions: sICAM-1 concentrations were found to discriminate between histological stage I/II and stage III/IV of PBC with higher sensitivity and specificity than “classical” cholestasis parameters. Increased serum concentrations for sICAM-1 in intra- and in extrahepatic cholestasis and detection of sICAM-1 in the bile may indicate that sICAM-1 is eliminated through the bile. In other words, not only increased synthesis but also decreased elimination may be responsible for increased sICAM-1 serum levels in patients with cholestatic liver diseases.     

Resección en 2 tiempos de tumores hepáticos perihiliares con torniquete en la cisura umbilical y embolización portal secuencial al cuarto día postoperatorio (ALTPS modificado)

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) achieves the hypertrophy of the future liver remnant in seven days. We achieved the same hypertrophy placing a tourniquet in the parenchimal transection line associating a right portal vein ligation (associating liver tourniquet and right portal vein ligation for staged hepatectomy-ALTPS). In perihiliar tumors a«non touch» technique should be performed. ALPPS y ALTPS do not comply with this technical aspect because a dissection of the hilum is carried out in both procedures during the portal dissection. To avoid this problem we devised a new method called sequential ALTPS. It consists of placing a tourniquet in the umbilical fissure without ligation of the right portal vein during the first stage. Subsequently, on the 4^th postoperative day we perform a percutaneous right portal vein embolization. We present the first case of this new technique in which we have obtained a hypertrophy of 77% of the future liver remnant seven days after portal vein embolization. In the second stage a right trisectionectomy was performed with inferior vena cava resection with a goretex graft replacement.     

UDCA 联合SAMe治疗妊娠期肝内胆汁淤积症的 Meta分析

目的系统评价熊去氧胆酸（UDCA）联合腺苷蛋氨酸（SAMe）与单用UDCA对改善妊娠期肝内胆汁淤积症（ICP）孕妇生化指标及瘙痒症状的效果。方法利用计算机检索2003年至今维普、万方、中国学术期刊网全文数据库（CNKI）、中国生物医学文摘数据库（CBM）、美国国立数据库（PUBMED）、荷兰医学文献数据库（EMBASE）等,查找关于UDCA联合SAMe与单用UDCA治疗ICP的随机对照研究文献,筛选后进行质量评价并提取数据,用RevMan5．2软件进行Meta分析。结果与单用UDCA相比,UDCA联合SAMe改善孕妇瘙瘁症状明显,降低血清总胆汁酸、总胆红素、谷丙转氨酶、谷草转氨酶效果显著。结论UDCA联合SAMe治疗ICP在改善孕妇瘙痒症状和血清生化指标方面明显优于单用UDCA。     

胆管消失综合征1例报告

<正>胆管消失综合征(VBDS)最早见Sherlock报道,是以肝内胆管减少为病理学特征,以胆汁淤积为主要临床表现的综合征[1]。病因中包括发育、代谢和免疫学异常、血管病变、感染、淋巴病、药物等因素,真正病因及发病机制尚不明确,临床较为少见[2]。1病历资料患者,女,56岁,无业,因"间断乏力1年"于2011年4月8日入院。既往19年前行剖宫产手术;口服避孕药17年(为短     

新生儿感染相关性胆汁淤积症血清内毒素检测及其临床意义

目的：分析感染相关性胆汁淤积症新生儿患儿血清内毒素水平及临床意义.方法：对42例诊断为感染相关性胆汁淤积症的新生儿进行内毒素测定,比较治疗前及病情好转后血清内毒素水平变化情况;同时以30例明确存在感染但未出现胆汁淤积的新生儿作为对照组,比较两组之间内毒素水平差异.结果：胆汁淤积症患儿治疗前血清内毒素水平为（28.25±9.08） pg/ml,明显高于对照组（9.33±2.05） pg/ml,（P＜0.05）,而治疗好转后血清内毒素水平为（10.32±3.21） pg/ml,明显低于治疗前（P＜0.05）.血渍内毒素水平与肝功能指标间呈线性关系,回归系数具有统计学意义（P＜0.05）.早产儿及低出生体重儿更容易出现感染相关性胆汁淤积症.结论：内毒素是导致新生儿感染相关性胆汁淤积的重要因素之一.进行抗内毒素治疗,可以缩短病程改善预后,具有重要的临床意义.     

Primary intrahepatic malignant epithelioid mesothelioma

INTRODUCTION

Primary malignant hepatic mesotheliomas are extremely rare. We report the case of a patient with primary intrahepatic malignant mesothelioma who was treated in our department.

PRESENTATION OF CASE

A 66-year old male patient was admitted to our department for the evaluation of anemia. An abdominal computed tomography scan revealed a large space occupying lesion in the right liver lobe.

DISCUSSION

The tumor was subsequently resected and a diagnosis of primary intrahepatic malignant mesothelioma was made after pathologic examination. The patient did not receive adjuvant therapy and is currently alive and free of disease, 36 months after the resection.

CONCLUSION

To our knowledge this is the eighth adult case of primary intrahepatic malignant mesothelioma reported in the literature. These tumors are rarely diagnosed preoperatively. Absence of previous asbestos exposure does not exclude malignant mesothelioma from the differential diagnosis. Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy.     

妊娠期肝内胆汁淤积症的妊娠结局及临床治疗分析

目的：分析研究妊娠期肝内胆汁淤积症的妊娠结局及临床治疗措施。方法选取我院2013年3月~2014年3月收治的83例伴肝内胆汁淤积症产妇,根据患者治疗方法的不同分为观察组和对照组,观察组43例行丁二璜酸腺苷蛋酸、丹参注射液联合熊去氧胆酸治疗,对照组40例单纯行熊去氧胆酸治疗,对比两组患者妊娠结局及并发症情况。结果观察组新生儿窒息及Apagar评分显著优于对照组(P<0.05),且观察组产妇妊娠并发症率也显著低于对照组(P<0.05)。结论腺苷蛋酸、丹参注射液联合熊去氧胆酸是一种有效的妊娠期肝内胆汁淤积症治疗方案,其在改善妊娠结局,降低产妇妊娠并发症上具有显著疗效,且优于单纯性熊去氧胆酸治疗疗效。     

产前超声诊断肝内门静脉-肝静脉瘘的价值

目的探讨产前超声诊断胎儿肝内门静脉-肝静脉瘘的临床价值。方法回顾性分析5例胎儿肝内门静脉-肝静脉瘘的超声图像特征,并追踪其预后。结果 5例肝内门静脉-肝静脉瘘中,1例多处吻合伴静脉导管缺如,经引产及血管铸形证实门静脉与肝静脉有5处吻合,其他4例均为单支吻合,经产后追踪3例已闭锁,1例仍有小的交通支。肝内门静脉-肝静脉瘘的主要超声特征有:(1)肝静脉扩张;(2)门静脉与肝静脉交通;(3)门静脉与肝静脉瘘的门静脉端血流频谱呈三相波形。结论产前超声诊断胎儿肝内门静脉-肝静脉瘘具有较高的准确率,可为临床干预提供重要参考。