Metabolic myocardial viability assessment with iodine 123-16-iodo-3-methylhexadecanoic acid in recent myocardial infarction: Comparison with thallium-201 and fluorine-18 fluorodeoxyglucose

The best test presently available to ascertain residual viability within an infarct-related area involves the use of fluorine-18 fluorodeoxyglucose (FDG) to detect the persistence of some cellular metabolism. Rest reinjection of thallium-201 is a less accurate alternative but is easy to perform. Iodinated fatty acids, which are used with standard gamma cameras, are proposed as markers of cellular metabolism. This study was performed to assess the value of 16-iodo-3-methyl-hexadecanoic acid (MIHA) as a marker of the residual cellular metabolism by comparison with FDG in patients with a recent myocardial infarction, and to evaluate its contribution compared with the²⁰¹Tl stress-redistribution-reinjection technique. Stress-redistribution-reinjection²⁰¹T1 imaging, rest MIHA imaging and glucoseloaded FDG imaging were performed in 22 patients with recent myocardial infarction. Out of the 628 myocardial segments obtained from the left ventricular analysis, 400 were hypoperfused (relative uptake <0.75 of maximum uptake on stress²⁰¹T1 imaging), 177 of which were severely hypoperfused (relative uptake <0.50). Receiver operating characteristic (ROC) curves for predicting metabolic myocardial viability with FDG were derived from the results in respect of (a)²⁰¹T1 activity during exercise, redistribution and reinjection and (b) MIHA up-take, using the two FDG thresholds most commonly considered to define metabolic viability (0.50 and 0.60). Analysis of the 400 hypoperfused segments demonstrated that²⁰¹T1 reinjection was the most accurate test in predicting the presence of myocardial viability (area under the ROI curves=0.85 and 0.86 at the 0.50 and 0.60 FDG thresholds, respectively;P<0.05 vs other tests). The global predictive values of MIHA and²⁰¹T1 reinjection were, respectively, 0.87 and 0.89 at the 0.50 FDG threshold (NS), and 0.82 and 0.87 at the 0.60 FDG threshold (NS). When only the 177 severely hypoperfused segments were considered,²⁰¹T1 reinjection remained the most accurate test (accuracy 0.84 at the 0.50 FDG threshold and 0.82 at the 0.60 FDG threshold), while the accuracy of MIHA decreased significantly (0.78 at the 0.50 FDG threshold and 0.73 at the 0.60 FDG threshold,P<0.05 vs²⁰¹T1 reinjection). In all circumstances, MIHA was less specific than²⁰¹T1 reinjection for the detection of metabolic viability. In conclusion, in patients with recent myocardial infarction, MIHA accurately detects the persistence of metabolic viability, but is not superior to²⁰¹T1.     

病毒性肝炎60例临床与病理分析

对６０例病毒性肝炎患者进行肝穿刺活检，结果发现，临床与病理诊断的符合率为４６．６％，其中，急性肝炎的诊断符合率最低（２３．８％），慢性迁延型肝炎（慢迁肝）为４４．８％；ＨＢｓＡｇ阳性首次发病的患者中，急性乙型肝炎仅为１１．２％（２／１８）；临床诊断的慢性活动型肝炎（慢活肝）仅为病理检出的２５．７％（９／３５）；肝炎患者中脾肿大，凝血酶元时间延长、Ａ／Ｇ值＜１．２、抗ＨＢｃＩｇＭ阳性可作为慢活肝与慢迁肝鉴别的重要指标。这些对提高病毒性肝炎临床分型诊断的准确率及指导临床治疗有意义。     

Zinc and magnesium in liver cirrhosis

Abstract. The Authors determined zinc (Zn) and magnesium (Mg) in the plasma, urine, erythrocytes (RBCs), mono- and polymorphonuclear cells (MNCs and PMNs) of patients with overt alcoholic and nonalcoholic liver cirrhosis. In order to obtain a clearer clinical picture, biochemical and nutritional parameters (retinol, tocopherol, six different carotenoids, creatinine-height index and tricipital skinfold), as well as markers of portal hypertension (spleno-portal size and platelet count) were also evaluated.
The plasma levels of Zn and Mg were found to be reduced, as were the urine levels of Mg. Urine Zn, on the other hand, was higher than normal. Plasma Zn correlated inversely, and urine Zn directly, with the severity of the disease, rather than with alcohol consumption or treatment with diuretics. Protein metabolism impairment would appear to affect the plasma transport of Zn rather than its overall availability in the organism; the opposite was found in the case of Mg, the availability of which appeared to be reduced. Determination of the two elements in RBCs, MNCs and PMNs suggested that a true nutritional deficit cannot be demonstrated. MNCs, rather than RBCs or PMNs seem better to reflect tissue status of trace elements.     

膳食结构的变化对脂肪肝患者疗效观察

目的 通过营养干预改变脂肪肝患的膳食结构和生活方式，并观察其疗效。方法 营养干预措施采用询问法登记摄入食物的种类和数量，制订膳食原则及编制食谱。健康教育进行营养知识讲座及咨询活动。结果 通过营养干预脂肪肝患改变了原有的膳食结构及饮食习惯，能量摄入和消耗处于动态平衡；增加粗粮、蔬菜和鱼禽类等食品的摄入量，动物性脂肪摄入减少；53．1％脂肪肝患有好转，46．2％超重或肥胖的人体重恢复到标准体重范围内。结论 普及营养知识，养成良好的饮食和生活习惯，防止食源性疾病的发生。     

Mutagenicity of benzo(a)pyrenyl-1-sulfate in the Ames test.

Comparison of the mutagenicity of nine isomeric benzo(a)pyrenyl [B(a)P] phenols conjugated with either sulfate or glucuronide was carried out using strain Salmonella typhimurium TA98. Of the nine conjugates tested, only B(a)P-1-sulfate was mutagenic. Accordingly, the mutagenicity of B(a)P-1-sulfate was compared with that of B(a)P and 1-hydroxybenzo(a)pyrene [B(a)P-1-OH] in the presence and absence of rat lung S9 and Aroclor-induced liver S9 with and without an NADPH-generating system. B(a)P-1-sulfate was slightly mutagenic, whereas B(a)P and the 1-hydroxy derivative were nonmutagenic when S9 fractions and NADPH were omitted. Addition of induced liver S9 with NADPH caused mutagenicity with B(a) -1-OH greater than B(a)P greater than B(a)P-1-sulfate. B(a)P-1-sulfate was the only mutagenic species when lung S9 was added. This mutagenicity did not require NADPH. Sodium sulfite, an inhibitor of arylsulfatase, decreased the mutagenicity of B(a)P-1-sulfate. These data suggest that a unique mutagenic species is generated from B(a)P-1-sulfate via arylsulfatase in rat lung.     

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap

Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques. Received: 19 January 1996/Accepted: 26 August 1996     

Low levels of essential fatty acids are related to impaired delayed skin hypersensitivity in malnourished chronically ill elderly people

Abstract Essential fatty acid (FA) deficiency, which may accompany protein-energy malnutrition (PEM), has been associated with impaired inflammatory reactions. We evaluated this relationship by analysing FA profiles and delayed cutaneous hypersensitivity in 20 malnourished elderly non-cancer patients and in 20 age-matched control patients. As indicated by serum cholesterol and serum triglycerides, the lipid levels were decreased by about one-third in the subjects with PEM. In comparison with the controls, there was a reduction in the ω 3 FA (e.g. eicosapentanoate) in total serum lipids (mgl^-1) and serum phospholipids (%) of 40% and 47%, respectively. Reductions in serum ω 6 FA (e.g. linoleate and arachidonate) levels corresponded to the drop in total FA concentrations (30%). The cutaneous hypersensitivity was impaired in 14 of the malnourished patients. The magnitude of the skin reaction was positively correlated ( P < 0·05) to the concentrations of eicosapentanoate in serum lipids and serum phospholipids, as well as to the linoleate concentration in total serum lipids. Six of the malnourished patients took part in a nutritional intervention programme for 3 months. In parallel with an improvement in the nutritional status there was a 35% increase ( P < 0·05) in the total ω 3 FA serum concentration. Negative skin tests became positive and the median skin induration enlarged threefold ( P < 0·05). Thus, deficiency of ω 3 FA might be one factor contributing to cutaneous anergy in elderly malnourished patients.     

B超,CT与DSA对肝癌介入治疗的指导价值

对１２６列原发性肝癌与３７例转移性肝癌介入治疗前均进行了Ｂ超、ＣＴ与数字减影血管造影（ＤＳＡ）检查。ＤＳＡ显示原发性肝癌多数血供丰富，而转移性肝癌以少血供者为主；ＣＴ显示小病灶的敏感性稍差，病灶的密度和均匀性与血供多少有一定关系，但特异性不高，而病灶的增强次应与血供关系密切，多血供者中９５％有显示的增强效应，少血供者仅占４．７％；Ｂ超所示病灶的回声高低与血供亦有一定关系，但特异性稍差。结果表明，Ｄ     

小鼠原位脂肪肝移植模型的建立

目的　建立了ob/ob小鼠脂肪肝移植模型 ,探讨保证建模成功的关键因素。方法　采用小鼠非动脉化肝移植技术 ,5～ 7周肥胖小鼠为供体 ,正常小鼠为受体 ,双袖套法行原位肝移植。受体肝组织行HE染色和油红O染色 ,血清ALT、AST水平检测采用常规生化分析法。结果非脂肪肝移植组 (lean to lean)受体长期存活率 (n =10 )为 70 % ,脂肪肝移植组 (ob/obtoagematchedlean)受体存活率为 0 (n =10 ) ,差异有显著性 (P <0 .0 5 )。脂肪肝移植给体积相当的正常小鼠 ,其短期存活率为 3 0 % (n =10 ) ,所有小鼠术后存活并苏醒 ,但均未超过 2 4h。脂肪肝移植受体ALT水平为 (62 85± 2 93 7)U /L ,AST为 (5 812± 2 942 )U /L ;而正常小鼠移植组ALT与AST水平分别为 (5 96± 114 )U /L ,(1796± 870 )U/L ,差异有显著性 (P <0 .0 5 ) ,组织学检测显示大量胆管中央凝固性坏死伴出血。结论　该模型的成功建立为我们提供了一种新的肝原发性肝无功能移植模型 ,为脂肪肝移植后脂肪肝细胞受损的机制研究奠定了基础。     

肝腺瘤的影像学诊断

目的探讨影像学(US、CT、MRI及DSA)诊断肝腺瘤的价值。方法回顾性分析经手术、病理证实的11例肝腺瘤的影像学表现,其中11例行US和CT检查(有1例行CT灌注成像,CTP),5例行MRI扫描,4例行DSA检查,并与手术病理所见对照。结果11例肝腺瘤均为单发肿块,无肝硬化背景,直径2.0～10.0cm。影像学表现:US检查,10例呈稍低或不均匀稍强回声,边界清晰,6例见低回声晕,彩色多普勒显示肿块内有较丰富的血流;CT检查,10例为稍低或等密度,8/10例动脉期全瘤明显强化,门脉期轻度强化,延迟期呈等密度,1例平扫和延迟期呈等密度,动脉期中度强化,门脉期轻度强化,误诊为血管瘤。1/11例CT灌注成像(CTP)检查,肝动脉灌注量(HAP)=1.08ml/(min.ml),门静脉灌注量(PVP)=0.19ml/(min.ml),肝动脉灌注指数(HPI)=0.85,各参数值与肝癌均有明显不同;MRI检查,5例肝腺瘤均能显示完整包膜,T1WI上2例稍高于肝脏信号,1例呈等信号,2例为稍低信号,T2WI上5例均表现为以稍高信号为主的混杂信号,脂肪抑制像(STIR)1例呈略低信号,4例信号与T2WI相似,行增强扫描的4例病灶动脉期显著强化,门脉期强化减退,平衡期呈等信号。DSA检查,3/4例病灶见粗细不均的异常血管影,实质期可见肿瘤染色表现。结论肝腺瘤的US和DSA表现均缺乏特异性,CT、MRI则具有一定的特点。CTP对肝腺瘤可能具有诊断和鉴别诊断价值。