EB病毒阳性老年人弥漫大B细胞淋巴瘤二例并文献复习

 目的　分析我国老年人EB病毒（EBV）阳性弥漫大B细胞淋巴瘤（DLBCL）的临床特点,提高对该病的认识。方法　报道2例老年人EBV阳性DLBCL患者临床、实验室资料及治疗经过。结果　老年人EBV阳性DLBCL高发年龄70～79岁,患者主要表现为全身淋巴结肿大,可伴结外器官受累,可出现巨脾和免疫性溶血性贫血,多伴有发热、体质量减轻等B症状,病理表现为多形性大细胞浸润,伴不同程度的反应性细胞,特别是T细胞增殖。结论　老年EBV阳性DLBCL患者肿瘤细胞CD20或CD79a阳性,EBV 编码的小RNA（EBER）阳性。疾病进展快,对标准化疗反应差。利妥昔单抗对CD20阳性病例短期有效,但疗效有限。患者的生存期短。死亡原因主要是感染所致的呼吸衰竭。     

Effects on splenic, hepatic, hematological, and growth parameters following high-dose poloxamer 407 administration to rats

The nonionic surfactant poloxamer 407, NF (PIuronic ^® F-127, NF) has previously been shown to produce marked hyperlipidemia in rats at a dose of 1.5 g/kg for greater than 96 h following a single intraperitoneal (i.p.) injection (Wout et al. J. Parenter. Sci. Technol., 46 (1992) 192–200). In an effort to characterize any potential toxicity of the polymeric vehicle to various organ systems in the rat following multiple i.p. injections, a dose of 0.33 g/kg per day (10% w/w solution) or 1.0 g/kg per day (30% w/w solution) of poloxamer 407 was administered once daily for 4 consecutive days. When compared to control (non-injected) animals, rats injected with 0.33 g/kg per day of poloxamer 407 did not show a significant (p > 0.05) increase or decrease in spleen, liver, or total body weight. A complete blood count (CBC) with a white blood cell (WBC) differential was performed on blood samples collected on day five from rats injected with poloxamer 407 at both doses. The CBC with WBC differentia] was conducted to assess any changes in the WBC count, percent lymphocytes (LY), percent monocytes (MO), percent granulocytes (GR), red blood cell (RBC) count, hemoglobin (HGB), percent hematocrit (HCT), and the mean corpuscular volume (MCV) following administration of poloxamer 407. Rats injected i.p. with a dose of 0.33 g/kgper day of poloxamer 407 for 4 days demonstrated a significant (p < 0.05) increase in the number of MO when compared to controls. Administration of 1.0 g/kg per day of poloxamer 407 to rats for 4 days demonstrated distinct splenomegaly when compared to non-injected control animals. In addition, a significant (p < 0.05) reduction in body weight and significant (p < 0.05) decrease in the percent LY, RBCs, HGB, and percent HCT were noted. Lastly, a significant (p < 0.05) increase in the number of WBCs and the percent MO was observed in this same group of rats. However, rats administered 1.0 g/kg per day of poloxamer 407 for 4 days were observed to have no detectable changes in the values of the MCV, the percent GR, or liver-to-body weight ratio when compared to control animals. Thus, repetitive i.p. injections of poloxamer 407 to rats at a dose of 1.0 g/kg per day for four days results in splenomegaly and a reduction in total body weight. Splenomegaly in rats administered poloxamer 407 at a dose of 1.0 g/kg per day resulted from red pulp expansion due to infiltration of macrophages which contained phagocytized lipids.     

中西医治疗巨脾一例

慢性粒细胞白血病（简称“慢粒”）是一种起源于骨髓多能造血干细胞水平的恶性克隆性增殖性疾病。常表现为感染、出血及贫血。中医虽无“慢粒”病名,但据其在病情发展过程中出现以上表现及倦怠乏力、心悸气短、自汗、盗汗、食纳减少、消瘦、肝脾肿大等临床症状,可归属“虚劳”、“血证”、“积”等范畴。在正虚前提下,感受邪毒,正邪相争,正不胜邪,邪气踞之,逐渐发展而成。内因为正气亏虚,外因情志抑郁、气滞血瘀或饮食不节,滋生痰浊或邪毒侵袭,留恋不去。以上诸邪气常交错夹杂,混合致病,痰、瘀、毒邪搏结于骨髓,连及脏腑,耗损正气而成虚劳。其病位多责之于肝脾,病理改变多为气滞、血瘀、痰结。邪毒久羁,变生多端,据以上病因病机采用中医扶正益气、活血化瘀解毒并配合羟基脲治疗巨脾一例效果显著。     

The outcome of partial splenic embolization for hypersplenism in the cirrhotic patients

Background

Although partial splenic embolization (PSE) has been widely used for treatment of leucocytopaenia and thrombocytopaenia in cirrhosis, only few studies evaluate both benefits and complications of it.

Objective

To evaluate outcome of partial splenic embolization benefits on both platelet and leukocytes counts and its complications in treatment of cirrhotic patients.

Patients and methods

Cirrhotic patients with hypersplenism-induced thrombo-cytopenia underwent partial splenic embolization (PSE). From All patients complete history and full clinical examination were taken and subjected to Laboratory investigations. After PSE was performed, the precise extent of embolization was calculated on CT examinations 2 weeks after PSE. Prophylactic antibiotics was given for 5 days after PSE. All patients were then followed up at the outpatient clinic. Peripheral blood cell parameters including white blood cell (WBC), platelet (PLT) and red blood cell (RBC) counts were monitored prior to PSE, on the 3rd, 14th, 30th day after PSE, and subsequently at 3-month intervals during the 2-year follow-up period. The complications associated with PSE were appropriately recorded. All patients underwent abdominal CT scanning before and 2 weeks after PSE.

Results

Twenty three patients were included in this study. 13 (57%) males and 10 (43%) females with mean age 42.37 years. PSE was successfully performed in all 23 patients. Post-embolization syndrome 91.3% (21/23) was the most frequent side effect. Other minor complications as puncture site hematoma occurred to one patient at site of femoral artery. Severe complications occurred in eight patients (34.8%). two patients had a large amount of pleural effusion and ascites. One patients developed bacterial peritonitis and died of septicemia. One patient complicated by splenic abscess. One patient had recurrent thrombo-cytopenia and treated by PSE. Portal vein thrombosis was found in one patient. One patient presented with huge splenomegaly and improved after splenectomy. Post-PSE, the platelets and leukocytes counts showed increase in the number. Best results obtained with larger splenic infarction area but in the expense of more major complications.

Statistical analysis

Blood parameters were compared using paired t test. P < 0.05 means significant differences.

Conclusion

PSE is a useful treatment in patients with hypersplenism caused by cirrhosis. PSE is safe in advanced disease patients, not suitable for splenectomy, with good long-term effect on the hematological parameters and a reduction in bleeding episodes from esophageal varices.     

原发性淀粉样变五例临床分析

目的：提高对原发性淀粉样样变的认识,方法：分析5例原发性淀粉样变的临床表现和实验室检查,结果：5例肾脏受累,4例心脏受累,3例肝肿大。结论：原发性淀粉样变临床表现多样化,大多为非特异性,易误诊,确诊靠病理活检,遇到肝脾肿大及肾功能不全等多系统损害的病人,应想到原发性淀粉样变。     

脾动脉部分栓塞与脾切除治疗脾功能亢进症的疗效比较

目的通过对脾动脉部分栓塞和脾切除治疗脾大伴脾功能亢进症的疗效及并发症分析,探讨两种方法治疗脾功能亢进的优越性。方法回顾分析35例行脾动脉部分栓塞和24例行脾切除治疗的脾功能亢进患者的临床资料,将两种方法治疗后的外周血液成份（血红蛋白,白细胞,血小板）改变及并发症等进行对比分析。结果两种方法近期均能有效治疗脾功能亢进,可明显改善血小板和白细胞计数（P〈0.01）。脾切除组对血小板和白细胞的改善优于部分脾动脉栓塞组（P〈0.01）。脾动脉部分栓塞组术后并发症较脾切除组多,而脾切除组手术适应症要求较高。结论两种方法均能有效治疗脾脏功能亢进,应根据患者情况选择适合的治疗方式。     

部分脾动脉栓塞与脾切除治疗脾功能亢进症的疗效比较

目的通过对部分脾动脉栓塞和脾切除治疗脾功能亢进症的治疗费用、疗效及并发症进行分析,评价两种方法治疗脾功能亢进症的特点。方法92例脾功能亢进症行部分脾动脉栓塞治疗患者作为脾栓塞组,208例脾功能亢进症行脾切除治疗患者作为脾切除组。比较两组患者住院天数及住院费用;术前、术后的白细胞(WBC)、红细胞(RBC)、血小板(PLT)水平;并发症发生情况。结果两组患者手术均安全、顺利、成功。脾栓塞组住院天数(23.39±10.15)d短于脾切除组的(31.54±11.08)d,住院费用中位数2.77万元少于脾切除组的4.82万元,差异均具有统计学意义(P<0.05)。术前,两组患者的WBC、RBC、PLT水平比较,差异均无统计学意义(P>0.05);脾栓塞组术后3、7、14、21 d的WBC、PLT水平均低于脾切除组,术后3 d的RBC水平高于脾切除组,差异均具有统计学意义(P<0.05);两组患者术后7、14、21 d的RBC水平比较,差异均无统计学意义(P>0.05)。脾栓塞组患者的腹水感染、脾周脓肿、门静脉血栓形成、发热、肝性脑病、腹泻发生率分别为25.00%、2.17%、0、88.04%、1.09%、2.17%,与脾切除组的42.79%、0、25.00%、98.08%、19.71%、0比较,差异均具有统计学意义(P<0.05);两组患者的腹水、腹痛、左下肺不张、肺炎、腹腔血肿、其他发生率比较,差异均无统计学意义(P>0.05)。结论部分脾动脉栓塞和脾切除均为治疗脾功能亢进症的有效方法,近期治疗效果明确。部分脾动脉栓塞更适合肝功能差、不能耐受外科手术的患者。     

比较腹腔镜与开放手术在小儿巨脾症的应用

目的：对比腹腔镜脾切除术(LS)和传统开放脾切除术(OS)治疗小儿巨脾的临床疗效,探讨腹腔镜切除小儿巨脾的可行性及安全性。方法：选取32例小儿巨脾的病例资料,根据手术方法不同,将其中16例LS组与16例OS组进行对比分析。结果：两组均实施巨脾切除术;两组相比,LS组手术时间长,术中出血量少,术后肛门排气早,术后住院时间短,副脾发现例数多;术后并发症发生率、长期随访率、有效率差异没有统计学意义(P>0.05)。结论：腹腔镜小儿巨脾切除术是一种安全、有效、可行的手术方法,能减少并发症,具有创伤小、恢复快、美容的临床疗效。     

脾大部切除术治疗肝硬化脾大脾亢的疗效分析

目的 探讨脾大部切除术治疗肝硬化脾大脾亢的疗效。方法 对２６例肝硬化脾大脾亢病人行脾大部分切除加断流术,术后１年内随访,观测门静脉压力和直径、外周血细胞计数、骨髓细胞学、血小板相关ＩｇＧ（ＰＡＩｇＧ）及残腺大小的变化。结果 脾大部切除加断流术后,门静脉压力下降,门静脉直径缩小,残脾显像良好,无明显增大,外周血红细胞、白细胞和血小板计数升高,骨髓像大致正常,ＰＡＩｇＧ下降,随访１年见脾亢明显改善或消     

Effect of Spleen Lymphocytes on the Splenomegaly in Hepatocellular Carcinoma-bearing Mice

Objective To study the effect of spleen lymphocytes on the splenomegaly by hepatocellular carcinoma-bearing mouse model. Methods Cell counts,cell cycle distribution,the percentage of lymphocytes subsets and the levels of IL-2 were measured,and two-dimensional gel electrophoresis(2-DE) was used to investigate the relationship between spleen lymphocytes and splenomegaly in hepatocellular carcinoma-bearing mice. Results Compared with the normal group,the thymus was obviously atrophied and the spleen was significantly enlarged in the tumor-bearing group. Correlation study showed that the number of whole spleen cells was positively correlated with the splenic index. The cell diameter and cell-cycle phase distribution of splenocytes in the tumor-bearing group showed no significant difference compared to the normal group. The percentage of CD3+ T lymphocytes and CD8+ T lymphocytes in spleen and peripheral blood of tumor-bearing mice were substantially higher than that in the normal mice. Meanwhile,the IL-2 level was also higher in the tumor-bearing group than in the normal group. Furthermore,two dysregulated protein,β-actin and S100-A9 were identi?ed in spleen lymphocytes from H22-bearing mice,which were closely related to cellular motility. Conclusion It is suggested that dysregulated β-actin and S100-A9 can result in recirculating T lymphocytes trapped in the spleen,which may explain the underlying cause of splenomegaly in H22-bearing mice.