Surgical treatment of hepatocellular carcinoma with bile duct tumor thrombi

AIM: To study the surgical treatment effect and outcome of hepatocellular carcinoma (HCC) with bile duct tumor thrombi (BDTT). METHODS: Fifty-three consecutive HCC patients with BDTT admitted in our department from July 1984 to December 2002 were reviewed retrospectively. The clinical data, diagnostic methods, surgical procedures and outcome of these patients were collected and analyzed. RESULTS: One patient rejected surgical treatment, 6 cases underwent percutaneous transhepatic cholangial drainage (PTCD) for unresectable primary disease, and the other 46 cases underwent surgical operation. The postoperative mortality was 17.6%, and the morbidity was 32.6%. Serum total bilirubin levels of these patients with obstructive jaundice decreased gradually after surgery. The survival time of six cases who underwent PTCD ranged from 2 to 7 mo (median survival of 3.7 mo). The survival time of the patients who received surgery was as follows: 2 mo for one patient who underwent laparotomy, 5-46 mo (median survival of 23.5 mo, which was the longest survival in comparison with patients who underwent other procedures, P=0.0024) for 17 cases who underwent hepatectomy, 5-17 mo (median survival of 10.0 mo) for 5 cases who underwent HACE, 3-9 mo (median survival of 6.1 mo) for 11 cases who underwent simple thrombectomy and biliary drainage, and 3-8 mo (median survival of 4.3 mo) for four cases who underwent simple biliary drainage. CONCLUSION: Jaundice caused by BDTT in HCC patients is not a contraindication for surgery. Only curative resection can result in long-term survival. Early diagnosis and surgical treatment are the key points to prolong the survival of patients.     

Lactadherin and procoagulant activities of red blood cells in cyclosporine induced thrombosis

Background The side effects of cyclosporine therapy include thromboembolic complications. However, the mechanisms underlying the hypercoagulable state induced by cyclosporine are not fully understood. Cyclosporine binds to red blood cells （RBCs） with a high affinity in circulation and alters the membranes of RBCs. Therefore, we propose that such alterations in RBCs membranes play a role in cyclosporine-induced coagulopathy and this disorder may be rectified by lactadherin, a phosphatidylserine binding protein. Methods RBCs from healthy adults were treated with various concentrations of cyclosporine. Procoagulant activity of the RBC membrane was measured by the single stage recalcification time and confirmed by detection of tenase and thrombin assembly through enzymatic assays. Inhibition assays of coagulation were carried out in the presence of lactadherin, annexin V or antitissue factor. Phosphatidylserine exposure was detected by flow cytometry and confocal microscopy through binding with fluorescein isothiocyanate （FITC）-Iabeled lactadherin as well as FITC annexin V. Results RBCs treated with cyclosporine demonstrated increased procoagulant activity. Cyclosporine treatment markedly shortened the clotting time of RBCs （（305±10） seconds vs （366±15） seconds） and increased the generation of intrinsic factor Xase （（7.68±0.99） nmol/L vs （2.86±0.11） nmol/L） and thrombin （（15.83±1.37） nmol/L vs （4.88±0.13） nmol/L）. Flow cytometry and confocal microscopy indicated that cyclosporine treatment induced an increased expression of phosphatidylserine on the RBC membrane. Lactadherin was more sensitive in detecting phosphatidylserine exposure of the RBC membrane than annexin V. The modulating effect of procoagulant activity was concomitant with and dependent on phosphatidylserine exposure. Blocking of phosphatidylserine with lactadherin effectively inhibited over 90% of FXa generation and prothrombinase activity and prolonged coagulation time. Conclusions Procoagulant properties of RBCs membranes resulting from phosphatidylserine exposure may play an important role in cyclosporine-induced thrombosis. Lactadherin can be used as a sensitive probe for phosphatidylserine detection. Its high affinity for phosphatidylserine may provide a new approach for the treatment of cyclosporine induced thrombogenic properties.     

Common carotid arterial thrombosis associated with ulcerative colitis

A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.     

Significance of Laboratory and Clinical Manifestations of Antiphospholipid Syndrome

##正##Clinical features of antiphospholipid syndrome Antiphospholipid syndrome(APS) is a form of immune mediated thrombophilia,characterized by thrombosis, recurrent fetal death and the presence of circulating antiphospholipid(aPL) antibodies directed against anionic phospholipids or protein-phospholipid complexes. Almost every vascular bed can be involved by thrombosis     

Effects of copper-aspirin complex on platelet-neutrophil interactions

To investigate the effects of copper-aspirin complex on rat thrombosis and the interaction between piatelet sand neutrophils. METHODS: The model of electrically stimulated carotid artery thrombosis in Sprague Dawley rats was used; the effects of copper-aspirin complex on rat platelet-neutrophil adhesion and platelet aggregation stimulated by activated neutrophils were observed by rosette assay and Born‘s method, respectively. RESULTS:Intragastric copper-aspirin complex (5, 7, and 10 mg/kg) doseMependently prolonged the occlusion time; it significantly decreased the rosette number formed between thrombin-activated platelets and neutrophils; the 50 % of inhibitory concentration (ICs0) was (54.6~4.3)/amol/L. Copper-aspirin complex markedly inhibited rat platelet aggregation induced by either cell free supernatant of activated neutrophils or by activated neutrophil suspension.The values of ICs0 were (224.5 16.2) lamol/L and (820.5~21.4) lamol/L, whereas aspirin had no influence.CONCLUSION: Copper-aspirin complex inhibited platelet-neutrophil interactions through a different property from aspirin and resulted in a more potent antithrombotic actvity     

Advances in Antiplatelet Therapy

Platelets play a central role in hemostasis and throm- bosis but also in the initation of atherosclerosis making platelet receptors and there intracellular signaling path- ways important molecular targets for antithrombotic and anti-inflammatory therapy.Therapeutic targeting of plate- lets has two objectives:prevention of vessel occlusion and inhibition of the platelet contribution to lesion progres- sion.     

川芎中抗血栓活性成分的计算机虚拟筛选研究

目的:运用计算机辅助药物设计寻找川芎抗血栓活性成分。方法:以"血栓症"为关键词,从治疗靶蛋白数据库中搜索筛选川芎抗血栓靶蛋白;再从蛋白质数据库中查询目标靶蛋白并下载其三维结构,采用蛋白质预处理工具确定活性区域中心坐标,应用PyRx和Discovery Studio Visualizer软件对从台湾中医药资料库下载的247个川芎小分子与靶蛋白进行分子对接,通过结合能筛选出活性成分并分析结合作用力。结果:筛选出4个活性成分即新绿原酸、1-H-苯并咪唑-2-胺、3,8-二羟基酰内酯、川芎三萜,其分别与凝血酶、抗凝血酶Ⅲ、凝血因子Ⅹa、血栓调节蛋白具有较高结合活性,结合能分别为-6.1、-4.5、-7.7、-8.6 k J/mol;分析结果显示范德华力、静电作用力在对接中发挥着重要作用。结论:新绿原酸、1-H-苯并咪唑-2-胺、3,8-二羟基酰内酯、川芎三萜可能是中药川芎抗血栓的活性成分。     

窦汇至左颈内静脉血栓形成一例的观察与护理体会

颅内静脉或静脉窦血栓形成是脑血管疾病中较为少见的特殊类型,颅内静脉窦合并颈内静脉血栓则更为罕见,国内外文献少有报道。我科近期收治1例窦汇-左颈内静脉T1段血栓形成患者,经治疗后痊愈,现将护理体会报道如下。     

窦汇至左颈内静脉血栓形成一例的观察与护理体会

颅内静脉或静脉窦血栓形成是脑血管疾病中较为少见的特殊类型，颅内静脉窦合并颈内静脉血栓则更为罕见，国内外文献少有报道。我科近期收治1例窦汇-左颈内静脉T1段血栓形成患者，经治疗后痊愈，现将护理体会报道如下。[第一段]     

64层螺旋CT在心律失常及瓣膜介入术中的应用价值

目的 探讨房性心律失常射频消融术及二尖瓣狭窄球囊扩张术前,应用64层螺旋CT检测患者左心耳血栓的临床价值.方法 需行房扑、房速、房颤射频消融术或二尖瓣狭窄球囊扩张术患者204例,术前常规行左房及肺静脉CT血管成像(CTA)检查,有左房血栓的病例作为实验组,未提示左房血栓的病例作为对照组,所有病例均行经食道超声检查(TEE).结果 204例患者中,64层螺旋CT检查显示左心耳血栓形成者32例,未见血栓征象者172例,TEE检查显示左心耳血栓形成者26例,无血栓征象者178例,CT显示的32例血栓中,22例经TEE证实,10例TEE显示为自发超声显影(SEC).CT显示的未见血栓征象者172例中,168例经TEE证实,另4例TEE显示为血栓形成.64层螺旋CT诊断左心耳血栓的敏感性84.6％,特异性94.4％,阳性预测值68.8％,阴性预测值97.7％,准确度93.1％.结论 64层螺旋CT检测房性心律失常射频消融术及二尖瓣狭窄球囊扩张术患者左心耳血栓具有较高的临床应用价值,未来有可能成为临床上检测左心耳血栓的一种无创、可靠的替代方法.