人原发性肝细胞癌核基质蛋白的研究

目的比较正常肝与原发性肝细胞癌（ＨＣＣ）核基质蛋白的异同,观察是否有ＨＣＣ特异性核基质蛋白的存在。方法用双向电泳方法比较了３例正常肝和８例ＨＣＣ核基质蛋白成分。结果正常肝和ＨＣＣ的核基质蛋白组成极为相似,但在ＨＣＣ中发现至少有４个ＨＣＣ的特异性核基质蛋白。其中以分子量为６２０００、等电点为５．３的蛋白最具代表性,它存在于所研究的８例ＨＣＣ中。其余３个ＨＣＣ特异性蛋白亦存在于大多数ＨＣＣ中。３例正常肝组织中未见有这４个ＨＣＣ特异性核基质蛋白。结论ＨＣＣ确实有ＨＣＣ特异性核基质蛋白的存在,它的发现可能会为ＨＣＣ的发生、发展、发病机理的研究提供一个新途径。     

Der Wert der Duplexsonographie nach der orthotopen Lebertransplantation Erfahrungen an 44 Patienten

Zusammenfassung In einer prospektiven Untersuchung wurde an 44 Patienten (33 Männer, 11 Frauen) riach einer elektiven orthotopen Lebertransplantation die Duplexsonographie 196ma1 angewendet. Ziel der Untersuchung war es festzustellen, inwieweit and in welchem zeitlichen Zusammenhang sich die Parameter pulsatiler FluBindex (PFI) und Dämpfungsindex (DI) bei Komplikationen wie Abstoung und Cholangitis verändern. Der Duplex-Doppler-Ultraschall wurde im Mittel 5mal pro Patient durchgeführt. Die letzte Sonographie erfolgte am Entlassungstag. Bei den Messungen fiber der Leberarterie, der Pfortader und den Lebervenen wurden jeweils der PFI und der DI bestimmt. Die Ergebnisse der Indexuntersuchungen wurden mit dem klinischen Verlauf (Abstoung, Cholangitis) sowie mit den Resultaten von 88 Biopsiepräparaten der Lebertransplantate in Beziehung gesetzt. Bezüglich einer histologisch gesicherten AbstoBung ergab der PFI (über der Leberarterie gemessen) eine Sensitivität von 69,4 % and eine Spezifitdt von 72,2 %, der DI (über den Lebervenen gemessen) eine Sensitivität von 89,4% und eine Spezifitdt von 89,1 %. Wenn auch die einfach und beliebig oft anwendbare Untersuchungstechnik die bioptische Sicherung einer Rejektion nicht ersetzen kann, so ist sie in hohem Mae in der Lage, Indikationen zur Biopsie frühzeitig stellen zu lassen und ein Ansprechen auf eine Therapie kurzfristig und mit holier Genauigkeit anzuzeigen.

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Duplex sonography after orthotopic liver transplantation: findings in 44 patients

In a prospective study, 44 patients (11 women, 33 men) who had received orthotopic liver transplants underwent a total of 196 consecutive duplex Doppler ultrasound examinations. The aim of the study was to evaluate the correlation between the pulsatile flow index (PFI) and the damping index (DI) as far as complications as rejection or cholangitis were concerned. The patients were examined five times each on average. The PFI and DI were measured in the hepatic artery, the portal vein and the hepatic veins. The findings were compared with the clinical course (cholangitis, rejection) and the histomorphological diagnosis as determined in biopsy specimens. In biopsy-proven rejection episodes, the sensitivity of the PFI in the hepatic artery was 69.4%, the specificity 72.2%. The sensitivity of the DI in the hepatic vein was 89.4%, the specificity 89.1 %. Combining the two, specificity was more than 90%. PFI and DI in the portal vein bore no apparent relation to clinical course or histomorphological diagnosis. We found duplex Doppler ultrasound extremely beneficial in determining the timing and indication for liver biopsy. In addition, this simple examination, which can be performed as often as desired, accurately shows the transplanted liver's response to measures taken to counter rejection.

     

Preparation and evaluation of sodium diclofenac controlled-release tablets

The dissolution behaviour of a direct compression compact prepared with sodium diclofenac and dibasic calcium phosphate (DCP) in different weight ratios with or without Biosoluble polymer^® (acrylic-based resin) was investigated in distilled water and in a medium with changing pH. The results indicate that the amount of sodium diclofenac released from the compact was dependent on the amount of drug and DCP used in the compact, and was also controlled by the amount of Biosoluble polymer^® added. A chemical reaction forming diclofenac acid might occur on the surface of the sodium diclofenac compact during exposure to the acidic medium, which was confirmed by diffuse-reflectance spectroscopy. The tablet with a 12 weight ratio of sodium diclofenac to DCP exhibited a sustained-release behaviour, similar to commercial sustained-release products (Voltaren SR-100^® and Grofenac Retard^®), but a lower release rate was found as compared to the commercial products. The dissolution behaviour of the study tablet and the commercial products was found to be dependent on the dissolution medium and the rotating speeds. Glass beads were added to the dissolution assembly to simulate the influence of food, and the enhanced friction between tablet and glass beads might result in a higher dissolution rate of the tablet and the commercial products.     

Fundus-first laparoscopic cholecystectomy

Removal of the gallbladder with commencement of dissection at the fundus is well recognized as a safe technique during difficult open cholecystectomy because it minimizes the risks of damage to the structures in or around Calot's triangle. We report here the routine employment of liver retractors and fundus-first dissection during laparoscopic cholecystectomy (LC) as an alternative to techniques previously described.Retraction of the liver and fundus-first dissection was used in 53 patients who underwent laparoscopic cholecytectomy. There were 16 male and 37 female patients. Seven were operations performed during an acute admission and 20 had moderate or severe adhesions involving the gallbladder. Thirteen patients had a preexisting abdominal incision.The procedure was successful in 52 patients (98%), but in one patient it was converted to open operation because of dense adhesions. Median duration of operation was 90 min (range 35–240 min). There was no mortality and two complications (persistent right upper quadrant pain for 2 weeks after operation and bile leakage from the gallbladder bed).The facility to retract the liver and carry out a fundus-first dissection extends techniques developed for open surgery into the laparoscopic arena. It offers the surgeon the safety and versatility during laparoscopic cholecystectomy that it confers during conventional open surgery.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 18–19 April 1994     

Retransplantation of the liver after side-to-side caval anastomosis

Caval reconstruction in orthotopic liver transplantation is generally performed by two end-to-end anastomoses, using a portal and caval-axillary bypass to sustain hemodynamic stability. In the piggyback modification, the donor's suprahepatic inferior vena cava (IVC) is anastomosed end-to-side to the recipient's preserved IVC. We have used a recently described variant of the piggyback in 18 patients in whom both IVCs are anastomosed side-to-side. We report two patients who needed three retransplants after this reconstruction and conclude that regrafting can be performed in a quick and safe manner.     

Bile-duct diameter at the porta hepatis and liver biopsies in Indian children with biliary atresia

Fibrous remnants from the porta hepatis and wedge biopsies of the liver were studied in 60 patients with biliary atresia. The patients were divided into three groups on the basis of bile duct diameter — I: no ducts; II: <50 m; III: >50 m. The liver damage was classified into three grades on the basis of ductular and parenchymal histopathologic changes and extent of inflammatory pathology. There was no correlation between severity of hepatic damage and duct diameter, although the levels of serum bilirubin and alkaline phosphatase varied in direct proportion to the degree of hepatic damage. There was an inverse relationship between age and duct diameter, but neither correlated with bile flow at surgery or in the postoperative period. The data suggest that Indian children with biliary atresia follow a different clinical course compared to those from Japan and Western countries. Correspondence to: V. Bhatnagar     

The output of budesonide from spacer devices assessed under simulated breathing conditions

BACKGROUND: Spacer devices are increasingly used to aid inhalational therapy, and many different devices are available. Patient and spacer size and spacer static charge may affect drug delivery, but the optimum spacer size and method of reducing static charge is not certain. OBJECTIVE: We sought to determine the output of budesonide from 3 different spacer devices when assessed by using simulated breathing at different tidal volumes and to assess the effect of washing and handling the spacer on drug output. METHODS: Three spacer types were assessed: 2 polycarbonate spacers, the Aerochamber and the Nebuhaler, and the metal Nebuchamber or Non-Electrostatic-Spacer. Breathing was simulated by using a sinus flow pump. Metered-dose inhalers of budesonide 200 microg were actuated into the spacer, which was attached to the breathing simulator for 5 simulated breathing cycles. Budesonide was collected on a filter placed between the spacer and breathing simulator and was assayed by HPLC. Spacers were assessed after they had been washed briefly in water, after they had been washed briefly in cetrimide solution in an attempt to reduce their static charge, and after they had been handled to simulate normal use. In separate experiments budesonide particle size from the spacers was measured by using a multistage liquid impinger. RESULTS: Drug output from the Nebuchamber was greater than that from the other 2 spacers, especially at lower tidal volumes. With 150 mL of tidal volume, the Nebuchamber delivered 36% of the nominal dose to the filter versus 13% from the Nebuhaler and 7% from the Aerochamber. The output from the Aerochamber and Nebuhaler increased linearly with tidal volume, but this was not the case with the Nebuchamber, in which output was constant at tidal volumes of 150 mL and above. Compared with washing in tap water, neither washing the spacers in 0.1% cetrimide solution nor vigorous wiping with a paper towel changed their output. Thirty-eight percent of the drug from the Nebuchamber was contained in particles smaller than 4.7 microm in diameter compared with 47% from the Nebuhaler and 53% from the Aerochamber. CONCLUSIONS: The Nebuchamber increases in vitro budesonide delivery compared with the polycarbonate spacers tested but delivers a greater percentage of the drug in large particles. No increase in delivery with tidal volume was seen with the Nebuchamber, which would deliver a higher dose of drug per kilogram of body weight to smaller patients. Briefly washing the polycarbonate spacers in water or in a weak detergent solution, simulating household washing, did not make them as effective as the metal spacer. Further research is needed to determine a practical washing and handling method to reduce static charge on polycarbonate spacers.     

p16在肝细胞癌组织内变异的研究

应用分子杂交及免疫组化方法检测５６例ＨＣＣ组织内的抑癌基因ｐ１６。结果显示,ＨＣＣ标本中ｐ１６蛋白在癌细胞内表达的阳性率为３７５％（２１／５６）,而ｐ１６ＤＮＡ斑点杂交的阳性率为５５３６％（３１／５６）。Ｓｏｕｔｈｅｒｎ转膜杂交证实,１２５％（７／５６）ＨＣＣ标本存在ｐ１６的甲基化变异,４４６４％（２５／５６）ｐ１６基因缺失。提示ＨＣＣ发生、发展过程中存在ｐ１６基因的缺失和甲基化变异     

化疗在晚期肺腺癌治疗中的作用

目的：探索晚期肺腺癌患者化疗疗效和对化疗的耐受性,化疗后生活质量变化和生存期。材料与方法：回顾分析1992－11~1995-04,经病理确诊为肺腺癌。按UICC分期为Ⅲb、Ⅳ期,Kamofsky评分≥60,连续完成2程以上的以铂类药物为主的联合化疗方案治疗患者。结果：化疗有效率3．1％,化疗后Kamofskv评分不变者43．8％,升高40．6％。下降≥10分15．6％,Ⅲb期中位生存期13月,Ⅳ期10月。结论：全身状况较好无化疗禁忌证的晚期肺腺癌患者,给予适当的联合化疗可使部分患者病情改善,生活质量提高。