肝癌细胞分泌物对凝血系统的直接影响

目的：探讨肝癌细胞分泌物对凝血系统的直接影响。方法：以一期法测定肝癌细胞分泌物对APTT、PT、TT及Ⅷ、Ⅴ因子活性的影响。结果：肝癌细胞分泌物使正常血浆APTT缩短、TT延长、Ⅷ因子活性增加、V因子活性降低。异常血浆PT、TT延长。结论：肝癌细胞分泌物可直接改变血浆凝血像。     

LAMS抑制肝癌细胞增殖和促凝活性的实验研究

目的：观察LAMS抑制肝癌细胞增殖和促凝活性的效果。方法：比较LAMS处理的肝癌细胞生长曲线、AgNoRs含量变化;用一步法APTT测定LAMS拮抗肝癌细胞分泌物的促凝血作用。结果：LAMS处理后的肝癌细胞增殖受抑制、AgNoRs数量减少,LAMS能拮抗肝癌细胞分泌物对APTT的影响。结论：LAMS可有效地抑制肝癌细胞增殖和促凝活性。     

Stone extraction with loop ureteral catheter versus ureteroscopy in small distal ureteral stones—retrospective comparison of 547 consecutive patients

BackgroundTo evaluate whether stone extraction with a loop ureteral catheter (LUC) in distal ureteral stones is associated with a higher frequency of ureteral strictures compared to treatment with primary ureteroscopic stone removal (p-URS) or ureteroscopic laser lithotripsy (l-URS).MethodsFive hundred and forty-seven consecutive patients were primarily endourologically treated for distal ureteral stones in our department between 2005 and 2019 and included in the study protocol. Data was retrospectively obtained from the patients’ charts and medical reports as well as from office-based urologists. Data analysis was performed using Fisher’s exact test, Mann-Whitney test or Student’s t-test as appropriate. A level of P<0.05 was assigned statistical significance.ResultsFour hundred and twelve patients were treated by URS (p-URS n=304, l-URS n=108) and another 135 by LUC stone extraction. Median follow-up was 41 [2–159] months. There was no difference between the groups concerning age, gender, proportion of patients with ureteral stenting, operating time, hospitalization or readmission rates. The number of ureteric strictures was small in all procedures [n=3 (1.0%) in p-URS, n=2 (1.9%) in l-URS and n=2 (1.5%) in LUC] and there was no difference between the groups concerning this serious complication (p-URS vs. LUC: P=0.6465; l-URS vs. LUC: P=0.9999).ConclusionsIn small distal stones, LUC stone extraction still is an alternative to URS procedures in stone management with comparable results concerning postinterventional ureteral strictures. In experienced hands, it still has its value in accurately selected patients.     

慢加急性肝衰竭合并自发性细菌性腹膜炎影响因素分析与预测模型构建

目的 探究慢加急性肝衰竭(acute - on - chronic liver failure,ACLF)患者合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的影响因素并构建预测模型。方法 收集来自重庆市7家医疗机构2018年1月—2020年6月的627例ACLF患者,根据其是否发生自发性腹膜炎分为ACLF合并SBP组(n = 423)和ACLF组(n = 204)。将纳入研究患者资料随机抽取70%（436例）作为训练集构建预测模型,剩余30%（191例）作为测试集进行内部验证。采用ROC曲线评估模型临床效能,并将预测模型以公式和列线图形式表现出来。结果 经Lasso - logistic回归结果显示,肝肾综合征(OR = 9.570,95%CI:2.662～34.407)和直接胆红素(OR = 1.006,95%CI:1.004～1.008)是ACLF患者合并SBP的独立危险因素;白蛋白(OR = 0.890,95%CI:0.846～0.937)和凝血酶原活动度(OR = 0.915,95%CI:0.913～0.917)是ACLF患者合并SBP的保护因素。logistic预测模型表现为,X = 6.105 + 2.259×肝肾综合征 + 0.006×直接胆红素 - 0.116×白蛋白 - 0.089×凝血酶原活动度。预测模型ROC曲线下面积为0.843(95%CI:0.825～0.861),敏感度为79.6%,特异度为70.1%;内部验证ROC曲线下面积为0.825(95%CI:0.809～0.841),敏感度为77.8%,特异度为73.0%。结论 ACLF合并SBP风险预测模型能较好地预测SBP的发生风险,同时可为医务人员及时采取预防性管理措施提供参考。     

Anatomic basis of vascular distribution in combined removal of liver and pancreas (28.5.93)

Summary Based on the study of the arterial distribution of 120 hepatic grafts removed from brain-dead patients, the authors assess the possibilities of vascular partition in cases of combined removal of the liver and pancreas. The discussion deals with the vascular distribution of each organ. The presence of a right hepatic artery arising from the superior mesenteric a. (SMA) requires preservation of the SMA with the hepatic graft, while the pancreas is removed with the celiac trunk (CT) and its branches. The presence of a left hepatic artery arising from the CT requires its preservation with the hepatic graft, the pancreas being removed with the SMA and the splenic artery.

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Partage vasculaire des prélèvements hépatiques et pancréatiques combinés : bases anatomiques (28.5.93)

Résumé A partir de l'étude de la distribution artérielle de 120 greffons hépatiques prélevés sur des patients en état de mort cérébrale, les auteurs apprécient les possibilités de partage vasculaire en cas de prélèvement combiné foie-pancréas. La discussion porte sur la distribution vasculaire de chaque organe. L'existence d'une artère hépatique droite naissant de l'artère mésentérique supérieure (AMS) nécessite de conserver l'AMS avec le greffon hépatique, le pancréas est prélevé avec le tronc coeliaque (TC) et ses branches. La présence d'une artère hépatique gauche naissant du TC impose de le conserver avec le greffon hépatique, le pancréas est prélevé avec l'AMS et l'artère splénique.

     

Morphometry of terminal hepatic veins

Summary In the present study, hepatic venous distribution per unit of liver surface area on normal wedge biopsies from man (n=11) and baboon (n=8) were analysed and compared. Terminal hepatic veins (THV - man:n=100; baboon:n=200) morphometric size variables were obtained with a Leitz ASM 68K morphometric equipment. THV, defined as hepatic veins up to 150 m in internal diameter (ID), in the centrolobular position and with sinusoidal openings, represented 84% and 74% of hepatic veins of man and baboon, respectively. Four or more THV were generally found on 8 mm² of liver surface. Transversely sectioned THV selected by the ratio IDminimum/IDmaximum >0.67, was found to be only 25% of the total THV. In baboon, THV merge with other terminal veins and the interlobular veins present sinusoidal inlets. The baboon THV wall surface (WS) and wall thickness (WT) values were higher than in man. Positive correlations between the number of mesenchymal cells (Mc) in the vein wall and wall surface of terminal hepatic veins (man: r= 0.79; baboon: r=0.83) and between wall surface and internal surface (IS) (man: r=0.80; baboon: r=0.72) were found. Two ratios were selected as the most reliable parameters: (1) for the THV wall rim, wall surface/internal surface (WS/IS - man: 0.43±0.16; baboon: 0.63±0.23), regarding transversely sectioned THV; and (2) for the evaluation of wall cell density (WS/Mc-man: 550±231; baboon: 558±183 m²/cell) as they did not depend on THV caliber.Dr. Porto was supported by a fellowship from MEC-CAPES, Brazil. A grant for morphometric equipment was obtained from the Fondation pour la Recherche Médicale and from the Societé d'Hépatologie Expérimentale, 77 rue Pasteur, Lyon, France     

Hepatic arterial variations and liver-related diseases of 100 consecutive donors

We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The normal arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as rare, one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally normal in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.     

Progressive tubulointerstitial nephritis and chronic cholestatic liver disease

We report the clinical and morphological features of a distinctive hepatorenal disorder in four patients and review the five similar patients in the literature. The main clinical characteristics were early onset of cholestatic liver disease and progressive tubulointerstitial nephritis leading to renal death in early childhood. Liver histology showed disturbed architecture with nodular and acinar formations and portal fibrosis and bile duct proliferation. Histological abnormalities in the kidney were severe interstitial fibrosis and tubular atrophy and dilatation, while the typical features of nephronophthisis were lacking. These clinical and morphological characteristics distinguish our patients from the majority described, as having nephronophthisis and congenital hepatic fibrosis or any other known syndrome with concomitant hepatorenel involvement. We suggest that the association of cholestatic liver disease and progressive tubulointerstitial nephritis represents a new syndrome.     

Hepatic Steatosis and Morbid Obesity

One hundred and twenty-seven consecutive morbidly obese patients who presented for bariatric surgery underwent open wedge liver biopsy at the completion of their gastric restrictive procedure. All hepatic specimens were graded histologically for degrees of steatosis. Three-quarters of the patients had histological evidence of hepatic steatosis and in one-fifth this was severe and diffuse. No patient had histological evidence of fatty hepatitis, portal fibrosis, or cirrhosis. There was no significant correlation between the degree of obesity (measured as percentage over ideal weight), age, sex, or preoperative liver function tests and the degree of fatty change observed. Insufficient data were available to implicate alcohol and poor protein nutrition in the aetiology of the observed fatty liver change. Other factors such as diabetes mellitus or drugs were not aetiological factors in this series of patients.