原发性肝恶性淋巴瘤1例报告：附文献复习

目的探讨原发性肝恶性淋巴瘤（ＰＬＬ）影响预后因素及治疗方法。方法收治１例ＰＬＬ治疗情况并复习国内外有关ＰＬＬ治疗病例３８例，合计３９例。分析ＰＬＬ预后因素及治疗结果。结果１．孤立性病灶治疗方式有手术局部切除（１０例），放射治疗（２例）和联合化疗（３例）。局部复发２例（手术１例，放射１例，剂量８Ｇｙ），死亡３例。多发病灶治疗方式有：联合化疗（１７例），放射治疗（３例）和未治疗（４例）。治疗病例中，局部复发７例（化疗６例，放射１例，剂量２１Ｇｙ。死亡１０例。２．有Ｂ症状者（１２例）死亡９例（７５％），无Ｂ症状者（２７例）死亡（３例）（１１．１％）（Ｐ＜０．０１）。结论有Ｂ症状者、肝内病灶多发者预后差；孤立性病灶者，无论手术、放射或／和化疗都有较好的局部控制。肝内多发病灶者，单纯全身化疗局部复发率高，放射治疗对控制局部有一定帮助     

雄激素受体与肝细胞肝癌预后的关系

目的探讨雄激素受体（ＡＲ）与肝细胞肝癌（ＨＣＣ）预后的关系。方法用葡聚糖包裹活性炭饱和吸附法检测４７例ＨＣＣ癌组织和癌旁肝组织中ＡＲ的含量。对４３例病人进行术后随访９～６０个月。结果３３例ＡＲ阳性（３．０～１００ｆｍｏｌ／ｍｇ蛋白），１４例ＡＲ阴性。ＡＲ阳性病人与ＡＲ阴性病人的一、五年存活率没有统计学差别，三年存活率ＡＲ阳性者（３５．５％）显著低于ＡＲ阴性者（６６．７％）。复发时间ＡＲ阳性者（２１．４±１５．２月）与ＡＲ阴性者（３３．９±１３．９月）有显著差异（Ｐ＜０．０５）。结论雄激素能促进ＨＣＣ的增长及周围组织的侵袭，部分ＨＣＣ具有雄激素依赖性，ＡＲ可作为ＨＣＣ的预后指标     

“抑肝纤”对大鼠实验免疫损伤性肝纤维化阻断作用的研究

目的本研究利用人血白蛋白免疫损伤Ｗｉｓｔｅｒ大鼠造成肝纤维化模型，以观察“抑肝纤”对大鼠肝纤维化的阻断作用。方法将不同浓度中药“抑肝纤”用于治疗组并与模型组和对照组进行对比，综合分析血清肝纤维化指标、肝组织病理改变、肝组织胶原纤维和网状纤维病理图像定量分析等结果。结果治疗组血清肝纤维化指标（ＰＣⅢ、ＨＡ、ＬＮ）均低于模型组，接近正常组，差异有显著性（Ｐ＜０．００１或Ｐ＜０．０５）。光镜下肝组织病理变化，肝组织中胶原纤维和网状纤维病理图像定量分析结果治疗组优与模型组，尤以低浓度组更为明显（Ｐ＜０．００５或Ｐ＜０．０５）。结论研究结果表明，中药“抑肝纤”如能早期应用，可有效地阻断或延缓实验鼠肝纤维化的发生     

Therapeutic effect of transcatheter arterial chemoembolization on hepatocellular carcinoma: evaluation with contrast-enhanced harmonic power Doppler ultrasound

The aim of this study was to investigate the usefulness of contrast-enhanced harmonic power Doppler ultrasound (US) for the detection of residual viable hepatocellular carcinoma (HCC) after treatment with transcatheter arterial chemoembolization (TACE). Forty-seven patients with 68 HCC lesions 1.8–9.5 cm in diameter (mean ± SD 4.3 ± 1.7 cm) underwent contrast-enhanced power Doppler US, in the harmonic mode, before and after treatment with TACE. Unenhanced spiral CT and contrast-enhanced dynamic MR imaging were also performed to help establish the outcome of therapy. Before treatment, intratumoral blood flow signals were detected at contrast-enhanced harmonic power Doppler US in 65 (95 %) of 68 lesions. After TACE, flow signals were no longer detectable in 22 of these 65 lesions, which showed complete response at spiral CT and dynamic MR imaging. In 38 (88 %) of the 43 lesions with partial response, intratumoral flow signals were still identified at contrast-enhanced harmonic power Doppler US. Twenty-eight of these 38 lesions underwent additional treatment with percutaneous ethanol injection (PEI) using contrast-enhanced harmonic power Doppler US guidance. Complete response was seen after PEI in 23 of 28 lesions. Contrast-enhanced harmonic power Doppler US proved useful for assessing the therapeutic effect of TACE on HCC and for guiding additional treatment with PEI in cases of partial response. Received: 25 January 2000; Revised: 21 April 2000; Accepted: 25 April 2000     

Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts

BACKGROUND: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long-term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine). METHODS: Seventy-two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long-term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature. RESULTS: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre-existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow-up. Six patients were lost during follow-up. CONCLUSIONS: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.     

Factors associated with liver biopsy performance in HCV-HIV coinfected injecting drug users with HCV viremia: Results from a five-year longitudinal assessment

The last international consensus conference about hepatitis C virus (HCV) treatment emphasized the importance of treatment for persons coinfected with HCV and human immunodeficiency virus (HIV). As liver biopsy precedes treatment, we aimed to identify factors associated with the performance of liver biopsy among HIV-HCV coinfected drug users during a 5-year follow-up to study their access to HCV treatment. Of the 296 patients followed in the HIV hospital departments of Nice and Marseilles and with retrievable records about HCV diagnosis and care, 166 were eligible for analysis having had detectable HCV RNA at least once during the study period. Overall, 45.2% of patients underwent liver biopsy during follow-up. Using proportional hazard models, predictors of having had a liver biopsy were high social support, complete abstinence from drug injection, and lack of immunosuppression as well as male gender, no history of multiple incarcerations, more recent onset of drug use, and an increase of liver enzyme levels. These results suggest that specific efforts should be devoted to HIV-HCV coinfected drug users to assist with stabilizing these patients to optimize their access to HCV care whenever possible. The MANIF 2000 study group includes C. Boirot, A. D. Bouhnik, M. P. Carrieri, J. P. Cassuto, M. Chesney, P. Dellamonica, P. Dujardin, S. Duran, J. G. Fuzibet, H. Gallais, J. A. Gastaut, G. Lepeu, D. A. Loundou, C. Marimoutou, D. Mechali, J. P. Moatti, J. Moreau, M. Nègre, Y. Obadia, I. Poizot-Martin, C. Pradier, D. Rey, C. Rouzioux, A. Sobel, B. Spire, F. Trémolières, and D. Vlahov.     

纳洛酮预处理大鼠肝细胞对缺血再灌注损伤的影响

为探讨纳洛酮预处理大鼠后对其肝细胞缺血再灌注损伤的影响 ,短期对 Wistar大鼠腹腔内注射纳洛酮 ,然后制作缺血再灌注损伤模型 ,检测血清中谷丙转氨酶 (ALT)和谷草转氨酶 (AST)的含量 ,检测肝组织中丙二醛 (MDA)和超氧化物歧化酶(SOD)的含量 ,通过光镜、电镜观察 ,了解肝细胞形态学及超微结构的改变。结果显示 ,纳络酮预处理组血清中 AL T和 AST含量及肝组织中 MDA含量于缺血再灌注组 (P<0 .0 5 ) ,而肝组织中 SOD含量则高于缺血再灌注组 (P<0 .0 5 ) ,与假手术组无明显差异 ,肝细胞形态学异常改变也明显减轻     

中国药物依赖自愿戒毒机构的医院文化与医学伦理建设

药物依赖自愿戒毒机构的医院文化和医学伦理建设直接关系到其职能的实施和宗旨的贯彻.以现代生命伦理学和社会伦理学为内涵的医学伦理学是指导现代药物依赖临床医疗机构文化建设的重要基础之一;其对构建具有中国特色的医院文化和禁毒工作意义重大.     

Immunohistochemical study of proliferating cell nuclear antigen (PCNA) in duckling liver fed with aflatoxin B1 and esterified glucomannan

The effect of esterified glucomannan on aflatoxin B₁ toxicity in ducklings was studied by immunohistochemical staining of proliferating cell nuclear antigen (PCNA) in hepatic cells on formalin-fixed paraffin-embedded liver samples. Cherry Valley ducklings were divided into five groups, 20 birds in each. One of the groups was fed with conventional feed, and the other groups were fed with diet containing 100 ppb aflatoxin B₁, that containing 0.05% esterified glucomannan, or that containing 100 ppb aflatoxin B₁ supplemented with 0.05 or 0.1% esterified glucomannan, from five days of age for one month, and subsequently all the groups were fed with conventional feed for 20 days. Four birds of each group were sacrificed on the 30th, 35th, 40th, 45th and 50th day of feeding, and PCNA on the liver tissue sections was quantitatively analyzed by immunohistochemical staining. The percentage of PCNA-positive hepatocytes was significantly higher in the group given diet containing aflatoxin B₁ than in the other groups, which were not significantly different from each other. The results demonstrate that supplementation of feed with esterified glucomannan is effective in reduction of aflatoxin B₁-induced hepatic injury in ducklings.     

结肠癌肝转移切除术后复发机制

结肠癌肝转移切除术后仍有较高的复发率.在肝部分切除之后,由于肝脏的损伤,启动了肝再生机制.肝切除术后局部血管生成增加、细胞外基质的降解、肿瘤抑制因子的减少、机体免疫力的改变、促肝细胞生长因子的作用等因素,都可能参与促进残癌生长的过程.