Looking for large-cell dysplasia in liver needle biopsies how and why?

Liver large cell dysplasia (LCD) is identifiable only at the microscopic level as foci of large hepatocytes with pleomorphic hyperchromatic nuclei and prominent nucleoli. LCD is mainly observed in cirrhotic livers, on surgical specimens, within macroregenerative nodules or low grade dysplastic nodules but also on liver needle biopsies. For needle biopsies, the prevalence of LCD ranges between 15% and 20%. in case of associated hepatocellular carcinoma, the prevalence is around 40%. LCD is more frequent in hepatitis B virus-induced liver cirrhosis than in cirrhosis related to other causes. Two prospective studies showed that LCD is a predictive factor for the occurrence of hepatocellular carcinoma in cirrhotic patients. Nevertheless LCD is probably not a precancerous lesion; dysplastic hepatocytes are biologically senescent polyploid cells unable to carry out normal cell division. Diagnosis of LCD on liver needle biopsy is indicative for the presence of large and numerous foci of LCD within the whole parenchya and allows consequently to select cirrhosis associated with advanced liver cell secescence, i.e. cirrhosis in which multistep genetic alterations of liver cell carcinogenesis could have happened with the greatest probability. Therefore pathologists have to identify and indicate the presence of LCD in the reports of liver needle biopsies     

阿片制剂在胆囊切除术后发生疑似奥狄氏括约肌功能障碍中的作用被低估

目的：胆囊切除术后疼痛复发常被考虑为奥狄氏括约肌功能障碍，但其诊断标准和治疗方法尚不明确。作进行了一项回顾性研究以评估阿片制剂的摄入对该病可能的诱导作用。方法：对接受超声内镜和（或）内镜逆行胆管造影（ERC）调查胆囊切除术后综合征的147例连续患的病历资料进行回顾性研究，获得37例胆型奥狄氏括约肌功能障碍的病例。结果：13例（30％）奥狄氏括约肌功能障碍可疑患曾在出现疼痛前15min～2h（中值为1h）接受了含阿片药物（“阿片组”）。与23例未接受阿片药物的患（“非阿片组”）比较，“阿片组”患较年轻（47岁粥60岁），胆总管较狭窄（5．0mmvs7．7mm），但是两组的生化异常相似，属于同样的Milwaukee分级，大多为Ⅱ级。“阿片组”患均未接受ERC或超声内镜检查，而“非阿片组”接受这两项检查的比例分别为52％和39％。平均随访3．5年后，“阿片组”有3例复发性胆型腹痛（1例为胆总管结石，2例为可疑奥狄氏括约肌功能障碍），“非阿片组”有2例（1例为胆总管结石，1例为可待因吸入）。     

Synthesis,characterization and hydrolysis of poly[styrene-co-(6-methylene-1,4-oxathiepane-7-one)] and poly[styrene-co-(6-methylene-5-methyl-1,4-oxathiepane-7-one)]

Vinylic-type polymers bearing ester groups inside the polymer backbone have been synthesized by free radical copolymerization of styrene (St) and 6-methylene-1,4-oxathiepane-7-one (MOTPO) or 6-methylene-5-methyl-1,4-oxathiepane-7-one (MMOTPO). The addition-fragmentation ring-opening polymerization of both MOTPO and MMOTPO leads to the formation of ester linkages located inside the vinylic polymer backbone. A strong decrease of the molar mass of the copolymer has been observed when the copolymers were dissolved in a mixture of THF and water in the presence of sodium hydroxide. This decrease can be attributed to the hydrolysis of the ester linkages, as followed by size exclusion chromatography (SEC). The molar mass of the degraded polymer samples was correlated with the number of ester linkages in the backbone, showing that only a fraction of these ester groups have been hydrolyzed.     

Natural history of non alcoholic and non familial chronic pancreatitis. Results of a multicentre study

The natural history and complications of non alcoholic chronic pancreatitis (NACP) is poorly understood compared to that of alcoholic chronic pancreatitis (ACP). PATIENTS AND METHODS: From April 1993 to April 1996, 77 patients with NACP were prospectively evaluated in 17 French centres. This population was compared to a cohort of 417 patients with ACP. RESULTS: No significant difference was observed with respect to mean age between NACP and ACP (43 +/- 20 vs 44 +/- 11 years, respectively). The median patient follow-up time was also comparable: 7 years (1-28) and 6 years (1-34) respectively for NACP and ACP. There were significantly more males in the ACP group (9/1 in ACP group and 1.3/1 in NACP group; P<10(- 7) ). Patients with NACP were less likely to have calcifications (58% vs 77%; P=0.01), pseudocysts (19 vs 47%, P<0.001), portal vein thrombosis (5 vs 16%, P<0.02). Importantly, patients with NACP required less surgical procedures than those with ACP (26% vs 44%, P=0.004). The actuarial death rate at 15 years was 0% in the NACP group compared to 20.5% in those with ACP (no CP related death). CONCLUSION: NACP has a less severe disease progression, fewer complications and requires less surgical interventions than ACP. The lower actuarial survival rate in patients with ACP correlates with the extra-pancreatic complications encountered in patients with alcohol related diseases and not with the evolution of CP itself.