查看更多>>摘要：AIM:To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices.METHODS:Fifty-six patients with gastric varices underwent BRTOs using microcatheters.A balloon catheter was inserted into gastrorenal or gastrocaval shunts.A microcatheter was navigated close to the varices,and sclerosant was injected into the varices through the microcatheter during balloon occlusion.The next morning,thrombosis of the varices was evaluated by contrast enhanced computed tomography (CE-CT).In patients with incomplete thrombosis of the varices,a second BRTO was performed the following day.Patients were followed up with CE-CT and endoscopy.RESULTS:In all 56 patients,sclerosant was selectively injected through the microcatheter close to the varices.In 9 patients,microcoil embolization of collateral veins was performed using a microcatheter.In 12 patients with incomplete thrombosis of the varices,additional injection of sclerosant was performed through the microcatheter that remained inserted overnight.Complete thrombosis of the varices was achieved in 51 of 56 patients,and the remaining 5 patients showed incomplete thrombosis of the varices.No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 mo.We experienced one case of liver necrosis,and the other complications were transient.CONCLUSION:The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures.
查看更多>>摘要：AIM:To examine the significance of branched-chain amino acid (BCAA) treatment before transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).METHODS:This study included 99 patients who underwent TACE therapy for HCC at our hospital and were followed up without treatment for at least 6 mo between January 2004 and January 2010.They were divided into 2 groups:those receiving BCAA granules (n =40) or regular diet (n =59,control).Data obtained were retrospectively analyzed (prior to TACE,and 1 wk,1,3,and 6 mo after TACE) in terms of nutritional condition and clinical laboratory parameters (serum albumin level and Child-Pugh score),both of which are determinants of hepatic functional reserve.RESULTS:The BCAA group comprised 27 males and 13 females with a mean age of 69.9 ± 8.8 years.The patients of the BCAA group were classified as follows:Child-Pugh A/B/C in 22/15/3 patients,and Stage Ⅱ/Ⅲ/IVA HCC in 12/23/5 patients,respectively.The control group comprised 32 males and 27 females with a mean age of 73.2 ± 10.1 years.In the control group,9 patients had chronic hepatitis,Child-Pugh A/B/C in 39/10/1 patients,and Stage I/Ⅱ /Ⅲ/IVA HCC in 1/11/35/12 patients,respectively.Overall,both serum albumin level and Child-Pugh score improved significantly in the BCAA group as compared with the control 3 and 6 mo after TACE (P ＜ 0.05).Further analysis was performed by the following categorization:(1) child-Pugh classification; (2) liver cirrhosis subgroup with a serum albumin level ＞ 3.5 g/dL; and (3) epirubicin dose.A similar trend indicating a significant improvement of all variables in the BCAA group was noted (P ＜ 0.05).CONCLUSION:Treatment with BCAA granules in patients who have undergone TACE for HCC is considered useful to maintain their hepatic functional reserve.
查看更多>>摘要：AIM:To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC).METHODS:Between December 2006 and June 2008,a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled.Liver stiffness was obtained noninvasively by using Fibroscan (Echosens,Paris,France).The date of blood transfusion was obtained by interview.Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM).Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years;40-49 years; and 50-70 years).The difference in liver stiffness between patients with and without HCC was assessed in each group.Multiple linear regression analysis was used to determine the factors associated with liver stiffness.RESULTS:A total of 524 patients underwent LSM.Eight patients were excluded because of unsuccessful measurements.Thus 516 patients were included in the current analysis (225 with HCC and 291 without).The patients were 244 men and 272 women,with a mean age of 67.8 ± 9.5 years.The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in nonHCC group).The patients who developed HCC in short duration of infection were male dominant,having lower platelet count,with a history of heavier alcohol consumption,showing higher liver stiffness,and receiving blood transfusion at an old age.Liver stiffness was positively correlated with duration of infection in patients without HCC (r =0.132,P =0.024) but not in patients with HCC (r =-0.103,P =0.123).Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P ＜ 0.0001).The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P ＜ 0.0001),duration of infection (P =0.0015),and heavy alcohol consumption (P =0.043)CONCLUSION:Although liver stiffness gradually increases over time,HCC develops in patients with high stiffness value regardless of the duration of infection.
查看更多>>摘要：AIM:To investigate the role of opioid μ-receptor subtype in opiate-induced constipation (OIC).METHODS:The effect of loperamide on intestinal transit was investigated in mice.Ileum strips were isolated from 12-wk-old male BALB/c mice for identification of isometric tension.The ileum strips were precontracted with 1 μmol/L acetylcholine (ACh).Then,decrease in muscle tone (relaxation) was characterized after cumulative administration of 0.1-10 μmol/k loperamide into the organ bath,for a concentration-dependent study.Specific blockers or antagonists were used for pretreatment to compare the changes in loperamide-induced relaxation.RESULTS:In addition to the delay in intestinal transit,loperamide produced a marked relaxation in isolated ileum precontracted with ACh,in a dose-dependent manner.This relaxation was abolished by cyprodime,a selective opioid μ-receptor antagonist,but not modified by naloxonazine at a dose sufficient to block opioid μ-1 receptors.Also,treatment with opioid μ-1 receptor agonist failed to modify the muscle tone.Moreover,the relaxation by loperamide was attenuated by glibenclamide at a dose sufficient to block ATP-sensitive K+ (KATP) channels,and by protein kinase A (PKA) inhibitor,but was enhanced by an inhibitor of phosphodiesterase for cyclic adenosine monophosphate (cAMP).CONCLUSION:Loperamide induces intestinal relaxation by activation of opioid μ-2 receptors via the cAMPPKA pathway to open KATP channels,relates to OIC.
查看更多>>摘要：AIM:TO investigate whether Notch signaling is involved in liver fibrosis by regulating the activation of hepatic stellate cells (HSCs).METHODS:Immunohistochemistry was used to detect the expression of Notch3 in fibrotic liver tissues of patients with chronic active hepatitis.The expression of Notch3 in HSC-T6 cells treated or not with transforming growth factor (TGF)-β1 was analyzed by immunofluorescence staining.The expression of Notch3 and myofibroblastic marker α-smooth muscle actin (α-SMA) and collagen I in HSC-T6 cells transfected with pcDNA3.1-N3ICD or control vector were detected by Western blotting and immunofiuorescence staining.Moreover,effects of Notch3 knockdown in HSC-T6 by Notch3 siRNA were investigated by Western blotting and immunofluorescence staining.RESULTS:The expression of Notch3 was significantly up-regulated in fibrotic liver tissues of patients with chronic active hepatitis,but not detected in normal liver tissues.Active Notch signaling was found in HSC-T6 cells.TGF-β1 treatment led to up-regulation of Notch3 expression in HSC-T6 cells,and over-expression of Notch3 increased the expression of α-SMA and collagen I in HSC-T6 without TGF-β1 treatment.Interestingly,transient knockdown of Notch3 decreased the expression of myofibroblastic marker and antagonized TGF-β1-induced expression of α-SMA and collagen I in HSC-T6.CONCLUSION:Notch3 may regulate the activation of HSCs,and the selective interruption of Notch3 may provide an anti-fibrotic strategy in hepatic fibrosis.
查看更多>>摘要：AIM:To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.METHODS:Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents.A part of patients completed 3D-CRT after stenting.Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment.The median survival,3D-CRT toxicity and complications were compared between 3D-CRT and control groups.RESULTS:From 1999 to 2008,99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents.Sixty-seven patients received 3D-CRT,while 36 patients treated with endoscopic stents alone were recruited as controls.After 3D-CRT treatment,the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ±10.2 cm3 to 28.8 ± 8.5 cm3 (P ＜ 0.05).The complete and partial response rate was 85.1％,and no response was 14.9％.After 3D-CRT,the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4％ while T4 decreased from 66.7％ to 21.6％ (P ＜ 0.05).3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P =0.031).3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d,P ＜ 0.05).And the median half-year survival rate in 3D-CRT group (91％) was higher than in the control group (50％,P ＜ 0.05).The most common toxicity was leukocytopenia in the 3D-CRT group (46.7％ vs 18.8％,P =0.008).The control group had a higher rate of restenosis than the 3D-CRT group (81.3％ vs 9.0％,P ＜ 0.05).The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3％ vs 15.6％,P ＜ 0.05).CONCLUSION:3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma.3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.
查看更多>>摘要：Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized,bone marrow-derived langerhans cells and mature eosinophils.The clinical spectrum ranges from an acute,fulminant,disseminated disease called LettererSiwe disease to solitary or few,indolent and chronic lesions of the bone or other organs called eosinophilic granuloma.Involvement of the gastrointestinal tract is very rare in LCH.We present the case of a 53-year-old woman referred by her primary care physician for a screening colonoscopy.A single sessile polyp,measuring 4 mm in size,was found in the rectum.Histopathological examination revealed that the lesion was relatively well circumscribed and comprised mainly a mixture of polygonal cells with moderate-to-abundant pink slightly granular cytoplasm.The nuclei within these cells had frequent grooves and were occasionally folded.Immunohistochemical staining was positive for CD-1a which confirmed the diagnosis of LCH.On further workup,there was no evidence of involvement of any other organ.On follow up colonoscopy one year later,there was no evidence of disease recurrence.Review of the published literature revealed that LCH presenting as solitary colonic polyp is rare.However,with the increasing rates of screening colonoscopy,more colonic polyps may be identified as LCH on histopathology.This underscores the importance of recognizing this rare condition and ensuring proper follow-up to rule out systemic disease.
Marcia Henriques de Magalh(a)es CostaMaria da Gloria Fernandes PegadoCleber VargasMaria Elizabeth C Castro...
1414-1416页
查看更多>>摘要：Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different drugs.We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin index.Gastroduodenal endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the moment.In addition,the duodenal mucosa presented marked signs of melanosis; later confirmed by histopathological study.Even though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.
NETL
NSTL
万方数据
维普