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Nodular Lesions of Cirrhotic Liver: Imaging Manifestations with Pathologic Correlation

Chinese Journal of Bases and Clinics in General Surgery.2003;0(03):-.

Objective To introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.Methods Ultrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.Results Many of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, low grade dysplastic nodule, high grade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.Conclusion Modern state of the art medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.

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Analysis of Risk Factors of Recurrent Inguinal Hernia by Cox Proportional Hazard Regression Model

Wei REN ; De SHI

Chinese Journal of Bases and Clinics in General Surgery.2003;0(03):-.

Objective To retrospectively analyze the risk factors of recurrent groin hernia. Methods Data came from all hernia repairs recorded in our hospital between 1991 and 2001. A total of 1 082 cases of groin hernia was analyzed through Cox proportional hazard model to determine the relative risks between recurrence and mode of admission, types of groin hernia, repair methods (traditional/tension free hernioplasty), and post operative complications.Results From 1991 to 2001,1 082 groin hernia operations were performed in our hospital, 88.9% for primary hernia and 11.2% for recurrent hernia. As compared with traditional hernia repair methods, Lichtenstein’s tension free hernioplasty technique had less relative risk for recurrent hernia repair than that for primary hernia repair. Postoperative complications and indirect hernia were linked to an increased relative risk for recurrence. Conclusion There are many factors affecting the recurrence of inguinal hernia, but the use of tension free hernia repair may decrease re recurrence of recurrent hernia.

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Target Antigen of Hyperacute Rejection in Pig-to-Human Xenotransplantation

Lingyu ZENG ; Youping LI

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To investigate the aim antigen coursing the hyperacute rejection of xenotransplantation. Methods Documents about hyperacute rejection in xenotransplantation were reviewed and summarized in detail. Results Pig is thought to be one of the ideal donors of xenotransplantation, but the major obstacle is hyperacute rejection mediated by complement that is activated though human serum. ?-Gal is recognized as the major antigen and its expression is controlled by ?-1,3 galactosyltransferase. Immunoabsorption of pre-exsisted antibody, enzymatic digestion of ?-Gal, knockout ?-GT gene and transgenic technology have been used to solve this problem. Even so, there remain other antigens which can combine with natural antibodies in human serum, such as, 40?10 3 molecule in erythrocyte, 210?10 3, 10 5?10 3 and 50?10 3 antigen in pig embryo brain cell, etc. Conclusion ?-Gal is the major antigen which course the hyperacute rejection. Besides ?-Gal, many nonalpha-gal need further investigation.

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The Relationship Between the Apoptosis Hepatocyte and Its Genic Mediation and the Ischemia of Portal Vein

Jingdong LI ; Bo LI

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To introduce the relationship between the apoptosis hepatocyte and its genic mediation and the ischemia of portal vein. Methods The combination of related literatures and our research findings were made.Results Portal vein ischemia may induced hepatocyte apoptosis, p53 and bcl-2 gene alternatively adjust hepatocyte apoptosis. Expression of p53 gene is enhanced in hepatic tissue when hepatocyte apoptosis is not obvious, but after 24-72 h of portal vein ischemia, when hepatocyte apoptosis is obvious, enhanced expression of p53 gene or reduced expression of bcl-2 gene occur. There exists close relationship between portal vein ischemia and hepatocyte apoptosis. Conclusion Apoptosis hepatocyte is involved in organic atrophy after ischemia of portal vein, and p53 and bcl-2 gene alternatively adjust hepatocyte apoptosis. At present, the mechanism of apoptosis of hepatocyte induced by ischemia of portal vein is not clear, which needs further study.

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Comparison of Clinical Application Between Tacrolimus and Cyclosporine A in Organ Transplantation

Xiaoping WEI ; Li LI

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To compare tacrolumus (FK506) with cyclosporine A (CsA) in clinical application to organ transplantation.Methods The literature in recent years has been reviewed and compared. Results FK506 was a powerful immunosuppression with a mechanism of action similar to that of CsA, but significantly superiori to CsA in terms of prophylaxis and treatment of allograft acute rejection, delay of chronic rejection, and withdrawal of steroid in early period. The cardiovascular mortality and chronic graft nephropathy (CGN),such as hypertension and hyperlipidemia were less frequently seen in FK506-treated patients and FK506 also had an acceptable safety profile, including a low incidence of hypertrichosis,gingival hyperplasia and infections.However, CsA had been showed a better result in prevention of posttransplantation diabetes mellitus (PTDM ) and more economic agent than FK506. Pharmacokinetic studies showed CsA in the form of Sandimmun Neoral showed less inter- an intrapatient variability than FK506.Meanwhile, the combination of MMF and FK506 or CsA has been proved effectively with excellent graft and patients survival. Conclusion FK506 and CsA are safe and effective long term maintenance immunosuppressive agents in organ transplantation with wonderful prospect.

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Clinical Decision for Adult Living Related Partial Liver Transplantation

Huihua YAO ; Tianfu WEN ; Lnan YAN

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To investigate the clinical choice on graft size and the type of donor's hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor's evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with left-side caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.

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Preoperative Imaging Evaluation of Donors and Recipients in Liver Transplantation

Yan CHENG ; Longlin YIN ; Bin SONG

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To review the various imaging modalities and their appropriate applications in the preoperative evaluation of both donors and recipients in liver transplantation (LT). Methods All the relevant literatures were reviewed. Different kinds of imaging modalities have been used in potential LT donors and recipients to assess the volume, the parenchyma and the vasculature of the liver, the biliary system, and the extrahepatic region of the upper abdomen and beyond. The techniques, the imaging findings, and the merits and shortcomings of various imaging modalities were presented.Results Traditional imaging techniques are still of valuable, while CT can provide rich and accurate information. "One-stop" comprehensive MR examination is emerging as the method of choice for the preoperative evaluation LT recipients and donors. Conclusion Each imaging method has its merits and limitations. Those imaging methods which can provide accurate and comprehensive information are likely to have better application future.

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Value of MUC1 and MUC3 in the Calcareous Cholocystitis and Cholecystic Adenomatoid Polyps

Hong CAO ; Dongfeng CHEN ; Wei ZHENG

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To study the change of mucins of expression in lithic cholecystitis and cholecystic adenomatiod polyps. Methods MUC1 and MUC3 were detected in the mucosa of human normal gallbladders (20 cases, control group), of calcareous cholecystitis (38 cases, calcareous group) and of adenomatoid polyps (18 cases, polyp group) with immunohistochemical stains and Western blotting methods. Results The positive rate and optical density values of MUC1 were increased significantly in calcareous and polyp group vs control group ( P

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The Expression and Significance of Multidrug Resistant Gene mdr1 in Hepatocellular Carcinoma

Yi QUAN ; Lnan YAN

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To explore the relationship between mdr1 gene expression of hepatocellular carcinoma (HCC) and pathological characteristics,chemotherapy and prognosis. Methods The mdr1 gene expression of HCC in 56 patients with the methods of immunohistochemistry was studied. The results were analysed with the pathological data by statistic methods. Results The positive expression of mdr1 gene in cancer tissues and pericancerous tissues of HCC were 30/56(53.6%) and 19/56 (33.9%) respectively. The difference was statistically significant (? 2=4.39, P

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An Experimental Study on the Protective Role of Aminoguanidine on Liver Injury in Endotoxic Shock

Wenzhe SONG ; Yan SONG ; Yan TAN ; Jiajun YIN

Chinese Journal of Bases and Clinics in General Surgery.2003;0(04):-.

Objective To study the effects of aminoguanidine (AG), a selective inhibitor of inducible nitric oxide synthase (iNOS) on the pathological changes of liver tissues and ultrastructural changes of liver cells in rodent model of endotoxic shock. Methods Twenty-four male Wistar rats were randomly divided into normal control group,lipopolysaccharide (LPS) control group and AG treatment group, each group had 8 rats. Rats were challenged by E.coli LPS to set up the model of endotoxic shock, AG group were treated by aminoguanidine. The pathological and ultrastructural changes of liver tissues and plasma NO contents of three groups were observed and compared. Results Light microscopy revealed that many tiny abscesses scattered in liver tissue in LPS group, accompanied by necrosis of liver cells and neutrophils infiltration, while liver injuries of AG group were much slighter than that in LPS group. Electron microscopy revealed that there were dissolved plaques in hepatocyte nuclears, swelling of mitochondria, decreasing in number of mitochondrial ridges, while AG play a protective role to nuclears and mitochondria of hepatocytes. The plasma NO levels of LPS control group were higher than that of normal control group, and plasma NO levels decreased significantly after AG treatment, but still higher than that of normal control group. Conclusion Aminoguanidine selectively inhibits iNOS activity and prevents the overproduction of NO induced by iNOS, thus attenuates the damages of liver structure induced by NO. This method has potential value in clinical application, which deserves more deep research.

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