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Clinical manifestations of patients with chronic pancreatitis

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hepatobiliary & pancreatic Diseases International 2006年第1期5卷 133-137页

作者： Wei-Xing Chen, Wei-Fang Zhang, Bo Li, Hui-Jia Lin, Xian Zhang, Hong-Tan Chen, Zhu-Ying Gu and You-Ming Li department of Gastroenterology, first Afliliated hospital. zhejiang university school of medicine. hangzhou 310003, china department of Intensive Care Unit, first affiliated hospital, zhejiang university school of medicine, hangzhou 310003, china department of Gastroenterology First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China. chenweixing@***

BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol comsumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.

关键词： chronic pancreatitis clinical manifestation etiology

Diagnostic analysis of hepatic angiomyolipoma

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hepatobiliary & pancreatic Diseases International 2005年第1期4卷 152-155页

作者： Tian-An Jiang, Qi-Yu Zhao, Miao-Yan Chen, Li-Jun Wang and Jian-Yang Ao hangzhou, china department of Ultrasonography, first affiliated Hos- pital , Distance Education Center and department of Pathology, first affiliated hospital , zhejiang university school of medicine, hangzhou 310003, china department of Ultrasonography First Affiliated Hospital of Zhejiang University School of Medicine Hangzhou 310003 China. Tiananjiang@***

BACKGROUND: Hepatic angiomyolipoma (HAML) is a rare tumor containing a variable amount of fat, vessels and smooth muscle. We report the image findings on ultra- sonography and computed tomography ( CT) of huge HAML. METHOD; The clinical, imaging and pathological data of a case of HAML were retrospectively collected and ana- lyzed. RESULTS; A huge heterogeneous hyperecho mass with anecho and hypoecho areas inside was found in the left he- patic lobe on ultrasonography. Color Doppler showed blood flow and arterial spectrum in it. CT scan showed a huge heterogeneous solid mass in the left lobe of the liver, with a low density and hypervascular area in arterial phase. The serum tumor marks were all negative. Ultrasound- guided biopsy was taken twice before resection and both showed necrosis tissue and reaction of inflammatory cells. Postoperative pathological results showed that the tumor was composed of epithelioid smooth muscle cells, thick- walled blood vessels and a few adipose cells with necrosis. The immunohistochemistry results showed appea-rance of typical HAML, with HMB-45 positive and alpha fetopro- tein (AFP) negative. CONCLUSIONS: Preoperative diagnosis of HAML relies on combination of CT, MRI and ultrasonography. Our case of HAML showed heterogeneous hyperecho image on ultra- sonography. Ultrasound-guided biopsy combined with morphological manifestation and specimen examination for HMB-45 may be helpful in the diagnosis of HAML.

关键词： liver angiomyolipoma ultrasound examination

Lipase and pancreatic amylase activities in diagnosis of acute pancreatitis in patients with hyperamylasemia

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hepatobiliary & pancreatic Diseases International 2005年第4期4卷 600-603页

作者： Rong-Wei Yang, Zhe-Xin Shao, Yi-Yi Chen, Zhou Yin and Wen-Juan Wang Clinical Laboratory, first affiliated hospital, zhejiang university school of medicine, hangzhou 310003, china and Clinical Laboratory, zhejiang Xinhua hospital, hangzhou 310003 , china Clinical Laboratory First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China.

BACKGROUND: Measurement of total serum amylase (AMY) is the most widely used biochemical test for the diagnosis of acute pancreatitis, but it is commonly considered a nonspecific marker. To improve the biochemical diagnosis of acute pancreatitis, lipase ( LIP ) and pancreatic amylase (PAMY) have been tested in recent years. The present study was designed to evaluate whether serum LIP and pancreatic PAMY tests could replace total amylase test to improve diagnostic efficiency in the evaluation of acute pancreatitis in patients with hyperamylasemia. METHODS: LIP and PAMY values were determined in serum samples from 92 patients with hyperamylasemia. Reference values for each enzyme were derived from serum samples of 147 healthy subjects. The activities of LIP and PAMY in patients with various diseases were shown directly by the boxplot graph. The diagnostic accuracy of LIP and PAMY was defined as the area under the receiver operating characteristic (ROC) curve. Their sensitivity and specificity in detecting acute pancreatitis at varying cutoff points were shown by the curve, and the best cutoff value for each enzyme was shown by the modified ROC curve. The diagnostic values of LIP, PAMY and LIP + AMY with each upper limit of reference range (ULR) were compared with the corresponding best cutoff values. RESULTS: The references values of LIP and PAMY were 12.2-47.6 U/L and 28-95 U/L, respectively. These values in patients with acute pancreatitis were higher than those patients with other diseases. The areas under the ROC curve ( AUC) of LIP and PAMY were 0. 799 and 0. 792, respectively, With the best diagnostic cutoff point of maximum (sensitivity + specificity) -100%, we obtained values of 97.9 U/L(LIP97.9 =2. 06 × ULR) for LIP and 209 U/L (PAMY209 =2.20 ×ULR) for PAMY. The best cutoff values for LIP, PAMY and LIP +AMY demonstrated the specificity, positive predictive value, and diagnostic efficiency higher than the corresponding ULRs. CONCLUSIONS: Serum LIP and PAMY are

关键词： pancreatic injury lipase pancreatic amylase

The Chinese classification system compared with TNM staging in prognosis of patients with primary hepatic carcinoma after resection

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hepatobiliary & pancreatic Diseases International 2005年第4期4卷 561-564页

作者： Jian-Ming Sheng, Wen-He Zhao, Fu-Sheng Wu, Zhi-Min Ma, Yi-Zheng Feng, Xing-Ren Zhou and Li-Song Teng department of Oncological surgery, first affiliated hospital, zhejiang university school of medicine, hangzhou 310003 , china department of Oncological surgery First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China. sjm418@***

BACKGROUND: The life expectancy of a patient with primary hepatic carcinoma (PHC) is hard to predict, and it is related to many prognostic factors. The Chinese classification system including five parameters: tumor, vascular thrombosis, lymph node metastasis, distant metastasis and Child-Pugh stage developed in 1999 was adopted by the 8th National Conference on liver Cancer of the Chinese Anti-Cancer Association in 2001. In this study, the discriminatory ability of the Chinese classification system -was compared with that of the TNM staging in patients for resection of PHC, in addition to the evaluation of prognostic value. METHODS: The data of 246 patients who had undergone resection of PHC from January 1986 to December 2000 (average age, 51 years; male/female ratio, 213/33) were retrospectively studied. Among the 246 patients, 227 were followed up for at least 3 years. RESULTS: The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates were 55% , 30% , 25% , 20% and 18% , respectively. The Chinese classification system was better than the TNM staging system in predicting survival rate of patients with PHC, as confirmed by survival curves shown by the Kaplain-Meier method. The mean survival time was 155, 70, 39, 16, and 4 months in patients with die Chinese classification stages Ⅰa, Ⅰb, Ⅱa,Ⅱb, and Ⅲ, respectively. The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates of the Chinese classification system and TNM staging were statistically significant and had a slightly positive relationship. The predictive capacity of the Chinese classification system was confirmed in any two subgroups of patients undergoing operation. COX proportional hazards regression analysis showed that the Chinese classification system was the only independent prognostic factor for survival. CONCLUSIONS: Taking both tumor extension and liver function into account, we consider that the Chinese classification system making up for the deficiency of UICC TNM staging is more precise in predictin

关键词： primary liver cancer staging system liver functional status prognosis

Gene heterogeneity of hepatitis B virus isolates from patients with severe hepatitis B

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hepatobiliary & pancreatic Diseases International 2005年第4期4卷 530-534页

作者： Wei Wu, Yu Chen, Bing Ruan and Lan-Juan Li hangzhou, china department of Infectious Diseases, first affiliated hospital, zhejiang university school of medicine, Key Laboratory of Infectious Diseases of Health Ministry of china, hangzhou 310003, china department of Infectious Diseases First Affiliated Hospital Zhejiang University School of Medicine Key Laboratory of Infectious Diseases of Health Ministry of China Hangzhou 310003 China.

BACKGROUND: The pathogenesis of severe hepatitis B remains unknown. Reports have indicated that hepatitis B virus (HBV) mutations are important factors in the pathogenesis of this disease. This study was to investigate the genetic heterogeneity of HBV strains from serum samples of patients with fulminant hepatitis B. METHODS: Full-length HBV genomes from 4 patients with severe hepatitis B were cloned and sequenced to observe mutations in every open reading-frame ( ORF). Serum samples of another 25 patients with severe hepatitis B, 30 patients with chronic hepatitis B, and 25 HBV carriers were collected for sequencing and comparison of mutations in preS2, preC and core promoter regions. RESULTS: Of 4 HBV full-length genome sequences, 3 had a G to A mutation at nucleotide A1896 in the preC region and 1 had double mutations of T1762-A1764 in the core promoter region. The 4 sequences showed mutations in the known B or T cell epitopes of the preS2 and C regions. For the other 3 groups, more mutations were seen in the preS2 region in the HBV isolates from the patients with severe hepatitis B than those from the patients with chronic hepatitis B and HBV carriers (P <0.01). There was a significant difference of mutations in the T cell epitope region of preS2 between the patients with severe hepatitis B and those with chronic hepatitis B or HBV carriers (P <0.01). In the preC and core promoter regions, the mutation frequencies of T1653 and C1753 were 48.0% and 24.0% respectively in the patients with severe hepatitis B, but none of these mutations were observed in the patients with chronic hepatitis B group or HBV carriers (P <0.01). The mutation frequency of T1762-A1764 was 76.0% in the patients with severe hepatitis B, 40.0% in the patients with chronic hepatitis B (P <0. 01) , and 16. 0% in the HBV carriers ( P < 0. 01). There was a significant difference in A1896 mutation between the patients with severe hepatitis B and the patients with chronic hepatitis B (P < 0. 05 ) o

关键词： hepatitis B virus severe hepatitis virus genome gene heterogeneity preS2 preC core promoter

Is the hypoxia-inducible factor-1 alpha mRNA expression activated by ethanol-induced injury, the mechanism underlying alcoholic liver disease?

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hepatobiliary & pancreatic Diseases International 2006年第4期5卷 560-563页

作者： Lin Li, Shao-Hua Chen, Yu Zhang, Chao-Hui Yu, Shu-Dan Li and You-Ming Li department of Gastroenterology, first affiliated hospital, zhejiang university school of medicine, hangzhou 310003, china department of Gastroenterology First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China. liph@***

BACKGROUND: Excessive alcohol consumption can result in multiple organ injury, of which alcoholic liver disease (ALD) is the most common. With economic development and improvement of living standards, the incidence of diseases caused by alcohol abuse has been increasing in china, although its pathogenesis remains obscure. The aim of this study was to investigate the role of hypoxia in chronic ALD. METHODS: Twenty-eight male Sprague-Dawley rats were randomized into a control group (n=12) with a normal history and an experimental group (n=16) fed with 10 ml/ kg of 56% (vol/vol) ethanol once per day by gastric lavage for 24 weeks. At 24 weeks, blood samples were collected and then the rats were killed. Liver samples were frozen at -80 ℃ and used for RT-PCR; other liver samples were obtained for immunohistochemical staining. RESULTS: When the period of alcohol consumption increased, the positive rate of expression of hypoxia- inducible factor-1 alpha (HIF-1α) mRNA was more significantly elevated in the liver of the alcohol group than in the control group (P≤0.05). The HIF-1α protein located in the cytoplasm was seldom expressed in the control group, but significantly in the alcohol group (P≤0.01). CONCLUSION: HIF-1α mRNA expression was activated by ethanol-induced injury in this study, suggesting that hypoxia is involved in the underlying mechanism of ALD.

关键词： alcoholic liver disease hypoxia-inducible factor-1 alpha mRNA immunohistochemical staining

Focal nodular hyperplasia of the liver: pathological analysis of 11 cases

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hepatobiliary & pancreatic Diseases International 2004年第2期3卷 199-203页

作者： Yi Pan, Zhao-Ming Wang, Ling-Jun Mou, Xiao-Dong Teng, Zhou-Jun Zheng and Li-Xiong Ying hangzhou, chinadepartments of Pathology and General surgery first Affilia- ted hospital, zhejiang university school of medicine, hangzhou 310003, china department of Pathology First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China. tjphy@***

BACKGROUND: Focal nodular hyperplasia (FNH) is a benign tumor-like lesion of the liver, predominantly affect- ing women. Its etiology is obscure and its pathogenesis is poorly understood. FNH should be differentiated from oth- er benign and malignant hepatic lesions. The aim of this study was to explore the pathological characteristics of FNH of the liver. METHODS: Eleven patients with FNH were studied retro- spectively by using hematoxylin and eosin, immunohisto- chemical and histochemical staining. RESULTS: In 8 female and 3 male FNH patients aged 19 to 54 years (mean 32), most of lesions showed central scars macroscopically. Microscopically 8 patients were found of classical type, 2 were of telangiectic type, and 1 was of mixed type. CONCLUSION: FNH is an uncommon benign hyperplastic lesion of the liver. It should be differentiated from hepato- cellular adenoma, alpha-fetoprotein negative hepatocellular carcinoma, and fibrolamellar carcinoma.

关键词： hepatic focal nodular hyperplasia pathology pathological diagnosis

Ultrasonographic findings at the resected area after hepatectomy

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hepatobiliary & pancreatic Diseases International 2006年第3期5卷 401-405页

作者： Guo-Qiang Mo and Xue-Ming Liu department of Ultrasound, Second affiliated hospital, zhejiang university school of medicine, hangzhou 310009, china department of Ultrasound Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310009 China.

BACKGROUND: Since hepatectomy has been widely performed, different operative manner, operating areas, and material in the residual cavity may be found ultrasonographi-cally near the resected area after the operation. In this study, we investigated the changes of focal ultrasonography at the resected area post hepatectomy and recognized the characteristic ultrasonographic images. METHODS: 176 patients whose ultrasonographic findings were studied in the residual area during the early and later periods after hepatectomy were retrospectively analyzed in terms of operative manner, operative area, and material in the residual cavity. RESULTS: There were absence of partial hepatic lobe or hepatic segment, focal anechoic area with thin wall or mixed mass at the resected area, and conformation of irregular high-echoic conglomeration at the resected area, cystic non-anechoic area, and mixed mass with irregularly thickened wall at the resected area, inconsistent internal echoes,and color Doppler twinking artifacts around the material and the residual cavity after curettage and aspiration. CONCLUSIONS: Focal ultrasonographic findings at the resected area after hepatectomy vary with different operative procedures, operative area, resection size, absence or existence of material, and kinds of material in the residual cavity.

关键词： ultrasonography liver diseases hepatectomy

Monitoring the level of serum paraoxonase 1 activity in liver transplantation patients

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hepatobiliary & pancreatic Diseases International 2005年第2期4卷 178-181页

作者： Gen-Yun Xu, Guo-Cai Lv, Yu Chen, Yong-Chuan Hua, Shen-Mei Zhu and Yi-Da Yang hangzhou, china Clinical Laboratory, first affiliated hospital, zhejiang university school of medicine, hangzhou 310003, china Clinical Laboratory First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China. genyunxu@***

BACKGROUND: Paraoxonase 1(PON1) is an ester hydro- lase in serum and in the liver. Studies have suggested that PON1 measurement to the current battery of tests may im- prove the evaluation of chronic liver diseases. The aim of this study was to investigate the clinical significance of mo- nitoring the level of serum PON1 activity in liver transplan- tation patients. METHODS: A series of biochemical indexes were moni- tored in preoperative, operative and postoperative serum samples of 17 liver-transplanted patients. The change of se- rum PON1 level and its relations with other biochemical in- dexes were analyzed. RESULTS: PON1 was distributed normally in the healthy population and its reference value ranged from 45.5 to 265.8 U/mL. The PON1 level of all patients was lower than that of control group significantly (P<0.001); the level be- gan to elevate continuously 5 minutes after opening of the portal vein and was higher than that 90 minutes after open- ing of the portal vein ( P <0.05). Two days after operation it was still higher than the normal. The levels of serum ALT and AST elevated more significantly after opening of the portal vein than before operation and they were higher than the normal values till 2 days after the operation. CONCLUSIONS: The level of PON1 in serum may be taken as one of the effective indexes to assess whether the implant is alive and to monitor liver function of the patient together with other tests.

关键词： paraoxonase 1 liver transplantation alanine transaminase aspartate transaminase γ-glutamyltransferase cholinesterase