Liver angiogenesis as a risk factor for hepatocellularcarcinoma development in hepatitis C virus cirrhotic patients

AIM： To evaluate the predictive value of hepatocyte proliferation and hepatic angiogenesis for the occurrence of Hepatocellular carcinoma （HCC） in hepatitis C virus （HCV） cirrhotic patients.METHODS： One hundred-five patients （69 males, 36 females; age range, 51-90 year; median 66 year） with biopsy proven HCV cirrhosis were prospectively monitored for HCC occurrence for a median time of 64 too. Angiogenesis was assessed by using microvessel density （MVD）, hepatocyte turnover by MIB1 and PCNA indexes at inclusion in liver biopsies.RESULTS： Forty six patients （43.8%） developed HCC after a median time of 55 （6-120） mo while 59 （56.2%） did not. Patients were divided into two groups according to the median value of each index. The difference between patients with low （median MVD = 3; range 0-20） and high （median MVD = 7; range 1-24） MVD was statist（caUy s（gn（ficant （χ^2= 22.06; P 〈 0.0001） wh（ch was not the case for MIB1 or PCNA （MIB-I： χ^2 = 1.41; P = 0.2351; PCNA： χ^2 = 1.27; P = 0.2589）. The median MVD was higher in patients who developed HCC than in those who did not. HOe-free interval was significantly longer in patients with the MVD ≤ 4 （P = 0.0006）. No relationship was found between MIB1 or PCNA and MVD （MIB-1 r^2 = 0.00007116, P = 0.9281; PCNA： P =0.001950; P = 0.6692）. MVD only was able to predict the occurrence of HCC in these patients. Among other known risk factors for HCC, only male sex was statistically associated with an increased risk. CONCLUSION： Liver angiogenesis has a role for in HCV- related liver carcinogenesis and for defining patients at higher risk.

肠易激综合征(IBS)的发病率与不同的诊断标准

Objectives-The main objectives of this study were to assess whether the use of different definitions of irritable bowel syndrome(IBS) could influence measurements of its prevalence and characterize the patient population fulfilling these different diagnostic criteria. Method-A telephone survey was carried out by contacting 8,221 subjects aged ≥ 18 years representative of the French population. A “ screening” questionnaire based on three algorithms of IBS classification (Manning, with or without a notion of a minimal duration of symptoms, Rome I and Rome II) was used by specialised inquirers. Results-Twenty three percent of the subjects interviewed stated that they had suffered from abdominal pain during the previous 12 months.The prevalence of IBS considerably varied, depending on the diagnostic criteria used: 12% based on Manning criteria without reference to the duration of symptoms; 2.5% if the notion of duration of symptoms was added to the Manning criteria,and 2.1% and 1.1% based on the Rome I and Rome II criteria,respectively (the latter includin the same notion of duration). In total, 212 subjects (2.6% ) met at least one of the criteri a including a minimal duration of symptoms, with a predominance for women (sex-ratio close to 2). Conclusion-The prevalence of IBS is strongly dependent on the classification algorithm employed.The requirement of a minimum duration of symptoms eliminates IBS in a large number of subjects complaining of abdominal disorders. Once these methodological variations were taken into account, the prevalence of IBS in France was found to be comparable to that published in international literature.

与短期塞来考昔应用相关的持续性胆汁淤积症

Drug-induced liver injury due to celecoxib, a first generation Cox-2 inhibitor, has been rarely reported. We describe one case of severe and prolonged cholestasis after treatment with celecoxib for 12 days in a young woman with no evidence of other causes of liver disease or allergy. Jaundice lasted for 3 months, pruritus and abnormal liver biochemistries persisted for 18 months after stopping the drug. Liver biopsy specimens showed a cholestatic pattern of liver injury with only minimal mononuclear infiltrate in the portal tracts. This case report supports the notion that celecoxib may cause bland, long term cholestasis.

与塞来考昔治疗密切相关的急性大肠炎

Selective inhibitors of cyclooxygenase-2 have less gastroduodenal toxicity than non selective anti-inflammatory drugs. However, there is little information on their effect on the distal gut. A 91 year old woman presented with acute diarrhoea 5 weeks after beginning celecoxib treatment. Laboratory results showed an inflammatory syndrome and increased alanine aminotransferase (ALT) to 13 N. Endoscopic examination of the colon showed diffuse erythematous lesions of the sigmoid and of part of the right colon. No aetiology has been found for colitis or hepatitis. Diarrhea and blood test anomalies disappeared one week after celecoxib was stopped. The role of celecoxib in the etiology of colitis was considered plausible but not for liver damage. This report and a few other cases in the literature suggest that cyclooxygenase-2 selective non-steroidal anti-infla-mmatory drug inhibitor toxicity should be investigated in case of unexplained acute colitis.

肠易激综合征患者的脊髓痛觉处理调节的变化

Background: Visceral hypersensitivity has been evidenced in patients with irritable bowel syndrome (IBS) but its mechanisms remain poorly elucidated. We investigated the spinal transmission of nociceptive signals in IBS patients by analysing the effects of rectal distensions on electromyographic recordings of the somatic nociceptive flexion (RIII) reflex, an objective index of spinal nociceptive processes. Methods: Fourteen IBS and 10 healthy volunteers were included in the study. Slow ramp (40 ml/min) and rapid phasic (900 ml/min, 10, 20, 30, and 40 mm Hg) rectal distensions were randomly performed while the RIII reflex evoked by electrical stimulation of the sural nerve at the ankle was continuously recorded from the ipsilateral biceps femoris. Results: In healthy volunteers, significant progressive inhibition of the RIII reflex was observed during slow ramp distension (61 (13)%of control values) while biphasic effects (facilitation and inhibition) were observed during rapid distensions. In contrast, in IBS patients, the RIII reflex was significantly facilitated during slow ramp distension (139 (15)%of control values) and inhibitions induced by rapid distensions were significantly reduced. Volumes of distension and rectal compliance were similar in both groups. Conclusions: Our results provide direct evidence that a hyperexcitability of spinal nociceptive processes is present in a large subgroup of IBS patients.

结肠肉瘤样癌:病例报道及文献回顾(法)

Sarcomatoid carcinomas or carcinosarcoma are rare tumors composed of mixed carcinoma cells and mesenchymal cells.Thirteen cases with colorectal involvement have been published to date. We report a case of sarcomatoid carcinoma of the colon in a 67-year-old woman hospitalized with a history of anemia and bloody stools. The patient underwent a left hemicolectomy.Immunohistochemistry revealed two cell components (undifferentiated carcinomatous and sarcomatous; components). The patient died of her tumor 2 months after the operation. Our review of the literature stresses the poor prognosis associated with colonic sarcomatoid carcinoma.