Diffuse liver infiltration by melanoma of unknown primary origin is rare. We encountered a unique case of diffuse liver infiltration by melanoma of unknown primary origin in our hospital. A 62-year-old woman was referred to our hospital for anorexia of 6 months duration and abdominal distension for 1 month. Ultrasonography (US), computerized tomography (CT) and magnetic resonance imaging (MRI) revealed an obvious enlarged liver without detectable nodules. She was diagnosed as liver metastasis by melanoma of unknown primary origin via percutaneous liver biopsy. The report demonstrates the difficulty of making a noninvasive diagnosis of diffuse hepatic infiltration on metastatic melanoma.

Objective To investigate the association of serum lipid,lipoprotein,apolipoprotein,leptin,cholecystokinin(CCK)and bile lipid with cholesterol gallstone formation.Methods The patients with gallstone were divided into cholesterol(n=99)and non-cholesterol(n=57)gallstone groups by infrared spectometry.And 52 healthy volunteers were served as control group.The concentrations of serum cholesterol,triglyceride,high and low density lipoproteins,apolipoprotein(Apo),leptin and CCK were measured and compared among three groups.The levels of total bile cholesterol,bile acid and lecithin were also detected.Results The concentrations of serum triglyeeride and total cholesterol in two gallstone groups were higher than those in control group(P value all＜0.01).The level of Apo-B in cholesterol gallstone group was higher than that in control group(P=0.017).While the concentrations of high density lipoprotein and CCK were significantly lower in two gallstone groups than those in control group(P value all=0.000).Serum leptin was higher in male patients compared to controls(P＜0.05).The bile cholesterol saturation index in two gallstone groups was above 1.Conclusions The changes of serum CCK,triglyceride,total cholesterol,high density lipoprotein,Apo-B and leptin may be correlated to the formation of gallbladder gallstone.

肝脏恶性黑色素瘤多为转移性,原发性者国内外鲜见报道.我们近日遇到1例,为进一步加强对该病的认识,现将该病例报道如下,并作相关文献复习.

Objective To investigate the relationship between and the clinical significance of the characteristics of serum leptin and lipids levels in patients with gallbladder gallstone and gallstone formation.Methods 156 patients with gallbladder gallstone were selected as case group and 52 healthy people as control group.Radioimmunoassay and other methods were used to measure the levels of serum leptin and lipids,and then statistical methods were used to analyze the differences.Results Serum leptin,triglyceride(TG)and total cholesterol(TCH)levels in case group were higher that in control group,but serum high density lipoprotein(HDL)level was significantly lower.Serum leptin in male patients with gallbladder gallstone was significantly higher than that in control group.Conclusion The variations of serum leptin,TG,TCH,HDL levels in patients with gallbladder gallstone may be related to the formation of gallbladder gallstone.

病历摘要 患者男，66岁。无明显诱因出现发热、左下腹持续性隐痛和腹泻3个月，体温波动于38．5～39．5℃，大便3～6次／d，黄色水样便；无畏寒、恶心、呕吐等症状，2006年3月6日至24日在当地医院住院治疗。肠镜检查提示降结肠、乙状结肠溃疡，活检病理为“结肠慢性炎症伴坏死及肉芽组织形成”；大便培养“粪肠球菌优势生长”，诊断为“溃疡性结肠炎（UC）伴菌群失调”，用奥沙拉嗪和头孢三嗪等抗炎治疗，腹痛缓解，体温下降，但未降至正常，半个月后因腹泻症状无改善而自动出院。

> 胆囊结石症是常见和多发疾病,其确切病因目前尚不清楚,也缺乏疗效确切的预防和药物治疗措施。本研究通过分析胆囊结石患者结石中胆固醇含量和血脂水平变化,探讨胆囊结石症结石成分中胆固醇的含量及其与患者年龄、性别和血脂水平的关系,为胆囊结石症的发病机制和临床防治提供新的思路。一、材料与方法

Objective To explore the characteristics of serum lipid,lipoprotein,apolipoprotein and the mechanisms of cholesterol gallstone,study the significance of some indexes in patients with cholesterol gallstone disease.Methods The concentrations of serum total cholesterol(TCH),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),apolipoprotein AI(Apo-AI),apolipoprotein B(Apo-B)and apolipoprotein E(Apo-E)were detected in cholesterol gallstone group and control group.Results The concentrations of serum HDL and LDL were lower in cholesterol gallstone group than in control group.The concentration of Apo-B was higher in cholesterol gallstone than in control group.Conclusions The patients with cholesterol gallstone disease have low levels of serum HDL and LDL,yet have high level of Apo-B.HDL,LDL and Apo-B may be the predictable indexes of cholesterol gallstone.Intervention of these indexes may inhibit the formation of cholesterol gallstone.

病历摘要 患者男,59岁,反复黑便、腹痛、间断发热7个月入院.

患者女,43岁,因“上腹部疼痛1年,加重伴呕吐腹泻4个月”入院。患者1年前因“胆囊炎,胆石症”行腹腔镜下胆囊切除术后1个月于无明显诱因下反复发作中上腹部阵发性绞痛,腰背部放射,屈曲位疼痛好转。伴腹泻,解黄色糊状便带有食物残渣,进食后腹痛加剧,伴恶心、呕吐、反酸暖气,于2005年9月行腹腔镜食管裂孔疝术。术后上述症状未见缓解。该患者确诊“糖尿病”6年,血糖控制不佳。体检：上腹轻压痛,其他无异常。胃镜检查示：反流性食管炎。腹部B超

临床发现结核性腹膜炎患者血清及腹水CA125,腺苷脱氨酶(ADA)往往升高,尤以腹水明显.本研究通过对诊断明确的结核性腹膜炎患者进行前瞻性研究,探讨检测CA125,ADA在结核性腹膜炎患者中的临床意义.

AIM:To investigate the relationship between matrix metalloproteinase-2 (MMP-2) mRNA expression and clinicopathologic and urokinase-type plasminogen activator (uPA) system parameter and prognosis in human gastric cancer.METHODS:Expression of MMP-2 mRNA, uPA, and uPA-R mRNA in tumor tissues and > or =5 cm adjacent normal tissues from 67 cases of gastric cancer was studied using RT-PCR and Northern blot respectively. Survival analyses were done using the Kaplan-Meier method.RESULTS:The expression rates of MMP-2 mRNA, uPA and uPA-R mRNA in tumor tissues (31%, 41%, and 51%, respectively) were significantly higher than those in > or =5 cm adjacent tissues (19%, 11%, and 9%; chi(2) = 4.59, 43.58, and 53.24 respectively, P<0.05, 0.0001, and 0.0001, respectively). Expression of MMP-2 mRNA was significantly correlated with lymph node metastasis (metastasis: 61.9%, no metastasis: 39.1%, chi(2) = 7.61, P<0.05), Lauren's classification of diffuse/mixed types: 54.2%, intestinal type: 26.3%, chi(2) = 4.25, P<0.05, expression of uPA and uPA-R mRNA (uPA+: 55.1%, uPA-: 22.2% and uPA-R+: 54.9%, uPA-R-: 18.8%, chi(2) = 5.72 and 6.40 respectively, P<0.05). Kaplan-Meier survival analysis of MMP-2 mRNA expression did not show significant difference in all 67 cases, but revealed an association of the expression of MMP-2 mRNA, uPA, and uPA-R mRNA with worse prognosis (P = 0.0083, 0.0160, and 0.0094, respectively).CONCLUSION:MMP-2 may play an important role in the development of invasion and metastasis of gastric cancer.

Objective To investigate the difference of mRNA levels of hepatic cholesterol ~metabolism regulatory enzymes between genetically gallstone-susceptible (C57L) and resistant (AKR) mice for exploring the molecular mechanism of biliary cholesterol hypersecretion and cholesterol gallstone ~formation. Methods The inbred C57L and AKR mice were fed with a lithogenic diet containing 15% fat, ~1.25% cholesterol and 0.5% cholic acid for four weeks. Before and after the lithogenic diet, their liver weight, hepatic cholesterol content and gallstone formation in gallbladder were examined, and ~mRNA levels of hepatic 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCoAR), cholesterol 7α-hydroxylase ~(C7H) , acyl-CoA: cholesterol acyltransferase (ACAT) and low density lipoprotein receptor (LDLR) were analyzed by RT-PCR. Results Before or after feeding the lithogenic diet, hepatic cholesterol content in AKR mice displayed markedly higher than that in C57L mice. Challenged with the lithogenic diet for four weeks, cholesterol gallstones were formed in C57L mice but not in AKR mice. Basal hepatic HMGCoAR mRNA level was significantly higher in gallstone-resistant AKR mice compared with the C57L gallstone-susceptible strain. Basal mRNA levels of ACAT, LDLR and C7H did not differ significantly among the mouse strains studied. In response to the lithogenic diet, expression levels of HMGCoAR and C7H mRNAs significantly decreased by 31% and 30%, respectively, in AKR mice, but unchanged in C57L mice, the LDLR ~mRNA levels increased slightly (14%) in AKR mice, and a 41% elevation was present in C57L mice. ~Conclusions The lithogenic diet as an environmental challenge unmasked phenotypes of mRNA expression of hepatic cholesterol metabolism regulatory enzymes of C57L and AKR mice. After feeding the lithogenic diet, failure to sufficiently down-regulate HMGCoAR expression and significant increase of LDLR level in C57L mice may play a role in biliary cholesterol hypersecretion and cholesterol gallstone formation.

OBJECTIVE:To investigate the clinical value of miniature ultrasonic probes (MUP) in the diagnosis and treatment of digestive tract diseases.METHODS:537 patients who were indicated for endoscopic ultrasorography (EUS) underwent EUS with 7.5 - 20 MHz MUP and double-cavity electronic endoscope. According to the diagnoses of MUP, those patients who presented the indication of treatment were treated by endoscopic resection or surgical excision respectively, the postoperative histological results were compared with the preoperative diagnoses of MUP. A follow-up with MUP was periodically made for a few patients without endoscopic resection or surgical excision.RESULTS:Among the 537 patients the diagnosis of gastrointestinal submucosal lesions was made in the 256 cases, polyp in 56 cases, inflammatory prominence in 37 cases, extrinsic compression 53 cases, digestive tract cancer 50 cases, peptic ulcer 17 cases, cholecystolithiasis 11 cases, chronic pancreatitis in 8 cases, and achalasia 2 cases and 47 cases were diagnosed as normal, After examination of MUP, 220 patients were treated by endoscopic resection or surgical excision respectively, the postoperative histological results of 211 patients were completely consistent with the preoperative diagnosis of MUP, and diagnostic accuracy of MUP was 95.9%. The result of follow-up with MUP indicated that gastrointestinal leiomyoma, lipoma, phlebangioma and cyst were unchanged within 1 - 2 years. The patients who were treated by endoscopic resection or centesis showed no complication.CONCLUSION:EUS with MUP is a valuable method in diagnosis of gastrointestinal submucosal lesions, staging of digestive tract cancer and diagnosis of biliary-pancreatic diseases. It plays a very important role for making scientific, effective, safe and economic therapeutic plan.

胆道胆固醇的过高分泌是胆囊胆固醇结石形成的主要病理生理改变.关于胆道胆固醇高分泌的确切病因目前尚不清楚,经研究与肝脏胆固醇代谢的多个不同环节有关.该综述将从肝脏胆固醇的合成、摄取、转化、酯化、转运以及分泌等方面对胆道胆固醇高分泌的发生机制进行阐述.