1988年 · 第101卷第02期

The capacity for interleukin 2 (IL2) and immune interferon (IFNγ) production by phytohemagglutinin-stimulated peripheral blood lymphocytes (PBL) is investigated in a group of 76 patients with hepatitis B virus (HBV) infection. A significant decrease in IL2 and IFNγ production is observed in patients with acute and chronic type B viral hepatitis when compared with normal level IL2 and IFNγ activity in age-matched healthy donors. The degree of depression in IL2 and IFNγ production was correlated to the clinical types of HBV infection, as manifested by the following order of depression: acute and subacute fulminant hepatitis>chronic persistent hepatitis(CPH)>chronic active hepatitis (CAH)>acute hepatitis (CH). In the CAH and CPH patients with detectable hepatitis B virus surface antigen (HBsAg), the impairment of IL2 and/or IFNγ production was still marked in the majority, although the live enzyme value (SGPT) was returning to normal. There was positive correlation between the depression in IL2 and IFNγ production calculated on individual samples. These data suggest that the defect in the ability to produce IL2 and IFNγ probably constitutes the basis of the anomalous immunoregulation during HBV infection.

We studied the antiplatelet autoantibodies and their related antigens of idiopathic thrombocytopenic purpura (ITP) patients using three McABs against platelet glycoproteins, ELISA, immunoprecipitation and autoradiography. The results of the study indicate that the related antigens of antibodies are nonhomogeneous including GPIb, GpIIb, and/or GPIIIa and other components of platelet membranes. We suggest that ITP may be a complex and nonuniform autoimmune disease with different autobodies and different related antigens.

Removing sodium from standard ionic contrast media markedly increases the incidence of ventricular fibrillation in patients undergoing coronary angiography. Newer nonionic contrast media, Iopa-midol (IOP), Iohexol (IOH) and Ioversol (IOV), contain only trace amounts of sodium. To determine whether sodium influences the fibrillatory propensity of nonionic contrast media, we measured the prolongation in QT interval and performed programmed electrical stimulation with l, 2 and 3 ventricular extra stimuli in 40 dogs during 4 ml intracoronary injections of IOP, IOH and IOV. Solutions of each contrast media with added NaCl at concentrations of 0.225%, 0.45% and 0.9% were compared to stock contrast media. The addition of NaCl markedly increased the amount of QT interval prolongation produced by each contrast media. With IOP, the amount of QT interval prolongation was 40±11msec with standard IOP but was 58±11 msec with 0.225% NaCl/IOP, 84±17 msec with 0.45% NaCl/IOP, and 132±42 msec with 0.9% NaCl/IOP(P<0.001). Similar results were seen with IOH and IOV. Ventricular fibrillation was difficult to induce with standard IOP, IOH and IOV (even with 3 extra stimuli), but became progressively easier to induce when NaCl was added. Three extra stimuli produced ventricular fibrillation in 0 of 11 dogs with standard IOP, 0 of 11 with 0.225% NaCl/IOP, 3 of 11 with 0.45% NaCl/IOP and 8 of 11 with 0.9% SaCl/IOP (P<0.001). Similar results were observed with IOH and IOV. Unlike NaCl, the addition of choline chloride or dextrose did not increase ventricular fibrillation or QT interval prolongation. It is concluded that standard preparations of nonionic contrast media have a very low fibrillatory propensity. The addition of NaCl increases the amount of QT interval prolongation making ventricular fibrillation easier to induce. The detrimental effects of added NaCl are due to the addition of the Na+ rather than the Cl-, an osmotic effect.

Twelve cases of nodular goiter and 7 of colloid adenoma were studied by scanning electron microscopy. The surface structures of the follicular cells varied with their functional cycles. Three types of follicular cells were classified in this study. Type I were quiescent looking cells with polygonal borders, flat surfaces and multiglobular structures lacking microvilli. Type II cells showed microvilli development and different patterns of blebs induced by TSH-stimulated exocytosis. Type III showed long, dense microvilli covering the cell surfaces due to TSH-stimulated endocytosis. Both Type II and III appeared active. In order to indicate the different thyroid functional conditions it is useful to distinguish these three types of follicular cells by scanning electron microscopy.

Iohexol (omnipaque) has been used in clinical trials in 60 myelographs. The image quality was good to excellent. Manifestations of neurologic signs and psychic symptoms were noted, but there were no severe adverse effects. More common reactive symptoms in the series were mild headache(18%) and dizziness (15%). EEGs were taken in 20 cases before and after myelography. There were no significant changes. The conclusions were: Iohexol is a new nonionic contrast medium in the aqueous state with low neurotoxicity and high patient tolerance appropriate for intrathecal use.

In 1979, we studied the thyroid glands, cerebral cortices and bones of therapeutically aborted fetuses from an endemic goiter region in Guizhou, and found that the thyroids were markedly enlarged and hyperplastic, while the cerebral cortices and bones were retarded in development. In 1984, we restudied the fetuses from the same region, then supplied with iodized salt, with the methods and criteria used previously. The data were compared with those of the fetuses from a nonendemic region and those obtained in 1979. The results showed that the thyroids, cerebral cortices and bones of the fetuses from the endemic region supplied with iodized salt no longer exhibited significant changes seen 5 years ago.

A prospective study on the changes of exophthalmos after subtotal thyroidectomy was made on 105 patients with hyperthyroidism admitted from December 1979 through March 1982. The protrusion of eyeballs was measured with Hertel's exophthalmometer. Basing on the control study of 40 normal adults, 14 mm was taken as the normal limit of eyeball protrusion. The incidence of exophthalmos (protrusion>14 mm) was 41.7%. Mild exophthalmos (14-16 mm) waspresent in 19 cases and marked exophthalmos (>16 mm) in 15 cases. In a few cases the exophthalmos was asymmetrical. Following subtotal thyroidectomy, improvement in exophthalmos was seen in 46.8%, no change in 50.6% and worsened in 2.6%. For mild cases, the protrusion could return to normal in 41.9% of cases, whereas in severe cases no full recovery to normal was seen and 5.9% got worsened. In patients without exophthalmos preoperatively, 8.7% became mild exophthalmic after the operation. The mechanism of exophthalmos is not yet clear and probably an auto-immune process is involved.

Thyroglossal cyst carcinoma is a rare tumor. Uchermann reported the first case in 1915, and since then less than 100 cases have been described in the literature. There has not yet been a case reported in China. Here we present a case in this study.

A retrospective matched case-control study was done on 259 cases of ectopic pregnancy in Beijing Chaoyang Hospital during the period from January 1973 to December 31, 1984. All the cases were confirmed by pathological findings of specimens. The result showed that the risk of ectopic pregnancy in women who currently used IUD as contraceptive method was 3.06-4.0 times that in those who did not use IUD. The rate of ectopic pregnancy per 1000 conceptions increased significantly. This trend is parrallel to the sharp rise of IUD insertions. A brief investigation was done on two other contraceptive methods to evaluate the association between oral contraceptives (OC) or sterilization and ectopic pregnancy, showing that the use of OC or sterilization has no correlation with the increased risk of ectopic pregnancy.

This method, first presented by the author in September 1980, stops accessory pathway conduction without damaging the myocardium. 93 cases received treatment by absolute alcohol intramyocardial injection to the lesion site localized by epicardial mapping in a total 109 cases of Wolff-Parkinson-White syndrome given surgery in our hospital with l-86 months of follow-up. The results were successful in 84 cases (90.3%). In posterior septal cases, 18 of 22 (81.8%) were successfully treated.