1990年 · 第103卷第02期

A prospective concurrent study was made on 2 groups of patients suffering from acute myocardial infarction admitted at random into the Coronary Care Unit (CCU) or general wards (GW). After excluding those older than 70 years of age, the two groups were similarly matched according to their ages and clinical severity. Those who were initially treated in the CCU had a higher chance of survival from myocardial infarction as compared with those in the GW. The overall mortality was 15.3% (17/111) and 29.3% (27/92) respectively (P less than 0.02), and the risk of dying in the GW comparing to that in the CCU was 2.3 (95% confidence interval 1.1-4.8). Sudden death was more frequently encountered in those treated in the GW. Our findings strongly support the use of the CCU for patients below 70 years.

The sodium and calcium cation transport in erythrocyte and their influencing factors were studied in essential hypertensive (EH) patients. The result showed that plasma sodium pump inhibitor, endogenous digitalis-like compound (EDLC), rose in some patients and sodium pump was depressed in the others, but there were no parallel links between EDLC and sodium pump. The patients with normal sodium pump have mainly shown a decrease of their maximal CA++ pump activity and calmodulin (CaM) content in erythrocyte. It indicated that there might be different types of ion transporting defect in EH, and the abnormalities of these cation transports might be an important pathogenesis in EH.

A prospective study was done on 110 patients, 55 Chinese and 55 American elderly who had clinically proved acute myocardial infarction with histologic confirmation. The Chinese patients were much more likely to have typical pain than the American (65.4% vs 49.0%). The incidence of painlessness was only 18.1% vs 36.3%. The difference has statistical significance (P less than 0.05). Cardiac failure, shock, pulmonary infection as a major complication had no statistical significance, but the incidence of cardiac rupture group was 29.0% vs 10.9%. Ventricular fibrillation incidence was 18.1% in the Chinese vs 45.4% in the American. The incidence of recent occlusive coronary thrombi, hemorrhage and rupture of plague in coronary arteries had significant statistical difference. The incidence of triple, double and single vessel diseases were 41.8%, 29.0% and 27.2% in the Chinese group vs 36.3%, 27.2% and 25.4% in the American respectively.

Two-dimensional echocardiography was used to guide and locate the balloon of Swan-Ganz catheter during catheterization in 43 patients. The echoes of balloon appeared as a series of strong light spots, with a rate of detection of 100%. Under monitoring of two-dimensional echocardiography, the site of balloon and its moving route could be determined. The coincidence of echographic findings and X-ray findings showed that it can be used instead of X-ray monitoring to lessen irradiation during catheterization. The depth of catheter inserted was measured. The differential points between the echoes of balloon and tubing, the terminology of the balloon site in echocardiography and fluoroscopy, its clinical value and limitation are discussed.

Eighteen patients with leukemia have received HLA-identical allogeneic bone marrow transplantation (BMT) at our hospital since 1981. Fifteen of these patients have been living without relapse. for prophylaxis of GVHD, MTX was used in 8 patients, and cyclosporine (CSP) together with MTX in 6 patients, 3 received multiple agents at much smaller dosage, including monoclonal antibody. All patients received intravenous placental gamma-globulin, and 16 received garlic extract. Three patients died. One, who neither received MTX, nor CSP died of hyperacute GVHD, one who did not receive garlic extract died of GMV pneumonia, and the third one died of tuberculosis 18 months after BMT.

Following the use of rigid ureteroscopic lithotripsy (URS) in 1984 and extracorporeal shock wave lithotripsy (ESWL) in 1987, the treatment for ureteral stones has undergone significant changes. Our experience showed that the successful rate of URS for 132 patients was 89.4% and for the upper third was rather low, percutaneous antegrade URS should be considered. 376 patients treated with ESWL in prone position with a successful rate of 96.8%. The applicability of open surgery was reduced to 17.8% in 1987 and 14.5% in 1988.

A family with Fabry's disease including 2 hemizygotes and 3 heterozygotes is reported. The ocular manifestations include tortuosity of conjunctival vessels, Fabry's deposits underlying the anterior capsule of the lens and the whorl-like corneal dystrophy. Foam cells or mulberry cells in the urinary sediment and varying numbers of high electron-dense inclusions in the cytoplasm of endothelial cells in skin lesions are also important in diagnosing this disease. The concentrations of lipid peroxide in the sera of 2 hemizygotes in this report were higher than normal, possibly due to the patients weak ability of anti-oxygenation and malfunction of cells whose plasma membranes are easily attacked by free oxygen radicals. The biochemical and pathological changes, diagnosis, treatment, genetics and prevention of the disease are discussed.

300 orthotopic liver transplantations in rats were performed for a variety of reasons. Male rats including Lewis, ACI, Wistar, and SD, with a body weight of 150 to 400 g, were used as liver donors and recipients. A midline abdominal incision was performed in both donor and recipient animals. The donor's liver was perfused through the aorta abdominalis. The recipient's liver was flushed via the protal vein (PV) with 2 ml of lactated Ringer's solution immediately after occlusion of the PV to make intrahepatic blood enter the circulation. The bile duct was reconstructed by end-to-end anastomosis via a Teflon catheter. The cuff technique was applied to anastomoses of the infrahepatic vena cava (VC) and PV. The suprahepatic VC was anastomosed using either suture or cuff technique. The operative success rate was 92.7% (278/300) on the average and 1-week survival rate 88.4% (199/225) in isografting. The model proved reliable for studies of liver transplantation.

An intravenous tryptophan tolerance test (ITrpTT) was designed for liver function since 95% Trp is metabolized by the liver. After an intravenous loading dose of 4 mg/kg body weight, serum levels of both free (F) and total (T) Trp were determined at 45 and 60 minutes. In normal controls and nonhepatic-disease patients, F45 (60) and T45 (60) did not exceed 7 μmol/L and 80 μmol/L, respectively, and F/T ratio not greater than 0.14. These were set up as cutoffs of upper normal limits. The test was abnormal in 87.5% of chronic persistent hepatitis (CPH) characterized by elevation of T45 (60), 100% of chronic active hepatitis (CAH) by elevation of F45 (60) and/or T45 (60), and 100% of hepatic cirrhosis by increase in F45 (60) and F/T ratio but not in T45 (60). The test seems to be more sensitive than the conventional tests for liver function. However, one should be cautious in interpretation of the test as there are some factors which might influence the Trp metabolism like exercise, alcoholism, corticosteroids and enzyme-inducers. It merits as an indication of liver dysfunction only when these factors are considered and excluded.

This paper reports the successful experiences of in vitro and in vivo studies on endoscopic fragmentation of gastric bezoars using a laser-ignited mini-explosive device. This new technique has been used clinically in 31 patients with gastric bezoars since January 1988. All patients were completely cured without any complication. The relationship between gastric bezoars and ulcers, and the technique of treatment were discussed.

Cardiovascular community control program in Beijing started in 1969. In the past 20 years, eleven such programs had been established, covering a total population of 750,000. For those programs that have been operating for over 5-10 years, a marked drop in the mortality and morbidity rates of hypertension, stroke and acute myocardial infarction has been observed. It is proposed that this type of community control program should be further expanded in the next ten years so as to materialize the WHO goal of "Health for all by 2000".