1990年 · 第103卷第07期

Five hundred patients with aortoarteritis were studied in this series. The long-term administration of small dosage of corticosteroid is effective in treating this disease in its active stage. The patients with renal vascular hypertension should be treated by percutaneous transluminal renal angioplasty or by surgery if indicated. About one third of the pulsations of the involved arteries were improved. The incidence of complications was 17% and the mortality rate was 11% in this series. Cerebral thrombosis was found as a common complication and hemorrhage as a common cause of death. Three patients died of heart failure without aortic regurgitation. Five-year and ten-year survival rates were 93.1% and 91.1% respectively.

Plasma levels of tissue plasminogen activator (tPA) antigen, tPA activity and plasminogen activator inhibitor (PAI) activity were determined in 40 cases of acute myocardial infarction (AMI) at the onset and 2-4 weeks after the onset of the disease. 24 healthy subjects served as controls. At the onset of AMI, mean plasma level of tPA antigen was significantly higher than that of control subjects (13.5±4.8 ng/ml vs 6.4±2.0 ng/ml), with the highest elevation in the group greater than 65 years of age. Mean plasma level of tPA activity was significantly lower than in the controls (1.1±0.4 IU/ml vs 1.6±0.4 IU/ml), especially in patients over 65 years of age. Mean plasma level of PAI activity was significantly higher than in the controls (17.5±12.0 AU/ml vs 9.0±4.6 AU/ml), especially in patients over 65 years of age. At 2-4 weeks, mean plasma levels of tPA and PAI activities of AMI patients had dropped to 1.5±0.6 IU/ml and 9.5±8.9 AU/ml, respectively, not significantly different from controls. The tPA antigen had come down to 11.0±5.4 ng/ml, but still higher than in the controls. The possible mechanism of these phenomena was discussed.

Severe acute pancreatitis is highly controversial on its diagnostic criteria, the optimum time for surgery, the selection of surgical procedures, and the prevention and treatment of complications. We treated 40 patients with severe acute pancreatitis from July 1983 to July 1988. The comparison of clinical and laboratory data of severe acute pancreatitis and mild acute pancreatitis showed that in some patients neither Ranson's nor Bank's criteria are reliable in classifying or predicting the severity of the disease. The coexistence of acute peritonitis and bloody ascites with elevated amylase level is very helpful to identify the local conditions of pancreatic necrosis and hemorrhage. We suggest early operation (within 48 hours) be applied in severe acute pancreatitis. In our series, five types of surgical procedures were used. We consider that proper treatment of acute respiratory distress syndrome (ARDS) is most important in the management of severe pancreatitis.

Thirty-four pregnant women with hepatitis A and their neonates were investigated on serum anti-HAV IgM, ALT (GPT) and clinical manifestations (with 34 randomized controls) during the outbreak of viral hepatitis A in Shanghai. The result showed no evidence of maternal-infant transmission of hepatitis A, and no birth defect was found. Sufficient rest and proper diet for and close surveillance of the pregnant woman were suggested to ensure the well-being of mother and child. In addition, we found immune gamma-globulin given to the neonates born of mothers with hepatitis A may be beneficial to avoid horizontal transmission of hepatitis A.

Liver biopsies of 50 patients with chronic active hepatitis B were analysed immunohistochemically for HBcAg and HBsAg, and, by in situ hybridization, for hepatitis B virus (HBV) DNA. Double staining for manifesting HBV DNA and viral antigen simultaneously was also performed in some of them. The localization patterns of HBV DNA in hepatocytes could be classified into whole cytoplasmic, submembranous, nucleic and intermembranous types. The last type suggests that HBV DNA might be transmitted directly to the adjacent hepatocytes through the cell membranes. The double staining indicated that the majority of hepatocytes with high levels of HBV replication did not contain HBcAg of HBsAg. Conversely, most liver cells with strongly positive HBAg had low or negligible levels of viral replication. In addition, in a few cases HBV DNA could be found in the cytoplasm of bile ductule epithelia and sinusoidal endothelia.

1,351 specimens resected surgically from 100 patients with gastric carcinoma were studied with PAP immunoperoxidase and ultrastructural method. The tumor cells were found positive for gastrin, serotonin, somatostatin and argyrophil particles in 19 patients. Among them the gastrin-secreting tumor cells consisted of 50% of the total in 4 cases, representing a separate new subtype, neuro-endocrine (NE) gastric carcinoma. Of the 100 cases, 16 (32%) contained NE cells among 50 undifferentiated type, while only 3 cases (6%) contained NE cells among the remaining 50 cases, the well-differentiated type. These results suggest that the appearance of NE tumor cells is closely correlated with the degree of differentiation of cancer, and confirms theoretically the heterogenicity of gastric carcinoma, and further supports the concept that exocrine and endocrine type gastric cancer cells are isogenous, i.e., from the endodermal stem cells.

Chromosomal fragile sites analyses were performed in peripheral lymphocytes of 37 patients with lymphoma and 16 patients with leukemia, and also of 50 healthy individuals as controls. The results were: 1) The rates of chromosomal aberration and frequency of expression of fragile sites in patients with lymphoma and leukemia were significantly higher than those of normal controls. 2) There was a statistical association between 21 of 44 fragile sites and specific cancer breakpoints in patients with lymphoma and this was also the case with 19 of 30 fragile sites and specific cancer breakpoints in patients with leukemia. 3) Concordance between fragile sites and location of oncogenes in the diseases was established. The possible important role of fragile sites in the pathogenesis of lymphoma and leukemia is discussed.

In an attempt to evaluate the significance of DNA-ploidy as an objective prognostic indicator of oral squamous cell carcinoma, a retrospective analysis of 70 paraffin-embedded specimens using flow cytometry was performed. Forty-one patients (58.6%) had aneuploid tumors and 29 patients (41.4%) had diploid DNA distribution patterns. There was a significant difference in 5-year disease-free survival rates between patients with aneuploid and diploid tumors. The difference in cervical metastatic rates between aneuploid and diploid group approximated statistical significance. No obvious correlation was observed between DNA indices and histologic grade, clinical stage or tumor size. It is concluded that patients with aneuploidy primary tumors have a significantly poorer prognosis and higher risk for regional metastases than those with diploid tumors.

This article presents 102 cases of recurrent parotitis in children with studies of clinical findings, sialographic manifestations, dynamic functions of the parotid gland examined with radionuclide, laboratory findings and follow-up studies of 28 cases with sialography. The following conclusions are reached: 1. Retrograde infection induced by the mumps virus and upper respiratory infection seem to play a major role in the etiology of recurrent parotitis. Familial abnormalities are potential factors. Incomplete immune functions of the children are factors related to the pathogenesis, and following growth and development of the immune system, this disease will undergo remission; 2. Sequential scintigraphy shows normal uptake and retarded excretion function of the parotid; 3. Long-term follow-up studies demonstrate that the patients are free from symptoms for many years, but the punctate dilatation in sialography may diminish, disappear, or be unchanged; and 4. If the disease is not cured in childhood, it may continue into adulthood and healing will take place eventually. Relationship with Sjogren's syndrome has not been revealed.

Cysts of Giardia lamblia from fresh stool specimens of a 13-year-old boy, who lived in suburban Beijing and had suffered from recurrent diarrheas for years, were concentrated, purified and suspended in physiological saline. Six suckling gerbils (Meriones unguiculatus) were each inoculated with 0.2 ml of this suspension which contained 20,000 cysts/ml. On day 8 after inoculation, the infected animals were sacrificed and trophozoites of G. lamblia which appeared numerous in the upper small intestines were isolated aseptically. The trophozoites were inoculated into modified TYI-S-33 medium and cultivated at 37 C. On day 14 of cultivation, the organism grew luxuriantly and formed a cellular monolayer on the inner wall of the culture tube. The organism replicated every 15±2 hours and the peak growth occurred 120 hours after seeding. No bacterial growth was detected by repeatedly transferring the culture onto blood agar plates and into beef broths. Several lots of the culture have been subjected to cryopreservation in liquid nitrogen and the viability of the thawed organism ranged from 50% to 80% 1-10 weeks after being cryopreserved. The thawed parasites grew well in subcultures. This axenic culture has been maintained for one year and 4 months, and more than 150 subcultures have been made.

111 patients with fresh dislocation of shoulder joint were treated with modified Putti-Platt procedure. Of these, 17 had recurrent anterior dislocation. 13 patients were followed up on the average for 25 years. According to Rowe criteria, 10 patients (76.9%) showed excellent results, 2 (15.4%) good, and (7.7%) fair. No recurrence and restriction of external rotation were found. Clinical experience and fetal investigation on congenital factors of recurrent shoulder dislocation were described.