1990年 · 第103卷第10期

A clinical trial, to evaluate the effects of a Chinese herbal drug, Rheum E and angiotensin converting enzyme inhibitor, Captopril on chronic renal failure (CRF), was conducted. Thirty cases with initial serum creatinine (Scr) levels of 344.8±114.0 μmol/L were allocated randomly to 3 groups: Rheum E treated group, Captopril treated group and Rheum E + Captopril group. A control group of 12 cases were on dietary therapy alone. During the 6-22 months of treatment, all the patients were kept on low-protein (0.6g/kg/d), and low-phosphorus (10mg/kg/d) diet. The results showed that the progression rate of renal failure, calculated by regression analysis of 1/Scr vs time, was found to be retarded after treatment with the increased regression coefficient (b value). Scr levels and blood urea nitrogen were kept stable or fell slightly. Albumin rose during the follow-up period (P less than 0.05) in the treated patients, being more marked in both Rheum E and Rheum E + Captopril groups. Uremic symptoms of nausea, anorexia improved in most of the treated patients. It is concluded that long-term low-dose Rheum E taken orally is beneficial to CRF. Its effect is better than that of Captopril. The regime of Rheum E and Captopril is a preferable choice in the long-term treatment for preventing progression of CRF.

Chronic renal failure (CRF) was induced in male wistar rats (Group I) by 5/6 nephrectomy and the sham-operated ones served as control (Group II). The results showed that in Group I, plasma atrial natriuretic peptide (ANP) levels increased progressively as the Scr was elevated. Plasma R-A rose simultaneously compared to the normal (P less than 0.001). At the 20th week after operation, urine volume and Na decreased significantly (P less than 0.05). The number of glomerular receptors decreased markedly at the 12th week (P less than 0.05) and 20th week (P less than 0.01). Our data suggest that in 5/6 nephrectomized rats, the elevation of plasma ANP level might be partly caused by the damage of glomerular ANP receptors, and the elevated plasma ANP could not play its role in diuresis, natriuresis, blood pressure depression and R-A inhibition as a result of the damage of kidney ANP receptors.

In vitro study of rat glomerular mesangial cell growth was carried out to investigate the pattern of serum renotropic stimulation in 5/6 nephrectomized (5/6NT) rats. Incorporation rates of 3H-TdR, 3H-UR and 3H-Leu into mesangial cells were used as parameters to measure serum renotropic stimulation. Renotropin activity increased immediately after 5/6NT, reaching peak at 48 h, and was succeeded by a rapid decline at 96 h postoperatively. A second rise occurred on the 7th day, followed by gradual decrement. It seemed evident that the serum obtained 48 h after 5/6NT surgery was capable of stimulating the uptake of 3H-TdR, 3H-UR and 3H-Leu by the mesangial cells (MCs). It may be concluded that renotropin promotes DNA, RNA and protein synthesis of MCs. The prolonged and constant effect of serum renotropin on MCs might be one of the important mechanisms in progressive sclerosis of the remaining kidney after subtotal nephrectomy.

A model of crescentic glomerulonephritis (GN) in mice was induced by intravenous injection of rabbit anti-mouse glomerular basement membrane (GBM) antiserum and lipopolysaccharide. The procedure was carried out in BALB/c mice, heterozygous mice and nude mice. In order to examine the role of T cells in the pathogenesis of crescentic GN, immunofluorescent and morphologic changes in the glomeruli of these animals were studied. Intense (4+) linear deposition of rabbit IgG was found along the GBM of all test animals. Intense (3+ -4+) linear deposition of mouse IgG along the GBM was present in normal and heterozygous mice, but not in nude mice. Normal mice developed typical crescentic GN characterized by severe degeneration and destruction of GBM, fibrin deposition and crescent formation 3-6 weeks after injection. Heterozygous mice only developed mild mesangial proliferation. No glomerular lesions were seen in nude mice. These preliminary data suggest that glomerular immunologic damage requires the participation of functional T cells, and that the induction of typical crescentic GN requires integral T-cell function.

A two-week bile duct ligation (BDL) in Sprague-Dawley (SD) rats raised the serum billirubin level and decreased the mean arterial blood pressure and renal cortical ATP contents compared with those in sham-operated (SO) rats (3.6±1.15 mg% vs 0.54±0.36, P less than 0.001; 69±24 mmHg vs 86±21, P less than 0.05; 3.72±0.86×10-10 mol/mg tissue vs 7.27±0.18, P less than 0.05). No difference could be found in the medullary ATP contents (8.42±2.20 vs 8.70±2.80, P=NS). In SO rats, injection of endotoxin (0.7 mg/kg BW) and E. coli (3.1×105 bacteria/100 g BW) reduced cortical ATP content to 1.86±0.97 and 1.30±0.47 (P less than 0.001), and medullar ATP to 1.33±0.31 and 2.12±0.46 (P less than 0.001) respectively. In BDL rats, the same treatment led to further decrease in cortical ATP to 1.25±0.40 and 0.62±0.20, medullary ATP to 0.97±0.41 and 1.64±0.83 (P less than 0.001). Basal Na-K ATPase activity in BDL is the same compared with that in SO both in the cortex (2.85±2.2 μmol/mgpr/h vs 2.19±0.75; P=NS) and medulla (2.79±1.83 vs 3.05±1.38; P=NS). After E. coli or endotoxin attack, the enzyme activity decreased both in the cortex and medulla although there was no statistical difference in the E. coli group (1.14±1.12 and 1.88±0.67; P=NS) and in BDL rats (0.81±0.43 and 1.23±0.70; P less than 0.05). No such change could be found in SO rats (2.62±1.47 and 2.43±1.38, P=NS), (2.38±1.23 and 3.23±2.30; P=NS). IV injection of fructose diphosphate (FDP) (2 g/kg BW) after E. coli attack could raise the cortical ATP content to 3.85±1.99 (P less than 0.01) and medullary ATP to 2.98±1.25 (P less than 0.01) as well as cortical Na-K ATPase activity to 2.54±0.70 (P less than 0.05) in BDL rats while no such phenomena could be found by small injection (1.02±0.46, 0.78±0.23, 1.13±0.61). Our results indicate that was disorder in renal energy metabolism during BDL, and endotoxin worsened the disturbance; and FDP could improve these abnormalities to some extent.

Monoclonal antibody defined antigen (CA19-9), carcinoembryonic antigen (CEA), ultrasonography (US) and computerized tomography (CT) were carried out as the tests in 113 patients suspected to have pancreatic cancer. Of 98 patients who underwent operation, 55 were found to have pancreatic cancer, 25 benign pancreatic disease, and 18 cancer of the biliary tract. Follow-up study was carried out for more than 1 year in 15 other patients suffering from pancreatitis without surgical intervention. The accuracy of CA19-9, US, CEA and CT was 87%, 69%, 61% and 56% respectively. The sensitivity of each test was CA19-9, 98%; US, 89%; CT, 80%; and CEA, 38%. The sensitivity of parallel test combined with CA19-9 and CEA was 100%. It may be regarded as the first step to detect pancreatic cancer in suspected population. The specificity of each test was CEA, 82%; CA19-9, 76%; US, 50% and CT, 40%. And the specificity of serial tests combined with CA19-9 and US was 90%. When these two tests were both positive, pancreatic cancer was highly suspected.

This article sums up the histochemical and immunohistochemical study of 55 cases of gastric carcinoma and 21 controls with benign gastric lesions. The results showed most of the adjacent mucosa of gastric carcinoma developed incomplete type intestinal metaplasia (IM). The percentage of Type IIb (ie, secreting sulphomucin) reached 72.5%. In most cases, high iron diamine (HID) rose in cancerous tissue and concomitantly in the IM epithelium of the adjacent gastric carcinoma. The phenomena of separation condition of HID+ in cancerous tissue, HID- in IM epithelium surrounding carcinoma, or HID- in cancerous cell but HID+ in IM of the surrounding epithelium of carcinoma, were much fewer. The two kinds of mucin antigen distribution were observed simultaneously. In the control and gastric carcinoma groups, neither large intestinal mucin antigen (LIMA) nor small intestinal mucin antigen (SIMA) could be detected in the normal epithelium of gastric mucosa. SIMA was mainly found in the goblet cells of IM and the mucous cells of columnar epithelium, while LIMA was mainly present in the columnar cells, in luminal border and/or in goblet cells. LIMA in the carcinoma group is apparently higher than that in the controls. The percentage of LIMA+ in the IM epithelium of adjacent gastric carcinoma and that in carcinoma cells were also raised in most cases. All these demonstrated a close relationship between IM and gastric carcinoma. Our results also showed that not only HID+, but also LIMA+ may represent a precancerous lesion in gastric carcinoma.

Using flow cytometry (FCM), we measured the DNA content of bone marrow from 25 patients with acute leukemia (AL) in complete remission (CR) and followed them up for 0.5 to 1 year. Five of 13 patients in early relapse had normal DNA index (DI), while the remaining 8 showed DNA aneuploidy 1.5 to 5 months (mean 2.6 months) before relapse. The relapse rate was higher in CR patients with DNA aneuploidy (88.9%) than in those with normal DI (31.3%, P less than 0.05). Intensive chemotherapy was helpful to prolong CR duration in CR patients with DNA aneuploidy. DNA measurement by FCM was considered a reliable method for detecting minimal residual disease (MRD), and the appearance of DNA aneuploidy might predict a relapse of CR.

The Ph1 translocations were observed in 43 of the 51 patients with chronic myeloid leukemia (CML). Of the 43 patients with Ph1 chromosome, 19 (45%) had other structural abnormalities. Complex translocations were observed in 5 patients (12%). Twenty-eight patients with Ph1-positive CML have been followed up genetically.

From November 1986 to February 1989, 18 patients with traumatic carotid-cavernous fistulas were treated by means of detachable balloon, which was made by ourselves. Successful embolization was achieved in 15 patients. Draining features of the fistulas and methods of embolization were introduced. The method was compared with other methods. Selection of treatments and problems in embolization are discussed.