1991年 · 第104卷第02期

Two hundred and thirty-eight patients with duodenal ulcer were subjected to vagotomy. According to the clinical manifestations and the results of gastric acid secretion test, parietal cell vagotomy was done in 100 patients and selective vagotomy plus antrectomy in 138 patients. Follow-up after operation for 10 years showed that 96% and 97% of patients belonged to Visick Grade I and II respectively. The recurrence rate for parietal cell vagotomy was 1.96%, but no recurrence was seen in the group of selective vagotomy plus antrectomy. Long-term side-effects were rarely found in the patients. They had good nutritional states. The follow-up data showed that the recurrence rate could be greatly reduced if the modality of vagotomy was selected according to the type of gastric acid secretion test. The importance of surgeons experience and careful manipulation was emphasized.

Monoclonal antibody 131I-COC183B2, developed in our laboratory and proved to fit for human treatment was injected intraperitoneally or subcutaneously in 13 patients. In 8 cases with i.p. injection the disease corresponded with the image, i.e. 3 primary ovarian epithelial cancers showed positive images, 1 ovarian Krukenberg tumor was negative and the other 4 negative images included 1 uterine myoma and 3 ovarian teratomas. In the subcutaneous injection group, 4 cases had ovarian carcinoma, surgery and chemotherapy. Two negative images corresponded with the clinical status-in good health, another negative case had metastatic left supraclavicular lymph node due to ovarian mucinous adenocarcinoma. The last negative image in this group was a case of benign ovarian teratoma which was proved after surgery. The 1 positive case was waiting to be proved by a scheduled third operation. The computer scintigram calculation of T/NT was 5.35 to 13.7. The results suggest that this monoclonal antibody can be used for radioimmunoimaging for the localization of ovarian carcinoma, which is not only helpful for clinical staging and differential diagnosis but is also a good follow-up method.

One hundred and sixty-four cases of upper gastrointestinal tract stricture were treated by balloon dilatation in 4 years. A total of 682 procedures were performed. One hundred and forty cases (anastomosis stenosis 95, caustic stenosis 33 and other stenoses of the esophagus 12) were followed up with an effective rate of 90% (126/140) and a long-term effective rate of 71.4% (100/140). Fourteen cases (10%) failed, and 11 of them were due to tumor recurrence. The concept about the short-term and long-term effects, the criteria for evaluation of the results, the factors influencing the effectiveness, and the time suitable for dilatation are described. For the dilatation, indications are anastomosis stricture of the upper gastrointestinal tract, esophageal web and caustic stenosis of the esophagus. This method is also indicated for cicatricial stricture of the upper gastrointestinal tract of various causes.

With monoclonal antibodies serum immunoglobulin G(IgG) subclasses were measured in seventy children aged 2 to 13 years with recurrent respiratory tract infections including upper respiratory tract infections, otitis media, sinusitis, asthmatic bronchitis and pneumonia. 211 healthy, aged-matched children served as control. IgG subclass deficiency was found in 19 out of the 70 patients (27.1%, single IgG1 deficiency in 7, IgG2 deficiency in 4, combined IgG1-IgG3 deficiency in 5, IgG1-IgG2-IgG3-IgG4 deficiency, IgG1-IgG2-IgG4 deficiency and IgG2-IgG4 deficiency each in 1). The incidence of IgG subclass deficiencies was in the sequence as follows: IgG1, 20%; IgG2, 10%; IgG3, 8.6% and IgG4, 4.3%. The results suggest that IgG subclass deficiency indicate a common disorder in children with recurrent respiratory tract infections.

Pre-S2 protein and its antibody were detected in 130 children with hepatitis B virus (HBV) infection and 30 with T6 hepatitis B (HB) vaccination. The results showed that pre-S2 was positive in most chronic persistent hepatitis (CPH) and chronic active hepatitis(CAH) patients, while anti-pre-S2 was positive in only 8% (2/92 cases) and 11.5% (3/26 cases) respectively. The positive rate of anti-pre-S2 was 78.9% (15/19 cases) in cases at the convalescent stage of acute hepatitis B, 91.7% (55/60 cases) in cases with T6 HB vaccination and 83.3% (25.30 cases) in naturally acquired anti-HBs children, while pre-S2 was not noted. Anti-pre-S2 was negatively related to ALT and positively to anti-HBs (P less than 0.01). The positive relation of pre-S2 to HBsAg was observed. These results suggest that pre-S2 could be a marker for HBV infection, and anti-pre-S2 may indicate a favourable prognosis of HBV infection. There was no correlation between anti-pre-S2 and pathogenic damages induced by HBV.

A single intravenous injection of adriamycin (5 mg/kg) into rats induced nephrotic syndrome. In the various stages of the model, alterations of glomerular fixed anionic charge sites stained with colloidal iron were analyzed quantitatively by image analyzer, which is reported here for the first time. The results showed that there was a significant decrease in glomerular fixed anionic charge sites at 3 hours after administration of adriamycin as compared with the control animals (P less than 0.01). Marked loss of the anionic charge sites preceded the onset of proteinuria and steadily increased along with the progress of the disease. The results suggest that the loss of glomerular fixed anionic charge sites may play an important role in the development of proteinuria in nephrotic syndrome.

A prospective study on consecutive fetal monitoring in 559 deliveries was carried out. The difference between the first 30-minute and the last 30-minute monitoring was compared. Abnormal fetal heart rate (FHR) pattern in the last 30 minutes combined with abnormal fetal scalp blood pH has a good predictability of 1- and 5-minute Apgar scores. The correlation of fetal heart rate-uterine contraction (FHR-UC) monitoring (525 cases) and fetal scalp blood pH determinations (FSB-pH) (79 cases) with the fetal condition was assessed. It is indicated that the first 30-minute FHR tracing can reflect the fetal status in labor, and FHR-UC monitoring assessment is evidently superior to FSB-pH in the prediction of a vigorous fetus. Whereas, FSB-pH is superior to FHR-UC monitoring in the prediction of a compromised fetus.

Twenty-seven infants with cytomegalovirus hepatitis were followed up for 15-40 months after onset of the illness. They had recovered from the hepatitis, but microcephaly was present in 2 (7.4%), sensorineural hearing loss in 5 (18.5%), quadriplegia, mental retardation, ventricular septal defect and tooth defects in 1 (3.7%) each. The patients with congenital infection had more severe and complex defects, some with perinatal infection had mild defects, those with postnatally acquired infection had no sequelae. The mean MDI and frequency of expressive language delay in the former group differed significantly from those of the other 2. Five patients still excreted cytomegalovirus in the urine at follow-up.

108 patients with acute myocardial infarction (MI), aged 70 years or younger, underwent left ventriculography and coronary arteriography (mean one month) after infarction and were followed up for an average period of 22 months (range 5-47 months). The contribution of angiographic variables to a first cardiac event (death, recurrent infarction, coronary artery bypass grafting or congestive heart failure) was evaluated with Kaplan-Meier survival curve analysis and long-rank test. Patients with cardiac events had left ventricular dilation, systolic dysfunction, multivessel coronary disease and lack of residual flow to the infarct region. Multivariate analysis showed that left ventricular end-systolic volume (P less than 0.001), end-diastolic volume (P less than 0.01) and the number of the diseased coronary vessels (P less than 0.05) were of significance in predicting the outcome. This prospective study indicates that in survivors of first acute transmural MI, cardiac catheterization performed one month after infarction can provide additive prognostic information that can be used to stratify risk.

Kinetic changes of viremia were observed in 287 cases of hemorrhagic fever with renal syndrome (HFRS) in whom ribavirin was administered with double blind random control studied by means of virus isolation, indirect immunofluorescence assay and enzyme-linked immunosorbent assay. The positive rate of viremia was 79.7% (Sp = 3%) and positive rate of HERS IgM was 85% (Sp = 3.1%) before treatment. Viremia could be interrupted by ribavirin as in the ribavirin treated group, the viremia positive rate decreased, duration of viremia was shortened, viral antigen products, virus titer and HFRS IgG antibody level were reduced as compared with the control group. This showed that viremia was very frequent in patients in the febrile phase and ribavirin is an effective antiviral drug in HFRS during the febrile phase. Dosage and course of treatment of this drug are discussed.