1993年 · 第106卷第01期

Tumor necrosis factorα (TNFα) mRNA expression in bronchoalveolar lavage (BAL) cells from patients with lung fibrosis was studied by a reverse transcription-DNA polymerase chain reaction (RT-PCR). The results indicated that two thirds of the tested samples were TNFα mRNA positive. On the other hand, TNFα activity was detected in a big part of the BAL supernatants from the patients. Furthermore, recombinant TNFα was found to be mitogenic to lung fibroblasts. These data suggest that TNFα expression in BAL cells may play a role in the development of lung fibrosis in human.

The therapeutic effects of intentional hemodilution (IHD) on 64 patients of rheumatic mitral valvular disease with chronic pulmonary stasis were estimated. The mean hematocrit was decreased from 0.50±0.06 to 0.41±0.04 by withdrawing blood and replacing it with diluent. The whole blood ratio viscosity was decreased from 11.7±2.4 to 6.4±0.8 (P<0.01), the pulmonary arterial pressure was reduced from 6.4±0.6 to 4.1±0.5 kPa (0.133 kPa=1 mmHg) (P<0.01), the pulmonary vascular resistance brought down from 536.0±108.0 to 315.0±62.0 dynes.s.cm-5 (P<0.01), the cardiac output increased from 3.4±0.4 to 5.6±0.5 L/min (P<0.01), the cardiac index increased from 2.2±0.5 to 3.5±0.4 L/min/m2 (P<0.01), and venous oxygen saturation and oxygen content increased from 28.5±3.4%, 5.1±0.5% to 56.0±5.0%, 11.3±1.2%, respectively (P<0.01). The patients' symptoms and signs improved significantly. The protective role of IHD in the early stage of lethal pulmonary edema induced by epinephrine in 39 rabbits and 27 rats was also observed. The experimental data show that intentional hemodilution increased the animals' survival rate (P<0.01), reduced the pulmonary coefficient, permeability index of Evans blue and protein content in broncho-alveolar lavage fluid (BALF) (all P<0.01), and alleviated the pathomorphological changes of the lungs of animals in Group IHD were alleviated. The results suggest that IHD acts well in both chronic pulmonary stasis and acute pulmonary edema.

Twenty-seven samples of pleomorphic salivary adenoma (PSA) were examined for expression and structure of c-myc, c-Ha-ras, c-erbB-2, c-sis oncogenes by RNA dot blot, DNA dot blot and Southern blot hybridization. Eighteen of 25 PSA showed 5.02±4.74 fold overexpression of c-myc oncogene, 6 of 19 PSA had 4.91±3.87 fold overexpression of c-Ha-ras oncogene. Two of 16 PSA were found to have overexpression of c-erbB-2 oncogene. In addition, 7 of 10 PSA and 1 of 9 PSA were detected to have c-myc and c-erbB-2 oncogene amplification respectively. However, no rearrangement, amplification or overexpression of c-sis gene was found. We also discussed various clinicopathological parameters of PSA, which however, had no significant correlation with expression of c-myc or c-Ha-ras oncogene. Our results indicate that activation of c-myc, c-Ha-ras and their combination may play an important role in the pathogenesis of PSA.

With regard to pulmonary tissue damage secondary to extracorporeal circulation, most studies focused on the pulmonary histological changes after artificial lung bypass, but none compared the pre- and post-operative pulmonary changes of artificial lung with those of autogenous lung. We compared the changes in autogenous lung oxygenation and artificial lung oxygenation during cardiopulmonary bypass (CPB). The results showed that autogenous lung oxygenation is less injurious to the lung than bubble oxygenation and is more physiological. We think that during open heart surgery with autogenous lung bypass, the lung is functioning physiologically and supplied with normal amount of oxygen, while using bubble oxygenation for CPB, the native lung, the only nonperfused organ, is insulted by pulmonary ischemia, which is one of the most important reasons for pulmonary injury after CPB.

The clones containing parasite DNA fragments were screened from a genomic DNA library of Plasmodium falciparum FCC1/HN isolate. A DNA probe derived from clone pBF4 consisting of 3 kilobase pairs hybridizes specifically with P. falciparum DNA but not with human DNA, P. cynomolgi DNA or P. berghei DNA. The nick translated radiolabelled probe can detect 10 pg purified P. falciparum DNA and a 0.001% parasitemia after 24 hours of film exposure. The probe reacts with all microscopically diagnosed P. falciparum samples and 3 of 41 P. vivax samples as well but not with any of 10 human DNA samples.

Somatosensory evoked potentials (SEP) arising from median nerve stimulation were recorded in 102 patients with unilateral cerebral hemorrhage or infarct located in basal ganglion, internal capsule, thalamus or cerebral lobe. Of them 42 cases were followed up and reexamined with SEPs. Three types of SEPs were observed: 1) absence of all SEPs components, 39 cases; 2) slight to moderate abnormalities of SEPs, 37 cases; 3) symmetric and normal SEPs, 26 cases. The total abnormal rate of SEPs was 76.5%. There were no definite correlations between abnormal SEPs and lesion location, size and lesion nature. The diagnosis of cerebral vascular disease might be obtained more directly and precisely by CT scan than by SEPs. However, SEPs may serve as an objective neurophysiologic means in assessing the neurological function of the affected limb, in which their abnormalities and severity are of great value to evaluate the probability and the degree of sensorimotor functional rehabilitation of the limb. When SEPs are absent, the recovery of the limb functions may be very poor no matter whether it is hemorrhage or infarct regardless of its lesion size and location.

The function of a bovine pericardial xenograft valve in the mitral position was studied in 18 patients by using stress Doppler echocardiography after submaximal supine exercise. In 10 patients with normally functioning tissue valve, peak and mean gradients increased from 9.3±1.3 and 2.7±0.7 mmHg, respectively at rest, to 14.7±0.9 and 4.1±1.0 mmHg at peak exercise. The tissue valve area assessed by the Doppler pressure half-time method increased from 2.69±0.38 cm2 at rest, to 3.15±0.38 cm2 at peak exercise (P<0.05). In 6 patients with mitral regurgitation, peak and mean gradients increased from 17.3±5.3 and 7.0±1.8 mmHg, respectively at rest, to 24.3±5.0 and 9.0±2.6 mmHg at peak exercise, but there was no significant change in valve area at peak exercise. Patients with severe isolated mitral regurgitation had a Vmax of more than 2 m/s and elevated pressure gradients at peak exercise. But the pressure half-time was relatively unaffected, allowing their differentiation from patients with tissue valvular stenosis. Stress Doppler echocardiography is a simple, noninvasive and reliable method for the evaluation of the mitral tissue valve function which is recommendable for patients with suspected mitral tissue valve dysfunction.

Plexiform lesions are a characteristic vascular change of pulmonary arteries in pulmonary hypertension. Autopsy of lungs from 28 patients with primary pulmonary hypertension were examined to clarify the nature of the plexiform lesions. Histological studies showed that the plexiform lesions, were usually related to fibrous occlusion at the peripheral sites of pulmonary arteries. To clarify the topographic correlation between the arterial occlusion and plexiform lesions a three dimensional analysis of the pulmonary arteries was performed with a computerized image analyzer. The plexiform lesions were located in the small supernumerary branches which were raised at more proximal sites than the occlusive lesions of their parent pulmonary arteries. An electron microscopic study demonstrated that the arterial branches were severely injured and developed into aneurysm-like dilatation with organization. Within the organized arterial branches, endothelial cells proliferated to form complicated capillary-like channels, which is a feature of the plexiform lesion. From these findings the following process may be considered in pulmonary hypertension: the occlusive changes of peripheral pulmonary arteries may induce a by-pass in the proximal supernumerary branches which are severely affected by increased shear stress and ultimately organized. As a result of the organizing, proliferation of endothelial cells may produce plexiform lesions in the special branches of pulmonary arteries.

One hundred and fifty-nine patients (140 females, 19 males) with lupus nephritis (LN) were studied. Renal biopsy was performed for each patient with light microscopy, immunofluorescence and electronic microscopic studies. 27 normal subjects were selected as controls. Blood levels of sex hormone including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and testosterone (T) were measured by radioimmunoassay (RIA), and some clinical, laboratory and histological parameters were collected for analysis of lupus activity. It was found that serum FSH, LH and plasma E2 of all patients were much higher than normal (P<0.01) while plasma T was much lower in female patients (P<0.01) but normal in male patients. The lupus activity was proved to be closely related to plasma E2 and T (P<0.05). There was no definite relationship between abnormal plasma E2 or T and serum IgG, C3 C4, ANA, A-dsDNA or A-Sm. The levels of sex hormones among every histological type of LN were not significantly different. It was concluded that: 1. The increment of plasma E2 is associated with lupus activity in both male and female patients. 2. The decrement of plasma T only in female patients is also related to lupus activity. 3. No relationship could be found among FSH, LH, E2 and T.

One hundred and two patients with femoral neck fracture underwent combined hook-pin and compression screw fixation. Eighty-five patients were followed up for over 6 months. The fracture was united in 80 patients. The advantages of this method included less trauma, simple technique and firm internal fixation and early postoperative partial weight-bearing. Biomechanical study showed that this method is superior to Smith-Petersen nailing and two hook-pins methods. The sliding and continuous compression of this method promotes impaction and healing of the fracture.

During the 30 years from 1960 to 1989, 100 sequential patients with atherosclerotic infrarenal abdominal aortic aneurysm (AAA) were admitted to Zhongshan Hospital. Twenty-eight were not treated surgically and 72 underwent resection of the AAA with prosthesis replacement. Nineteen non-surgical patient were followed up, and 8 died from ruptures with a five-year survival rate of 41.3±13%. In 72 surgically treated patients, the operative mortality was 2.8%. The five-year survival rate is 77.5±6.2%, which is higher in comparison with the non-surgical group (P<0.01). The data show that the operation for AAA is safe and the postoperative long-term results are satisfactory.