1993年 · 第106卷第09期

Plasma levels of endothelin (ET) were determined by radioimmunoassay in 11 healthy volunteers and 34 patients with liver cirrhosis. The results revealed that mean ET plasma level was significantly lower in 34 cirrhotic patients than in normal subjects (40.21±4.38 ng/L vs 84.55±7.88 ng/L, P<0.01). Plasma ET was 32.17±3.98 ng/L in 23 cirrhosis patients with ascites compared with 57.0±9.0 ng/L in patients without ascites (P<0.01). Moreover, it is apparent that plasma levels of ET decreased with the increase of ascites volume, and increased after the disappearance of ascites. But plasma levels of atrial natriuretic peptide (ANP) in cirrhotic patients were markedly higher than those in the controls (830.12±72.18 ng/L vs 439.45±50.18 ng/L, P<0.01). In patients with ascites, ET plasma levels were inversely correlated to ANP. The results suggest that deficiency of circulating ET might be one of the important factors involved in sodium and water retention in cirrhosis.

HCV RNA and anti-HCV were detected respectively by complemented DNA polymerases chain reaction (cPCR) and ELISA in the sera of 28 acute leukemia patients with repeated blood transfusion and changes in liver function. HCV RNA positive rate was 78.6%. Anti-HCV positive rate was 60.7%. 25 subjects showed positive results in HCV RNA or anti-HCV, or in both of them. By combined assessment, the HCV infection rate was 89.3%. Acute leukemia patients were the high risk group of HCV infection because of the lowered immune function and repeated blood transfusion. By cPCR, HCV RNA can be detected earlier and the sensitivity is higher than by anti-HCV. So cPCR is a sensitive and specific method for early diagnosis of HCV infection. The combination of HCV RNA and anti-HCV detection methods may improve the diagnostic rate of HCV infection.

The total phospholipids in serum and the percentages of major phospholipid classes of phosphatidylserine (PS), phosphatidylcholine (PC), phosphatidylethanol-amine (PE) and sphingomyelin (SM) were studied based on 21 patients with multiple sclerosis (MS) and 18 healthy subjects. Serum samples were extracted with isopropanol, then major phospholipid classes were separated by thin-layer chromatography, finally, the samples were quantitated by CS-910 densitometer. Though the results were insignificantly different in the concentration of total phospholipid between the MS patients and the controls, there was partial reduction of the concentrations of PS and PE (P < 0.01), moreover, the percentages of PS and PE were relatively lower, correspondingly, the percentage of PC was higher as compared with control group. The results suggest that there should exist an abnormality in the metabolism of phospholipids in patients with MS in the sense of the alterations of phospholipid compositions in serum samples.

Catheter ablation of atrioventricular accessory pathway by radiofrequency current is a new treatment for patients with refractory supraventricular tachycardia. 71 patients (37 male, 34 female, mean age 36±11 years) with 77 atrioventricular accessory pathways were ablated in the study. Left-sided pathways were ablated at the ventricular side of mitral annulus by using large-tip ablation catheter. While right-sided pathways were ablated along the tricuspid annulus, 70 (90.9%) accessory pathways of 64 patients (90.1%) were blocked successfully. There were no deaths. Left femoral vein thrombosis occurred in one patient. Recurrence was found in 3 patients (4.2%) after 7 months of follow-up and all of them were ablated again successfully.

The changes in 15 cases of viral myocarditis and 28 cases of dilated cardiomyopathy were reported and compared, which were the pathological changes of endomyocardial biopsy; NK cells activity; % of peripheral T lymphocytes and its subsets determined by using OKT3,4,8 (OKT3-peripheral total lymphocytes; OKT4-helper cells; OKT8-suppressive cells) monoclonal antibody; values of immunoglobulin IgG, IgA, IgM; titer of coxsackie B antibody neutralization test. And a discussion on their relationship was included.

Myocardial revascularization by Nd: YAG laser used in rats with myocardial infarction was studied. The left coronary artery was ligated and the laser channels with a diameter of 300 μm were made immediately by 2.5-4.2 W lasersonics YAG unit. After 24 hours, the rats were killed. Evaluation included hemodynamics, lactate dehydrogenase of myocardium and myocardial infarct size. The results showed that laser myocardial revascularization reduced myocardial infarct size and enzyme leakage, and improved left ventricular function. The study may provide theoretical basis for the clinical applications of this new technique in the treatment of ischemic heart disease.

Endoscopic variceal ligation (EVL) is a new alternative to sclerotherapy in the treatment of esophageal variceal hemorrhage, which results in strangulation, necrosis and scar formation of varices without systemic or local adverse effect. From May 1, 1991 through July 1, 1992, EVL was performed in 78 consecutive patients, in 35 of them it was performed during active massive bleeding, and active bleeding was controlled by the initial session in 31 patients. With repeated EVL treatment, 32 patients had their varices obliterated. The varices had reduced in size in other patients. No ligation-related complications were observed. This procedure is a safe, effective and rather simple method to treat esophageal varices, especially in patients with poor liver function and recurrent bleeding after devascularization or shunt surgery.

One hundred and eight patients with spasticity of the paralytic limbs were treated successfully with hyperselective posterior rhizotomy (SPR). Of the 108 patients, 100 had cerebral palsy, 2 hemiplegia, 3 sequelae of cerebral injury, 2 paraplegia and 1 multiple sclerosis. Twelve patients received cervical SPR and 96 lumbosacral SPR. Laminectomy is performed to open the dura and to separate the posterior spinal root into several rootlets. The lower threshold rootlets were divided after electrical stimulation. Follow-up for 6 to 30 months showed that the effective rate of reducing spasticity was over 95% and functional improvement rate over 80%.

Infection is a leading cause of death of renal transplantation and how to control it is still an urgent problem to be solved. Bacteria culture, computerized modified McGuckin's monitoring methods, OKT monoclonal antibody technique and radioimmunoassay (RIA) were used on studying the cause, monitoring and prevention of the infection. Results showed that 22 out of 24 cases (91.7%) were colonized by Gram-negative bacilli in pharynx and groin region. Of them, 15 were infected with the same bacteria in wound, urine, blood and lung. Six out of 7 cases with serious infection were colonized by Gram-negative bacilli on the surface of the whole body. The computerized modified McGuckin's method predicted and analyzed the infection outbreak much more fast and accurate, with a rate of over 80%. Helper/suppressor lymphocyte ratio of 1.08 was taken as a threshold value for the diagnosis of infection. The results suggested that the change of skin flora is closely related with the infection. Monitoring the alteration of skin flora is an effective method for the prevention and control of severe infection. The pharynx and groin regions of the patients are stable reservoirs of Gram-negative bacilli which may cause infection easily. Computerized quantitative analysis may increase the efficiency and accuracy of infection surveillance. In order to preserve the immune system as much as possible and prevent rejection of transplant graft, proper use of immunosuppressive drugs and regulation of the immune system of the patients are the key for preventing infection.

Smooth muscle fibers are considered very important in penile erection and relaxation. The reduction of intracavernosus smooth muscle fibers can provoke impotence. The percentage of smooth muscle fibers in corpus cavernosum specimens was studied quantitatively in normal men and impotence patients by means of computerized image analysis. The percentage of smooth muscle fibers in the specimens of 14 normal men, ranged from 41% to 61% (average 50%) and in 12 impotence patients, it was 22% to 46% (average 31%). A decrease of smooth muscle fibers and an increase of collagen fibers were noted in impotence patients.