1993年 · 第106卷第10期

With radioligand binding assay, we studied the central benzodiazepine receptors (CBR) in the different regions of brain including the telencephalon, diencephalon, brain stem and cerebellum in a rat model of hepatic encephalopathy (HE) induced by partial hepatectomy following carbon tetrachloride (CC14) intoxication and in the controls. Affinities (Kd) and densities (Bmax) of [3H]-flunitrazepine binding to crude synaptic membranes in the telencephalon of HE rats were obviously increased as compared with those of the controls. It was only in the diencephalon, the brain stem and the cerebellum of HE rats that increased Bmax values were observed, while the Kd values remained unchanged. The results support the recent suggestion that the alterations of CBR play a significant role in the pathogenesis of HE. Among the ranges of the alterations of CBR in the HE rats, the telencephalon ranked first, the brain stem second, the cerebellum third, and the diencephalon last.

Total hip replacement was carried out in 7 patients with advanced osteoarthritis of the hip joint. The patients were given tetracycline orally before operation to label the newly formed bone tissues. The excised femoral heads were processed into undecalcified sections, which were subjected to both fluorescence microscopic and scanning electron microscopic (SEM) observation. Band-shaped golden fluorescence was detected along the trabeculae, reflecting newly formed bone tissues by the cambium layer of the periosteum. In the intertrabecular space, reticular and spherical golden fluorescence was detected, implying newly formed bone tissues by the marrow stromal cells. Under SEM, both reticular and spherical new bone tissues were discovered in the inter-trabecular space as mentioned above. There were two forms of reticular new bone tissues, a diffuse form and a tape-shaped new bone tissues. The diffuse bone tissues grew and expanded and eventually studded the inter-trabecular space. The tape shaped tissues, which were first deposited on the trabecular arch surface, increased in amount and then woven into thin and dense tapes of the reticulum. These tapes contacted in an end-to-end fashion, and appeared to shuttle back and forth through the trabecular arches, forming new secondary arch structures. The spherical new bone tissues were deposited on the surface of the trabecular arch structures and gradually packed the intertrabecular space. These new bone tissues were contributed to hyperplasia in the osteoarthritic femoral head.

The efficacy of oral cholelitholytic therapy with chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) in 137 patients with gallstones was studied in relation to their CT patterns. The best dissolving results were obtained in patients with the stones in isodensity and faint category (<50 Hu) on CT. The stones with high density or heterogeneous calcification on CT were insoluble, and therefore, were contraindicated for oral cholelitholytic therapy. The attenuation value of stones was classified as complete dissolution ranged from -2 to 35 Hu (14±12 Hu, n=13), and their upper limit of 95 percentiles was 33.4 Hu. CT analysis improved the predictability of dissolving gallstones in comparison with plain abdominal radiography or oral cholecystography (OCG). The complete dissolving rate increased from 9.49% (13/137) in patients selected by classic X-ray to 40.7% (11/27) in isodensity category on CT. Besides, radiolucent gallstones, which showed no obvious filling defect on OCG but distinct echo and shadow on B-type ultrasonography, were also insoluble.

The sugar moiety detected from rectal mucus by the Galactose oxidase-schiff (Shams' test) is considered a substitutive test for immunological fecal occult blood test (FOBT) in screening colorectal carcinoma. Two strategies of screening were applied in 6480 subjects over 40 years of age, and 130 cm flexible colonoscope used for sigmoidoscopy or pancolonoscopy. Of them, 3820 were taken for immune FOBT (SPA test) and Shams' test. Only those who showed positive tests were chosen for 60 cm flexible sigmoidoscopy, while another 2660 subjects for both sigmoidoscopy and tests at the same time. Additionally, 130 cm flexible pancolonoscopy was carried out in 103 individuals with positive Shams' test for evaluating the false positive rate. Shams' test showed a sensitivity of 85.7% for colorectal cancer, 47.1% for adenomas in preselected patients, while the positive rate of SPA test were 90.5% and 41.2% respectively. In 3820 asymptomatic subjects undergoing sequential screening (aged 45 years and higher), Shams' test showed 9.1% positive, SPA showed 11.2% and 620 (16.2%) subjects were selected for sigmoidoscopy based on their positive galactose oxidase result or positive FOBT result. Two early stage carcinomas and 33 adenomas (0.32% and 4.2% respectively in sigmoidoscopy) were found. Another 2 660 subjects were taken for sigmoidoscopy screening. Four carcinomas and 78 adenomas were found. Of them, only two carcinoma (50%) and 17 (21.8%) or 22 (28.2%) adenomas were positive in Shams' or SPA test. But both tests combined in screening showed a rate of 61.3% in adenomas and 75.0% in cancers. 103 subjects with positive Shams' test were taken for pancolonoscopy. 82.5% showed no lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

From January 1986 to April 1991, 107 consecutive patients with acute promyelocytic leukemia (APL) were treated with retinoic acid (RA) at an oral dose of 45-60mg/m2/d, alone or in combination with chemotherapy. In 91 cases treated with RA alone, 74 (81.3%) achieved complete remission (CR). The CR rate was 75% in 16 cases treated with combined therapy. Among 50 patients closely followed for a median of 36 months (4-60), 10 received RA as continuation therapy (Group A), 10 received chemotherapy (Group B) and 30 were treated with RA and chemotherapy alternately in regular sequence (Group C). The mean survival time was 8.4, 9.7 and 21.6 months, respectively, for the 29 cases who died. The survival probability was higher in Group C than in Group A and B (P<0.01). RA did not provoke or aggravate DIC, it did not cause marrow hypoplasia or aplasia. The side effects were relatively mild as compared with chemotherapy. CFU-GM markedly reduced before treatment was restored to normal level after CR, while the result for L-CFU was reversed. In 40 cases examined for in vitro induction of differentiation, 39 responders were culminating in CR. Aberrant karyotype t (15; 17) was positive in all 47 cases examined prior to the treatment. It disappeared in all of the 20 cases studied after achieving CR, and reappeared in 3 cases following relapse. The best regimen to maintain a longer CR duration and survival time in this study was to use RA and chemotherapy alternately as continuation therapy.

Sixteen patients with local stasis and swelling after implanting cardiac pacemaker were treated with Mangxiao (Natrii Sulphas) on the implanted local surface for 4-14 days. The effect was satisfactory. Reopening of the skin for the cleaning of the stasis and swelling and removal of the pacemakers could thus be avoided in these patients. The mechanism of action of Mangxiao in relieving stasis and swelling was studied preliminarily.

The effects of caffeine on diaphragmatic contractility and fatigue was investigated in 21 dogs. Diaphragmatic contractility was assessed by measuring transdiaphragmatic pressure (Pdi) during supermaximal stimulation of the phrenic nerves at different frequencies, and Pdi was measured with a pair of balloons. In protocol 1, the effect of caffeine on contractility of non-fatigued diaphragm was studied in 7 dogs. Caffeine infusion increased Pdi significantly at all frequencies of stimulation. In protocol 2, diaphragmatic fatigue was induced by electrophrenic stimulation (30 Hz, duty cycle 1.0, 30 minutes). The recovery profile after fatigue run was observed in 5 dogs. In another group of 9 dogs, caffeine was infused during stable fatigue period and Pdi increased significantly at all frequencies of stimulation after caffeine infusion. The increase in Pdi was not due to changes in cardiac output or lung mechanics (Cdyn and Rtot), neither of which changed significantly after caffeine infusion. We conclude that caffeine improves muscle contractility both in non-fatigued and fatigued diaphragm in dogs.

The effect of a physical training course of 1-2 month duration using cycloergometer with the intensity of VO2 max 60%, 30 min per day was observed in non-insulin dependent diabetes mellitus (NIDDM) patients. The results showed a decrease of plasma glucose and insulin levels, ΣPG and ΣIRI and an improvement of blood lipid constitution. These were accompanied by a decreased erythrocyte insulin receptor binding rate and a reduction of receptor binding sites of both high and low affinity receptors.

Bone marrows from 30 newly diagnosed Ph+chronic myelocytic leukemia (CML) (21 in chronic phase, CML-CP, 9 in accelerate phase, CML-AP) and 8 followed up patients in blast crisis (CML-BC) were tested by DNA strand breaks (%D value), DNA-aneuploidy, flow cytometry-cell surface antigen expression for CD15 and HLA-DR ratio. Our results showed that all these three parameters changed as the disease escalated. A very low value of %D and DNA-aneuploidy occurrences were high risk factors. Cell surface antigen expression CD15 and HLA-DR ratio measurement was simple and reliable. The ratio<1.0 appeared earlier than morphology clarifying CML-AP and should be followed up regularly.

Biopsied liver tissues from 352 cases were tested for hepatitis C virus (HCVAg) with improved PAP immunohistologic chemical method. Furthermore, corresponding seroantibody to hepatitis C virus was also tested. The total HCVAg positive rate was 9.1%. The HCVAg positive rate in chronic persistent hepatitis (CPH) was 5%. The HCVAg positive rate in chronic active hepatitis (CAH) was 11.2%. The HCVAg positive rate raised gradually along with the severity of hepatocytic injury. HCVAg may be seen in necrotic liver cells exfoliating into the liver sinus, indicating a close relationship between HCVAg and hepatocytic injury. Expression of HCVAg was mostly of the nucleus type in CPH cases and was mostly of the plasma type in CAH cases. The periphery of nucleus type-expressed positive cells generally had no marked inflammatory cell infiltration. The periphery of plasma type-expressed positive cells had a certain amount of inflammatory cell infiltration. Along with the severity of hepatocytic injury, HCVAg expressed itself in a positive correlation according to the nucleus and plasma types. The HCVAg positive cells were located mostly in the lobular peripheral band and rarely located in the venoperipheral band. It was possible that this had some relation with the lobular microcirculation of blood and blood supply. In this study, there was no obvious correlation between the HCVAg positive rate in hepatic tissues and the anti-HCV positive rate in sera. Neither the patients with HCVAg positive liver tissues nor the patients with seropositive anti-HCV had any history of blood transfusion and the use of blood products. This suggests that the characteristics of sporadic spread of HCV infection in some areas of China deserve our attention.

Although foreign bodies of the gastrointestinal tract are common in children, they are rare in the adult. Complications of the foreign bodies are well recognized to be a cause of obstruction, bleeding and perforation of the intestine, or furthermore, they sometimes lead to death unfortunately. On the other hand, it is very difficult to diagnose and treat foreign bodies in the handicapped because of disability of complaining the symptoms. This paper reports a 31-year-old severe handicapped man suffering from foreign bodies in the esophagus and the small intestine, and was successful removed by endoscope.