1993年 · 第106卷第11期

Temporary arterial occlusion during intracranial aneurysm surgery is a safe and effective modality. It is not only an emergency measure for controlling aneurysmal bleeding, but also a helpful means for accurate and meticulous dissection and clipping of an intracranial aneurysm with the advantage of minimizing the chance of its premature rupture or causing damage to the vital neurovascular structures. This technique is especially useful for treating large or giant aneurysms, carotid-ophthalmic arterial aneurysms, or thin-walled and complicated aneurysms tightly adherent to their surrounding tissues. A series of 52 patients with temporary clipping of the involved arteries during intracranial aneurysm surgery were reviewed retrospectively, which represented 37.1% of all aneurysms operated on in Huashan Hospital, Shanghai Medical University during the same period (from 1980 to 1990). Of them, one died (1.9%), 10(19.2%) had immediate or early neurological deficits which were mostly resolved later. A follow-up study with an average time of 3.8 years showed that 98% of patients had an excellent and good recovery without significant deficits. Comparing these results with those in 88 patients with aneurysms operated on over the same period in which temporary clips were not used, there is clearly no significant difference. The use of brain protectors, barbiturates, hypothermia and some monitoring systems can increase the safe coefficient to the brain and reduce the occurrence of ischemic complications during the application of temporary arterial occlusion. However, there is so far neither an absolute reliable medication or monitor, nor a well accepted safe time-limits to vascular occlusion. Therefore, the use of temporary arterial occlusion and time-limits for its application during the operation should be individualized depending basically on the patient's age, the clinical grade of the patint, the estimated adequacy of the collateral circulation, the location of the aneurysm and its relation to the surrounding tissues, the site of the artery to be occluded, and the involvement of the important perforating arteries.

Cerebral spinal fluid (CSF) pulse waveform basing on 899 records was classified. Eleven types of CSF pulse waveform were further classified according to the harmonic wave relation and the configuration of the pulse waveform. The characteristic features of various types of CSF pulse waveform were considered to reflect certain intracranial pathophysiological conditions including cerebral compliance, cerebral vasomotor reactivity and intracranial elastance.

A new approach to perfuse arterial blood through venous channels for revascularization of severely ischemic limbs is reported. The procedure studied and used consists of creating an arteriovenous fistula between the normal arterial trunk proximal to the occlusion and the deep venous trunk of the diseased limb, constricting the venous trunk proximal to the anastomosis to one third of its lumen diameter, ligating the communicating and small tributary veins distal to the constriction in the operative field. The results of the experimental and clinical studies have shown that the treated ischemic limb was quickly revascularized without undesirable influence on cardiac function. This new approach has been used in the treatment of severe ischemia involving total 212 limbs in 156 patients, and the results appeared more satisfactory than those treated with staged arteriovenous reversal.

Between November 1987 and October 1991, 40 consecutive cadaveric renal recipients immunosuppressed with cyclosporine (CsA) who developed renal allograft rejection were treated with domestically prepared muromonab CD3 (Wu 338) and CD4 (Wu167). CD3 and CD4 monoclonal antibodies (McAb) as rescue treatment (n=34) successfully reversed 29 cases of (85.3%) intractable renal allograft rejection (steroid resistant rejection 32 and anti-human thymocyte globulin [AHTG] resistant rejection 2) and completely reversed 4 cases of acute renal rejection episodes CD3 McAb as first-line treatment (n=4). Two cases of chronic rejection failed in the treatment of McAb. Rejection episodes were reversed from 4 to 11 days (mean 6 days). Combined use of CD3 and CD4 McAb seemed to yield better results. Peripheral blood T lymphocyte subsets showed that CD3+, CD4+ and CD8+ decreased significantly after the treatment of McAb. No severe side-effects were observed in the treatment of McAb. The McAb could be administered safely. Pulmonary infection rate was 15%. The yearly graft survival rate was increased significantly (87.8% vs 80.0%).

Fibroblast were harvested from in vitro culture of split-thickness skin of New Zealand rabbit. Some opaque bone nodules were found in the culture flasks when the fibroblasts underwent subculture for 8 days. After a 37-day subculture of fibroblasts, some of the nodules might enlarge extend and form trabecular-like or flake-like structures. The above-mentioned structures revealed golden-yellow fluorescence under the blueviolet light fluorescence microscope when the specimens were labeled with tetracycline intravitally, denoting that they were newly formed bone tissues. Both calcium salt and collagen stainings for these structures showed positive reaction, fully reflecting the calcium and collagen composition. Osteogenesis caused by dermal fibroblast cultured in vitro was thus verified.

The study examined the articular cartilages of 14 patients who suffered from temporomandibular joint disturbance syndrome (TMJDS) and 3 healthy fresh cadavers by light microscopy and immunofluorescence, and assayed 14 patients' synovial fluids and sera with indirect hemoagglutination. The results showed that there were antibodies to type II collagen in synovial fluids in 5 of 14 patients and there were some immune complexes in cartilage. So, the authors think that there are autoimmune reactions in the articular tissues in TMJDS because of the exposure of some sequestered antigens.

Clinical, laboratory and sialographic findings were studied in 35 adult patients with recurrent parotitis. The patients were followed up for 0.5-23 years. The results showed that sialographic recovery occurred 3-5 years after disappearance of clinical symptoms. Recurrent parotitis is not a autoimmune disease, and remission may take place spontaneously, including clinical and sialographic healing. However, marked degeneration of the parotid gland or chronic obstructive parotitis may develop consequently. The differential diagnosis of recurrent parotitis in adults is also discussed.

A lung fibroblast cell line was isolated from lung biopsy of a patient with lung fibrosis. Gene expression of ten growth factors in the fibroblasts were investigated by a reverse transcription-DNA polymerase chain reaction. The results indicated that the fibroblasts expressed acidic fibroblast growth factor (aFGF) mRNA transcript. Further experiments revealed that recombinant aFGF could be internalized by the fibroblasts and stimulated the proliferation of the cells. These data suggest that aFGF may activate lung fibroblasts in a way of autocrine and, therefore, may be involved in the development of lung fibrosis.

Fecal culture for Campylobacter jejuni with the method of Skirrow and serum class specific antibodies (IgG, IgM, IgA) against Campylobacter jejuni using a solid phase enzyme linked immunosorbent assay were performed in 17 cases of Guillain-Barre Syndrome, 17 other neurological disease controls, and 33 normal controls. The results revealed: 1. the incidence of Campylobacter jejuni infection, especially the recent one in Guillain-Barre Syndrome was much higher than in the other two groups; 2. the recent incidence of infection in those below 30 years old and those within the period of summer and autumn was higher than that above 30 years old and that in the other seasons. The results suggested that Campylobacter jejuni infection might be one of the important precipitating factors of Guillain-Barre syndrome and might play an important role in the epidemiological pattern of Guillain-Barre Syndrome in China.

Polymerase chain reaction (PCR) and blot hybridization by probe labelled with digoxin were used to detect human cytomegalovirus (HCMV) DNA in 31 patients with acute leukemia and 20 controls. The positive rate detected by PCR in acute leukemia was 74.2% and 15.0% in the controls. The difference was statistically significant. The results suggest that acute leukemia patients are the high risk population with high infection rate of HCMV. The positive rate detected by digoxin method in acute leukemia was 58.1%. Six patients showed negative results by digoxin method, but positive by PCR. It was demonstrated that PCR was superior to digoxin method in sensitivity. Anti-HCMV IgM in serum of patients was detected at the same time, the positive rate was 16.1%. Only 6 of the 23 PCR positive patients showed positive anti-HCMV IgM. It suggests that the immune response is weak in acute leukemia patients and HCMV recently infected could not be excluded in the anti-HCMV IgM negative cases.

This article summarizes the contents and results of extensive surveillance on hemorrhagic fever with renal syndrome (HFRS) in China. Data from surveillance on human HFRS, including morbidity and case fatality rate, trend of epidemics, periodicity of epidemics, factors related to epidemics, types of epidemic areas, environment structure of natural nidi, geographic distribution, seasonal distribution, age distribution, sex distribution and occupation distribution, as well as surveillance on animal infection with HFRS virus were collected and analysed.

Four cases of systemic fibrous dysplasia were selected from 356 cases of fibrous dysplasia. All of them were verified pathologically. In these 4 cases, the long, short, flat and irregular bones were involved. Some of the changes were characteristic in comparison with those of the monostotics or regional types. This disorder was often seen clinically in females, started in early childhood and exacerbated during puberty. Its main symptoms were primary or secondary deformities. Radiologically, the main changes were diffuse and uniform expansion and developmental disturbances of the bones and joints.