1994年 · 第107卷第08期

There are still controversies concerning the concept and diagnosis of multiple systems organ failure (MSOF), since the term does not precisely define its true nature, and its differential diagnosis with other irrelevant clinical conditions, such as senile dysfunction of organs, agonal state, etc, remains unclarified. Our studies on both human burn patients and rat model by means of electron spin resonance (ESR) showed that there was an excessive generation of free oxygen radicals resulting in lipid peroxidation of cell membrane of various tissues. The intestine seemed to be particularly sensitive to hypoperfusion-reperfusion injury, as diamine oxidase activity of the ileum was lowered and translocation of bacteria occurred, indicating failure of intestinal mucosal barrier function. Concomitant determinations of plasma endotoxin (LPS) and tumor necrosis factor alpha (TNFa) levels showed significant elevation, especially in patients who finally developed MSOF. The data suggested that intestinally derived bacteria and/or LPS exacerbate the systemic responses initiated by ischemia reperfusion injury and the presence of large amounts of devitalized tissue. Early diagnosis is important in order to improve the prognosis. However, current criteria of diagnosis for MSOF do not conduce to an early diagnosis, as they only describe the end stage manifestations, while our therapeutic strategy should be directed against different levels of initiators, systemic mediators, and effectors of injury. Therefore, it is important to emphasize the role of septic responses in the development of the syndrome. We propose that the name of the syndrome be changed to "sepsis with organ dysfunction" or "mediator injury of organs".

115 children with burn injuries were admitted to the Children's Hospital of Chongqing Medical University. Of the 1554 samples, 276 strains of staphylococcus aureus were isolated from the burn wounds and other sites. The rate of burn wound infection caused by S. aureus was 25.2% (29/115). The 54 epidemic strains of S. aureus all carried 1.6 and 1.9 Md plasmid DNAs belonging to phage type 618, and were resistant to at least 10 antimicrobial agents, including oxacillin, cephalothin and cephaloridine, but sensitive to tobramycin and amikacin. Identical plasmid profiles and phage types of isolated S. aureus indicated that a patient carrying a multi-resistant strain of S. aureus in his anterior nares caused an epidemic of S. aureus wound infection in 13 patients. S. aureus isolated from burn wounds of 8 cases were derived from the contaminated hands of their family members.

Using 20% DMSO and 6% propylene glycol in Kreb' Ringer phosphate solution as cryopotective agent for homograft vitrification storage, the viability of stored homograft (79.2%) was higher than that of slow cooling storage (59.7%). About 540000 cm2 of vitrified homograft were used to cover the wounds after excision of burn eschar in 135 patients with major burns. The take-rate was over 94%. The cryopreservation of skin by vitrification can improve the viability and quality of skin and save time and cost.

Selective ablation of slow pathway by radiofrequency (RF) current in 34 patients with atrioventricular (AV) node pathways and tachycardia was performed with two methods in our section; posterior approach was used in the first 12 patients, the slow pathways were ablated successfully. Inferior approach was performed in the other 22 patients. Slow pathways were interrupted in 14 patients. Retrograde fast pathways and/or slow pathways were ablated in 6 patients. Retrograde fast pathways and slow pathways were abolished and antegrade fast pathways were injured transitorily in 2 cases. The total procedure time was shorter, RF applications were fewer by inferior approach than by posterior approach (P<0.05). Both antegrade and retrograde conduction of fast pathways had not been affected after slow pathways were ablated (P>0.05). After a mean of 8 months follow-up, two patients recurred and were ablated successfully again. We come to the conclusion that inferior approach might be a preferable method compared with posterior approach; the slow pathways is the compact node and its posterior input of transitional cells; the retrograde fast pathway may be the anterior superficial group of transitional cells and is not always in the same location of antegrade fast pathway.

Intracerebral co-grafting of Schwann's cells and human fetal adrenal medullary tissue was performed in 10 patients with Parkinson's disease. One to six months after grafting, symptoms were improved significantly for 1 to 3 grade. Among them, 2 patients resumed nearly normal daily activities. Long-term follow-up showed that the symptoms were not improved satisfactorily in some patients. It is considered that careful selection of patients, administration of amantadine, and co-grafting of Schwann's cells which prompts the survival of chromaffin cells are essential to better results.

C-erbB-2(HER-2/neu) proto-oncogene is mainly expressed in epithelial tissue and activated due to its amplification. Amplification of the C-erbB-2 proto-oncogene has been associated with poor prognosis in human ovarian cancer. Our study was to examine whether amplification is more frequently observed in ovarian cancer, or it is associated with poor prognosis of human ovarian cancer in China. The DNA of ovarian cancers was extracted and consequently digested with restriction endonuclease EcoRI, electrophoresed in 0.8% agarose gels and blotted onto nitrocellulose filter with Southern transferring method. It was then hybridized with a 32P-labelled C-erbB-2 probe and subsequently underwent autoradiography. The result has shown that the C-erbB-2(HER-2/neu) gene was amplified in 8 of 26 human ovarian cancers (30.8%). The clinical data showed that all of the 8 cases with the amplified C-erbB-2 were in their advanced stage (III-IV). Five of the patients died from 2 to 4 months after operation. These data suggest that amplification of the C-erbB-2 gene may play a role in the pathogenesis of ovarian carcinoma; it is frequently observed in advanced ovarian cancer and is associated with poor prognosis for these patients.

C/EBP is a sequence-specific DNA-binding protein. In order to identify its distribution and localization, immunohistochemical technique (ABC method) was done using anti-C/EBP polypeptide antibodies 1103#, 425# in liver specimens from 20 normal adults, 5 neonates, 6 patients with hepatitis, 25 with liver cirrhosis, 80 with hepatocellular carcinoma (40 cases were associated with surrounding nontumorous tissues) and 26 patients with cholangiocarcinoma (15 cases were associated with surrounding nontumorous tissues). The results showed that C/EBP was diffusely distributed in nuclei and cytoplasm of differentiated liver cells and very low or undetectable in liver cancer cells. The manifestation of C/EBP correlated with degree of differentiation of tumour cells, and was obviously weaker than that in surrounding nontumorous tissues. C/EBP positive staining has also been found in regenerating epithelial cells of bile ductules. The results suggested that C/EBP should play an important role in establishing and maintaining the differentiation of liver cells.

The effect of parathyroid hormone (PTH) (0.01 nM-10 nM) and 17 β-estradiol (E2, 1 nmol-10 nM) alone or in combination on 3H-thymidine incorporation, alkaline phosphatase and adenylate cyclase activities were investigated in human fetal osteoblasts using serum-free monolayer primary cultures. The results showed that PTH inhibited cell proliferation while E2 promoted it. On alkaline phosphatase activity, PTH showed a complex results while E2 were slightly inhibitory. PHT-E2 combination suggested that E2 could alter the effect of PTH alone, also potentiated the anabolic and antagonize the catabolic effects of PTH on bone formation.

In 18 consecutive patients receiving the transjugular intrahepatic portosystemic stent shunts (TIPSS), 15 were male and 3 female. The patients aged from 34 to 66 years had liver cirrhosis with portal hypertension and esophageal varices. Twelve had recurrent bleedings from raptured gastroesophageal varices. Shunts were established in 16 of the 18 patients and no operative death was noted. Portal vein pressure was reduced from 3.98±0.24 kPa before shunting to 2.40±0.16 kPa after shunting. Doppler ultrasound examination revealed that the maximum blood flow velocity in the main portal vein increased from 14.0±4.5 cm/sec to 48.0±16.5 cm/sec. The mean follow-up time in the successful cases was 4.5 months (range 2-8 months). The shunt patency was determined with color Doppler ultrasound in 15 patients: occlusion in one and no accites in 4. Varices disappeared in 8 patients and became less evident in 7. No patients had recurrence of varices bleeding or encephalopathy during follow-up. The results suggest that TIPSS is a safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that portal vein puncture is largely dependent on understanding the three-dimensional relationships between hepatic and portal veins. To achieve an adequate portal decompression, we recommend that a stent of 12 mm in diameter be used in severe cases.