1995年 · 第108卷第03期

Twenty patients undergoing open-heart valve replacement were divided randomly into two groups in this study; intermittent perfusion of cold crystalloid (St. Thomas Hospital solution) with hypothermic cardiopulmonary bypass (CPB) (hypothermic group) and continuous administration of warm blood cardioplegia with normothermic CPB (normothermic group) respectively. Tissue samples were taken from the right atrium before weaning from CPB and from the right appendage 30 minutes after removal of the cross-clamp. The results of pathological study in these two groups were as follows: the structural alterations were most severe during the ischemic period in the hypothermic group. Damages of the myocardial mitochondria examined with transmission electron microscope were found more severe in the hypothermic group than in the normothermic group, and in the reperfusion period than in the ischemic period. Loss of integrity of the mitochondrial membrane could be noted during reperfusion in the hypothermic group. The surface to volume ratios of mitochondria of each period of the two groups were calculated by computerizing the microphotographs of the myocardium. It was shown that the average of the surface to volume ratios was smallest in the reperfusion period in the normothermic group. It seemed that the volumes of the mitochondria were larger in the warm group than in the cold one. Probably the results were due to more severe damages of the mitochondrial membranes in the hypothermic group, which led to the release of the contents out of the mitochondria while in the normothermic group, the sodium-pump was disordered and it made the mitochondria swell. Pathologically, blood cardioplegic perfusion with the use of normothermic CPB is a feasible method for myocardial protection in open-heart surgery.

The effect of sublingual administration and intravenous drip of nitroglycerin (SLNTG and IVNTG) on left ventricular volumes (LVVs) were studied and systolic function was quantitatively assessed with two-dimensional echocardiography (2DE) in 28 patients with myocardial infarction (MI), including 13 cases without heart failure (MI-NHF) in one group and 15 with heart failure (MI-HF) in another. The results showed that after SLNTG and IVNTG in both groups the heart rate (HR) increased significantly (P<0.05-0.001); the systolic blood pressure (SBP) decreased significantly (P<0.05-0.001); the diastolic blood pressure (DBP) was not significantly changed (all P>0.05); the left ventricular end-diastolic and end-systolic volumes (EDV and ESV) both significantly reduced [EDV: decreased by 5.8-11.6% (-13.2-19.0 ml), P<0.05-0.001; ESV: decreased by 9.6-16.6% (-8.6-17.3 ml), P<0.05-0.001)]; the left ventricular ejection fraction (LVEF) all significantly elevated (increased by 6.6%-9.4% (3.2%-3.4%), P<0.05-0.001] except in MI-NHF group after IVNTG; the segmental EF of normal and hypokinetic segments also significantly increased (P<0.05-0.001). The results suggest that NTG could beneficially reduce left ventricular EDV and ESV; and improve or strengthen its global and segmental systolic function in MI patients, particularly noticeable in patients with heart failure.

Five cases of endolymphatic stromal myosis (ELSM) were studied using histological, histochemical and immunohistochemical methods. ELSM is a well-differentiated tumor resembling the normal endometrial stoma, with a low mitotic activity. So ELSM is considered as a kind of potentially malignant tumor different from endometrial stomal sarcoma and benign stromal nodules as well, though it can metastasize to the outside of uterus. ELSM may be derived from the stem cells that are normally present in the stroma of uterus, and can manifest multidifferentiation.

The authors report the results of long-term follow-up after thymectomy on 92 cases with myasthenia gravis (MG), including 22 cases of thymomatous MG. These patients were followed up for 6-73 months with an average of 23 months. The surgically effective rate was 88.0% and the late mortality, 6.5%. The sex of the patients and the durations of disease were not obviously related to the prognosis, however the effect of thymectomy was much better in patients aged 10-39 years than in other age groups. The modified Osserman's clinical classification, acetylcholine receptor (AchR) antibodies and citric acid extract (CAE) antibodies titers in plasma and pathological patterns of the surgical specimens of thymus including immunohistochemical observation play an important role among various factors related to the long-term effects.

Urinary and serum pseudouridine concentrations were determined by high-performance liquid chromatography in 80 patients with primary liver cancer, 32 with benign space occupying lesions of the liver, 42 with liver cirrhosis and 40 healthy subjects. Their mean urinary and serum pseudouridine levels were 39.2±11.5 nmol/μmol creatinine and 3.4±1.3 μmol/L, 24.5±5.4 nmol/μmol creatinine and 2.5±0.5 μmol/L, 22.8±7.8 nmol/μmol creatinine and 2.3±0.4 μmol/L, 26.4±4.6 nmol/μmol creatinine and 2.3±0.4 μmol/L, respectively. Exceeding the mean plus 2SD of pseudouridine of healthy control was considered as positive value for the diagnosis of primary liver cancer. Thus the positivity of urinary and serum pseudouridine in hepatoma was 71.3% and 70.0%, respectively. The positive rate of combined pseudouridine and alpha-fetoprotein assay was 91.3% in patients with hepatoma. Besides, pseudouridine levels could elevate before positive localization and reduce to normal levels after tumor resection. The results showed that the determination of pseudouridine is of clinical significance in the diagnosis and monitoring of primary liver cancer.

Acute interruption of arterial blood flow to the extremities is often associated with significant morbidity and mortality. Broad-spectrum mitogenic and non-mitogenic activities of FGFs inspired us to study its protecting effects on tissue injuries in ischemia reperfusion condition. We found that systemic administration of aFGF after reperfusion onset prevented severe skeletal muscle injuries. In rats treated with aFGF, the tissue edema was reduced significantly, the tissue viability was increased, and the muscle fibers contained more succinate dehydrogenase (SDH) and adenosine triphosphatase (ATPase). The pathological results supported the concept of improved prevention with aFGF treatment. The possible tissue protection by aFGF may come from its ability to regulate the concentration of extra- and intracellular calcium ion. Besides, it may moderate other Ca2+ dependent enzyme conversion processes. Also, it may take part in the vascular tone regulation under ischemia and reperfusion conditions. These results suggest further study of tissue ischemia prevention with FGF and its possible mechanisms in the future.

It is difficult to make a precise diagnosis of intestinal tuberculosis and to differentiate it from Crohn's disease. For evaluating Polymerase Chain Reaction (PCR) assay in these two aspects, 36 specimens of intestinal tuberculosis from surgical resections and endoscopic biopsies and 26 Crohn's disease samples were subjected to PCR assay. 21 specimens of normal colon tissue surrounding cancer were used as the control. Oligonucleotides derived from the IS 6110 sequence, which is repeated in M. tuberculosis chromosome and highly specific for the M. tuberculosis complex, were used as a primer. The amplified PCR products were detected by examination of ethidium-bromide-stained polyacrylamide gels. The specificity of PCR products was confirmed by digestion with Sal I restrictive endonuclease and southern blot hybridization using digoxigenin-labeled probe. The results showed that the M. tuberculosis DNA was identified in 27/36 intestinal tuberculosis, but none of 26 Crohn's disease. Acid fast bacilli were only found in 16/36 intestinal tuberculosis. In conclusion, as a rapid, sensitive, and specific pathogenic method in diagnosis of intestinal tuberculosis, PCR assay has been developed in this study, and is considered valuable in the differentiation between intestinal tuberculosis and Crohn's disease.

Neuron-specific enolase (NSE) levels of cerebrospinal fluid (CSF) were measured in 39 patients with ischemic stroke and 15 controls. There was a significant increase of CSF NSE in acute ischemic stroke patients as compared with the controls. The altered CSF NSE levels correlated well with the infarct size in CT scan. The CSF NSE levels were higher in 6-multiinfarct dementia (MID) patients who were diagnosed after 6-month follow-up than those in 22 non-MID patients of this series. Our research supports the view that CSF NSE can be a useful biochemical marker for brain ischemia. The importance of CSF NSE in the study of dementia related to ischemic stroke is worth further studies.

Oral and maxillofacial tumor (OMT) constitute a great number in tumors of head and neck as a whole. The incidence of OMT in China is rather low, but, owing to our big population, the absolute number of the patients is high. The diagnosis and treatment of OMT in China with special emphasis on malignancies are briefly introduced below.

In recent years, great advances of otorhinolaryngology have been achieved in China, in the following three aspects chiefly.

Low density lipoprotein (LDL) receptor is a cell surface glycoprotein that regulates plasma cholesterol by mediating endocytosis of LDL ans supplies cells with cholesterol. LDL receptor was first identified in 1973 by Goldstein and Brown, who won the Bobel Prize in 1985.

Rheumatic fever (RF) is considered to be an autoimmune disease that is a delayed response to pharyngeal infection by beta-hemolytic Group A streptococcus (GSA). One of the severe complications is carditis. A significant decline in the incidence of RF has been observed since the 1960s, so that in the early 80s some of the experts in developed countries declared that this disease was vanishing.