1995年 · 第108卷第10期

In recent years, neurosurgery in China is developing repidly along with the advancement of medical equipment and microsurgery and interventional neuroradiology. The high lights are summarized below.

Recent progress in the studies of anticancer drugs originating from plants in China is reviewed in this paper. Guided by the experience of traditional Chinese medicine (TCM), several new anticancer drugs have been found.

Chinese oncologists have made great progress on the prevention and treatment of tumor with the combined traditional Chinese medicine (TCM) and Western Medicine (WM). Combining TCM with WM features the cancer research and control in China and has obtained world attention.

Forty cases of Guillain-Barre Syndrome were reported, (GBS) which came from the regions where "Chinese Paralytic Syndrome" and "Acute Motor Axonal Neuropathy (AMAN)" were presented before. A study on their clinical, electrophysiological and pathological features was conducted, records on 3,733 GBS cases reported in northern China from 1978 to 1992 were reviewed and compared with cases of "acute moter axonal nouropathy". The results showed that the clinical, electrophysiological and pathological features of GBS in north China are similar to those of typical GBS cases in western countries, though there seemed to be some special epidemiological features in age, seasonal and regional distribution. It was concluded that the GBS in northern China is demyelinating GBS dominantly, not a new entity.

An NcoI restriction fragment length polymorphism in the first intron of the lymphotoxin α gene was investigated in 35 patients with Crohn's disease, 40 patients with ulcerative colitis, and 30 unrelated healthy controls, all of Dutch origin. The results showed that no significant differences existed in the genotype frequencies of the NcoI polymorphism in the first intron of the LTα gene between ulcerative colitis patients or Crohn's disease patients and the healthy controls. The study indicates that the NcoI polymorphism in the LTα gene can not be used as a genetic marker for the predisposition to inflammatory bowel diseases. However, since this polymorphism may control the production of tumor necrosis factor, study of this and other related tumor necrosis factor gene polymorphisms may be used as markers to identify patient subgroups and to define patient heterogeneity. Further studies are being carried out on other polymorphisms and on the relevance of LTα and TNFα haplotypes.

In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA). The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42±0.08 versus 0.78±0.16, P<0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51±1.42 mm2 versus 1.63±1.20 mm2, P<0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3±8.07% versus 21.80±16.84% P<0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.

The results of 31 cases of sutureless esophagogastrostomy by intraluminal elastic circular ligation (IECL) with the biodegradable supporting tube were reported. The fate of the supporting tube could be tracked satisfactorily by X-ray. The tube-dislodge time was 15.03±2.23 days and unaffected by the size of supporting tube or the site of anastomosis. The supporting tube could be safely absorbed or partially discharged through the alimentary tract. IECL, with the merits of saving time, anastomosing tightly and leaving no suture materials in the anastomotic site, can be expected to further reduce the incidence of anastomotic leakage and provide references for other gastrointestinal anastomosis.

From January 1970 to June 1992, 141 patients with superficial esophageal and cardiac carcinomas (SEC and SCC) underwent surgical treatment. Of the 141 patients 128(90.8%) had slight symptoms related to swallowing, and the remaining 13(9.2%) were asymptomatic. Balloon cytology and esophagoscopy proved very useful for the diagnosis of SEC and SCC, and Lugol's solution staining technique was an effective auxiliary diagnostic measure. Lymph node metastasis was not found in patients with epithelial (EP) cancer. However, it was present in one (2.9%) of 34 patients with muscularis mucosal (MM) invasion, and in 5 (8.6%) of 58 patients with submucosal (SM) cancer. The 5-year survival rates of the patients with SEC and SCC were 75.5% and 71.4%, respectively (P>0.05). The different depth of tumor invasion including EP, MM and SM cancers showed significant differences in the 5-year survival rate (P<0.05). Although the prognosis for the patients with lymph node metastasis is poor, we should advocate extended lymph node dissection in surgical treatment of the patients in whom MM and SM cancers are suspected.

By using image analysis technique with 6 normal synovial tissue specimens as controls, nuclear DNA content and morphological parameters in specimens from 51 synovial sarcomas and 15 synovioma were examined quantitatively. The DNA content in synovial sarcoma and synovioma was significantly different (P<0.01), and that of synovioma and normal synovial tissue was also different (P<0.05). Morphological parameters including nuclear areas and perimeters differed significantly among the above three groups (P<0.01). There was no correlation between the DNA content of synovial sarcoma and its histologic type (P>0.05), but the DNA content greatly differed between its higher and lower differentiated grade in each type (P<0.01). The DNA content in synovial sarcoma IIA stage, according to Enneking's staging system was lower than that in IIB, IIIA and IIIB (P<0.05). The 5-year survival rate of synovial sarcoma with diploid/nearly diploid (D/ND) pattern was higher than that of aneuploid (AN) pattern (P=0.028). The study suggests that analysis of the DNA content and morphological parameters of tumor cells is helpful in the diagnosis and pathologic grading of synovial sarcoma. It also provides a guide to clinical operation and estimation of the prognosis. Although synovioma is usually a well-differentiated and benign lesion, this investigation also suggested that increased DNA content may be an indication of poor prognosis for this neoplasm.

Monoclonal antibody-drug conjugate was applied in a clinical trial for patients with bladder cancer. Monoclonal antibody HB7A from a mouse splenocyte immunized against human bladder cancer was used as a drug carrier. The anti-cancer drug adriamycin (ADR) was bound to HB7A through a dextran (DEX) bridge to form the conjugate HB7A-DEX-ADR. The in vitro cytotoxic effect of the conjugate on BIU-87 bladder cancer cells was similar to that of free ADR and the mixture of HB7A and ADR. Seven patients with bladder cancer were given HB7A-DEX-ADR intravenously. The immunoperoxidase studies of the resected specimens showed that HB7A was localized specifically in cancer, and histological studies revealed degenerative and necrotic changes of the tumor cells. Patients receiving the conjugate did not experience serious side effects. This study suggests that immunotargeting chemotherapy with HB7A-DEX-ADR is well tolerated by patients and its cytotoxicity on tumor is substantial.

The use of two urethral stents woven from titanium nickel alloy (TiNi) in the form of a tubular mesh or a spiral stent (both made in China) is described. They were implanted in 62 patients with prostatic outflow obstruction. All patients were considered contraindicated for surgery. They were divided into a spiral stent group (group 1) treated between March 1992 and May 1993, comprising 35 cases, and a tubular mesh group (group 2) treated between October 1993 and December 1994, comprising 31 cases, including four failures in group 1. Thirty-three out of the 35 patients in group 1 were treated successfully. Good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%), giving a total effective rate of 91.3%, with a follow-up of 11 to 27 months. Fourteen stents were removed within 6 months after the insertion and six more were removed within 12 months. The mean effective time of the stent in situ was 10.8 months. All 31 cases in the mesh group were treated successfully. Dramatically good effects were obtained in 28 cases (over 90%) and distinct improvements were achieved in two, giving a total effective rate of over 96.5%, with a follow-up of 6 to 14 months (mean 10.5 months). Cystoscopy was carried out in 12 patients after 6 months following the insertion. The major part of the meshes became covered by urothelium. Compared with the spiral, the mesh makes it possible to insert a prosthesis with a larger diameter and anti-pressure. The spiral, however, can be used as a temporary alternative for the relief of prostatic obstruction. A tubular mesh can work well for the relief of prostatic obstruction and remain in situ without causing major problems for at least 1 year.

The following general status concerning nation-wide health institutions, hospital beds, personnel and hospital work as well as causes of diseases and death is briefly reported according to the Information Centre of Health Statistics of the Ministry of Public Health of China.