1996年 · 第109卷第05期

OBJECTIVE To evaluate the role of combination chemotherapy and the optimal cycles of treatment in improving the prognosis of ovarian endodermal sinus tumor, and to study the relationship between the type of surgical management and the outcome of the disease. PATIENTS AND METHODS Sixty-three patients with ovarian endodermal sinus tumor were divided into 3 groups according to the postoperative chemotherapy they had received. Group 1 (37 patients) patients were treated with at least 6 cycles of VAC (vincristine, actinomycin-D and cytoxan) or 4 cycles of PVB (cysplatin, vincristine and bleomycin). Group 2 (17 patients) patients were treated with VAC in less than 6 cycles or PVB in less than 4 cycles. Group 3 (9 patients) patients received no VAC or PVB but some other drugs like TSPA, 5FU, MTX and cytoxan in various combinations. The sustained remission rates and survivals were compared among these 3 groups. For patients with full courses of treatment with VAC or PVB (Group 1), different types of surgical management were studied about their relationship with the outcome of the disease. RESULTS The persistent remission rates are 81.8%, 23.5% and 11.8% for group 1, group 2 and group 3 patients respectively (P<0.001). The survival curve of group 1 is very much different from that of group 2 and group 3 patients. With full courses of chemotherapy with VAC or PVB, it appears that the different types of surgical managements (unilateral vs bilateral adenectomy; with vs without systemic lymphadenectomy; residual tumor<2 cm vs>2 cm) did not show definite relationship with the outcome of the disease. CONCLUSIONS Combination chemotherapy with VAC or PVB dramatically improved the prognosis of ovarian endodermal sinus tumor but it should be emphasized that the favorable results could be obtained only when the treatment is given on time and in optimal cycles. Although ovarian endodermal sinus tumor is chemosensitive, appropriate surgical treatment is still important, however, the surgical techniques need some further studies.

OBJECTIVE To investigate the effect of carboplatin based combination chemotherapeutic regimen given intraperitoneally and intravenously on ovarian epithelial cancer. MATERIALS AND METHODS Carboplatin based combination chemotherapy was given intraperitoneally and intravenously to 48 patients with epithelial ovarian cancer. Of them, 10 cases with ascites had received no treatment before, and 38 patients had undergone cytoreductive surgery prior to the study. RESULTS The results of this study showed that carboplatin based combination chemotherapy could not only reduce the tumor mass but also decrease the amount of ascites (P<0.05) in patients with ascites. The response rate was 80% (clinical complete response rate was 10%) in untreated patients with ascites. The 3-year survival rate of patients with ovarian epithelial cancer was 92.3% in stage I, and 30% in stage III patients after the cytoreductive surgery. Tumor recurrence occurred during the course of chemotherapy in 15% of stage I patients and 53.3% of stage III patients. CONCLUSION Carboplatin based combination chemotherapy given intraperitoneally and intravenously has potent effect on untreated ovarian cancer with ascites. But carboplatin based chemotherapy could not overcome the problem of drug resistance. To improve the prognosis of ovarian cancer, much more researches on the mechanisms of drug resistance need to be carried out.

OBJECTIVE To explore the mechanism of cisplatin resistance and its reversion in human ovarian cancer. METHODS A cisplatin resistant cell subline of SKOV3, SKOV3/cp, was established, and a xenograft mice model of human ovarian cancer was established by microencapsulation technology. Various biochemical changes and the effects of modulators on the resistance in the model were observed. RESULTS The intracellular platinum accumulation. Pt-DNA adducts and interstrand cross links of DNA (ISC) in SKOV3 was 5.1, 2.4 and 4.8 times respectively of those in SKOV3/cp cell line. Amphotericin B (AmB) and Novobiocin (NVB) could raise platinum accumulation and Pt-DNA adducts concentration in SKOV3/cp and this resulted in reversion of cisplatin resistance. CONCLUSIONS The primary factors resulting in SKOV3/cp resistance to cisplatin are the reduction of intracellular drugs and the augmentation of the ability to remove Pt-DNA adducts. AmB and NVB can reverse cisplatin resistance in SKOV3/cp cells.

OBJECTIVE To explore the therapeutic effect of three drugs, i.e., hydroxyprogesterone caproate (HPC), Tamoxifen (TMX) and Aminoglutethimide (AG), in the treatment of endometrial carcinoma. METHODS The patients were collected by double-blind method and classified into 6 groups (3 groups used single drug and 3 groups used combined drugs) at random. The patient was given assigned drug therapy for 10 days according to her group after being admitted to the hospital. Operations were performed 7-10 days after drug therapy. Plasma FSH, LH, E2 and P were measured by standard radioimmunoassay of WHO. ER and PR in cancer tissues were examined by enzyme linked histochemistry. Cancer tissues obtained before and after drug therapy were examined pathologically. RESULTS The values of FSH, LH and E2 decreased and that of P increased after single drug therapy in the group treated with HPC; and the values of FSH, LH, E2 and P all decreased in the groups treated with TMX and AG respectively (P<0.05). The values of FSH, LH and E2 decreased to different extent in the groups treated with combined drugs. The changes of FSH and E2 are remarkable (P<0.05). The value of P increased a little with no statistical difference (P>0.05). PR and ER usually increased after treatment with TMX, but decreased with HPC or AG, or combined drugs. The pathological changes indicate that the tumors responded to all of the three drugs. The response to TMX was most significant, following which was HPC. CONCLUSIONS HPC and TMX are two drugs proved to be useful in endometrial carcinoma. AG also can be used to treat endometrial carcinoma. It adds a new drug to the drug therapy for endometrial carcinoma.

OBJECTIVE To develop a possible alternative laboratory diagnostic method, an in situ polymerase chain reaction (ISPCR) for definitive diagnosis of human cytomegalovirus (HCMV) pneumonia in infants. METHODS The material involved in this study was formalin-fixed paraffin-embedded lung tissue specimens from 6 infants died of histopathologically diagnosed cytomegalic inclusion body pneumonia (CMIBP) and from 4 infants died of other diseases. When DNA extracts from the specimens of these 10 infants were tested by using a previously applied conventional PCR, the specimens from the 6 infants with CMIBP were positive for HCMV DNA, while those from the other 4 infants were negative. In the ISPCR, biotin-11-dUTP was used for labeling the amplified products and streptavidin, biotin-alkaline phosphatase for in situ color development. RESULTS The results of the study showed specific staining for HCMV DNA in the lung tissue slices from the 6 cases with CMIBP, while no staining was found in the specimens from the 4 infants who died of other diseases. The control ISPCR tests on the HCMV DNA positive specimens without adding either biotin-11-dUTP or Taq DNA polymerase or the primers for HCMV DNA showed negative results. The specific staining for HCMV DNA was seen in bronchial and alveolar epithelial cells, small vascular endothelial cells and leukocytes in the lumens of small blood vessels. CONCLUSIONS The results suggested that the ISPCR was able to demonstrate both presence of HCMV DNA in the lung tissues and active HCMV infection; therefore the ISPCR may be applicable in definitive diagnosis of HCMV pneumonia when proper specimens such as lung biopsy material or bronchoalveolar lavage is available for the test.

OBJECTIVE To evaluate the effects of carbon tetrachloride (CCl4) on the expressions of both intracellular proteins and extracellular matrix and the protective role of taurine. METHODS Forty Sprague-Dawley rats were divided into five groups: 1.5% taurine, CCl4, CCl4 + 0.5% taurine, CCl4 + 1.5% taurine and control. CCl4 was given ig at a dose of 500 mg/kg body weight, twice a week for 5 weeks. The taurine solution or tap water was given to the rats for drinking. The sections (4 μm) of rat liver were stained with haematoxylin and eosin, immunohistochemistry or colloid silver methods. RESULTS The animals treated with 1.5% taurine and control had normal liver structures. Light microscopic examination of sections of the liver taken 5 weeks after dosing of CCl4 showed hydropic degeneration of hepatocytes around the central veins and lipid vacuolation in mid-zonal and some periportal hepatocytes. Necrotic cells and neutrophil infiltration around most central veins as well as hepatocytes showing various stages of mitosis indicative of regeneration were observed. These histopathological changes in the animals treated with CCl4 alone showed more extensive and severe lesions than those seen in the animals treated with CCl4 plus taurines. The incidences of PCNA and p53 antigen positive hepatocytes, and the numbers of nuclear apoptotic bodies and AgNORs granules were markedly higher in the CCl4-treated animals than in those protected with taurine. Declined and unevenly distributed expressions of LN and FN were seen in the CCl4 treated rats. CONCLUSIONS Both the damage of hepatocellular DNA and the abnormal expressions of hepatic extracellular matrix were observed in the CCl4-treated rats. Taurine, in this study, not only inhibited hepatocellular degeneration, necrosis and DNA damage, but also inhibited the lesion of extracellular matrix induced by CCl4.

OBJECTIVE To observe the effect of granulocyte-colony stimulating factor (G-CSF) on differentiation and proliferation of CD34+ cells from peripheral blood in presence of recombinant hematopoietic growth factor (HGF). METHODS Peripheral blood mononuclear cells mobilized by G-CSF were obtained from patients suffering from carcinoma, preparing for autologous bone marrow transplantation. CD34+ cells were isolated by derivatized polystyrene tissue culture flask which had covalently immobilized soybean agglutinin lectin and was coated with anti-CD34 antibody; and this kind of cells were incubated in liquid culture medium for up to 28 days under the stimulation of combination of growth factors, i.e., stem cell factor (SCF) and interleukin-3 (IL-3) with or without G-CSF. The changes of nucleated cells, colony forming unit-granulocyte and monocyte (CFU-GM), burst forming unit-erythrocyte (BFU-E), colony forming unit-megakaryocyte (CFU-MK), and myeloid-associated markers were evaluated. RESULTS An increase of nucleated cells (mean 640-fold increase) occurred during culture CFU-GM production is parallel to the nucleated cell production until the 11th day (mean 82-fold increase) in combination of 3 HGF, i.e., G-CSF, IL-3 and SCF. A large number of cells expressing late myeloid markers appeared on the 11th day in suspension culture of CD34+ cells. CONCLUSIONS G-CSF was found to synergize with IL-3 and SCF in inducing rapid proliferation of purified CD34+ cells and differentiation to multiple myeloid lineages. The stroma-free, cytokine-driven culture system could achieve a degree of amplification of colony forming cells, suggesting the feasibility of culture of hematopoietic progenitor cells in vitro as an adjunct to hematopoietic stem cell transplantation.

OBJECTIVE To assess coronary flow reserve using a computer-assisted method with intracoronary papaverine in patients with angina pectoris. METHODS Coronary arterial diameter, cross-sectional area and blood flow velocity were measured during coronary arteriography before and after intracoronary papaverine in 26 control subjects, 45 patients with significant coronary artery disease (>50% luminal narrowing), 16 patients with syndrome X and 14 patients with hypertension and left ventricular hypertrophy (LVH). RESULTS After intracoronary administration of papaverine, proximal diameter, cross-sectional area, blood velocity, flow volume and reserve capacity of both left anterior descending and right coronary arteries were lower in patients with significant coronary stenosis than in the controls. Despite similar changes in diameter and cross-sectional area, the blood velocity, flow volume and reserve capacity of the two vessels were also lower in patients with syndrome X than in the controls. In 14 patients with hypertension and LVH, although the blood velocity and flow volume were augmented for the two arteries and did not differ from those in the controls, the flow reserve was reduced because of higher baseline blood velocity and flow volume. CONCLUSIONS Coronary flow reserve is reduced in patients with coronary artery disease, syndrome X or hypertensive LVH, which may be related to abnormal changes at different levels of the coronary vasculature or resting flow states.

OBJECTIVE To evaluate the feasibility and accuracy of exercise echocardiography (Ex-Echo) for the diagnosis of coronary artery disease (CAD) based on coronary angiography (CA). METHODS Forty-seven patients were found to have CAD and examined by upright exercise electrocardiography (Ex-ECG) on a treadmill within two weeks of CA. Before and immediately after exercise, the patients lay on a bed beside the treadmill in the left lateral position and parasternal long and short axis and apical two and four chamber views of the heart were acquired. Pre- and post-echocardiograms were analysed in a side-by-side multiple screen format on the imaging view and hypodynamic wall motion of the left ventricle after exercise was defined as Ex-Echo positive. The sensitivity, specificity and predictive accuracy of Ex-Echo and Ex-ECG were calculated on the basis of CA data. RESULTS Satisfactory echocardiograms were recorded in 46 patients after exercise. The success rate was 97.8%. Compared with Ex-ECG, Ex-Echo was more sensitive (87.5% vs 62.5%, P<0.05), specific (92.8% vs 60.0%, P<0.05) and accurate (89.4% vs 61.7%, P<0.01). The concord of determining the number of diseased vessels between coronary angiography and Ex-Echo was 90.9% in single vessel disease and 45.0% in multiple vessel disease. Wall motion scoring index, however, was higher in multiple than in single vessel CAD. CONCLUSIONS Ex-Echo test is feasible and accurate in detecting CAD and wall motion scoring index is probably useful in distinguishing multiple from single vessel CAD.

OBJECTIVE To obtain etiologic and epidemiologic information about bacterial meningitis, especially the H influenza type B (Hib), from a medium-sized city, Hefei, China. METHODS Data were collected prospectively over 3 years, from 1990 to 1992 by a well-organized group including 13 hospitals. All children with a clinical diagnosis of acute bacterial meningitis were enrolled and the specimens were taken for the etiologic studies. CSF and blood were tested by standard bacteriologic technique. CSF, blood and concentrated urine were tested directly for detection of antigen by countercurrent immuno-electrophoresis (CIE). Data were analyzed by epidemiologic methods. RESULTS Bacterial culture and CSF Gram's staining were positive only in 13.3% and 11.7%, respectively. Bacterial antigen detection was positive in up to 90% by CIE which was more sensitive than bacterial culture (χ2=67.7, P<0.005). The annual incidence of acute bacterial meningitis in the city is calculated as 9.3 cases/100,000 children from 1 month to 15 years of age and 19.2 cases/100,000 children from 1 month to 5 years of age. Hib meningitis accounted for 51.7%, N. meningitis (Nm) for 38.3%, and S. pneumoniae (Sp) for 8.3%. There was no significant seasonal variation. Of the patients, 76.7% were children under 5 years of age, and 51.7% under 1 year of age. The case fatality rate was 11.7% for all bacterial meningitis, 9.7% for Hib, 17.4% for Nm and 20% for Sp. A total of 22.6% of survivors suffered from neurological or psychological problems. CONCLUSIONS Using antigen detection combined with bacterial culture, we could make an etiologic diagnosis in up to 90% of the patients in this group. Hib, Nm and Sp were the predominant pathogens, which was similar to the findings in other countries. Hib was the most common cause of bacterial meningitis, but the incidence was much lower than in most parts of the world.

Ovarian carcinoma is the leading cause of death from gynecological malignancies. Its management should be a combination of surgical procedures and chenmotherapy, otherwise it will not be a full treatment. So chemotherapy of ovarian carcinoma plays the same important role as the tumor debulking surgery does.