1996年 · 第109卷第06期

OBJECTIVE To develop an alternative approach in conjunction with microwave-induced hyperthermia. PATIENTS AND METHODS Thermotherapy with microwave intracorporeal irradiation was used to treat 73 patients with bone tumors. The series was composed of 58 patients with malignant tumors and 15 with benign tumors: most of tumors occurred about knee joints (53/73=72.6%). The surgical procedure included separating the tumor bearing segment from surrounding normal tissues with a safe margin, cooling the normal tissues including the neurovascular bundle and the intraarticular structures with a water circulation system, while heating the tumor with the antenna array of a microwave system and providing an adequate soft-tissue cover for the dead bone. Postoperatively, an immune therapy regimen was carried out regularly. The patients' immunologic functions were monitored by assay of the subpopulation of T cells, IL-2 and sIL-2 R (soluble IL-2 receptor). RESULTS Follow-up varied from 3 to 38 months (mean 19 months). Excluding 3 patients with malignancy in the vertebrae treated for palliation, 70 were evaluated according to oncological and orthopedic criteria. Five patients had local recurrence and required amputation. The remaining 65 had excellent local control. In 6 of the 55 patients with malignancy of the extremities, lung metastasis occurred one to two years after surgery. The oncological results were similar to those obtained by other limb-saving procedures. Pathological fracture occurred at devitalized bone in 5 patients. In 72.5% of the patients (29 of 40 tumor-free cases followed more than one year), knee joints functioned well, being stable and painless with almost full range of motion. Single photon emission computered tomography (SPECT) for 16 patients revealed revascularization of the devitalized tumor bearing bone segment could accomplish in one year or more. The immune states were improved in various extends after thermotherapy plus immunotherapy in the majority of patients. CONCLUSIONS These results show that the use of microwave hyperthermia and adjuvant immunotherapy in conjunction with the surgical treatment of bone tumors can be considered a definitive procedure, which is safe and well-tolerated. The oncological and orthopedic results are encouraging.

OBJECTIVE To use intraoperative microwave heat for the treatment of tumor-bearing bone in situ for limb-salvage in primary malignant bone tumor. PATIENTS AND METHODS Twenty-five patients with malignant bone tumor received surgical protocol for limb-salvage by wide exposure and intraoperative microwave heat treatment of tumor bone in situ. The tumor was localized at distal femur in 16 patients, proximal tibia in 5, shaft of femur in 2, and illia in 2. RESULTS The pathological diagnosis revealed osteosarcoma in 16 patients, parosteal osteosarcoma in 4, chondrosarcoma in 3, and leiomyosarcoma in 2. The stage of tumor was classified into IIB in 16 patients, IIA in 6, and IIIB in 3. The operative technique was wide exposure for tumor in soft tissues, protecting the surrounding normal tissue from heat injury by copper mesh, and heating tumor-bearing bone at 50 degrees C for 15 minutes. The patients were followed up from 4 to 180 months (mean, 63 months). The survival rate of 2, 5 and 10 years was 81.3%, 70.4%, and 53.8% respectively. The functional results were less than 50% in 4 patients, between 50% and 75% in 9, and more than 75% in 12, referred to the normal function of a normal limb. The complications consisted of infection in 4 patients, pathological fracture in 4, and separation of epiphysis in 1. Oncological results showed that local recurrences of tumor were in 4 patients, and 6 patients suffered from distant metastasis. CONCLUSIONS The treatment is an alternative to replacement by prosthesis or allograft bridging techniques.

OBJECTIVE Based on the anatomical study and clinical trial of transposition of the flexor pollicis brevis muscle (M.f.p.b.) for the reconstruction of thumb opposition, we suggested a new method for the treatment of irreparable median nerve injury which causes paralysis of the opponens pollicis and the abductor pollicis brevis muscles (M.a.p.b) and leads to loss of thumb opposition. MATERIAL AND METHODS Anatomical study and biomechanic analysis were performed on 20 cadaveric hands and 8 patients who had been treated and followed up on an average for 12 months. RESULTS The M.f.p.b. overlaps the M.a.p.b. for about half of its width at the muscle origins and the overlapping reduced to about 1/3 of the width at the muscle belley level. The M.f.p.b. chiefly inserted on the palmar aspect of the base of proximal phalanx. The M.a.p.b. primarily was inserted on the radial side of the first metacarpophalangeal(MP) joint, and the M.f.p.b. was entirely innervated by the deep branch of the ulnar nerve. In an attempt to increase the angle between longitudinal force lines of these two muscles for 7°-9°, we transferred the insertion of the M.f.p.b. to the radial side of the MP joint, so that it gives this muscle the function of opposition. Eight patients were treated and followed up on an average for 12 months. All had fine functional results. CONCLUSIONS This method is effective, and least traumatic, and does not need transposition of another tendon.

OBJECTIVE To introduce the surgical technique and a new evaluation grading system and to report the results of the vascular iliac periosteal grafting for avascular necrosis of the femoral head. PATIENTS AND METHODS From 1983 to 1994, a new technique was used to treat 75 hips of 60 patients with avascular necrosis (AVN) of the femoral head using the vascular iliac periosteum with deep iliac circumflex artery and vein pedicle. 52 patients (66 hips) were followed up for 3-11 years and all patients were evaluated clinically and roentgenographically according to the new evaluation grading system for AVN by the Chinese Society for Osteonecrosis. RESULTS Preoperatively, the average AVN score was 57 pts., and all patients had significant pain and limp. Five hips were at Ficat/Arlet stage Ⅳ, 40 were at stage Ⅲ, and 21 were at stage Ⅱ. Postoperatively, the average AVN score was 83 pts., 47 hips were pain free, 13 had mild pain, and 6 had moderate pain. At the latest follow-up, according to the new evaluation grading system, 26 hips were graded as excellent, 32 hips as good, 5 hips as fair, and 3 hips as poor. CONCLUSIONS It is one of the better alternatives that can prevent the necrotic femoral head from progressing to collapse and promote revascularization and new bone formation by a direct mechanism, and it is suitable for the treatment of AVN of the stage Ⅰ to Ⅲ.

OBJECTIVE To clarify whether free radical, which may play a role in pigment gallstone formation, is present in pigment gallstones in vivo. MATERIALS AND METHODS Free radical signal of gallstones from 18 patients was detected by electron paramagnetic resonance spectroscopy at 77K under anaerobic condition and in air (control). As soon as the anaerobic determination was finished, the fresh anaerobic sample was exposed to air and stored in a freezer at -20℃. RESULTS Free radical signal (g=2.0038) was detected in fresh anaerobic samples containing more than 2% bilirubin compound, and the signal intensity correlated linearly with the content of calcium bilirubinate (r=+0.95, P<0.0005). During the storage at -20℃ and exposure to air, the signal intensity of each anaerobic sample and its control increased gradually, eventually reaching the same stable level. Fe(III) signal intensity was enhanced synchronously and related linearly with free radical signal (r=+0.99, P<0.0005). CONCLUSIONS Free radical exists originally in pigment gallstones in vivo, and it may play an important role in pigment gallstone formation. The free radical signal carried by gallstones may be strengthened by the action of oxygen in air on bilirubin. The transition metal ions probably take part in the formation of bilirubin free radical.

OBJECTIVE To determine if a relationship exists between the extent of iron-catalyzed injury and the degree of tissue iron overload during reperfusion. METHODS To selectively increase tissue iron only during early reperfusion, isolated, buffer perfused rabbit hearts were exposed to 20 μM Fe2+-100 μM ADP during the last 3 minutes of ischemia and the initial 4 minutes of reperfusion. Control groups were exposed to ADP and iron-ADP regimens that did not increase intracellular iron. All the hearts received 30 minutes of normothermic global ischemia and 30 minutes of reperfusion. Heart function was monitored continuously throughout each experiment. Tissue iron and biochemical markers were analyzed at the end of experiments. RESULTS Hemodynamic recovery was decreased and tissue lipid peroxide levels were increased in the 20 μM Fe2+-100 μM ADP group compared to controls. The recoveries of developed pressure and positive/negative dP/dT at 30 minutes of reperfusion were negatively correlated with tissue iron levels, while cytosol and membrane lipid peroxide levels correlated positively with the iron levels during reperfusion. CONCLUSIONS The extent of oxidative injury during reperfusion was directly related to the tissue iron burden present during reperfusion. Increased lipid peroxidation was the principal chemical marker of iron-catalyzed injury.

OBJECTIVE To investigate the exercise hemodynamic benefits of activity-sensing rate adaptive ventricular pacing (VVIR) over fixed rate pacing (VVI) mode. METHODS Activity sensing rate adaptive pacemaker was implanted in 19 patients (13 males and 6 females, mean age 54.8 years) with bradycardia. All patients underwent symptom-limited upright bicycle exercise in VVIR and VVI pacing modes in random order after implantation. With electrocardiogram monitor and M-mode echocardiography, heart rate, stroke volume and cardiac output were measured at rest and at each stage of exercise. RESULTS All patients were pacemaker dependent, without any spontaneous heart rhythm throughout this study. In the activity sensing ventricular pacing mode, all patients achieved a significant increase in exercise duration compared to fixed rate ventricular pacing mode (mean±s, 437±45 vs 323±23sec; P<0.01), with a mean maximum pacing rate of 113±23ppm. Although the cardiac output was significantly improved in both pacing modes (10.2±1.4L/min with VVIR and 7.5±1.1L/min with VVI), the maximum exercise cardiac output in VVIR was increased over VVI by 46% (P<0.05). Additionally, the stroke volume was significantly increased by 50% or more at rest in VVI mode, but was relatively maintained in VVIR mode (P>0.05). CONCLUSIONS Rate adaptive ventricular pacing can significantly improve the exercise capacity and cardiac output in patients with bradycardia. The increment of exercise cardiac output in VVIR mode is mainly dependent upon the pacing rate during exercise.

OBJECTIVE To examine the effect of selective head cooling (SHC) on brain cell membrane activity involving ATPase, phospholipase A2, content of total membrane phospholipids during postischemic reperfusion, so as to elucidate the possible underlying mechanism on resuscitating effect of SHC. MATERIALS AND METHODS Complete cerebral ischemia (CCI) was induced by the four-vessel model. 56 New Zealand rabbits were allocated randomly into two groups, non-ischemic control group had 30, 180 and 360 minutes reperfusion after CCI (n=8); and SHC group with the same ischemic-reperfusion insult were all treated with SHC (28 degrees C, surface cooling method). Changes of Na+, K+-ATPase, Ca2+, Mg2+-ATPase, phospholipase A2, total phospholipids of brain cell membrane were observed. Comparison of data between two groups was made by Students' t test. RESULTS Compared with non-ischemic controls following 30 minutes CCI, activities of Na+, K+-ATPase stepwisely decreased at 30, 180 and 360 minutes, Ca2+, Mg2+-ATPase dropped at 180 and 360 minutes, phospholipidase A2 increased markedly at 30, 180, 360 minutes, and total phospholipids decreased at 180 and 360 minutes reperfusion (P<0.01). Selective head cooling inhibited all the above changes significantly (P<0.01). CONCLUSIONS The results suggest that selective head cooling initiated soon after reperfusion is beneficial for brain cell membrane function recruitment, which provides favourable effects on the damaged but still remediable brain cells for their resuscitation.

OBJECTIVE To investigate the effects of methotrexate (MTX) and platelet activating factor (PAF) antagonist ginkgolide B (BN52021) on PAF induced chemotaxis of neutrophils. METHODS All guinea pigs were randomly divided into 12 groups. They were given different dosages of MTX and BN52021 by intra-abdominal injections. The random and chemotactic migration of polymorphonuclear leukocytes (PMNs) were measured by the agarose method. The backs of all guinea pigs were given intradermal injections of PAF and the numbers of the infiltration of inflammatory cells into the skin were determined. RESULTS MTX inhibited random migration and chemotactic migration of PMNs to PAF, LTB4 and PAF-induced intraepidermal accumulation of inflammatory cells in dose- and time-dependent fashion. BN52021 specially inhibited PAF-induced chemotaxis of PMNs and intraepidermal accumulation of inflammatory cells, but did not inhibit PMNs random migration and LTB4-induced chemotaxis of PMNs. CONCLUSIONS The inhibition of PMNs activities may be part of the mechanism of MTX therapy for psoriasis; BN52021 is a selective inhibitor of PAF-induced chemotaxis of PMNs, and therefore can be useful in the treatment of some inflammatory dermatoses such as psoriasis.

OBJECTIVE To set forth the methods of diagnosis and treatment of nephrotic syndrome during pregnancy (NSP) so as to decrease perinatal mortality. MATERIALS AND METHODS Forty cases of NSP including 5 twins in Tianjin Central Hospital of Obstetrics and Gynecology in the past 13 years have been reviewed, and the diagnosis and treatment were compared between group A (1979-1990, 23 cases) and group B (1991-1992, 17 cases). RESULTS NSP occurred before the 20th gestational week in 15% of cases and the patient's condition was serious. Clinically, NSP was classified into three types: simple, nephritis and pregnancy induced hypertension (PIH) type. The perinatal maternal and fetal prognosis was poor. Complications occurred in 27.5% of patients. One patient died from eclampsia and disseminated intravascular coagulation (DIC). The total perinatal mortality was 42.22%, with group A (27 babies including 4 twins), 51.86% (14/27), and group B (18 babies including 1 twin), 27.78% (5/18) (P<0.01). CONCLUSIONS NSP is a result of reproductive immunology and belongs to type III allergic reaction in terms of immunology. Early diagnosis, early treatment and timely termination of pregnancy may improve the outcome.

Orthopaedics in China originates from two great branches of medicine: traditional Chinese Medicine (TCM) and western medicine (WM).