1998年 · 第111卷第07期

OBJECTIVE To evaluate the effects of patient education for hypertension on hypertension control. METHODS Of 169 eligible patients (systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥95 mmHg), 60 were assigned to educational group (group E, antihypertensive drug treatment with an addition of patient education) and 109 to routine group (group R, antihypertensive drug treatment alone). The average follow-up approximated to 3 years. RESULTS The blood pressure was reduced from at baseline and sustained in the three-year follow-up by 20/13 mmHg in group E and by 22/13 mmHg in group R. For this similar blood pressure reduction, about 10 mg less of metoprolol and 6 mg less of nitrendipine were used in group E than in group R. The percentage of the patients in whom goal blood pressure (under 160/90 mmHg) was achieved during follow-up was higher and progressively increased in group E (1st year: 65%, 2nd year: 72%) in comparison with in group R (1st year: 45%; 2nd year: 55%). Body weight was significantly reduced by 1.36 and 1.81 kg from at baseline to at the 1st and 2nd year repeated measurements in group E. The significant reduction from at baseline to at the 2nd year was significantly different from that in group R (P = 0.02). For 24-hour urinary sodium excretion, it was decreased in the group E, whereas it was increased in the group R. The cumulative rates of hypertension-related complications were 4.43% in group E and 7.02% in group R (absolute difference = 2.59%, P = 0.48). The rate of missed appointments was somewhat higher in group R (10%) than in group E (7%) during the first year but lower in the 2nd and 3rd year (R vs E: 10% vs 2% in the 2nd year; 8% vs 2% in the 3rd year). Four patients lost to follow-up in group R (6.87%) and 1 patient in group E (1.74%, P = 0.08). CONCLUSIONS The findings of this study suggest that patient education is of some benefits to the hypertension control.

OBJECTIVE To evaluate the effect of traditional Chinese herbal medicine on the prevention of hemolytic disease caused by maternal-fetal blood group incompatibility. METHODS A total of 126 Chinese patients with maternal-fetal blood group incompatibility were studied, including 105 cases of ABO type and 21 cases of Rh type incompatibility. The traditional Chinese herbal medicine was used for preventative treatment in 79 cases, and 47 cases served as controls. The prescription consisted of Herba leonuri 500 g, white peony root 180 g, Banksia rose 12 g, root of Chinese angelica 150 g and Rhizomal ligustica 150 g. RESULTS Preventative treatment with traditional Chinese herbal medicine significantly reduced the perinatal mortality rate in cases of Rh type incompatibility, from 50.0% in the control group to 7.7% in the treatment group (P<0.05). There was no death in the cases of ABO incompatibility. The traditional Chinese herbal medicine also decreased the degree of hemolysis. The percentage of severe cases in the control group was 29.8%, while it was 15.2% in the treatment group (P = 0.05). The duration of treatment was closely related to the outcomes. In patients who used traditional Chinese herbal medicine for more than 10 weeks, the incidence of severe hemolysis was 8.2%, compared with 38.9% in those treated for less than 10 weeks (P<0.05). The change of serum immune antibody (A and/or B) titers during the treatment was a very important predictive factor for the outcome of the pregnancy. CONCLUSIONS Traditional Chinese herbal medicine is effective not only for ABO type but also for Rh type maternal-fetal blood group incompatibility, with no side effects.

OBJECTIVE To probe into electron beam computed tomography (EBCT) angiography and 3-D reconstruction of coronary artery bypass grafts (CABG) and to evaluate the clinical application of EBCT angiography and 3-D reconstruction of CABG. METHODS EBCT angiography with 3-D reconstruction was achieved in 150 patients (142 men and 8 women, mean age, 57±8 years) with 399 grafts including 100 internal mammary artery grafts (IMG), 296 saphenous vein grafts(SVG) and 3 radial artery grafts (RAG) respectively. The time from bypass surgery to EBCT scanning ranged from 7 days to 120 months, averaging 15±28 months. Enhanced single slice mode (SSM) and flow studies were performed in all patients. The RESULTS of 3-D reconstruction of CABG were compared with bypass operation records and with coronary arteriograms (7 patients). RESULTS 150 patients underwent successfully EBCT angiography and CABG 3-D reconstruction. According to 3-D reconstruction of the coronary bypass grafts with flow studies, 318 of 399 coronary bypass grafts were patent including IMG patency in 87/100 (87%), SVG in 228/296 (77%) and RAG in 3/3 (100/100). The overall patent rate was 79.7%. In 7 patients with 12 coronary bypass grafts, EBCT studies showed graft patency (7 grafts) and occlusion (5), which were confirmed by conventional graft angiography. CONCLUSIONS EBCT angiography with 3-D reconstruction is effective in providing the entire anatomic structure of coronary bypass grafts and evaluating coronary bypass graft patency. EBCT flow study can provide quantitative data for evaluating coronary bypass graft patency and for supplemental diagnosis of CABG 3-D reconstruction. EBCT angiography is a noninvasive technique that could replace conventional coronary arteriography for follow-up survey of coronary bypass surgery in future.

OBJECTIVE To evaluate the use of enhanced dynamic MR images in nasopharyngeal carcinoma (NPC). METHODS Dynamic enhanced turbo spin-echo transverse images were obtained in 35 patients with newly diagnosed NPC. Comparison was made between the pre-contrast image, last enhanced scan and dynamic series in assessment of the extent of primary tumor and lymph node involvement. RESULTS Enhanced MR images improved delineation of tumor in the following regions, nasopharyngeal wall (6/35), levator palatini (44/70), tensor palatini (12/70), prevertebral muscles (3/70), medial pterygoid muscle (7/70), pharyngobasilar fascia (30/35), parapharyngeal fat space (23/70), nasal cavity (33/70), oropharynx (6/35), sphenoid sinus (6/35), maxillary sinus (6/70), ethmoid air cells (14/35), cavernous sinus (5/35), cranial fossa (4/35), clivus (13/35) and pterygoid genu (2/70). Eight of the 9 normal and 79/82 abnormal nodal groups, on conventional imaging criteria, enhanced with the same pattern and intensity as the primary tumor. The dynamic series did not improve delineation of tumor extent in comparison with that obtained on last enhanced image. CONCLUSIONS Enhanced MR images are valuable in evaluating the extent of primary tumor. Dynamic imaging was of no additional benefit in the evaluation tumor extent.

OBJECTIVE To assess the value of MR in the diagnosis of avascular necrosis (AVN) of the femoral head. METHODS MR images in 34 consecutive patients (26 men and 8 women) with AVN (57 hips) were reviewed. All lesions were confirmed by radiographic, radionuclide, computed tomographic, and/or histologic examination. Eleven specimens were obtained after total replacement of the hip. Four hips underwent biopsy. All MR images were obtained using a 0.35 T superconductive imaging unit with SE sequence. Specimens were cut coronally into 5 mm thick section and radiographs were obtained. RESULTS There were four types of MR patterns of AVN. Type one appeared liner or patchy low signal area in the superoanterior portion of the femoral head. In type two, a band or ring of low signal intensity was found surrounding a central area of high signal intensity on T1WI and intermediate signal intensity on T2WI. The low signal band or ring consisted of thickened trabecular bone, mesenchymal and fibrous tissue, and amorphous acidophilic cellular debris. The central zones within the ring were composed of necrotic bone and marrow that had not been reached by the repair process. In type three, the focal subchondral region showed intermediate signal intensity on T1WI and high signal on T2WI surrounded by a low signal ring. The low signal ring consisted of thickened trabecular bone and little mesenchymal tissue. The central area was composed of mesenchymal tissue rich in capillaries and cystic necrotic zones. In type four, the signal intensity of femoral head was inhomogeneous on both T1WI and T2WI. There were low signal bands in the femoral neck surrounding the necrotic zone. Only limited areas of some lesions had signal intensity isointense with fat on T1WI and T2WI. The inhomogeneous area of low signal intensity consisted of a mixture of necrotic bone and marrow, amorphous cellular debris. The first type of MR pattern corresponded to the early stage of radiograph, and the third type of MR pattern to stage 5. The second and fourth type of MR patterns correlated less with the radiographic stage. CONCLUSIONS MR imaging plays an important role in the diagnosis of AVN of femoral head especially in the early detection of AVN. The MR patterns of AVN is not correlated with radiographic stages exactly.

OBJECTIVE To investigate the relationship between the expression of splice variants of CD44 (CD44v) and the metastasis of primary hepatocellular carcinoma (PHCC) in humans. METHODS The expression of metastasis-associated CD44v mRNA in 54 specimens of human PHCC was detected by reverse transcription and polymerase chain reaction (RT-PCR) method. RESULTS CD44v mRNA was expressed in 50 (92.59%) of the 54 specimens of PHCC, with moderate or over expression in 42 (77.78%). Among the 42 specimens with moderate or over expression, deficient tumor capsules were found in 25 (59.52%), penetration of tumor capsule in 15 (35.71%), tumor emboli in the portal vein in 34 (80.95%), and daughter tumor nodules in 29 (69.05%). Meanwhile, 12 of the 54 specimens showed negative or weak expression of CD44v mRNA. Of them, all had tumor capsules, 1 (8.33%) had penetrated tumor capsule, 1 (8.33%) had tumor emboli in the portal vein, and 2 (16.67%) had daughter tumor nodules. CONCLUSIONS CD44v may contribute to the metastatic potential of PHCC.

OBJECTIVE To conduct a screening survey of glycophorin (GP) variants and observe the content changes of sialic acid (SA) and total sulfhydryl (SH) groups on the erythrocyte membranes among residents in a tertian malaria hyperendemic area of Guizhou Province. METHODS GP variants were detected in the erythrocyte hemolysates of 173 local residents at two villages of Libo County by SDS-PAGE on 10% to 15% gradients gel and Western immunoblotting. Their SA and total SH group contents were estimated in erythrocyte membranes by spectrophotometric methods. 114 healthy subjects in Changsha and 49 individuals at a neighbouring village of the above area showing low morbidity of malaria served as normal and endemic controls respectively. RESULTS Three distinct types of GP variants were found among 19 propositi in this hyperendemic area. The incidence of GP variants was 7.9% (8/101) at Yaolu Village whose population was mainly composed of Yao ethnic group; while that of Buyi ethnic group at Maolan Village was higher (15.3%; 11/72). The erythrocyte membrane contents of SA in residents at both villages exhibited a very significant tendency of decline (P<0.01), whereas those of total SH groups increased prominently in residents of Yaolu Village only (P<0.05). CONCLUSIONS The frequency of GP variants in this hyperendemic area does not depend upon the severity of malarial prevalence. The evident reduction of SA contents in the residents may be related to the breaking down of the SA residues on membrane GPs by the invasion of Plasmodium vivax.

OBJECTIVE To assess the results of paediatric liver transplantation in our institution. METHODS From September 1993 to November 1996, 10 living-related liver transplants (LRLT) and 3 reduced-size liver transplants (RSLT) were performed on 12 children at our hospital. The medical records of the patients were reviewed. All patients suffered from end-stage liver disease resulting from biliary atresia with failed Kasai's operations. Their ages at initial transplantation ranged from 8 months to 11 years. Excluding the 2 older children aged 7.5 and 11 years, the remaining patients were aged 10.5 months on the average and weighed 6 to 9.5 kg (mean: 6.8 kg) at the time of initial transplantation. RESULTS All living donors were discharged on postoperative day 4 to 8 and resumed their previous normal activities. All recipients were alive with normal liver function and growing after a follow-up period of 3-40 months (mean: 21 months). The patient survival rate was 100%. One patient with RSLT had hepatitis of undetermined aetiology and underwent retransplant with a graft from her mother. The graft survival rate was 92%. Postoperative complications included: postoperative bleeding (n = 3), hepatic vein stenosis (n = I), biliary-enteric anastomotic stenosis (n = 3), intestinal perforation (n = I) and portal vein thrombosis (n = I). They were all treated promptly. In all patients, the hepatic artery (diameter ranged from 1.5 to 2.5 mm) anastomosis was achieved by microvascular technique. There was no hepatic artery thrombosis in our patients. CONCLUSIONS With technical refinements, early detection and prompt treatment of complications, and advances in immunotherapy, excellent results can be achieved in paediatric liver transplantation.

OBJECTIVE To obtain information on the distribution of serotypes and antimicrobial agent susceptibilities to group B streptococcus (GBS) strains isolated in Beijing area from 1991 to 1996. METHODS Bacterial isolates of GBS were obtained from vaginal and cervical tract of pregnant and nonpregnant women in Beijing Tian Tan Hospital by culture. A total of 76 GBS strains were identified finally by coagglutination. Serotyping was determined by Standard Lancefield method. Susceptibility to test agents was assessed by determining the minimal inhibitory concentrations (MICs) with agar dilution method that was established by the National Committee for Clinical Laboratory Standards (NCCLS). RESULTS Seven serotypes were identified among 76 GBS strains isolates. Types Ⅱ (33%), Ⅲ (23%) and Ⅰa (16%) were the predominant serotypes in pregnant and nonpregnant women. MICs of penicillin G and ampicillin were ≤0.06 μg/ml. MICs of cephazolin, cefuroxime and cefoperozone were 0.003 μg/ml-0.06 μg/ml. MICs of erythromycin were 0.003 μg/ml-0.03 μg/ml. MICs of gentamycin were 1 μg/ml-32 μg/ml. MICs of amikacin were 4 μgs/ml- ≥64 μg/ml, nearly 12.8% and 40.4% of the strains were resistant to gentamycin and amikacin, respectively. CONCLUSIONS Our study provides useful epidemiologic data for preparation of GBS type-specific vaccines which can prevent GBS infections and antimicrobial agents susceptibility patterns in China. Routine reports on GBS susceptibilities by clinical laboratories and continuous surveillance for changes in the susceptibility are of considerable clinical importance.

OBJECTIVE To provide suitable animal model (hyperoxia-induced premature rat lung damage) for research of bronchopulmonary dysplasia (BPD) and to better understand pathogenesis of BPD and look for effective drugs to prevent and treat BPD. METHODS Rat litters delivered prematurely at 21-day gestation by hysterotomy. Vigorous resuscitation at birth resulted in a high survival rate. Surfactant and antioxidant enzyme (AOE) system were measured. The model was tested in an experiment of hyperoxia-induced lung injury. RESULTS Compared to litters delivered spontaneously at term (gestation 22 days), these preterm rats had immature pulmonary surfactant composition with low total phospholipid (x±s: 10.09±1.49 μg/mg wet weight vs 12.04±1.31 μg/mg wet weight; P = 0.0367) and phostidylcholine (5.06±1.82 μg/mg wet weight vs 8.28±2.35 μg/mg wet weight; P = 0.0238) levels. The concentrations of AOE enzymes, superoxide disμtase (11.40±2.04 μ/mg DNA vs 15.78±1.84 μ/mg DNA; P<0.01) and catalase (92.81±62.25 μ/mg DNA vs 412.24±117.50 μ/mg DNA; P<0.01) were also significantly lower. Animals exposed to hyperoxia had a significantly higher mortality. Pulmonary edema and histological features of lung damage were observed in the pups exposed to hyperoxia. CONCLUSIONS The premature rat model is relatively cheap, readily available and has a high survival rate. Pulmonary surfactant and AOE systems are immature. These properties make them a suitable model for the study of acute and chronic lung damage related to prematurity and O2 toxicity.

Conscious sedation is a technique in which drugs are used to depress the central nervous system to allow treatment or examination to be performed, while verbal contact with the patient is maintained throughout sedation. A lack of response from the patient may indicate the transition from sedation to the state of general anaesthesia.

OBJECTIVE To introduce a common but not well-recognized acute abdominal disease in children. METHODS Thirty-eight children with spasm of the internal anal sphincter were reviewed. RESULTS The main symptom was the sudden onset of continuous pain in the lower abdomen with paroxysmal exacerbation. The typical sign was the dilation of the sigmoid colon with tenderness aggravated by pressure. Plain X-ray films showed dilation of the sigmoid colon and rectum. The symptoms could be relieved by digital rectal examination or a glycerin suppository. CONCLUSIONS It is the temporary achalasia of the internal anal sphincter that causes acute abdominal pain.

The interventional radiology in China took off in the early 80's. Even with a late start, it has nevertheless made a tremendous progress in the past 15 years in areas such as basic research, diagnostic technology as well as the related equipment and devices. Interventional therapy, more significantly has gained national and international recognition due to its successful treatment of multi-large series of cases with excellent to good results.