1998年 · 第111卷第12期

OBJECTIVE To evaluate Bletilla striata as a vascular embolizing agent in interventional treatment of primary hepatic carcinoma. METHODS We made a vascular embolizing agent from a Chinese medicinal herb, Bletilla striata (bai ji). From October 1991 to January 1995, 56 patients with primary hepatic carcinoma were treated by hepatic arterial chemoembolization with Bletilla striata angioembolus, and 50 patients with primary hepatic carcinoma who were treated by conventional gelfoam embolization served as controls. All patients were followed up for 10-48 months. RESULTS Embolization with the Bletilla striata powder produced extensive and permanent vascular obstruction, resulting in marked shrinkage of the tumor and significant decrease of serum alpha fetoprotein (AFP) level. After embolization, less collateral circulation formed later. The treatment interval was prolonged to an average of 7 months. The 1-, 2- and 3-year survival rates were 81.9%, 44.9%, and 33.6%, respectively, with a mean survival period of 19.8 months. All the clinical parameters were better than those in the control group treated by conventional gelfoam embolization. CONCLUSIONS Bletilla striata angioembolus is a good vascular embolizing agent for treating PHC.

OBJECTIVE To evaluate the role of increased portal pressure and portosystemic shunting in elevated level of prostacyclin (PGI2) in portal hypertension. METHODS Thirty-six male Sprague-Dawley rats were divided into four groups: prehepatic portal hypertension (PHPH, 8 rats), intrahepatic portal hypertension (IHPH, 9), end-to-side portacaval shunt (PCS, 8), and sham-operated controls (SO, 11). Two weeks after surgery, free portal pressure (FPP) was measured; systemic and splanchnic hemodynamics was studied by radioactive microsphere technique and blood sample from the femoral artery was obtained to measure the level of plasma 6-keto-PGF1 alpha with radioimmunoassay. RESULTS The FPP (mmHg) in IHPH, PHPH, PCS and SO rats was 13.10±1.02, 12.10±1.52, 3.0±0.82 and 6.86±0.69, respectively. The value of FPP was significantly increased in IHPH, PHPH rats and significantly decreased in PCS rats when compared to SO rats. Cardiac index (CI) and portal venous inflow (PVI) were in the order of PCS>PHPH>IHPH>SO rats. Portosystemic shunting (PSS) in PCS, PHPH, IHPH was 99.7±0.29%, 76.02±20.62% and 30.34±10.18%, respectively. The concentrations of plasma 6-keto-PGF1α (ng/ml) in PHPH, IHPH, PCS and SO rats were 6.93±2.43, 5.09±2.27, 2.36±1.01 and 1.56±0.61, respectively. The concentrations of plasma PGI2 in PHPH, IHPH and PCS rats were significantly higher than those in SO rats. Furthermore, the concentrations of plasma PGI2 in PHPH and IHPH rats were also significantly higher than those in PCS rats. Moreover, a closed positive correlation existed between plasma PGI2 and FPP (r = 0.67, P<0.001). CONCLUSIONS The results of the present study suggest that the elevated PGI2 in portal hypertension is mainly due to the overproduction of PGI2 in vascular epithelium cells induced by increased portal pressure, whereas portosystemic shunting and liver dysfunction play a secondary role. In addition, the results of this study do not support that PGI2 mediated the hyperhemodynamics in portal hypertension.

OBJECTIVE To detect hepatitis C virus (HCV) RNA sequences in the hepatic portal cholangiocarcinoma tissues and their relationship. METHODS RNA was extracted from paraffin-embedded cholangiocarcinoma tissues of 6 patients by guanidinium method, subjected to reverse transcription and then amplified by double PCR technique using nested primers from the highly conserved 5' noncoding region of HCV genome. RESULTS HCV RNA of 5' NT sequences was found in the hepatic portal cholangiocarcinoma tissues of 5 out of 6 (83%) patients. CONCLUSIONS HCV RNA sequences present with high infectious rate in cholangiocarcinoma, and reverse transcription polymerase chain reaction (RT-PCR) assay using primers derived from 5' NT region of HCV sequence is most useful in detecting HCV infection. The development of cholangiocarcinoma awaits further studies.

OBJECTIVE To examine the effects of cholecystokinin octapeptide (CCK-OP), vasoactive intestinal peptide (VIP) and substance P (SP) on the dynamics of the biliary system and cardiovascular system, and the relationship between the dynamics of the biliary system and cardiodynamics. METHODS In 91 anesthetized guinea pigs, a triple-lumen, side-hole perfusion catheter (1.0 mmOD) was inserted through the duodenal papilla into the common bile duct (CBD) and the sphincter of Oddi (OS). An end-hole PE-50 catheter was inserted into the left ventricle of heart through the left jugular artery. The left ventricle of heart motility, OS motility and CBD pressure were recorded during the intravenous administration of CCK-OP, VIP, SP and the combination of CCK-OP and VIP. RESULTS Intravenous CCK-OP increased the fasted OS motility index (MI), decreased the basal pressure in OS, increased CBD pressure, and inhibited the motility of the left ventricle of heart. VIP alone showed no significant effect on the biliary system and cardiovascular system, but when infused together with CCK-OP, it inhibited the effects of CCK-OP on both systems. Exogenous SP acted like CCK-OP on both biliary system and cardiovascular system, but less potently. CONCLUSIONS The gastrointestinal peptides have important effects on both biliary system and cardiovascular system. There is an important negative correlation between CBD pressure and the motility of the left ventricle of the heart during the infusion of peptides.

OBJECTIVE To explore the effects of proglumide, a gastrin receptor antagonist, on the amount of viable cells, synthesis of DNA and protein, and cell proliferation cycle in human large intestine carcinoma SW480 cell line in order to provide experimental basis for treatment of large intestine carcinoma using proglumide. METHODS Large intestine carcinoma SW480 cells at logarithmic growth stage were cultivated with different concentrations of proglumide for different periods of time, then the amount of viable cells was determined by MTT colorimetric analysis. The SW480 cells were cultivated with proglumide, pentagastrin, proglumide + pentagastrin for the same period of time, then the contents of DNA and protein and the cell proliferation cycle were determined by flow-cytometry. RESULTS The amount of viable cells, synthesis of DNA and protein, distribution of cell cycle, and proliferation index (PI) in the proglumide group did not differ significantly from those in the pentagastrin group (P>0.05). The amount of viable cells in the pentagastrin group was significantly higher than that in the pentagastrin group (P<0.01). In the proglumide + pentagastrin group the amount of viable cells, synthesis of DNA and protein, amount of S and G 2M phase cells, and PI were all significantly lower than those in the pentagastrin group (all P<0.01), and the amount of G0/G1 phase cells was significantly higher than that in the pentagastrin group (P<0.01), but none of the above differed from those in the control group (all P>0.05). CONCLUSIONS Proglumide has no obvious effect on the growth of human large intestine carcinoma SW480 cell line, but can inhibit the growth-promoting effect of pentagastrin on large intestine carcinoma cells. The mechanism may be that proglumide inhibits the promoting effect of pentagastrin on the synthesis of DNA and protein of carcinoma cells, and then inhibits carcinoma cell growth from G0/G1 phase to S and G2M phase.

OBJECTIVE To determine the effect of PGE1 on liver microcirculation disturbance following orthotopic liver transplantation in rats. METHODS Forty male adult Wistar rats were divided randomly into 3 groups. Eight transplantations were established in both the experimental and control group, while in the sham group, the liver was dissected like in the experimental group, but no resection was performed. In the experimental group, PGE1(0.5 μg/kg·min-1) was injected intravenously into the donor before the operation, and added (1 mg/L) to the flush and preservation fluid, while PGE1 was replaced by normal saline in the control group. Confocal laser scan microscopy, biochemical test, and optical and electronic microscopy were used. RESULTS In the control group the reperfusion state was poor, leukocyte infiltration appeared in the center of lobule, and transaminase rose after transplantation. In the experimental group distinctive improvement was seen as compared with the control group (P<0.05). Histological findings showed progressive degeneration and necrosis following transplantation in the control group, while in the experimental group the histological changes were improved to some degree by the use of PGE1. CONCLUSIONS In liver transplantation, ischemic reperfusion damage may lead to hepatic microcirculation disturbance, which is the major cause of graft failure. Infusing PGE1 into the donor intravenously before ischemia and adding PGE1 to the cold storage fluid could improve hepatic microcirculation, and thus reducing ischemic reperfusion damage in liver transplantation.

OBJECTIVE To assess retrospectively the clinical value of androgen receptor (AR) levels in primary hepatocellular carcinoma (HCC) as a prognostic factor of the disease. METHODS Fresh HCC tissue and the surrounding liver tissue were obtained surgically from 32 patients with HCC, and preserved in liquid nitrogen. The levels of AR in all specimens were determined by radio-ligand binding assay. RESULTS The median level of AR was 42.8 fmol/mg protein in the cancerous tissue and 48.3 fmol/mg protein in the surrounding non-cancerous liver tissue. The overall survival rate of the patients with AR<30 fmol/mg protein in either HCC or the non-cancerous liver was significantly higher than that of the patients with AR ≥ 30 fmol/mg protein (P<0.05 and P<0.01, respectively). The relative risk on prognosis was 3.27 (P<0.01) for AR level in HCC and 6.06 (P<0.001) for AR level in the non-cancerous tissue. The main prognostic factors except the tumor size were not different between the group with higher AR level and that with lower AR level in HCC. The AR level in HCC had a positive correlation with the tumor size (r = 0.44, P<0.05). CONCLUSIONS AR can be detected in HCC and the AR status might be a prognostic parameter that provides additional predictive information on the survival. Different AR status might define a real difference of biological characteristics between HCCs.

OBJECTIVE To study the effect of pericardial devascularization combined with Latarjet's innervation on portal hypertension. METHODS Forty-eight patients undergoing pericardial devascularization combined with Latarjet's innervation were compared with 57 patients with devascularization. Clinical results were evaluated by postoperative portal vein pressure, postoperative rebleeding, operative mortality, abdominal distension, sudden diarrhea, and gastric retention. RESULTS The incidence of rebleeding, mortality, abdominal distension, sudden diarrhea, and gastric retention was 2%, 6.3%, 6.3%, 4.2% and 0% respectively in pericardial devascularization combined with Latarjet's innervation, and 12.5%, 12.3%, 24.6%, 15.6% and 14% respectively in devascularization. CONCLUSIONS Pericardial devascularization combined with Latarjet's innervation preserves the normal function of gastric emptying. This method plays an important role in maintaining nutritional supply and digestive function.

OBJECTIVE To investigate the correlation between angiogenesis and tumor growth pattern as well as the lymph node metastasis to reveal the significance of vascularity in the early stage of gastric cancer. METHODS 97 specimens from patients with early gastric cancer were studied by immunohistochemical method using anti-factor Ⅷ related antigen antibody. RESULTS Microvessel count was related to tumor growth pattern. The mean vessel count was higher in superficially spreading and penetrating types of tumors. Lymph node metastasis was correlated to microvessel count. Tumors with lymph node metastasis had higher microvessel counts than those without lymph node metastasis. CONCLUSIONS In the early stage of gastric carcinoma, angiogenesis is correlated with tumor growth pattern and lymph node metastasis. Identification of tumors with high density of vascularization is beneficial for closer follow-up and adjuvant therapy.

OBJECTIVE To investigate the effect of horizontal platform supported (HPS) prosthesis on cementless total hip replacement for surgical treatment of arthritis in a long-term follow-up study. METHODS Clinical and radiographic follow-up of 65 consecutive primary cementless porous coated HPS total hip replacements, which were implanted in 60 patients between 1982 and 1989, was carried out. RESULTS The 53 hips in 50 patients were evaluated both clinically and radiographically. The average follow-up was 6.8 years (range: 5 to 12 years). According to the Harris hip score, 52 (98%) of the hips had sustained an excellent or good result with an average score of 92. At the time of final assessment, no patient experienced anterior thigh pain. There were two revisions performed early in the series due to technical failures. Radiographically, osteolysis and bone remodelling were assessed. CONCLUSIONS The findings suggest that the clinical and radiographic results after cementless total hip replacement for primary hip arthroplasty may be favourably influenced by the use of the proximal stress loaded HPS femoral component.

This issue of Chinese Medical Journal (CMJ) focuses on many aspects of hepato-biliary-pancreatic surgery, which represent some of lated development of general surgery in China.

Rathke's cleft cysts (RCC) are usually incidental autopsy findings and are asymptomatic. Although symptomatic RCC is extremely rare, recent advances in magnetic resonance imaging (MRI) provide the means by which to detect them preoperatively. RCC may become symptomatic when its size increases and it compresses the surrounding tissues: the hypothalamus, hypophysis, optic nerve and chiasma.

Torsion of the greater omentum is a rare condition of acute abdomen. About 300 cases were reported after the first description by Eitel in 1899. Primary omental torsion may occur in any age and only 15% in children. In this article, an additional case of primary omental torsion with necrosis was presented.

The use of single lead for atrial synchronous ventricular (VDD) pacing in patients with high grade atrioventricular (AV) block and normal sinus node function is an acceptable alternative to dual chamber (DDD) pacing. Implantation and follow up procedures are simplified, and cost is usually reduced by more than the cost of an additional atrial lead. With the use of either diagonally arranged dipole or closely spaced ring electrodes, reliable atrial sensing can be achieved using differential atrial amplifier and high atrial sensitivity. Also oversensing is infrequently observed using provocation tests and dynamic recordings, clinical undersensing is unusual and minimized by programming to the highest atrial sensitivity. However, as atrial pacing is not possible, loss of AV synchrony and rate response may occur for unrecognized or progressive sinus node disease and lower rate limit. The development of single lead dual chamber pacing system may overcome this limitation. Recent studies have demonstrated that atrial pacing can be effective either with the use of a special pacing lead configuration or via floating atrial electrode with a novel stimulation method. Overlapping biphasic impulse (OLBI) can reduce atrial pacing threshold. Early clinical experience suggested that this new pacing method can provide effective and reliable atrial pacing with a relatively low incidence of diaphragmatic pacing. Thus the problem of atrial sensing is solved with a single pass lead but further long term evaluation is required to assess the efficacy and feasibility of new instrumentation for single lead dual chamber pacing.