1999年 · 第112卷第01期

Objective To determine the pattern of dynamic change in types of heart diseases in the past 4 decades for providing a reference to treatment and prevention of heart diseases in China. Methods All adult cardiac patients admitted to the Zhong Shan Hospital and Hua Shan Hospital from 1948 to 1989 were analyzed. The constituent ratio of different heart diseases in the 1950s, 1960s, 1970s and 1980s was compared. Results The percentage of heart diseases among medical inpatients increased in each of the recent 4 decades, from 9.89%, 15.69%, 20.90% to 23.54% respectively. The constituent ratio of different heart diseases changed, coronary heart disease constituted the highest proportion, next came rheumatic heart disease, and congenital heart disease was in third place. Congenital heart disease, myocarditis, cardiac dysrhythmia without organic heart disease, cardiomyopathy and endocarditis increased, rheumatic heart disease, pulmonary heart disease and hypertensive heart disease apparently decreased; syphilitic heart disease could rarely be encountered. Conclusion China is now facing a low overall death rate, a long life expectancy and an aging population. The incidence of heart diseases increased gradually and patterns of heart diseases kept changing. The overall trend is that heart diseases which were not related to infection are increasing while heart diseases related to bacterial infection are decreasing.

Objective To compare the effects of low dose of recombinant tissue-type plasminogen activator(tPA) with those of conventional dose of urokinase (UK) and assess the influence of different regimens of intravenous UK in patients with acute myocardial infarction (AMI). Methods Eighty patients with AMI were randomized to 50 mg of tPA (Group Ⅰ; n=26) using an accelerating approach or 1.0-1.5 million U of UK (Group Ⅱ; n=54). UK was administered as a single bolus injection of whole dose (Group Ⅱa; n=26) or half dose bolus injection followed by half dose infusion (Group Ⅱb; n=28). All patients underwent coronary arteriography 90 min after the initiation of intravenous thrombolysis, and the infarct-related coronary artery (IRA) patency was evaluated. Cardiac events during hospitalization were recorded and predischarge left ventricular function was determined by two-dimensional echocardiography. Results The IRA patency rate was significantly higher in Group Ⅰ (88.4%) than in Group Ⅱ (53.7%) (P<0.01). Group Ⅰ patients had less cardiac events during hospitalization (11.5% vs 33.3%) and greater improvement in left ventricular function than Group Ⅱ patients. However, these angiographic, left ventricular functional and prognostic parameters did not significantly differ between Group Ⅱa and Group Ⅱb. Conclusions Thrombolysis after AMI with low dose of intravenous tPA exerts better angiographic and clinical effects than that with conventional dose of UK. The thrombolytic effects of UK were not affected by different regimens of intravenous administration of the agent.

OBJECTIVE To report our initial experience of transveneous pectoral implantation of single lead implantable cardioverter defibrillator(ICD) in fifteen patients. METHODS Fifteen patients (male 13, female 2, mean age of 51.7 years), including dilated cardiomyopathy in 4, hypertrophic cardiomyopathy in 2, coronary artery disease in 5 and syncope of unknown etiology in 2, underwent ICD implantation. Indications for ICD implantation were ventricular fibrillation (8 patients) and refractory ventricular tachycardia (7 patients). All patients had syncope out of hospital. The ICD system were Medtronic Jewel active can in 5 patients (Model 7219C in 2, 7220C in 3) and CPI Ventak PRxⅢ in 9 patients. For active can, shocks were delivered through distal coil to ICD shell and for PRxⅢ through the endotak lead of proximal to distal coil. Successful implantation criteria was 2 consecutive defibrillation at less than 24 J. RESULTS All 15 patients had successful implantation using single lead ICD system in catheter laboratory. The mean defibrillation threshold was 12.8 J (5-15 J) and R wave was 9.9 mV (3.7-14.6 mV). All devices were of pectoral implantation. No operative and perioperative complications occurred. In 7.6 months (1-18 months) of follow-up, 3 patients had VT terminated by antitachycardia pacing (ATP) and 1 patient VF terminated by shock. Conclusion Transveneous pectoral implantation of single lead ICD is easy to perform and has high defibrillation efficacy and should be a preferred approach.

OBJECTIVE To summarise the clinical RESULTS of surgical treatment of 2004 cases of lung cancer over a period of 33 years and to evaluate the main influencing factors for long-term results. METHODS 2004 patients treated at our department were included in this study. The pathological classification proposed and revised by WHO in 1982 was used. The TNM (tumour, nodes, and metastasis classification) system of staging proposed and modified by UICC (International Union Against Cancer) in 1987 was followed. Pearson’s Chi-square test was used in comparing variables. RESULTS There were 1571 men and 433 women, with a man to woman ratio of 3.6∶1. The pathological findings were squamous cell carcinoma (944 cases, 47.1%), adenocarcinoma (694, 34.6%), small cell carcinoma (167, 8.3%), adenosquamous cell carcinoma (78, 3.9%), large cell carcinoma (22, 1.1%), alveolar cell carcinoma (17, 0.8%) and miscellaneous carcinoma (82, 4.1%). The p-TNM staging in 1721 resected cases was: stage 0 (2 cases, 0.1%), stage Ⅰ (860, 50%), stage Ⅱ (407, 23.6%), staging Ⅲa (396, 23.0%), stage Ⅲb (35, 2.0%) and stage Ⅳ (21, 1.2%). The overall resection rate was 85.9% (1721/2004) and the complication rate was 15.7% (271/1721). The 30-day mortality was 1.3% (22/1721). The 5-, 10- and 15-year survival rates were 38.8%, 31.6% and 21.8%, respectively. Factors influencing the long-term survival rate included the nature of resection, the mode of resection, presence or absence of lymph gland metastasis, tumour size and degree of extension, pathological type and p-TNM staging. CONCLUSIONS Surgery is recommended for stage Ⅰ, Ⅱ and Ⅲa non-small cell lung cancer and for stage Ⅰ and Ⅱ small cell lung cancer. Meticulous preoperative staging process is important. Bronchoplastic resection is recommended to replace pneumouectomy whenever the conditions are permissible.

OBJECTIVE To evaluate the diagnosis and treatment of splanchnic artery aneurysms. METHODS A retrospective study of our case records from 1957 to 1997 was carried out. Fifty-seven patients with splanchnic artery aneurysms were involved in this study with 62 aneurysms, including hepatic aneurysm (14 patients), gastric and pancreaticoduodenal aneurysm (13), splenic aneurysm (14), renal aneurysm (6), superior mesenteric aneurysm (3), inferior mesenteric aneurysm (1), truncus coeliacus (3) and epiploic arterial aneurysm (3). Among them, 5 patients had multiple aneurysms; 29 had massive bleeding of spontaneous rupture into the biliary tract (14 patients), the upper gastrointestinal tract (10), and the peritoneal and retroperitoneal cavity (5). RESULTS Preoperative diagnosis was confirmed by arteriography in 37 patients, digital subtraction angiography (DSA) in 2, and magnetic resonance angiography (MRA) in 2. Among the 46 patients who underwent surgical intervention, 9 died. Splanchnic arterial embolotherapy was performed in 6 patients. Conclusion Splanchnic artery aneurysms have a potential for rupture with life-threatening hemorrhage. Clinical assessment of these lesions before operation is very difficult. The most valuable examination is selective arteriography of the splanchnic artery (including DSA). Surgical treatment is a safe and effective procedure. Embolic therapy may be the method of choice for selected splanchnic artery aneurysms. Prognosis of this disorder depends on the anatomic location of aneurysms, primary disease and general condition of patients.

OBJECTIVE To study the influence of maternal immunological factors on clinical pregnancy outcome in an in vitro fertilization and embryo transfer (IVF-ET) program. METHODS One hundred and fifty IVF-ET treatment cycles from November 1995 to November 1996 were studied. The indication for IVF-ET treatment was bilateral blocked tubes. Serum antisperm antibodies and anticardiolipin antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Cleavage rate and successful pregnancy rate in relation to antibody status of infertile women after IVF-ET treatment were assessed. RESULTS Lower cleavage rate (64.2%±32.1%) was found in 44 cycles of antisperm antibody seropositive women, compared with 84.8%±18.7% in 106 cycles of seronegative women (P<0.05). The clinical pregnancy rate was 31.8% in antisperm antibody-positive cycles and 20.8% in negative cycles (P>0.05). The abortion rates of the two groups were similar (P>0.05). Lower pregnancy rate (9.5%) was found in 21 cycles of serum anticardiolipin antibody-positive group, compared with 26.3% in 129 cycles of seronegative women (P<0.05). Of patients with bio-chemical pregnancy and no pregnancy, 20.0% and 16.2%, respectively, had seropositive anticardiolipin antibody, compared with 5.6% of patients with clinical pregnancy (P<0.05). Conclusion Serum immunological factors may play a part in clinical pregnancy outcome in IVF-ET.

OBJECTIVE To evaluate the efficacy of hepatitis B immune globulin (HBIG) in preventing intrauterine infection by hepatitis B virus (HBV) and to investigate its mechanism. METHODS Forty-eight pregnant women positive for hepatitis B surface antigen (HBsAg) were randomly divided into 2 groups. The 34 women in the study group were injected with HBIG during pregnancy; the other 14 women were controls. Maternal blood samples were taken before HBIG injection and at delivery. Neonatal blood samples were taken within 24 hours after birth before HBIG and hepatitis B vaccine were given. HBsAg and antibody to HBsAg (anti-HBs) were tested by radioimmunoassay. RESULTS None of the 35 newborns (including 2 twins) in the study group was positive for HBsAg, but 3 (21%) in the control group were positive (P=0.02). The HBsAg titers in the women in the study group decreased after HBIG injection. Of the 35 newborns in the study group, 32 (91%) were positive for anti-HBs. Conclusion Systematic injections of HBIG during pregnancy may prevent intrauterine HBV infection, the mechanism of which may be reduction of maternal HBV viremia and production of fetal passive immunity.

Objective To investigate the relationship between c-jun mRNA and apoptosis of neurons following perinatal ischemic-hypoxia. Methods We set up a fetal rat model of perinatal ischemic-hypoxia by ligating unilateral uterine horn vessel of pregnant Wistar rats (21-day gestation). The contralateral horn vessel was not ligated and the fetuses in these uteri served as controls. Rat pups were delivered by cesarean section at the end of ischemic hypoxic insult and then the rats’ brain tissues were collected in different points of time. In situ hybridization and TUNEL methods were used to detect the c-jun mRNA expression and neural cells apoptosis separately. Results The expression of c-jun mRNA in brain tissues began at 15 minutes, reached the first peak at 1-2 hours after ischemic-hypoxic insult and reduced gradually after 4 hours and the second peak at 24th hour after insult, gradually disappeared till 72nd hour. There were very low c-jun mRNA expression of hippocampus in the control group 24 h after birth. Meanwhile, we observed that the apoptosis of neuronal cells in cerebral cortex was much more than that in the control group. Conclusion The increases of immediate early gene c-jun expression and the cell apoptosis could be induced by perinatal ischemic-hypoxia. The higher expression of c-jun mRNA might induce the transcription of its target gene, especially, so called “death related genes”, which would be a promoter for cell apoptosis.

OBJECTIVES To get a more comprehensive recognition about carpal tunnel syndrome (CTS), especially the manual housework as its risk factor, and to facilitate early diagnosis and proper treatment. METHODS 262 CTS patients (396 CTS hands) were analyzed retrospectively. A 1∶1 matched case-control study of 61 woman pairs in relationship between manual housework and the occurrence of CTS was carried out. RESULTS In 262 CTS patients, 84% were female, and the dominant hand was more frequently affected; repetitive and forceful movement of the hand and wrist might be associated with CTS. Typical clinical manifestations include pain and paresthesia in the median nerve territory, but 75.3% of our 396 CTS hands had all five digits involved. Conduction abnormalities appeared selectively in the median nerve distal to the wrist. In the case-control study, for manual washing, rolling or kneading dough, and knitting woolen sweater, the odds ratios (OR) of CTS between high and low intensities were 3.86 (95% confidence interval 1.79-8.33, χ2=11.76, P<0.01), 6.25 (95% confidence interval 2.50-15.63, χ2=15.21, P<0.01) and 1.13 (95% confidence interval 0.57-2.22, χ2=0.125, P>0.05) respectively; and those between long and short duration (i.e. the number of years engaging in these manual housework) were 2.33 (95% confidence interval 0.63-8.64, χ2=1.6, P>0.05), 1.88 (95% confidence interval 0.81-4.38, χ2=2.13, P>0.05) and 1 (χ2=0, P>0.05). CONCLUSIONS The diagnosis of CTS requires confirmation of illness history, symptoms and signs with objective electrodiagnostic tests. Manual washing and rolling or kneading dough might be associated with the onset of CTS.

OBJECTIVE To hibernate fetal ventral mesencephalic tegmental (VMT) cells from Spraque-Dawley rats E-15 for 5 days at 4℃ in either hibernation media (HM) or in conditioned hibernation media (CHM) supplemented with trophic factors such as epidermal growth factor (EGF 200 ng/ml), basic fibroblast growth factor (bFGF 100 ng/ml), recombinant human brain derived neurotrophic factor (rhBDNF 20 μg/ml), recombinant human glial cell-derived neurotrophic factor (rhGDNF 20 μg/ml), fetal calf serum (FCS 9%), or human placental cord serum (HPCS 10%). METHODS The percent of cell viability and the density of tyrosine hydroxylase immunoreactive (THir) cells in fetal striatal-VMT co-culture were determined. RESULTS The viability of fetal striatal cells (0.8±0.104) was slightly higher than that of fetal VMT cells (0.7±0.072) at 0-time point (F17,1=4.677; P=0.045). After 5 days of hibernation, the viability of fetal VMT cells reduced by 30% (F7,1=88.493; P<0.001) in HM. However, THir-cell density reduced by more than 90% as compared to the freshly harvested VMT cells (F7,1=179.944; P<0.001). CHM with HPCS, bFGF, EGF, BDNF, and GDNF showed higher THir-cell density than that of HM or CHM supplemented with FCS (P<0.001). Conclusion Supplementation of appropriate trophic factors for hibernated fetal VMT cells promotes cell viability and the subsequent expression of Thir-cell density.

Purpose To document and review all the published reports on smoking and coronary heart disease (CHD) in China and Hong Kong, and to estimate the risks of CHD due to smoking. Data sources Papers cited in Medline, Chinese Biomedical Literature Disc and Chinese Medical Current Contents, references in review papers, conference papers and abstracts. Study selection All published reports which had findings on smoking and CHD were included.|Data extraction|Reports on 13 cross-sectional, 16 case-control and 13 prospective studies were included. Available data on risk estimates from 23 studies were extracted and pooled odds ratios (OR) and relative risks (RR) were calculated using Mantel-Haenszel’s methods. Results In China in 1970s, most results, which were from cross-sectional studies, did not show an association between smoking and CHD. In the 1980s, most case control studies found an association but the prospective studies did not. In the 1990s, there was stronger evidence from prospective studies mainly in men. The relative risk was about 1.90 in men and about 2.50-3.50 in women although the 95% confidence interval for the latter was wide. Dose response relationships were observed in 12 studies. In Hong Kong, there were one cross-sectional and two case control studies. Conclusions The existing evidence supports that smoking is a cause of CHD in Chinese, particularly in men. More data in women are needed to quantify the risk more precisely. The risk estimates probably indicate only the early stage of a growing tobacco epidemic.

This short review summarizes an integrated approach to new methods of managing hepatocellular carcinoma (HCC) developed at our centre. HCC-specific isoforms of alpha-fetoprotein were detected by isoelectric focusing and their value in the differential diagnosis of early HCC on a background of chronic liver disease has been shown. Selective internal radiation therapy using yttrium-90 (90 Y) microspheres has been shown to be an effective treatment for inoperable HCC in a phase Ⅰ and Ⅱ study. A partition model for estimating the radiation doses from the　90 Y microspheres to the tumour and the non-tumorous liver during the therapy was then formulated, verified by correlating with intraoperative dosimetry, and evaluated in clinical settings. This permits　90 Y microspheres to be administered safely without the need of an open surgery and a randomized therapeutic controlled trial is in progress. Another radomized controlled trial using iodine-131 Lipiodol as a post-operative adjuvant therapy, aiming at reducing the recurrence rate is also on-going. HCC may be more effectively combated with a better understanding of its pathogenesis from chronic liver disease.