2001年 · 第114卷第08期

Objective To discuss the diagnosis and surgical treatment of temporal lobe epilepsy. Methods From 1996 to 1998, 36 patients presenting with medically intractable temporal lobe epilepsy were identified by EEG and MR, including volumetric MR, for hippocampal formation. Among them, 16 patients underwent anterior temporal lobectomy, while 20 patients accepted selective amygdalohippocampectomy. The results of surgical operation and follow-up are analyzed. Results With respect to seizure outcome, all patients benefited from surgery. The surgical results were satisfactory in 24 cases, notable in 11 cases, and good in 1 case, and there were no complications. Conclusion MR is beneficial for the localization of epileptic foci. Surgery is an effective method for the treatment of temporal lobe epilepsy; selective amygdalohippocampectomy is the first choice for medial temporal lobe epilepsy. The transzygmatic-temporal lobe base approach presented in this study improved the safety of the surgery. Chin Med J 2001; 114(8):787-790

Objective To investigate the effects of extrinsic positive end-expiratory pressure (PEEPe) on work of breathing in patients with chronic obstructive pulmonary disease (COPD) and their corresponding mechanism. Methods Ten ventilated patients with COPD were included in the study. A Bicore CP-100 pulmonary monitor (Bicore Monitoring System, USA) was used for monitoring respiratory mechanics. First, dynamic intrinsic positive end-expiratory pressure (PEEPi, dyn) was measured when PEEPe was zero, which was called PEEPi, dynz. Then the PEEPe was set randomly at 0%, 40%, 60%, 80% and 100% of PEEPi, dynz respectively. Pulmonary mechanics and other parameters (heart rate, blood pressure and blood gas analysis) were measured 30 minutes after the level of PEEPe was changed. Results Work of breathing patient (WOBp), pressure time product, difference of esophageal pressure and PEEPi, dyn decreased significantly when PEEPe was applied, and continued decreasing as PEEPe was increased. Work of breathing ventilator increased significantly when PEEPe was increased to 80% and 100% of PEEPi, dynz. Significantly positive linear correlation was found between the changes in WOBp and in PEEPi, dyn. Conclusions WOBp decreases gradually as PEEPe is increased. WOBp decreases by narrowing the difference between the alveolus pressure and the central airway pressure at the end of expiration when PEEPe is applied. Chin Med J 2001; 114(8):791-794

Objective To elucidate the clinical features and treatment of Hemangiopericytomas (HPCs) in the central nervous system. Methods Twenty-six HPC operations performed at Huashan Hospital from January 1993 to June 1999 were analyzed retrospectively, and a review of relevant literatures was done. Results Among the 26 cases, total tumor removal was achieved in 24 cases, and subtotal removal in 2 cases. Postoperatively, neurological symptoms were improved or unchanged in 21 cases, worsened in 4 cases, and pneumonia caused death in 1 case. Eighteen patients received postoperative radiotherapy. Eighteen patients were followed up from 1 month to 58 months (average, 22 months). During the follow-up period, 2 patients presented one or more distant metastasis, and one patient died of recurrence. Conclusion Surgical management is the best choice for treatment of patients with HPCs. Postoperative radiotherapy can postpone the risk of tumor recurrence. Chin Med J 2001; 114(8):795-798

Objective To clarify whether the disturbances in metabolic kinetics of the essential aminoacid, phenylalanine (phe), are implicated in the genetic pathogenesis of essential hypertension (EH). Methods 1. L-(2, 3D3)-leucine, L-(2, 3D3)-isoleucine, L-15 N-lysine. L-(2, 3D3)-valine and L-(2, 3D3)-phe were used for simultaneously studying comparative metabolic kinetics using stable isotope tracer methods with a GC-MS system. Study groups were the offspring with both parents suffering EH (n = 10, FH+), 2 or more than 2 parents and grand-parents with EH and stroke (n = 12, FS+) and those without genetic predisposition of EH and stroke (n = 12, F-) groups. 2. By comparing the radioactive counts of [3H]-phe, and their weight transformation in blood after 1.5 Ci/kg i. v. administration at defined intervals and in tissues obtained after being sacrified among spontaneously hypertensive rats (SHR), 2 kidney-1 clip hypertensive rats (2K1C) and their normotensive controls (WKY). 3. The time transport and concentration transport of [3H]-L-phe in cpm between the cultured vascular smooth muscle cell of 5th generation in SHR and WKY were compared. Results A single and unique disturbance of metabolic kinetics in phe were found in FH+, FS+ and SHR. The plasma pool or apparent volume of distribution was enlarged, and the turnover rate constants between plasma and cell tended to show a decrease. The pharmacokinetics of phe in 2K1C was not changed. Only phe content in heart and aorta, the vital organs for predicting BP, were higher in SHR than in WKY tissues studied. Both the time and concentration transport were higher in SHR, e.g., an increment in the net-uptake of L-phe by vascular tissue. Conclusion A unique aberrant of metabolic kinetics of phe might be implicated in the inherited pathogenesis of EH and stroke both from clinical and animal studies. Chin Med J 2001; 114(8):799-802

Objective To evaluate the effectiveness of hepatic angiography and embolization in the diagnosis and treatment of hemobilia after hepatobiliary surgery. Methods Nine patients had upper gastrointestinal bleeding 7 days to 3 months after surgery. They underwent emergency hepatic artery angiography and were treated by embolization using Gelfoam particles only (8 patients) and Gelfoam particles plus microcoils (1 patient). Results Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, diffuse hemorrhage of the hepatic artery branches in 3, right hepatic artery-bile duct fistulas in 2, and hepatic artery-small intestine fistula in 1. Hemobilia was controlled with embolization in 7 patients, of whom 1 had recurrent bleeding 1 day after treatment. During the follow-up, 3 patients died of multiple organ dysfunction syndrome. Two patients whose hemorrhage could not be controlled due to technical reasons died several days later. Conclusion When hemobilia after hepatobiliary surgery is suspected, patients should receive hepatic angiography as a first diagnostic procedure and be treated with minimally invasive procedure of selective embolization of the involved artery as soon as possible. Chin Med J 2001; 114(8):803-806

Objective To construct a renal cell carcinoma (RCC) cDNA subtractive library using suppression subtractive hybridization. Methods Polyadenylated RNA [Poly (A)+ RNA] was isolated from tissues of RCC and normal kidney, and single-strand cDNAs and double-strand cDNAs were synthesized in turn. RCC cDNAs were divided into two groups and ligated to the specific adaptors I and 2, and then hybridized with normal kidney cDNA twice with two rounds of suppression PGR. Second round PGR products were cloned to T/A plasmid vectors to set up the subtractive library. One hundred clones were randomly picked to perform enzyme digest analysis, and some underwent sequence analysis and Northern blot to identify RCC specifically expressed genes. SMART RACE procedure was operated to clone full length novel RCC specifically expressed genes. Results A human RCC subtractive library with high subtractive efficiency was successfully set up. The amplified library contains 350 positive clones. Random analysis of 100 clones with enzyme restriction showed that 85 plasmids in the clones contained 50-400 bp inserts. Sequence analysis was performed for 10 clones. All the 10 sequences were unknown before and derived from 6 unique, novel genes among which the cDNA insert RCC18 had five copies. Northern blot analysis showed that RCC18 cDNA was highly expressed in RCC, but no signal could be detected in normal kidney. Using SMART RACE technique, we obtained the full length of the novel gene RCC18. Conclusions The constructed cDNA subtractive library of human RCC is a highly efficient one and lays a solid foundation for large scale screening and cloning new and specific oncogenes or tumor suppressor genes of RCC. The novel specifically expressed genes provided an important clue for studying the mechanisms of occurrence and development of RCC. Chin Med J 2001; 114(8):807-812

Objective To investigate the effect of immune cell from idiopathic nephrotic children on extracellular matrix (ECM) synthesis by cultured rat glomerular epithelial cell (GEO) and on the proliferation of mesangial cell (GMC). Methods Twenty-eight children with idiopathic nephrotic syndrome and 15 age-matched healthy children were randomly selected and divided into 4 groups: Group 1, untreated nephrotic children; Group 2, glucocorticoid treated nephrotic children; Group 3, children undergoing glucocorticoid treatment with negative proteinuria; and Group 4, normal control. The peripheral blood mononuclear cells (PBMC) were collected from these children and PBMC conditioned medium (PBMC-CM) were prepared. The PBMC-CM was co-cultured with GEC and GMC respectively. The concentrations of collagen, laminin, collagen Ⅲ and collagen Ⅳ in the GEC and PBMC-CM co-culture medium were investigated. The GMC proliferation was measured by the 3H-thymidin incorporation method. Results The 3H-proline incorporation coefficients of the GEC treated with the PBMC-CM of the 4 groups were 0.93, 1.24, 1.23, and 1.11, respectively. The laminin inhibitory coefficients of the 4 groups were 0.95, 1.02, 1.01, and 1.04, respectively. The inhibitory coefficients of collagen Ⅲ were 0.97, 1.00, 0.99, and 1.01, respectively, for the 4 groups. All these parameters showed a significant difference between Group 1 and the other 3 groups (P < 0.05). However, there was no significant difference in the inhibitory coefficient of collagen Ⅳ between each two of the 4 groups (1.04, 1.05, 1.04, 1.08, P > 0.05). The 3H-thymidine incorporation coefficients of GMC responsive to PBMC-CM were 1.21, 1.53, 1.50, and 1.10, respectively, and no significant difference was found between the 4 groups (P>0.05). Conclusion The results suggested that the circulating immune cells from idiopathic nephrotic children have a direct effect on some ECM component synthesis in cultured rat GEC; the bio-activity of immune cells could be neutralized by administering glucocorticoid; and the circulating immune cells of nephrotic children have no direct effect on GMC proliferation. Chin Med J 2001; 114(8):813-816

Objective To evaluate the biomechanical stability and the preliminary clinical efficacy of a self-designed anterior cervical butterfly-like locking plate fixation system. Methods The anterior cervical fixation system is composed of one butterfly-like plate and three types of screws made of titanium alloy (TC4, Ti6A14V) on the basis of unicortical screw fixation and point contact plate fixation. Biomechanical stability analyses of the system and Orion locking plate system (Sofamor-Danek Corp) were performed in fresh cervical spine specimens from 14 young male cadavers. Sixty-one patients with cervical discorders were stabilized with the fixation system. The mean age of the patients during surgery was 48.2 years (range 18 to 68 years). The diagnosis included spondylosis in 26 cases, cervical intervertebral disk protrusion in 14 cases, fracture and/or dislocation in 18 cases and tuberculosis in 3 cases. Results This anterior butterfly-like cervical plate fixation system holds similar biomechanical stability effects as the Orion system. Of the 61 patients who received the plate fixation system after anterior decompression and autologous interbody fusion, 48 were followed up for 6 to 10 months, and showed solid interbody fusion in 3 to 4 months. No early complications such as implant loosening or failure related to the fixation system were noted. Conclusion The anterior cervical plate fixation system can provide sufficient biomechanical stability to the cervical spine after anterior decompression surgery. Chin J Orthop 2001; 21: 205-208

Objective To study the relationship between apoE alleles and life-span. Methods Apolipoprotein E genotypes were determined in 164 unrelated Uygurs including 35 persons aged 90 years or older, 71 men aged 20-35 and 54 men with myocardial infarction by using polymerase chain reaction-restriction fragment length polymorphism. Apolipoprotein E gene polymorphism was analyzed among three groups. Results There was statistically significant difference in the ε4 allele frequencies among three groups. The ε4 allele frequency in olds was the lowest (0.057), while in patients suffering from myocardial infarction (MI) was the highest (0.213). In MI patients the average age of first attack in ε4 allele carriers was significantly younger than that of non-carries, 51.3 and 58.3 years, respectively (P < 0.05). Conclusion ApoE genotype may have some impact on human longevity. Chin Med J 2001; 114(8):817-820

Objective To determine the relative factors in predicting birth weight and to evaluate the usefulness of the fetal abdominal circumference measurement by ultrasound in prediction of macrosomia. Methods One hundred and forty-eight pregnant women whose sum of the fundus height plus the abdominal circumference was greater than 135 cm were chosen. The biparietal diameter (BPD), abdominal circumference (FAC), and femus length (FL) of their fetus within 3 days before delivery were measured by ultrasound. At the same time, the fundus height of the uterus, abdominal circumference, the gestational age, the body weight gain during pregnancy, and the body height of the mother were obtained. Stepwise multiple regression analysis was used to determine the relationship between birth weight and these factors. According to the birth weight, two groups were made, the macrosomic and nonmacrosomic groups. The characteristics of the two groups were compared. Results The best linear predictor of birth weight was ultrasound measurement of fetal abdominal circumference (FAC), whcih had a correlation coefficient of 0.85. An FAC of 36 cm or more can predict 82% of macrosomic infants. The cesarean section rate of the macrosomic group was 70.2%. Conclusions Fetal abdominal circumference measurement by ultrasound is the best predictor of birth weight among the parameters studied. FAC is useful in screening for suspected macrosomia. Chin J Perinat Med 2001; 4: 3-6

Objective To confirm previous effort to identify type 2 diabetes susceptibility genes in a Northern Chinese population by conducting a new genome scan with both an increased number of type 2 diabetes families and a new set of microsatellite markers within the previously localized regions. Methods A genome scan method was applied. After multiplexed PCR, electrophoreses, genescan and genotyping analysis, we obtained size information for all loci, and then a further study was done by both parametric and non-parametric linkage analysis to investigate the P values and Z values of these loci. Results We surveyed 34 microsatellite markers which distributed within 5 regions along chromosome 1, and a total of 12 000 genotypes were screened. Evidence of linkage with diabetes was identified for 8 of the 34 loci. All P values of the 8 loci were lower than 0.05, and the highest Z value was 2.17. A very interesting finding is that all 5 markers at the p-terminal 1 p36.3-1p36.23 region, spanning a long range of 16.9 cM, were identified to have a low P value of less than 0.05, which suggests that this region may contain multiple susceptibility genes. Regions 4 and 5 also confirmed the previous findings, and we narrowed these two regions to a 2.7 cM and 2.5 cM regions, respectively. Conclusions We further confirmed the results gained in the previous genome-wide scan using an increased number of NIDDM families and a new set of microsatellite markers lying within the initially localized regions. The fact that all 5 loci at the p-terminal region displayed a low P value of less than 0.05 suggests that more than 1 susceptibility gene may reside in this region. Chin Med J 2001; 114(8):876-878

Objective To observe the preliminary results of lower cervical spine instability following the placement of the AXIS lateral cervical mass plate. Methods The screw prick point, angle and depth were measured and defined on the lower cervical specimens. Twenty-two patients with lower cervical spine instability suffering from a variety of cervical spinal disorders were treated with the AXIS lateral cervical mass plate. Results The screw prick point was defined in the medial and lower 1-2 mm of the mass center. The arrow angle, horizontal angle and depth of internal fixation screw were 36 -54 degree (45°), 23-35 degree (29°)and 10.8-17.5 mm (14.5 mm), respectively. Twenty-two patients were followed up for an average of 10 months. No complication of the injury to the arteries or nerve endings was found. There was no loosening of the plate and screw. Nineteen cases had bone union. The spinal cord function of all patients improved to different degrees. Conclusion The AXIS lateral cervical mass plate is suitable for the treatment of lower cervical spine instability. Chin J Orthop 2001; 21: 201-203