1990年 · 第103卷第03期

We studied the clinical characteristics and long-term follow-up of 5 patients with choroidal osteoma. All the patients but one were female. The choroidal lesions were unilateral in 3 patients and bilateral in 2. During the follow-up, the lesions enlarged somewhat, but the progression was very slow and inconspicuous. Clinical diagnosis and treatment are briefly discussed.

From 1981 to 1985, omental autotransplantation was performed for 28 patients with thromboangiitis obliterans on the left lower extremities in 16 patients, the right ones 11, and the right upper limb 1. The early results in all patients were satisfactory. In 19 patients followed up from 1 to 4 years, the results were encouraging, with the improvement of symptoms after operation. In 18 patients, digital ulcers healed within 2-4 weeks. Doppler and electrical impedance plethysmography examinations showed the blood circulation of affected extremities was markedly improved in the 18 patients except one who had the recurrence of digital ulcer 2 years later. In one of the 19 patients the disease recurred one month after the operation, and a lumbar sympathectomy was performed. The indications, the operative technique, and the mechanism of this operation are discussed.

We treated 52 patients with anal and low rectal carcinomas by orthotopic reconstruction of the anus, using an unilateral split gluteus maximum (GM) muscle flap to form the external anal sphincter and levator ani together with invagination of the colon to form the internal sphincter after radical resection of carcinoma. Among the 36 patients who were followed up for over 6 months, 34 (94.4%) exhibited good to excellent continence.

An animal model of coronary artery spasm-coronary thrombosis-acute myocardial infarction (CAS-CATH-AMI) was obtained by injecting ergonovine(0.22 mg/kg) directly into the left coronary artery (LCA) of 17 dogs under general anesthesia. Various parameters of the experimental group were compared with those of the control group consisting of 5 dogs. The following changes were observed: increased average arterial blood pressure (MAP), pulmonary capillary wedge pressure (PCWP), stroke volume (SV, P less than 0.05), PAP (P less than 0.01) transient decreased cardiac output (CO); elevated ST-T in EKG; ventricular arrhythmia in 60% of animals; transient spasm of 50%-75% of LCA in the LCA angiographs; enhancement of platelet aggregation and TXB2 (P less than 0.01) and decline of 6 Keto-PGF1 alpha, SAO2 (P less than 0.05), indicating acute hypoxia and high coagulating pathophysiological changes after CAS. Pathological examination one hour after CAS induction revealed CATH(53%) in addition to CAS induced morphological changes of the CA and myocardium, as well as necrosis of the corresponding sites in its early stage. This study provides a reproducible animal model of CAS-CATH-AMI for research of coronary heart disease and pathomorphological criteria for the diagnosis of CAS. It also shows that CAS may lead to CATH-AMI, therefore, prevention of CATH and AMI is possible.

The hepatoma-specific band of serum gamma-glutamyl transferase II (GGT II) and other three markers were evaluated in 77 patients with primary hepatocellular carcinoma (PHC). The positive rate of GGT II (87%) was much higher than that of the increased α-fetoprotein (AFP greater than or equal to 400 ng/ml, 54.5%), the increased α-1-antitrypsin (AAT greater than or equal to 400 mg/dl, 64.9%) and alkaline phosphatase isoenzyme I (ALP I, 13.0%). In patients with AFP less than 400 ng/ml, the positive rate of GGT II was 95.2%, higher than that of ALP I (22.8%) and AAT (60.0%). The positive rate of GGT II was positively correlated to the volume of PHC (r=0.324, P less than 0.05), but even in patients with small PHC (less than or equal to 65 cm3), the positive rate of GGT II (78.6%) was higher than that of AFP (50.0%) and AAT (28.6%). The ALP I positivity was only seen in patients with larger PHC. Follow-up study showed that GGT II, like AFP, might occur before liver tumor could be detected by B-mode ultrasonography and computerized tomography. Therefore, GGT II is a valuable marker of PHC, especially in patients whose AFP was negative or slightly increased; GGT II may be useful for relatively early diagnosis of PHC.

The immunologic phenotypes of 12 cases of nonepidermotropic cutaneous T-cell lymphoma are reported. All cases consisted of mature peripheral T-cells. There were 9 cases of helper T-cell (Th) phenotype and 2 cases of suppressor T cell (Ts) phenotype. One case, however, expressed both the Th and Ts phenotypes. Two separate cases displayed OKT9 positivity. OKT6 positive lymphoid cells were found in the dermis during the early and late stages of the disease. We suggest that these OKT6 positive cells should represent a dermal infiltrate of Langerhans cells of immature T-cells.

Clones of hepatitis B surface antigen-reactive CD8+ and CD4+ T cells were obtained from peripheral blood mononuclear cells (PBM) of a hepatitis B immunized individual whose PBM proliferated when cultured with hepatitis B surface antigen (HBsAg). Lymphocytes were activated by culturing for 2 weeks with HBsAg and high concentrations of interleukin-2 (IL-2), then cloned in the presence of irradiated HBsAg-activated PBM and autologous Epstein-Barr virus (EBV)-transformed B cells, together with antigen and IL-2. All clones examined proliferated in an antigen-specific manner. Of 7 clones examined by flow cytometry, 4 were CD4+, CD8-; and 3 were CD4-, CD8+. Several clones produced IL-2 activity after stimulation with hepatitis B surface antigen. Since development of CD8+ T-cell clones specific for soluble antigens is difficult, the high frequency with which CD8+ cells were cloned in these experiments suggests that the cloning strategy employed might have general use for development of CD8+ clones. Availability of hepatitis B virus specific T cell clones of different phenotypes may help elucidate mechanisms of immunotolerance in hepatitis B infection.

The effects of prostaglandin E1(PGE1), prostaglandin synthesis inhibitor and indomethacin (IN) on the growth and metastasis of Lewis lung carcinoma (LLC) were studied and their mechanisms of action were investigated. Seventy-five C57BL mice of both sexes were utilized in the experiment. It was found that both PGE1 and IN could significantly retard the growth of transplanted LLC and reduce the number of pulmonary metastatic foci. PGE1 obviously decreased the acid phosphatase (ACP) activity of LLC cells while IN showed no such effect. Besides, PGE1 could markedly elevate the plasma cAMP level of LLC-bearing mice, but not normal controls. Meanwhile, it could decrease plasma cGMP concentration of both normal and tumor-bearing mice. IN, like PGE1, could increase plasma cAMP and decrease plasma cGMP levels of LLC-bearing animals. TEM observation revealed that tumor cells treated with PGE1 and IN presented a series of degenerative and destructive changes. In addition, PGE1 and IN exhibited a different effect on several cell-mediated immune responses of the tumored hosts, the former inhibitory and the latter stimulatory. The possible mechanisms of action of the two chemicals are discussed.

A dog model was used to measure the hemodynamic changes in acute pancreatitis (AP) caused by intraductal injection of fresh trypsin-bile mixture and to investigate the efficacy of dopamine in the treatment of AP. Dopamine was administered intravenously for 3 hours at a dose of 0.6 mg/kg/hour starting 10 min after the induction of AP. Hemorrhagic pancreatitis was characterized by a fall in cardiac output (CO), systemic arterial pressure (SAP), an increase in pulmonary vascular resistance (PVR), systemic vascular resistance (SVR) and the development of early reduction of pancreatic blood flow (PBF). Administration of dopamine produced a significant increase in PBF and leads to a normalization in CO, SAP, PVR and SVR. In addition, dopamine significantly reduced the severity of the AP, as assessed by histological staging and mortality rate. These results suggest that dopamine can limit the progression from edematous to hemorrhagic pancreatitis and prevent irreversible pancreatic damage through preserving PBF at the early phase of AP.

The plasma concentration of gamma-aminobutyric acid (GABA) was measured by radioreceptor assay in galactosamine (GalN)-induced Wistar rat model of fulminant hepatic failure (FHF). The results of sequential observations in 10 FHF rats showed that the plasma GABA concentration doubled 24 hours after GalN injection, while there was no obvious clinical evidence of hepatic encephalopathy (HE). In overt HE 48 hours after the administration of GalN, the plasma concentration of GABA reached the peak value of 9,744±1,661 pmol/ml, which was 12 times as high as that before GalN injection. The consciousness, plasma concentration of GABA and SGPT activity became normal 120 hours after GalN injection. It is suggested that determination of plasma concentration of GABA is of value in the diagnosis of HE.

The autopsy findings of two cases of disseminated histoplasmosis capsulatum are reported here. The pathologic changes involved multiple organs, such as lungs, liver, spleen, kidneys, thymus, and deep and superficial lymph nodes. The main pathologic features were caseous necrosis and macrophage infiltration, which engulfed numerous histoplasma in yeast form. In the first case, the colon and skin were also attacked by histoplasma capsuli, as was the head of pancreas in the second case. Acute regression of the thymus was found in both cases.