1990年 · 第103卷第08期

Microlaryngoscopic operations were performed on 300 cases of very small lesions of the vocal cord from October 1985 to December 1987 under high frequency ventilation (HFV) and compound venous anaesthesia. 233 cases were followed up for at least 1 month after operation. Among them, 91% recovered completely or improved significantly. The indications, contraindications, anaesthesia, surgical procedures, complications, results, merits and disadvantages of the microlaryngoscopic surgery were discussed in detail.

This study denotes that MRI is a valid imaging modality in the differential diagnosis of mass lesions in the liver. From the different prolongation of T2 relaxation time, it is possible to differentiate benign and malignant liver masses. Cavernous hemangioma and cyst present high signal intensity on heavily T2 weighted images whereas hepatoma and liver metastasis show moderate signal intensity. Quantitative study, including T2 value calculation and tumor mass/liver ratio, is a complementary measure for the differential diagnosis of liver mass lesions. Active and passive maneuvers to restrict the abdominal respiration for the preparation of patients before MR scanning are simple and effective approaches to reduce the respiratory motion artifacts.

Angiographic features of the pulmonary artery were studied in 24 patients with aortoarteritis (Takayasu's arteritis) by digital subtraction angiography. The pulmonary artery involvement was found in nine cases (37.5%). The right side was involved in eight and the left side in five cases. The right pulmonary artery was involved in two cases, the lobar artery in six, the segmental artery in six, and subsegmental as well as peripheral branches in four. The angiographic features were stenosis and/or occlusion as were the changes of the systemic arteries in aorto-arteritis. The aorta and its main branches were involved in all nine patients, but the severity of pulmonary vascular changes was not always related to the systemic vascular changes. Bronchial angiography demonstrated enlarged and tortuous bronchial arteries in four cases. Lung ECT revealed abnormalities in four cases.

Berberine was evaluated for antitumor activity against malignant brain tumors. In addition, studies on combination of berberine with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) were done. Several experimental approaches were used. In vitro studies were performed on a series of 6 human malignant brain tumor cell lines and rat 9L brain tumor cells (gliosarcoma) by using a colony forming efficiency (CFE) assay. 9L was also evaluated by a sister chromatid exchange (SCE) assay. In addition, in vivo treatment of intracerebral 9L solid brain tumors was analyzed by CFE assay. Berberine used alone at a dose of 150 μg/ml showed an average of 91% cell kill (1.08 log kill) for the 6 malignant brain tumor cell lines. On the average, BCNU alone at a dose of 23 μM gave a 43% cell kill (0.24 log kill). Treatment with a combination of berberine and BCNU at 23 μM showed additive effects with an average of 97% cell kill (1.55 log kill). The relative number of SCEs for 9L cells was increased 2.7 times over background following in vitro treatment with 150 μg/ml berberine. Following in vivo treatment of animals harboring solid 9L brain tumors with 10 mg/kg of berberine, an 80.9% cell kill (0.69 log kill) was noted. This activity is equivalent to treatment with 1/3 LD10 dose of BCNU (4.44 mg/kg). In vivo combination treatment with berberine and BCNU showed additive cytotoxicity. Using a BCNU-resistant 9L subline (9L-2), treatment with berberine in combination with BCNU also demonstrated additive cytotoxicity. In conclusion, our results indicate that berberine has potent antitumor activity against human and rat malignant brain tumors. This agent deserves further laboratory study and possibly clinical investigations for the treatment of malignant brain tumors in human.

The effects of low-dose estrogen and progestogen on menopausal symptoms were studied with Kuppermen score and urinary excretion of calcium as fasting morning urine Ca/Cr ratio in 69 perimenopausal women. The subjects were divided into 3 groups: amenorrhea less than 1 year (14 women); post menopause 1-3 years (19); and post menopause more than 3 years (36). Fasting urine Ca/Cr ratio in the post menopause 1-3 years group was 0.19±0.01, significantly higher than that (0.14-0.01) in the amenorrhea less than 1 year group and (0.11±0.006) the post menopause more than 3 years group. 18 women had 4 patterns of low-dose oral estrogen and progestogen: MPA 2 mg QOD, EE 5 μg QD, EE 5 μg QOD, and EE 5 μg and MPA 2 mg QOD. Each pattern was used in turn for 3 weeks, and discontinued for 2 weeks, then the next pattern started and so on. EE 5 μg and MPA 2 mg QOD alternately gave the best results both in improving symptoms and lowering urine Ca/Cr ratio. Seven women given intermittent large dose, namely, EE 50 μg every 10 days or premarin 2.5 mg every 7 days had symptoms relieved but inconsistent decrease of urine Ca/Cr ratio.

Chronic cervicitis was shown to be related to papillomavirus type 16(HPV-16), herpes simplex virus type 2 and cytomegalovirus (CMV) infections as demonstrated by DNA hybridization technique and virus isolation method from samples taken from erosive and normal cervices. After one course of treatment with recombinant interferon alpha 1 (rIFN-α1), 93.8% of cases showed clinical improvement and 60% marked improvement. The HPV-16 and HSV detection rates dropped down significantly after rIFN-α1 treatment as compared with those before treatment. Astragalus membranaceus, a Chinese herbal drug, was shown to be synergic to interferon therapy.

Measurement of luminol-dependent chemiluminescence (CL) was employed to estimate the generation of reactive oxygen species (ROS) in polymorphonuclear leukocytes (PMN) in patients with latent iron deficiency. There were no differences in the resting value of PMN CL among 20 patients with iron deficient erythropoiesis (2.92+0.38 number of pulses) and 20 normal controls (3.07+0.52; P greater than 0.05), but a significant decrease of peak value of PMN CL was observed in patients (45.82+7.41) as compared with controls (76.08+10.12; P less than 0.01). CL production by PMN in 6 patients with storage iron depletion was similar to that of 6 healthy controls. As a good correlation was found between the peak value of PMN CL and free erythrocyte protoporphyrin (FEP) level, increase of FEP could serve as a clinical indicator in the evaluation of decrease of ROS generation in PMN of patients with iron deficiency. Oral iron supplementation could effectively improve the impaired PMN ROS generation.

Preoperative B-mode ultrasonograms of the biliary system in 302 patients with cholelithiasis confirmed operatively between March 1981 and December 1986 were analyzed retrospectively in contrast to the operative findings. The results showed that during 1985-1986 the sensitivity of ultrasonography (US) to detect stones in gallbladder (GB), extrahepatic bile duct (EHD) and intrahepatic bile duct (IHD) was 98.4%, 68.2% and 82.4% respectively, each was much higher than its counterpart during the periods 1981-1982 and 1983-1984 (P less than 0.01). The specificity of US in detecting GB, EHD and IHD stones was all over 90% during the latter two years. The observations made in the present study suggest that the accuracy of US has risen so significantly that it should be used as the first modality in diagnosing cholelithiasis, particularly cholecystolithiasis. It, however, should be supplemented with such tests as oral cholecystography, intravenous cholangiography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) to establish a correct diagnosis when its interpretation is equivocal.

Postoperative choledochofiberscopy was performed in 188 patients with retained biliary stones and recurrent lesions. The following entrances to the biliary tract for choledochoscopy were used: the T-tube tract (129 patients), an afferent jejunal limb of a choledochojejunostomy (43), the jejunostomy tube tract of an efferent limb (12), an U-tube tract (2), and a ductal fistula after segmental liver resection (2). 380 choledochoscopic sessions were carried out, 2 sessions on the average for each patient. The overall success rate of stone removal was 90.5%. No mortality was related to this procedure. Eleven patients developed fever and chills after manipulations but all responded to antibiotics. Two patients had perforation of the T-tube tract during the removal of stones and were reoperated on for abdominal drainage. They recovered eventually. Stone extraction with a flexible choledochoscope is a proven procedure. For residual intrahepatic stones, however, a satisfactory entrance into the biliary tree should be provided for subsequent stone removals. We believe that the jejunostomy tube tract of an efferent limb of an afferent jejunal limb of a choledochojejunostomy is a useful entrance for choledochoscopy because it is permanent in meeting therapeutic demands.

A simple method was established for the separation and identification of serum cholinesterase (SChE) isozymes by using gradient polyacrylamide gel electrophoresis and densitometric scanning. With this method, SChE isozyme patterns of 39 healthy adults and 232 patients with liver diseases were studied. 9 to 11 bands of SChE were demonstrated in healthy adults. The activities increasing in Band 1 and decreasing or disappearing in Bands 2, 3, 4 and 5 were found in most patients with liver diseases in comparing with the control. It showed that the activity decreasing is correlated closely with the severity of liver diseases.

A case of pulmonary infarction presenting as aseptic cavitation was reported. Basically, the patient suffered from rheumatic heart disease, mitral stenosis and insufficiency, and atrial fibrillation with predominant right heart enlargement. Hemoptysis, chest pain and dyspnea were present. Chest film simulated a thin wall lung abscess. The clinical picture suggested aseptic cavitation, which was confirmed by 99mTc-MAA lung scan.

A 68-year-old male patient with Hallervorden-Spatz disease with autopsy findings is presented. He died 5 years after the occurrence of progressive rigidity, mask face, shuffling gait and tremor. Family history was negative. At autopsy, loss of neurons with gliosis in the globus pallidus and substantia nigra, large deposits of iron pigments and axonal spheroids in the same areas were found. So far as we know, this is the first case of Hallervorden-Spatz disease with autopsy findings reported in China.