1990年 · 第103卷第09期

Multiple organ failure (MOF) in the elderly is a new syndrome evolved from multiple organ chronic diseases on the basis of multiple organ dysfunction in the aged. Its characteristics are clinically different from those of MOF due to serious trauma. 122 cases of MOF were analysed retrospectively and their clinical features discussed. MOF with a long course is the natural presentation in many of the elderly before death. Its main precipitating factors are pulmonary infection, metastatic carcinoma, cardiac attack, etc. The sequence of a failure in organs is heart, lung, kidney, liver, etc. The mortality is similar to that of MOF due to trauma. However, those suffering from 4-organ failure can still survive, and instead, the renal failure can be mostly fatal. More attention should be paid to the prevention of MOF in the elderly so as to shorten its developing course.

Six malignant Brenner tumors of the ovary were studied electronmicroscopically. The histologic features of the tumors resemble to those of nonkeratinized squamous cell carcinoma of the uterine cervix. The ultrastructural features of malignant Brenner tumor included intracytoplasmic glands and cysts, presence of cilia, abundant glycogen, numerous desmosome-tonofilament complex, of which the cilium is most characteristic in the ovarian surface epithelium or Mullerian epithelium, but not in uroepithelium. Desmosome-tonofilament complex, the ultrastructure specific for the squamous epithelium, was not seen in the uroepithelium. We conclude that the appearance of cilium in malignant Brenner tumor indicates that the tumor is derived from the Mullerian epithelium, and that the presence of desmosome-tonofilament complex evidences that the tumor cells have differentiated into squamous epithelium. Our findings have proved that the malignant Brenner tumor arises from the Mullerian epithelium and recapitulates the vaginocervical epithelium.

The possibility of the combined effects on the alveolar macrophage cytotoxicity due to zinc and Ni-coal dust was studied. The parameters in the experiments were cellular ATP level in alveolar macrophage (AM), cellular K+ and Zn++ in AM and the surface morphological changes of AM. The experimental results showed that low zinc can protect the toxicity of Ni-coal dust on AM, and that the protective effects on the toxicity of Ni-coal dust by zinc are dependent on its dosage. The ATP level and K+ content in AM are sensitive indices in reflecting the cytotoxicity and can be used in detecting environmental toxic substances.

The plasma endothelin (ET) level in spontaneously hypertensive rats (SHR) and 2K1C hypertension animal models and its vasoconstrictive effect on renal and tail arteries were studied. The results demonstrated that there was no difference in plasma ET level between the hypertensive groups SHR, 2K1C, normotensive control groups Wistar Kyot (WKY) and Sprague Dawley (SD), while the vasoconstrictive effect of ET in SHR was more dominant than in WKY. The EC50 of the renal and tail arteries in SHR (0.8912±0.1662×10-8 M, 0.6103±0.0878×10-8 M) was apparently lower than that in WKY (1.77±0.2991×10-8 M, 1.2267±0.2502×10-8 M, P less than 0.05), but no difference was found in 2K1C and SD rats. The four groups of animals exhibited no difference of such effects as response to norepine-phrine (NA). The findings suggested that the increased arteriole sensitivity to ET be an important factor in the pathogenesis of hypertension in SHR.

The incidence of uterine cervical carcinoma, though decreasing in many cities of China, dose not show any diminution in the rural areas where it appears to be high in some regions. Therefore, radical hysterectomy is particularly important for the patients with cervical adenocarcinoma and squamous adenocarcinoma which are insensitive to chemotherapy and radiotherapy. The operation is effective in the treatment of early cervical carcinoma and even late carcinoma when the procedure is combined with extraperitoneal radical lymphadenectomy, radiotherapy and chemotherapy reinforced by the traditional Chinese medicine. This operation gets rid of technical difficulties in manipulating the deep pelvic cavities of obese patients, and is suitable for those patients with general weakness, heart and renal diseases, hypertension, severe tuberculosis complicated by the poor tolerance of the abdomen or fear to transabdominal procedures. The detailed procedures of the operation and its results are described.

Ventricular myocytes from neonatal Wistar rats were cultured with 80% Dulbecoo's modified Eagle medium and 20% fetal bovine serum. An appropriate amount of xanthine and xanthine oxidase was added to the culture medium to increase the content of free radicals in cardiac cells. Variation in action potential and input impedance of cardiac myocytes indicated the oxidative damage to the membrane. The ultrastructure of heart cells, characteristically the myofilaments and mitochondria, was damaged. Electron spin resonance measurement demonstrated that xanthine and xanthine oxidase elevated the free radical content, while selenium (Se) and manganese (Mn) reduced the free radicals in cultured heart cells. Supplementation of 0.173 microgram/ml Se and 0.1 microgram/ml Mn into the culture medium separately or simultaneously antagonized the damage induced by xanthine and xanthine oxidase. The possible mechanism might be the production of superoxide anion free radical leading to free radical damage to cardiac cells. Se and Mn might play a role as scavengers through glutathione peroxidase and superoxide dismutase respectively and thus protect cardiac cells from free radical damage.

Using spectrophotometric method, we studied the activities of serum alpha-L-fucosidase, N-acetyl-beta-D-glucosaminidase and alpha-D-mannosidase in 94 patients, of whom 32 had acute hepatitis, 4 subacute fulminant hepatitis, 27 chronic active hepatitis, 22 posthepatitic cirrhosis and 9 hepatocellular carcinoma. In comparison with normal controls, the activities of the three glycosidases in the patients were significantly increased. The degree of the elevation of alpha-L-fucosidase activity correlated to the clinical phases and the course of acute infection of hepatitis B virus (HBV). The levels of glycosidase activities could reflect to a certain degree the pathological variations of the liver. Monitoring the levels of glycosidase activities, especially alpha-L-fucosidase, would be helpful in the diagnosis and medical care of viral hepatitis and hepatocellular carcinoma.

Capsulotomy in primary Salter's osteotomy shaped by T or + and is difficult to tighten joint capsule. A new technique or L-shaped incision i.e., a L-shaped incision on the right hip and a reversed L-shaped incision on the left is designed to incise and sew the capsule. This technique can make the acetabulum fully exposed, and the capsule can be conveniently tightened with overlapping sutures. When it is combined with modified external fixation, redislocation after operation can be avoided.

From May 1985 to May 1988, 55 patients with scoliosis were given interspinous process segmental spinal instrumentation with bone button-wire. The Harrington distraction rod and Luque's rod were placed separately in the concave and convex sides of the curvature fixed with bone button-wire. The fixations were subjected to biomechanical analysis, and the patients were followed up for an average of 18 months with satisfactory results. The curves were corrected from 69.4° to 33.2°, with a corrective rate of 47.8%. The merits of this procedure lie in (1) no injury to the spinal cord and minimal neurological complications, (2) strong fixation for correcting deformities, and (3) minimal blood loss and short time for operation.

An innovated composite treatment for intra-articular fracture of the calcaneus has been developed. A Steinmann's pin is introduced into the calcaneus percutaneously to release the impaction of the fragments and to lift the compressed subtalar joint facet, which forms a potential cavity in the calcaneal body facilitating restoration of Bohler's angle and correction of widening of the calcaneus by manual reduction. A new type external fixation device, the calcaneus fixation boot, is used to substitute for the traditional plaster immobilization. The boot can exert continuous centripetal pressure on both sides of the calcaneus to control transverse displacement and to maintain the normal height of the heel. The patient is allowed to do functional exercises 24 hours after reduction with the aid of the spring stepping roller, which not only helps dissipate swelling in the early stage but also remold the articular facet. Biomechanical determination showed that the power of triceps surae muscles returned to nearly normal in 4-5 weeks. The patients were allowed to bear weight with crutches in 6-7 weeks. In this series, 94 (87.8%) of 107 cases with an average follow-up period of 2 years and 9 months attained excellent and good results.