1990年 · 第103卷第10期

From the femoral heads of nine cases of advanced osteoarthritis of hip joint, three categories of granulation tissues with different colors (bright red, dark-red and white granulation tissues) and texture were obtained. After processing, the specimens were observed under scanning electron microscope and transmission electron microscope. With transformation of the granulation tissues from bright red to white, the collagen fibers therein contained gradually changed from fine to thick ones. Nevertheless, the cellular components in these three types of granulation tissues always possessed the characteristics of both fibroblasts and chondrocytes, i.e., fibroblastic configuration with pericellular Type I collagen fibrils bearing 64 nm periodicity; and chondrocytic scallop-shaped cytoplasmic membrane with intracytoplasmic fat droplets and glycogen granules and pericellular Type II collagen fibrils. All these indicated that in osteoarthritis of hip joints, the granulation tissues of the femoral heads transformed eventually into fibrocartilage, irrespective of their color and texture.

ATPase-stained normal and topical nitrogen mustard treated Langerhans cells (LC) in guinea pig epidermis were studied quantitatively and morphologically by computerized image analysis. Significant correlation and linear regression were found between the perimeter and square root of its area for both cytoplasm and nucleus; a theoretical basis was thus given for morphological identification of LC. The directly measured and derived geometric parameters indicated not only substantial alteration of cytoplasm morphology of post-treated LC such as cytoplasmatosis and dendrites reduction but also a potential change of nuclear size and functional status. We conclude that quantitative morphological analysis is an objective, precise and practical method for LC research.

198 preterm delivery placentas of 28 weeks to less than 37 weeks pregnancy were analyzed. Gross examination revealed that the differences of placenta previa and low implantation (2.91%), bipartate placenta and rupture of marginal sinus (0.97% respectively), large placenta (2.91%), short cord (4.85%), velamentous insertion of cord (3.88%), etc in comparison with those of term delivery placentas were statistically significant. Microscopic examination of 165 placentas showed that in 19 cases (11.52%) of infection of membranes and umbilical vessels, 11 were due to premature rupture of membranes or cervical interventions and 8 to preterm delivery. Among 72 cases of PIH, 65 (90.28%) had arteriopathy of decidua capsularis. 18 cases (25%) which had not been diagnosed clinically as PIH were found to be neglected after discovery of arteriopathy of decidua capsularis by pathologic examination. Placental examinations showed that preterm delivery may be attributable to the factors of placenta, amniotic fluid and umbilicus. 20 cases (27.78% of total PIH) of premature rupture of membranes were complicated by PIH. Whether the cases of decidual arteropathy are liable to have rupture of membranes awaits further investigation.

Different methods of ovum pick-up were used in an IVF program from January 1, 1988 to January 31, 1989. In the initial stage of the program, laparotomy ovum pick-up with surgical treatment of pelvic diseases resulted in two cases of clinical pregnancy in 1987 with full-term delivery of two healthy babies. Transvaginal ovum pick-up with a needle using an ultrasonic endovaginal transducer was started in late 1987. In 1988-1989 the transvaginal method was employed more frequently than laparotomy, and it has become a routine practice in the IVF program. The ultrasonic endovaginal approach seemed to give a low ovum recovery rate (70.99%), but the fertilization rate was high (85.10%, P less than 0.05), and the rate of embryo transfer was 89.33%. The average number of pre-embryo per transfer was 2.26. These figures were quite similar in the two groups. The ultrasonic transvaginal approach for egg retrieval was noninvasive, easily accepted by patients. We suggest that it can be done repeatedly on one patient to improve the cumulative pregnancy rate. However, the laparotomy for ovum pick-up has shown some special merits and is still indicated in some cases.

An adult case of metachromatic leukodystrophy, proved by characteristic findings of the brain and superficial sural nerve biopsies, but with absence of deficiency of arylsulphatase A activity in the leucocytes, was reported. The long course of thirty years, the absence of deficiency of arylsulphatase A activity, the discrepancy between the normal conduction velocity of the peripheral nerves and the typical pathological findings of the superficial sural nerve under the light and electron microscopes and the significance of the diffuse hypodense areas and high intensity signals of the cerebral white matter on CT and MRI respectively, were discussed.

From November 1986 to February 1989, 18 patients with traumatic carotid-cavernous fistulas were treated by means of detachable balloon, which was made by ourselves. Successful embolization was achieved in 15 patients. Draining features of the fistulas and methods of embolization were introduced. The method was compared with other methods. Selection of treatments and problems in embolization are discussed.

The Ph1 translocations were observed in 43 of the 51 patients with chronic myeloid leukemia (CML). Of the 43 patients with Ph1 chromosome, 19 (45%) had other structural abnormalities. Complex translocations were observed in 5 patients (12%). Twenty-eight patients with Ph1-positive CML have been followed up genetically.

Using flow cytometry (FCM), we measured the DNA content of bone marrow from 25 patients with acute leukemia (AL) in complete remission (CR) and followed them up for 0.5 to 1 year. Five of 13 patients in early relapse had normal DNA index (DI), while the remaining 8 showed DNA aneuploidy 1.5 to 5 months (mean 2.6 months) before relapse. The relapse rate was higher in CR patients with DNA aneuploidy (88.9%) than in those with normal DI (31.3%, P less than 0.05). Intensive chemotherapy was helpful to prolong CR duration in CR patients with DNA aneuploidy. DNA measurement by FCM was considered a reliable method for detecting minimal residual disease (MRD), and the appearance of DNA aneuploidy might predict a relapse of CR.

This article sums up the histochemical and immunohistochemical study of 55 cases of gastric carcinoma and 21 controls with benign gastric lesions. The results showed most of the adjacent mucosa of gastric carcinoma developed incomplete type intestinal metaplasia (IM). The percentage of Type IIb (ie, secreting sulphomucin) reached 72.5%. In most cases, high iron diamine (HID) rose in cancerous tissue and concomitantly in the IM epithelium of the adjacent gastric carcinoma. The phenomena of separation condition of HID+ in cancerous tissue, HID- in IM epithelium surrounding carcinoma, or HID- in cancerous cell but HID+ in IM of the surrounding epithelium of carcinoma, were much fewer. The two kinds of mucin antigen distribution were observed simultaneously. In the control and gastric carcinoma groups, neither large intestinal mucin antigen (LIMA) nor small intestinal mucin antigen (SIMA) could be detected in the normal epithelium of gastric mucosa. SIMA was mainly found in the goblet cells of IM and the mucous cells of columnar epithelium, while LIMA was mainly present in the columnar cells, in luminal border and/or in goblet cells. LIMA in the carcinoma group is apparently higher than that in the controls. The percentage of LIMA+ in the IM epithelium of adjacent gastric carcinoma and that in carcinoma cells were also raised in most cases. All these demonstrated a close relationship between IM and gastric carcinoma. Our results also showed that not only HID+, but also LIMA+ may represent a precancerous lesion in gastric carcinoma.

Monoclonal antibody defined antigen (CA19-9), carcinoembryonic antigen (CEA), ultrasonography (US) and computerized tomography (CT) were carried out as the tests in 113 patients suspected to have pancreatic cancer. Of 98 patients who underwent operation, 55 were found to have pancreatic cancer, 25 benign pancreatic disease, and 18 cancer of the biliary tract. Follow-up study was carried out for more than 1 year in 15 other patients suffering from pancreatitis without surgical intervention. The accuracy of CA19-9, US, CEA and CT was 87%, 69%, 61% and 56% respectively. The sensitivity of each test was CA19-9, 98%; US, 89%; CT, 80%; and CEA, 38%. The sensitivity of parallel test combined with CA19-9 and CEA was 100%. It may be regarded as the first step to detect pancreatic cancer in suspected population. The specificity of each test was CEA, 82%; CA19-9, 76%; US, 50% and CT, 40%. And the specificity of serial tests combined with CA19-9 and US was 90%. When these two tests were both positive, pancreatic cancer was highly suspected.