1991年 · 第104卷第03期

Five cases of pseudoxanthoma elasticum (PXE) found in one family are reported. The hereditary pattern is probably of autosomal dominant type 2. In the fundi of all the 5 cases, mottlings of the retinal pigment epithelium or orange skin-like lesions in both eyes which are of significant diagnostic importance are seen. The fundus changes are more prominent when skin lesions are typical. Under electron and light microscope, the pathological changes of clinically typical and atypical lesions show similar characteristics of this disorder. Remarkable calcification of elastic fibers with abnormal contour and fragmentation, destruction of mitochondria of fibroblasts and a great number of mast cells leaning against fibroblasts are the chief findings in the histochemically stained specimens. The pathogenetic mechanism of this disorder is possibly dystrophy of elastic fibers with its inherent nature of being easily calcified. Involvement of autoimmune factors in the pathogenesis is quite possible.

Eighteen cases of cutaneous germinal center cell-derived lymphomas (CGCCL) were classified into 3 types according to Kiel classification: centrocytic lymphomas (CC), 7; centroblastic-centrocytic lymphomas (CB/CC), 9; and centroblastic lymphomas (CB), 2. The duration of the disease was 3-14 months (median 9.5 months) after the first admission. In all cases, monomorphous cutaneous nodules were found as the initial manifestation of the disease. Twelve cases of CGCCL, especially those of CB and CB/CC, initially presented with normochromic anemia, a finding which is helpful in the diagnosis of the disease. Cytomorphologically, CB tumor cells were easily identified, white CC cells were hard to distinguish from the cells of nonepidermotropic cutaneous T cell lymphoma. In many cases, however, electron microscopic examination and cytochemical stains of skin biopsy tissue imprints are useful in diagnosing CGCCL. Immunoenzyme labelling (ABC method) with monoclonal antibodies indicated that B1, K and λ positivity are very important markers for CGCCL. Our findings also showed a higher percentage of rK type in CGCCL as compared to the Western countries.

Between February 1989 and May 1983, 172 patients with esophageal carcinoma were given radiotherapy. They were randomly assigned to an accelerated hyperfractionation group and routine fractionation group. There was no statistically significant length of survival difference between these two groups at 1, 3 and 5 years. Therefore accelerated hyperfractionation is useful for its economy of duration and cost.

The presence of meconium-stained amniotic-fluid (MSAF) during labor in cephalic presentation is a potentially ominous sign of fetal distress and, a direct cause of meconium aspiration syndrome (MAS). The authors designed a new method of intrapartum amnioinfusion for replacement (IAR) of the MSAF with normal saline solution. A total of 177 parturients with MSAF were studied from July 1986 to January 1987. Seventy-three cases receiving IAR treatment were analysed and 104 cases treated routinely served as controls. The newborn infants receiving IAR treatment had a significantly lower incidence of neonatal asphyxia (P less than 0.001) and MAS (P less than 0.05). No neonatal death occurred in the treated group; whereas, three infants died in the controls. There was no significant difference in puerperal morbidity between these two groups. The results of this study suggest that IAR might be a hopeful and effective treatment for parturients with MSAF in reducing the incidence of MAS.

From June 1973 through November 1988, fifteen cases of ovarian pregnancy were admitted to the Shanghai First People's Hospital. All these cases met the four criteria for the diagnosis as listed by Spiegelberg. The incidence of ovarian pregnancy as compared to those of normal and ectopic pregnancy are 1:3 179 and 1:28.1, respectively, which are higher than foreign data reported. Ovarian pregnancy is quite similar to tubal pregnancy in clinical manifestations. Etiological analysis does not reveal any close relationship with inflammation of the female genital tract. However, application of IUD increases the risk of ovarian pregnancy. The principle of management is wedge resection of the diseased ovary.

The corresponding antigens of MG series monoclonal antibodies (MG5, MG9, MGd1 and MGe1) against gastric cancer were purified and partially characterized. Each of these monoclonal antibodies was purified by passing through a DEAE-52 cellulose columns and covalently coupled with CNBr-activated sepharose 4B successively. By means of concanavalin A and antibody affinity chromatography, the corresponding antigens of MG series McAb were extracted from gastric cancer tissue respectively. Immunological and biochemical studies confirmed that the corresponding antigens of MG series McAb were a new group of gastric cancer associated neutral glycolipid and glycoprotein antigens.

The authors had designed cervical root nerve transfer from the contralateral normal side for the treatment of brachial plexus root avulsions in August 1986. Since then, the operation was performed in 50 cases. Follow-up studies showed that resection of C-7 root from the healthy side produced no long-term ill effect except numbness and pain of the fingers and weakness of gripping strength shortly after the procedure. In 10 recipient nerves of 9 cases with follow-ups of more than 2 years, satisfactory results were seen in 7. This is a new approach for the treatment of persistent cases of brachial plexus avulsion.

It has been shown in a rat model that surgical injury to the right cerebellum with resultant ataxia can be corrected by implantation of embryonic cerebellar tissue into the injured cerebellum. Histological examinations of the cerebellar tissue revealed that mitoses of Purkinje cells of the implanted group were increased substantially over the control group's. The surgically induced ataxia resolved more rapidly in the cerebellar implant group than the control group. Based on this experimental data, a similar technique was applied in 6 patients with severe hereditary cerebellar degenerative ataxia. The preliminary results in these 6 surgically implanted patients with heredity degenerative cerebellar disease show 2 with marked improvement, 3 with moderate improvement and 1 with improvement for 2 months followed by mild deterioration but still better than presurgery. We also studied immunological markers in the blood and CSF in an attempt to determine whether rejection of implanted tissue occurs.

This paper reports the variation of peripheral T lymphocyte subsets in patients before and after operation under epidural anesthesia using OKT monoclonal antibodies (McAb). The results show that TH and TS after anesthesia and during surgery were lower than before anesthesia and in normal controls (P less than 0.05). The ratio of TH/TS after anesthesia and during operation were lower than before anesthesia (P less than 0.05), but there was no significant difference with normal controls (P greater than 0.05). Therefore, we consider that the decrease in TH cells was one of the reasons for decrease in patient immune function during anesthesia and surgery. Five to seven days after surgery, patient TH cell levels tended to normalize. This showed that this abnormality was transient and reversible. The results also indicated that emphasising prevention of infection in post-operational case, should be done during the first 5-7 days after surgery.

Osteoarthritis (OA) models in bipedal rats were used to study the immune response, including the changes of IgG, antibody dependent cytotoxicity tests toward articular chondrocytes and the matrix. The results revealed significant difference between the bipedal and the quadruped rats. Immunological studies have proved that the OA model of bipedal rats is appropriate for the study of OA.

The authors developed a titanium-based alloy artificial total femur incorporating its total hip and total knee joints with plasma-sprayed ceramic coating 0.3 to 0.6 mm in thickness and a myriad of micropores of 50-200 μm in diameter. On the basis of reliable data obtained in the animal experiments and physical testing, the prosthesis was applied clinically with satisfactory results. This paper reports the results of two patients with a follow-up of 42-70 months.

Three cases with disseminated Penicilliosis marneffei (PSM) are reported. They are all natives of Guangxi Zhuang Autonomous Region. Among them, 2 died and 1 remains alive. Their clinical features were characterized by multiple organ involvement, multiple subcutaneous abscesses, inflammatory papules, nodules and pustulae, and enlargement of superficial lymph nodes with chills, fever, anemia and leukocytosis. The mycology and histopathology of PSM are also discussed. The authors propose that the medical profession in Guangxi should be vigilant against the disease and reduce the mortality by early diagnosis and treatment.

From April through July 1988, an epidemiological investigation on Lyme disease was carried out in Nalati Xanyuan, Xinjiang Uygur Autonomous Region, China. Of 150 Ixodes persulcatus ticks examined by darkfield microscopy, 42 (28%) were found to have spirochetes. Two strains of spirochetes were isolated from I. persulcatus with BSK medium. Rabbits inoculated with the spirochetes showed erythema chronicum migrans at the sites of inoculation and the spirochetes were found in the cerebrospinal fluid by darkfield microscopy. Serum samples from 63 patients were examined for antibodies to B. burgdorferi by IFA test and 11 of them were positive with a titer of 1:64. Upon these results, it may be concluded that natural focus of Lyme disease exists in Xinjiang, China.