1993年 · 第106卷第03期

Morphine elicits a series of adverse effects including the inhibition of intestinal motility in addition to the therapeutic benefit of alleviating postoperative pain. To ascertain the role of electroacupuncture (EA) in diminishing those detrimental effects on recovery, we imitated the clinical procedures in rabbits. Morphine was given via a preimplanted cannula within spinal subarachnoid space, while the duodenal motility, respiration rate and arterial pressure were simultaneously recorded. It was found that morphine (6 mg/rabbit, IT) markedly suppressed duodenal peristalsis, decreased respiration rate throughout 90 min observation. When EA was administered together with morphine, peristalsis of the duodenum was much less inhibited (P<0.05, vs morphine alone group), but no significant improvement of respiratory depression was noticed (P>0.05), nor obvious change of arterial pressure in both groups. The results strongly recommend extensive application of EA in postoperative care, so as to decrease both the required dosage of morphine and the subsequent occurrence of postoperative ileus, while attaining sufficient analgesia.

From November 1986 to June 1991, 91,683 neonates were screened for congenital hypothyroidism by measuring thyroid-stimulating hormone (TSH). 10,284 neonates were screened with chemical luminoimmunoassay (CLIA), and 80,399 screened with time-resolved fluoroimmunoassay (DELFIA). The critical value of TSH was 20 mU/L. Twenty cases were confirmed to be congenital hypothyroidism. The incidence was 1:4584, with a female to male ratio of 3:2. These patients were treated with thyroid gland desiccant, with a dosage equivalent to L-thyroxin 5-7.5 μg/kg/day. Their physical growth and intellectual ability were normal. 81,201 dried blood specimens were tested in single for TSH by DELFIA and T4, T3 and TSH serum testing for those with elevated TSH. No false negative and missing case was found after the screening program started. When frequent fluctuation of T4 and TSH concentration occurred at normal level in some infants, it is better to wait and have a close observation, however the treatment must be started before 3 months of age to avoid the risk of mental retardation.

From January 1989 to June 1990, 13 institutions in our country studied jointly the application of a 20-item neonatal behavioral neurological assessment (NBNA) in asphyxiated babies. Of 145 cases, 125 were followed up to 1-2 years of age. The results showed that in predicting prognosis, the sensitivity and specificity of NBNA score at 7 days after birth were 88.9% and 82.6% and 12-14 days, 84.6% and 97.4% respectively. Its value in predicting prognosis is superior to Sarnat degree, cranial CT and B ultrasound. This method is practical, economical and reliable. It is worth popularizing.

HPV-16 and HCMV DNA homologous sequence and the status of cellular oncogene C-myc DNA were examined in uterine cervical diseases with dot blot hybridization and Southern hybridization. The results showed a positive rate of 70.8% in HPV-16 and 38.7% in HCMV in cervical carcinoma, and that of 36.7% in HPV-16 and 16.7% in HCMV in cervicitis. C-myc DNA was widely detectable in uterine cervical carcinoma, but the manifestation of translocation, deletion or overexpression in cervical carcinoma was frequent. The value of these findings in the development of cervical carcinoma is discussed.

From April 1986 to March 1992, flaps were used in the surgical treatment of 17 patients with congenital bladder exstrophy. Eleven of these patients had had surgery in other hospitals but all failed. Using the flap method for the repair all of them had procured a functional bladder except one who could not have a complete control of urination. The longest follow-up period was 3 years, and the renal and bladder functions were completely normal. The immediate result in 14 patients was good in the control of urination right after the removal of the catheter. The follow-up results were good in 16 cases. The flaps used included 8 types of skin flaps, fasciae and vascular pedicles. Provided with the central vascular supply, the new series of procedures were suitable for the treatment of a variety of exstrophy deformities.

We studied the ultrastructural changes of the corneal epithelium of the experimental rabbit dry eye and the effects of three topically applied eye-drops. Fourty rabbits were divided into experimental rabbit dry eye group, 0.1% bromhexine-treated group, 50% Chinese medicinal herb-treated group and 0.01% retinoic acid-treated group. Ten days after surgical removal of lacrimal gland, nictitating membrane and Harder's gland of the rabbit eyes, and corroding the conjunctiva with 50% trichloroacetic acid, the rabbit eyes showed typical dry eye signs. A lot of pathologic ultrastructural changes of the corneal epithelium were observed. Fourteen days after topically applying the three eye-drops, no significant effect was found on the ultrastructural changes of the dry eye corneal epithelium in the 0.1% bromhexine-treated and 50% Chinese medicinal herb-treated groups. However, in the 0.01% retinoic acid-treated eyes, normal microvilli and microplicae reappeared, denuded corneal epithelium was covered by new epithelial cells, no cell swelled, degenerated mitochondria recovered, basement membrane returned completely, and the completely recovered corneal epithelial cell count showed a significant difference compared with the control (P<0.01). We conclude that removing the lacrimal gland, nictitating membrane and Harder's gland of rabbit eye, and corroding the conjunctiva with 50% trichloroacetic acid can result in rabbit dry eye and topically applying 0.01% retinoic acid can promote the recovery of the dry corneal epithelium.

Neuroretinal rim area (NRA) is the only clinical measurement that reflects the real amount of nerve fibers in optic disc. We measured the photographs of the optic disc in 132 eyes of 132 subjects in 6 groups: normal subjects with small cups, normal subjects with large cups, suspected glaucoma with small cups and those with large cups, primary open angle glaucoma (POAG), low tension glaucoma (LTG). The mean NRAs of POAG, LTG and suspected glaucoma with large cups were less than those of normal subjects with large cups. In normal subjects, a high correlation between cup area and disc area was found, while NRA correlated weakly with disc area. Both semiquantitative scores of diffuse and localized retinal nerve fiber layer defects were correlated significantly with NRA. We suggest that measurement of NRA and examination of retinal nerve fiber layer defect could improve the detection of acquired changes of optic disc in early glaucoma.

The two step small-bowel transplantation was performed experimentally in pigs. Both ends of heterotopic segmental allografts of 100 cm small bowel were enterostomized during the first operation. After 4-6 weeks, the allograft was interposed in the continuity of the intestine. Rejection was developed in Group I (n=6) without immunosuppression. The mean survival time of the grafts was 17.7±7.6 days, and recipients were alive after resection of necrotic grafts. The animals of Group II (n=6) were treated by cyclosporine concomitantly with azathioprine and methylprednisolone. Two pigs were killed for severe pneumonia on day 92, 97 and the grafts were alive, the other four recipients and their grafts survived for more than 300 days, 270 days, 260 days and 260 days respectively. No GVHD was observed and rejection was the major problem in segmental intestinal transplantation.

EDAP piezoelectric shock wave lithotripsy combined with oral ursodeoxycolic acid dissolution of stones was used to treat 1055 patients with gallbladder stones. 926 of them (87.8%) were followed up for more than 1 year. The patients were divided into two groups: Group I, 637 patients with functioning gallbladders containing one radiolucent stone less than or equal to 20 mm in diameter or 2 to 3 stones each less than or equal to 12 mm, and Group II: 289 patients with stones exceeding the above criteria. The stone fragmentation rate was 96.2% and 94.1% respectively in Group I and in Group II. Gallbladder stones disappeared in 18.5%, 35.0%, 46.2% and 52.4% of the patients in Group I in 1, 3, 6, and 12 months after treatment and 7.3%, 11.4%, 20.1%, and 27.7% in Group II. The treatment was more effective for solitary stones less than or equal to 20 mm in diameter. No serious complications were noted. The midterm curative effect was satisfactory. Further study is required to raise the curative effect and prevent stone recurrence.

The saliva samples from 13 patients with hepatocellular carcinoma and a control group of 21 random healthy adults were measured for alpha-fetoprotein (AFP), using a highly sensitive sandwich enzyme immunoassay specific for human AFP. In patients with hepatocellular carcinoma, significantly higher levels of saliva AFP were observed (mean±Sx: 3 552.6±2 829.9 ng/L) when compared with the value of the normal controls (mean±Sx 18.1±3.8 ng/L, P<0.001). There was significant correlation between saliva and serum AFP in both normal controls (rs=0.526, n=21, P<0.005) and patients with hepatocellular carcinoma (rs=0.931, n=13, P<0.001). In patients with hepatocellular carcinoma, those with positive serum AFP had positive saliva AFP, while those whose serum AFP was negative showed saliva AFP negative as well. It is likely that saliva AFP is derived from plasma by passive seepage. It is promising that the saliva AFP surveillance may be helpful in detection of AFP positive hepatocellular carcinoma, because of its noninvasiveness, acceptableness by almost every person, simplicity in technique, and the strong correlation between saliva and serum AFP.