1993年 · 第106卷第06期

From April 1989 to July 1991, 72 patients with residual or recurrent nasopharyngeal carcinoma (NPC) were treated by MSH Ir-192 brachytherapy or combined external radiation therapy. All were proven histologically. 39 patients with residual disease and 6 with recurrent lesion at the primary site were identified after one or more courses of radical external radiation. Eleven patients had received brachytherapy for boost therapy after one or more courses of external radiation. Sixteen were treated with a planned protocol of external irradiation combined with intracavitary brachytherapy. The overall local control rate was 93.3%; the local control rate for residual and recurrent disease was 100% and 50%, respectively. Soft palate perforation was observed in 3 patients. Brachytherapy is believed to be a useful treatment for residual or recurrent NPC following radical external radiation.

Microscopic quantitative cardiomyopathy was previously reported in spontaneous diabetic biobreeding (BB) rats, but the nature of the lesions remains obscure. To further study the specificity of cardiomyopathy in streptozotocin-diabetic rats and discuss the existence of diabetic heart disease, we compared 40 streptozotocin-diabetic rats (D group) with 40 normal control rats (C group) at various durations in plasma glucose, fructosamine, plasma lipid, left ventricular enzyme contents and alterations of myocardial cells and coronary artery tree under electron and light microscope respectively. In 4 weeks, D rats showed myocardial mitochondrial swelling and degeneration, whereas at 8 weeks, myocardial enzyme contents markedly decreased, and myocardial lesions were more conspicuous with disruption of myocardial cells, formation of myocardial contraction bands, dilatation of intercalated discs, deposition of glycogen granules, etc. At 11 weeks, microscopic changes were essentially similar, whereas the decrease of enzyme contents became more conspicuous. During the 11 weeks, persistent and marked hyperglycemia and elevation of fructosamine were observed, however, no abnormalities were found along the coronary artery tree in the D rats. The results indicated that cardiomyopathy is diabetes specific, and exists independently as one of the three important components of diabetic heart disease.

Sepsis was induced in rats by cecal ligation and perforation (CLP). Five and 15 hours post CLP, alveolar macrophage (AM), Kupffer cell (KC), and peritoneal macrophage (PM) were isolated and cultured for 18 hours. Culture supernatant was examined for bioactivity of tumor necrosis factor (TNF) and interleukin 6 (IL-6) and response to lipoplysaccharide (LPS) stimulation in vitro. Results showed that AM produced more TNF during sepsis as compared with KC and PM. Stimulation with LPS in vitro was responded only by AM at 15 hr after CLP. Pattern of IL-6 production was different from TNF while KC produced the highest level of IL-6 after induction of sepsis.

The present study was designed to examine the effect of higher concentration of anisodamine on α-adrenergic responses in isolated canine blood vessels. Up to 10-3 mol/L, anisodamine did not significantly affect the responses of saphenous vein to α2-adrenergic agonist UK-14, 304. In contrast, anisodamine (10-5, 10-4, 10-3 mol/L) caused the concentration-response curves of femoral artery to norepinephrine (pA2=4.81±0.11) to phenylephrine (pA2=4.86±0.20) shift markedly. However, the antagonism on the α1-adrenergic responses of canine femoral artery to norepinephrine and phenylephrine by higher concentrations of anisodamine produces dose ratios which yield a linear Schild regression with a slope less than unity, indicating an inequilibrium between agonist, antagonist, and receptors. The probable mechanisms involved are discussed.

One hundred eight-two patients underwent percutaneous lumbar discectomy using a new nucleotome system. The curative and effective rates were 84.6% and 89.6% respectively, without serious complications. To overcome the difficulty of puncture and cutting the nucleus pulposus at L5-S1 interspace, an efficient approach was undertaken to drill through the iliac wing at L5-S1 using a self-designed circular drill so that the nucleotome could safely reach L5-S1 disc, the successful rate was 100%. By varying the distance and angle of puncture, it is possible to treat central type of lumbar disc herniation, thereby expanding the indications for this procedure.

One hundred thirty-one patients with hepatocellular carcinoma were subjected to permanent hepatic artery embolization with dextran microspheres (G-25, 50-150 μ). Dextran hepatic artery embolization is indicated for massive, nodular or multinodular hepatocellular carcinoma with total bilirubin less than 3 mg/dl, serum albumin greater than 3.0 g/dl, tumor involvement area less than 50% or without involvement of the main portal vein. Following hepatic angiography a catheter was inserted superselectively into the hepatic artery feeding the tumor. Adriamycin (60-80 mg) or cisplatin (60-100 mg) was infused immediately before embolization. Under fluoroscopic guidance, 0.3-0.5 g of dextran microsphere embolizer permeated with 10 mg of mitomycin C was infused into the feeding artery through the catheter. Dextran microspheres caused marked homogeneous and distal micro-arterial embolization, especially in the arteriole with a caliber of about 100 μ. Dextran microspheres were not resorbed in a period of 16 weeks in humans, thus reducing or preventing the formation of intrahepatic and extrahepatic collaterals after hepatic artery embolization. Dextran hepatic artery embolization was very effective for not only main tumor but also daughter foci or metastatic nodules, as was confirmed histologically in 8 cases. The 1-year, 2-year and 3-year survival rates were 57.0%, 31.4% and 24.2% respectively.

Serum pregnancy specific beta 1 glycoprotein (SP1), human placental lactogen (HPL) and urinary estrogen/creatinine (E/C) ratio levels were determined to study their clinical significance in predicting low birth weight (LBW) in women with normal pregnancy and patients with LBW. The results showed that the sensitivity of urinary E/C ratio was better than that of serum SP1 and HPL, and was increased gradually with the reduction of fetal weight. The specificity in predicting LBW decreased gradually with the increase of serum SP1 and HPL levels and urinary E/C ratio. When serum SP1 level was less than 50 mg/L, HPL less than 2.0 mg/L, and E/C ratio less than 10, their specificity could increase over 90%. It is suggested that multi-indexes measurement would improve the accuracy for predicting LBW. We conclude that SP1, HPL and E/C ratio measurement could be an useful index for predicting LBW.

Microsurgical tubocanalization was done in 412 patients. 278 women had the operation before the end of December 1987 and were followed up. The overall intrauterine pregnancy rate was 81.3% (92.86% for isthmus-isthmus anastomosis and 87.5% for ampulla-ampulla anastomosis). Two patients had ectopic pregnancy which was followed by term pregnancy subsequently. The factors affecting operative results were analyzed.

A study on the incidence and high risk factors of hypothermia in the newborn was carried out in a period of four months (Nov. 1988-Feb. 1989) in 6 counties of 3 provinces. Totally 14,809 newborns were studied, in whom 100 cases were found to be ill with sclerema, having an incidence of 6.7%. Gestational age, body weight, low room temperature, improper methods of thermopreservation during delivery and asphyxia are determined as the most probable high risk factors, in which gestational age and body weight are negatively correlated with the contraction of the disease. It suggests that the prevention of prematurity and asphyxia, and promotion of thermopreservation during delivery should be helpful in preventing sclerema of newborns.

Plasmid analysis, restriction endonuclease analysis, antimicrobial susceptibility testing, biotyping, phage typing and outer membrane protein electrophoresis were used to study an outbreak of Salmonella typhimurium infection at a newborn nursery. Seven out of the 12 neonates had positive blood cultures for S. typhimurium, and 2 of them died of severe sepsis. Thirty epidemic strains of S. typhimurium belonging to phage type 12 had the same plasmid profiles (98.0, 6.7 and 3.8 Kb) and identical restriction digest patterns (23.0, 20.4, 15.0, 9.6, 8.2, 7.4, 5.8, 4.3, 3.8, 2.0 and 1.8 Kb) which were different from those of the 2 non-epidemic strains. Laboratory data suggested that the source of the infection was the index patient's mother who had a slight diarrhea; the mode of transmission was most likely due to the transfer of organisms from infant to infant by the contaminated hands of nurses during milk feeding.

The neutrophils in 2 patients with atopic disease were studied. Ultrastructurally, a number of abnormal azurophilic granules (AG) with low electron-density (Case 1) and secondary lysosomes with "myelinoid membranes" figures (Case 2) were found. Myeloperoxidase (MPO) and acid phosphatase activity were detected by light cytochemical techniques, and showed significantly low values. The deficiency of MPO and abnormal distribution of AG were also demonstrated by electron microscopic cytochemical technique. The neutrophils from the parents revealed changes similar to the patients. This study suggests that since genetic partial deficiency of neutrophil AG enzymes existed, the phagocytosed substances were only partially degraded, leading to accumulation of substances with antigenicity, and became trigger event of atopic disease.