1993年 · 第106卷第10期

Perinatal asphyxia is one of the major causes of cerebral injury in neonates. It may be due to the increased endogenous opioid-like substances (OLS) in the body. The levels of three OLS, namely leucine-enkephalin (LEK), β-endorphin (β-EP) and dynorphin A1-13 (DynoA1-13) of 44 cases with neonatal asphyxia were studied by radioimmunoassay. The OLS level in plasma and cerebral spinal fluid (CSF) were higher in asphyxiated group than those in the control group, especially in asphyxiated cases with fetal distress. The OLS levels of CSF were also higher in cases with cerebral injury than in those without cerebral injury, while the levels of OLS in plasma had no difference in these two groups. The relationship between OLS levels and asphyxia and cerebral injury is also discussed.

A case of sympathetic ophthalmia (SO) is reported. A long lasting stable result was obtained for this patient treated basically with traditional Chinese medicine. His exciting eye was investigated under light and transmission electron microscopes. Prominent granulomatous lesions in the choroid, Dalen-Fuchs nodules (DFNs) and disruption of outer and inner basement membrane of Bruch's membrane under DFNs are found, plasma cells are not few and melanocytes and retinal pigment epithelial cells are possibly the target cells. In various cells, nuclear bodies (NBs) are ubiquitous and sometimes multiple in an individual cell nucleus. Microtubule-like structures are present inside and outside the NBs and parallel lines composed of relatively uniform high electron dense granules as lattice-like structures can be seen. It was surmised that a virus induced autoimmune process might be involved in the pathogenesis of SO.

The authors studied the effect of tonsillectomy for IgA nephropathy and the relationship between chronic tonsillitis and IgA nephropathy. Forty-five patients with IgA nephropathy were treated by tonsillectomy in our department. The effective rate of hematuria type IgA nephropathy was 86.2% and that of non-hematuria type 62.5%. We also determined the immunoglobulin composition of the tonsilla tissue in 18 IgA nephropathy patients and compared it with that of 18 chronic tonsillitis patients. The immunoglobin level of the IgA nephropathy group was higher than that of the contrast group, indicating that the disorder of tonsilla immunity may be one of the pathogenic factors for IgA nephropathy. Since no specific method has been available for the treatment of IgA nephropathy, we use tonsillectomy as an effective procedure.

An outbreak of viral central nervous system infection occurred from May to September, 1991 in Shanghai, China. Totally 376 cases were admitted into our hospital, 54% with encephalitis and 46% with meningoencephalitis. Echovirus type 30 was isolated from CSF and stools of the patients. Only 3 of the patients were under 1 year of age. CSF examination revealed the cell count from 0-1600×106/L. Interestingly, 9 had CSF PMNs over 90% and 13 had low sugar levels. EKG was randomly done in 20 patients and 15 demonstrated myocarditis. The outcome was uneventful in all except 1 who had psychological problem at the time of discharge.

Biopsied liver tissues from 352 cases were tested for hepatitis C virus (HCVAg) with improved PAP immunohistologic chemical method. Furthermore, corresponding seroantibody to hepatitis C virus was also tested. The total HCVAg positive rate was 9.1%. The HCVAg positive rate in chronic persistent hepatitis (CPH) was 5%. The HCVAg positive rate in chronic active hepatitis (CAH) was 11.2%. The HCVAg positive rate raised gradually along with the severity of hepatocytic injury. HCVAg may be seen in necrotic liver cells exfoliating into the liver sinus, indicating a close relationship between HCVAg and hepatocytic injury. Expression of HCVAg was mostly of the nucleus type in CPH cases and was mostly of the plasma type in CAH cases. The periphery of nucleus type-expressed positive cells generally had no marked inflammatory cell infiltration. The periphery of plasma type-expressed positive cells had a certain amount of inflammatory cell infiltration. Along with the severity of hepatocytic injury, HCVAg expressed itself in a positive correlation according to the nucleus and plasma types. The HCVAg positive cells were located mostly in the lobular peripheral band and rarely located in the venoperipheral band. It was possible that this had some relation with the lobular microcirculation of blood and blood supply. In this study, there was no obvious correlation between the HCVAg positive rate in hepatic tissues and the anti-HCV positive rate in sera. Neither the patients with HCVAg positive liver tissues nor the patients with seropositive anti-HCV had any history of blood transfusion and the use of blood products. This suggests that the characteristics of sporadic spread of HCV infection in some areas of China deserve our attention.

Bone marrows from 30 newly diagnosed Ph+chronic myelocytic leukemia (CML) (21 in chronic phase, CML-CP, 9 in accelerate phase, CML-AP) and 8 followed up patients in blast crisis (CML-BC) were tested by DNA strand breaks (%D value), DNA-aneuploidy, flow cytometry-cell surface antigen expression for CD15 and HLA-DR ratio. Our results showed that all these three parameters changed as the disease escalated. A very low value of %D and DNA-aneuploidy occurrences were high risk factors. Cell surface antigen expression CD15 and HLA-DR ratio measurement was simple and reliable. The ratio<1.0 appeared earlier than morphology clarifying CML-AP and should be followed up regularly.

The effect of a physical training course of 1-2 month duration using cycloergometer with the intensity of VO2 max 60%, 30 min per day was observed in non-insulin dependent diabetes mellitus (NIDDM) patients. The results showed a decrease of plasma glucose and insulin levels, ΣPG and ΣIRI and an improvement of blood lipid constitution. These were accompanied by a decreased erythrocyte insulin receptor binding rate and a reduction of receptor binding sites of both high and low affinity receptors.

The effects of caffeine on diaphragmatic contractility and fatigue was investigated in 21 dogs. Diaphragmatic contractility was assessed by measuring transdiaphragmatic pressure (Pdi) during supermaximal stimulation of the phrenic nerves at different frequencies, and Pdi was measured with a pair of balloons. In protocol 1, the effect of caffeine on contractility of non-fatigued diaphragm was studied in 7 dogs. Caffeine infusion increased Pdi significantly at all frequencies of stimulation. In protocol 2, diaphragmatic fatigue was induced by electrophrenic stimulation (30 Hz, duty cycle 1.0, 30 minutes). The recovery profile after fatigue run was observed in 5 dogs. In another group of 9 dogs, caffeine was infused during stable fatigue period and Pdi increased significantly at all frequencies of stimulation after caffeine infusion. The increase in Pdi was not due to changes in cardiac output or lung mechanics (Cdyn and Rtot), neither of which changed significantly after caffeine infusion. We conclude that caffeine improves muscle contractility both in non-fatigued and fatigued diaphragm in dogs.

Sixteen patients with local stasis and swelling after implanting cardiac pacemaker were treated with Mangxiao (Natrii Sulphas) on the implanted local surface for 4-14 days. The effect was satisfactory. Reopening of the skin for the cleaning of the stasis and swelling and removal of the pacemakers could thus be avoided in these patients. The mechanism of action of Mangxiao in relieving stasis and swelling was studied preliminarily.

From January 1986 to April 1991, 107 consecutive patients with acute promyelocytic leukemia (APL) were treated with retinoic acid (RA) at an oral dose of 45-60mg/m2/d, alone or in combination with chemotherapy. In 91 cases treated with RA alone, 74 (81.3%) achieved complete remission (CR). The CR rate was 75% in 16 cases treated with combined therapy. Among 50 patients closely followed for a median of 36 months (4-60), 10 received RA as continuation therapy (Group A), 10 received chemotherapy (Group B) and 30 were treated with RA and chemotherapy alternately in regular sequence (Group C). The mean survival time was 8.4, 9.7 and 21.6 months, respectively, for the 29 cases who died. The survival probability was higher in Group C than in Group A and B (P<0.01). RA did not provoke or aggravate DIC, it did not cause marrow hypoplasia or aplasia. The side effects were relatively mild as compared with chemotherapy. CFU-GM markedly reduced before treatment was restored to normal level after CR, while the result for L-CFU was reversed. In 40 cases examined for in vitro induction of differentiation, 39 responders were culminating in CR. Aberrant karyotype t (15; 17) was positive in all 47 cases examined prior to the treatment. It disappeared in all of the 20 cases studied after achieving CR, and reappeared in 3 cases following relapse. The best regimen to maintain a longer CR duration and survival time in this study was to use RA and chemotherapy alternately as continuation therapy.

Although foreign bodies of the gastrointestinal tract are common in children, they are rare in the adult. Complications of the foreign bodies are well recognized to be a cause of obstruction, bleeding and perforation of the intestine, or furthermore, they sometimes lead to death unfortunately. On the other hand, it is very difficult to diagnose and treat foreign bodies in the handicapped because of disability of complaining the symptoms. This paper reports a 31-year-old severe handicapped man suffering from foreign bodies in the esophagus and the small intestine, and was successful removed by endoscope.