1994年 · 第107卷第09期

PCR was used to detect (HPV) in condyloma acuminata (CA), pseudocondyloma whose cause is unclear, and the other benign lesions in female genital tract. The results showed that HPV prevalence rate in CA was 98.2%, type 6 was in 11 was 85.7%, and that in pseudocondyloma, cervical polyp, cervical erosion and chronic vaginitis was 40.4%, 76.2%, 77.3% and 16.0%, respectively. Even in normal vaginal tissue, there existed HPV subclinical infection. HPV prevalence rate in swabs from patient's underwears and normal vaginal tissues was 73.6% and 54.0% respectively. The investigation of estrogen receptor (ER) in CA tissue carried out by immunohistochemical method found that positive ER was achieved in most of CA, and few of normal vulvar tissues was found. This result indicated that the occurrence of CA is probably related to estrogen.

All diabetic patients should be screened for the early stage of diabetic nephropathy, because microalbuminuria has a great prognostic significance. The albusure test (AT), alatex agglutination nephelometric immunoassay, is a rapid and low cost test for the detection of microalbuminuria of 30 mg/L or more. We compared the results of AT and of radioimmunoassay (RIA) for urinary albumin to evaluate the clinical utility of AT using fresh urine samples from 74 diabetic patients without persistent proteinuria and from 11 healthy subjects. Urinary albumin levels measured by RIA were 6.0±2.3 mg/L in the healthy subjects, 11.0±8.7 mg/L in the AT-negative group (n=61), and 38.1±10.2 mg/L in the AT-positive group (n=13). Using a cut-off value of 30 mg/L by RIA, the rate of coincidence between AT and RIA was 89.2%, although five subjects were false-positive by AT, and three were false-negative. These results show that AT may provide a useful monitor microalbuminuria, a reliable early mark of diabetic nephropathy.

Left ventricular wall motion was analyzed from the contrast ventriculograms of 42 patients with mitral and aortic valvular diseases by the computer-aided 100-chords centerline method. The results showed that ventricular wall motion was decreased in the anterobasal and mitral valve regions in patients with mitral aortic valvular diseases. In 15 patients, there were also other local ventricular wall motion abnormalities, which were located in the anteroapical and posterobasal regions. Almost all of the patients with ejection fraction(EF) less than 0.5 had diffuse or localized hypokinesis. Ventricular wall motion in patients who died from cardiac causes early after receiving valvular replacement was lower than that of survivors. Using Fisher's judgement method, a formula could be established to predict the early prognosis of patients with chronic valvular diseases after valve replacement.

It is traditionally considered that angiotensin-converting enzyme inhibitor (ACEI) and spironolactone could not be used simultaneously because of the assumed risk of hyperkalemia. However, despite ACEI therapy edema and congestive status remain in some of the patients with severe congestive heart failure (CHF). In order to seek an effective therapy for these patients, we observed the efficacy and safety of captopil plus spironolactone in patients with refractory CHF, with strict monitoring of renal function, serum and urine electrolytes and blood pressure (BP). Thirty-five patients with refractory CHF and New York Heart Association functional class IV without renal dysfunction, hypotension and hyperkalemia, whose plasma aldosterone (ALD) level in 88.6% of them was above normal value, were randomly assigned to group A (n=16, captopril alone) and B (n=19, captopril plus spironolactone) for a 4-week treatment. The dosage of both drugs was individually adjusted in time according to the results of serum potassium and renal function. The improvement in dyspnea-fatigue ratings, urinary volume and Na+/K+ ratio in group B was more significant than that in group A, and the plasma ALD level in group B decreased obviously while it remained high in group A after therapy. Two patients in group B who had had normal plasma ALD level with urinary Na+/K+ ratio>1.0 before the therapy did not exhibit any clinical improvement. A strong negative correlation was found between plasma ALD level and urinary Na+/K+ ratio (correlation coefficient -0.689, P<0.01). None of the patients had obvious hyperkalemia and hypoaldosteronism. The present results showed that the effects of captopril plus spironolactone exceeded those of captopril alone in treating refractory CHF patients who had normal renal function, and that high plasma ALD level and urinary Na+/K+ ratio<1.0 in patients with severe CHF could be prevented if indivialized dosage adjustment was made in time according to the monitoring results of serum potassium, renal function and BP.

Quantitative analysis of ras oncogene product P21 was performed on paraffin blocks from 55 smooth muscle tumors of the gastrointestinal tract by immunofluorescence and flow cytometry. No positive evidence for P21 was found in 5 cases of normal smooth muscle tissues. Eight of 14 leiomyomas were P21 positive (57%) but all of them were lower expressed with fluorescence index (FI)<1.25, whereas a total of 29 leiomyosarcomas and 12 potential malignant smooth muscle tumors were found to be P21 positive (100%), and the majority were overexpressed with FI>1.25 (P<0.005). ras P21 was overexpressed significantly in the tumors with mitotic counts of more than 1/10 high power field (P<0.005). It was also overexpressed significantly as soon as the mild cytologic atypia of the tumor was found (P<0.005). Five-year survival rate was significantly higher in the patients with lower-expression of ras P21 than those with overexpression (P<0.005). It was suggested that the expression of ras oncogene product P21 could be used as an objective parameter in distinguishing malignants from benigns and predicting the prognosis of the patients with smooth muscle tumors of the gastrointestinal tract.

Percutaneous balloon mitral valvuloplasty (PBMV) was successfully performed in 50 selected patients with mitral stenosis by using Inoue pillow-shaped balloon and Inoue technique. The average diameter of balloon used was 26.9±0.9 mm. 90% (45/50) of cases had either double or single mitral commissura split. Of the rest 5 cases, 1 had a mitral score 13 and 4 had a history of mitral valve commissurotomy. Totally they had a mean mitral valve area increase from 1.13±0.32 to 2.21±0.43 cm2, left atrial pressure decrease from 31.8±9.3 to 14.7±5.6 mmHg, left atrial diameter reduction from 44.9±7.7 to 37.4±4.9 mm, and transmitral gradient decrease from 21.7±9.8 to 4.0±5.2 mmHg. Most patients had a obvious cardiac function improvement, especially in patients with mitral score of 8 or less. 30% patients (15/50) had a mild mitral regurgitation, but relieved 3-6 months after procedure. During one year of follow up, the majority of patients (16/20) were found in a good cardiac function, mitral area and the left atrial diameter, except in 4 patients with a high mitral score of more than 10. It is suggested that for patient with lower mitral morphological score and good general health, a larger diameter balloon might be suitable for effectively improving patient's symptom, but for patients with a previous surgical mitral commissurotomy, PBMV should not be selected.

An immunosuppressed rat model was established by injecting cortisone acetate 25 mg/rat twice a week for 4 weeks and 12.5 mg/rat for another 2 weeks subcutaneously. A development of Pneumocystis carinii pneumonia (PCP) was found at the end of the 6th week in all rats. These rats were injected intramuscularly with artemether at 100 mg/kg once a day for 5 consecutive days. All rats were necropsied at the end of the 8th week. The lung impression smears were stained with Gomori's stain, and Pneumocystis carinii cysts were counted. The ultrastructural changes of trophozoite, precyst and cyst were investigated by transmission electron microscopy on the 7th day after treatment.

The aim of this study was to evaluate whether Tripterygium wilfordii (TW) could be used as an immunosuppressant, and whether antirejection therapy with low-dose cyclosporin A (CsA) and TW was better than the treatment with large-dose CsA alone in intestinal transplantation in pigs. 100 cm intestines were transplanted by using two-step models. Four pigs which received large-dose CsA for 100 days and then were given TW survived 251.5±181.5 days; 2 of these died of pneumonia 92 and 97 days after the operations respectively. Five pigs which received low-dose CsA and TW for 100 days, then TW was the only drug used in the survival animals, survived 243.2±90.9 days; none of these succumbed to infection. All the grafts in those which were administered with low-dose CsA were destroyed by acute rejection at 12.4±2.6 days. These results indicated that TW had some immunosuppressive effects, and antirejection treatment with low-dose CsA and TW could be considered as an acceptable therapy in small bowel transplantation.

The triangular fibrocartilages (TFC) of 136 wrist joints from 48 fetuses and 20 infants fresh cadavers without any evidence of known deformity and injury were studied. Perforations of the TFC were found not only in infants (18.8%), but also in fetuses (25%). The difference between the incidences of the perforations in the two groups is not statistically significant (P>0.05). Furthermore, we did not find that perforation of the TFC is correlated with either sex or side of wrists (P>0.05). Histologically, the vascularity and cellularity of the TFC have no significant correlation with the absence or presence of perforation in it. We believe that, besides trauma, inflammation and degeneration, some perforations of the TFCs are congenital in origin, which all take the form of fissure and are located mainly in the radial half of the TFC.

A strain of Chlamydia trachomatis was isolated from a patient with nongonococcal urethritis (NGU). Alternate passages between chick embryo and McCoy cell culture were examined. From the Giemsa stained coverslips taken from the cell culture 96 hours after inoculation, we found, to our surprise, that elementary bodies (EBs) distributed over a large area, and several intact cells embedded in them. These pure EB particles are round, fairly uniform in size and often appeared in pair. According to their morphology, distribution, arrangement and relationship with host cells, they are not the remains after cell lysis or directly released from host cells. We considered that they consisted of EBs which continued to divide by binary fission after their release. The name "Extracellular Multiply Form" was designated and their formation mechanism was proposed. This discovery gives a great challenge to primary theory, i.e. Chlamydias are obligate intracellular prokaryotic parasites. If we can further reveal the law of their formation, it will be of great significance both theoretically and practically.

We used three methods to reconstruct a same bony and membranous labyrinth by an image processing work station (IPWS). Three dimensional (3-D) models of the bony and membranous labyrinth were thus obtained. Different parts of the labyrinth were measured and the spatial relationship between the bony and membranous labyrinth was observed. Many 3-D parameters such as cochlear length, volume of different parts of the labyrinth, angles among the three semicircular canals were measured. The results of this experiment are useful in the study of the cochlear and vestibular function.

Forty-eight male mice in 6 groups were studied. Conditioned taste aversion (CTA) in mice was produced by various motions including cross-coupled acceleration, rotation to two directions (with or without visual field) and linear acceleration. Deprived of water for 24 hours, the mice were exposed to motion immediately after drinking a novel solution, 0.15% saccharin. All groups received two pairings of CTA training related to motion. The results showed that both of cross-coupled and rotation produced frank CTA and former was far more obvious than the latter. In addition, motion with visual field had a trend to intensify sickness response.

Twenty-seven patients with gametocytes of Plasmodium falciparum (PF) were divided into groups A, B, and C. A daily dose of 1200 mg artemisinin was given for 5 days to group A, a state dose of 750 mg of mefloquine to group B and a single dose of 750 mg mefloquine combined with 45 mg primaquine to group C. After treatment, the gametocyte count was taken daily, and infectivity of the gametocytes to Anopheles dirus via membrane feeding was also studied. Results showed that in group A, the density of gametocyte and infectivity were significantly reduced on days 4, 7, 14 and 21 after treatment; In group B, the gametocytes were significantly reduced on days 7, 14 and 21 and infectivity was significantly cut down on days 14 and 21 after medication. In group C, gametocytes disappeared in 5 out of 9 patients with failure of infecting mosquitoes in all 9 patients on day 4 after treatment. These indicate that artemisinin can effectively influence the infectivity of gametocytes of PF. Artemisinin is much better in blocking the transmission of PF malaria than mefloquine.