1996年 · 第109卷第05期

OBJECTIVE To evaluate the optimal dose and route of interferon-alpha-2b (INF-α-2b) given to the Chinese patients with cutaneous T-cell lymphomas (CTCL). PATIENTS AND METHODS Sixteen Chinese patients with CTCL treated with INF-α-2b were evaluated. They were divided into groups according to the TNM Classification: ⅠB (8 patients), ⅡA (2), ⅡB (5) and ⅣB (1). During induction INF-α-2b was given intramuscularly every other day or two times a week, beginning with a dose of 1-3×106 IU. Depending on tolerance, the dosage could be increased weekly to a maximum tolerated dose of 18×106 IU (mean, 6×106 IU/week) with administration two or three times a week. Patients with clinical response were given maintenance dosage from the start. Thereafter the dosage was gradually decreased after disappearance of skin lesions. Three patients were treated by combining intramuscular and intralesional injection of INF. RESULTS Six patients (ⅠB, 2 patients: ⅡA, 2, ⅡB, 2) achieved complete response (CR). Seven patients (ⅠB, 5 patients) showed partial response. The overall response rate in this group was 81.25%. The prominent initial clinical response in three patients was manifested early at one week after intramuscular treatment with INF and then the skin lesions were resistant to the therapy but disappeared rapidly by combining intralesional injection of INF. The conditions of those patients obtaining CR within 3 to 6 weeks were stable for 1-36 weeks. CONCLUSIONS This study had demonstrated that the overall response rate in treatment of patients with CTCL was 81.25% and higher (85.7%-87.5%) in the subgroups at early stages Ⅰ and Ⅱ of the disease. The dosage (mean dose of 6×106 IU/week) adopted by us is optimal for the Chinese patients with CTCL. Intralesional injection of INF could be recommended.

OBJECTIVE To investigate osteoclastic resorption in trabeculae of osteoporotic femoral head. METHODS Osteoporotic femoral heads were collected from 7 aged women with an average age of 72.4 years, who underwent endoprosthetic replacement for intracapsular hip fracture. Femoral head trabeculae from 3 young adults killed in traffic accidents served as control. The two types of specimens were processed and studied under scanning electron microscope. RESULTS The trabeculae of femoral head formed round or roundish arch structure. The columnar trabeculae of femoral head in the aged women showed overt osteoclastic resorption, manifested in thinning, tapering and perforation, resulting in formation of icicle-like trabeculae, which then became rounded, lost height and eventually turned into small tubercle. As a result, the inter-trabecular space enlarged markedly. Under high magnification, the trabeculae could be discerned oval, narrow oval or spindle-shaped. Howship resorption lacunae, which varied in size, depth and content, but all revealed punched-out margin. During bone resorption, the inorganic and organic components were successively resorbed. In the Howship lacunae and surrounding areas, newly formed collagen fibrils and bone tissues emerged, signifying reversal and new bone formation phases after bone resorption phase. CONCLUSIONS Osteoclastic resorption markedly compromises the structural integrity and strength of the trabeculae of the arch structure of the femoral head in the aged women.

OBJECTIVE To evaluate retrospectively our surgical experience, techniques and long-term results in 11 patients with coronary artery fistulae associated with other cardiovascular anomalies. METHODS From January 1980 to April 1995, 11 patients with coronary artery fistulae associated with other cardiovascular anomalies were found among 20,000 open-heart procedures and treated surgically. Besides closure of the fistulae, coronary artery bypass grafting was performed in 5 patients with atherosclerotic coronary artery disease, and aneurysm angioplasty was done in 4 patients with coronary artery aneurysm. Ventricular septal defect and patent ductus arteriosus were closed in one patient and mitral valve replacement was performed in another patient. RESULTS There were no surgical deaths, but one late death due to acute myocardial infarction occurred 6 months after surgery. The mean follow-up time was 75.7 months and all patients' functional status improved by an average 1.4 judged by the New York Heart Association functional classification. CONCLUSIONS Coronary artery fistula associated with other cardiovascular anomalies will aggravate symptoms and cause deterioration of heart function. Therefore, evaluation and surgical intervention should be done as soon as possible to restore coronary blood flow and correct concomitant cardiovascular anomalies. The surgical results are excellent with a low operative risk and good long-term results.

OBJECTIVE To find morphological changes of synapses related to the spike discharge by observation on ultrastructures of the EEG spike foci of cerebral cortexes. MATERIAL AND METHODS The cerebral cortexes were obtained surgically from the EEG spike (recorded by flaky silver electrodes on the surface of cortexes) foci and nonspike areas within the limits of the brain tissue that would be removed in 20 cases of human epilepsy, and were processed for transmission electron microscopic (TEM) observation. RESULTS In the spike foci, presynaptic terminals of axospinal asymmetric synapses were obviously swollen but postsynaptic spines were relatively unaffected. In these synapses, the synaptic vesicles remarkably decreased in number and accumulated predominantly at the presynaptic membranes or aggregated. Similar changes were observed in the presynaptic terminals of the axospinal asymmetric synapses in the nonspike areas but were of milder degree than in the spike foci. CONCLUSIONS Axospinal asymmetric synapses may release a large quantity of excitatory neurotransmitters, which may result in epileptic abnormal electric activities during seizure.

OBJECTIVE To obtain etiologic and epidemiologic information about bacterial meningitis, especially the H influenza type B (Hib), from a medium-sized city, Hefei, China. METHODS Data were collected prospectively over 3 years, from 1990 to 1992 by a well-organized group including 13 hospitals. All children with a clinical diagnosis of acute bacterial meningitis were enrolled and the specimens were taken for the etiologic studies. CSF and blood were tested by standard bacteriologic technique. CSF, blood and concentrated urine were tested directly for detection of antigen by countercurrent immuno-electrophoresis (CIE). Data were analyzed by epidemiologic methods. RESULTS Bacterial culture and CSF Gram's staining were positive only in 13.3% and 11.7%, respectively. Bacterial antigen detection was positive in up to 90% by CIE which was more sensitive than bacterial culture (χ2=67.7, P<0.005). The annual incidence of acute bacterial meningitis in the city is calculated as 9.3 cases/100,000 children from 1 month to 15 years of age and 19.2 cases/100,000 children from 1 month to 5 years of age. Hib meningitis accounted for 51.7%, N. meningitis (Nm) for 38.3%, and S. pneumoniae (Sp) for 8.3%. There was no significant seasonal variation. Of the patients, 76.7% were children under 5 years of age, and 51.7% under 1 year of age. The case fatality rate was 11.7% for all bacterial meningitis, 9.7% for Hib, 17.4% for Nm and 20% for Sp. A total of 22.6% of survivors suffered from neurological or psychological problems. CONCLUSIONS Using antigen detection combined with bacterial culture, we could make an etiologic diagnosis in up to 90% of the patients in this group. Hib, Nm and Sp were the predominant pathogens, which was similar to the findings in other countries. Hib was the most common cause of bacterial meningitis, but the incidence was much lower than in most parts of the world.

OBJECTIVE To evaluate the feasibility and accuracy of exercise echocardiography (Ex-Echo) for the diagnosis of coronary artery disease (CAD) based on coronary angiography (CA). METHODS Forty-seven patients were found to have CAD and examined by upright exercise electrocardiography (Ex-ECG) on a treadmill within two weeks of CA. Before and immediately after exercise, the patients lay on a bed beside the treadmill in the left lateral position and parasternal long and short axis and apical two and four chamber views of the heart were acquired. Pre- and post-echocardiograms were analysed in a side-by-side multiple screen format on the imaging view and hypodynamic wall motion of the left ventricle after exercise was defined as Ex-Echo positive. The sensitivity, specificity and predictive accuracy of Ex-Echo and Ex-ECG were calculated on the basis of CA data. RESULTS Satisfactory echocardiograms were recorded in 46 patients after exercise. The success rate was 97.8%. Compared with Ex-ECG, Ex-Echo was more sensitive (87.5% vs 62.5%, P<0.05), specific (92.8% vs 60.0%, P<0.05) and accurate (89.4% vs 61.7%, P<0.01). The concord of determining the number of diseased vessels between coronary angiography and Ex-Echo was 90.9% in single vessel disease and 45.0% in multiple vessel disease. Wall motion scoring index, however, was higher in multiple than in single vessel CAD. CONCLUSIONS Ex-Echo test is feasible and accurate in detecting CAD and wall motion scoring index is probably useful in distinguishing multiple from single vessel CAD.

OBJECTIVE To assess coronary flow reserve using a computer-assisted method with intracoronary papaverine in patients with angina pectoris. METHODS Coronary arterial diameter, cross-sectional area and blood flow velocity were measured during coronary arteriography before and after intracoronary papaverine in 26 control subjects, 45 patients with significant coronary artery disease (>50% luminal narrowing), 16 patients with syndrome X and 14 patients with hypertension and left ventricular hypertrophy (LVH). RESULTS After intracoronary administration of papaverine, proximal diameter, cross-sectional area, blood velocity, flow volume and reserve capacity of both left anterior descending and right coronary arteries were lower in patients with significant coronary stenosis than in the controls. Despite similar changes in diameter and cross-sectional area, the blood velocity, flow volume and reserve capacity of the two vessels were also lower in patients with syndrome X than in the controls. In 14 patients with hypertension and LVH, although the blood velocity and flow volume were augmented for the two arteries and did not differ from those in the controls, the flow reserve was reduced because of higher baseline blood velocity and flow volume. CONCLUSIONS Coronary flow reserve is reduced in patients with coronary artery disease, syndrome X or hypertensive LVH, which may be related to abnormal changes at different levels of the coronary vasculature or resting flow states.

OBJECTIVE To observe the effect of granulocyte-colony stimulating factor (G-CSF) on differentiation and proliferation of CD34+ cells from peripheral blood in presence of recombinant hematopoietic growth factor (HGF). METHODS Peripheral blood mononuclear cells mobilized by G-CSF were obtained from patients suffering from carcinoma, preparing for autologous bone marrow transplantation. CD34+ cells were isolated by derivatized polystyrene tissue culture flask which had covalently immobilized soybean agglutinin lectin and was coated with anti-CD34 antibody; and this kind of cells were incubated in liquid culture medium for up to 28 days under the stimulation of combination of growth factors, i.e., stem cell factor (SCF) and interleukin-3 (IL-3) with or without G-CSF. The changes of nucleated cells, colony forming unit-granulocyte and monocyte (CFU-GM), burst forming unit-erythrocyte (BFU-E), colony forming unit-megakaryocyte (CFU-MK), and myeloid-associated markers were evaluated. RESULTS An increase of nucleated cells (mean 640-fold increase) occurred during culture CFU-GM production is parallel to the nucleated cell production until the 11th day (mean 82-fold increase) in combination of 3 HGF, i.e., G-CSF, IL-3 and SCF. A large number of cells expressing late myeloid markers appeared on the 11th day in suspension culture of CD34+ cells. CONCLUSIONS G-CSF was found to synergize with IL-3 and SCF in inducing rapid proliferation of purified CD34+ cells and differentiation to multiple myeloid lineages. The stroma-free, cytokine-driven culture system could achieve a degree of amplification of colony forming cells, suggesting the feasibility of culture of hematopoietic progenitor cells in vitro as an adjunct to hematopoietic stem cell transplantation.

OBJECTIVE To evaluate the effects of carbon tetrachloride (CCl4) on the expressions of both intracellular proteins and extracellular matrix and the protective role of taurine. METHODS Forty Sprague-Dawley rats were divided into five groups: 1.5% taurine, CCl4, CCl4 + 0.5% taurine, CCl4 + 1.5% taurine and control. CCl4 was given ig at a dose of 500 mg/kg body weight, twice a week for 5 weeks. The taurine solution or tap water was given to the rats for drinking. The sections (4 μm) of rat liver were stained with haematoxylin and eosin, immunohistochemistry or colloid silver methods. RESULTS The animals treated with 1.5% taurine and control had normal liver structures. Light microscopic examination of sections of the liver taken 5 weeks after dosing of CCl4 showed hydropic degeneration of hepatocytes around the central veins and lipid vacuolation in mid-zonal and some periportal hepatocytes. Necrotic cells and neutrophil infiltration around most central veins as well as hepatocytes showing various stages of mitosis indicative of regeneration were observed. These histopathological changes in the animals treated with CCl4 alone showed more extensive and severe lesions than those seen in the animals treated with CCl4 plus taurines. The incidences of PCNA and p53 antigen positive hepatocytes, and the numbers of nuclear apoptotic bodies and AgNORs granules were markedly higher in the CCl4-treated animals than in those protected with taurine. Declined and unevenly distributed expressions of LN and FN were seen in the CCl4 treated rats. CONCLUSIONS Both the damage of hepatocellular DNA and the abnormal expressions of hepatic extracellular matrix were observed in the CCl4-treated rats. Taurine, in this study, not only inhibited hepatocellular degeneration, necrosis and DNA damage, but also inhibited the lesion of extracellular matrix induced by CCl4.

OBJECTIVE To develop a possible alternative laboratory diagnostic method, an in situ polymerase chain reaction (ISPCR) for definitive diagnosis of human cytomegalovirus (HCMV) pneumonia in infants. METHODS The material involved in this study was formalin-fixed paraffin-embedded lung tissue specimens from 6 infants died of histopathologically diagnosed cytomegalic inclusion body pneumonia (CMIBP) and from 4 infants died of other diseases. When DNA extracts from the specimens of these 10 infants were tested by using a previously applied conventional PCR, the specimens from the 6 infants with CMIBP were positive for HCMV DNA, while those from the other 4 infants were negative. In the ISPCR, biotin-11-dUTP was used for labeling the amplified products and streptavidin, biotin-alkaline phosphatase for in situ color development. RESULTS The results of the study showed specific staining for HCMV DNA in the lung tissue slices from the 6 cases with CMIBP, while no staining was found in the specimens from the 4 infants who died of other diseases. The control ISPCR tests on the HCMV DNA positive specimens without adding either biotin-11-dUTP or Taq DNA polymerase or the primers for HCMV DNA showed negative results. The specific staining for HCMV DNA was seen in bronchial and alveolar epithelial cells, small vascular endothelial cells and leukocytes in the lumens of small blood vessels. CONCLUSIONS The results suggested that the ISPCR was able to demonstrate both presence of HCMV DNA in the lung tissues and active HCMV infection; therefore the ISPCR may be applicable in definitive diagnosis of HCMV pneumonia when proper specimens such as lung biopsy material or bronchoalveolar lavage is available for the test.

Ovarian carcinoma is the leading cause of death from gynecological malignancies. Its management should be a combination of surgical procedures and chenmotherapy, otherwise it will not be a full treatment. So chemotherapy of ovarian carcinoma plays the same important role as the tumor debulking surgery does.