1996年 · 第109卷第09期

OBJECTIVE To develop a new automatic biopsy device (ABD) that enables a radiologist to obtain multiple samples with one hand and free the other hand to handle the ultrasonic scanner for continuous monitoring. MATERIALS AND METHODS The new ABD developed by us in April 1994 enabled a radiologist to complete all the biopsy procedures including loading and reloading the spring system, firing the device, emptying the specimen, selecting the depth of needle advancement, and multiple sampling, simply by pressing 3 buttons in turn with his/her right thumb. Using this new ABD, transrectal prostate biopsy under the guidance of transrectal ultrasonic imaging was performed in 60 consecutive cases of prostate diseases. Each biopsy procedure was completed by a single radiologist, who was able to obtain multiple specimens with one biopsy needle, using only one hand and freeing the other hand for the manipulation of the ultrasonic scanner for guidance. RESULTS A total of 265 satisfactory core tissue specimens of 285 needle passes (93%) were obtained from the 60 patients. Definite pathologic diagnoses were made for all the 60 patients (100%). No serious biopsy-related complications were observed. The main complications were hematuria in 24 of 60 (40%) patients and fever in 5 (8.3%). CONCLUSIONS On the basis of our experience with the 60 patients, this new ABD can be operated smoothly and effectively with the right hand, while the left hand is freed to handle the ultrasonic transducer for continuous monitoring.

OBJECTIVE To evaluate the role of magnetic resonance (MR) imaging in determining the cause of central diabetes insipidus (CDI) by using MR imaging to describe the findings in the hypothalamic-pituitary area in patients with CDI. METHODS Thirty-one cases of clinically proved CDI were prospectively studied. A control study was also conducted in 200 normal subjects. MR imaging was performed on a 1.0 T superconductive unit with T1-weighted images obtained in the sagittal, coronal and axial planes. RESULTS Hypothalamic-pituitary masses or structural changes were identified in 26 cases and normal structures in 5. The normal high signal intensity of the posterior pituitary lobe was absent in 29 cases, but remained unchanged in 2. In the control group, the frequency of the high signal of the posterior lobe was 93%. CONCLUSIONS The absence of the normal high signal in the posterior pituitary lobe is closely related to the loss of hypothalamic-pituitary function. MR imaging is very sensitive in demonstrating the changes in this area in CDI and it can provide an accurate diagnosis when combined with the clinical information.

OBJECTIVE To establish a rapid genotyping for HLA-DR alleles by polymerase chain reaction with sequence-specific primers (PCR-SSP) for clinical application. MATERIAL AND METHODS The subjects of study included 69 recipients, 43 unrelated donors and 5 cell lines. Genomic DNA was prepared from peripheral blood leukocytes by a salting-out method. Thirty primers were designed according to the HLA-DRB nucleotide sequences, and synthesized on a 391 DNA synthesizer. Twenty separate PCR reactions were performed for each sample. The amplification was accomplished by 34 cycles consisting of denaturation at 94 ℃ for 30 seconds, annealing at 60 ℃ for 50 seconds and extension at 72 ℃ for 40 seconds. The specificity of matching was determined by standard DNAs and Southern hybridization using DIG labeling probes. RESULTS All 112 samples and 5 cell lines were able to be typed by PCR-SSP. No false positive or false negative typing results were obtained. The reproducibility was 100%. The size of the specific product was in concordance with the size of the designed primers. The overall time for genotyping was 4 hours. The typing RESULTS were confirmed by Southern hybridization. CONCLUSIONS Genotyping for HLA-DR by PCR-SSP is a rapid and accurate matching technique suited for clinical application.

OBJECTIVE To investigate the relationships between degradation of bone and activated blood polymorphonuclear leukocytes (PMNL) and mononuclear leukocytes (ML) as well as their soluble products in vitro. MATERIALS AND METHODS A neonatal mouse calvarial bone model was used to assess the activity of degradation (by measuring the amount of 45Ca release) by normal human blood leukocytes, separated PMNL and ML following 24-hour incubation. The effects of conditioned culture medium obtained from Staphylococcus aureus-stimulated ML on PMNL-mediated calvarial bone loss were also studied. RESULTS It was demonstrated that isolated human PMNL rapidly degraded bone in a dose and time dependent manner. The PMNL-mediated bone degradation was enhanced by conditioned medium obtained from Staphylococcus aureus-stimulated ML. CONCLUSIONS These findings implicate PMNL as major contributors to early bone loss in infectious diseases such as acute haematogenous osteomyelitis.

OBJECTIVE To reveal the sequence of events of osteoclastic resorption taking place in the cortical bone of the femoral neck in aged women. MATERIAL AND METHODS The cross sections of cortical bones of the femoral neck from 7 aged women who underwent endoprosthetic replacement for intracapsular hip fracture, were processed and subjected to scanning electron microscopic observation. RESULTS The cortical bone sections revealed enlargement of the Haversian canals. On the inner linings of the enlarged canals many oval resorption lacunae could be found, reflecting osteoclastic resorption of the Haversian systems. The osteoclastic resorption with subsequent enlargement of the Haversian canals into round or oval cavities took place first over the inner portions of the cortical sections, thereby rendering these areas porotic (cancellization). These processes of the Haversian systems and canals then gradually emerged over the central and eventually over the outer areas of the cortical bone, and the entire cortical bone became porotic. Meanwhile, the inner porotic portion of the cortex turned into trabeculae (trabecularization) and became gradually resorbed, resulting in thinning of the medial cortex. CONCLUSIONS Cortical cancellization, trabecularization and thinning compromised the material strength of the femoral neck so that fracture would ensue even with trivial injury.

OBJECTIVE To design convenient lateronasal and infrafrontal approaches or lateronasal subvolution approach to radically resect skull base tumors involving cranial cavity. METHODS From 1987 through 1994, 22 patients with malignant tumors, 6 with benign tumors, one with a giant sphenoid sinus cyst and one with intranasal meningoencephalocele underwent the operation. Twenty-three cases had anterocranial fossa involved; 4, midcranial fossa; 2, anteromedial cranial fossa; and 1 case, posteromedial cranial fossa. Among the patients with malignant tumors, 11 underwent expansive maxillectomy and 10 had orbital contents resected. The intracranial approaches through lateronasal and infrafront (21 cases), nasal columella lateral subvolution (3 cases) and other approaches were used. RESULTS The reconstruction of bony skull base defect in excess of 3.00 cm×3.00 cm with total front musculocutaneous flap (8 cases), galeal and pericranial flap (5 cases) or other tissues (3 cases) has effectively prevented meningoencephalocele. Twelve cases had the dura resected in a range of 2.00 cm×2.00 cm to 7.00 cm×6.00 cm. Reconstruction of the dura defect with autofascia lata in 9 cases and other tissues in 3 cases effectively prevented the cerebrospinal fluid leak. Eight of 22 (36.4%) patients with malignant tumors have been alive and free of disease for 3-7 years after the operation. Six patients with benign tumors, one patient with giant sphenoid sinus cyst and one with meningoencephalocele were cured with this reconstructing method. CONCLUSIONS Frontal musculocutaneous and pericranial flaps have advantages over free bone because of easy surviving and easy operating without occurrence of osteonecrosis and exclusive reaction.

OBJECTIVE To study the relation among enzymic ultrastructural localizations, cell organelles and functions of Trichomonas vaginalis (T. vaginalis) as well as its pathogenic mechanism. MATERIAL AND METHODS The specimens were Trichomonas vaginalis cultured purely for several generations. After prefixation, several electron microscopic cytochemical reactions for marker enzymes of lysosome, Golgi body, mitochondrion and microbody as well as Ur-Pb-Cu impregnation were undertaken. Then the specimens were post-fixed and embedded, and the unstained ultrathin sections were observed under a transmission electron microscope. RESULTS The activities of acid phosphatase and cytidine monophosphatase appeared in the primary and secondary lysosomes of the parasite, and the reaction product of peroxidase was found in the secondary lysosomes. It was found that lysosomes could release hydrolytic enzymes out of the cell. The reaction products of thiamine pyrophosphatase and nicotinamide adenine dinucleotide phosphatase were located within the mature-surface and intermediate saccules of Golgi body respectively. The reactions for succinate dehydrogenase, cytochrome oxidase and catalase were negative. The hydrogenosomes, endoplasmic reticulum and Golgi bodies of the parasite were densely stained by Ur-Pb-Cu impregnation method. CONCLUSIONS T. vaginalis has lysosomal system which can release hydrolases out of the parasite, causing damage to the vaginal and urethral epithelial cells. This may be an important pathogenic mechanism of vaginitis and urethritis caused by T. vaginalis. This protozoon has well-developed Golgi bodies and rich endoplasmic reticulum. It lacks mitochondrion and microbody, but has abundant hydrogenosomes which are energy producing organelles of anaerobic metabolism and resemble microbody in morphology and mitochondrion in some functions.

OBJECTIVE To evaluate the effects of myocardial viability assessment with positron emission tomography on cardiac revascularization decision-making and consequential outcomes of patients with multivessel coronary artery disease. METHODS Thirty-three patients with multivessel coronary disease and heart failure were studied in this series, using 13NH for myocardial perfusion and F-18-deoxy-glucose for myocardial metabolism. Viable myocardium (mis-matched perfusion-metabolism) was visually and quantitatively analyzed in anterior, apical, septal, inferior, and lateral segments of the left ventricle. Left ventricular ejection fraction (LVEF) was also measured with first-pass radionuclide angiocardiography. RESULTS Based on the assessment of myocardial viability, 19 patients (group A) with sufficient viable myocardium underwent revascularization (coronary bypass graft and/or angioplasty), and 14 patients (group B) without sufficient viable myocardium received conservative medical treatment. During an average of 17-month follow-up, there were 2 (10.5%) deaths in group A and 2 in group B (14.3%) deaths (P>0.5). Patients with revascularization showed significantly improved average LVEFs post-revascularization, without revascularization procedure-related mortality; patients with medical treatment had an initial average LVEF of 25% and class Ⅱ-Ⅲ (NYHA) average cardiac function with a survival rate of 86% in average, which was better than that reported in literature. CONCLUSIONS Positron emission tomography is useful in myocardial viability assessment for cardiac revascularization decision-making through precisely selecting suitable patients for revascularization and avoiding operations on those who will not benefit, which results in promising effects on outcomes of patients with multivessel coronary disease and severe left ventricular dysfunction.

OBJECTIVE To investigate the relationship between left ventricular diastolic dysfunction and episodes of angina decubitus. METHODS The study population consisted of three groups, groups Ⅰ (20 controls) had no cardiovascular diseases. Group Ⅱ (20 patients) had coronary artery disease (CAD) without angina decubitus. Group Ⅲ (24 cases with ejection fraction (EF)>45%) were selected from 26 patients with angina decubitus. RESULTS Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction (1/3FF) was significantly reduced in groups Ⅲ as compared with groups Ⅱ and Ⅰ (P<0.01). Left ventricular end-diastolic pressure (LVEDP) significantly increased in patients with angina decubitus after LVG as compared with that before LVG (P<0.01). However, there were no statistically differences in LVEDP, before and after LVG in both groups Ⅱ and Ⅰ. CONCLUSIONS Patients with angina decubitus have abnormalities of LV diastolic filling and decrease in LV compliance.

OBJECTIVE To study red blood cell (RBC) membrane band 3 protein structure and anion transport function in cor pulmonale patients with respiratory failure. PATIENTS AND METHODS Blood samples were obtained from 80 cases of cor pulmonale and 37 normal subjects (control group). The patients were divided into type Ⅰ respiratory failure (Group Ⅰ, n=40) and type Ⅱ respiratory failure (Group Ⅱ, n=40). The anion permeability of the erythrocyte membrane (Pcl), PO2 and PCO2 in 12 of the patients with type Ⅱ respiratory failure were observed in acute stage (AS), chronic stage (CS) and recovery stage (RS). Membrane protein was analyzed by polyacrylamide electrophoresis in SDS. 55-KDa membrane domain was fractionated on 10% NaDodSO4 polyacrylamide gel column and purified further with a sephadax G-25 column. The composition of amino acids was analyzed on a Beckman 6300 Gold system amino acid analyzer. The Pcl was determined by the hypoisotonic hemolysis method. RESULTS The relative content of band 3 protein erythrocytic membrane, anion permeability coefficient of the erythrocyte membrane and plasma chloride in the patients with cor pulmonale with type Ⅱ respiratory failure were significantly lower than those in the patients with type Ⅰ respiratory failure and the control. The number of residues in the anion transport domain of the trypsin fragment of 55,000 daltons of band 3 protein showed no significant difference among the three groups. CONCLUSIONS The structure of anion transport sites remains intact and so the reduction of the anion transport function of band 3 protein in patients with cor pulmonale with type Ⅱ respiratory failure may be due to the decrease of the relative content of band 3 protein, the decrease of extraerythrocytic chloride and hypoxia.