1997年 · 第110卷第08期

OBJECTIVE To determine the pathologic bases of the abnormal signal intensities detected on magnetic resonance imaging (MRI) in Shy-Drager syndrome (SDS) and striatonigral degeneration (SND). METHODS The correlation of MRI and pathological findings was prospectively evaluated by postmortem scanning of the brain in a case of SDS and another of SND. MRI was performed by using a 1.0 T superconductive magnetic unit, with spin echo (SE) pulse sequences. The brain sections were prepared parallel to the MRI planes. The gross and microscopic pathological studies were conducted according to the corresponding abnormal signal intensities on MRI. RESULTS In SDS, abnormal hypointense signals on T2 weighted MR images were symmetrically demonstrated in bilateral putamen, where a remarkable positive Prussian blue stain reaction was revealed on pathological examinations. In SND, MRI showed isointense signals on T1 weighted images and hyperintense signals on T2 weighted images in bilateral putamen, and the microscopic findings included necrosis, abundant reactive fibrillary astrocytes and prominence of capillary vascular networks, as well as marked lipofuscin. The number of neurons decreased in both cases. CONCLUSIONS The demonstration of the abnormal signals in the putamen on MRI is of important value in establishing an antemortem diagnosis of SDS and SND.

OBJECTIVE To find out the implications of significant probability mapping (SPM) in patients with lacuna infarct. METHODS Quantitative electroencephalograms (QEEGs) of 45 patients with lacuna infarcts verified by computerized tomography (CT) were compared with mean power of different frequency bands of the healthy control group by Z transform. RESULTS Thirty patients with one focus of lacuna infarct and 15 patients with multiple foci were verified by CT scan. Thirty patients had focus, and the focal abnormality was found by SPM in 22 cases, but only 5 cases by EEGs (P < 0.05). In multiple lacuna infarcts, focal abnormalities were discovered on SPM in 5 cases. Both general and focal abnormalities in the predominant findings were the increased power of slow frequency band. In 13 cases the focal abnormalities were basically in correspondence with the localization verified by CT scan. CONCLUSIONS SPM could be helpful in discovering the remote dysfunction of cortex. The sensitivity of SPM was better than the electroencephalogram (EEG) and brain electrical activity mapping (BEAM).

OBJECTIVE To determine whether the hepatovenous intrahepatic anastomoses exist in normal humans. METHODS A total of 13 livers were isolated during the early autopsies of normal men who died in accidents. Perfusion venography of the branches of hepatic veins using meglucamine diatrizoate was performed in 6 cases. This method of investigation has not been reported in the literature. In one case, a portal venography was done. In the remaining 6 cases, liver substance stainings were done by injecting ink through the middle hepatic vein, and the tissue sections of these livers were observed under light microscope. RESULTS There were intrahepatic anastomoses between the hepatic veins within the liver. These anastomoses belonged to the 4th or 5th branch of hepatic vein near the capsule. There were also anastomoses between the middle hepatic vein and the hepatic short veins. Shunts existed between the portal veins and hepatic veins. CONCLUSIONS The detection of anastomoses of intrahepatic veins in normal individuals provide anatomical rationale for the performance of irregular hepatectomy, as well as rationale for the ligation of one or two hepatic veins should such veins be traumatized or invaded by liver cancer.

OBJECTIVE To evaluate conservative management of patients with histological incomplete excision of CIN after large loop excision of transformation zone (LLETZ). METHODS Two hundred and seventeen patients with high grade CIN were treated with LLETZ from October 1, 1992 to December 31, 1994. Fifty-three patients (24.4%) had incomplete excision on histology. All patients were followed up cytologically every 3 to 6 months during the first 18 months and then yearly till December 1996. Those patients with positive endocervical margins were followed up with both cervical smear and endocervical smear. RESULTS The mean follow-up duration was 30.4 months. Ten patients were found to have persistent or recurrent disease. Five patients had second LLETZ and complete excision was achieved in 4 of them, one patient had cone biopsy and two had hysterectomy. One patient was found to have stage I a cervical cancer. CONCLUSIONS A report of incomplete excision of CIN after LLETZ calls for follow-up with cytology and colposcopy and not aggressive retreatment.

OBJECTIVE To document the recent surgical results in the treatment of primary hyperparathyroidism (HPT) at Queen Mary Hospital. METHODS From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. The data of 11 men and 19 women with ages ranging from 19 to 86 years (median: 57 years) were prospectively recorded with emphasis on the need of preoperative localization. RESULTS Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respectively. Seventy-seven localization studies were performed in 28 patients (average: 2.6 tests/patient). Localization was accurate in 12 of 23 (52%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scintigraphies. Twenty-six patients had a single adenoma excised while 3 patients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical exploration. Immediate normocalcemia was achieved in 29 patients. One patient had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second operation. One patient had a unilateral vocal cord paralysis and 4 patients needed calcium supplement on discharge. During a median follow-up of 5 months, all patients were normocalcemic with one requiring calcium supplements. CONCLUSIONS Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experience routine preoperative localization study is not cost-effective.

OBJECTIVE To analyse the relationship between the number of T-cell receptor (TCR) γ gene rearrangement and clonality of malignant cells in lymphocytic leukemia and lymphoma. METHODS The TCRγ gene characteristics of 73 cases of lymphocytic leukemia and lymphoma and other diseases that had presented 1 or 2 prominent bands of amplified TCRγ VI subgroups-J1/2 gene rearrangement (GR) were detected by polymerase chain reaction-restriction enzymes (PCR-RE), heteroduplex formation (HDF), DNA sequencing and single-strand conformational polymorphism (SSCP). RESULTS Thirty-four percent patients had 2 of TCRγ GR (biallelic rearrangement); twenty-six percent had 1 of TCRγ GR; fifty-four percent of acute lymphocytic leukemia's and nineteen percent of non-Hodgkin's lymphomas (NHL) had 2 of TCRγ GR. HDF could rapidly confirm more than 1 of alleles while more alleles were difficult to be recognized by restriction analysis. Sense and antisense strands of heteroduplex were composed of 2 of TCRγ GR respectively. By combining HDF method, oligoclonalities in three patients (2 acute lympholytic leukemia and 1 myelodysplastil syndrome and clone evolution in one NHL were found. CONCLUSIONS The fact that many patients had 2 of TCR GR means that complications of two neoplastic clones can be affirmed only if more than 2 of TCR GR are found. HDF can be used to detect the clonality, oligoclonality and polyclonality of lymphoid cells in lymphocytic leukemia and lymphoma by analysis of the difference of gene segments. HDF is a reliable method for the clone evolution research of lymphoid malignancies in progression.

OBJECTIVE To investigate the actions of beta-blocker (atenolol) and ACE inhibitor (enalapril) for the secondary prevention of the main cardiac complications after acute myocardial infarction (AMI). METHODS 1106 cases of AMI from 7 hospitals in the Beijing area were collected and were divided randomly into three groups: control (group C), atenolol (group A), and enalapril (group E). Drugs for investigation were administered 2-4 weeks after the onset of AMI, and the subjects were followed up for a median period of 19 months. All patients were given aspirin 50 mg/day. The end points of observation were cardiac events and non-cardiac events. Cardiac events included sudden cardiac death (SCD), heart failure death, total cardiac deaths, and myocardial re-infarction. RESULTS The clinical conditions of the three groups were compatible. Sixty-six cardiac events (6.0%) occurred. Comparing with group C, the rate of SCD decreased significantly by 68% in group A after atenolol treatment for 28 months. Both atenolol and enalapril significantly increased left ventricular ejection fraction (LVEF), whereas in group C the LVEF did not change during the follow-up peroid. There was obvious decreasing tendency of the survival curve in group C, compared with the other two groups. Totally drugs decrease one cardiac death‰/month. But the rate of myocardial re-infarction was the same in the three observed. CONCLUSION Both atenolol and enalapril (domestic products) are beneficial to the secondary prevention of SCD and heart failure death after AMI, but not to re-infarction. Both drugs should be continued for a prolonged period to be effective. Drugs given 2-4 weeks after acute stage are also effective, with no serious side effects.

OBJECTIVE To explore the relationship between heart failure and changes in intracellular calcium concentration of the myocardium. METHODS The intra-and extracellular concentration of ionized calcium and total calcium of myocardium in 11 cases of heart failure was measured using calcium fluorescence indicator Fura-2 and atom absorption spectrophotometry. The activity of the erythrocyte membrane pump was determined with hemolysate chemical method. RESULTS The concentration of ionized calcium in myocardial cells and the erythrocyte was significantly higher in the patients with heart failure (280.85±47.8 nmol/L, 1.76±0.04 F335/F385) than in those without heart failure (121.88±13.15 nmol/L, 1.47±0.08 F335/F385). Total calcium in the erythrocyte was also increased markedly in the patients with heart failure, but the activity of the erythrocyte membrane pump was lower than in those without heart failure. The intracellular calcium of the peripheral erythrocyte and the activity of membrane pump returned to normal after the heart failure was cured. CONCLUSIONS There is excessive calcium accumulation in the myocardium and erythrocyte and the latter may be cause of the disturbance of myocardial diastolic function during heart failure.

OBJECTIVE To determine antiganglioside antibodies (AGA) in cerebrospinal fluid (CSF) of children with neuropsychiatric lupus erythematosus (NPLE), and to investigate their association with clinical manifestations and other laboratory tests. METHODS An enzyme linked immunoabsorbent assay was used to detect AGA in 22 CSF samples obtained from 18 children with systemic lupus erythematosus (SLE). These patients were further classified into clinical active NPLE (9 patients) and SLE (9 patients) groups. Indirect immunofluorescent assay was used for determination of CSF antinucleus antibodies (ANA). RESULTS AGA could be found in CSF of all the 9 active NPLE children who had neuropsychiatric manifestations within 6 months before or after AGA was tested. A clear association was observed between AGA and brain CT scan. No detectable ANA was found in CSF samples even though high titer of ANA was present in corresponding serum samples of SLE patients. CONCLUSIONS Detection of AGAs in CSF, more sensitive and specific than routine CSF examination and EEG, and positively associated with brain CT scan, is a simple and practical test for early judgment of childhood NPLE.

OBJECTIVE To determine the effects of transforming growth factor-β3 (TGF-β3) on expressions of surfactant proteins (SPs). METHODS Northern blot hybridization and reverse transcriptase polymerase chain reaction (RT-PCR) were employed to determine the SP-A, SP-B and SP-C mRNA levels of cultured lung explants and type Ⅱ cells from fetal rat lungs. RESULTS TGF-β3 alone did not affect the expressions of SPs either in explants or in type Ⅱ cells. However, TGF-β 3 did inhibit the increase of SP-B, SP-C mRNA levels caused by dexamethasone (100 nmol/L), in a dose-dependent manner. Furthermore, TGF-β3 had no direct inhibition on the increase of SP-B, SP-C mRNA induced by dexamethasone in type Ⅱ cells, but had an indirect inhibitory effect mediated by fibroblasts. CONCLUSIONS TGF-β3 plays an important inhibitory role in the development of pulmonary surfactant proteins. The present study may provide a possible explanation for the unideal effect of glucocorticoids in the prevention of neonatal respiratory distress syndrome.

The second National Congress of Young Pediatricians was held in Yichang from the 21st to 22nd of October, 1996, organized by the National Pediatric Society, Chinese Medical Association. Young pediatricians from various municipalities and most of the provinces and autonomous regions submitted papers. During the first round of review, 259 papers were invited to Yichang to verbally present their papers. Finally authors of 8 papers were awarded the first prize, 16 papers received the second prize and 32 papers the third.