1997年 · 第110卷第09期

OBJECTIVE To describe the clinical, pathologic and immunohistochemical characteristics of collecting duct carcinoma (CDC) of the kidney. METHODS Five cases of CDC (3 males and 2 females, aged 41 to 67 years) were identified between January, 1990 and December, 1994. Routine histopathologic study and immunohistochemical examinations of the surgical specimens were performed. RESULTS Four patients underwent radical nephrectomy; 3 have been alive without evidence of recurrence for 3 months, 2 years and 2.5 years, respectively after the operation. Bone metastasis was noted 2 months after the operation in 1 case. One patient was submitted to simple nephrectomy because of extensive regional node involvement and died of lung metastasis 14 months after the surgery. Grossly, the tumors were usually grey-whitish in color and located in the renal medulla. Microscopically, the characteristic structure of tubulo-papillary pattern could be identified. Marked desmoplastic reaction was noted and atypical hyperplastic changes were found in the adjacent collecting ducts. Immunohistochemical studies revealed positive results to epithelial membrane antigen, high molecular weight cytokeratin and peanut agglutinin. CONCLUSIONS CDC of the kidney is a rare disease with a poor prognosis. Radical nephrectomy is recommended even if the tumor is small.

OBJECTIVE To demonstrate the hypoglycemic effects and translocation of glucose transporter (Glut 1 and Glut 4) promoted by peroxovanadate and nicotinic acid complexes (nicotinic chelated bitriperoxovanadate, POR; N-O nicotinic chelated peroxovanadate, POV) in streptozotozin-induced diabetic rats. METHODS Peroxovanadate complexes of nicotinic acid (POR and POV) were prepared and characterized in laboratory. POR, POV and vanadate were administrated in drink water. The muscles from diabetic rats were subjected to prepare plasma membrane and microsome membrane. Antibodies to COOH-terminal of glucose transporter were used in Western Blot to evaluate the translocation. RESULTS POR and POV showed markedly hypoglycemic effects in streptozotocin (STZ)-induced diabetic rats. POV, which may be a N-oxide compound of peroxovanadate, have high potency of acute effects comparing to carboxylate-complexes of peroxovanadate (POR). In chronic tests, 1 mg/kg oral pathway POR could significantly reduce the plasma glucose levels over four week's treatment, whereas the same dose of single sodium vanadate or nicotinic acid did not have hypoglycemic effects. The net vanadium intake is about 1/90 of single effectively vanadate treatment. The Western Blot showed that POR increased the translocation of Glut 4 and Glut 1 from intracellular site of membrane. CONCLUSIONS Peroxovanadate-nicotinic acid complexes (POR and POV) are the novel vanadyl that acutely and markedly reduce plasma glucose in a lower dose comparing to vanadate in STZ-DM rats by oral administration. Translocation of glucose transportor may take a part in their hypoglycemic effects.

OBJECTIVE To observe the changes of tissue lithium content and its relationship with glucose metabolism in spontaneous hereditary diabetic Chinese hamsters (SHDCH). METHODS Twenty diabetic and ten normal Chinese hamsters were paired and separated randomly into four groups: controls (C), diabetics (D), controls treated with lithium carbonate (CT) and diabetics treated with lithium carbonate (DT). The lithium carbonate treatment was administrated with drinking water containing lithium carbonate (0.2 mg/ml). Blood glucose levels were determined at 0, 1, 3, 5, 6th month, and insulin levels at 1, 3, 6th month. The lithium contents in liver, kidney and muscles were determined at the end of 6th month, using wet digestion assay and ICP-AES. Concentrations of fructosamine, lactic acid, GPT, BUN were also evaluated. RESULTS The data showed that in Group D the lithium levels in hepatic tissue were lower than in Group C (P<0.05), and lithium contents in kidney and muscle also decreased. In Group DT, the lithium contents in tissues were higher than in Group D (P<0.05) and similar to Group C. Blood glucose levels and fructosamine concentrations decreased while insulin and lactic acid levels did not alter significantly. GPT and BUN levels did not change in both Group CT and Group DT. CONCLUSIONS There is lithium deficiency in hepatic, renal and muscular tissues from diabetic Chinese hamsters. Low-dose and six-month-treatments of lithium carbonate can improve tissue lithium deficiency and glucose metabolism, and do not damage liver and kidney functions.

OBJECTIVE To compare the hemodynamic change, course of recovery and adverse reaction in desflurane, sevoflurane and enflurane inhalation under low flow for patients undergoing selective abdominal surgery. METHODS Following thiopental induction, 42 patients were divided into three groups: the first group received desflurane, the second sevoflurane and the third enflurane. During surgery, one of the agents around 1 minimum alveolar concentration (MAC) was used for maintenance, with fresh gas flow of 0.3-0.5 L/min for either desflurane or enflurane, and (0.8-1.0) L/min for sevoflurane. Heart rate (HR), blood pressure and end-tidal anesthetic concentration were monitored continuously. Time intervals from cutting off anesthetic to patient opening eyes, following commands, stating the time and location and recalling date of birth were all recorded. In addition, postoperative nausea or vomiting was traced. RESULTS Desflurane caused the least cardiovascular depression. with mean arterial pressure (MAP) maintained significantly better at 10, 30 and 60 minutes of surgery and with HR stabilized right after incision as well. Its emergence was 2 times faster than sevoflurane, and 5-6 times quicker than enflurane. However, nausea or vomiting was found the lowest in patients receiving sevoflurane, though no distinct difference was shown between desflurane and enflurane. Nevertheless, patients under desflurane suffered less. CONCLUSIONS Desflurane offers significant advantages for clinical anesthesia maintenance over sevoflurane and enflurane. It provides minimal cardiovascular depression, much quicker recovery, yet still causes some nausea during emergence.

OBJECTIVE To investigate the complications of laparoscopic cholecystectomy in China. METHODS All Chinese articles about laparoscopic cholecystectomy published between April 1994 and November 1995 were identified through CMCC (Chinese Medical Computerized Contents). From more than 600 titles, 105 articles were screened for analysis. Another 21 articles from the 6th Biliary Surgical Congress and 300 cases from the General Hospital of PLA were added. A total of 39,238 cases of laparoscopic cholecystectomy from 91 hospitals were studied. RESULTS Severe complications of laparoscopic cholecystectomy were identified in 409 (1.04%) patients, including bile duct injury (in 0.32% of patients), postoperative cystic duct leak (0.11%), postoperative bile leak (0.20%), peritoneal abscess (0.07%), bowel injury (0.06%) and postoperative hemorrhage (0.1%). Fourteen postoperative deaths (0.04%) resulted from operative injury. CONCLUSIONS The data demonstrate that laparoscopic cholecystectomy is an operation associated with low morbidity and mortality rate, but bile duct injury is still a major problem. Complications of laparoscopic cholecystectomy can be minimized by improving operative procedure.

OBJECTIVE To evaluate the value of transesophageal color Doppler echocardiography in the diagnosis of intrathoracic masses. METHODS Twenty patients with intrathoracic masses were examined by transesophageal echocardiography (TEE), including 12 patients with central lung masses and 8 with mediastinal masses. The neoplasms were explored by two-dimensional realtime ultrasonography, Doppler color flow imaging (DCFI) and pulsed Doppler (PD). The results were compared with computed tomography (CT), operative and pathological examination findings. RESULTS We were able to identify the size, structure (solid or cystic), anatomic relationship, metastatic lymph nodes and venous carcinoembolus of the masses. Furthermore, the hemodynamic data in the vasculature inside the masses were detected. CONCLUSIONS As a new method, TEE with Doppler technique is not only valuable in differentiating malignant and benign neoplasms but also useful for preoperative evaluation of the mass resectability in patients with intrathoracic neoplasms.

OBJECTIVE To examine the relationship between antibodies to acetylcholinesterase and myasthenic syndrome. METHODS Serum class specific antibodies to acetylcholinesterase and acetylcholine receptor were prepared with solid phase enzyme-linked immunosorbent assay in 51 patients with myasthenic syndrome, 31 controls with other neurological diseases (diseased controls) and 44 normal controls. RESULTS The positive rate of anti-acetylcholinesterase antibody in patients with myasthenic syndrome was 25%, while the RESULTS of the other two control groups were negative. Furthermore, the positive rate in patients without myasthenia gravis was 45%, which was much higher than that (13%) in those with myasthenic gravis. CONCLUSIONS Anti-acetylcholinesterase antibody may play a role in the pathogenesis of myasthenic syndrome.

OBJECTIVE To observe the biliary copper content of nonhepatolenticular degeneration (HLD) controls and changes in the trace elements in the bile, cerebrospinal fluid, blood and urine of hepatolenticular degeneration patients before and after dimercaptosuccinic acid (DMSA) treatment in order to further explore the etiological mechanism of HLD and prove the therapeutic effect of DMSA on HLD patients. METHODS A consecutive series of 20 patients with HLD were given DMSA orally for 4 weeks. Adult dosage was 1.5 g/day and child dosage 1.0 g/day. Their bile, cerebrospinal fluid, blood and urine samples were obtained before and after treatment with DMSA through duodenal drainage and lumbar puncture. Biliary samples of 22 non-HLD controls were taken by drainage tube after surgical operation. Hitachi-208 atom absorption spectrophotometer was used to assay the content of copper, zinc and iron of each sample. RESULTS DMSA could effectively improve the symptoms such as dysphasia, salivation, dysphagia and darkening of the skin; limb trembling and myotonia came second; but it showed no obvious effect on dysstasia, limb contracture and deformity, and hepatosplenomegaly. It was effective for the patients who were younger and had no obvious hepatic damage. No serious side effects were seen through the course of treatment. Laboratory study showed that biliary copper content of HLD patients was evidently lower than that of non-HLD controls (P<0.01); DMSA could evidently improve biliary copper excretion besides clearly increase urinary copper excretion (P<0.01) and had nothing to do with biliary zinc excretion (P>0.05). CONCLUSIONS Biliary copper excretion disturbance participates directly in the pathophysiology of copper retention of HLD patients. DMSA is a favorable cupruretic drug for patients with HLD.

OBJECTIVE To make clinical analysis and pathological study on 40-case Gullain-Barré syndrome with sural nerve biopsy. METHODS A total of 90 cases of GBS were retrospectively analyzed of which sural nerve biopsies were performed in 40 cases. The type of GBS was determined according to Asbury and Ropper criteria, and its correlation with pathological findings was studied. RESULTS In the 40 biopsy cases, demyelination was the predominant pathological change in 38 cases. Mild axonal degeneration was also seen in 13 of the 38 cases. Prominent axonal degeneration was seen in only 2 of 13 cases. The increased monocyte infiltration and varied capillary permeability were observed in 19 of 25 cases. Onion-bulb like changes were seen in 6 cases. CONCLUSIONS We studied the correlation between paresthesia and the pathological findings of sural nerve biopsy and concluded that sural nerve biopsy is very useful in the diagnosis of GBS and its variant.

OBJECTIVE To evaluate the association of the level of urine and serum soluble interleukin-2 receptor (sIL-2R) with disease activity and response to cyclosporine A (CsA) therapy in patients with lupus nephritis (LN). METHODS Sixteen hospitalized patients with LN were studied. At admission, fifteen patients had type IV-LN and one had type V-LN. All patients received CsA 6 mg/kg per day for 6-8 weeks, then tapered off gradually to 2 mg/kg per day. The levels of urinary and serum sIL-2R were determined by enzyme-linked immunosorbent assay (ELISA). Serum antinuclear antibody (ANA), anti-dsDNA antibody (A-ds-DNA), complement C3 and C4, total IgG, creatinine, urinary red blood cells and protein excretion, and lymphocyte subpopulations in the peripheral blood were also measured before and after CsA treatment. RESULTS In LN patients, both urinary (534±101 U/ml) and serum SIL-2R levels (326±148 U/ml) were higher than those in normal controls. These findings were associated with higher levels of peripheral blood CD4 + and CD8 + lymphocytes (29.3±4.24 and 28.6±9.12%), higher titer of serum anti-ds-DNA, lower levels of serum complement C2 and C4 (0.98±0.23 and 0.24±0.12 g/L), as well as more proteinuria (Upro 2.99±0.76 g/24 hrs) and hematuria (URBC 83.9±95.2 104/ml). These abnormalities were gradually ameliorated by CSA therapy. The changes in the levels of both serum (116±58.6 U/ml) and urine (136±43.2 U/ml) SIL-2R induced by CsA (at 8 weeks) were correlated with the changes in the levels of CD4 + and CD8 + cells (23.2±3.30 and 26.7±3.54%), degrees of immune abnormalities (serum C3 and C4 1.28±0.14 and 0.42±0.06 g/L), and renal injuries (Upro 1.07±0.46 g/24 hrs, URBC 5.82±3.15 104/ml). CONCLUSIONS These results suggest that serum and urinary sIL-2R are sensitive markers for the disease activity in patients with LN. CsA, a powerful immunosuppressive agent, significantly improves both immunologic disorders and renal functional impairments, the mechanism of which on patients with LN appears to inhibit the lymphocyte activation in the peripheral blood and renal tissues as indicated by the decrease in sIL-2R levels.

OBJECTIVE To compare the effects of metoprolol and propafenone in patients with ventricular arrhythmia (VA) of positive ventricular late potential (VLP) and to discuss the effect of medicine on high risk VA. METHODS 30 A total of 128 patients (78 males and 50 females) with VA of positive VLP were randomly divided into 3 groups. Groups A and B were given metoprolol and propafenone respectively, group C was given vitamin C as placebo. Twenty-four hours dynamic electrocardiogram and VLP were examined before treatment and 4 weeks after treatment. RESULTS Propafenone could effectively control VA but could not reverse positive VLP to negative meanwhile it had proarrhythmia effect (2/40), metoprolol could effectively control VA (38/46) and reverse positive VLP to negative (39/46) with no obvious side effects. The dosage from 50 to 100 mg/day made no difference. VA and VLP had no significant changes in group C. CONCLUSIONS Metoprolol is superior to other medicine for VA of positive VLP when the patients have no contraindication of β-receptor blocking agents.