1998年 · 第111卷第01期

OBJECTIVE To investigate the protective effect of apo-lipoprotein (apo) AⅠ, AⅡ, CⅠ and CⅡ, the main proteins in high density lipoprotein (HDL), on the morphology and function of human umbilical vein endothelial cells injured with low density lipoprotein (LDL) in vitro. METHODS Cultured human endothelial cells derived from umbilical veins were exposed to LDL, HDL, and apoAⅠ, AⅡ, CⅠ and CⅡ. The morphology of endothelial cells was examined with phase contrast and transmission electron microscope. The released amount of lactate dehydrogenase (LDH) and 6-keto-prostaglandin F1α (PGF1α) was also measured. RESULTS Endothelial cells after being injured by LDL showed cell contraction, increased release of LDH and decreased secrection of prostacyclin (PGI2). However, the addition of HDL, and apoAⅠ, AⅡ, CⅠ and CⅡ before incubation with LDL inhibited the cellular injury induced by LDL as demonstrated by lowered LDH release, increased level of PGF1α and prevention of morphological changes. CONCLUSIONS The results indicate that apoAⅠ, AⅡ, CⅠ and CⅡ, as well as HDL, may play an important role in combating atherogenesis by protecting endothelial cells from damages induced by LDL.

OBJECTIVE To study the changes of creatine kinase MM (CK-MM) isoforms in Duchenne muscular dystrophy (DMD) patients. METHODS Serum samples from 49 DMD patients and 40 control subjects were collected for CK-MM isoforms measurement. CK-MM isoforms were separated within 30 minutes by electrophoresis on agarose gel with a discontinuous buffer system at constant current of 30 mA and low voltage of 200-300 V, then measured by fluorescence scanning. RESULTS Significant differences of MM2/MM1 ratio were found between DMD patients and control subjects (P<0.05) as well as among the three different age groups of DMD patients (P<0.05). CONCLUSIONS CK-MM isoforms may present useful information for the early diagnosis and evaluation of DMD and the ratio of MM2/MM1 can be considered as a specific indicator of the degree of seriousness for DMD patients.

OBJECTIVE To investigate the growth and development of myelin of sheath fetal brain. METHODS Forty-four cases of pregnant women were imaged with magnetic resonance (MR) at 0.35 T (tesla). The signal changes of the main structures of fetal brain were analysed. RESULTS The signal intensity of cerebral (except basal ganglia) and cerebellar matter was hypo-signal on the T1WI (T1 weighted spin-echo image), iso-signal of the PDWI (Proton density weighted image) and hyper-signal on the T2WI (T2 weighted spin-echo image). As to the brain stem and basal ganglia, their signal intensities showed difference in different gestational weeks on T1WI. The intensities were of slight hypo-signal before and iso-signal after the 29th week. However, their signal intensities on PDWI and T2WI were the same as those of the cerebral and cerebellar matter. CONCLUSIONS There was no myelinization of fetal cerebral (except basal ganglia) and cerebellar matter during pregnant period. The myelin sheath was formed in the brain stem and basal ganglia after 29 gestational weeks. The process of myelinization began from brain stem to basal ganglia.

OBJECTIVE To study the effects of pretreatment with triptorelin on uterine fibroid before abdominal hysterectomy. METHODS Fifteen premenopausal Chinese women with symptomatic uterine fibroids requiring hysterectomy were recruited in the study. All patients received monthly intramuscular injections of 3.75 mg triptorelin for three months prior to abdominal hysterectomy. RESULTS There was significant reduction in the serum levels of oestradiol (68.6%), progesterone (95.6%) and luteinizing hormone (73.9%) and in uterine (45.0%) and fibroid (68.0%) volumes. The serum level of follicle-stimulating hormone and haemoglobin concentration were not significantly different. CONCLUSIONS Shrinkage of uterine fibroids can be achieved in women who are rendered hypoestrogenic with monthly injections of triptorelin for three months. This treatment modality may be of value prior to hysterectomy or myomectomy especially when the fibroid is large.

OBJECTIVE To observe the survival of embryonic motoneurons after they were transplanted into the denervated skeletal muscles and to find a new method to retard the atrophy of denervated muscles. METHODS Dissociated embryonic motoneurons prelabled with 5-bromo-2'-deoxyuridine (Brdur) on the embryonic days 12 were injected into the denervated gastrocnemius muscles of adult rats. Then gastrocnemius muscles were processed with Nissl staining, acetylcholinesterase staining and Brdur immunocytochemical staining to show the implanted motoneurons at 9 and 22 weeks post-transplantation. Myofibrillar ATPase staining was used to show the morphology of muscle fibers. The rats in experimental group were implanted with embryonic motoneurons in the predenervation muscles, while the rats in control group were injected with just culture medium without motoneurons. RESULTS Embryonic motoneurons survived, developed and extended long axons to form neuromuscular junctions with the denervated muscles. The differentiation of muscle fibers and fiber type grouping occurred among bigger fibers in experimental group. The transverse area was smaller and there was no apparent fiber type grouping in control group. CONCLUSIONS Embryonic motoneurons can survive, develop and reinnervate denervated muscles after being transplanted into denervated muscles. It is worth further investigating on ameliorating the atrophy of denervated muscle.

OBJECTIVE To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (<2 cm in diameter); 2) intraventricular hemorrhage; 3) hemorrhage in the corpus callosum; 4) small focal areas of hemorrhage adjacent to the third ventricle (<2 cm in diameter); and 5) brain stem hemorrhage. All patients were divided into two groups, DAI and non-DAI group, according to the criteria. There were 42 patients in the DAI group and 75 patients in the non-DAI group. The injury causes, Glasgow coma scale (GCS) scores on admission, coexisting injuries and outcomes were compared between the two groups. The relationship between DAI and the outcomes in the patients with severe head injury was analyzed. RESULTS Traffic accident was the main injury cause in the cases of DAI. GCS scores on admission in patients with DAI were significantly lower than those in patients without DAI. The incidence of diffuse brain swelling (DBS) in the DAI group was significantly higher than that in the non-DAI group, whereas the incidences of both skull fracture and epidural hematoma (EDH) in the DAI group were significantly lower than those in non-DAI group. There was no significant difference between the incidence of subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) in the two groups. The incidence of poor outcome in the DAI group was significantly higher than that in the non-DAI group, although there was no significant difference between the mortalities in the two groups. CONCLUSIONS Because DAI is a very important factor worsening the outcome of patients with head injury, it is essential to make a diagnosis as soon as possible. The clinical manifestations of DAI, however, are not specific and DAI does not show directly on CT scans, so it is difficult to make a definite diagnosis. The CT diagnostic criteria of DAI put forward in this article are practicable, though they are by no means perfect.

OBJECTIVE To investigate the metabolic changes, pathological state and histological types of intracranial tumors with hydrogen-1 magnetic resonance spectroscopy (H-1 MRS). METHODS Thirteen patients with intracranial tumors were studied with localized proton magnetic resonance spectroscopy (H-1MRS), in vivo. All spectra were obtained with a 2.0 T whole body MR imaging system. RESULTS All the spectra of these tumors exhibited high ratios of choline (Cho)/creatine (Cr) and Cho/N-acetyl aspartate (NAA), and histologically different tumors showed obvious variations in the metabolite ratios. Significant differences of Cho/Cr ratio were found between meningiomas and astrocytomas by statistical evaluation. The spectra obtained after operation were remarkably different from those before operation. CONCLUSIONS H-1 MRS can serve as a non-invasive clinical test for therapeutic and prognostic uses for intracranial tumors.

OBJECTIVE To present our initial experience in transurethral vaporization of the prostate (TVP) using an oval electrode for the treatment of benign prostatic hyperplasia (BPH). METHODS A total of 82 patients underwent TVP procedures with the oval electrode. The newly designed oval-shaped electrode can work with a High Frequency Electrosurgery Unit. Prostate gland tissue was vaporized through an Fr 24 percutaneous nephroscope transurethrally. The operation procedure was similar to transurethral resection of the prostate (TURP) or transurethral laser prostatectomy (TULP). Power setting ranged from 240 W to 320 W. Local vaporization temperature reached 120 ℃. RESULTS Urination was recovered in all 82 patients after TVP. Mean post-treatment International Prostate Symptom Score (I-PSS) reduced from 27.10 to 5.05; mean bladder residual urine volume dropped from 147.71 ml to 33.2 ml; and mean urine flow rate (MFR) increased from 4.45 ml/s to 14.57 ml/s (P < 0.01). The initial results of short-term follow-up were excellent. CONCLUSIONS TVP with the oval electrode is easy to perform and causes less hemorrhage and few complications. It especially benefits elderly and/or critically-ill patients. We believe that TVP with our oval electrode is feasible with low risk.

OBJECTIVE To test the validity of continuous low-flow perfusion with low-potassium dextran (LPD) to preserve rabbit lung. METHODS Isolated rabbit lungs were preserved for eight hours either in Ringer's solution by simple storage (Group I) or in continuous low-flow perfusion with LPD (Group II). After preservation, lung functions were assessed to compare these two methods. RESULTS The water gain in Group I was higher than that in Group II. During reperfusion, the functional test values for the immersed lungs were lower than those for the perfused lungs. The lipid peroxidation product (MDA) was significantly decreased in perfused lungs during reperfusion. CONCLUSIONS Low-flow perfusion with LPD is better than immersion for the lung preservation.

OBJECTIVE To elucidate the mechanisms of protective immunity in mice elicited by living hookworm (Ancylostoma caninum third-stage infective larvae (L3). METHODS The number of migrating infective larvae recovered from the lungs was used as an endpoint for vaccine immunity. The timing of maximal L3 lung entry was determined by counting the number of lung larvae at several time points after infection with 500 or 1000 L3. Mice were immunized either orally or subcutaneously with 500 L3, followed by two boosts of L3 once every two weeks. The immunized mice were challenged orally with 500 L3 one week after the final boost. To evaluate the protective immunity, the number of L3 recovered from the lungs of the immunized mice during the time of maximal larval entry was compared with that of controls. Host immunity was also evaluated by comparing circulating anti-L3 antibodies between immunized and controlled mice, using both enzyme immunoassays and immunoblotting techniques, and by lung histopathology. RESULTS The peak time of larval entry into the lungs occurred 48 hours after infection. Mice immunized either orally or subcutaneously with L3 exhibited a marked reduction (90.2% and 86.2% respectively) in the number of recovered lung larvae in comparison to controls (P < 0.01). The protection might be associated with circulating anti-L 3 antibodies, including antibodies directed against 132-200 kDa L3 antigens, as well as three major antigens ranging from 28 to 51 kDa. Larvae migrating through the lungs of vaccinated mice showed cuticular damages accompanied with host-inflammatory cell invasion. CONCLUSIONS Immunization with living L3 protects mice against lung invasion after challenged with hookworm infection. Vaccine immunity is associated with circulating antibodies against L3 antigens and lung inflammatory responses. The mouse model is potentially useful for developing a hookworm vaccine.

It has been a difficult problem to repair or reconstruct common bile duct after choledochectomy. The substitutious made from different materials by various methods have been tried for nearly a century, but almost all of them have had the same problem of retrograde infection. The purpose of this study is to verify a polyurethane replacement which can wave self-rhythmically through a bag under diaphragm.

Vecuronium is a new nondepolarizing muscle relaxant with the intermediate clinical duration. The previous study showed that the neuromuscular blocking effect of vecuronium in children differed from that in adults. There is no reference dealing with the causes of the difference. To determine whether the difference results from changes in elimination, distribution or sensitivity, we studied the pharmacokinetics and pharmacodynamics of vecuronium in adults and children during nitrous oxide-enflurance anesthesia.

In the past, total resection of the gastric stump and esophagojejunostomy were carried out for cardiac cancer of the gastric stump. After surgery, patients were usually severely affected in quality of life. In this study, we applied the gastroesophagostomy after cardiectomy of the gastric stump.

The neuroendocrine and immune systems are bidrectionally linked. Products of the immune system like lymphokines and monokines modulate the neuroendocrine functions while various neuroendocrine signals also affect the immuune functions. Neuroendocrine and lymphoid cells share a number of neurotransmitters, neuromodulatory substances, hormones and their receptors suggesting the existence of a bidrectional regulation between the two systems. Evidence shows that such a reciprocal interaction exists between the pineal gland and the immune system.

Acute upper gastrointestinal haemorrhage is a common reason for admission to hospital. Approximately 20% of our annual upper endoscopy workloads are performed for upper gastrointestinal bleeding. The incidence of acute upper gastrointestinal haemorrhage increases markedly with age and is higher in men than in women. Peptic ulcers account for approximately half the lesions, with gastric ulcers less common than duodenal ulcers.

Hypertrophic cardiomyopathy (HCM) is one of the primary cardiomyopathies. The primary pathologic changes are left ventricular hypertrophy and ventricular septal hypertrophy. Based on the location of myocardial hypertrophy and the outflow tract of left ventricle, HCM can be classified into two types: obstructive and non-obstructive HCM. HCM is considered a familial disease. However, there are few reports of more than 10 cases in a family. The authors report 11 cases of HCM with familial line investigations.

The list of known causes of granulomatous peritonitis is long and well established. However, as far as we know, only one case about a granulomatous response to escaped gallstone granuloma may clinically resemble tumor deposits, it should cause the attention of histopathologists. In this report, we present a case of an omental foreign body-type granulomatous reaction to gallstones spilt during a previous laparoscopic cholecystectomy.

We report a rare association between the use of rifampicin and the development of pseudomembranous colitis. The diarrhoea promptly responded to oral vancomycin and the withdrawal of antituberculous medications. The long latency between the administration of rifampicin and the onset of disease was an atypical feature of pseudomembranous colitis.