1999年 · 第112卷第03期

OBJECTIVE To review the modern recognition of growth hormone deficiency (GHD) in adults and the beneficial effects of growth hormone (GH) treatment in such cases. DATA SOUCES AND METHODS Most published original articles about GH and GHD in recent domestic and world wide related literatures were available. STUDY SELECTION More than 65 originally identified articles were reviewed and 29 were selected that especially addressed the stated purpose. RESULTS Treatment of GHD in adult human beings became an option following the development of rhGH and the numerous reports on the effect of rhGH therapy in such patients. The syndrome of GH deficiency in adults principally comprises abnormalities in body composition, cardiovascular risk factor, and psychological well-being. In comparison with normal individuals, these patients have increased total-body fat mass (particularly visceral adiposity), reduced muscle mass, reduced muscle strength exercise performance, and reduced bone mass. The psychological dysfunction comprises self-reported reduction in energy, mood, and sleep, along with objective reductions in marital and socioeconomic performance. CONCLUSION The evidence that rhGH administration may be beneficial for the prevention, as well as treatment, of various clinical situations.

OBJECTIVE To prevent anastomotic stricture of the trachea. METHODS Forty young mongrel dogs, weighing 5-7 kg, were randomly divided into two groups: experimental group and control group, with 20 dogs in each group. Four tracheal rings were removed from each dog. In the experimental group, two "Z"-shape tracheoplastic anastomoses were performed on each dog, one on the anterior wall and the other on the membranous part of the trachea. In the control group, each dog received only simple end-to-end anastomosis. Vicryl 3-0 absorbable suture and OB fibrin glue were used for both groups. All dogs were killed when their body weight doubled. RESULTS The average sagittal stenotic ratio were 1.20±0.12 for the experimental group and 0.83±0.05 for the control group. The average cross-sectional area stenotic ratio were 0.90±0.12 and 0.69±0.09 and T values were 8.71 and 4.57 for the two groups (P<0.01). CONCLUSIONS "Z"-shape tracheoplasty is superior to simple end-to-end anastomosis in preventing anastomotic stricture of canine trachea.

OBJECTIVE To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) (>6.0 cm) and prevent normal perfusion pressure breakthrough (NPPB) for lowering the postoperative mortality. METHODS During the operation under barbiturate anesthesia, the proximal end of the feeding arteries were ligated at first, and 0.5 ml isobutyl 12-cyanoacrylate (IBCA) with 0.5 ml 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were resected totally. Postoperative digital subtraction angiography of the four vessels was performed in all patients. RESULTS 50 patients with giant AVM survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a follow-up of 6-36 months. No patient suffered from normal perfusion pressure breakthrough (NPPB). CONCLUSIONS The embolization could block the arteriovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain so as to prevent the incidence of intra- and postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which make it operable for those used to be regarded as inoperable cases.

OBJECTIVE To investigate the best surgical approach for the removal of trigeminal neurinomas (TNs). METHODS A retrospective analysis of 75' patients with TNs in Huashan Hospital was carried out. RESULTS In the early group (1978-1984), a series of conventional intradural approaches were used; in the late group (1985-1995), an epidural approach via the skull-base craniotomy was used. Total tumor removal was achieved in 58% (20/35) of patients in the early group and 80% (32/40) in the late group (P<0.025). Temporary and permanent cranial nerve morbidity were 62.7% and 37% in the early group and 28.1% and 10% in the late group (P<0.001). CONCLUSIONS The best microsurgical approach for the removal of trigeminal neurinomas except those confined to the posterior fossa is epidural approach or epidurotransduro-transtentorial approach via the skull-base craniotomy.

OBJECTIVE To evaluate preliminarily the therapeutic efficacy of transcatheter arterial embolization (TAE) for different histopathologic subtypes of primary hepatocellular carcinoma (HCC). METHODS A retrospective study of 226 patients with histopathologically diagnosed primary HCC was performed. The patients were treated with either single TAE, surgical resection of tumor alone, or TAE combined with surgical resection. Follow-up information was achieved in 157 of 226 patients. Comparative analyses of survival data and image findings were performed with correlation to histopathologic classification and different therapeutic methods, respectively. RESULTS Eight histopathologic subtypes of primary HCC were found in this group, including HCC of trabecular pattern, pseudoglandular pattern, fibrolamellar HCC and sclerosing HCC, as well as HCC of clear cell, of small cell, poorly differentiated or undifferentiated HCC, and hormonally active HCC. The accumulated survival rate for these 157 patients was 74.52% of 1 year, 53.50% of 2 years, 31.85% and 14.01% of 3 and 5 years, respectively. Fibrolamellar HCC and clear cell HCC had relatively higher survival rate (25.00% and 33.22% of 5 years, respectively) than that of other subtypes, and the median survival time of the latter was 71 months. The mean survival time was 25.06 months (SE = 1.87) in single TAE group, 30.38 (SE = 2.05) months in surgical resection, and 72 months (SE = 6.90) in TAE combined with resection. CONCLUSIONS Discrepancies do exist in therapeutic effect of different subtypes of HCC. In this study, clear cell HCC was more sensitive to TAE than other subtypes, and, in contrast, small cell HCC and poorly differentiated or undifferentiated HCC were of lower sensitivity to TAE.

OBJECTIVE To study the outcome of a multi-centred post-molar pregnancy serum human chorionic gonadotrophin (hCG) surveillance programme. METHODS Patients recruited into the multi-centred post-molar serum hCG surveillance programme between 1988 and 1996 were studied. The clinical data were obtained from medical records and computer database. RESULTS There were 616 patients in the study. Twenty-five (11%) of 224 patients with molar pregnancy and 28 (7%) of 392 patients with partial molar pregnancy were diagnosed to have persistent trophoblastic tumour (PTT) requiring chemotherapy. Of the 53 patients treated for PTT, 58.5% received intravenous methotrexate (MTX), 22.6% received both MTX and actinomycin D, and 19% received CHAMOC, a multiple chemotherapeutic regimen. Four patients receiving single drug had to change the regimen because of poor response, and all recovered and remained well. There were 3 cases of recurrence, one in each group of patients receiving single, dual or multiple agents. One patient died because of treatment complication. The rest were well with a mean follow-up of 42 months. CONCLUSIONS Post-molar serum hCG surveillance is important to detecting persistent trophoblastic activity. Early treatment of PTT by the appropriate chemotherapy has a near hundred percent cure and prevents the progression of PTT into more advanced trophoblastic malignancy such as choriocarcinoma.

OBJECTIVE To examine the utilization and contribution of cardiac perfusion scans to patients undergoing percutaneous transluminal coronary angioplasty. METHODS From July 1996 to January 1998, 34 patients underwent percutaneous transluminal coronary angioplasty and cardiac SPECT imaging was studied. Twenty-five patients had pre-procedure SPECT scans. The agreement between angioplasty strategies and SPECT findings of ischemia and hypokinesia was examined. RESULTS When radionuclide imaging was performed before revascularization procedures, 84% of the patients had intervention strategies guided by scan findings. Perfusion scan findings including extent and severity of ischemia, degree of hypokinesia directed the selection of target vessel for angioplasty in the patient subgroup with multi-vessel disease. Post-angioplasty radionuclide cardiac scans were performed only on symptomatic patients, demonstrating ischemia and hypokinesia in most of them, conceivably reflected the selection bias. CONCLUSIONS We recommend routine pre- and post-angioplasty radionuclide imaging with multigated scans for wall motion assessment for all patients receiving coronary intervention.

OBJECTIVE To investigate the expression of growth factor Wnt-5A in urinary tumor cell lines. METHODS By semi-quantitative RT-PCR (reverse transcriptase polymerase chain reaction), the expression of Wnt-5A in six urinary malignant cell lines, one primary cultured renal fibroblast and one case of normal human renal tissue was detected using Gel Doc 1000 computer controlled molecular analysis system. RESULTS The expression of Wnt-5A in-urinary tumor cell lines was much higher than that in primary cultured renal fibroblasts (PRF) and normal human renal tissue (NRT). The levels of Wnt-5A mRNA were different between six malignant cell lines. CONCLUSIONS The overexpression of growth factor Wnt-5A has a potential effect on the oncogenesis of urinary malignancies.

OBJECTIVE To explore the possibility of using specific antigens for immunodiagnosis of hookworm disease in endemic area. METHODS Infective third-stage larvae of the canine hookworm, Ancylostoma caninum (A. caninum), were prepared as the source of antigen. Enzyme-linked immunoelectrotransfer blotting (EITB) was employed as an immunodiagnostic method. RESULTS Two immunodominant bands of hookworm antigens (42 kDa and 55 kDa) were recognized by the sera of hookworm-infected patients (serum dilution 1:200; antigen centrifuged at 36,000 r/m for 20 minutes, but not by sera from negative controls. CONCLUSIONS The 42 kDa and 55 kDa A. caninum antigens might be the specific antigens that could be used for immunodiagnosis of hookworm disease in endemic area.

OBJECTIVE To investigate the variations of auditory evoked potentials (AEP) and visual evoked potentials (VEP) of patients with idiot savant (IS) syndrome. METHODS Both AEP and VEP were recorded from 7 patients with IS syndrome, 21 mentally retarded (MR) children without the syndrome and 21 normally age-matched controls, using a Dantec concerto SEEG-16 BEAM instrument. RESULTS Both AEP and VEP of MR group showed significantly longer latencies (P1 and P2 latencies of AEP, P<0.01; N1 and N2 latencies of VEP, P<0.01/0.05), lower P2 amplitudes (P<0.01) and higher P3 amplitudes (P<0.01), as compared with normal controls. But none of above-mentioned changes was found with IS group. Almost all MR patients (90.1%) presented P4 component in both AEP and VEP, which was also in sharp contrast with its incidence in other 2 groups (IS: 14.3%; normal controls: 9.5%). CONCLUSIONS Patients with idiot savant syndrome presented normalized AEP and VEP.

OBJECTIVE To type haplotypes among the patients, carriers and normal offspring in a family of males with Becker muscular dystrophy in one generation by allelic fragment length polymorphism analysis. METHODS Deletion analysis of the patients were performed using multiplex polymerase chain reaction (PCR) of amplification with 9 dystrophin exon primers. Intragenic short tandem repeat (STR) sequence (STR44, STR45, STR49 and STR50) were amplified by PCR to analyse allelic fragment length polymorphisms in the members of the family. RESULTS The deletions of exons 17, 19 and 45, as well as deletions of allelic fragments at the loci of STR44 and STR45 were determined in the patients. Hemizygosity at those two loci were detected and carrier status ascertained in the mother of the patients. The normal haplotypes were typed in the sister of the patients. CONCLUSIONS The method of STR sequence polymorphism analysis can determine haplotypes at normal status or at risk status. It would be used in prenatal diagnosis and carrier detection in the families of Duchenne and Becker muscular dystrophy.