2000年 · 第113卷第09期

Objective To investigate two rare benign lesions, hepatocellular adenoma(HCA)and focal nodular hyperplasia(FNH), and evaluate differential diagnosis. Methods Twenty-four consecutive patients with presumed HCA and FNH were studied at the Liver Cancer Institute from January 1996 to May 1999. Preoperative assessment included clinical evaluation, symptoms and laboratory tests. New imaging techniques were prospectively appraised in addition to usual techniques. All had hepatic resections and follow-up. Histologic examination of surgical specimens was obtained in all cases. Results In every instance, FNH was an incidental finding. FNH consists of nodular aggregates of cytologically normal hepatocytes with foci of intranodular bile duct proliferation. In this series, patients with HCA had larger tumors and more often were symptomatic but the occurrence was unrelated to oral contraceptive steroids(OCS)usage. Intralesional hemorrhage or necrosis is common, and was seen in 75% of cases. The best imaging procedure in the diagnosis of FNH was MRI. Color Doppler US was a useful adjunct, but CT lacked specificity, making histological diagnosis mandatory. All patients underwent tumor resected were tumor--free during the follow-up. Conclusions FNH is a distinct histopathologic entity, and is distinguishable from HCA. FNH is a hyperplastic response by the liver parenchyma to a pre-existing arterial malformation. HCA is a liver neoplasia and has the potential of malignant transformation to HCC. Based on these findings, we believe that if the clinical suspicion of HCA or FNH is strong, resection is usually the best approach if technically feasible and histologic diagnosis is mandatory. Chin Med J 2000; 113(9): 852-857

Objective To investigate the relationship between c-myc expression and mdrl regulation in multidrug resistance(MDR)tumor cell line KBv200. Methods A DNA sequence encoding the ribozyme gene was incorporated into a eukaryotic expression vector(pHβ Apr-1 neo)and transfected into the cell line KB, which is resistant to vincristine and expresses the MDR phenotype. The changes of c-myc protein, P-glycoprotein(P-gp)and c-myc mRNA in the KB cell line were assessed before and after treatment with anti-mdrl-ribozyme using immunohisto-chemistry, flow cytometry and semi-quantitative RT-PCR methods. Results The results demonstrate elevated levels of c-myc mRNA and c-myc protein as well as P-gp in KBv200 cells which are resistant to vincristine(VCR), compared to these of the KB cell which is not resistant to VCR. The expression of c-myc protein, P-gp and c-myc mRNA in the multidrug resistant cell, KBv200, displayed higher than that in the sensitive cell, KB. However, after reversing the multidrug resistance phenotype by anti-mdrl-ribozyme, the level of c-myc protein, P-gp and c-myc mRNA expression showed significant down-regulation in KBv/5mR3, without difference in KB/5mR3 and KB. Conclusion The results of our study suggest that there is a close relationship between c-myc gene and mdrl gene, c-myc may be involved in regulating the expression of mdrl. Chin Med J 2000; 113(9): 848-851

Objective To investigate the effects of nitric oxide(NO), endothelin(ET), substance P(SP)and calcitonin gene-related peptide(CGRP)immunocompetence substances and their relationship to chronic periodontitis. Methods Immunohistochemical aod histochemical staining methods were used to detect the expression of the NO synthase(NOS), ET, SP and CGRP levels in 20 patients with chronic periodontitis and 20 healthy subjects as control. Results Quantitative analysis by Quantimat 970 showed that NOS and ET in periodontitis tissue increased significantly(P < 0.01), particularly the content of ET in comparison with healthy subjects. The intergroup expression of SP and CGRP showed no remarkable changes. Conclusion Our results demonstrate that the level of NOS and ET were significantly increased in periodontitic tissue, which may diminish the blood supply and influence the periodontal tissue causing tissue damage. Our study suggests that immunocompetence substances NO and ET are closely associated with periodontitis and may play an important role in the disease. Chin Med J 2000; 113(9): 844-847

Objective To investigate the effect of propofol combined with diazepam on the y-aminobutyric acid(GABA)-activated chloride current (IGABA) evoked in rat sensory neurons. Methods Whole cell patch clamp recordings were made from cultured rat dorsal root ganglionic neurons. GABA(3 μmol/L)was applied by pressure ejection. The anesthetics were dissolved in the external solution and given by the "Y-tube" method. Results Co-application of propofol(0.3-3 μmol/L)and diazepam(100 nmol/L)potentiated the lGABA which was significantly larger than the sum of that potentiated by drug alone. Diazepam(100 nmol/L)shifted the concentration-response curve for the IGABA potentiation induced by propofol to the left in a parallel fashion. The EC50 value for propofol was decreased by diazepam from 7.6 ± 1.8 μmol/L to 3.9 ± 1.1 μmol/L(n=9). Conclusions Our results suggest that propofol combined with diazepam synergistically potentiates the IGABA. Diazepam-induced increase in the apparent binding affinity of propofol for the GABAA receptors is likely responsible for a clinical synergistic hypnotic action during co-application with propofol and diazepam. Chin Med J 2000; 113(9): 840-843

Objective To investigate the expression of Fas, FasL mRNA and proteins on keratinocytes and fibroblasts, and the influence by retinoid acid(RA)and dexamethasone(Dex). Methods RNase protection assay and flow cytometry were used. Results Fas mRNA was expressed on neonatal murine keratinocytes and was up-regulated by all-trans retinoid acid and down-regulated by Dex. RA and Dex also increased the Fas protein expression on keratinocytes. Newborn murine keratinocytes express FasL mRNA, which was up-regulated by RA and Dex, while its protein expression was moderately induced by RA. Newborn murine fibroblasts also expressed Fas and FasL mRNA, which were up-regulated by the RA and Dex. Conclusions The results indicated that RA and Dex might regulate apoptosis of keratinocytes and fibroblasts via the Fas-FasL system. Chin Med J 2000; 113(9): 833-835

Objective To assess the therapeutic effects of long-term albendazole therapy in intraabdominal cystic echinococcosis. Methods Fifteen patients with a total of 45 cysts were treated with albendazole with dosage regimen of 20 mg· kg-1 ·d-1 for an average of 2.5 years. Repeated CT and ultrasound scannings(US)were performed after the end of therapy. The duration of follow-up was 3.6 years on average. The number, size and morpiology of cysts were compared before and after treatment. Results The hydatid cysts were classified according to location and CT patterns into hepatic simple cysts, hepatic cysts with daughter cysts, hepatic/abdominal cysts and splenic cysts. The hepatic simple cysts responded most favorably to albendazole therapy, with an overall cure rate of 88.7%. The disappearance of cysts was observed in 43.0% of cases(15/35). Sixteen cysts(45.7%)became solidified or calcified, among which 8 cysts were completely calcified, 6 showed egg shell-like calcification of the cystic walls, and 2 showed solidification and calcification of cyst contents. Four patients had large hepatic cysts containing daughter cysts; the daughter cysts all disappeared after treatment, but one patient relapsed with the reappearance of daughter cysts at 4-year follow-up. Two splenic cysts also calcified. Two patients had peritoneal cysts; one calcified and the other one reduced in size. Among 15 patients treated, 9 were cured and 6 were improved. There was no serious toxic reactions with continuous long-term therapy in a small series of patients. Conclusions Continuous long-term albendazole treatment of intraabdominal cystic echinococcosis is safe and effective in the treatment of hepatic simple cysts, and some daughter cysts, peritoneal secondary cysts and splenic cysts. No serious toxic reactions were found. Chin. Med J 2000; 113(9): 827-832

Objective To investigate the effects of retinoic acid(RA)on the growth, morphology, oncogene expression and regulation of nasopharyngeal carcinoma cells. Methods Nasopharyngeal carcinoma cell line(HNE1)was induced by RA. The RA-treated and control cells were established and cellular morphology and growth patterns were defined. Oncogene expression and regulation were detected by Northern hybridization and DNase-I hypersensitive site analysis. Results RA markedly inhibited cell growth. The growth of HNE1, cells was reduced to 50% of the control level on the 4th day of RA(10-4 mol/L)treatment. After 4 days of treatment, the rapidly growing polygonal cells were reversed into a slow growing phenotype, with flattened morphology similar to fibroblast-like cells. Northern hybridization showed that c-myc and c-Ha-ras expression was high in HNE1, cells and undetectable in normal blood cells, c-myc was down-regulated at 48 h of RA treatment. In contrast, the c-Ha-ras was not affected. DNase I hypersensitive site analysis detected changes in the regulatory elements of c-myc and c-Ha-ras genes. 5 hypersensitive sites were found in the c-myc of HNE1, cells, while 3 hypersensitive sites disappeared upon HNE1 induction. However, only 1 hypersensitive site was found in c-Ha-ras of RA treated cells and controls. In normal peripheral white blood cells, no DNase I hypersensitive sites were found in the inactive c-myc and c-Ha-ras gene. Conclusion RA can induce differentiation in a nasopharyngeal carcinoma cell line at high concentration of RA; HNE1, shows some similar patterns of DNase I hypersensitive sites with the common one in other types of cells expressing c-myc. The repression of c-myc expression with induction is accompanied by the loss of 3 DNase-I hypersensitive sites; c-myc has more than one inactive conformation. Chin Med J 2000; 113(9): 823-826

Objective Fifteen loci on chromosome 9p and 17 were analyzed to clarify the involvement of loss of heterozygosity(LOH)in hepatocellular carcinoma(HCC)in Chinese patients positive for hepatitis B(HBV)and/or hepatitis C(HCV)infection. Expression of tumor suppressor genes(TSG)of p53, p16, and p15 gene was found to correlate with a deletion of these genes. Methods Immunohistochemistry and PCR-based microsatellite polymorphism analysis techniques were used. Results A high frequency of LOH was detected on chromosome 9p24 at locus D9S54(61.8%)and 9p21, concentrated at loci D9S1747(52.4%)and D9S1752(51.8%). On chromosome 17, high frequent LOH was concentrated on 17p at the p53 gene locus(53.8%)and locus D17S520(52.8%). p53 protein expression was increased in HCC, which correlated with p53 gene loss. Expression of p16 and p15 protein decreased in HCC when LOH occurred at locus D9S1752(p15 gene locus)or at locus D9S1747 and D9S1748(p16 gene is located between these 2 loci). LOH at the p53 gene and p15 gene loci was closely associated with HBV and HCV co-infection in HCC. No significant relationship between LOH and HCC clinico-pathological outcomes was observed. Conclusion High frequency LOH occurs on chromosomes 9p and 17 in HCC in Chinese patients. Such sites may contain several putative tumor suppressor genes critically involved in the development and/or progression of HCC. Deletion of p53, p16, or p15 tumor suppressor genes may cause abnormal expression of the protein product of these genes. HBV and/or HCV infection may be closely associated with LOH p53 and/or p15 gene expression. Chin Med J 2000; 113(9): 817-822

Objective To examine the effects of prenatal tetrandrine(Tet)therapy on pulmonary arterial structural remodeling in nitrofen-induced congenital diaphragmatic hernia(CDH). Methods CDH was induced in fetal rats by maternal administration of 100 mg nitrofen by gavage on day 9.5 of gestation(term, day 22). Control animals received olive oil(00). Tet(24 mg/kg per day)or normal saline(NS)was given by gavage every day from 16 to 20 days of gestation, and fetuses were delivered by caesarean section on day 21.5. Lung sections from 3 fetuses in each group were studied. The number of vessels were calculated, the external diameter(ED), medial wall thickness(MT), percent of medial wall thickness, and wall structure were evaluated by image analysis software. Results In the pre-acinar arteries, CDH-NS pups had a significantly increased % MT compared with the 00-NS group(P< 0.05), while CDH-Tet animals had a reduced %MT compared with the CDH-NS rats(P < 0.05). Similar results were seen in the intra-acinar level. Significant differences were observed between CDH-NS animals and 00-NS controls in the percentage of muscularized intra-acinar blood vessels(P < 0.001). Tet-treated CDH pups had a reduced percentage of muscularized intra-acinar arteries compared with CDH-NS animals. Conclusions Medial hypertrophy is present in both the pre-acinar and intra-acinar arteries in the nitrofen-induced CDH rat model. Tet treatment inhibits medial hypertrophy and reduces the percentage of muscularized intra-acinar vessels. Prenatal Tet therapy may be efficacious in reducing the risk of PH in human newborns with CDH. Chin Med J 2000; 113(9): 813-816

Objective To compare the surgical managements for ectopic pregnancy. Methods In a retrospective analysis, we examined the trend of surgical procedures and the results of different management in 149 patients. Results The change from laparotomy to laparoscopic treatment was significant. The success rates of salpingostomy and salpingectomy under laparoscopy or laparotomy were 100%. No serious complications occurred. The operation time and length of hospital stay for laparoscopic salpingostomy were shorter than those for laparotomy with salpingostomy. Conclusion Laparoscopic salpingostomy and laparoscopic salpingectomy are better than laparotomy in the treatment of ectopic pregnancy. Chin Med J 2000; 113(9): 810-812