2001年 · 第114卷第05期

Objective To investigate the effect of Hantaan virus infection on the expression of stress genes. Methods Techniques of virus infection, Western blot, immunohistochemistry, dual-immunofluorecsence staining, laser scanning confocal microscopy, RNA dot blot and in situ hybridization were used. Results Expression of heat shock protein 70 (Hsp70) was observed in cells infected with HTV as well as the translocation of Hsp70 from cytoplasm to nucleoli following virus infection. The variable distribution of Hsp70 was related to the various time after infection. Double-label indirect immunofluorescence of nuclear protein (NP) and Hsp70 in infected cells demonstrated co-localization of these proteins in the cytoplasm. Conclusion Overexpression of Hsp70 can be induced directly by Hantaan virus, which may be associated with virus protein assembly. The Hantaan virus proteins co-localize with, and possibly form a physical complex with cellular Hsp70 in infected cells. Chin Med J 2001; 114(5): 535-539

Objective To review experience with endoscopic palliation of malignant obstructive jaundice (MOJ) in 929 patients. Methods From 1994 to 1998, 929 patients (598 males and 331 females) underwent 1215 endoscopic palliation drainages for MOJ in our hospital. The mean age of these patients was 57 yeara (range, 8 - 86). Tumor obstruction occurred in the distal GBD (263 patients), the middle CBD(43), and the hilum (909), with a mean bilirubin level of 284 μmol/L (range, 26 - 810) . Of the 1215 drainages, 595 were performed by stenting with plastic endoprosthesis,385 by nasobiliary catheterization, 167 by expandable metal stents, 39 by combined drainage methods, 19 by tumor papillotomy, and 6 by endoscopic fistulostomy. Results The success rate of the endoscopic procedure was 94.3%. Jaundice was improved in 81.8% of the patients with a significant reduction of serum bilirubin (64.7%). The post-drainage complication rate was 2.6%. Complications included cholangitis (23 patients),pancreatitis (8), and bleeding (1). The overall drainage-related mortality rate was 0.2%, mainly due to uncontrolled cholangitis and renal failure. The median survival time of all patients was 14 months. Analysis showed a life expectancy of 76%, 44% and 25% at year 1, 2 and 3 postoperatively, respectively. Conclusions In patients with MOJ secondary to pancreatobiliary malignancy, successful endoscopic drainage provides adequate relief of biliary obstruction and is associated with low moibidity and mortality. Endoscopic interventional treatment should be an alternative to palliative biliary operation for terminal stage pancreatic and biliary malignancies.

Objective To evaluate gasless laparoscopy in treating gynecological conditions. Methods With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operative field and pelvic organs with routine operative instruments under epidural anesthesia. When a dense pelvic adhesion was confronted, we used the temporarily low-pressured pneumolaparoscopy to dissect it. Results All procedures were carried out without organ injury, hematoma, or other complications. The operative field can be clearly seen with this method. The mean time for appendagectomy was one hour and for laparoscopic assisted vaginal hysterectomy 80 minutes. Conclusion Gasless laparoscopy avoids the complications which occur in the routine laparoscopy such as subcutaneous or mediastinal pneumatoma, hypercarbonemia, air embolism, cardiopulmonary dysfunction. Our lifting method is simple, convenient, time and money saving, as well as more flexible for treating gynecological conditions. Chin Med J 2001;114(5): 514-516

Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL). Methods According to the distribution and complications of upper urinary calculi, 164 patients were divided into five groups. Group A consisted of 48 patients with 1 to 4 renal calculi, which were or less than 2 cm in diameter. Group B was composed of 24 patients with renal calculus larger than 2 cm in diameter or one to multiple renal calculi. Group C was composed of 22 patients with 1 to 3 renal calculi accompanied by 1 to 2ureteric calculi. Group D consisted of 51 patients with 1 to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter, respectively. Group E included 19 patients with complicated renal calculus, such as casting and staghom renal calculus. Urine and blood samples of these patients were obtained before and after ESWL, respectively. Their urine samples were proven sterile prior to treatment. All samples were cultured for bacteria and investigated for endotoxin concentration by the limulus tysate test. Results No significant difference in serum endotoxin was noted before and after ESWL. Blood bacterial cultures were all negative in all patients after ESWL, similar to those before ESWL. Significant increases in urine endotoxin after ESWL compared with that before ESWL in patients of Groups B, C and E were observed, respectively (P <0.05). There was no significant difference in urine endotoxin after ESWL compared with that before ESWL in patients of Groups A and D. The positive incidences of urine bacterial culture were significantly increased (P <0.05) in Groups B and C and very significantly increased(P<0.01) in Group E compared with those in Groups A and D. Conclusions Urinary infection risk following ESWL was lower in patients with one to several renal calculi, which were less than 2 cm in diameter and did not interfere obviously with the urine flow or in patients with 1to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter. The risk was higher in those with complicated calculi, such as casting, staghom renal calculus, renal calculus larger than 2 cm in diameter or renal calculi accompanied by ureteric calculi. For patients with higher infection risk after ESWL, prophylactic antibiotics are necessary even if bacteriuria is not present before ESWL. Endotoxin determination in urine is a reliable, sensitive and simple method for the diagnosis of bacterial infection in patients undergoing ESWL. Chin Med J 2001; 114(5): 510-513

Objective To analyze the characteristics of hepatic metastasis of pure immature ovarian teratoma and explore its proper diagnosis and treatment. Methods Eighteen cases of hepatic metastasis of pure immature ovarian teratoma were included in this study. The clinical stage, operation, chemotherapy and histopathology of primary and secondary tumors as well as the data from long term follow-ups were analyzed retrospectively. Results All of the hepatic metastatic tumors were located on the surface of the liver. 61.1%(11/18) of them were clinical stage III and 44.4%(8/18) were grade 1 at first operation. The hepatic metastatic rate was 16.7%(3/18) in the standard adjuvant chemotherapy group but increased markedly to 31.2%(15/48) in the irregular chemotherapy group. Auxiliary diagnostic methods could not indicate the correct results. The surgical resection rate of hepatic metastasis of pure immature ovarian teratoma was 94.4%(17/18). There were less complications in the group with tumor diameter less than 15 cm. The follow-up time ranged from 3 to 205 months with a mean of 20.9 months. The 3-year-survival rate was 77.8%(14/18), and mortality rate was 22.2%. The 5- and 10-year-survival rate was 55.6%(10/18) and 38.9%(7/18), respectively. The rate of loss in follow-up was 22.2%(4/18) and 38.9%(7/18), respectively, and one patient has survived for more than 17 years. Conclusions The hepatic metastatic rate of pure immature ovarian teratoma could be decreased using standard adjuvant chemotherapy. Suitable surgical treatment could reduce complications and improve the prognosis for patients. Chin Med J 2001; 114 (5): 506-509

Objective To evaluate the inhibition effect of capecitabine a new prodrug of 5-fluorouracil which is dependent on platelet-derived endothelial cell growth factor (PD-ECGF)], on recurrence and metastasis after liver cancer resection in LCI-D20, a nude mice model with highly metastatic human liver cancer. Methods The protein level of PD-ECGF was determined by using immunohistochemical methods in 18 liver cancer samples and 18 lung metastasis samples of LCI-D20. The liver tumors were radically removed in 24 LCD-D20 nude mice on day 10 after their orthotopic implanting. Capecitabine, 5-fluorouracil, and arabic gum (control) via oral administration were used on day 3 after their removal. All treatment lasted 3 weeks. Tumor size was calculated by using the formula: V=a× b2 ×0.5. The AFP levels in the plasma of the nude mice were detected by radioimmonoassay. Lung metastasis was evaluated by HE staining in lung samples. Results PD-ECGFs were expressed in all 18 liver cancer and 18 lung metastasis samples. After the intervention of capecitabine, the size of recurrent intrahepatic tumor [168±206mm3] was smaller than that of the control [3162±690 mm3] . The AFP level [107 ±90 ng/ml] was also significantly lower than that of the control [1519 ±807 ng/ml] (P <0.05) . The rate of intrahepatic recurrence and lung metastasis decreased significantly (P <0.05). However, no difference was noted in the above characteristics between the 5-fluorouracil group and the control group. Conclusion Capecitabine may inhibit the recurrence and metastasis of highly metastatic liver cancer after its resection.

Objective To study the effects of the p16 gene on tumor cell growth inhibition and cell cycle arrest. Methods The recombinant retroviral vector pLp16SN was constructed by cloning the human p16 cDNA into the retroviral vector pLXSN. Retroviruses with or without the p16 gene were obtained by transfecting pLp16SN and pLXSN vectors into PA317 cells. Bcap-37 human breast cancer cells were infected with these retroviruses followed by selection with G418. The expression of p16 was detected by Northern and Western blots. Cell biological characteristics, including cell growth rate, cell cycle and tumorigenesis in nude mice were assessed. Results Both mRNA and protein expression of p16 in Bcap-37 cells transfected with retroviral vector containing the p16 gene were much higher than that in Bcap-37 cells transfected with empty vector or parental Bcap-37 cells. Cell overexpressing the p16 gene exhibited a slower rate of growth, a higher percentage of cells in the G1 phase, and smaller tumors in nude mice, compared with parental Bcap-37cells and cells transfected with empty vector. Conclusion Overexpression of the p16 gene could suppress the growth of Bcap-37 breast cancer cells by arresting the cell cycle at the G1 to S-phase. Chin Med J 2001; 114(5): 497-501

Objective To investigate the prevalence and features of active human cytomegalovirus (HCMV) infection in children with systemic lupus erythematosus (SLE) and evaluate the diagnostic value of the HCMV antigenemia assay, PCR, and serological tests. Methods Twenty-one SLE children who underwent immunosuppressive therapy were enrolled in this study. As a control group, twenty-one immunocompetent children with skeletal malformation were also included in this study. The two groups were comparable in age (range, 8-13 years), sex, and observation period. Serum and whole blood samples were collected before and monthly after immunosuppression during a successive 2- to 3-month period. Immunofluorescence assay, PCR, and serological tests were used to determine HCMV pp65 and p72 antigens in leukocytes, HCMV DNA in sera, and HCMV specific IgM and IgG antibodies, respectively. Results Active HCMV infection was diagnosed in 29%(6/21) of SLE patients, while there was none in the control group, The difference between two groups was significant (P=0.027). Two out of 6 SLE patients developed active HCMV infection before immunosuppressive therapy and the other four patients developed it after immunosuppressive therapy. Among the 21 SLE children, HCMV pp65antigenemia was detected in 5 patients, p72 antigenemia in 3 patients, HCMV DNA in sera in 9 patients, serum HCMV-specific IgM in 2 patients, and IgG in 19 patients. The sensitivity and specificity for diagnosis of active HCMV infection were 83% and 100%, respectively for pp65antigenemia; 50% and 100% for p72 antigenemia; 100%and 80% for serum PCR; 33% and 100% for serum HCMV IgM antibody detection; and 50% and 100% for serum HCMV IgG antibody detection. Conclusion Compared with the control group, the active HCMV infection seemed to be a much more common complication in SLE children. It could occur before treatment with immunosuppressive agents, but mostly occurred after immunosuppressive therapy. Compared with other techniques used in this study, the pp65 antigenemia assay seemed to be a better method for the early diagnosis and monitoring of active HCMV infection in children with SLE.

Objective To observe engraftment kinetics, the incidence and severity of graft-versus-host disease(GVHD), and clinical outcome on 40 recipients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods From June 1997 to May 1999, forty leukemia patients with a median age of 35 years underwent allo-PBSCT. PBSC were mobilized with G-CSF at a dose of 5 μg/kg s.c. every 12 hours for 5 days. A median of 7.7 (2.0 - 16.8) × 106 CD34+ cells/kg was infused into the recipients. Busulfan-cyclophosphamide (BU-CY) was used as the conditioning regimen. All patients received cyclosporine A and either methotrexate (n=34) or methylprednisolone (n=6) for GVHD prophylaxis. Results Engraftment of neutrophils and platelets was achieved at a median of 13 days (9 - 28 days) and 12 days (7-60 days) respectively. Patients receiving ≥4×106 CD34+ cells/kg or given G-CSF post transplant had significantly accelerated neutrophil and platelet engraftment. Acute GVHD occurred in 17 of 40 patients (42.5%), with grade II-IV acute GVHD in 10 patients (25%). Chronic GVHD developed in 21(9 extensive, 12 limited) out of 30 evaluable patients (21/30, 70%) with a median follow up of 380 days(180 - 900 days). Transplant related mortality was 17.5%and the relapse rate was 10%. The probability of leukemia free survival at 3 years was 72.5%. Conclusion Allo-PBSCT can provide rapid hematopoietic reconstitution without an increased incidence of acute GVHD, but may be associated with a high risk of chronic GVHD. Chin Med J 2001; 114(5): 493-496

Objective To investigate the incidence of pregnancy induced hypertention (PIH) in Shanghai during 1989 -1998. Methods Data were analyzed retrospectively from three municipal general hospitals and five special hospitals of obstetrics and gynecology. Results There were 158 790 deliveries during the ten years. The total number of PIH was 8852 cases. The incidence of PIH was 5.57%. The rates of mild, moderate and severe PIH were 55.83%, 29.39%, and 14.78%, respectively. There were 114 cases (1.29%) complicated with eclampsia. The rate of cesarean section was 66.97%in PIH patients. The complications of PIH were as follows: abruption of Placenta 0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.07%, hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome 0.03%, and one case of maternal death. There were 9197births in 8852 cases of PIH (twins 343 cases, triplets one case). Perinatal death occurred in 66 cases (7.18‰), of which fetal death accounted for 48 cases, stillbirth 12 cases and neonatal death 6 cases. Conclusion The incidence of PIH and the rate of perinatal infant death can be reduced by strengthening antenatal monitoring, prevention, early diagnosis and treatment of PIH.

Objective To discuss the diagnostic accuracy of the preliminary clinical use of stereotactically guided wire localization biopsy for nonpalpable breast lesions and its value in the early detection of breast carcinomas. Methods Stereotactically guided wire localization biopsy was performed on 26 lesions. The distance between the needle tip and disease center (D) was calculated and compared to that directly obtained from measurement of the localization between the wire tip and center of the lesion. Localization was rated as excellent, good or bad when D values were ≤2.5 mm, =2.6- 2.9 mm, and ≥5.0 mm, respectively. Results Excellent, good, or bad localization results were achieved in 20, 5, and 1 procedure, respectively. These data correlated well with the direct measurements of the localization between the wire tip and center of the lesion. Resection of 26 lesions by a single operation was achieved,and the median volume of the resected specimens was 10.5 cm3. The breast carcinoma detection rate of 6/26 was achieved. Conclusion Our initial application of the technique showed that stereotactically guided wire localization biopsy of nonpalpable breast lesions is an effective tool for the localization and specification of breast lesions. It could avoid false negativity and help excise the entire lesion without excessive excision of the surrounding normal tissue. The technique is worthy of wider application for the preoperative diagnosis of nonpalpable breast lesions.

Objective To investigate the clinical effects of cordotomy on bilateral cord abductal paralysis. Methods With unilateral cordotomy, we treated 4 patients with bilateral cord paralysis whose glottis size was about 2.0 mm to 2.5mm. They were followed up for over one year. Results One week after surgery, the tracheotomy tubes of all 4 patients were plugged and no dyspnea occurred during rest and mild action. Their voices were more hoarse than before surgery. After 3 months, the tracheotomy tubes were successfully decannulated, and in the following one year, their respiration was normal and then speech was clear, although their voices were still a little hoarse. Conclusion We suggest that cordotomy be one option in the treatment of bilateral cord abductal paralysis. Chin Med J 2001; 114(5): 542-543

Objective To evaluate the diagnosis and management of bronchial rupture from blunt thoracic trauma. Methods A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tomography and bronchoscopy were performed on all patients. The surgical technique and complications were described. Results Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneumonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81 %(25/31)of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, "drop lung" sign and marked radiodensity of hilum widened mediastinum. Conclusion Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients. Chin Med J 2001, 114(5): 540-541

Objective To investigate the expression of the Fas antigen and the induction of apoptosis in eosinophils (EOS) by anti Fas antibody in vitro. Methods The purified EOS from healthy donors were cultured for 72 h in the presence of human IL-5 with or without anti-Fas monoclonal antibody (MoAb) at various concentrations (1- 1000 ng/ml). The changes of eosinophil viability, percentage of apoptosis, and fragmented DNA electrophoresis were observed. The eosinophils treated by Fas MoAb for 24 h, 48 h, 72 h were cultured with monocyte-derived macrophages. The positive percentage of macrophages which engulfed EOS was calculated. Results The anti-Fas MoAb suppressed IL-5-mediated EOS survival in a dose- and time-dependant manner. High concentration of IL-5 (106 U/L) could not inhibit anti-Fas MoAb-mediated apoptosis. The percentage of apoptosis was 35% ± 6% after 24 h treatment with Fas MoAb (P <0.01(, and increased to 96% ± 3% after 72 h (P < 0.01), The percentage of macrophages which engulfed eosinophils was significantly higher than that of control (P < 0.01). Conclusion The anti-Fas MoAb can efficiently induce eosinophil apoptosis, and apoptotic EOS induced by anti-Fax MoAb could be engulfed by macrophages.