2001年 · 第114卷第10期

Objective To determine the value and limitation of water enema spiral CT (WESCT) in staging of colorcetal carcinoma. Methods Forty-eight patients with histologically proven rectum or colon carcinoma were studied in this study. All of them were examined by SCT, and the preoperative staging of TNM and Duke were used based on the finding of SCT. The results of WESCT were compared with those of surgical and pathological examination in all cases. Results All lesions in the 47 cases were demonstrated clearly by WESCT and the sensitivity was 97.9%. 39 cases of 48 patients were correctly staged with TNM and 42 cases with Duke. The accuracy was 81.3% and 87.5%, respectively, which were higher than the overall 50%accuracy reported by references. The accuracy of VESCT was 89.6% (43/48) in T stage and 81.3% (39/48) in N stage. Three cases in M stage were all diagnosed correctly. Conclusion WESCT scan is a better method of depicting the colorectal carcinoma. It allows for accurate depiction and staging of colorectal carcinoma, especially deterling the invasion of adjacent tissues and distant metastasis. It is the best imaging method for staging the colorectal carcinoma. However the value of WESCT for early T staging in colorectal carcinoma and minute metastasis of lymph nodes or liver is limited. Chin J Radiol 2001; 35: 262-266.

Objective To investigate the kinetics and the magnitude of intragraft gene expression of interleukin-2 (IL-2), interferon-gamma (IFN-γ), perforin and granzyme B, and intragraft expression of interteukin-2 receptor (IL-2R) and intercellular adhesion molecule-1 (ICAM-1) during acute rejection episodes, and to analyze the changes in apoptosis in small intestinal allograft rejection. Methods Heterotopic small intestine transplantation was performed with inbred rats F344/N (RT11) and Wistar/A (RT1-Ak, RTI-Ed). All recipients were divided into four groups: group 1: Wistar, native control; group 2: Wistar→Wistar; group 3: F344→Wistar and group 4: F344→Wistar + cyclosporine A (6 mg· kg-1, · d-1 I.M.). The grafts were harvested on postoperative days (PODs) 3, 5 and 7. All samples were examined pathologically. Intragraft mRNA expression of IL-2, IFN-γ, perforin and granzyme B were detected with reverse transcriptase polymerase chain reaction (RT-PCR) and intragraft expression of IL-2R and ICAM-1 were stained using immunohistochemistry. We also analyzed the change in apoptosis rejection with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). Results Mild acute rejection occurred on POD 3 in the allograft group, moderate acute rejection on POD 5, and severe acute rejection on POD 7, while none of the isografts had histological evidence of acute rejection. Cyclosporine A could effectively control rejection. Gene expression was virtually negative in the native control. Only on POD 5 was IL-2 mRNA expression of allografts significantly higher than that of isografts (P<0.05). IFN-γ mRNA expression was significantly higher than that of the control groups (P < 0.01) on PODs 3, 5 and 7, and the level of perforin and granzyme B mRNA expression reached significantly higher levels than in the other two control groups on POD 5 and POD 7. Intragraft IL-2R expression of the allograft was significantly higher than that of the other three control groups. Only on POD 3 was intragraft ICAM-1 expression of allografts significantly higher than isografts. The number of apoptotic cells per crypt of allografts was significantly higher than that of the other three control groups on POD 3 and POD 5 (P<O.O1). Conclusion Transcription of IL-2, IFN-γ, perforin and granzyme B, and expression of IL-2R and ICAM-1 as well as apoptosis of epithelial cells of the grafts play an important role in small intestine allograft rejection. Intragraft gene expression of IFN-γ and intragraft expression of IL-2R as well as apoptotic epithelial cells may become a specific and sensitive diagnostic method of clinical value. Furthermore, therapeutic strategies to alter these molecules in small intestine transplantation may improve the outcome of current antirejection therapy. Chin Med J 2001; 114(1O):1089-1094

Objective To explore the biological features of basaloid squamous cell carcinoma (BSC) of the esophagus. Methods Cytokeratins (CK4, CK18 and CK19), epithelial membrane antigen (EMA), carcino embryo antigen (CEA), α-smooth muscle antigen (α-SMA), S-100, laminin (LN), collagen Ⅳ (Col-Ⅳ), neural-specific enolase (NSE), proliferating cell nuclear antigen (PCNA) and p53 antibodies were used to detect the corresponding antigen expression in 8 cases of BSC with ABC immunohistochemical methods. Results Two kinds of BSC cell components have different responses to the above antibodies. For basaloid cells (BCs), 7 cases were positive for CK19, and were negative for the other 4 epithelial antibodies CK4, CK18, CEA and EMA. BCs of 4 cases were positive to the muscular antibodies α-SMA and S-100, and the hyaline degeneration in the tumor nests was positive for LN and Col-Ⅳ. BCs had a high index of PCNA, with an average level of 54%. For squamous cells (SCs), 7 cases were positive for the epithelial antigen CK4, CEA and EMA, but were negative for CK19, α-SMA and S-100. The index of PCNA of SC was low, with an average level of 25%. Conclusion BSC of the esophagus is a high-malignancy tumor which is of multi-oriented differentiation. BCs represent basal cells which have the tendency of myoepithelial differentiation and have strong proliferation ability, whereas SCs represent typical squamous cell differentiation. Chin Med J 2001; 114(10):1084-1088

Objective To evaluate efficacy of percutaneous transluminal angioplasy (PTA) and stenting for treatment of transplanted ranal artery stenosis (TRAS). Methods Seven patients with TRAS were included in this study. By femoral or axillary approach, balloon angioplasty and/or metallic stent placement at stenostic renal artery were performed. Results Of the seven patients, balloon angioplasty was carried out in 3 (2 cases via femoral artery, and 1 via axillary artery), both balloon angioplasgy and metallic stent placement were performed in 4 (2 via femoral artery, and 2 via axillary artery). After the procedure, blood pressure recovered to normal in 5 cases, controlled with administration of anti-hypertensive in the other 2 cases. By 9 to 36 month's follow-up, restenosis of renal artery occurred in only 1 case at 9 months after stent implantation. The second balloon angioplasty were taken and better renal artery blood flow was obtained in this case. Other 6 cases showed no restenosis. Conclusion PTA and stent placement are effective and safe approaches in treatment of TRAS. Further investigation is needed to prevent and manage restenosis after these procedures. Chin J Radiol 2001; 35: 337-338.

Objective To study the histopathological changes of relevant internal organs of Macaca mulatta infected with Plasmodium knowlesi (P. knowlesi). Methods Histopathological examination of 3 monkeys who died of P. knowlesi infection, 2 P. knowlesi infected monkeys who died of treatment failure with artesunate suppository and 1 P. knowlesi infected monkey that was cured by piperaquine phosphate (PQP) but died of trauma and necrosis of the fore limb. Results The heart, liver, spleen, lung, kidney, brain, pancreas, parathyriod, pituitary and lymph nodes showed severe pathological changes in 3 monkeys (No. 1, 7 and 12) who died of P. knowlesi infection and 1 infected monkey (No. 72) who died of treatment failure with artesunate suppository. Red blood cells containing malarial parasites and pigments were concentrated in the capillaries of these organs. Malarial pigments were deposited in many organs or phagocytized by macrophages in 1 monkey (No. 131), it was cured by piperaquine phosphate but died of trauma and necrosis of the fore limb; cellular atrophy and disappearance of pancreatic islets, parathyroid and pituitary cells were also observed. One monkey (No. 33) treated with artesunate suppository, showed that blood parasites became negative but recrudesced and prtuiary later died from a gavage accident. Its organs showed a significant difference to those of the infected monkeys receiving no treatment. Only the liver Kupffer cells and cerebral matrix contained malarial parasites and pigments; many relevant internal organs showed repair. Conclusion The pathological changes of relevant internal organs of Macaca mulatta infected with P. knowlesi were examined in detail, especially cellular atrophy and the disappearance of pancreatic islets, parathyoid and pituitary cells and myolysis of cardiac muscles. These changes have not previously been reported elsewhere. Chin Med J 2001; 114(10):1073-1077

Objective To evaluate the effectiveness and safety of percutaneous fluoroscopically guided removal of metallic foreign bodies imbedded deeply in soft-tissue. Methods There were 23 patients with 69 metal foreign bodies embedded in soft-tissue. The foreign bodies were 0.2 -0.3 cm long and 0.1 - 0.5 cm wide, and embedded in soft tissue 2-5 cm deep for 120 days. A set of instrumentation for percutaneous diskectomy was used. The outer cannula was inserted toward the foreign body using trocar technique under fluoroscopic control. A grasping forceps was then passed through the outer cannula, and used to clamp and remove the foreign body. Results All foreign bodies were successfully removed (success rate 100%). The time of procedures and radiation exposure required for removal of one foreign body was 8-15 minutes and 1-4 minutes, respectively.There were no complication. Conclusion Percutaneous fluoroscopically guided removal of metal foreign bodies imbedded deeply in soft-tissue using trocar technique is safe and effective. Chin J Radiol 2001; 35: 299-301.

Objective To study the interaction between telomerase activity and abnormalities of the p16 gene in liver metastases of colorectal carcinoma. Methods Telomerase activity was detected by a non-isotopic PGR-based telomeric repeat amplification protocol (TRAP) assay, and homozygous deletions of the p16 gene were detected by a semiquantitative multiplex polymerase chain reaction in tissue samples from 24 liver metastases of colorectal carcinoma and 5 primary colorectal carcinomas. Results Telomerase activity was observed in 19 (79.2%) of 24 liver metastases of colorectal carcinoma. Telomerase activity was also observed in all 5 primary colorectal carcinomas and in 3 of their liver metastatic samples. The incidence of telomerase activity in liver metastases of colorectal carcinoma was not significantly correlated to tumor diameter, number of tumors, cirrhosis, and HBsAg. Homozygous deletions of the p16 gene were found in 9 of 24 (37.5%) liver metastases of colorectal carcinoma. Homozygous deletions of the p16 gene were observed in 2 of the 5 primary colorectal carcinomas and in 1 of the matching liver metastatic cancers. There was a correlation between telomerase activity and homozygous deletions of the p16 gene. Conclusions There is a correlation between telomerase activity and homozygous deletions of the p16 gene in liver metastases of colorectal carcinoma, suggesting its crucial role in liver metastases. However, telomerase activation and homozygous deletions of the p16 gene might not be the initiating event in liver metastases of colorectal carcinoma. Chin Med J 2001; 114(10):1068-1072

Objective To determine whether the cyclic adenosine monophosphate (cAMP) mediated protein kinase signal transduction pathway is involved in the pyrogenic action of corticotropin releasing hormone (CRH) in rats. Methods Corticotropin releasing hormone, 2', 3'-dideoxyadenosine (DDA) and adenosine-3', 5'-(cyclic) monophosphorothionate, Rp-Isomer (Rp-cAMPS), were administered intracerebroventricularty (i.c.v.). The colonic temperature was measured using a thermistor, and the content of cAMP in the hypothalamus was determined by radioimmunoassay. Hypothalamic incubation was used to assess the effects of CRH on the content of cAMP in the hypothalamus in vitro. Results Microinjection (i.c.v.) of CRH (2.5 μg, 5.0 μg and 10 μg) caused increases in colonic temperature and the hypothalamus cAMP level in conscious rats. CRH increased hypothalamus cAMP level in vitro. The pyrogenic effects of CRH were abolished or markedly inhibited by prior injection (i.c.v.) of an adenylate cyclase inhibitor, DDA (30 μg), or an inhibitor of cAMP-dependent protein kinase, Rp-cAMPS (15 μg). Conclusion cAMP mediates the pyrogenic action of centrally administered of CRH in rats, and protein kinase A may play an important role in the central CRH-induced fever. The cAMP-dependent protein kinase signal transduction pathway may be involved in the central mechanisms of the pyrogenic action of CRH in rats. Chin Med J 2001; 114(10):1064-1067

Objective To evaluate and compare the CT and hypotonic duodenography (HD) findings of duodenal adenocarcinoma. Methods CT and HD signs of 16 duodenal adenocarcinomas proved histologically were evaluated retrospectively. Results The main CT sign included intraluminal mass, thickening of bowel wall and necresis. Ulceration was present in 4 cases, invasion of adjacent structures in 11, liver metastasis in 1 and adenopathy in 1. The size of intraluminal tumor measured by HD was identical with operative result. Irregular filling defect and mucosal destruction in 14 cases and ulcerations in 7 cases were seen. Conclusion CT scan can demonstrate the intraluminal lesions, exttaluminal involvement and metastasis. In primary duodenal adenocarcinoma HI) displays the intraluminal abnormality better than CT. Chin J Radiol 2001; 35: 270-272.

Objective To compare the effects of ouabain and digoxin on the gene expression of sodium pump α-subunit isoforms in the myocardium of rats. Methods Normal Sprague-Dawley (SD) rats were injected with ouabain (20 μg-1 • d-1, i.p.), digoxin (32 μg • kg-1 • d-1, i.p.) and normal saline (NS) once a day, respectively, and indirect systolic blood pressure was recorded once a week. Six weeks later, all of the rats were killed, and sodium pump α1-, α2-, and α3-subunit mRNA levels in the myocardium were detected with the reverse transcription polymerase chain reaction (RT-PCR) method. Results The systolic blood pressure of the rats infused with ouabain increased significantly at the end of week 6 (132.6±9.0 mm Hg vs 115.7 ± 8.2 mm Hg, P < 0.01), while no difference in blood pressure was found between the digoxin group and the NS group. The expression of sodium pump a-subunit isoforms in the ventricular myocardium was regulated by either ouabain or digoxin. Both ouabain and digoxin stimulated expression of the α3-isoform, whereas α2 was unchanged in those two groups, α1-isoform expression decreased in the ouabain group and was unchanged in the digoxin group. Conclusions These results suggest that both ouabain and digoxin could regulate sodium pump α-subunit isoform expression, which might be related to the physiological roles of endogenous ouabain and might be responsible for the difference in the pharmacological and toxicological effects of ouabain and digoxin, including their effects on blood pressure. Chin Med J 2001; 114(10):1055-1059

Objective To isolate and purify the subcomponents of guinea pig inner ear antigens for further study on the autoimmunity of the inner ear. Methods Inner ear tissues were homogenized in phosphate buffered saline containing 0.1%SDS, and then frozen and defrosted repeatedly to extract inner ear antigens. Preparative polyacrylamide gel electrophoresis was used to separate the subcomponents of inner ear antigens. Following electrophoresis, the protein bands were localized by rapid staining and destaining. Results The major protein bands were clearly distinct when 3 mg of crude inner ear antigens was loaded, and the three major subcomponents (31, 42-45 and 60 kD proteins) accounted for about 25.99%, 21.91% and 21.10%, respectively. Conclusion Preparative polyacrylamide gel electrophoresis can be used to purify the major subcomponents of inner ear antigens. Chin Med J 2001; 114(10):1102-1104

Objective To analyze the clinicopathological character and MRI features of cerebral gliomatosis (CG). Methods Five cases with CG were analyzed by using clinical, radiological manifestations as well as pathological sections. Results All cases had headache, intracranial hypertension, and complicated with mental retardation, or dementia epilipsy, and hemiparesis. CT showed only slightly abnormal changes. MRI revealed diffuse lesions in both hemispheres without formation of a tumor mass. Histological examination showed the tumor cells diffusely infiltrating both cerebral hemispheres with perineuronal, perivascular collectous, the underlying neuronal architecture was still present. Conclusion Clinical and radiological features may be helpful to suggest the diagnosis of CG. However, confirmation by brain biopsy is necessary. Chin J Radiol 2001; 35: 277-280.

Objective To investigate if low dose total body irradiation (TBI, 6.0-9.0 Gy) combined with intensified chemotherapy followed by autologous peripheral blood stem cell transplantation results in better survival in children with refractory leukemia or solid tumors. Methods Twenty-one children with malignant tumors were included in this study. There were 14 males and 7 females aged 3.5-12 years. Underlying disease included high-risk acute lymphoblastic leukemia (ALL, CR1 in 3 children and CR2 in 5 children), acute myeloblastic leukemia (AML, 9 children), non-Hodgkin's lymphoma stage Ⅳ (2 children), and neuroblastoma stage Ⅳ (2 children). The peripheral hematopoietic stern cells were collected six to eleven months after complete response, mobilized with high dose chemotherapy alone or combined with GM-CSF or G-CSF. The conditioning regimen consisted of chemotherapy with two to three combinations of the following drugs: cyclophosphamide, arabinosylcytosine, McNU, etopside, and Idarubicin on the basis of TBI (6.0-9.0 Gy). A mean of (1.8±0.5) × 108/kg autologous mononuclear cells were transplanted. The patients were followed up after transplantation. Results Severe bone marrow suppression occurred in all patients around day +7. Peripheral white blood cell count decreased to 0 in all patients at day + 4.8 ± 2.9, and platelet count decreased to less than 20 × 109/L at day + 9.0 ± 2.6, Successful engraftment was achieved in 21 patients, but four died of infection at day + 17, + 20, + 31 and + 67, respectively. Recovery of white blood cell (WBC) to 10 × 109/L, absolute neutrophil count to 0.5 × 109/L, platelet count to 20 × 1O9/L occurred on 21 ± 12, 26 ± 13, and 27 ± 10 days, respectively. During the follow up period, three patients relapsed at + 5 months, + 1.5 years, and +2 years 10 months, respectively. One patient died of intracranial hemorrhage at +8 months. Thirteen patients had event-free survival for 2-12 years, with a mean of 6.7 ± 3.4 years. Conclusion Our preliminary data suggest that myeloablative therapy with low dose TBI (6.0-9.0 Gy) combined with intensified chemotherapy followed by autologous peripheral blood stem cell transplantation might be associated with favorable results in children with refractory leukemia or solid tumors. Chin Med J 2001; 114(10):1098-1101

Objective To make a survey of the nutritional composition of the diets of centenarians. Methods Thirty-four centenarians were selected as subjects. Retrospective surveys were made on the variety and amounts of food consumed and their nutritional composition. Physical examinations with laboratory tests such as cardiograms, ultrasonic B rays, and blood, urine and hair tests were performed. Neutron activation testing was done on hair content. The transmission turbidimetric method was used to measure apolipoprotein content. Results The main food of the centenarians showed the characteristics of low calories, protein and fat but high fiber and mineral content. Laboratory results showed that the content of the elements of Cu, Se and Mn in hair was higher (P < 0.01). Zn was normal. The apoA1/apoB100 ratio was higher than in the control group (P<0.0l), and total cholesterol (TC) was lower than in the control group (P<0.01). Conclusions The variety of diet and its nutritional composition may be the main factors influencing not only the content of elements in body, but also the levels of apoA1 and apoB100, which may be helpful in preventing arteriosclerosis and forming and maintaining immunity. The diet of these centenarians might aid in preventing cardiovascular and cerebrovascular diseases and malignant tumors. Chin Med J 2001; 114(10):1095-1097

Objective To understand CT features of polypoid ampullary carcinoma by enhanced dual-phase spiral CT. Methods 15 cases of polypoid ampullary carcinoma (PAC) confirmed by surgical and pathological results were studied with thin slice enhanced dual-phase spiral CT (including arterial and portal phase scanning) with retrospective analysis. The scanning parameters were 5 mm thickness and 1.0 pitch for arterial phase scanning, and 5 mm thickness and 5mm space for portal phase scanning. Results All cases could display an enhanced mass as local filling defect at the site of the duodenal Vater' s ampulla during arterial and portal phase scanning. The tumors ranged in size from 1 cm to 5 cm with mean of 2.3 cm. All were accompanied with dilated intrahepatic and common bile duct, enlarged gallbladder and dilated pancreatic duct, except one case which had marked atrophy of the pancreatic body and tail. Conclusion The thin slice enhanced dual-phase spiral CT could not only accurately define the level of obstruction, but also demonstrate an enhanced mass as direct CT sign of the PAC, which is crucial for the diagnosis of the PAC. Chin J Radiol 2001; 35: 267-269.