Iron, copper and alpha 1-antitrypsin deficiency in the liver of cirrhotic and schistosomotic patients. While a number of studies investigated iron and copper storage or alpha 1-antitrypsin (A1AT) deficiency in the liver of patients with cirrhosis, we did not find any similar study in schistosomotic patients reported in literature. We investigated the storage of both metals and the A1AT deficiency in the liver of 72 cirrhotic and 27 schistosomotic patients (5 with the hepatointestinal and 22 with the hepatoesplenic form of the disease). Forty-four patients with cirrhosis were also alcoholic, and 28 were not. Iron storage was detected in 23 patients with cirrhosis (31.9%); among these 16 (36.3%) were alcoholic and 7 (25.0%) non-alcoholic (the difference was not statistically significant). Thirteen (56.5%), 5 (21.7%) and 5 (21.7%) patients presented I-grade, II-grade, and III-grade iron storage, respectively. Copperstorage was detected in 24 cirrhotic patients (33.3%), 15 being alcoholic (34.0%) in contrast with 9 non-alcoholic patients (32.1%), a statistically non-significant difference. A1AT deficiency was observed in 2 patients with cirrhosis (2.8%), one with history of alcoholism. HBsAg and HBcAg in hepatic tissue were detected in 5 cirrhotic patients (6.9%), three of them with a history of alcoholism. Iron and copper storage and A1AT deficiency were observed in 3 patients with cirrhosis (12.5%), while iron storage and A1AT deficiency were found in 2 additional patients with cirrhosis (2.8%). The authors underline that neither iron nor copper storage nor A1AT deficiency was found in any schistosomotic patient. The authors discuss the possible importance of these data.


Increased risk of bacterial endocarditis in inflammatory bowel disease. The purpose of this retrospective as well as prospective case-control study was to analyze a possible overrepresentation of inflammatory bowel diseases among patients with native valve endocarditis as well as the factors that predispose patients with inflammatory bowel disease to infective endocarditis. Among 213 consecutive patients treated for proven native valve endocarditis, six (2.8%) had inflammatory bowel diseases (three with ulcerative colitis and three with Crohn's disease). Three patients with inflammatory bowel disease were from the retrospective group, and three were from the prospective group. The prevalence of inflammatory bowel diseases has been determined to be 0.0641% in the Düsseldorf area. On the basis of these data, a 44-fold overrepresentation of inflammatory bowel diseases among the 213 patients with endocarditis was calculated with a statistical significance of p much less than 0.001. Inflammatory bowel disease may be considered an independent risk factor for bacterial endocarditis. Reasons may be more frequent bacteremias as a result of the higher incidence of diagnostic and therapeutic interventions, as well as increased permeability of the damaged mucosa for bacteria and the therapeutic immunosuppression in patients with active inflammatory bowel disease. Prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.


[Two cases of severe cutaneous vasculitis with thrombocytopenia associated with hepatic cirrhosis: autoimmune and infective-inflammatory component with endothelial lesion and restrictive pulmonary pattern in one case]. Two clinical cases of female patients with hepatic cirrhosis and autoimmune multisystemic involvement with infectious intercurrent are reported. Case 1 presented infective endocarditis and erysipelas on the left thigh. In the course of the clinical picture a cutaneous vasculitis developed in the same place together with autoimmune thrombocytopenia, leukopenia and pulmonary restrictive picture with inflammatory pattern. There are also elevate immune complexes and complement consumption. Case 2 presented erysipelas on the left thigh cutaneous vasculitis and complement consumption. In Case 1 the infective endocarditis was treated with antibiotic therapy during 4 weeks followed by 1 mg/kg corticoid (Prednisone) with thrombocytopenia and leukopenia reversion. Case 2 presented an improvement with antibiotic only. The relation between chronic liver diseases and systemic autoimmune phenomena is commented, special attention being paid to the cutaneous, hematological and pulmonary affection.


Cutaneous manifestations of gastrointestinal disorders. Part II. The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease, and bowel-associated dermatosis-arthritis syndrome are reviewed. The significance of these signs, guidelines for their management, and investigations are discussed.


Comparative report on endoscopic and surgical treatment for early gastric cancer in elderly patients. Two cases of elderly patients with similar early gastric cancers who were submitted to endoscopic and surgical treatment are presented as examples. Considering older patients as a sole group in the decision-making process we discuss the pros and cons of each therapy supporting efficacy and opposing side effects in order to maintain a reasonable quality of life.


[Cytopathological test performed during colonoscopy in the diagnosis of colorectal stenosis]. The etiological diagnosis for the colorectal strictures can be very difficult. With the colonoscopy, it was possible to obtain samples with direct vision of the lesion. Consequently, the cytologic efficiency improved, with similar or even better results than histopathology. In the present study (107 patients) it was used the cytopathology performed during colonoscopy. After a specimen was obtained, it was smeared on glass slide, fixed in 95% alcohol, stained by HE, and examined microscopically, with conclusions during the procedure. The results were compared and further correlated to the histopathology of surgical specimen or based on clinical follow-up in those case not submitted to operation. The results showed a striking degree of correlation between both exams. For the cytopathology there were no inconclusive results, false-negative were less frequent than with histopathology, and only one case of false-positive (rectal villus adenoma) was observed. Considering the type, localization and perviousness of the lesion, similar conclusions were drawn, and did not affect the results, except that there were more false-negatives in both exams when the lesions were impervious. The cytopathological and histopathological studies were both highly sensitive and specific for the diagnosis of carcinoma. In conclusion, cytopathology performed during colonoscopy is safe and efficient in the study of colorectal strictures, which contributes to improve the orientation of these patients.


Nail biopsy. Indications and methods.

Nail biopsy. Indications and methods. Nail biopsy is a safe and useful diagnostic procedure for many nail disorders when routine clinical and laboratory methods fail to produce a diagnosis. Prerequisites for nail biopsy are an understanding of the surgical anatomy of the nail, adequate anesthesia and hemostasis, and a nail abnormality for which histopathology can provide the diagnosis. Indications and methods for nail biopsy vary according to the site and type of pathology in the nail unit. Nail bed and perionychial biopsies can be performed easily and with minimal scarring. They are most commonly used to diagnose tumors as well as infectious and inflammatory disorders of the nail. The most important reason to biopsy the nail matrix is to make or exclude the diagnosis of melanoma in a patient with longitudinal melanonychia. Great care must be taken in nail matrix biopsy to minimize the risk of permanent nail dystrophy.


The search for the new pineal gland. Brain life and personhood. The concept of "brain life," sometimes offered as the criterion for determining when personhood begins, cannot tell us what we want to know about persons. Neurological facts will not automatically yield ethical conclusions.


An analogue approach to audit in anaesthesia. The predicted outcome of anaesthesia and surgery was compared with the immediate outcome in 508 patients by means of two 100 mm linear analogue scales. The results were used to obtain a statistically based rule by which the anaesthetist may consistently select three groups of patients for audit: group 1, patients in whom immediate outcome of anaesthesia and surgery is worse than predicted; group 2, patients whose outcome is better than predicted; and group 3, the remaining patients. The rule, which is simply adapted to departmental audit, does not necessarily need a computer but is suited to the computer as it is numerically based.


Evaluation of a program to prevent head and spinal cord injuries: a comparison between middle school and high school. This study was designed to test whether the Oregon THINK FIRST-Head and Spinal Cord Injury Prevention Program, developed for the high school audience and previously shown to have a beneficial effect, would have the same effect on students in middle school. During the spring of 1989, four schools (two high schools and two middle schools) participated. Two weeks before and after the presentation of the THINK FIRST program, 830 student questionnaires were distributed in classrooms. Questionnaire items were designed to measure knowledge, attitude, behavior, and demographic features. There was a significant difference between high school and middle school students on pretest knowledge (P = 0.0001). The average knowledge increase among all students was 0.81 correct responses (95% confidence interval: +/- 0.22) among 15 questions. The increment in knowledge did not differ significantly (P = 0.37) between high school and middle school students. One-way analysis of variance revealed no significant differences in pretest knowledge or knowledge increase associated with membership in Students Against Drunk Driving or acquaintance with someone having sustained a head or spinal cord injury. After the program, students were more likely to believe that there were actions they could take to keep from getting injured (P less than 0.0001). However, there was no change in self-reported seat belt use and most students reported that they "never" wore a bike helmet. The findings suggest that the THINK FIRST program is appropriate and beneficial for viewing by middle school-aged students.


A survey of state insurance commissioners concerning genetic testing and life insurance. Rapid advances in genetic testing have stimulated growing concern about the potential for misuse of genetic data by insurance companies, employers, and other third parties. Thus far, reports of genetically based discrimination in life insurance have been anecdotal. Reasoning that state insurance commissioners were likely to be aware of (1) the extent of current use of and interest in genetic tests by life insurers and (2) consumer complaints about insurance being denied because of genetic condition or because of genetic test results, we conducted a survey of that group. We received responses from 42 of the 51 jurisdictions. Our results suggest (1) that those who regulate the life insurance industry do not yet perceive genetic testing to pose a significant problem in how insurers rate applicants, (2) that life insurers have much legal latitude to require genetic tests, and (3) that so far few consumers have formally complained to commissioners about the use of genetic data by life insurers.


The presence of two different infantile Tay-Sachs disease mutations in a Cajun population. A study was undertaken to characterize the mutation(s) responsible for Tay-Sachs disease (TSD) in a Cajun population in southwest Louisiana and to identify the origins of these mutations. Eleven of 12 infantile TSD alleles examined in six families had the beta-hexosaminidase A (Hex A) alpha-subunit exon 11 insertion mutation that is present in approximately 70% of Ashkenazi Jewish TSD heterozygotes. The mutation in the remaining allele was a single-base transition in the donor splice site of the alpha-subunit intron 9. To determine the origins of these two mutations in the Cajun population, the TSD carrier status was enzymatically determined for 90 members of four of the six families, and extensive pedigrees were constructed for all carriers. A single ancestral couple from France was found to be common to most of the carriers of the exon 11 insertion. Pedigree data suggest that this mutation has been in the Cajun population since its founding over 2 centuries ago and that it may be widely distributed within the population. In contrast, the intron 9 mutation apparently was introduced within the last century and probably is limited to a few Louisiana families.


Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. The risk of recurrent neural-tube defects is decreased in women who take folic acid or multivitamins containing such during the periconceptional period. The extent to which folic acid supplementation can reduce the first occurrence of defects is not known. We conducted a randomized, controlled trial of periconceptional multivitamin supplementation to test the efficacy of this treatment in reducing the incidence of a first occurrence of neural-tube defects. Women planning a pregnancy (in most cases their first) were randomly assigned to receive a single tablet of a vitamin supplement (containing 12 vitamins, including 0.8 mg of folic acid; 4 minerals; and 3 trace elements) or a trace-element supplement (containing copper, manganese, zinc, and a very low dose of vitamin C) daily for at least one month before conception and until the date of the second missed menstrual period or later. Pregnancy was confirmed in 4753 women. The outcome of the pregnancy (whether the fetus or infant had a neural-tube defect or congenital malformation) was known in 2104 women who received the vitamin supplement and in 2052 who received the trace-element supplement. Congenital malformations were significantly more prevalent in the group receiving the trace-element supplement than in the vitamin-supplement group (22.9 per 1000 vs. 13.3 per 1000, P = 0.02). There were six cases of neural-tube defects in the group receiving the trace-element supplement, as compared with none in the vitamin-supplement group (P = 0.029). The prevalence of cleft lip with or without cleft palate was not reduced by periconceptional vitamin supplementation. Periconceptional vitamin use decreases the incidence of a first occurrence of neural-tube defects.


Alfalfa cyclins: differential expression during the cell cycle and in plant organs. Cell division in eukaryotes is mediated by the action of the mitosis promoting factor, which is composed of the CDC2 protein kinase and one of the various mitotic cyclins. We have recently isolated a cdc2 gene from alfalfa. Here, we report the isolation of two cyclin genes, cycMs1 and cycMs2, from alfalfa. The cycMs2 gene shows highest similarity to type B cyclins. In contrast, the predicted amino acid sequence of the cycMs1 gene shows similar homology scores to cyclins of all types (25 to 35%). Both genes are expressed in dividing suspension cultured cells but cease to be expressed when the cells enter stationary phase. In synchronized alfalfa suspension cultured cells, the mRNAs of cycMs1 and cycMs2 show maximal expression in the G2 and M phases. Transcripts of cycMs2 are found only in late G2 and M phase cells, an expression pattern typical for cyclin B genes, whereas cycMs1 appears with the onset of G2. This pattern indicates that alfalfa cycMs1 and cycMs2 belong to different classes of cyclins. In young leaves, expression of both genes is high, whereas in mature leaves no transcripts can be detected, indicating that the two cyclin genes are true cell division markers at the mRNA level. In other organs, a more complex expression pattern of the two cyclin genes was found.


Understanding and evaluating chronic urinary incontinence. Urinary incontinence is a geriatric syndrome of large proportions financially and psychosocially. It may be one of the most neglected ailments. An understanding of the anatomy and pathophysiology of the problem is necessary to creatively assess and treat individual cases. The physician should have in mind an orderly and reasonably complete classification of urinary incontinence and be familiar with the terms traditionally used to describe various mechanisms and phenomena related to the condition. Evaluation of patients involves a discriminating selection of studies and, at times, trials of therapy. A "bedside cystometrogram" may yield much information.


Mutation in codon 713 of the beta amyloid precursor protein gene presenting with schizophrenia. Following reports of mutations of codon 717 in exon 17 of the amyloid precursor protein (APP) gene in early-onset familial Alzheimer's disease, we screened exon 17 for new mutations in presenile dementia. The majority of the 105 patients screened had definite or probable Alzheimer's disease, but we also included atypical cases and some chronic schizophrenics. We identified a single abnormal case--a chronic schizophrenic with cognitive defects. Sequencing revealed a C to T nucleotide substitution which produces an alanine to valine change at codon 713. We were unable to detect the mutation in the remaining members of the original cohort nor in a further 100 chronic schizophrenics and 100 non-demented controls. Nonetheless, the position of the mutation in a critical portion of the APP gene suggests that it may well prove to be pathogenic.


Hormones, genetic program and immunosenescence. Immunosenescence is discussed in the context of an integrated immune-neuroendocrine homeostatic network. Under this new perspective, immunologic decline during aging appears as part of a multilevel phenomenon which affects intracellular as well as systemic regulatory mechanisms. In particular, the experimental data suggesting that during puberty, sex and adrenal steroids trigger thymus involution by inducing extensive apoptotic death of thymocytes is briefly reviewed. Next, the evidence indicating that aging brings about a progressive disruption in immune-neuroendocrine integration and the possible role of this disruption in the occurrence of age-associated autoimmune phenomena is considered. Finally, the possible mechanisms by which the genome can determine life span as well as the potential involvement of the major histocompatibility complex in this process are discussed.


Age-related changes in the expression of T cell activation antigens following phytohaemagglutinin stimulation. The role of accessory cells (AC) in the temporal expression of several key T-cell-activation-associated antigens has been studied in healthy aged subjects. Compared to responses seen in young adults, phytohaemagglutinin (PHA) induced weak proliferation in peripheral blood mononuclear cells from the aged and lower numbers of T cells expressing CD71, CD25, CD38 or HLA-DR. T cell responses to the monoclonal antibody OKT3, however, were normal. Whereas HLA-DR+ T cell numbers could be increased by raising the AC content (up to 50%) in cultures comprising purified T cells and graded numbers of autologous AC, CD25+ T cell numbers remained largely unaltered. Co-stimulation with PHA + phorbol myristate acetate in the absence of AC restored both proliferation and CD25 expression in the aged. These results indicate that T cells from the healthy aged show selective deficiencies in their capacity to respond to mitogenic stimuli and suggest that impaired PHA responsiveness is due, at least in part, to defective AC-derived signals.


Poly(ADP-ribosyl)ation: its role in inducible DNA amplification, and its correlation with the longevity of mammalian species. In this paper, we review our recent work on poly(ADP-ribosyl)ation and its relationships with DNA amplification and with the life span of different mammalian species. Poly(ADP-ribosyl)ation is a eukaryotic posttranslational protein modification catalyzed by poly(ADP-ribose) polymerase (PARP; EC 2.4.2.30). This enzyme is strongly activated by DNA strand breaks and apparently plays a role in DNA repair and other cellular responses to DNA damage. Our data from two different cell culture systems for inducible DNA amplification strongly suggest that poly(ADP-ribosyl)ation acts as a negative regulatory factor in the DNA amplification induced by carcinogens. Furthermore, we could show a strong positive correlation between directly stimulated PARP activities in mononuclear leukocytes of 13 mammalian species and the species' maximal life spans. The hypothesis is raised that a higher poly(ADP-ribosyl)ation capacity of long-lived species might contribute to the efficient maintenance of genome integrity and stability over their longer life span. Finally, we could show that the selectively overexpressed PARP DNA-binding domain efficiently inhibits poly(ADP-ribosyl)ation in a transdominant manner. This molecular genetic approach should permit further interventional studies on biological role(s) of poly(ADP-ribosyl)ation without application of low-molecular-weight PARP inhibitors, thus avoiding any of their possible side effects.


Mutations in the candidate gene for Norrie disease. Recently, we and others have isolated a candidate gene for X linked Norrie disease (ND) which was found to be deleted or disrupted in several patients. As a prerequisite for the identification of point mutations in the ND gene we have established the exon-intron structure of this gene. In 17 unrelated patients and 15 controls, PCR products derived from the promoter region, exons 1 and 2 as well as the coding part of exon 3 were analysed with the single strand conformation polymorphism (SSCP) technique. In 12 patients altered PCR fragments were detected which were studied in detail by direct sequencing. Eleven different mutations were found, and all but one are likely to give rise to significant structural changes in the predicted protein. These findings, and the absence of functionally relevant base changes in healthy controls, emphasize the causal role of this candidate gene in Norrie disease and pave the way for reliable diagnosis and carrier detection.


Unstable DNA may be responsible for the incomplete penetrance of the myotonic dystrophy phenotype. Myotonic dystrophy (DM) is associated with the expansion and instability of a trinucleotide (CTG) repeat in a sequence encoding a cAMP-dependent protein kinase. The normal copy number of 5-35 repeats is exceeded in DM patients, with the size of the expansion broadly correlating with the severity of symptoms experienced. In most families reported, the unstable DNA sequence has increased in size on transmission to affected offspring, thereby providing a molecular explanation for the phenomenon of anticipation in DM, i.e. an increase in the severity of symptoms associated with an earlier age at onset of the disease in successive generations of a family. Here we present the first reported case of a family where the transmission of the affected chromosome from father to son is accompanied by a reduction in the size of the triplet expansion, such that it falls within the normal range. As the son remains asymptomatic, this type of molecular event may provide an explanation for the incomplete penetrance of the disease phenotype reported for this disorder. The implications for genetic counselling of DM families and the mechanistic considerations of the trinucleotide instability are discussed.


The large non-collagenous domain (NC-1) of type VII collagen is amino-terminal and chimeric. Homology to cartilage matrix protein, the type III domains of fibronectin and the A domains of von Willebrand factor. Type VII collagen, the major component of anchoring fibrils, consists of a central collagenous triple-helical segment flanked by non-collagenous domains, NC-1 and NC-2. In this study, we examined the domain organization of human type VII collagen through analysis of deduced amino acid sequences derived from cloned complementary and genomic DNAs, as compared to peptide segments derived from amniotic membrane type VII collagen. The results revealed that the peptide segments derived from the NC-1 domain of type VII collagen could be assigned to the 5' portion of the composite cDNA, indicating that NC-1 resides at the amino terminal end of the molecule. Several sub-domains with homology to adhesive molecules were also identified within NC-1. These protein domains may confer adhesive properties to NC-1, thereby facilitating the binding of type VII collagen to the lamina densa in the cutaneous basement membrane and the anchoring plaques within the dermis.


Characterization of a 1.0 Mb YAC contig spanning two chromosome breakpoints related to Menkes disease. Menkes disease, an X-linked recessive disorder of copper metabolism, has recently been mapped to Xq13.3 by two Menkes patients carrying chromosome rearrangements within this region. The breakpoints have been investigated by nonisotopic in situ suppression hybridization using YACs isolated from this region with the flanking markers DXS56 and PGK1. Three YACs were extending over the breakpoints at Xq13.3 and were shown to be overlapping by partial digest restriction maps, IRS-PCR fingerprinting and by the presence of common cosmid clones. These cosmids were subcloned and one of the single copy probes detected both breakpoints using rare-cutting restriction enzyme digests of the patients. All the results together localize the breakpoints to about 100 kb within the overlapping region of the YACs. Mapping of both breakpoints in a 1 Mb YAC contig implies that these YACs contain at least partially, the gene responsible for Menkes disease.


Autosomal dominant branchio-oto-renal syndrome--localization of a disease gene to chromosome 8q by linkage in a Dutch family. Branchio-oto-renal syndrome (BOR) is an autosomal dominant disorder with variable clinical manifestations affecting branchial, renal and auditory development. Varying clinical expression of the disease between different families suggests that multiple loci may be involved. However, the possibility of genetic heterogeneity as the cause of clinical variability cannot be resolved until the gene(s) causing BOR syndrome are mapped. DNA from four generations of a family with autosomal dominant BOR syndrome have been typed with a series of genetic markers on the long arm of chromosome 8. Using two point linkage analysis, a significant lod score of Z = 4.0 at theta = 0.05 was obtained with the D8S165 microsatellite marker. Multipoint analyses with 8q markers place the gene for BOR between the markers D8S87 and D8S165.


Androgen receptor gene mutations identified by SSCP in fourteen subjects with androgen insensitivity syndrome. The androgen insensitivity syndrome (AIS) is a disorder of male sexual development resulting in a wide range of clinical phenotypes. AIS is classified into two phenotypic forms: complete (CAIS) and partial (PAIS). To determine the molecular basis of the phenotypic diversity in AIS, we have studied 27 subjects (13 CAIS, 14 PAIS), spanning the full range of AIS phenotypes. We report the results of a mutation screen of the androgen receptor gene. The coding regions of the gene were amplified by the polymerase chain reaction and screened for single strand conformation polymorphisms to identify mutations. This was followed by DNA sequencing of putative mutant segments. Androgen receptor gene mutations were identified in nine CAIS and five PAIS subjects. Two of the CAIS mutations in exon A resulted in frameshifts. A third CAIS mutation resulted in the deletion of a single amino acid from the ligand binding domain of the receptor. All other mutations caused single amino acid substitutions in the ligand binding domain. These results suggest that mutations affecting the ligand binding domain of the androgen receptor are the most frequent cause of AIS, although some cases of PAIS may be the result of other, as yet undefined, genetic lesions.


Expression of four alternative dystrophin transcripts in brain regions regulated by different promoters. Cognitive impairment occurs in one-third of patients with Duchenne muscular dystrophy, a lethal X-linked, recessive disease caused by mutations in the dystrophin gene which is expressed in both brain and muscle, the two transcripts having alternative first exons. Previous reports have indicated that the 'brain-type' dystrophin transcript predominates in brain. Using in situ hybridisation with antisense oligonucleotides, expression of four distinct mRNAs in specific brain areas is demonstrated here; the 14 kb muscle-type and brain-type transcripts were found to coexist in cortical and hippocampal neurons and two new transcripts have been identified in dentate gyrus and cerebellar Purkinje neurons, respectively. The latter has a novel first exon which was isolated and sequenced from mouse and human, and which would encode a protein with a different amino-terminus from the known muscle- and brain-type isoforms. Mapping in human located this exon in a large intron between the muscle-type promoter and second exon of the dystrophin gene. This finding of four alternative transcripts regulated by different promoters in brain reveals a new complexity to dystrophin expression that may have important insights for mental retardation mechanisms.


Segregation of the fragile X mutation from an affected male to his normal daughter. We report here a family in which the fragile X mutation segregates from an affected grandfather through his normal daughter to an affected grandson. The grandson shows clinical and cytogenetic expression of fragile X syndrome due to a full mutation (large methylated insertion) in the fragile X gene (FMR-1). The mother shows a premutation (small unmethylated insertion) in her FMR-1 gene as the sole manifestation of the fragile X syndrome. The grandfather expresses the fragile X syndrome at the clinical and cytogenetic level, whereas he is mosaic for a methylated full mutation and an unmethylated premutation. The absence of expression of the fragile X mutation when transmitted through an expressing male might present further evidence for genomic imprinting of the FMR-1 gene. Alternatively, it is possible that the grandfather transmitted his premutation to his daughter due to germline mosaicism with both the premutation and the full mutation present in his sperm.


Detection of a nonsense mutation in the dystrophin gene by multiple SSCP. A combination of multiplex PCR with the single strand conformation polymorphism (SSCP) technique was employed to screen for point mutations in the human dystrophin gene. Co-amplification of 11 exons from genomic DNA of Duchenne and Becker muscular dystrophy (DMD/BMD) patients with no deletion or duplication was performed and the samples subjected to multiple SSCP analysis. We report the case of a nonsense mutation in a Duchenne patient identified by this approach. The mutation introduces a termination codon within exon 8 of the dystrophin gene. It is predicted to cause a very premature translational termination accounting for the severe phenotype observed. The patient inherited this mutation from his mother. In addition the analysis revealed 5 polymorphisms useful for internal control.


Oligonucleotide probes for the analysis of specific repetitive DNA sequences by fluorescence in situ hybridization. Five non-isotopically labeled oligonucleotides have been designed and synthesized to facilitate the analysis of specific human and murine repetitive DNA sequences by fluorescence in situ hybridization (FISH). Three of the oligonucleotides contain alphoid DNA sequences; one hybridizes to the centromeres of all human and mouse chromosomes except the Y, while the other two are specific for human chromosomes 2 and 12, respectively. The fourth oligomer, containing sequences from the spacer region of a human 5S rDNA repeat, was used to confirm the map location of a approximately 100 copy 5S rDNA tandem repeat locus. The fifth oligomer, specific to the Alu family of repeats, generates a sharp R-banding pattern on human metaphase chromosomes, suitable for FISH karyotyping. These probes permit highly specific chromosome enumeration and aneuploidy detection with hybridization times as short as 30 minutes.


[Malaria situation in the People's Republic of China in 1991. Advisory Committee on Parasitic Diseases]. According to the case reporting system, there were 101,636 malaria cases in the nation (Taiwan not included) in 1991, the incidence being 8.875 per a hundred thousand, and 45 cases succumbed to the disease. In comparison with the data of 1990, the case number was reduced by 15,723 and the incidence, by 15.9%. In areas where there were no malaria cases occurred or the incidence was below 1/10000, the residents accounted for 88.1% of the whole population of the country, whereas incidence of 1-10/10000 was recorded in areas covering 10.0% of the total population, and only in areas with 1.9% population, the incidence exceeded 10/10000. In southern part, an increase of 8.61-54.35% in incidence was revealed in Guangdong, Guizhou, Yunnan and Guangxi provinces/autonomous region, which was accompanied by some focal outbreaks; the situation was primordially attributed to the frequency of population migration. In Hainan, Sichuan and Fujian provinces, the malaria incidence was reduced by 3.77-50.57%, however, increase in incidence was noted in individual places at district/city and county levels. In these 7 provinces/autonomous region, the subtotalled cases were 67,241, in a proportion of 66.2% of the total malaria cases of the nation. In the middle and eastern part, despite the flood severely affected many places in Anhui, Jiangsu, Hubei and Henan provinces in 1991, the implementation and intensification of malaria prophylaxis and treatment effectively resulted in an incidence decline by 9.44-41.28%, and no malaria epidemics had occurred.(ABSTRACT TRUNCATED AT 250 WORDS)


[Isolation and purification of Pneumocystis carinii cyst]. Twenty Wistar rats were injected with cortisone acetate twice a week subcutaneously for 6-12 wks. By 7 weeks Pneumocystis carinii pneumonia was induced in rats successfully. The cysts of Pneumocystis carinii from infected lungs of cortisonized rats were identified by phase-contrast microscopy, Giemsa's stain, Chalvardjian's stain and Gomori's methenamine silver nitrate stain. The process of isolation and purification of Pneumocystis carinii from infected rat lungs included the following three test steps. First, the tissue was cut into small pieces and homogenized and filtered through #60, #100, #200-gauge wire mesh respectively. Secondly, the homogenate was digested with collagenase, the optimal concentration of collagenase being 0.2%. Thirdly, the discontinuous percoll density gradient centrifugation was used to separate P. carinii cysts. The majority of P carinii cysts were present in a density zone of approximately 1.033g/ml and were essentially free from host lung debris, the latter being removed due to their higher density, 1.040g/ml.


[Diagnosis of toxoplasmosis by polymerase chain reaction]. Based on the partial sequences of the specific DNA cloned fragment from T. gondii (ZS2 strain) a specific primer of the oligonucleotide for the Toxoplasma gondii DNA sequence has been designed and synthesized in our laboratory. The method of the DNA diagnosis for toxoplasmosis by polymerase chain reaction (PCR) has been established. A specific amplified band was shown in the PCR products from DNAs of T. gondii and seven manifold terata. The DNAs from the peripheral blood leukocytes of fifty normal individuals and seventy-five patients as infants with hepatitis syndrome and pregnant women with previous abnormal birth histories were diagnosed by PCR. Among the seventy-five diagnosed cases, ten were positive. The normal individuals all were negative. Using 32P-cloned T. gondii specific DNA fragment as probe and Southern blot assay, the results showed that the probe only hybridized to the specific amplified DNA bands, but did not hybridize to the amplified DNA products of negative cases. Our PCR method is a rapid, highly specific and sensitive one for detecting toxoplasmosis as compared with DNA probing, immunoassay and animal inoculation.


[Studies on the establishment of malarial animal model of short-term relapse. I. Asynchronous growth of exoerythrocytic schizonts of Plasmodium cynomolgi]. A monkey was infected with sporozoites of Plasmodium cynomolgi from Vietnam. Parasitemia was detected on the 8th day with a starting density of 17/100 white blood cells. 22 hours after that time, many EE schizonts appeared with an average density of 3.74 +/- 0.66 per mm3 hepatic tissue in liver biopsy specimens from the monkey. Most of the EE schizonts were immature and grew at an uneven rate, having an average diameter of 34.22 +/- 7.28 microns but some of them even remained 15.75 +/- 2.47 microns in diameter similar to the EE schizonts on the 6th day. The results showed that the EE schizonts of Plasmodium cynomologi were asynchronous in growth. The authors suggest that the release of merozoites from liver might be a successive process for many times, and not to be completed at a time.


[Efficacy of ivermectin for control of microfilaremia recurring after treatment with diethylcarbamazine. I. Clinical and parasitological observations]. We compared the efficacy of a single dose of ivermectin with that of a standard course of deithylcarbamazine (DEC) for the control of microfilaremia in 60 patients with banrroftian filariasis who had developed recurrent microfilaremia after each of three or more prior treatments with DEC. The study was done as a randomized, double-blind trial. Complete, but transient clearance of microfilaremia was observed in both treatment groups. One year later, recurrent microfilaremia was present in 7 patients treated with ivermectin and in 5 treated with DEC. Pretreatment levels of microfilaremia were significantly higher in patients who relapsed within one year after treatment than in those who remained amicrofilaremia. Side effects of either treatment were common but mild. Febrile reactions were more frequent in the ivermectin group: while localized reactions consistent with a flare up of acute filarial disease occurred mostly in the DEC group. We conclude that ivermectin is an effective and practical alternative to DEC for treatment of recurrent microfilaremia due to bancroftian filariasis.


Impotence.

Impotence. The National Institutes of Health Consensus Development Conference on Impotence was convened to address (1) the prevalence and clinical, psychological, and social impact of erectile dysfunction; (2) the risk factors for erectile dysfunction and how they might be used in preventing its development; (3) the need for and appropriate diagnostic assessment and evaluation of patients with erectile dysfunction; (4) the efficacies and risks of behavioral, pharmacological, surgical, and other treatments for erectile dysfunction; (5) strategies for improving public and professional awareness and knowledge of erectile dysfunction; and (6) future directions for research in prevention, diagnosis, and management of erectile dysfunction. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) the term "erectile dysfunction" should replace the term "impotence"; (2) the likelihood of erectile dysfunction increases with age but is not an inevitable consequence of aging; (3) embarrassment of patients and reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction; (4) many cases of erectile dysfunction can be successfully managed with appropriately selected therapy; (5) the diagnosis and treatment of erectile dysfunction must be specific and responsive to the individual patient's needs and that compliance as well as the desires and expectations of both the patient and partner are important considerations in selecting appropriate therapy; (6) education of health care providers and the public on aspects of human sexuality, sexual dysfunction, and availability of successful treatments is essential; and (7) erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research.


[Characterization of a surface antigen of Plasmodium falciparum merozoite with monoclonal antibody]. The monoclonal antibody (McAb) designated as C6 against erythrocytic stage of Plasmodium falciparum Fcc7801/HN showed significant growth inhibition of P. falciparum in vitro, having cross immunofluorescence reaction with P. falciparum Fcc-1/HN, Fcc7802/HN, Fcc8703/JS and P. berghei, P. cynomolgi. McAb C6 bound to the antigen distributed evenly over the entire surface of merozoites of P. falciparum, as demonstrated by immunoelectron microscopy. The McAb C6 also recognized a single protein of 71 kDa of P. falciparum by Western blotting. This antigen might be a candidate of malaria vaccine.


[Preliminary study on the role of macrophage in processing and presenting antigens of Schistosoma japonicum]. The horseradish peroxidase labeled affinity purified mice anti-UEA (Urea soluble egg antigen of Schistosoma japonicum) antibody was used in enzyme-linked immunoelectrotransfer blot (EITB) to monitor the changes after UEA being processed by M phi. The immune responsive peptides were detected in the culture supernatant and homogenate of M phi pulsed with UEA in vitro (M phi+). After processing by M phi the high molecular weight UEA was cleaved into low molecular weight peptides, as shown, by the reactive bands. They markedly differed from that native UEA or trypsin-digested UEA. The bands of M phi supernatant and homogenate showed similarity with certain quantitative differences. According to the result described above, we considered: 1. UEA could be processed into smaller pieces by M phi, the style of processing is cleavage. 2. The processed peptides might be released to extracellular environment.


[Comparative study on antigenicity and immunogenicity of the 24-26 kDa antigen and the recombinant Sj26 antigen of Schistosoma japonicum]. This paper reports on the comparison of the recombinant Sj26 (rSj26) antigen originated from the Philippine strain and 24-26 kDa antigen isolated and purified from Chinese mainland strain of S. japonicum for their antigenicity and immunogenicity. The results showed that there were obvious cross reactions between rSj26 and 24-26 kDa antigen when rSj26 antigen was tested against specific antibodies in sera from mice infected with the mainland strain of S. japonicum or 24-26 kDa antigen was tested against specific anti-rSj26 antibodies by ELISA, IFA and Western blotting etc. Both of 24-26 kDa and rSj26 antigen had weak cross reaction with SEA antigen. The worm reduction rate after challenging with mainland strain cercariae in mice immunized with rSj26 was 26-32%, similar to that in mice immunized with 24-26 kDa antigen. It is suggested that rSj26 antigen can induce certain level of specific protective immunity to protect the host against infection by Chinese strain of S. japonicum cercaciae.


[Role of human and domestic animal reservoirs of schistosomiasis japonica in Dongting and Boyang Lake regions]. In Dongting and Boyang Lake regions, the main reservoirs of schistosomiasis were farm cattle (mostly buffaloes), pigs and mobile nonnatives. However, the role of these reservoirs in different types of endemic areas were not the same in the transmission of schistosomiasis. In islet-beach type area, the main infectious sources were pigs and local residents. The proportion of IRC (Index of Real Contamination) of local residents and pigs to the total IRC was 30.9% and 39.9% respectively. In fork-beach type area having luxuriant grass and abundant aquatic products, there were a number of buffaloes and people from other places. The proportion of IRC of the nonnative buffaloes and mobile nonnatives made up 51.9% and 21.8% of the total IRC respectively, the main reservoirs being from other places. The embankment-beach type area had a vast snail-infected area and a large number of buffaloes from both local and other places as well as mobile nonnatives. The proportion of IRC of buffaloes and nonnatives made up 69.8% and 21.4% of the total IRC respectively, serving as the main reservoirs. As regard to season differences, the infected buffaloes were the main reservoirs during dry seasons, especially from March to May, whereas the mobile nonnatives including fishermen and boatmen were the main infectious sources during flood seasons from June to October.


[Sensitivity in vitro of Plasmodium falciparum to chloroquine, pyronaridine, artesunate and piperaquine in south Yunnan]. The sensitivity of P. falciparum to chloroquine, pyronaridine, artesunate and piperaquine (CQ, PD, AT, PQ) was assayed using in vitro microtechnique in south Yunnan in 1990. The resistance rates were 98.7% (75/76), 27.6% (16/58), 13.8% (9/65) and 97.7% (43/44) respectively, and ID50 were 125.0, 19.0, 4.7 and 243.3 nmol/L, respectively. The resistance rate against CQ showed no change as compared to the rates against CQ 5 and 9 years ago; but the ID50 was lower. CQ-resistant P. falciparum showed a marked cross-resistance to PQ, but not to PD and AT. AT-resistant P. falciparum exhibited cross-resistance to the above-mentioned three drugs. PD-resistant P. falciparum showed no cross resistance to AT, but showed cross resistance to CQ and PQ. In comparison with chloroquine-coated plates, the plates coated with pyronaridine, artesunate or piperaquine gave similar results as the former, which were shown by the rise in schizont inhibition rates along with the rise in drug concentration. It indicates that pyronaridine-, artesunate-, and piperaquine-coated plates can be used in the assay of sensitivity of P. falciparum to the three drugs.


[Studies on the strain differences of Schistosoma japonicum in the mainland of China. X. Comparison of SDS-page protein patterns]. The purpose of the present study was to investigate the SDS-PAGE separation of proteins of the 5 different isolates of Schistosoma japonicum from the mainland of China to determine their similarities and/or differences and to gain additional data which could give an added insight into the degree of relationship. Soluble proteins of freshly sonicated adult worm extract of the 5 different isolates (i.e., Anhui, Hubei, Guangxi, Sichuan and Yunnan) were compared by SDS-polyacrylamide gel electrophoresis. The results indicated that no marked difference could be observed among the isolates after gels were stained by Coomassie blue white both male and female worms of Guangxi isolate showed some definite differences in their protein profile, i.e., lack of 50-75 kDa band in male worms and a marked reduction in the quantity of > 110 and 30 kDa bands in female worms as shown by silver stain.


[Effect of sodium artesunate on Plasmodium yoelii analysed by flow cytometry]. The effect of sodium artesunate on Plasmodium yoelii-infected mouse erythrocytes was analysed by flow cytometry. The results showed that malarial DNA content in experimental group was obviously decreased 2-5 hours after the drug was administered, fluorescence distribution of malarial DNA almost disappeared within 24 hours after the administration. Thus we deem that sodium artesunate can inhibit the DNA synthesis in P. yoelii.


[Observation on the effectiveness of repellent coating against mosquitoes]. The present paper reports on the effectiveness of a repellent coating for the first time. The repellent coating was made by combining DETA (N,N-diethyl-meta-toluamide) with slow-releasing reagent. With this coating employed in the laboratory against Aedes aegypti, the rate of blood-sucking was 3.9-9.5% and the rate of protection was 88.9-95.3% for 1-720 days. During 1-77 days' field trial, the RPI (Relative Population Index) was 0-8.98% in the day-time and 0.74-17.15 during the night-time against Anopheles sinensis, Culex pipiens pallens and Culex tritaeniorhynchus. It is concluded that the repellent coating is effective against mosquitoes, safe and prolongs the protection time following exposure to mosquitoes.


[Comparison of mosquito larvicidal efficacy between microbial encapsulated BTI (EBTI) and standard BTI (SBTI)]. A comparative study was conducted on the efficacy of mosquito larvicides EBTI and SBTI. The results showed that: 1. The residual efficacy of EBTI was remarkably higher than that of SBTI at 0.007-0.002ppm BTI concentration (P < 0.01), the mosquito larvae mortality of EBTI remained 100% until the 4th week; in contrast, the mosquito larva mortality of SBTI gradually and obviously declined from the 2nd to 4th week after treatment (x2 = 8.17-24.08), and reached 0 at the 4th week. 2. The lowest BTI concentration of EBTI at which a high efficacy persisted for 4 weeks was 0.007ppm BTI, the mosquito larva mortality remaining 100%.


[Toxoplasmic retinochoroiditis].

[Toxoplasmic retinochoroiditis]. Retinochoroiditis is a frequent ocular lesion in toxoplasmosis. It may be severe, and even lead to blindness. Sixteen cases of toxoplasmic retinochoroiditis verified through IFA were presented in this paper. Among these cases, 1 was of the multifocal type, its appearance being similar to that of the Coats disease; while the other 15 were of the focal type resembling to the central exudative retinitis (Rieger disease) or retinochoroidal scar. Serological finding of all the cases showed a positive IFA titer of > 1:80. A combination of pyrimethamine and sulfadiazine as well as spiramycin in addition to dexamethasone had been administered and proved effective. Since toxoplasmosis mostly occurs as latent and examination of the eye cannot differentiate from other causes of retinochoroiditis, so such clinical report of toxoplasmic retinochoroiditis was rare with particular reference in our country. The authors claimed that any individual presenting with retinochoroiditis suspected of toxoplasmosis should be subjected to serologic antibody test for establishing diagnosis.


[Observation on metacercariae of Paragonimus westermani by transmission electron microscopy]. The ultrastructure of metacercariae of Paragonimus westermani was observed by transmission electron microscopy. The worm is composed of integument, parenchyma, gut and excretory sac. The integument consists of tegument, muscular layer and tegumental cell. The tegument, a syncytium, includes tegumental membrane, tegumental cytoplasm, and basal plasma membrane. On the surface of the tegument, many finger-like processes with branches and spines can be readily identified. The spines projecting beyond the surface of the tegument are completely enclosed within the outer tegument membrane and the basal plasma membrane; in the transverse section, the spine shows a crystalline lattice structure. The tegumental cytoplasm consists of an electron dense granular matrix, in which two types of inclusion bodies, spherical and rod-like bodies may be recognised, both of them comprise a unit membrane and dense granular contents, the rod-like bodies are arranged along the edge of the spines. The tegument nuclei are located not within the surface syncytium but within sunken tegumental cells situated beneath the muscle layer, the tegumental cells contain a few cell organelles, and the two types of characteristic tegument inclusion bodies. The cells are joined to the tegument by one or more long, tortuous cytoplasmic tubules, responsible for the synthesis of the tegumental inclusion bodies, and that these inclusion bodies are translocated into the tegument by the cytoplasmic tubules. It suggests that the tegument of metacercaria is the main absorptive site of nutrients.


[Scanning electron microscopic observation on Demodex brevis]. This paper presents the first description of the morphology of Demodex brevis examined by scanning electron microscopy. The authors found that D. brevis can be distinguished from D. folliculorum by the characteristic features of the following structures: the flat gnathosoma, the humplike podosoma and the absence of transverse striation on its anterior dorsal surface, the supracoxal spines, the hypostome, the oral opening, the pedipalpal claws and the claws on legs, and the annuli of the terminal part of the opisthosoma. The morphology of the above structures observed are briefly compared with those of D. folliculorum.


[Experimental study on detection of serum antibodies by immunoenzyme staining using adult Angiostrongylus cantonensis frozen section]. This paper reported on the results of detection of serum antibodies in rats with Angiostrongylus cantonensis infection by immunoenzyme staining of adult frozen section. The positive rates of serum antibodies in rats 2 and 4 weeks after infection were 80% and 93.3%, respectively. The result of healthy control rats was negative.


[Transabdominal termino-esophago-proximal gastrectomy for portal hypertension. An analysis of 61 cases]. The results of transabdominal termino-esophago-proximal gastrectomy in 61 patients with portal hypertension were presented. The patients were followed up for 2 to 7.5 years. Two patients died from the surgery. There was no esophageal varix rebleeding during the follow-up period. We conclude that it is a good method for controlling bleeding varices.


[Immune complex in the wall of the gallbladder in patients with cholelithiasis: deposition and its pathological significance]. The gallbladder specimens from 53 patients with cholelithiasis were studied by immunohistochemical method. Deposition of immune complex (IC) was observed on the mucosal and glandular epithelium in 84% of patients with gallstones and 47% of patients with choledocholithiasis. IgG and C3 were the most frequent complement component demonstrated at the site of IC deposition, but Clq, factor B and C4 were also present in many cases, suggesting the local complement activation. We conclude that IC may play a pathogenetic role in the injury of the mucosa and tissue of gallbladder in patients with cholelithiasis.


[Primary retroperitoneal tumors].

[Primary retroperitoneal tumors]. Two hundred and one patients with primary retroperitoneal tumors underwent surgery from 1957 to 1988. The tumors were found malignant in 113 patients (56%) and benign in 88 (44%). Abdominal mass and/or pain was the most common symptom (88%), with palpable abdominal mass in 91% of the patients. Complete resection was performed in 81% of the patients with benign tumors and 51% with malignant ones. Fourteen patients (24%) with malignant tumors were subjected to the excision of adjacent organs for the complete resection. The 5- and 10-years survival rates of the patients with benign tumors were 96% and 95% respectively. In patients with malignant tumors, the 5- and 10-year survival rates were 56% and 30% respectively for those undergoing complete resection, compared to 8% and 8% respectively for those undergoing partial resection or biopsy (P < 0.001). Partial resection with adjuvant radiotherapy or chemotherapy may be beneficial to some of the patients with malignant tumors. Reoperation should always be attempted in patients suffering from recurrence.


[High risk factors in the prognosis of acute necrotizing pancreatitis]. In this study, Ranson's risk factors were evaluated on 36 cases of acute necrotizing pancreatitis. It was found that all 13 cases with more than 7 factors each died, the mortality rate was 100%, and 2 of 5 cases with 5-7 factors each succumbed with the mortality rate of 40%. The remaining 14 cases, all of them with less than 3 factors each, survived the stormy attacks. The authors believe that Ranson's risk factors are reliable in predicting the prognosis of acute necrotizing pancreatitis.


[The correlation between urine urea nitrogen and total urine nitrogen output in perioperative patients]. Daily urine urea nitrogen (UUN) and total urine nitrogen output (TUNO) concentrations were measured in 19 patients undergoing G-I surgery during the perioperative period of 114 days. The results showed that there was a strong correlation between UUN and TUNO in statistic regression analysis. A formula is worked out TUNO = UUN + 0.7 which is of great value in estimating the nitrogen balance of TPN patients.


[Veno-valvulectomy and primary in situ arteriolization of the great saphenous vein for the treatment of ischemic lower limbs]. After the study of the valvular distribution of 18 cadaveric great saphenous veins, we performed microsurgically great saphenous veno-valvulectomy and primary in situ veno-arteriolization for 18 severely ischemic limbs of 17 patients of these patients, 14 had thromboangiitis obliterans, and 3 arteriosclerosis. 16 patients were followed up for 14 to 32 months after operations. The results were excellent. The procedure is a good alternative for the treatment of extensive arterial occlusive disease of the lower limbs.


[Effects on the normalization of amino acids in metabolic support for trauma surgical patients]. Both serum and muscle intracellular amino acids pattern are changed after trauma. The formulation of amino acid solutions is important for the balance of the patient's serum or intracellular amino acids. In 45 gastric cancer patients after total gastrectomy, the efficacy of individualizal amino acid solution (IDAA) was compared with that of other two balance amino acid solutions. The result showed that metabolic support with IDAA could decrease the muscle intracellular phenylalanine level and increase the levels of free neoglycogenic amino acids, arginine and ornithine both in serum and muscle cells. It is beneficial to the early recovery from trauma and normalization of serum or muscle amino acids pattern.


[Embolization of drainage veins used in sclerotherapy of hemangiomas]. To improve the result of sclerotherapy for hemangiomas, the drainage veins of hemangiomas were embolized by injecting 95% alcohol into the hemangioma cavities. Alcohol injected into the cavity had to drain away through the vein of hemangioma and result in damage of the endothelial cells, and thrombosis on the venous wall, then the drainage vein is embolized. With the result of embolization of the drainage vein, the sclerosant solution injected into the hemangioma cavity cannot flow off any more. The sclerosant solution got much time to bring drug action into play, so the curative effect was raised. 30 patients including 24 cavernous hemangiomas and 6 mixed hemangiomas were treated with this method. 15 cases were cured, 11 cases were effective and 4 cases were ineffective. The effective rate was 86.7%.


[Operation for discrete subvalvular aortic stenosis]. 33 patients with discrete subvalvular aortic stenosis, membranous in 14 cases, fibromuscular rige in 16 and tunnel in 3 were treated surgically in the past ten years. This spectrum of abnormalities can be differentiated by echocardiography and angiocardiography. Our policy is to excise the membrane or fibromuscular rige. When the outflow tract has remain narrow owing to concentric thickening of that portion of the septum and free wall proximal to aortic annulus, a septal myomectomy is indicated. Because the operation of subaortic stenosis is safe and effective, once the diagnosis is established, operation is a reasonable surgical treatment alternative. Operative mortality rate was 6%. Follow-up results of all survivors are satisfactory.


[Thoracoplasty in scoliosis].

[Thoracoplasty in scoliosis]. Since 1978, 108 cases of scoliosis with severe thoracic deformity have received thoracoplasty. Most of them were operated at the same time for correction of scoliosis. The resected ribs were served as bone graft for posterial spinal fusion. The rib prominence was reduced 2.5-6.9 cm after operation, and the costectomy also found to be beneficial to the correction of lateral curvature and axial rotation of the spine. The thoracoplasty showed no affect upon the pulmonary function. In this paper, three kinds of thoracoplasty and their indications are discussed and compared.


[Closed rupture of the cervical trachea]. Two patients with closed rupture of the cervical trachea secondary to blunt trauma, one secondary to neck injury and the other secondary to thoracic injury, were analysed with those reported else where (58). Signs and symptoms included subcutaneous emphysema, respiratory distress, hoarseness/dysphonia, dysphagia, hemoptysis and so on. We conclude that: (1) the diagnosis of blunt trauma of the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy is the best means of airway control; (3) good long-term airway quality is best obtained by immediate repair of injuries.


[Experience in repairing fistula of bronchus by Eleosor's method]. The repairing treatment of 10 cases of the fistula of bronchus stump by us/ng Eleosor method was reported in this article. All the 10 cases were cured once and no one died of operation. The author have introduced the way of operation and compared it with the other methods of treating such a disease at present. This operation method have the characteristics of collapsing the thorax on the troubled side thoroughly, filling the fistula with large fresh muscles which have very good blood circulation and suturing the wound by the nearest sleeve way etc. The curative effects of such treatment is superior to other way of operation.


[Postoperative cardiac intensive care for patients with thoracic cancer: analysis of 430 cases]. 430 patients with thoracic cancer were given intensive care after major thoracic surgery. Of those 188 (43.72%) developed cardiac complication during their stay in ICU and 2 (0.46%) died. The results indicated that postoperative cardiac complications were closely related to the patients age, preoperative concomitant cardiovascular diseases, duration of operation, hypoxemia, hypercapnia, and surgical complications. Postoperative cardiac intensive care could reduce the mortality rate.


[Diagnosis and treatment of primary aldosteronism]. Twenty-eight patients with primary aldosteronism were treated from 1974 to 1990. The serum potassium concentration was higher than normal level in all patients with the exception of one whose serum potassium concentration was normal. All of 14 tested patients had low renin values. The plasma aldosterone concentration was higher than standard value in all of 5 patients, and the A/PRA ratio was more than 400. Spironolactone administered preoperatively could not only normalize serum potassium concentration level and blood pressure, but also predict postoperative prognosis of hypertension. Only 37.5% of adenomas were detected by retroperitoneal pneumography with tomography in the early period. 80.0% of adenomas were found by B-ultrasonography, and 92.8% by CT after 1982. The operation was done through abdominal incision because of indefinite localization of adenoma before 1982, and the operation was performed through lumbar incision because of definite localization of adenoma after 1982.


[Pericatheter urethrography and its use in post interlocking sound urethroplasty]. 21 cases of posterior urethral rupture due to pelvic fracture were treated by acute interlocking sound urethroplasty since 1982. Postoperative pericatheter urethrography was carried out to observe the recover of urethral rupture. The results showed that the time for recover of ruptured urethra varied from 4 to 13 weeks. 71% of all cases required more than 8 weeks for recovery. The patients were followed up from 1 to 9 years, and 86% of them showed satisfactory results. It is believed that pericatheter urethrography not only provides an objective proof for the recovery of ruptured urethra but also can be used as a reliable basis for the removal of stenting catheter.


[Sensitivity of Staph aureus and Ps. aeruginosa and clinical application of antibiotics in patients with burn septicemia]. The sensitivity of 245 strains of Staph. aureus and 171 strains of Ps. aeruginosa to antibiotics was tested in patients with burn septicemia. The results indicated that both the bacteria were resistant to the widely used antibiotics. The causes for producing the resistance to drugs were analyzed. We consider that "circular therapy" of antibiotics, alternatively stopping and reusing some antibiotics according to the variation in the bacterial resistance to drugs, should be a valuable method for preventing the resistance to drugs.


[Postmenopausal osteoporosis and treatment with sex hormones]. An animal model of postmenopausal osteoporosis was established and the animals were treated with sex hormones in the experiment. From a group of fifty female Wistar rats, forty were castrated and ten were subjected to sham operation served as controls. After fourteen weeks, ten rats each from the castrated (the Model group) and control rats were killed. Through bone histomorphometry and bone mineral analysis it was sure that a good model of postmenopausal osteoporosis was established with a high bone turnover rate at the tissue level. The bone loss occurred mainly at the trabecular surface through decreased osteoblastic activity, resulting in a negative balance of the bone metabolitic unite. Of the remaining thirty castrated rats, ten were treated beginning from the 15th week for eight weeks with oestrogen, ten with progesterogen, and ten without treatment served as positive controls. The result showed that stilbestrol at 0.2 mg/day could maintain bone mass, and provera alone at 0.8 mg/day had the similar effect as oestrogen.


[The mineral content in adult radius and ulna in southwestern area of Guang-xi]. We investigate the BMD of ulna and radius of 2690 persons in southwestern areas of Guang-xi. The results show that the bone mineral content in male is higher than that in female and it is higher in middle-aged person than in the elderly. It is at 32-33 years old that the BMD reaches the peak, then decreases after 35 years old with 5-7 percent and/10 percent loss of the bone mass in male and female per 10 years, respectively. The losing rate of bone mass in female after 50 years old is faster than that in male. In addition, we compared the BMD in workers of different professions at the same age, and found that the heavier the labour intensity, the higher the bone mineral content and the BMD is higher in workers doing outdoor works. The bone mineral content in miners who work in the mine for a long time is lowered. This presentenship that there is a close relationship between the bone mineral content and age, sex, sunshine exposure and intensity of labour.


[Electrical stimulation in the treatment of osteoporosis in sciatic denervated rat tibia]. Osteoporosis in the sciatic-denervated rat tibia was reversed with a capacitively coupled electrical field. In the reversal of a previously established osteoporosis, a statistically significant enhancement of wet weight, dry weight, ashed weight, ultimate strength, cortical area, cortical thickness and a concomitant decrease in cortical porosity occurred in the stimulated, denervated tibiae of the experimental animals compared with the nonstimulated, denervated tibiae of the control animals. A 60 Hz symmetrical sinewave signal was effective in reversing osteoporosis at 10 V peak to peak. Reversal of a well-established osteoporosis in laboratory animals has not been reported previously.


[The changes in bone mineral content in experimental limb lengthening]. The results of bone mineral content measurement in experimental limb lengthening are reported. The results demonstrated that in the restoring process, both the strength and the stiffness of the lengthened bone are positively correlated to the relative bone mineral content with coefficients of correlation 0.59 (P < 0.001) and 0.85 (P < 0.001) respectively. Analyses of curve fitting showed that the strength is directly proportional to the 1.7479 th power of bone mineral content and the stiffness to its 2.05842 th power Hence, the authors consider that bone mineral content measurement could be used as a noninvasive index for monitoring the changes of bone strength and stiffness during recovering process of bone lengthening.


[Comparison of the stress distribution with bone density in the spine]. The results of study on stress distribution of the lumbar spine analyzed with a mechanical model of the lumbar motion segment constructed by a three-dimensional finite element method, and the comparison of resulting values with the corresponding bone density represented by the attenuation value of CT were reported. The results indicated that the stress levels in various parts of the lumbar spine were closely related to the CT values. The authors conclude that the mechanical stress is an important factor in maintaining the dynamic balance of bone growth.


[Culture and characterization of normal human hepatocytes]. Small pieces of normal liver tissues were obtained from patients with gallstones undergoing cholecystectomy, and hepatocytes were isolated from these tissues. They were cultured in a medium of DFH containing several growth factors and hormones, successively for more than two years over 60 passages. They showed doubling time about 25 hours, peak mitotic index near 4% and heteroploid karyotype. They kept secreting some enzymes and albumin, that are usually produced by normal liver tissue. In contrast with hepatoma cells, the cultured normal hepatocytes failed to form xenograft tumor in nude mice and their proliferation was depended upon exogenous growth-factors in vitro. The cultured hepatocytes can be used as a cell model for study of carcinogenic process and stored as a cell-pool for clinical cell transplantation in the coming years.


[Carcinoid of the digestive tract. An analysis of 36 cases]. 36 cases of carcinoid of the digestive tract were presented. The malignancy of the carcinoid was established solely by the presence of local infiltration and remote metastasis irrespective of the size of the original tumor three of 10 cases of the tumor less than 2 cm in diameter had metastasis although smaller tumors were usually benign. Immuno-histochemistry study in 15 cases showed 1-4 kinds of different polypeptides in each case. Three of 8 cases of malignant carcinoid syndrome had normal blood level of 5-HT and 5-HIAA, suggesting other polypeptides as the cause of the syndrome. The absence of hepatic metastasis in 4 of the 8 cases favors the hypothesis that polypeptides may get access to the general circulation by such as retroperitoneal pathways.


[Surgical treatment of esophageal stricture after chemical burn]. 26 patients with esophageal stricture caused by chemical burn were treated from Nov. 1972 to Nov. 1990. No operative death occurred. Follow-up showed good therapeutic effects 92.3% of the patients. We believe that surgical treatment using colonic interposition as the main procedure may bring about satisfactory results. The indications for dilatation of esophageal stricture, preoperative treatment and selection of reconstruction of the esophagus are discussed.


[Neurovascular decompression for hemifacial spasm]. Thirty-six cases of hemifacial spasm were treated by neurovascular decompression. Via transposterior cranial fossa approach, a small incision was made behind the ear. After careful dissection, a piece of teflon was placed between the vessel and initial segment of the facial nerve root and fixed with silver clip after wrapping of the nerve root. The cases were free from tic immediately after operation. Follow-up of 34 cases for 1 month to 3.5 years showed no recurrence and less and mild operative complications. In this series physiological function of the facial nerve was kept well and there was no mortality. This operation is regarded as the first choice in the treatment of hemifacial spasm.


[Therapeutic results after resection of asymptomatic lung cancer]. This article reported a group of 43 cases of lung cancer who had no symptoms before resection, and were detected by mass screening or routine physical examination. They accounted for 15.2% of 282 cases undergoing lung cancer resection during the periods from January, 1977 to June, 1990 in our hospital. Pathologic study of the resected specimens showed that there were 32 cases of Stage I lung cancer (74.4%). Among them 15 cases were of early stage (T1N0M0) which accounted for 5.3% of 282 cases. 5-years survival rate of this subgroup was 81.8%. About one fourth of asymptomatic lung cancer belonged to middle or late stage.


[Selective control of blood supply to part of thoracic wall before resecting intrathoracic lesions with adhesions rich in systemic bypass]. Five patients with intrathoracic lesions with dense adhesions containing rich systemic-pulmonary were treated with selective control of blood supply to part of thoracic wall. Four of five patients were followed up for more than five years and were found excellent in health. Operative method and high lights were described. During the operation, this method for the prevention or control of severe bleeding was proved to be useful in above mentioned cases.


[Emergency lung resection in patients with massive hemoptysis]. Emergency lung resection was done in 32 patients with massive hemoptysis. The morbidity and mortality rates were 18.75% and 6.25% respectively. Problems about how to find the focus of hemoptysis, when to perform the operation, how to select anaesthesia, operative techniques and limits of lung resection were discussed.


[Closure treatment of finger-tip injury with chimehers]. The result of closure treatment of 98 finger-tip injuries in 79 patients with Chimehers were reported. Of these injuries, 91 (93.8%) were crush injury. Among these patients, 54 were injured in industrial accidents and 46 patients (85%) resumed their original work within one month after healing of wound. Typing was done for these 98 finger-tip injuries, and their prognosis was evaluated in this paper. Besides, the basic principles for the closure treatment with Chimeherb were also presented.


[Bile acid pool in the formation of pigment stone: an experimental study]. A method with isotopic 3H-CDCA was established to determine bile acid pool. Sixty male guinea pigs were divided randomly into two groups; 20 guinea pigs fed with standard chow served as control, and 40 with 10% low protein lithogenic chow were subdivided into 4 groups executed on 10,20,30 and 40 days (In the last subgroup, vitamin C was added to the chow), respectively. The bile acid pool of lithogenic animals decreased on the 10th days and significantly decreased on the 20th, 30th, 40th day (P < 0.01) when compared with controls in the same periods. The incidence of pigment gallstone was 90% on the 20th day, 100% on the 30th day, 40% on the 40th day in lithogenic animals. The pool size decreased slightly on the 40th day in lithogenic animals which were fed with supplement of Vitamin C. A significant positive correlation was noted between gallbladder volume and bile acid pool size (r = 0.842) in the 30th day lithogenic animals. We postulate that the decreased bile acid pool size occurs before the development of pigment gallstone and it may be an important factor in promoting the formation of gallstone.


[Adherent skin grafting: experiment and clinical application]. Adherent skin grafting, using a biological binder abstracted from different animal tissues, was done successfully in 24 rabbits. The grafting was also performed in 26 patients; the results were satisfactory in all but 2 with disseminative dry necrosis of the grafted skin caused by excessive binder. We consider that this method is simple and of clinical value.


[Microcirculation in unphysiological flaps at early stage after operation: an experimental study]. Microcirculation and blood perfusion in unphysiological flaps were observed with rabbit ear microcirculation chamber. The microcirculation of the venous flap in two days after operation was reestablished mainly by diversion of blood flow through the "to and fro" movement of venous blood. Arteriovenous anastomoses were gradually opened, resulting in the microcirculation to restore normal perfusion, venous blood through the anastomoses into arteriole then to capillaries. The microcirculation of arterialized venous flaps was almost the same as that of the venous flaps. In two days after operation, the diversion of blood flow perfused the capillaries under high pressure, so that the flow velocity and rate were much faster and larger than those of the venous flaps. The microcirculation of venouslized arterial flap, nourished by venous blood through the arterial system, was the same as that of the physiological flap. But the capillaries were perfused venous blood flow, and the blood flow velocity and rate were much slower and smaller than those of the physiological flap.


[Reconstruction of first web space of hand: follow-up analysis of 40 cases]. The follow-up outcome of 40 cases after reconstruction of the first web space of hand was reported. Of them, the hand function was improved in 31 cases, not improved in 6 cases, and worsened in 3 cases. The authors thought that the pedicled ilio-inguinal axial flap for treatment of first web space defect is one of the reconstructive methods for choice in spite of its bulky appearance. Though the operative method of the dorsal local skin flap of hand is simple, it may interfere with the flexion of MP joint of the index finger and the reconstructed first web space is very deep and not plumpy. The author proposed that the extent of the reconstructed first web space should depend upon the patient's occupation, and that the function of internal muscles of the hand and of the flexion and extension muscles of thumb should be taken into consideration because too large a first web space may interfere with the function of opposing finger.


[Treatment of chronic mallet finger with tendon flap graft. Report of 16 cases]. A series of 16 cases of chronic mallet finger deformity repaired with tendon flap from palmaris longus tendon or lateral band of extensor tendons is reported. Follow-up ranged from 1 to 4 years, the deformity has been corrected and pain disappeared in all cases. The active extention of DIP joints are 0 degrees in 12 cases and 5 degrees-15 degrees hyperextention in 4 cases. The active flexion of DIP joints are normal (65 degrees-80 degrees) in 11 cases, has 5 degrees-15 degrees flexion lag in 5 cases. The PIP and MP are normal in all cases. The anatomic basis of this procedure is narrated. The restoration of the anatomic continuity of the terminal extensor tendon reestablishes the coordinative effect between the long extensor tendon, intrinsic lateral band and oblique retinacular ligament and thus brings good long term result.


[Surgical results of various injuries related to central slip in extensor tendon of the hand]. In this article the results of surgical repair in 41 cases with different degrees of the central tendon band injuries of hand were reported and the results were compared for different kinds of operation. In this series all patients with degree I injury (3 cases) achieved excellent result by direct repairing disrupted tendons. 25 cases with degree II injury were repaired using three different procedures, among which the method of splitting lateral bands with cross suture yielded better result. However, only 7 patients (47%) reached excellent and good result, The reason for that is due to attention paid insufficiently to key problems during operation. For degree III injury only 5 cases out of 13 attained excellent and good result by transplantation of free tendons. The main cause for that failure is that the operator misplaced the crossing point of the tendons.


[An experimental study of the treatment of root avulsion of brachial plexus using contralateral C7 nerve neurotization (nerve transfer)]. This study compared the functional results of contralateral C7 root neurotization with homolateral phrenic nerve transfer for repairing root avulsion of brachial plexus in rats. It was found that in the C7 nerve root group all the parameters of evoked muscle potential amplitude (EMPA), regenerating axon count, biceps weight and muscle fibre area, and muscular maximal tetanus tension were statistically superior (P < 0.05-0.01) to those in the phrenic nerve group; while there were no significant differences between these two groups in motor nerve latency regenerating axon area and persisting time of muscular maximal tetanus tension (P > 0.05). The reasons why C7 root neurotization is superior to phrenic nerve transfer were also discussed.


[Congenital perforation of the triangular fibrocartilage of the wrist]. The authors dissected 136 wrist joints from fetus and infant fresh cadavers. The perforation rates of the triangular fibrocartilage of the wrist in these two groups were found to be 18.8% and 25%, respectively. The authors believe that, besides traumatic, inflammatory and degenerative causes, some perforations are congenital in origin. They are not found to be correlated with either sex or side of wrists (P > 0.05).


[A microcirculation observation of the venous flaps]. This article presented the observation results of microcirculation of 84 island venous flaps performed on the ears of 42 rabbits. The survival rates of 5 groups divided by differently handling the vessel pedical of the flaps were: 1. maintaining artery and venous 90.36%. 2. maintaining distal and proximal venous 86.29%. 3. only maintaining proximal venous 75.71%. 4. only maintaining distal venous 28.75%. 5. ligating all vessels O(P < 0.01). The results of blood flow examined by laser Doppler and the number of micrangium counted by microcirculation microscope were decreasing upon the sequence of the above groups (P < 0.05). We found that there were exact microcirculation in the venous flaps of group 2, 3, 4, but the blood flow in these groups, especially the group 4, were slower than the group 1.


[Clinical evaluation of blood supply of the hand]. The blood supply of 39 apparently normal hands was examined by the use of the Allen test and a Doppler Ultrasonic Blood Flow Detector. The ultrasonic examination appears to be more sensitive to the change of blood supply to the hand than the Allen test and to have higher degree of accuracy. The Allen test seems to provide some useful information, but it is a relatively crude test. The ultrasonic examination should become one of the routine examinations of patients who are likely to undergo procedures which may interfere with the normal circulation of the hand.


[Percutaneous transluminal angioplasty of subclavian arteries]. 12 cases of subclavian arterial stenosis or obstruction were treated with percutaneous transluminal angioplasty (PTA). Atherosclerosis was considered as the cause of the arterial lesion in 7 cases. In 6 of them the lesion was located near the orifice of the subclavian artery. The lesion was 10.8 +/- 5.4 mm in length and 1.67 +/- 0.8 mm in diameter. After PTA the lumen was 6.58 +/- 1.11 mm in diameter. The clinical result was satisfactory. Arteries was found in 5 cases. Most of them had long segment obstructed lesion (46 +/- 36.6 mm in length, and 0.5 +/- 0.5 mm in diameter). The result of PTA was not satisfactory. The technique of PTA has been discussed.


[Acute purulent pericarditis: clinical experience with primary pericardiectomy plus continuous pericardium lavage]. 106 patients with acute purulent pericarditis were treated surgically with three different methods without operative mortality. The pericardiectomy plus continuous pericardial lavage was more effective than pericardiectomy without irrigation or simple pericardial drainage in several aspects, such as recovery of body temperature, elimination of infectious-toxic symptoms and cutting short hospitalization days. Besides, cardiac tamponade or late constriction of the pericardium could be avoided.


[Lung hamartoma: a report of 30 cases and review of 477 cases]. 507 cases of lung hamartoma (30 cases reported and 477 reviewed) were analysed. 467 cases of them were of intrapulmonary type, 30 were endobronchial, 8 were multiple and 2 were diffuse. 505 were benign and 2 malignant. The male to female ratio was 1.74:1. The age span was from infant to 67 years with a mean of 41.4 years. 44.3% of the lesions showed no symptoms. The frequently seen symptoms were cough and chest pain. X-ray findings of the intrapulmonary type were characterized by sharply outlined round or oval mass (87.9%), with diameters 3.0 cm (62.1%), lobulation (33.5%), calcification (23.6%). These tumors grew slowly. The average doubling time for 16 cases was 4.2 years. The diagnosis was confirmed in only 18% cases preoperatively. The other cases were misdiagnosed as lung cancer, tuberculoma, metastatic tumors of the lung, etc. The etiological causes, classification, diagnosis, differential diagnosis and treatment of the tumors were discussed.


[The microsurgery of the tumor involving Meckel's cave and nearby area]. A retrospective review of 12 cases of tumor involving Mackel's cave and nearby area seen at the Tongji hospital in a 20-year period. All of the cases may be divided to three clearly defined clinical groups: (1) Patients with typical trigeminal neuralgia. The tumor usually involve the ganglion. After removal the mass the prognosis were excellent. (2) Schwannoma or neurofibrosarcoma embedded in the semilunar ganglion with a history of atypical face pain without neurological deficit. After operation the pain relief was not as good as the group 1. (3) Patients with the history of face dysethesias and pain, tumors usually involving the middle fossa of cranial base with multiple cranial nerve deficit. These patients had variable mass lesions and after removed tumor the prognosis was not as good as in group 1 and group 2. The anatomy of Meckel's cave and surgical technique in treating these tumors were discussed also.


[Surgical treatment of left ventricular right atrial fistula (II-type): report of 12 cases]. 12 cases of left ventricular right atrial fistula (II-type) were identified and repaired by open heart surgery. Our date showed that defects of the septal leaflet of tricuspital valve can be divided into three groups: multiple-opening, single-opening and split defects. When there were VSD and fistula at the same position, the VSD was not repaired completely if the opening of tricuspital septal leaflet was mistaken as the VSD itself. It is important to expose the edge of the VSD completely by cutting tricuspital septal leaflet when repairing the VSD. The cutting septal leaflet can be sutured after closure of the VSD.


[Preoperative CT scan for esophageal tumor]. Thoracic CT scans were performed preoperatively in 19 patients with carcinoma of the esophagus and one patient with esophageal leiomyoma. CT findings were compared with surgical and pathological findings before and after operation. CT was shown to be inaccurate in the preoperative assessment of the involvement of esophageal carcinoma and of little value in judging potential resectability (69%). Its accuracy was low in staging the tumor, usually understaging (37.5% staging II) or overstaging tumor (45.4% staging III), without information about suitable treatment of esophageal cancer. With low accuracy in visualizing lymph nodes of the mediastinum and periesophagus (30%), it is not helpful in distinguishing benign from malignant tumor of the esophagus.


[Need for more emphasis on fungal infection in burns]. We have made quantitative bacterial and fungal culture for 148 biopsy specimens from burn patients. Further confirmation was made by frozen section with PAS stain in 82 of the specimens. It was discovered that the fungal infections in these burn patients were characterized by early onset with multiple organisms. It was also found that the incidence of fungal infections was higher in severe burns. Two rare cases of fungal infection were discovered, one of them was infected by Geotrichum SP, and the patient died; the other an infection by Homodendrum SP on the face, and the finally recovered.


[Traumatic external gastrointestinal fistula: report of 77 cases]. Seventy-seven patients developed gastroenteric fistula as a complication of abdominal trauma, including small bowl fistula (25), duodenal fistula (17), colonic fistula (16), pancreatic fistula (3), gastric fistula (2), and multiple fistula (14). These patients accounted for 15.9% (77/483) of all patients with intestinal fistula treated in the same period in our department. An average of 8.8 days had elapsed before the final diagnosis of GI fistula was made, during which 73 patients had 1-8 kinds of complications, 48 received 1-5 operations, and 67 were given nutritional support for 6 to 254 days. Thirty patients were cured operatively and 33 (52.4%) spontaneously. The mortality was 18.2%. The etiology, principles of prevention, and management of traumatic intestinal fistula were discussed with emphasis on effective nutritional support and intraabdominal drainage.


[10 year-follow up of 2815 patients with resected recto-anal adenomas or polyps]. Ten year-follow up of 2815 patients with resected rectoanal adenomas or polyps revealed recurrence in 225 patients with a rate of 7.99%. The recurrence rate of villotubular adenoma and villous adenoma was 18.26% and 15.79% respectively, the more the volume of adenomas and polyps is, the higher the recurrence, in which the recurrence rate of more than 2 cm in diameter is 19.23% and the recurrence rate of multiple adenoma and polyps had a higher recurrence rate than single ones (17.39% vs 6.88%). Canceration in 10 years was found in 16 patients with a rate of 0.57%.


[Effects of shock and reperfusion on multiple organ function after gunshot wounds]. The effects of shock and reperfusion on multiple organ function in gunshot canine model were studied. The results showed that organ function damage even failure of the lung, liver and kidney occurred 24 hours after wound. In some dogs bacterial translocation and increase of lipid peroxidation (LPO) were also found. The experimental findings suggested that the activated free radical system and bacterial translocation may be the underlying pathogenesis of multiple organ injuries and failure. It is possible to establish a model for studying multiple organ failure on this experimental condition.


Stimulation of renal tubular transport of p-aminohippurate in rats of different ages by treatment with adrenocortical steroids. Treatment with prednisolone or dexamethasone is followed by an increase in renal excretion of p-aminohippurate (PAH) and in accumulation of PAH in renal cortical slices, particularly in 5- and 10-day-old rats with immature kidney function. Treatment with triamcinolone is effective both in immature and in 55-day-old rats. There is no stimulation of PAH transport after treatment with mineralocorticoids (desoxycorticosterone, aldosterone).


Effects of phenobarbital on cerebral blood flow in the newborn piglet. To determine the neonatal cerebrovascular effect of a therapeutic dose and a high dose of phenobarbital (Pb), the effect of Pb on cerebral blood flow (CBF) and total brain oxygen consumption (CMRO2) was studied in three groups of awake newborn piglets (aged 1-3.5 days). Group I (control n = 9) received normal saline solution, group II (n = 9) received a therapeutic dose of Pb (15 mg/kg i.v.) and group III (n = 9) received a high Pb dose (45 mg/kg i.v.). Four CBF measurements per piglet using radioactive microspheres (141Ce, 85Cr, 95Nb, 46Sc), arterial blood gases, O2 content, hematocrit and plasma glucose were obtained at 0, 15, 30, 60 min after saline or Pb injections. In all groups, pH, PaO2, PaCO2, blood pressure, heart rate, temperature and plasma glucose remained unchanged except a 14% decrease (p < 0.01) in blood pressure and an increase (p < 0.05) in PaCO2, 60 min after drug injection in groups II and III. Total CBF in group II decreased by 14% (p < 0.05) 15 min after drug injection and was significantly lower (p < 0.05) than control (group I) but returned to baseline after 30 min. High Pb dose progressively lowered CBF by 11% 15 min after drug injection and produced a significant decrease by 20% (p < 0.01) 30 min after drug injection with return to baseline after 60 min. Similar effects were noted in different brain regions (cerebrum and thalamus). CMRO2 remained unchanged in the control group; however, it was decreased by 35% (< 0.01 p > 0.05) 15 min after drug injection and returned to baseline after 60 min. In group III, high Pb dose lowered CMRO2 by 31% 30 min (p = 0.02) after drug injection. Data indicate that Pb exerts a minimal but transient dose-dependent effect on CBF and CMRO2.


Placental transfer of phenobarbital: what is new? The placental transfer of phenobarbital was investigated in 35 mother-infant pairs at birth. The drug was administered prenatally to the mothers for maternal epilepsy (group 1, n = 5), gestational hypertension and preeclampsia (group 2, n = 20) and prophylaxis of intraventricular hemorrhage in premature deliveries (group 3, n = 10). The phenobarbital levels in arterial cord blood were 100 +/- 2.8% in group 1, 89 +/- 21% in group 2 and 77 +/- 16% in group 3 with respect to the levels observed in the mothers. The most important factor influencing the transplacental passage was the duration of maternal treatment in the infant of group 1 (r = 0.80, p < 0.01), the gestational age in the infants of group 2 (r = 0.74, p < 0.01) and the arterial cord pH in the infants of group 3 (r = 0.89, p < 0.001).


Albendazole and mebendazole uptake by isolated enterocytes. Uptake of albendazole (ABZ) and mebendazole (MBZ) by isolated rat enterocytes was carried out. These drugs, widely used oral anthelmintics, exhibit a scarce water solubility which reduce its absorption by the oral tract. The present study was designed to assess the captation for ABZ and MBZ in different enterocyte populations isolated from upper to crypt villus. The concentration range used for the absorption experiments was within 10-500 microM for both drugs, using DMSO as solvent. The results obtained show the existence of a passive mechanism for the uptake of ABZ and MBZ at concentrations between 10 and 100 microM, with a maximum intake value around 20 microM/mg protein. No differences were found with respect to the cell populations analyzed. The drug uptake levels seem to be higher for MBZ than for ABZ prior to reaching the maximum plateau.


Patient-controlled versus conventional analgesia for postsurgical pain relief in adolescents. We performed a randomized nonblinded, cross-over comparison of patient-controlled analgesia (PCA) with conventional intramuscular analgesia in 10 adolescents (13-18 years) undergoing spinal fusion for idiopathic scoliosis. PCA use afforded more effective pain control (p < 0.02) on a 10-point linear pain intensity scale than did intramuscular injections, while causing an equal amount of sedation and no side effects. PCA appears to be a promising technique for providing postoperative pain relief in this group of adolescents. Further studies are needed to define its role for other pediatric conditions.


Delayed thromboxane synthesis inhibition, but not cholinergic blockade, reverses group B streptococcus-induced pulmonary hypertension. Anisodamine, an anticholinergic drug, is widely used in China for treatment of infants with septic shock and has been reported to inhibit thromboxane synthesis in cultured cells. Thromboxane A2 plays an important role in the early pulmonary hypertension in sepsis; however, the role of thromboxane A2 later in sepsis is unclear. We tested the hypothesis that thromboxane A2 synthesis inhibition with dazmegrel, and cholinergic blockade with anisodamine, would attenuate the later phase of pulmonary hypertension induced by 4 h of group B streptococcus (GBS) infusion. 1 mg/kg of dazmegrel reversed the pulmonary hypertension and slightly increased cardiac output; these hemodynamic improvements persisted for 30-60 min. Plasma thromboxane B2 levels returned toward pre-GBS baseline values after dazmegrel treatment. Thus, thromboxane A2 is still a major mediator of pulmonary hypertension in piglets after 4 h of continuous GBS infusion. 0.5 mg/kg of anisodamine had no significant hemodynamic effect. 2 and 4 mg/kg of anisodamine each caused transient, dose-related decreases in systemic artery pressure; cardiac output also fell after the highest anisodamine dose. Pulmonary hypertension was not alleviated by anisodamine. All hemodynamic changes induced by anisodamine were short-lived and returned to preanisodamine values within 10 min. Anisodamine did not ameliorate thromboxane-mediated pulmonary hypertension in this animal model, and therefore may not inhibit thromboxane synthesis in vivo. The results of this study do not support the use of anticholinergic therapy to improve hemodynamics in GBS sepsis, but do suggest that thromboxane synthesis inhibition may be a clinically useful therapy in advanced GBS sepsis.


Synergistic effect of triiodothyronine and dexamethasone on renal tubular transport of p-aminohippurate in rats of different ages. Postnatal maturation of the renal tubular transport of p-aminohippurate (PAH) was verified in rats both in diuresis experiand on renal cortical slices in vitro. Following treatment with various doses of triiodothyronine (T3) or dexamethasone (3 days, once a day), the increase in renal tubular transport of PAH was more distinct in young rats with immature kidney function. The synergistic effects of simultaneous treatment with both hormones indicate differences between T3 and dexamethasone in the modulation of cellular function.


Wilson's disease treatment by triethylene tetramine dihydrochloride (trientine, 2HCl): long-term observations. Wilson's disease is an autosomal recessive disorder characterized by an accumulation of a toxic amount of copper in the body. Triethylene tetramine dihydrochloride (trientine, 2HCl) is a new chelating agent that may be effective in the removal of excess copper but long-term efficacy has not yet been investigated. Here we report the use of trientine over more than 8 years in 2 patients with Wilson's disease who could not tolerate D-penicillamine. We found no significant side effect, except a decreased serum iron concentration without clinical symptoms of anemia. In annual examinations at a steady state, the serum copper levels remained below 20 micrograms/100 ml. The 24-hour urinary copper excretion was less than that found using D-penicillamine, while the basal copper excretion, after 5 days abstinence from trientine, was maintained below 100 micrograms/day. Both hepatic and neurological manifestations except bulbar symptoms were recovered without any initial deterioration.