[Fascia dehiscence--cause and prognosis]. During a period of 5 years, 4476 interventions in abdominal surgery were prospectively analyzed. The incidence of fascial dehiscence was 0.7% (n = 30). Seventeen of these patients underwent surgery on account of intraabdominal infection (total incidence of intraabdominal infection 4.4%). Fascial dehiscence developed in 22 out of 30 patients (73%) after emergency surgery. All of them had to be operated out of routine surgical schedule with the exception of four patients. Using multivariate stepwise logistic regression analysis, main determinant factors in fascial dehiscence were the ASA score (p = 0.0001), reflecting the severity of primary or concomitant diseases, and wound infection (p = 0.0075), mostly due to intraabdominal contaminations. Fascial dehiscence was associated significantly with a higher morbidity, reflected by longer inpatient management. Nevertheless, the overall lethality of 20% was associated to serious primary or concomitant diseases. Therefore, the results emphasize the significance of diligent preoperative work-up. Adequate treatment for concomitant disorders should be performed preoperatively, whenever possible even in emergency surgery.


[Randomized study of preoperative chemotherapy in squamous cell cancer of the esophagus. CAO Esophageal Cancer Study Group]. Only 46 of 77 patients with potentially resectable squamous cell carcinoma of the esophagus who were asked to participate in a phase-III trial to be treated by either immediate surgery (n = 24) or surgery plus preoperative chemotherapy (n = 22) agreed to randomization. A priori 13 patients chose chemotherapy before surgery and 18 patients only surgery. The complete chemotherapy program consisted of three cycles with 5-FU (1g/m2/d x 5) and cisplatin (20 mg/m2/d x 5). The response rate (CR and PR) to chemotherapy was 47%. Side effects of therapy were higher than expected, based on results of previous phase-II studies. Two drug related deaths were observed. The resectability rate for patients in the operation-only group was 80 and 70% for patients receiving chemotherapy. The postoperative rate of septic complications (41 vs. 26%) and respiratory disorders (37 vs. 26%) were higher for patients with preoperative chemotherapy in comparison to the only surgically treated controls. Surgery related mortality was increased in the chemotherapy group (18%) compared to the controls (10%). Patients responding to preoperative chemotherapy had a prolonged survival (median 13 months) when compared with non-responders (median 5 months), but the median survival for the chemotherapy group and the only-surgery group was identical (10 months). We conclude, that the preoperative chemotherapy regime used in this multi-institutional trial neither influences resectability, nor increases overall survival of patients with localized esophageal cancer. However, preoperative chemotherapy was associated with considerable side effects and a high postoperative mortality.


[Liver transplantation after trans-jugular intrahepatic portosystemic stent shunt]. Every third patient with parenchymal liver disease bleeds from esophageal varices. Treatment of this complication is of special interest with regard to liver transplantation which may become necessary later on. The mesocaval H-shunt excluded, surgical shunting results in technical and hemodynamic problems during transplantation. They may be avoided by the new approach of transjugular intrahepatic portosystemic stent shunt (TIPSS). We report our experience with liver transplantation in two patients after TIPSS.


[Cardiac morbidity and fatalities in patients with vascular surgery. Identification of risk groups]. Incidence and type of cardiac complications in 701 patients undergoing arterial vascular surgery were prospectively investigated to identify high-risk groups. Cardiac morbidity was 10.1%. Cardiac complications were responsible for 28 deaths (57%). Using logistic regression analysis, age (cardiac morbidity greater than 7017.3%), impaired renal function (19.8%), and congestive heart failure (17.3%) were the main independent risk factors. In addition, 4 risk factors (arrhythmia, coronary artery disease, anemia, emergency surgery) showed significant individual association with cardiac complications. Cardiac morbidity increased to 27.8% in patients with more than 2 of these 7 risk factors. A further association could be demonstrated between the degree of peripheral vascular disease and cardiac morbidity, but not with the extent of the operation. Based on our results a distinction between three groups of different cardiac risk can be made. A clinical algorithm for further cardiac assessment in high-risk patients is presented.


[Functional results of subtotal and partial colectomy in therapy-resistant chronic constipation. A follow-up study of 32 patients]. In 32 female patients with severe constipation subtotal (n = 27) or partial (n = 5) colectomy was performed. In 8 cases slow transit constipation was preexistent, 24 patients had a megacolon/dolichocolon. Ileosigmoid anastomosis was found to show the most favourable results. None of these patients complained of constipation postoperatively and all of them reported regular (daily) bowel movements. Incontinence for flatus and/or liquid stools was less likely to occur with ileosigmoid than with rectal anastomosis (29 versus 46%).


[Treatment of pilonidal sinus with excision and primary suture using a local, resorbable antibiotic carrier. Results of a prospective randomized study]. The excision of a pilonidal sinus with wound healing by second intention, often results in a long duration of treatment. On the other hand, primary suture after excision has a high rate of abscess formation. In a randomized study we treated 40 patients with excision of pilonidal sinus, insertion of a collagen sponge containing Gentamicin and primary suture (group 1) to prevent this abscess formation. Another 40 patients were treated in the same way but without applying the Gentamicin-collagen sponge (group 2). There had been no significant differences as to the history and duration of the disease, the wound size, the degree of inflammation, the weight of the patients or the amount of hair near the sinus. In group 1 only 7.5% of the patients had a postoperative abscess formation, in contrast to group 2, with an abscess rate of 52.5% and consecutive surgery (p less than 0.001). One year after the operation the recurrence rate was 0 in both groups. Considering the results mentioned, surgical excision of the pilonidal sinus in combination with insertion of a resorbable antibiotic sponge we recommend this therapy.


[Thoracoscopic use of staplers. New possibilities for minimally invasive diagnosis and therapy]. Thoracoscopic resection of peripheral lung tissue is possible by using special staplers (Endo-GIA). Main indications for using this technique are the treatment of a spontaneous pneumothorax by resection of bullous lung areas (15 patients) and the excision of macro biopsies for diagnostic reasons (13 patients). It is reported about the technique and the early outcome of these 28 thoracoscopically performed lung resections. This way minimally invasive procedure is combined with well-established surgical technique.


[Ultrasound assisted brachial plexus anesthesia]. Plexus brachialis anaesthesia is a common technique for hand and forearm surgery. If the distance between puncture site and plexus brachialis is to long the anaesthesia will be incomplete. If there happens a direct puncture and injection of anaesthetics in the nerves, neurological deficit can occur. Intravascular injection causes cardial complications. This problems can occur mainly in obese patients in whom the brachial artery cannot be identified well by clinical examination. In these patients we perform the plexus brachialis anaesthesia under sonographical control. For the examination we use a linear 7.5-MHz transducer. The technique is presented.


[Evaluation of antenatal monitoring of unconjugated estriol in the saliva]. A new radioimmunoassay kit for unconjugated salivary estriol (SE 3) determination was used to monitor 497 fetuses in late pregnancy, 217 normal and 280 at high-risk. The SE 3 values of normal pregnancy were also measured in 1378 cases at 20th to 41st gestational week. The normal concentration weekly was established. The results were 1. The false negative and false positive rate of SE3 were 2.0% and 0.6%, respectively; thus the correct rate of SE3 in prenatal prediction of fetal well-being was 97.4%, similar to that of serum E3 (95.6%, P greater than 0.05) and significantly higher than that of overnight 12-hour urine E3/C (84%, P less than 0.05). 2. There were 8 fetal deaths of 11 cases with lower SE3, whereas, only one death due to nuchal cord in the 486 with normal SE3, and no perinatal death. It is highly important to collect saliva and measure the SE3 correctly in order to guarantee accuracy of the results. The advantages of salivary SE3 assaying are reliable and being more scientific and practical than that of serum E3. We suggest that determination of SE3 may replace serum E3 measurement for assessing fetal-placental well-being.


[Prevention of post-operative infection by using antibiotics of 217 cases of cesarean section]. A prospective study was undertaken to compare the efficacy of local antibiotics irrigation with that of systemic antibiotics in Cesarean section patients in the prophylaxis of post-operative infection. 217 patients delivered by Cesarean section were randomly divided into three groups: (1) intrauterine and pelvic irrigation with ampicillin; (2) systemic use of penicillin+gentamycin (intravenously and intramuscularly); (3) control group: no antibiotics given. The incidences of post-operative infection for the two treatment groups were significantly lower than control group, and the difference of post-operative infection between the two treatment groups was not statistically significant. It suggests that administration of antibiotics either by local irrigation with ampicillin or by systemic using of penicillin+gentamycin are just as effective in preventing post-operative infection. In our study, 8 out of 10 of the positive cultures from the uterine cavity of non-elective Cesarean section cases became negative after irrigation. This implies that antibiotic irrigation has the effect of reducing bacterial flora locally. Two to three days after operation, the incidences of positive uterine cavity culture for the two treatment groups were lower than control group, but not of statistical significance. Therefore, it remains to be clarified whether prophylactic use of antibiotics can prevent the vaginal flora from ascending into the upper genital tract.


[Prospective study of intrauterine fetal resuscitation with aminophylline]. 80 cases of fetal distress were divided at random into group A and B. Group A was treated with the traditional three drugs combination treatment. Group B was treated with intravenous injection of aminophylline slowly. FHR CTG and BPS were monitored and analysed. The results were as follows: (1) The differences before and after treatment in group B were significant. (2) Only FHR in group A showed difference before and after treatment. (3) The changes after treatment between group A and B were significant. These suggested that the effect of aminophylline on intrauterine fetal resuscitation is better method.


[Prevention and factors inducing respiratory distress syndrome in prematures]. An analysis of 105 cases of prematures with respiratory distress syndrome, the idiopathic type were 9.5% (10/105). Fetal anoxia and ischemia, induced by pregnancy and during labour amounting to 87.6% (92/105), and of which 2.9% (3/105) was due to diabetes. It indicated that most cases of RDS are predominantly related with fetal anoxia and ischemia which results in pulmonary surfactant abnormality or impaired activity. It is important that in clinical diagnosis one should monitor cautiously the presence of premature birth with anoxia and ischemia, Thus, a preventive treatment must be given at least 24 hours prior to birth, and the earlier the least morbidity of RDS occurred.


[Lung function changes during pregnancy]. The lung functions in different pregnant stages were measured in 41 women with pregnancy and 12 normal women without pregnant. Forced Vital Capacity (FVC) was found gradually decreasing as pregnancy advanced (P less than 0.05). After 28 weeks of gestation, the Vital Capacity (VC), Forced Expired Volume in 1 second (FEV 1) significantly decreased as compared with the normal values (P less than 0.01 or P less than 0.05). These results suggested that the lung function changed gradually during pregnancy, especially after the 28th week, significantly in VC, FVC and FEV 1. Maybe there are slight obstructions in the bronchial tubes. After the 28th week of gestation and it may be the reason for occurrence of breathshort and the lung infection.


[Luteinization of unruptured follicles during clomiphene treatment]. Twenty-eight anovulatory, infertile patients under clomiphene (cc) treatment were studied. Ovarian function was ascertained through BBT, cervical score (cs) and serial hormonal assays. Follicular development and ovulatory events were monitored by serial ultrasonography. Of a total of 66 treatment cycles, 49 presented ovulatory responses, but only 28 cycles showed actual ovulation (42.4% of total; 57.1% of ovulatory response cycles); follicles in 21 cycles were unruptured but luteinized (LUF) (31.8% of total; 42.9% of ovulatory response cycles); deficient follicular development occurred in 17 cycles. With analysis of parameters investigated and hormonal assays, the characteristics of LUF and some factors involved in its development are discussed.


[Clinic-pathological study of 485 cases of postmenopausal bleeding]. Four hundred and eighty-five patients with postmenopausal bleeding (PMB) who underwent a curettage were studied retrospectively to evaluate the relationship of clinical cause and pathological findings. The results showed that nonorganic causes were the most common, benign causes were much commoner than malignant causes. Bleeding from the uterus was the most common in all PMB. Pathological examination revealed atrophic endometrium in 41.5%, proliferative and secretory endometrium only a few. Endometrial and cervical carcinoma were the most common among the malignant causes. PMB with an enlarged uterus, and women with advanced age have a statistically significant correlation with more serious pathology. It is suggested that the postmenopausal endometrium changes are regulated by ovarian and ectopic sex hormones, and endometritis or vascular diseases of the endometrium may be involved in the mechanism of bleeding.


[Relation between macrophages in peritoneal fluid of endometriosis and infertility]. Peritoneal fluid was collected from 18 endometriosis-associated infertile patients and 14 unexplained infertile women. The cells were counted in a hemacytometer and subjected to morphologic analysis. The phagocytic activity on Candida Albicans and on Sperms was evaluated and the activity of acid phosphatase in the pelvic fluid and within the macrophages were measured. The results showed that the endometriosis samples have macrophages of large size as compared with the macrophages found in unexplained infertile or fertile women, the concentration of pelvic macrophages in endometriosis is higher, the phagocytic and bactericidal activity is also higher and the macrophages in endometriosis engulf sperms as well. The accentuated activity of pelvic macrophages may be associated with the infertility in patients with endometriosis.


[Effect of placenta previa on fetal growth and development]. A retrospective study of 151 fetuses born of mothers with placenta previa in the maternity and our hospital in 1984-1991 was done. This study aimed at determining whether placenta previa affects growth and to what extend. We recorded the birth weight, crown-heel length, head and chest circumferences of each of the 151 fetuses. After calculating the average of each item. According to gestational week and type of placenta previa, they were compared with the 50th percentile numbers in normal fetuses of the same gestational age. The results were among the 151 features, born of mothers with placenta previa 19 (12.6%) suffered from intrauterine growth retardation, 80(53.0%) with birth weight less than normal fetuses, and 52(34.4%) with birth weight basically the same as normal fetuses. Most of the fetuses with birth weight less than normal, were born of mothers with total or partial placenta previa while most of those with birth weight basically the same as normal fetuses. At 28th to 32nd week were born mothers with lowly placenta previa of gestation there was no obvious difference between the birth weights of fetuses of placenta previa mothers and normal pregnancies (P greater than 0.05). But from 33rd week to 40th week, the difference became obvious (P less than 0.05); the chest circumference in fetuses of total and partial placenta previa cases obviously less (P less than 0.05). So we may say that placenta previa affects fetal weight gain, especially from 33rd week and the chest circumference, in the last three weeks.


[Analysis of 65 cases of abruptio placenta]. From Jan 1, 1971 to Dec 12, 1990, 65 cases of abruptio placenta were admitted to our hospital. The incidence was 0.19%. Among them, thirty were complicated by pregnancy induced hypertension (46.2%). The perinatal fetal mortality was 19.7%; perinatal death occurred mostly in the premature group. All babies survived except two abnormalities. Cesarean section rate was 32.3%. All postpartum hemorrhage 29.2%. Couvelaire uterus 6.2%, were cured by conservative treatment. There was neither stillbirth nor newborn death in the thirty three cases treated expectant, but a newborn asphyxia rate of 6.1% and a cesarean section rate of 15.1%. Analysis showed that abruptio placentae should be suspected in cases with abnormal fetal heart rate of unknown cause accompanying signs of labor, premature labor of unknown cause, uterine tongue, ultrasonically visualized liquid from dark area behind the placenta, besides classical signs of abdominal pain and vaginal bleeding. Expectant treatment is appropriate if gestational age is small and no acute symptoms exists so as to minimize the perinatal mortality and cesarean section rate.


[Diagnosis and management of obstetric acute disseminated intravascular coagulation]. Twenty-seven in-patients with obstetric DIC in our hospital from Jan. 1971 to Dec. 1990 were analysed retrospectively. The incidence was 0.12% in the first decade and 0.02%, in the second, showing a difference of significance between them. The most common predisposing factors included amniotic fluid embolism, abruptio placenta and hemorrhagic shock. Bleeding from multi-organs in various extent and coagulation disorders occurred in all those 27 cases. [Besides anti-shock treatment, heparin was employed together with fibrinogen in 4 postpartum and 1 antepartum DIC patients, fibrinogen alone in 8 cases, and hysterectomy in 11 cases. 17 patients were saved and 9 died. It is important that early diagnosis and much attention paid to clinical characteristics together with serial laboratory tests. Key management should include prompt treatment and eradication of predisposing factors. Quick decision spite of to terminate the pregnancy and even hysterectomy should be done in some risks.


[Analysis of 18 cases of postpartum haemorrhagic shock in pregnancy with virus hepatitis]. In this article, 147 pregnancies with virus hepatitis admitted to our hospital from Dec 1987 to Jun 1991 were studied. The incidences of postpartum haemorrhage and haemorrhagic shock were 36.05% and 12.24% respectively, and were related to the clinical classification of the hepatitis, with a difference of high significance (P less than 0.01). Analysis of the clinical manifestations and results of the blood tests in 18 cases of shock suggested that the main cause of shock was hepatitis resulting in injury of the liver and thus absence of clotting factors increasing postpartum haemorrhage. Therefore, emphases on antenatal care by keeping the women under the monitoring by obstetrician and physician together. Replenishing clotting factors, rectifying clotting defects; preventing acute hepatitis from proceeding to severe hepatitis and pregnancy-induced hypertension are keys to treat antenatal hepatitis. Close intrapartum care and shortening the duration of labor, especially the third stage, are important to reduce postpartum haemorrhagic and prevent occurrence of haemorrhagic shock.


[Perinatal fetal prognosis of essential hypertension complicating pregnancy]. Pregnancy induced hypertension (PIH) in patient of essential hypertension is a high risk factor for both mother and child. From July 1959 to June 1991 there were 52,898 deliveries after the 28th week of gestation in our hospital, among whom essential hypertension occurred in 2.5% and 337 cases were superimposed by PIH with an incidence of 25.9%. There was a perinatal fetal mortality rate of 117.6/1000 in those 337 cases. A scoring system for perinatal fetal prognosis was worked out. The clinical criteria consist of: preexisting diastolic blood pressure, the highest diastolic pressure during pregnancy, proteinuria and the time of onset of PIH. A perinatal survival rate of 75.0% was obtained in those patients with preexisting diastolic pressure lower than 14.8 kPa (110 mmHg). A perinatal survival rate of more than 98.0% may be expected of those patients developing P I H after the 36th week of gestation. When the score is more than 8, the patient could usually get a living baby. If the score is less than 7, it is important to treat P I H effectively, terminate pregnancy at an appropriate time and keep the baby in the intensive care unit.


[Effects of gentamycin on the fetal kidneys]. Gentamycin was given in 24 women during termination of mid-trimester pregnancy. The concentration of gentamycin in the blood of pregnant women, umbilical cords and in tissue of placenta, fetal kidneys were determined by fluorescence polarization immunoassays, and the morphological changes of fetal kidneys were investigated as well. The results indicated that the concentration of gentamycin in circulation of pregnant women was not significantly different from that of the umbilical cords (P greater than 0.05), but in tissue of fetal kidneys gentamycin concentration was remarkably higher than that in placenta (P less than 0.05). The following pathological findings of fetal kidneys were seen: marked congestion in glomeruli, cloudy swelling in the proximal tubules, reduced cilial cells and granular degeneration in epithelium. All these have shown that the placenta did not act as a barrier on gentamycin. It should be noted that while gentamycin in therapeutic dosage was given to pregnant women, it would be accumulated in fetal kidneys and caused damage.


[Intrauterine device-induced menorrhagia and endometrial content of prostacyclins]. The endometrial concentration of 6-keto-PGF1 alpha and TXB2 were measured by RIA in women with Tcu-IUD induced menorrhagia (MBL greater than 80 ml) and in levonorgestrel-IUD users with oligomenorrhea or amenorrhea. Non-IUD users with normal menses (MBL less than 80 ml) were chosen as control. It was found that the Tcu-IUD group showed a significantly higher 6-keto-PGF1 alpha concentration than the other two groups (P less than 0.01). Conversely, the TXB2 concentration of levonorgestrel-IUD group was significantly higher than that of the other groups (P less than 0.05). As a result, the 6-keto-PGF1 alpha/TXB2 ratio was much higher in Tcu-IUD group (P less than 0.01). Our results indicated that the unbalance of PGI2/TXA2 ratio may be the direct cause of the IUD-induced menorrhagia.


[The value of fingernail creatinine measurement in the identification of acute and chronic renal failure]. It is difficult to distinguish acute renal failure (ARF) clinically from chronic renal failure (CRF), especially in the patients who do not have medical history records. Since fingernail creatinine (Ncr) reflects serum creatinine (Scr) at the time of nail formation, it has been suggested that Ncr level might represent that of Scr around 4 months previously. In this study, clipped fingernail specimens from 60 normal individuals (Scr 85.75 +/- 3.54 mumol/L), 35 patients with CRF (Scr 568.41 +/- 47.74 mumol/L) and 15 patients with ARF (Scr 123.60 +/- 17.29 mumol/L) were analyzed for creatinine by a standard alkaline picrate method. The results showed that Ncr level was significantly lower in the normal group (61.89 +/- 10.25 mumol/100g fingernail) than in the CRF group (130.04 +/- 34.55 mumol/100g fingernail) P less than 0.001. In the ARF group Ncr level (65.59 +/- 2.5 mumol/100g fingernail) was more or less the same as that in normal controls. It is concluded that Ncr measurement is of clinical value in identification of ARF.


[Effect of serum from IgA nephropathy patients on IL-1 production from P388 D1 cell lines]. The study was designed to investigate IL-1 production from P388D1 cell using serum from 40 cases with IgA nephropathy (IgAN) as stimulative factor. It was found that there was a relationship between IL-1 and renal morphological change. The result indicated that IL-1 production by P388D1 cell was much higher in the presence of the serum than that in the absence (CPM: 47597 +/- 26213 vs 36567 +/- 14377 P less than 0.05). The level of IL-1 correlated obviously to the renal morphologic changes (r = 0.406, P less than 0.05). It is suggested that in the serum of IgAN patients there are certain factors stimulating P388D1 cell to produce IL-1, which may contribute to the pathogenesis of IgAN.


[Prognostic evaluation of severe viral hepatitis]. The Cox's regression model is used for analysis of registered survival data of severe viral hepatitis. The final regression model showed six covariates, i.e. grade of coma, prothrombin time, the interval between jaundice to bleeding, the interval between jaundice to coma, LDH, and pathological scores as well as the recurrence frequency were associated with survival significantly. The final model can be presented as a "pocket chart" by which a prognostic index (PI) for a new subject can easily be obtained. By a simple graph, the PI can be translated to estimates of the probability of surviving within a given time and the median survival time. A small sample of prospective study showed the predicted survival length did not differ from the observed survival length significantly.


[Association between essential hypertension and immunology]. Using the immunofluorescence method, autoantibodies of serum IgG was investigated in 100 consecutive patients of essential hypertension with or without family history of hypertension. 30 healthy normotensive subjects with family history of hypertension and 40 healthy normotensive subjects of the same age range were also studied. The results showed that in the treated patients, the frequency of smooth muscle antibodies (SMA), antimitochondrial antibodies (AMA), antinuclear antibodies (ANA) and heart reactive antibodies (HRA) was higher than that in healthy normotensive subjects. The frequency of these antibodies was not associated with difference in mean arterial blood pressure, sex, and clinical stage and a possible genetic predisposition is suggested. The autoantibodies may even appear before the elevation of blood pressure in patients with essential hypertension. The above-mentioned results show that lack of autoimmunity may be one of the pathogenetic factors of essential hypertension.


[An analysis of 21 cases of idiopathic dilatation of the pulmonary artery]. Idiopathic dilatation of the pulmonary artery (IDPA) is a disease which, generally speaking, does not need treatment. But a correct differential diagnosis is of great importance. 21 cases of IDPA were reported. The clinical data showed that 66.67% of the patients were asymptomatic and all the patients had normal respiratory and cardiovascular functions. 10% of the cases had had a history of more than 20 years. The results showed that IDPA was a benign anomaly and most of its symptoms were iatrogenic. It was usually misdiagnosed as pulmonary stenosis (42.86%), atrial septal defect (38.10%), pulmonary hypertension (28.57%), and so on. Careful chest X-ray, ECG and UCG examinations are useful for the differential diagnosis, but a clinical diagnosis should be based on the normal result of right heart catheterization.


[Alterations of Ulex europaeus agglutinin-1 receptor in human colorectal benign and malignant tumors]. The distributions and alterations of UEA-1 receptor in 116 human colorectal mucosa, included 20 normal mucosa, 16 inflammatory and 14 hyperplastic polyps, 34 adenomas, and 32 carcinomas, were studied with ABC technique. The results follow as: 1. There were positive staining of UEA-1 in proximal colon and negative in distal colon and rectum; 2. The frequency and intensity of UEA-1 receptor stained were increasing with the sequence of normal mucosa (7.7%), inflammatory polyps (25%), hyperplastic polyps (57.1%), adenomas (76.4%), and carcinomas (100%) in distal colon and rectum; 3. The staining pattern of UEA-1 in severe atypia adenomas was very similar to that in carcinomas and both of them were significantly difference from that in the other groups (P less than 0.05 or less than 0.01). The results suggested that UEA-1 receptor in distal colon and rectum may be considered as a probe studying course of malignant transformation and benefit to the diagnosis of carcinoma.


[T-lineage acute lymphoblastic leukemia. Report of 23 cases]. 23 cases of T-lineage acute lymphoblastic leukemia (TALL) were identified by multiple monoclonal antibodies. TALL was characterized by a younger age of the patients (average age 28 years), strong male preponderance (M:F, 4.8: 1), mediastinal mass (19%), higher leucocyte count (71.4%), hepatomegaly (76.2%) and splenomegaly (90.5%). Of 19 cases of TALL who were subclassified according to the criteria for subclassification of TALL proposed by Reinherz, 10 cases expressed a surface antigen pattern consistent with the early thymocyte stage of TALL development, 8 cases were of common thymocyte stage and 1 case was of mature thymocyte stage. The phenotypes of TALL cells appear to be considerably heterogeneous. 12 of 18 patients who received chemotherapy had achieved complete remission (67%).


[The effect of lovastatin in the treatment of primary hypercholesterolemia]. The effect of Lovastatin, an HMG. CoA reductase inhibitor, on serum lipids and apolipoproteins was studied in 40 cases of primary hypercholesterolemia in a 4-month period of treatment. The level of serum lipids did not change significantly after a 35-day period of placebo treatment as compared with that of the baseline (P greater than 0.5). The patients then took Lovastatin with the evening meal in a daily dose from 20 to 80 mg for 3 months. The results were as follows: Lovastatin reduced significantly the mean serum level of total cholesterol (TC) by 31.5% (P less than 0.001), LDL-C by 39.8% (P less than 0.001), Apo-B by 27.3% (P less than 0.002), and the ratio TC/HDL-C by 35.9% (P less than 0.01). It also reduced the mean serum level of triglycerides (TG) by 22.1% (P greater than 0.05) and increased that of HDL-C by 6.3% (P greater than 0.2) and Apo-AI by 1.6% (P greater than 0.5), but without much significance. The drug was well tolerated by all the patients. Transient elevation of CPK was noticed in 2 patients and AKP in one patient. 7 patients complained of gastrointestinal discomfort. All these side effects did not necessitate stop of the medication. We are, therefore, of the opinion that Lovastatin is an effective agent for lowering the serum level of TC, LDL-C and Apo-B.


[Treatment of chronic renal failure with Oenothera beinnis L in rats with subtotal nephrectomy]. The effect of orally administered Oenothera Biennis L on chronic renal failure was studied in the partially nephrectomized rats. As compared with the control groups, the group treated with Oenothera showed the following features. 1) Urine protein excretion was reduced; 2) Level of serum cholesterol decreased; 3) Scr maintained the same level as before treatment; 4) Level of PGE1 and PGE2 increased both in renal cortex and medulla; 5) 6-keto PGF1 alpha increased in cortex; 6) Increased TXB2 production was only observed 4 weeks after nephrectomy; 7) Glomerular lesions were more severe in control group. It is concluded that Oenothera Biennis L has beneficial effect on the remnant kidney and may be useful as a kind of conservative treatment for chronic renal failure.


[Degree of cellular proliferation in the first-time bone marrow smear and its significance in the diagnosis of aplastic anemia]. According to the cellularity in the first bone marrow aspirate, 541 cases of aplastic anemia (AA) diagnosed in the Peking Union Medical College Hospital were divided into two groups--hypoplastic and hyperplastic. Comparison of the transformation, remission and long-term survival rates in the two groups showed the following results. (1) Transformation: In the hypoplastic group, 60% of the cases maintained the original degree of proliferation, 34% was transformed to hyperplastic, 3% had repeated transformation and 3% became leukemic. In the hyperplastic group, 44% maintained the original degree of proliferation, 44% was transformed to hypoplastic, 9.3% had repeated transformation and 2.7% became leukemic. (2) Remission rate: The total remission rate was 15.9% in the hypoplastic and 14.6% in the hyperplastic group. (3) Long-term survival rate: The 1-, 5- and 10-year survival rates were 70.43%, 57.66% and 51.51% in the hypoplastic group, while they were 86.7%, 71.24% and 63.34% respectively in the hyperplastic with statistical significance (P less than 0.01). It is emphasized that AA can not be ruled out if there is hyperplasia in the bone marrow smear taken for the first time or in several smears taken from the same site. Smears taken periodically from different sites are essential for correct diagnosis.


[Clinical investigation of vitamin A deficiency and endotoxemia in patients with liver cirrhosis]. Eighty four patients with liver cirrhosis were studied and their plasma levels of vitamin A, fibronectin and endotoxin were assayed. Various degrees of vitamin A deficiency were found in 79% of the patients, but no deficiency in vitamin A caused the rise in plasma fibronectin. The incidence of endotoxemia and secondary infections in vitamin A deficient patients (82%, 31%) was significantly higher than that in normal vitamin A group (P less than 0.01). In 62% of the patients, vitamin A deficiency and endotoxemia existed simultaneously. For patients in whom vitamin A deficiency and fibronectin decrease coexisted, the incidence of endotoxemia was 93%. The findings demonstrated that vitamin A deficiency is an important cause of complicating endotoxemia and secondary infection in cirrhotic patients. Further efforts should be made to evaluate the clinical value of combined assay of vitamin A and fibronectin in estimating the liver function and prognosis of the patients.


[Studies on plasma beta-thromboglobulin, thromboxane A2, prostaglandin I2 concentration and platelet count in liver diseases]. We measured blood platelet count and plasma beta-thromboglobulin concentration in 67 patients with acute or chronic liver diseases. Plasma TXB2 and 6-keto-PGF1a concentration were also measured in these patients. The results showed that blood platelet count of less than 100 x 10(9)/L was found in 14% of the patients with acute hepatitis, 23% with chronic hepatitis, 67% with hepatic cirrhosis but without splenectomy and 40% with primary liver carcinoma. Platelet count is lowest in patients with hepatic cirrhosis without splenectomy but normal in patients with hepatic cirrhosis after splenectomy. Plasma beta-TG concentration increased in patients with acute or chronic liver diseases. A negative correlation was found between beta-TG concentration and platelet count in chronic liver diseases. It is suggested that platelet is in activated state in vivo and this may be one of the important reasons for both decrease of platelet count and impairment of platelet function. Plasma TXB2 concentration increased in chronic liver diseases, while plasma 6-keto-PGF1a concentration decreased. The balance between TXA2 and PGI2 is upset; this may be an important mechanism for activation of platelets in vivo.


[Evaluation of serum SC6 antigen using immunoradiometric assay for diagnosis of pancreatic cancer]. A solid-phase immunoradiometric sandwich assay for SC6 antigen was defined by a monoclonal antibody (SC6). The concentration of SC6 antigen in samples was determined by reference to a standard curve. The average intra- and interassay CV were 5.4% and 8.7% respectively. This antibody was found at low concentration in serum from 33 healthy individuals and the cutoff of normal upper limit of SC6 antigen was 41 U/ml. The level of serum SC6 antigen was assayed in 41 patients with pancreatic cancer, 95 with non-pancreatic carcinomas, and 48 with nonmalignant diseases. Frequency of elevated SC6 antigen level was highest in patients with gastrointestinal cancer, especially pancreatic cancer. The sensitivity and specificity were 70.7% and 84.3% for pancreatic cancer. The level in most cases of benign diseases was within upper normal limit. The results show that detection of SC6 antigen is valuable in the diagnosis of pancreatic cancer. It may be of help for detecting pancreatic cancer in its early stage.


[Sclerotherapy of gastric varices].

[Sclerotherapy of gastric varices]. 160 patients, 128 males, 32 females, with portal hypertension were admitted into our department for sclerotherapy from May 1987 to August 1990. Gastric fundus could be observed clearly in 145 of these patients who were examined with endoscope. Gastric varices were found in 105 of the 145 patients. Sclerotherapy of gastric varices were carried out in 47 of the 105 patients by intravenous injection with the method of lesser injection points and larger dosage. The results showed that a satisfactory effect was obtained with a rate of immediate stoppage of bleeding by 95.7%; and a rate of disappearance of gastric varices by 95.3%. The rate of recurrent bleeding was 7.9%. In addition, the occurrence rate, the severity, the manifestations under endoscopy and the classification of gastric varices as well as the indication, and complications of sclerotherapy of gastric varices were discussed in detail.


[Studies on second-degree atrioventricular block during atrial fibrillation]. The degree of AV block after cardioversion in 80 episodes of atrial fibrillation in 61 patients who suffered from atrial fibrillation associated with second-degree AV block was observed. Only in 34 of the 80 episodes the electrocardiogram showed first-degree AV block. The remaining 46 had normal AV conduction. No second-degree block was found. It demonstrates that second-degree AV block during atrial fibrillation is not identical with that in sinus rhythm.


[Treatment of various types of acute leukemia in adult. An analysis of 98 cases. The Leukemia Cooperation Group of Beijing City]. 47 cases of acute non-lymphocytic leukemia (ANLL) were treated with daunorubicin, cytosine arabinoside. Complete remission (CR) rate was 61.7%. 6 cases of ANLL M3 type were treated with trans-retinoic acid and all had CR. 45 cases of acute lymphocytic leukemia (ALL) were treated with vincristine, daunorubicin, cyclophosphamide, prednisone with a CR rate of 88.9%. The preliminary result of consolidation or intensive therapy after CR was reported. The toxic and side effects of all kinds of treatment program were described.


[The expression of C-myc oncogene in leukemia and its relationship to clinical symptoms]. The expression of C-myc proto-oncogene were studied at the levels of protein in bone marrow cells obtained from patients with AML and CML. It was found that the expression of C-myc in florid AML and during blast phase of CML were much higher than that in remission of AML and in chronic phase of CML. In 7 cases of AML diagnosed for the first time, 2 cases with high C-myc expression had no remission after 3-6 months, while 5 with rare C-myc expression had remission after 3-6 months. This results suggest that the expression of C-myc proto-oncogene are possibly sensitive indicator of the prognosis of leukemia.


[A regimen of DATV in the treatment of acute nonlymphocytic leukemia with high complete remission rate]. Thirty-eight adults including 24 males and 14 females with acute nonlymphocytic leukemia were treated with DATV (Daunorubicin, Cytarabine, 6-thioguaninum, Vincristine) regimen from December 1987 to May 1991. The median age was 31 years old (range 13-54). The DATV regimen consisted of DNR 60 mg/day IV for 3 days; Ara-C 100 mg by continuous infusion every 12 hours for 7 days; 6-TG 150 mg PO for 7 days and VCR 2mg IV on day 1. Complete remission (CR) was achieved in thirty-three of 38 patients after 1-2 courses (mean 1.3) with CR rates 86.8%. Five patients had no response to the regimen. Twenty-four of 33 patients who achieved CR are still in CR for 1-41 months with a median follow-up of 10 months.


[A clinicopathological study of leukemic kidney]. A clinicopathological study of leukemic kidney was carried out by observing the changes of the kidney in 104 autopsied cases of leukemia. The main changes of the leukemic kidney were increase of renal weight, calcinosis of renal tubules, interstitial leukemic cell infiltration, intravascular stasis and renal bleeding. Calcinosis intravascular stasis, renal bleeding as well as hyperuricemia may lead to abnormal urinary findings. The presence and severity of interstitial infiltration have no obvious relation with the level of blood urea nitrogen, creatinine and muric acid as well as the abnormal change of the urine. However, the presence of intravascular stasis by leukemic cells are correlated with the disturbance of renal function.


[Magnetic resonance imaging in diagnosing hypertrophic cardiomyopathy: an analysis of 10 cases]. Ten patients with hypertrophic cardiomyopathy (HCM) were examined with ECG-gated magnetic resonance imaging (MRI), one of whom was a child. MRI shows deformities of left ventricular cavity in all 10 patients, shapes of majority being long and narrow. Interventricular septums (IVS) were identically thickened in 5 patients, middle areas of IVS were thickened in 3 patients, local area of IVS was thickened in ball-shape in 1 patient, the apex was thickened in 1 patient. The ratio of thickened of IVS between in systole and diastole was less 1.08 in 5 patients and equal to 1.0 in 4 patients. The ratio of thickness of thickened left ventricular posterior wall between in systole and diastole was less than 1.25 in 7 patients. Ratios were respectively 1.25 and 1.53 in a child, obviously higher than those of adults. Left ventricular outflow tract was narrow in 1 patient. Left atria were enlarged in 7 patients. left ventricular diastolic function was damaged in 8 patients and systolic function was damaged in 1 patient. Signal intensity in IVS was not identical in 6 patients, of whom 3 patients suggests degenerate degree of myocardium in comparison with histology of myocardium. Proximal ends of coronary arteries were clear in 4 patients and didn't show narrow. All 10 patients were examined with UCG, 9 patients with ECT, 3 patients with ventricular angiography. All results coincide with features of HCM.


[The interaction of some active and immunological factors in blood in the development of chronic cor pulmonale]. Fourteen experimental indices were determined in 26 patients of chronic cor pulmonale due to COPD and in 32 healthy nonsmokers. It was found that elastase, TXB2, ATII, 5-HT, IgE, CTC and Ach were significantly higher whereas 6-keto -PGF1 alpha, C4 and cAMP lower in the blood from the patients. The roles played by these factors in the development of chronic cor pulmonale were discussed.


[Thin membrane nephropathy (TMN). Analysis of 8 cases]. This present study first reported 8 cases of Thin membrane nephropathy (TMN) in China. Most patients had persistent microscopic hematuria, who could be accompanied with mild proteinuria or macroscopic hematuria. The contrast microscopy showed glomerular hematuria in the majority of the cases. Some patients (25%, 2 cases) had familial hematuric histories, suggesting this disease may be associated with heredity. All the patients had normal renal function at following-up period (average 2.9 years), this result showed this disease was benign glomerular disease. LM showed pathological change is mild, IF was negative, diffuse thin GBM was outstanding change by EM. The thickness of TMN was 265 +/- 39 nm, the thickness of IgA GN and normal control were separately 383 +/- 32 nm and 398 +/- 34 nm, the thickness of TMN was significantly thinner than IgA GN and normal control (P less than 0.01). This study showed ultrastructural observation of glomeruli by EM was necessary to diagnose this disease.


Tyrosine phosphatases and their possible interplay with tyrosine kinases. Protein tyrosine phosphatases represent a new family of intracellular and receptor-linked enzymes. They are totally specific toward tyrosyl residues in proteins, and, with specific activities 10-1000-fold greater than those of the protein tyrosine kinases, they can be expected to tightly control the level of phosphotyrosine within the cell. Most transmembrane forms contain two conserved intracellular catalytic domains, as displayed by the leukocyte common antigen CD45, but highly variable external segments. Some are related to the neuronal cell adhesion molecules (NCAMs) or fasciclin II and others contain fibronectin III repeats; this suggests that these enzymes might be involved in cell-cell interaction. The intercellular enzymes appear to contain a highly conserved catalytic core linked to a regulatory segment. Deletion of the regulatory domain alters both substrate specificity and cellular localization. Likewise, overexpression of the full-length and truncated enzymes affects cell cycle progression and actin filament stability, respectively. The interplay between tyrosine kinases and phosphatases is considered. A hypothesis is presented suggesting that in some systems phosphatases might act synergistically with the kinases and elicit a physiological response, irrespective of the state of phosphorylation of the target protein.


Calmodulin and protein kinase C cross-talk: the MARCKS protein is an actin filament and plasma membrane cross-linking protein regulated by protein kinase C phosphorylation and by calmodulin. The myristoylated, alanine-rich C kinase (PKC) substrate (MARCKS) is a major, specific substrate of PKC that is phosphorylated during macrophage and neutrophil activation, growth factor-dependent mitogenesis and neurosecretion. MARCKS is also a calmodulin-binding protein and binding of calmodulin inhibits phosphorylation of the protein by PKC. Several recent observations from our laboratories suggest a role for MARCKS in cellular morphology and motility. First, in macrophages MARCKS is located at points of cellular adherence where actin filaments insert at the plasma membrane and is released to the cytoplasm upon activation of PKC. Second, during neutrophil chemotaxis MARCKS undergoes a cycle of release from, and reassociation with, the plasma membrane. Third, in vitro, MARCKS is an F-actin cross-linking protein whose activity is inhibited by PKC-mediated phosphorylation and by binding to calmodulin. MARCKS therefore appears to be a regulated cross-bridge between actin and the plasma membrane. Regulation of the plasma membrane-binding and actin-binding properties of MARCKS represents a convergence of the PKC and calmodulin signal transduction pathways in the control of actin cytoskeleton-plasma membrane interactions.


T lymphocyte activation signals.

T lymphocyte activation signals. Activation of T lymphocytes results in immediate biochemical changes including increases in intracellular calcium levels, activation of protein kinase C (PKC) and changes in tyrosine phosphorylation. In T cells recent studies have indicated that activation of the guanine nucleotide-binding proteins p21ras is mediated by PKC, which suggests that the p21ras proteins may regulate intracellular signalling events downstream of PKC. The p21ras proteins can be activated in T cells by signals generated by triggering of the T cell antigen receptor (TCR), the CD2 antigen and the interleukin 2 receptor. Experiments using a PKC pseudosubstrate inhibitor indicate that PKC does not mediate TCR-induced activation of p21ras. These results imply that an alternative signal transduction pathway not involving PKC can regulate the activity of p21ras proteins in T cells.


Growth factor phosphorylation of PLC-gamma 1. The hydrolysis of phosphatidylinositol 4,5-bisphosphate has a central role in many signalling pathways. One of the phospholipase C (PLC) isozymes that mediates this reaction is a direct substrate for the tyrosine kinase activity of several growth factor receptors. Growth factors elicit increases in both the phosphoserine and the phosphotyrosine content of the PLC-gamma 1 isozyme. PLC-gamma 1 contains three tyrosine phosphorylation sites, which have been identified as residues 771, 783 and 1254. Phosphorylation of tyrosine residues is sufficient to increase the catalytic activity of PLC-gamma 1, though other proteins may modulate this activation. However, the role of growth factor-enhanced phosphorylation of serine residues on PLC-gamma 1 remains obscure. In vitro studies of PLC-gamma 1, recovered from growth factor-treated cells, indicate that activation by tyrosine phosphorylation is not due to increased sensitivity to Ca2+, a required co-factor, but is reflected in altered kinetic constants, i.e. V(max) and, to a lesser extent, Km.


Protein tyrosine kinases belonging to the src family. There are nine non-receptor-type protein tyrosine kinases that show a high level of similarity in their primary structures and in the structures of their functional domains. Together, they are called the src family. They seem to have common sites specific for oncogenic activation. Recent findings suggest that the kinases are closely associated with cell surface molecules and that they mediate extracellular signals through the activation of their tyrosine kinase activity. They appear to act more on the differentiated phenotype than in haemopoietic cell proliferation. Possible functions of the products of the lck, fyn, lyn and fgr genes in lymphocytes and monocytes are discussed.


The acetylcholine receptor: a model of an allosteric membrane protein mediating intercellular communication. Over the past 20 years the nicotinic acetylcholine receptor has become the prototype of a superfamily of ligand-gated ion channels. As a single macromolecular entity of M(r) about 300,000, the receptor protein mediates, altogether, the activation and the desensitization of the associated ion channel and the regulation of these processes by extracellular and intracellular signals. The notion is discussed that the acetylcholine receptor is a membrane-bound allosteric protein which possesses several categories of specific sites for neurotransmitters and for regulatory ligands, and undergoes conformational transitions which link these diverse sites together. At this elementary molecular level, interactions between signalling pathways may be mediated by membrane-bound allosteric receptors and/or by other categories of cytoplasmic allosteric proteins.


The signal-induced phospholipid degradation cascade and protein kinase C activation. Acting in synergy with diacylglycerol, unsaturated free fatty acids such as arachidonic, oleic, linoleic, linolenic and docosahexaenoic acids dramatically activate some members of the protein kinase C family at the basal level of Ca2+ concentration. It is plausible that phospholipase C and phospholipase A2, and possibly phospholipase D as well, are involved in the activation of protein kinase C. Presumably, this enzyme activation is integrated into the signal-induced membrane phospholipid degradation cascade, prolonging the activation of protein kinase C. The sustained activity of this enzyme appears to be of importance for long-term cellular responses such as development of neuronal plasticity and gene activation.


[Magnetic stimulation motor evoked potential in multiple sclerosis. Comparison with visual evoked potentials, brain stem auditory evoked potentials and somatosensory evoked potentials]. This study consists of 45 patients with clinically definite MS, laboratory supported definite MS and clinically probable MS. We compared MEP results with other multimodal evoked potentials (VEP, BAEP and SEP). The abnormal rate of MEP was 87.6%, which was the highest. Abnormal MEP showed prolonged central motor conduction time (CMCT), consistent with pathological change of the demyelination. There was a evident correlation between the abnormal MEP and VEP, which is consistent with the most common MS (Devic Syndrome) in our country.


[Diagnostic value of suspect epilepsy by means of 24 hour of ambulatory electroencephalogram]. 106 cases of suspect epilepsy random observed by means of 24 hr tape recording of AEEG were given in this paper. Among them 57 cases. (accounting for 53.77%) are lightly abnormal including 42 cases (accounting for 39.62%) recorded as epilepsy burst. Comparing with EEG: Among 93 cases 25 cases as lightly abnormal by EEG (accounting for 26.88%), 52 cases recorded as lightly abnormal by AEEG (accounting for 55.91%) (P less than 0.005); arising rate of epilepsy burst 11 cases were recorded by EEG (accounting for 11.82%), 41 cases by AEEG (accounting for 44.01%) (P less than 0.005). The record of epilepsy burst patients monitored showed that positive rates of transient consciousness loss (8/15, 53.33%) and convulsions (9/19, 47.39%) are the highest. Abnormal burst time by AEEG is during sleeping (54 cases observed accounting for 77.14%) with positive rate highest at the same time, most accorded in the front temporal area (29/92, 31.52%). The author therefore, suppose that AEEG is more accurate to find abnormal bast wave or epilepsy burst wave than EEG because of superior condition in recording time to EEG and could offer more objective diagnosis reference for suspect epilepsy patients who are difficult to be checked clinically because of low positive rate of EEG.


[Benign focal epilepsy of childhood (BFEC)]. Thirty cases of benign focal epilepsy of childhood were reported. The seizures were partial or generalized motor ones in all cases. One patient had episodes of visual hallucination with motor seizures. No objective examination has demonstrated cerebral lesions in all cases. The most characteristic in the present study was that the attacks were in relation to the sleep in 90% of cases, 56.7% of all patients had nocturnal seizure only. The characteristic EEG patterns were the spike or sharp discharges in Rolandic area in 29 cases, and occipital sharps or sharp wave complexes in one patient on normal background activities. The discharge rate of Rolandic spikes or sharps were significantly higher during sleep than during the awake stage, and 12 cases had Rolandic discharges only during sleep. Sleep EEG recordings is suggested when children were suspected of having such kind of seizure type but having a normal EEG pattern when awake. Brief induced sleep is usually adequate.


[A study of alexia in Chinese language]. Twenty-five cases of alexia were examined with Chinese Alexia Test which was devised according to the features of Chinese ideogram. The result of our study showed that alexia in Chinese ideographic language differs from alexia in western phonographic languages. It has its own characteristics and is manifested as following patterns: difficulty in reading aloud, dissociation of appearance and meaning of character, alexia of combinative character, alexia of associative compounds, alexia of abstract word, visual paralexia, surface alexia, deep alexis, phenomenon of word completion (formation of words by addition of another character), substitution with neologisms, perseveration in alexia, character and word alexia, syntactic alexia, and total alexia. Twenty-five cases of alexia were classified according to Benson's classification of alexia as anterior, central, subcortical aphasic and total alexis. One case with proterior alexia was briefly reviewed. The main differential points of various alexia in Chinese language were suggested.


[Acute herpes simplex encephalitis treated with acyclovir. Report of 5 cases]. 5 cases of acute herpes simplex encephalitis were verified by specific IgG antibodies in cerebrospinal fluid and serum among 31 cases with 'sporadic encephalitis' within one year. All were treated with acyclovir, 4 with remarkable response--2 cured and 2 significantly recovered, except one died due to delayed specific treatment. The dosage of acyclovir used by the author was 5mg/kg/12-24 hours.


[HLA and acetylcholine receptor antibody in patients with myasthenia gravis]. Human leucocyte antigen (HLA) and acetylcholine receptor antibody (AchRab) titer in the serum assayed were in 106 and 100 patients with myasthenia gravis (MG), respectively. 93 of the total patients had both HLA and AchRab assays. There is a strong association between HLA Bw46, Cx46 antigens and the patients with MG. The AchRab level in the patients with positive Bw46, Cx46 antigen is significantly lower than that of the patients with negative Bw46 Cx46 antigen. The geometric means (G) of AchRab were 2.99 and 4.74, respectively, P less than 0.05. From our study, We think the patients with MG could be divided into two groups, according to the clinical presentation, the AchRab level and the association with HLA Bw46, Cx46 antigens. The first group is that who present ocular muscular myasthenia, childhood or adolescence onset, lower level of AchRab titer and strong association with HLA Bw46 and Cx46. The second one is that who have general muscular myasthenia, adult onset, higher level of AchRab titer and no association with Bw46 and Cx46.


[A preliminary study of cerebrospinal fluid cytology in aged patients with dementia]. 31 cases of dementia of the aged were studied with the method of CSF cytology. Of the 31 cases, 14 were of Alzheimer dementia (AD), 17 multi-infarct dementia (MID), and 25 aged subjects were studied as control. The results showed that the number of lymphocytes in the CSF in AD group was obviously higher than that in MID group. The number of monocyte--macrophages was decreased in both two studied groups in comparing with that of the control group. We didn't find macrophages in AD group. The number of neutrophils in the CSF was high in both observed groups, and more markedly in AD group. The significance and specialty of the results need further study.


[Study of 315 pedigrees with idiopathic mental retardation by segregation analysis]. 315 pedigrees with idiopathic mental retardation (MR) have been studied by complex segregation analysis. The results show that there is no major gene effect in the mild MR, but in the medium and severe MR there are major gene effect. The pattern of inheritance of the medium MR may be codominant and the penetrance of the dominant gene is 0.91. The mode of inheritance of the severe MR may be recessive and probably without sporadic cases.


[Neuropsychological and behavioral status of children with congenital heart diseases]. 39 children patients with acyanoid ventricular septal defect or atrial septal defect who received cardiac operation, were compared with a age and sex matched normal control group on a battery of neuro-psychological tests, intelligence tests and children behavioral checklist. Subject were examined prior to cardiac operation and 6 months after the operation. 12 of 39 children received postoperation tests. Among them, 8 were in younger children group (5 to 8 years old), 4 were in elder children group (9 to 14 years old). Results are: 1. Neuropsychological development status: (1) Full IQ(FIQ), Verbal IQ(VIQ), and Performance IQ(PIQ) of the group with heart diseases were lower than those of normal controls, and there were significant differences. (2) In cardiac patients significant impairments were found on some scores of the Halstead-Reitan Battery in comparison with the normal control group. These findings imply that patients before cardiac operation had generalized impairments in neuropsychological function. (3) Significantly more behavioral problems especially the so called externalizing and internalizing behavioral problems, were found in cardiac patients than the controls. 2. Comparison of the pre and post operative scores were made: Both groups (cardiac patients and controls) showed significant improvements in VIQ, PIQ, FIQ and most of H-R subtests scores 6 months later. But the improvements following surgery were attributed to practice effects.


[A comparative study of the serum levels of thyrotropin in depressed patients and normal subjects]. Serum TSH levels were measured by radioimmunoassay in 85 affective disorders and 41 healthy control persons. The results showed that the serum TSH levels of the patient group were significantly lower than the normal control's. TSH levels among different clinical episodes, however, have no significant difference. Furthermore, There were not a marked difference of TSH levels in age, sex and used antipsychotics, antidepressants, lithium or not. The results suggested that further investigations were needed to understand thyroid function state.


[Level of psychosomatic health influencing by the factors of life events and personality trait in 1,423 armymen]. A survey of the level of psychosomatic health influencing by life events and personality trait in 1423 armymen was presented in this paper. The results demonstrated that the level of psychosomatic health was relatively poor in old soldier group, especially more distinct seen in over than 3-year military service group. The psychosomatic health state of private soldier group was relative better. The main factors influencing over the psychosomatic health state were the frequency of the negative life events, negative life change units (LCU) within one year prior to survey, personality trait and length of military service. The subordinate factors were the frequency of the positive life events and LCU within one year prior to survey, age and family of mental disorders.


[Epidemiological study of children's mental health in Fuzhou]. This epidemiological survey of mental health's conditions among 1,428 children below the age of 14 in an urban and rural area with a population of 398,674 was carried out with the standardized methods and diagnostic criteria, the result shows that the total incidence of abnormal mental health's conditions is 70.03/1000. Through a statistical deal, the result shows that the weights of these infants are slight, that they can only recognize their parents slowly, that their parents are in low educated levels. That the emotion between their parents is always not so harmonious, and that their parents always treat their children with different attitudes. In short, all these factors are in close connection with the incidence of abnormal mental health of these children.


[Studies on the scope of labour contraindication for female workers]. According to the physiological characteristics of women and the specific effects of occupational hazards on the female, the medical basis of the scope of labour contraindications for female workers was discussed. The condition of female workers engaged in harmful works was investigated at 263 factories in 11 cities. In addition, an evaluation of the adverse effects on women's reproductive function of 28 harmful occupational factors was carried out. On this basis the range of labour contraindication for female workers was proposed.


[Measurement of superoxide dismutase activity in the blood of radiation workers]. In this study, we measured the superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase GPX) activities in the peripheral blood of radiation workers (111 cases) and the controls (108 cases), also analyzed chromosome aberrations in blood lymphocytes by means of G-banding technique. The chromosome deletions were not found in the controls. There were 7 cases chromosome deletions found by G-banding in 111 cases of radiation workers, their SOD activities were markedly lower than those in the controls (P less than 0.05). SOD and CAT activities in the other 104 cases of radiation workers were significantly higher than those in the controls (P less than 0.01). But there was no difference of GPX activity between the radiation workers and the controls. However, increase of SOD activity mainly occurred in radiation workers who were exposed to radiation over 0.0177 +/- 0.0032 Gy. The possible mechanism of this phenomenon was discussed.


[Sampling of expiratory benzene and gas chromatography]. The method of sampling alveolar air and gas chromatography of trace benzene is reported. The lowest detectable concentration of benzene is 7.9 x 10(-4) mg/m3 in 100 ml volume. Method parameters are r = 0.999.9, mean recovery 95.14% and mean relative deviation (CV) 4.94%. 42 non-occupational and 48 occupational workers who exposed to benzene were studied by this method. The concentrations of exhaled benzene are respectively 0.016 +/- 0.011, 0.138 +/- 0.093 (before workshift) and 10.17 +/- 4.11 mg/m3 (after the end of the workshift). The results showed that this method is a simplified method for sampling alveolar air and analysis. Besides for expiratory benzene, this method can be also applied to monitoring of atmospheric trace benzene.


[Experimental study on dose effect relationships between ultraviolet rays and its early impairment]. An experimental study on dose time effect relationships was carried out on mice by using epidermic cell DNA damage, skin immune suppression and histological change as indicators. The results showed that when animal exposed to a daily dose of 0.12 MED of Ultraviolet rays for 12 weeks, no obvious change was found. It suggested that this dose level would be safe. But at 0.5 MED dose level, increase in UDS repair, decrease in number of skin Langerhans cells and the presence of skin-aging occurred, showing that 0.5 MED dosage had a slow damaging effect. With regard to the effect of time, the longer the exposure the stronger the effects, but the early impairment was mainly related to the daily dose, rather than to the total dose.


[The multivariate canonical discriminant analysis between physical growth and nutrition status of children and youth]. This paper is on studying the relationship between physical growth and nutrition status of children and youth by using multivariate canonical discriminant analysis. 3,790 boys and girls of 7-19 yrs of age were classified into four groups according to the height-for-weight method. Then, by using seven physical measures as predict variables, canonical discriminant functions were set up for boys and girls respectively. The backward substitutional test showed that the coincidence ate was quite high, 90.90% for boys and 92.47% for girls respectively. The susceptibility of various physical measures in reflecting children's nutrition status was analysed, and the practical use of these discriminant functions was discussed.


[A study on the relationships among plasma testosterone, sex development and serum zinc in normal boys aged 10-15]. The plasma testosterone and serum zinc of 123 normal boys, aged 10-15 were measured and compared with their sex development in stages. The results showed: concentrations of plasma testosterone, serum zinc and other indicators of sex development increased along with age and stage of sex development. There was positive correlation between levels of plasma testosterone and serum zinc and the development of testicles and penis.


[Chinese strategies for hepatitis B virus markers screening in hepatitis B vaccination based on cost-effectiveness analysis]. By means of decision tree model and cost-effectiveness analysis 15 kinds of programmes which may be used for hepatitis B virus markers screening in vaccination were evaluated. The results showed that the most cost-effective alternative was to identify the negatives for anti-HBc again after testing for anti-HBs and vaccinating all test negatives. That is to say it must not be adopted for persons to be tested for HBsAg, anti-HBs and anti-HBc before being vaccinated. Sensitivity and threshold analysis were also done to determine the effects of changes in the costs of vaccine and screening tests.


[The effect of methylmercury on testicular function of mice]. The results showed that the amount of methylmercury (MeHg) in testis correlated positively with exposure doses (r = 0.99 P less than 0.01). MeHg affected the process of spermatogenesis, causing decrease of sperm count and increase of sperm abnormalities. Pathological and electron microscopic examinations indicated that spermatogenic cells were damaged by MeHg especially spermatogonium and spermatocyte. Changes of microstructure were mainly degeneration, fragmentation vacuolation and large lipid drop formation of spermatogenic cells. The acrosome of many spermatids showed obvious changes. Destruction of blood-testis barrier was observed in 1/10 LD50 group. Quantitative histological examination also confirmed that MeHg resulted in lessening of its area of seminiferous tubules and reduction of germ cells. The contents of testosterone were not decreased in the treated groups other than the 1/10 LD50 group.


[The aflatoxins and liver cancer in Guangxi, China]. The AFB1 intake and the AFM1 excretion of 81 households in 10 villages, Guanxi were investigated using the ELISA method. The results showed that there was positive correlation between PLC mortality and AFB1 intake from corn and peanut oil, but not from rice. The results of stepwise regression showed that main factors were AFB1 intake of males, AFM1 excretion of females and consumption of corn. The results showed that aflatoxins were correlated with mortality rates of liver cancer. Further investigation needs to be carried out in case-control and cohort studies.


[Blockage of glyrrhiza uralensis and chelidonium majus in MNNG induced cancer and mutagenesis]. Glyrrhiza Uralensis (GU) and Chelidonium Majus (CM) are two kinds of Chinese herbal medicine. GU and CM not only exert much stronger effects in blocking mutagenesis due to strains of Salmonella typhimurium (TA 97, TA 98, TA 100, TA 102), but also have different degrees of obstructing mutagenesis induced by Furapromidum (F30066), Zhengdingmycin Hydrochloride (DM), N-methyl-N1-nitro-N-nitrosoguanidine (MNNG) and Methyl-methanesulfonate (MMS). The blockage effect of GU and CM obviously depends on the doses used. GU and CM could also impede the occurrence of stomach cancer induced by MNNG, and the impeding rate is about sixty percent.


[Relationship between high sodium diet and hypertension and results of intervention in high sodium diet population]. An epidemiologic survey of the morbidity and mortality rates of hypertension and related disease was carried out in a population of 9,570 composed of salt workers and building workers. The survey rate was 96.59%. The age-standardized morbidity rate of hypertension in the salt workers was 27.88%, while that in the building workers was 8.5%. Na concentration and Na/K rate in 8 hrs' nighttime urine in salt workers were significantly higher than in building workers (P less than 0.001). Results of intervention of salt intake at the level of 10 g/person/day in 285 cases of hypertensives for 3 months showed that mean levels of systolic pressure and diastolic pressure decreased by about 3.1 kPa (P less than 0.001) and 1.9 kPa (P less than 0.01) respectively; the mean body weight decreased by about 2.2 kg; Na concentration in 8 hrs' nighttime urine and its Na/K radio significantly decreased (P less than 0.001), while K Concentration increased. The situation of high level of Na and low level of K in human body was obvious on long-term high sodium diet population. Intervention of salt intake had considerable effect of depression of both blood pressure and morbidity rate of hypertension in a population.


[Preliminary study of aluminum content of foods and aluminum intake of residents in Tianjin]. Aluminum content of 64 kinds of foods in Tianjin was determined. The results showed that the aluminum levels in different kinds of food varied greatly, and most foodstuffs from natural sources (including contamination from food processing) contained less than 10 mg/kg. Aluminum content was higher in foodstuffs of plant origin, especially dry beans contained larger amounts of aluminum naturally. It was estimated that most Tianjin inhabitants would consume 3-10 mg aluminum daily from natural sources, there being no significant difference between urban and rural inhabitants.


[Stereotactic intracavitary irradiation of huge cystic craniopharyngiomas]. From Jan. 1988 to June 1990, 32 patients with huge cystic craniopharyngiomas were treated by CT-guided stereotactic injection of phosphorus-32. Among them, 14 were male and 18 female. Their ranged 3 to 56 years (average 20 years). The history of illness varied from 1 to 8 years (average 2.8 years). All patients were confirmed pathologically, eleven of them had recurrent tumor after craniotomy. The volume of cystic tumor varied from 14 to 126ml (average 32ml). 1.2-5.6mCi (average 2.3mCi) of 32P were injected in each time. 65 injections were successfully performed. There were neither deaths nor serious complications. Follow-up time ranged from 12 to 24 months. The clinical symptoms of these patients were improved in 27 patients and volumes of the tumors were reduced on CT scans. The effective rate was 84.4%. We conclude that this technique is simple, efficient and safe for the treatment of huge cystic craniopharyngiomas.


[Primary observation of prolonged survival of cultured epidermal allografts]. It is still controversial that cultured epidermal allografts can survive long. In this study, seventy-nine pieces of cultured epidermal sheets were grafted on the wounds after taking for autografts. The wounds grafted with allogeneic cultured epidermis healed with mean time of 7.2 +/- 1.4 days, while the wounds uncovered with cultured epidermis healed with the mean time of 12.8 +/- 2.5 days (P less than 0.005). No evident signs of allogeneic rejection were found either by clinical or histological observation from 20 days to one year's follow-up. In order to prove the existence of cultured epidermal allografts on grafted area, two methods were established: 1) indirect enzyme conjugated SPA assay to detect A or B blood group antigens with McAb; 2) polymerase chain reaction (PCR) to amplify Y chromosome specific DNA sequence after the female were grafted with cultured male epidermis. In four patients grafted with ABO blood group mismatched cultured epidermis, the donor antigens were found in the grafted area as long as 35 post graft day (PGD). The recipient antigens appeared on 19 PGD. Y chromosome specific DNA was detected in five samples taken from two female patients grafted with cultured male epidermis. Of these five samples, the biopsy time was on 11, 19, 30, 35, 92 PGD respectively. Combining the clinical and histological observation with the results of two methods, it can be concluded that the survival time of cultured epidermal allografts were definitely prolonged.


[Percalcar Steinmann's pins fixation of intratrochaner fixation fracture. Clinical observation]. 80 cases of intratrochaner fractures were treated by fixation of 4 Steinmann's pins which were 3.5 mm in diameter and inserted percutaneously through the calcar and compression trabeculae and distension trabeculae respectively. They were compared with the cases treated by skeletal traction or fixed by Nail-plate or angle plate. The rate of bony union in fixed position in the percalcar Steinmann's pins group was 83.7%. Normal neck-shaft angle accounted to 53.1% in the traction group. Varus deformity occurred in 16.3% cases of the Steinmann's pins group, and 35.9% cases of the traction group. The deformity was most frequently seen in cases of type IIIa and IV. No fixation failure occurred in the Steinmann's pins group. The Steinmann's pins passing through the outer cortex, calcar and compression trabeculae produced strong fixation and it's direction was in parallel to the weight-bearing line of the hip, with less shearing force and much compression force distributed on the fracture line. The operation was done under local anesthesia. No blood transfusion and early mobilization were the advantages of this method.


[Arterioembolization with shape memory angioembolus. Experimental study and clinical application]. The results of experimental study and clinical application of arterio-embolization induced by the conical spiral or rugby spiral type of shape memory angioembolus(Nitinol-Conical Rugby Embolus, NT-CRE) were reported. The NT-CRE has a spring coil as its base line and is formed like a conical spiral or rugby spiral which has a two-way memory effect. Through a period of 1-48 weeks observation on 74 angiographic and histological specimens of 39 target arteries from 20 experimental dogs showed that the NT-CRE has good histocompatibility and is effective for embolization in large-bored arteries. Clinical application on target arteries of 7 patients showed successful occlusion of blood flow in 5-18 minutes in arteries with internal diameters of 3.33-5.83 mm. The NT-CRE being of the two-way memory effect and its configuration of relatively close state render its catheterization and release into target vessel simple, save, rapid and effective. In the researches we have not found any complication of hemorrhage from ruptured blood vessels and misembolization from regurgitation.


[E coli-induced idiopathic portal hypertension in rabbits. An experimental study]. An experimental model of portal hypertension was induced in healthy rabbits by intraportal injection of E coli or a mixture of E coli and rabbit anti-E coli sera. In all established models, there were significant elevation of portal vein pressure, increase of spleen weight, decrease of whole blood cells count, infiltration of inflammatory cells and fibrosis in intrahepatic portal area, decrease of the number and discontinuation of intrahepatic portal vein branch on portography with gross normal appearance of the liver. Hence this model was similar to that seen in human idiopathic portal hypertension (IPH) in many aspects. We believe that bacterial toxin and the abnormal immune reaction due to repeated stimulation of bacterial antigen may play a role in the pathogenesis of human IPH.


[Endoscopic sphincterotomy in the treatment of choledochol calculus]. Fifty patients with choledochal calculus were treated by endoscopic sphincterotomy (EST) and forty-nine of them were cured. Stones were excreted in forty-six patients spontaneously and in two patients by basket. Stones disappeared in one patient after extracorporeal shock wave therapy. The complications included gastrointestinal hemorrhage (2%), pancreatitis (2%) and cholangitis (4.1%). Twelve of them were followed by barium meal after EST. The barium was found in biliary tract in one patient and pneumatosis in another one without any clinical symptoms. The authors suggest that EST could be an important nonoperative therapy in the treatment of choledochal calculus.


[Intraoperative transgallbladder duct endoscopy replaces conventional common duct exploration]. Twenty patients of cholelithiasis underwent intraoperative transcystic duct fiberendoscopy in whom choledochotomy was otherwise indicated. Among them choledocholithotomy was done endoscopically in three patients and auxiliary choledocho-cystic junction incision was obligatory for easy insertion of the fiberscope in six. No T-tube was needed after the procedure and the postoperative recovery was uneventful in all cases.


[Correlativity of plasma endotoxin, plasma fibronectin and common bile duct pressure in severe acute cholangitis]. On the basis of common bile duct pressure measurement (CBDP) in 18 patients of severe acute cholangitis, plasma endotoxin (ET) was determined by modified synthetic chromogenic limulus amebocyte lysate assay and plasma fibronectin (FN) was detected with Laurell's rocket immunoelectrophoresis. CBDP was 2.23 +/- 0.49 KPa in patient group. There was striking positive correlation between ET and CBDP. Preoperative ET was 202.73 +/- 88.57 ng/L in patient group which was much higher than 15.47 +/- 7.38 ng/L in the control (P less than 0.001). Preoperative FN was 141.77 +/- 82.37 mg/L in the patient group which was lower than 317.21 +/- 12.57 mg/L in the control (p less than 0.001). Statistical differences could be noticed in postoperative ET and FN between the survivor and the dead. The study suggested that plasma ET levels are greatly influenced by pressure gradient of bile duct, dynamic observations of ET and FN levels are helpful to monitor disease course and predict prognosis.


[Biliogenic liver abscess caused by acute obstructive suppurative cholangitis]. Biliogenic liver abscess was found by autopsy in 52 of 61 (85.2%) cases died of acute obstructive suppurative cholangitis (AOSC) at our hospital from 1957 to 1980. Of the 52 cases with liver abscess, 44 (84.6%) had multiple abscesses and 47 (90.4%) suffered complications of the rupture of liver abscess. Liver abscess was clinically diagnosed in only 7 of 52 cases who underwent emergency operation, with the predeath definite diagnosis of 13.5% (7/52). The authors considered biliogenic liver abscess an inevitable outcome not an accidental complication of AOSC when the high pressure in bile duct could not be relieved, and emphasized the importance of prevention, early diagnosis and treatment of liver abscess in order to decrease the mortality of AOSC.


[The role of free fatty acids in the formation of cholelith]. Free fatty acids of bile were determined by gas chromatography in 57 patients with and without cholelithiasis. The results showed that 1. The percentage of free palmitic acid in total lipid was significantly higher in gallbladder stone group (0.38%) and duct stone group (0.32%) than that in control group (0.07%), P less than 0.05. 2. The percentage of free stearic acid and arachidonic acid was significantly higher in gallbladder stone group (0.08%, 0.09%) than that in control group (0.01%, 0.02%), P less than 0.05. Authors believed that the changes were related to the formation of fatty acid calcium in the stones and the oversecretion of prostaglandin in gallbladder.


[Primary gastrointestinal malignant lymphoma. An analysis of 63 cases]. Sixty-three patients with primary gastrointestinal malignant lymphoma confirmed by pathology and treated in our hospital from 1973 to 1989 were reported. There were 30 males and 33 females, four suffering hodgkin's diseases and 59 non-hodgkin's lymphoma, with 17 at stage I, 17 at stage II, 9 at stage III, and 20 at stage IV. Patients were treated by surgery, radiotherapy and chemotherapy separately or combined. Forty-seven patients underwent tumor extirpation. Five-year's postoperative survival at stage I, II, and III were 84.6%, 33.3%, and 14.2%, respectively. Surgery combined with postoperative radiotherapy and/or chemotherapy gave better results. The incidence, diagnosis, clinical staging and the therapeutic indications were discussed with a review of literature.


Experimental transmission of Cowdria ruminantium (Rickettsiales) by the American reptile tick Amblyomma dissimile Koch, 1844. A Senegalese isolate of the rickettsia Cowdria ruminantium was transmitted transstadially by nymphs of the American reptile tick Amblyomma dissimile. Only eight nymphs, fed as larvae on a Saanen goat reacting to heartwater, were required to transmit fatal heartwater to another susceptible goat. Since A. dissimile usually feeds on snakes, iguanas and lizards in central America, the tick is not considered to play a significant role in the transmission of heartwater between ruminants. However, the tick could play a role in maintaining a rickettsial reservoir in reptile populations, since it has been shown that an African reptile can be a subclinical carrier of C. ruminantium, infective to vector ticks.


Control of hemorrhage from a mucous fistula with Foley catheter tamponade. Massive hemorrhage from the colon is always a problem. When that bleeding occurs in a defunctionalized colonic mucous fistula, the surgeon can approach the bleeding site from both ends simultaneously. Two methods of controlling hemorrhage from a mucous fistula with the assistance of Foley catheter tamponade are presented.


Steroid complications in patients with ulcerative colitis. Physicians treating patients with ulcerative colitis are confronted with the difficult task of deciding whether medical or surgical treatment is best for their patients. There are no definitive criteria to indicate when medical therapy should be exchanged for definitive surgery. Even in patients who respond well to glucocorticoid treatment, the side effects of these drugs may necessitate surgery. We reviewed the steroid complications of our operative cases retrospectively. Although ulcerative colitis was usually in remission, severe steroid complications were no longer tolerable and definitive surgery was required. We also reviewed the literature regarding the adverse effects of steroid. Because of advances in sphincter-preserving surgery, re-evaluation of the treatment of ulcerative colitis is necessary. Although conservative treatment remains the first choice, tolerance of irreversible side effects (especially in children) no longer seems to be justified. In such patients, early definitive surgery may offer more than it appears to sacrifice.


Short-chain fatty acid enemas: a cost-effective alternative in the treatment of nonspecific proctosigmoiditis. The purpose of this study was to perform a randomized, prospective comparison of corticosteroid enemas (CS--100 mg of hydrocortisone/60 cc P.R. q.h.s.; n = 12), mesalamine enemas (5-ASA--4 g/60 cc P.R. q.h.s.; n = 19), and short-chain fatty acid enemas (SCFA--60 cc P.R. b.i.d.; n = 14) for the treatment of proctosigmoiditis. Patients presenting to the Ferguson Clinic with the diagnosis of idiopathic proctosigmoiditis were evaluated for age, sex, prior history of proctitis, duration of symptoms prior to presentation, endoscopic scoring, and mucosal biopsies. Clinical evaluation was performed at two-week intervals for six weeks, with repeat biopsies taken at six weeks. There was no significant difference with respect to age, male/female ratio, past history of proctosigmoiditis, length of colorectum involved at the time of initial presentation, symptom resolution, and endoscopic and histologic improvement among the three treatment groups. Recovery occurred in a similar proportion in each of the three groups: CS, 10/12; 5-ASA, 17/19; and SCFA, 12/14. The cost of six weeks of treatment was: CS, $71.82; 5-ASA, $347.28; and SCFA, $31.50. This study indicates that SCFA enemas are equally efficacious to CS or 5-ASA enemas for the treatment of proctosigmoiditis at a significant cost savings.


Clinical classification of perianal Crohn's disease. Assessment of the efficacy of therapeutic approaches to anal lesions of Crohn's disease is frustrated by the lack of precise definition of its various manifestations. A classification that is clinical and based on anatomic and pathologic aspects is presented; it has been derived from a 20-year prospective study of anal Crohn's disease in Cardiff. Conceptually, the classification is analogous to the TNM system for cancer. The main classification (U.F.S.) defines the presence of Ulceration, Fistula/abscess, and Stricture, qualified by numeric values reflecting severity (0 = not present, 1 = limited clinical impact, and 2 = severe). A subsidiary classification (A.P.D.) defines Associated conditions, Proximal intestinal involvement, and Disease activity. In addition, the classification may be used in a detailed form for research or comparative purposes or in a simple form defining only the dominant lesions for routine clinical use. General use of the classification would make it possible to compare in detail incidence, management, and results of treatment in different centers.


The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Eighty-two patients with colon and rectal polyps containing invasive adenocarcinoma treated by polypectomy alone were studied. Seven of 34 patients (21 percent) with sessile lesions had an adverse outcome, including five local recurrences and two distant metastases. They occurred from 4 to 68 months after the polypectomy. Forty-seven pedunculated polyps with invasion to the head (Level 1) or to the stalk (Level 3) and one polyp to the base of the stalk (Level 4) had no evidence of local recurrence or signs of metastasis. Twenty-eight percent of patients were found to have adenomatous polyps, and 4 percent had malignant polyps during the follow-up examinations (range, 3-119 months; mean, 53 months). The findings suggested that pedunculated polyps with invasion to the head (Level 1), neck (Level 2), or stalk (Level 3) can be safely treated with a complete polypectomy provided that the carcinoma is not undifferentiated. Sessile lesions as well as Level 4 pedunculated lesions should be treated aggressively. If resection is not performed, a long-term follow-up in these patients is essential.


Anastomotic-vaginal fistula after colorectal surgery. The most feared complication of anterior and low anterior resection is anastomotic dehiscence. Although most leakages remain clinically silent, some may lead to formation of a colovaginal fistula. At the Lahey Clinic Medical Center, the records of nine patients with colovaginal fistula as a complication of colorectal surgery were reviewed to determine clinical characteristics and optimal management. The mean age was 63.7 years (range, 47-72 years). The initial indications for surgery were carcinoma of the rectum (n = 4), diverticular disease (n = 3), and closure of the colostomy after Hartmann's procedure (n = 2). Hysterectomy had been performed earlier in seven patients (78 percent). The end-to-end anastomosis (EEA) stapling device was used in five patients, and four patients had a handsewn anastomosis. The fistula developed within 23 days after surgery and usually originated within 8 cm of the anal verge. Two patients underwent immediate diverting transverse colostomy. None of the seven patients who were initially managed medically had spontaneous closure of the fistula. High fistulas were successfully treated by colorectal resection in two patients, whereas low fistulas healed after transanal repair without colostomy in two patients. These results suggest that previous hysterectomy predisposes to development of a colovaginal fistula after colorectal surgery. Not all patients require fecal diversion. Colorectal resection for high fistulas and transanal repair for low fistulas appear to be viable options for treatment.


Anal endosonography: relationship with anal manometry and neurophysiologic tests. Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery.


Dysplasia in chronic ulcerative colitis: implications for colonoscopic surveillance. Mucosal dysplasia has been used as a marker for patients with chronic ulcerative colitis considered to be most at risk of developing cancer, and its identification is the basis for colonoscopic surveillance programs. To evaluate the reliability of this premise, colectomy specimens from two groups of patients who had undergone surgery for chronic ulcerative colitis (50 with cancer and 50 without) were retrieved. The groups were matched by age, sex, duration of disease, disease extent, and symptoms at the time of surgery. Using a standard technique of multiple random biopsies, we utilized the standard colonoscopic biopsy forceps to obtain four biopsies from mucosa that was not macroscopically suspicious for dysplasia or cancer in eight defined regions in each of the 100 colon specimens. This technique mimicked exactly the methods used in our clinical surveillance program. All 3,200 biopsies were evaluated blindly by one pathologist for presence and grade of dysplasia. Twenty-six percent of colons with an established cancer harbored no dysplasia in any biopsy from any region in the colon. While an overall association between the presence of cancer and high-grade dysplasia was detected (relative risk = 9.00; 95 percent CI of 2.73-29.67), the sensitivity and specificity of random colonic biopsies to detect concomitant carcinoma were 0.74 and 0.74, respectively. These findings prompt concern that reliance on random biopsies, obtained during colonoscopic surveillance, may be misplaced.


Colorectal trauma: primary repair or anastomosis with intracolonic bypass vs. ostomy. This prospective, randomized, controlled study was undertaken to compare primary repair or anastomosis with intracolonic bypass vs. ostomy in severe colon and intraperitoneal rectal injury. Patients were randomized at surgery following confirmation of injury. Data collected included demographics, mechanism and location of injury, trauma score (TS), injury severity score (ISS), penetrating abdominal trauma index (PATI), complications, length of hospital stay, and hospital charges. Twenty-two patients were studied: 11 with intracolonic bypass and 11 controls. The experimental and control groups were statistically similar in demographics and mechanism of injury, severity of injury (TS = 13.8 vs. 12.8; ISS = 27.5 vs. 24.2; PATI = 40.5 vs. 35.0), and complication rate. Length of stay (12.2 days vs. 20.7 days) and charges $27,885 vs. $53,599) tended to be greater in controls, and the comparison did not include subsequent colostomy closure. This study supports intracolonic bypass as a safe alternative to ostomy in severe colon and intraperitoneal rectal trauma.


Intraperitoneal hyperthermic treatment for peritoneal dissemination of colorectal cancers. Continuous hyperthermic peritoneal perfusion (CHPP) combined with administration of anticancer drugs was performed in eight colorectal cancer patients with peritoneal dissemination. An overall response rate of 50 percent was achieved in the eight patients. Two of three complete responders are long, recurrence-free survivors for 15 and 30 months. The two-year survival has been achieved in 18.8 percent of the patients receiving CHPP, and this rate is significantly higher than the rates in P2 and P3 patients who did not receive CHPP. The complications of CHPP with administration of anticancer drugs were mild bone marrow suppression in two (25 percent) of the eight patients and also a mild grade of renal dysfunction in one (12.5 percent), though not lethal. The results suggest that the combination of CHPP with the administration of anticancer drugs is a safe and effective therapy for peritoneal dissemination of colorectal cancers.


Colostomy plug devices: a possible new approach to the problem of incontinence. The authors report their experience in the use of the Conseal (Coloplast S.p.A., Bologna, Italy) Colostomy Plug, a new device for the regulation of continence in patients with colostomies. The devices were tested on 57 patients divided into two groups: Group A (36 patients) fit with a two-piece Conseal system and Group B (21 patients) fit with a one-piece Conseal system. All patients had the same colostomy type, and all were trained for self-irrigation. The objectives of this randomized, prospective study were to determine compliance with the different systems, to identify the advantages, and to verify the possible different applications among the population of irrigated patients. The following results were obtained. Regarding compliance: Group A's results were excellent in 22.2 percent and good in 52.7 percent of patients. Group B had better compliance than Group A (excellent in 66.6 percent and good in 19 percent of patients). Regarding controlled evacuation, continence time, and silent gas emission: in Group A, the device permitted controlled evacuations (23.8 percent of patients practicing daily washouts) with silent and odorless gas emission (100 percent of cases). In Group B, the results concerning improvement in continence were good (33.3 percent of patients) and excellent concerning the emission of flatus. Regarding the potential use of both systems in different groups of self-irrigated patients: the study has revealed the Conseal Uni-system as being ideal for patients with a well-constructed stoma, slight gas distention, and a better psychologic adaptability to larger-sized systems. In all other cases, the alternative two-piece system is more suitable, owing to the better safety it offers.