鄂西山区1592例成人泌尿系统疾病(USD)调查分析

本文对鄂西自治州一市二县三所医院近八年来(1980年元月～1987年12月)成人USD住院患者1592例的构成比作了回顾性调查分析.结果表明:USD患者占同期住院总人数的3.90%,其常见病种依次为尿路结石,尿路感染,慢性肾炎.急性肾炎、肾结核,慢性肾衰和肾病综合征;上尿路结石病人数有逐年上升趋势,且右侧显著高于左侧(P<0.001);慢性肾衰的病人数每隔1～2年有突然增高现象,1987年比1980年增加了四倍;急性肾炎和肾结核占有较大比例,肾结核为慢性肾衰病因的第三位.这些均为本组USD的临床流行病学特点.作者对各常见病种的特点进行了讨论.     

Debrisoquine hydroxylation and sulfamethazine acetylation in a Chinese population

Both debrisoquine hydroxylation and sulfamethazine acetylation phenotypes were studied in the same native Chinese population. Debrisoquine hydroxylation status was determined by HPLC assay of debrisoquine metabolic ratio in urine after a single oral dose of 10 mg debrisoquine. Three poor metabolizers were found in 220 subjects (1.36%). One hundred and one subjects of this population previously debrisoquine phenotyped were also tested for acetylation phenotyping on a separate occasion. Their acetylation status were determined by HPLC assay of "% acetylation" after a single oral dose of 1 g sulfamethazine. Twenty (19.8%) slow acetylators were found. There were no significant association between the 2 metabolic pathways.     

Mode of action of C-1027, a new macromolecular antitumor antibiotic with highly potent cytotoxicity,on human hepatoma BEL-7402 cells

Summary C-1027, a new macromolecular peptide antitumor antibiotic produced by aStreptomyces strain, was extremely cytotoxic to cultured cancer cells and markedly inhibited the growth of transplantable tumors in mice. As determined by tritium-labeled precursor-incorporation assay, C-1027 strongly inhibited DNA and RNA synthesis in hepatoma BEL-7402 cells without affecting protein synthesis. After incubation with the hepatoma cells for 4 h, IC₅₀ values for [³H]-thymidine and [³H]-uridine incorporation were 0.00012 and 0.00032 m, respectively. After 30 min incubation, C-1027 showed much stronger inhibition of [³H]-thymidine incorporation than did Adriamycin, mitomycin C or methotrexate, even at a concentration 10,000 times lower. The effect of C-1027 on pBR322 DNA suggested that the drug could cause single- or double-strand scission of DNA. As determined by flow cytometry, C-1027 delayed the progression of hepatoma cells through the S-phase and blocked the cells at G2+M. Cytological study showed that C-1027 caused a drastic reduction of the mitotic index within 1 h and that an overshot of the mitotic index occurred at 48 h. Our results indicate that C-1027 is an interesting compound with highly potent activity on cellular DNA.     

Relationship between age and effect of early and long-term captopril treatment in patients with acute myocardial infarction

Objective To analyse the relationship between age and treatment with captopril after acute myocardial infarction (AMI). Methods In a randomized trial, 822 patients with a first AMI received conventional medic al treatment, including intravenous thrombolytic therapy and oral aspirin or metoprolol, and then were randomly allocated to captopril ［dosage fr om the first 6.25 mg to 25 mg/t.i.d, 209 younger patients (≤64 years), 269 elderly patients (65-75 years)］ or conventional treatment only (131 younger p atients, 213 elderly). Survival in the four groups was calculated with the Kapl an-Meier method. Multivariate analysis was performed to understand the degree that multi-variables (including age) affect survival in patients taking captopr il in the hospital or during long term follow-up. Results The survival of patients who took captopril correlated significantly with age ( P&lt;0.001). The survival of the elderly patients on captopril treatment did increase (P&lt;0.0001), but not of the younger ones (P&gt;0.05) during hosp italization. During follow-up, the survival of patients who took captopril cor related insignificantly with age (P&gt;0.05), but both the elderly and the you n ger patients have good survival rates (all P&lt;0.01) and lower cardiac events (all P&lt;0.01) when they took captopril.Conclusions Captopril exerts a weak effect on the younger patients but a beneficial effect o n the elderly patients during hospitalization after AMI. However, there is no d ifference between the younger and the elderly in the prognosis, both having good survival and lower cardiac events when they take captopril long term during fol low-up.     

Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery

目的　观察血管造影和肝动脉栓塞术对胆道术后胆道出血的诊断和治疗价值。方法　 9例在胆道手术后 7天到 3个月出现上消化道出血。所有患者行急诊肝动脉造影并采用明胶海绵和微钢圈进行肝动脉栓塞治疗。结果　肝动脉造影检查可见肝动脉假性动脉瘤 3例 ;肝动脉弥漫性出血 3例 ;右肝动脉胆道瘘 2例和肝动脉小肠瘘 1例。通过肝动脉栓塞控制胆道出血 7例 ,其中 1例再出血。 7例患者随访其中 3例死于多功能脏器衰竭。 2例因技术原因无法止血 ,数天后死亡。结论　胆道手术后出现上消化道出血如怀疑是胆道出血 ,应首先采用肝动脉血管造影检查 ,同时尽可能早地采用选择性肝动脉栓塞术治疗胆道出血 ,可获得较好的临床效果。     

Diagnosis and surgical treatment of multiple endocrine neoplasia

Background Multiple endocrine neoplasia (MEN) is relatively rare. But more patients could be found by detailed examination. We discuss the diagnosis and surgical treatment of MEN. Methods The clinical data of 95 MEN cases were retrospectively analyzed. There were 30 cases of MEN1 including 19 cases from 6 families. The MEN1 gene mutation was detected in 81.48% of cases admitted after 1997. There were 22 cases of primary hyperparathyroidism (PHPT), 10 cases of enteropanceatic tumor including 9 cases of insulinoma, 15 cases of pituitary adenoma, 9 cases of adrenal adenoma, 2 cases of thymic carcinoid. Two patients had 4 glands involved, 3 patients had 3 glands involved, 16 patients had 2 glands involved, and 6 patients had only one gland involved. Three patients had neither clinical symptoms nor biochemical changes, and was diagnosed by MEN1 gene mutation. Six patients presented with nephrolithasis and 6 patients had impaired pancreatic endocrine function. There were 60 cases of MEN2a and 5 cases of MEN2b. 58 cases of MEN2a belongs to 19 kindreds. All MEN2a patients but one presented RET gene mutation in codon 634, and all MEN2b cases had mutation in codon 918. 48 cases of MEN2a had thyroid masses with elevated calcitonin levels. 27 patients had pheochromocytoma including 12 cases of multiple loci and 5 malignancy. 13 patients presented with hyperparathyroidism. 5 MEN2b patients had medullary thyroid carcinoma and mucosal ganglioneuromatosis with Marfanoid. Among them, 3 patients had bilateral pheochromocytoma. Results In MEN1, subtotal parathyroidectomy was performed in 12 patients with PHPT and one patient received parathyroid adenoma enucleation. Insulinomas were enucleated in 4 patients. Two patients underwent thymus tumor extirpation. Total thyroidectomy with bilateral dissection of regional lymph nodes was performed in 16 patients with MEN2a and nodule enucleation was performed in 9 patients. Twenty two MEN2a patients underwent pheochromocytoma enucleation including bilateral adrenal resection in 10 cases. 5 MEN2b patients underwent total thyroidectomy with bilateral lymph node dissection. Among them, 3 cases underwent bilateral adrenal operations. Conclusions MEN varies in symptoms. Germline mutation test is helpful in establishing a diagnosis. Surgical management should be aimed at the improvement of life quality in MEN1 and prevention of the fetal tumors in MEN2.     

Allogeneic peripheral blood stem cell transplantation for leukemia

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