Objective. To improve the localized diagn osis of insidious recurrent small intestinal hemorrhage.Methods. This retrospective analysis include 64 cases of such diseases, which were admitted from 1988 to 1998 to our hospital.Result. Ultrasonography, CT, small bowel pneumobariumgraphy, diluted barium enema, isotopic examination,DSA and intraoperative small-bowel endoscopy were used for diagnosis of hemorrhagic site, and 37 cases got a definite location before operation, while 10 cases were confirmed the diagnosis during the operation. Forty-seven cases were treated surgically, while the other 17 cases had non-surgical treatment. Of the 47 cases,39 cases underwent partual enterectomy, 5 cases had suture and ligature of vascular deformity, 2 cases had Whipple' s operation, and one patient had ectomy of the end of ileum and right colon.Conclusion. DSA, Isotopic examination and intraoperative enteroscopy are of considerable importance for the location judgement of recurrent small intestinal hemorrhage.

Objective. The effectiveness of surgical resection of adenosquamous carcinoma of the lung remains poorly defined because of the histology' s relatively low frequency, the failure in most published series to separate adenosquamous carcinoma from the other variants of non-small cell lung carcinoma. To define the effectiveness of surgical treatment of adenosquamous carcinoma, we have retrospectively reviewed our hospital experience over a 12-year period. Methods. Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated, except one patient,in the PUMCH from Jan. 1985 to Aug. 1997.This series constitutes the 1.9% of a total of 1 245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results. The adenosquanous carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n= 20).The overall 5-year survival was 23%.Those with stage Ⅰ tumors survival was only 18%(n= 13), stage Ⅱ 5%. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months.Conclusion. Our results suggest that adenosquamous carcinoma of lung was a virulent tumor, which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46% ) and its prognosis was worse than that of both squamous cell carcinoma and adenocarcinoma.

Objective. To study the mechanism and effects of blood perfusion to the acute ischemic region of myocardium through Ho-YAG laser channels with myocardial contrast echocardiography. Methods. To produce the model of acute myocardial ischemia, we partially ligated the left anterior decending (LAD)coronary artery of canine hearts between lst. and 2nd. diagonal branches and then performed transmyocardial revascularization in this region with Ho- YAG laser. Myocardial contrast echocardiography was made with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, after ischemia and after laser revascularization. Pictures were taken with “R” wave trigger skill.Results. Acoustic density derterming in the ischemia region (anterior wall)with MCE (myocardial contrast echocardiography )was obviously decreased( 5.40 ± 1.81) after the LAD was ligated, as compared with before( 11.69 ±1.61, P ＜ 0.01 ). It was increased remarkably after transmyocardial laser revascularizatuon (TMLR) ( 11.2 ± 2.01, P＜ 0. 01 )as compared with that when ischemia and approximated to that before ischemia(P ＞ 0.05). There were no differences in acoustic density in the lateral wall(as control)among these comprehensive three periods(P ＞ 0.05). Contrast in the laser region developed one cardiac cycle ahead of that in the non-ischemic normal region.Conclusion. Acute ischemic myocardium can be peffused by oxygenated blood from the left ventricle through HoYAG laser channels. Evidence of blood perfusion through laser channels during systolic phase was detected, and myocardial contrast ultrasonography using intravenous perfluorocarbon-exposed sonicated dextrose albumin may be regarded as a reliable method in the study of transmyocardial revascularization.

Objective. To investigate the differentiation process of the human glioblastoma cells.Methods. Differential display reverse transcribed-PCR(DDRT-PCR) was used to isolate the genes differentially expressed in control and all-trans retinoic acid treated human glioblastoma cell line BT-325. Routine method of cDNA library screening was performed to clone full-length cDNA.Results. Thirty-six RT-PCR reactions were performed and 64 differentially expressed fragments were recovered,amplified and cloned. Of them,46 ESTs were sequenced and delivered into the GenBank. The homology comparison using BLAST algorithm revealed that 22ESTs are highly homologous with the known genes and many of them play important roles in the cell differentiation progress. A dot-blot hybridization was conducted to certify the differentiation expres sion. The result showed that 27 EST clones are expressed at different level in control and all-trans retinoi c acid treated BT-325 cells. A full-length cDNA was cloned using the ES T-HGBB098.Conclusion. DDRT-PCR was a simple and effective method to serially analyze the differentially expressed genes.

Objectives. To observe the effect of basic fibroblast growth factor (bFGF) slow-release microcapsules on angiogenesis in infarcted myocardial regions.Methods. Myocardial infarction was induced in 24 New Zealand rabbits by ligating the root of left anterior descending coronary artery. Group Ⅰ (n = 8) served as control, group Ⅱ (n = 8) as a blank microcapsule group, group Ⅲ (n = 8, each microcapsule contains lμg bFGF) as micrpcapsule group. In group Ⅱ and Ⅲ, 5 blank microcapsules or bFGF slow-release microcapsules were implanted into myocardium underneath the epicardium between the left antefior descending coronary artery and left circumflex artery. Infarct size was evaluated by infarcted weight/left ventricle weight ratio and angiogenesis was evaluated by immunohistochemical examinations 5 weeks later.Results. As compared with group Ⅰ and Ⅱ, rabbits treated with bFGF slow-release microcapsules showed higher microvessel counts (group Ⅰ 37.75 + 4.50, group Ⅱ 38.37 ± 4.98, vs. group Ⅲ 135.50 ± 4.81, P ＜ 0. 001 ) and less infarcted weight/left ventricle weight (group Ⅰ 16.8% ± 0.4%, group Ⅱ 16.7% ± 0.5%, vs. group Ⅲ 7.0% ±0.2% ,P＜ 0.001).Conclusions. Subepicardial administration of bFGF slow-release microcapsule in the infarcted rabbit model results in effective angiogenesis and reduction in infarct size.

Objective. To investigate the effect of left ventricular diastohc dysfunction on the pathogenesis of angina decubitus (AD).Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ . Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF) ＞ 50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease.Results. Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction(1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ (both P ＜ 0.001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ (P ＜0.05, P ＜ 0.01). Left ventricular end-diastolic pressure(LVEDP)was markedly increased before and after LVG in group Ⅱ and Ⅲ as compared with group Ⅰ (bothP＜0.05, both P＜0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference,LACPD)before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P ＜0.01, P ＜ 0.001). Howevere,there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P ＜ 0.01).Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.

Objective. To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats.Methods. All ograft models including simultaneous pancreas and kidney(SPK)transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were compared morphologically and functionally.Results. Mean survival time (MST)of pancreas was significantly prolonged in SPK than in pancreas transplant alone(PTA)( 11.5 days vs. 9.2 days, P ＜ 0.05). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK(42.9% vs. 12.5% at grade Ⅱ and 28.6% vs 6.3% at grade Ⅲ , P ＜0.05). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclosporine A prolonged the MS T of pancreas and kidney, without altering the tendency stated above.Conclusions. In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoallergization and immunoregula tion, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclosporine A is effective on prolonging the MST of pancreas and kidney.

Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies.Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department.The procedures included 1421 surgeries of ovary and t utbe, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy ( 17.6% ).Results. Complications occured in 34 cases, the overall complication rate was 1.92%. Unintended laparotomies occured in 6 cases(0.34% ). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 35.3% of all complications of this series. Five intraoperative complications ( 14.7% ) occured during the laparoscopic surgery (3severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was requied in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities.Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.

Objectives. To investigate the genetic susceptibility for breast cancer of Chinese, a hospital-based case-control study, pedigree survey and molecular genetic study were conducted.Methods. Logistic regression model and stratification methods were used in the risk factors analysis. Li-Mantelart and Falconer methods were used to analyze the segregation ratio and heritability. Polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis were used to detect AI, G-banding technique was used to detect the chromosome aberration of peripheral blood lymphocyte.Results. Family history of breast cancer is related to enhanced breast cancer risk significartly, OR is 3.905( 95 % CI = 1.079 ～ 14.13), and it widely interacts with other risk factors. Accumulative incidence of breast cancer in first degree relatives is 9.99%, which is larger than that in second, third degree and non-blood relatives. Segregation ratio is 0.021, heritability among first degree relatives is 35.6 ± 5.8%. Frequencies of LOH at BRCA1 and BRCA2loci in sporadic breast cancer are 6.12% and 5.77% respectively. In the sibs, both of them show LOH at D13S173locus, and high frequencies of chromosome aberrations were observed.Conclusions. Genetic susceptibility contributes to breast cancer occurrence of Chinese, and its racial variation may be one of the important reasons for the large difference of incidence between western and eastern countries.

Objective. To determine whether serum vascular endothelial growth factor(VEGF)concentrations are altered in several kinds of coronary heart disease patients.Materials and methods. Using a VEGF enzyme-linked immunosorbent assay(ELISA), serum VEGF concentrations were determined in antecubital venous blood of 16 patients with stable angina pectoris(SAP), 16 with unstable angina pectoris(UAP) and 16 with acute myocardial infarction(AMI) before and after thrombolytic therapy, and of 16 age and sex-matched healthy volunteers who used as controls.Results. The concentrations of serum VEGF in patients with SAP(98.60 ± 26.99pg/ml) and UAP (103.61 ±24.89pg/ml) tended to be higher than those in control subjects(80.44 ± 24.57pg/ml), but the differences did not reach statistical significance (P ＞ 0.05 for each). Before throm bolytic therapy, the concentrations of serum VEGF in patients with AMI (285.92 ± 125.15pg/ml) were significantly higher than those in patients with SAP, UAP or control subjects ( P ＜ 0.01 ,respectively), and correlated with synchronous serum creatine kinase (CK) and its MB isoenzyme (CK-MB) contents(r=0.866, P ＜ 0.001 and r =0.948,P ＜ 0.001;respectively). Three hours after thrombolysis, the concentrations of VEGF had fallen to 111.57 ± 31.29pg/ml ( P ＜0.01 vs. before thrombolytic therapy and P＜0.05 vs .control subjects).Conclusion. The present study shows that serum concentrations of VEGF in patients with AMI are markedly elevated and that increased serum VEGF levels may be one of the most sensitive indexes in diagnosing AMI and judging reperfusion.

Objective. To introduce a new internal fixation system of spine and its characteristics.Methods. To review 16 patients with lumbosacral instability who were treated by this new technique, including their clinical outcomes and radiographic evaluation.Results. Fifteen patients gained complete recovery from their preoperative symptoms. One patient who had experienced two operations before and with problems of urinary and fecal incontinence and walking difficulty still had lower limb pain, muscle weakness and urinary incontinence after operation. There is no evidence of spine glide on X-ray,implant failure, neural complication or infection during follow up.Condusion. Diapason system can achieve good early postoperative results with few complications and ease to use for lumbosscral instability.

Object. The effects of ATP-introduced a rise in cytosolic free Ca2 + concentration and inhibition of nitric oxide were investigated.Method. Measurement of f ree Ca2+ ([Ca2+ ]i)of cultured rat tail arterial smooth muscle cells using Fura-2/AM dual excitation wavelength spoctrofluorometer.Results. There are two components of [ Ca2 + ]i can be evoked by ATP. One part is Ca2 + ertry from Ca2 + channel and formed a plateau. The another part is a peak that released f rom Ca2 + store. Both of them can be inhibited by NO.Conclusion. The ATP induced [ Ga2 + ]i rise that release Ca2 + from both InsP3 and ryanochine receptors and Ga2 + entry through calcium channels. The inhibition of NO on ATP induced [ Ca2 + ]i rise that was mediated by cGMP.

Objective. To study the treatment of the patients with blood sodium disorder after craniopharyngioma surgery.Method. The blood sodium in 44 patients with craniopharyngiomas was daily examined from operative to post-operative days. Hypernatremia is defined as [Na] ＞ 145 mmol/1, and hyponatremia as [Na] ＜ 135 mmol/L.Results. Of the 44 patients, 36 developed sodium disorder. Among them, simple hyponatremia was 16 patients,simple hypernatremia was 9 patients, and alternative sodiu m disorder was 11 patients.Conclusion. The blood sodium disorder in patients with craniopharyngiomas after surgery appears to present complicated changes. Three types of blood sodium disorder could be determined as simple hyponatremia, simple hypernatremia, and alternative sodium disorder. Treatment of the sodium disorder in patients with craniopharyngiomas after surgery could be carried in accordance with the above three types.

Objectives. To understand and grasp the diagnosis and treatment of chylothorax caused by various reasons.Method. The treatment results of 31 cases of chylothorax in PUMC hospital from 1963 ～ 1997 were retrospectively analyzed.Results. Among 31 cases, 18 underwent surgery, 14 of 18 were cured, 2 died. In the 13 treated conservatively,2 were cured, 3 died. Eleven cases were congenital, iatrogenic and traumatic chylothorax, 8 of them received surgical treatment and 6 of 8 were cured. The spontaneous chylothorax of unknown cause were 10 cases, 7 were treated by surgery and 6 were cured.Conclusion. Surgical intervention should be aggressively recorm mended for the waumatic, congenital, and iatrogenic chylothorax. The definite reason must be found out for the spontaneous chylothorax, corresponding management will be given according to the reason. Surgical ligation of the thoracic duct will contribute good result for the chylothorax of unknown cause, but combination of multiple treatment measures will be necessary for a successful management.