Volume 105  ·   Issue 11  ·  1992

Dog model of acute pancreatitis, induced by intrapancreatoductal injection of fresh trypsin-bile mixture, was used to investigate the effects of naloxone on hemodynamic changes in acute pancreatitis. In the control group, acute pancreatitis was induced and characterized hemodynamically by the decrease in maximum positive and negative dP/dt (±dP/dtmax), cardiac output (CO) and cardiac index (CI), and increase in pulmonary vascular resistance (PVR) and systemic vascular resistance (SVP), as well as early reduction of pancreatic blood flow (PBF). In the naloxone treated group, naloxone was given intravenously 10 minutes after the induction of acute pancreatitis (80 μg/kg as a bolus + 80 μg/kg/h for 3 hours). It was found that naloxone significantly increased PBF and the ±dP/dtmax effectively prevented the significant decrease in CO, CI and increase in PVR, SVR observed in untreated acute pancreatitis; and significantly reduced the severity of pancreatitis, as assessed by both histological staging and mortality rate. These results suggest that naloxone appears to limit the progression from edematous to hemorrhagic pancreatitis through preserving PBF and improving systemic hemodynamics at the early phase of acute pancreatitis; hence the hypothesis that endogenous opioid peptides may play a role in the pathophysiology of acute pancreatitis.

The Simple Descriptive Scale (SDS) has been known to be easier to use, but lacks sensitivity when compared to the Visual Analogue Scale (VAS). In this study, 79 cancer patients quantified the intensity of their pain experience on both the VAS and SDS before receiving pain therapy and on the fifth day after commencing the therapy. High correlations were observed between the two scales in age, sex and types of analgesics. The results demonstrate that the SDS provides a simpler and, perhaps, equally sensitive alternative to the VAS, in measurement of cancer pain among Chinese patients. It would be particularly useful for those with language barriers and/or other factors in understanding the requirements or the VAS.

Six New Zealand white rabbits were anesthetized with pentobarbital, and sciatic nerves were exposed and cut at the mid thigh. Both proximal and distal ends were incubated directly with Blue-SAb in a micropipe of 5 mm diameter covering the nerve trunk ends for 30 minutes at room temperature. After removal of the micropipe, the nerve ends were washed with physiological saline. Blue-stained fasciculi, i.e., sensory fasciculi were seen among unstained ones under the operating microscope. This method requires no histological sections. Neural cells of the spinal cord and ganglion were cultured in RPM11640 medium containing Bright Blue. The growth and metabolism of the neural cells were tested by MTT assay and their morphology was observed. Statistical difference between the experiment and control groups was determined, indicating that Bright Blue had no effect on the neural cells and their repairing power. This rapid immunostaining technique offers a good approach for the identification and accurate coaptation of sensory fasciculi in peripheral nerve repair.

The change of the stress distribution of the lumbar spine after discectomy was analysed by the three-dimensional finite element method. It was shown that the stress level in the posterior element was higher, but that in the anterior element was lower than before disc excision. The most significant change of the stress distribution was found in the trabecular bone of the vertebral body. It is considered that in discectomy the normal disc tissue should be preserved as much as possible to maintain good function of the spine.

When traumatic posterior urethral transection occurs with serious pelvic fracture, the patient is usually under severe hemorrhagic shock and multiple injuries. It is of prime importance to treat shock and the associated injuries promptly. As for the urethral disruption a simple suprapubic cystostomy at the moment is preferred. Occlusion of the posterior urethra would eventually appear and can be managed endoscopically 3-6 months later. Fifteen such cases were thus managed from 1984 to 1990 with an improved endoscopic technique with a success rate of 93.3% (14/15). The advantages of this technique and the merits and demerits of various primary urethral reconstruction procedures are discussed.

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous debridement using an instrument specially designed for that purpose. Four patients were chronically ill but stable, while the other two were septic, hypotensive and considered to be life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. Contrast enhanced CT of the abdomen in all cases revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases, resulting in complete healing within 12 days. Follow-up for 1-4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well developed external capsule and internal septations, and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses. This preliminary experience makes the authors to conclude that percutaneous debridement of pyogenic liver abscesses is a safe and curative procedure in selected cases of life-threatening chronic liver abscesses.

A prospective double-blind study was carried out in 136 women 0.5 to 21 years since menopause (YSM) in order to demonstrate the effects of a long-acting estriol derivative-Nylestriol (CEE3) on bone loss and lipoprotein lipids. They were orally administered at 2 mg of CEE3 or placebo every 2 weeks. Among 90 subjects who finished 1 year of medication, 49 received CEE3 and 41 placebo. The results were: 1. Serum ALP, Ca/Cr and Hop/Cr in fasting urine decreased in 3 months (P<0.05); 2. Menopause-related reduction of forearm bone density was restrained; 3. LDL-C decreased in 3 months and HDL-C increased in 6 months (P<0.05), with no significant changes in TC and TG; 4. Side effects were mild. 1/3 of those with intact uterus had spotting and another 1/3 had moderate withdrawal bleeding after the addition of medroxyprogesterone acetate at the end of 12 months of CEE3 therapy. This study demonstrates that CEE3 is effective and acceptable for preventing osteoporosis and lipoprotein lipids disorder in postmenopausal women. Long-term application awaits further studies.

The cerebral arteries in seven cases of Moyamoya disease, demonstrated by angiography were observed by light, transmission and scanning electron microscopy. In two cases, the lumen of the terminal portion of the internal carotid artery was completely occluded by proliferated connective tissue. The characteristic pathologic change was extensive destruction of the smooth muscle cells and the elastica interna. Degeneration and necrosis of smooth muscle cells were obvious in the media. Many condensed organelles and other elements of cellular destruction were dispersed throughout the interstitium. The media was thinned. The proliferated smooth muscle cells in the intima showed the same destructive changes as in the media. The elastica interna was excessively infolded and was thickened or thinned, disrupted or disintegrated in some segments. Identical, but less severe and more localized changes were seen in three middle cerebral arteries (M2 and M5 segments) and two collateral arteries at the base of brain. These changes suggest that Moyamoya disease is a progressive disorder characterized by repeated destruction of smooth muscle cells occurRing over a long time period. The pathogenesis of these changes is discussed.

The effect of hamster liver passage on the isoenzyme patterns of isolates of Entamoeba histolytica was investigated. Three isolates, F, G and T were originally obtained from patients with acute amebic dysentery and another strain, C, was obtained from an asymptomatic carrier. All these strains were maintained for over two years in axenic culture. The isoenzyme pattern (zymodeme) of hexokinase (HK), phosphoglucomutase (PGM) and glucose phosphoisomerase (GPI) of these strains was found to belong to non-pathogenic group X, but the isoenzyme pattern of GPI resembled less pathogenic zymodeme XX and might be an intermediate type. Following inoculation of trophozoites into hamster livers and recovery after abscess formation, their isoenzyme pattern changed and revealed that they belonged to pathogenic type XIV. Liver passage caused an enhancement in amebic virulence as evidenced by their increased ability to destroy leukocytes. The results indicate that isoenzyme pattern is not a stable property of E. histolytica.

Psoralen (PSO) was found cytotoxic against in vitro cultured human mucoepidermoid carcinoma cells of MEC-1 cell line. Its IC50 value was 8.6 μg/ml, and relative antitumor activity (RAA) 15. PSO suppressed DNA synthesis, damaged microvilli and cell membrane, and induced degeneration of mitochondria. It inhibited the growth of MEC-1 cells transplanted in nude mice by 79.1% which was as strong as pingyanmycin (PYM 81.4%). The body weight loss of PSO treated tumor-bearing mice was 5%, whereas that of PYM treated ones 13.3% (P<0.01). PSO may be an effective agent for the treatment of human mucoepidermoid carcinoma.