Volume 111  ·   Issue 05  ·  1998

OBJECTIVE To analyse the epidemiology and trends of abdominal aortic aneurysm (AAA) in an ethnic Chinese population over a 21-year period in a representative referral institution in Hong Kong. METHODS Over a 21-year period from 1975 to 1995, 533 patients with abdominal aortic aneurysms were treated in a single Vascular Surgical Unit at the Department of Surgery, Queen Mary Hospital, Hong Kong. Their characteristics, treatment and mortality were reviewed. RESULTS There was an increase in the incidence from a mean annual admission of 10 cases per year during 1975-1980, to that of 38 per year during 1991-1995. The increase was largely detected in males, the male to female ratio being 2.5:1 in the 1980s and 3.6:1 in the 1990s. There was no parallel increase in the incidence of ruptured aneurysms which accounted for 12.6% of all aneurysm admissions. CONCLUSIONS There is a progressive increase in the incidence of AAA in Chinese patients, in a time frame and pattern similar to that reported in the West.

OBJECTIVE To determine the morphological features of 18 pathologically proven intrahepatic peripheral cholangiocarcinoma (IHPCC) cases in computerized tomography (CT) image. METHODS All 18 patients had CT, using Picker I.Q.T/C and taking pre-contrast continuous 10-mm sections throughout the liver and post-contrast continuous 10-mm sections throughout the focuses. RESULTS The disease was characterized in CT image by the following: all focuses were found in the periphery of the liver and shown as a lobulated or fused hypodense space-occupying mass; there were one or more divergent or confluent, circular or irregular cystic areas with much lower density, in the majority. All focuses could be enhanced slightly and most revealed a dim edge. Dilated bile ducts around the focus were found frequently; the dilated bile ducts especially seemed to encircle the focus (33.3%, 6/18). This phenomenon were referred to as "encysted sign of dilated bile ducts". CONCLUSIONS CT scanning should be one of the most important investigative methods for IHPCC due to the disease characteristics identified in CT image, especially "encysted sign of dilated bile ducts" which possesses specificity in diagnosing the disease.

OBJECTIVE To establish a model of renovascular hypertension. METHODS A 4/0 resorbable chromic catgut ligature was used to ligate subtotally the renal arteries of 18 dogs, forming experimental renovascular hypertension steadily. Blood pressure, plasma renin activity, the ultrastructural changes of juxtaglomerular apparatus and renal artery wall were studied after the constriction. RESULTS It was reasonable that renal blood flow measured with an electromagnetic flowmeter was reduced by 30% after the constriction. The pathological changes of the induced renal artery stenosis were similar to those of fibromuscular dysphasia. CONCLUSIONS The findings provide valuable evidence for the treatment of renovascular hypertension.

OBJECTIVE To investigate the muscle-controlled dynamic stability of the glenohumeral joint through X-ray fluoroscopy in active and passive shoulder elevation in scapular plane. METHODS Sixty healthy volunteers were collected in this study, including 23 men and 37 women, with an average age of 28.4 years. Passive and active shoulder elevation in scapular plane were observed under X-ray imaging. In 18 subjects, X-ray films were taken when the shoulder elevated in scapular plane from 0° to 150° with a 30° interval at each stage in both active and passive movements. The angles between the pivot of the humerus and the glenoid surface (GHA) during the active and passive motion were calculated and analyzed. Manual examination was also applied in the same manner. RESULTS The pivot of the humerus had a tendency to be vertically closer to the glenoid surface in the active elevation than in the passive elevation. The differences of GHA between the active and passive motion at 0°, 30°, 60°, 90°, 120° and 150° elevation were 4.55°±0.37°, 5.44°±1.16°, 6.50°±1.50°, 4.94°±0.82°, 4.50°±0.40° and 1.44°±0.68°, respectively. Manual examination found the angle between the scapula and the humerus tended to be larger in the active motion than in the passive motion. CONCLUSIONS The active coordination of the muscles around the shoulder is beneficial to the dynamic stability of the glenohumeral joint.

OBJECTIVE To investigate the effects of combined blockade by platelet activating factor (PAF) receptor antagonist BN52021 in combination with opiate receptor antagonist naloxone on neurological function and neurological tissue damage after cervical cord injury. METHODS Spinal cord contusion at C6 segment was made with Allen method in cats, which were randomly divided into four groups: saline control group; BN52021 group; naloxone group; and combined treatment group with BN52021 and naloxone. Alteration of cervical cord blood flow, blood barrier permeability of the spinal cord, cervical cord tissue pathology and neurological functional scores were studied after experimental cervical cord injury. RESULTS The animals treated with BN52021 or naloxone had significantly better functional scores than saline controls 6 weeks after injury (P<0.05). Moreover, the combined treatment showed significantly better neurologic recovery than either naloxone or BN52021 treated animals (P<0.05). The other indexes in combined treatment animals were also superior to those in naloxone or BN52021 treated animals. CONCLUSIONS Combined blockade by two kinds of autolesion mediator receptor can more effectively inhibit secondary damage production and development after cervical cord injury and improve neurologic function.

OBJECTIVE To study the mechanism of gastric metaplasia in duodenum through the transplantation of a flap of duodenal wall with vascular pedicle to the stomach. METHODS The pediculated duodenal wall flaps of Wistar rats were transplanted to their stomachs. The rats were killed at the 3rd, 6th, 9th and 12th month after the operation respectively, and histological changes of the duodenal grafts were observed with optical and electron microscopy. RESULTS Gastric metaplasia was found in the mucosa of duodenal grafts transplanted to the stomach at the 6th, 9th and 12th month. CONCLUSIONS The formation of gastric metaplasia in the duodenal mucosa may be related to a change of the microenvironment around the tissues, and duodenal mucosa may differentiate into gastric epithelium by the decrease of pH value.

Purpose To promote the systematic development, interests, practice, research and clinical applications of health psychology in general hospitals in Hong Kong and the mainland of China. Data Source The targets and aims of therapeutic work with patients in pain, cancer patients, child and adolescent patients, patients with chronic illnesses, the elderly, and patients requiring organ transplantation are highlighted. Study Selection The psychological interventions described are experiences derived from routine clinical services carried out in the Clinical Health Psychology Unit where the authors are affiliated, and can be seen as an example of a more comprehensive psychological intervention program for physically ill patients in Hong Kong. RESULTS Psychological interventions have intrinsic values in reducing patients' distress and sufferings. The services are also an integral part of modem day comprehensive patient care with positive effects on treatment effectiveness and eventual illness outcome. CONCLUSIONS Physical illnesses affect a person physically as well as psychologically. Psychological care in general hospitals is cost effective and beneficial in reducing undue psychological complications precipitated by physical afflictions as well as in promoting better overall outcomes.

OBJECTIVE To observe apoptotic process in various cardiovascular disorders with a particular attention to the ultrastructural morphology of apoptosis in cardiomyocytes, fibroblasts, vascular endothelial cells and smooth muscle cells. METHODS Transmission electron microscopic observations of the tissue specimens obtained from endomyocardial biopsies or surgical excisions of left ventricular myocardium or calcified aortic valves were carried out in 50 patients with various cardiovascular diseases. RESULTS The ultrastructural features of apoptosis was consistently observed in cardiomyocytes, fibroblasts, vascular endothelial cells and smooth muscle cells in all diseased tissues. In cardiomyopathies and rheumatic heart diseases apoptosis was commonly observed in the cardiomyocytes. It was often found that fibroblasts underwent apoptosis in calcific aortic valve tissues. Apoptosis of arterial smooth muscle cells was a frequent finding in renal arterial stenosis due to Takayasu's arteritis and fibromuscular dysplasia. Regardless of the cell types, the nuclear hallmarks of apoptosis were identical with minor modifications of the fragmentation of the condensed cells into apoptotic bodies. CONCLUSIONS Based on electron microscopic findings, it is suggested that the underlying disease processes determine which type of cells predominantly undergoes apoptotic changes in various cardiovascular disorders. In addition, different cells with similar structural morphology may have common ultrastructural features of apoptosis.

OBJECTIVE To summarize the experience of utilization of video-assisted endoscopy in 91 patients operated on at Chang Gung Memorial Hospital, Taipei, China. METHODS From October 1995, through August 1996, 91 patients (44 male and 47 female) received video-assisted cardiac surgery (VACS). Their ages ranged from 1 year to 79.5 years (25.7±21.7). Indications for surgery were atrial septal defect (59 patients), ventricular septal defect (15), coronary artery disease (4), severe mitral regurgitation (4), severe tricuspid regurgitation (3), thrombosis of mitral mechanical prosthesis (3), left atrial tumor (2), and left ventricular thrombus with dilated cardiomyopathy (1). The VACS was performed through right or left anterior minithoracotomy and guided by video-assisted endoscopic techniques by means of projected images on the video monitor under extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature 22.6±4.0 ℃). Conventional instruments were used. RESULTS All lesions were corrected successfully. The bypass time was 27 to 335 minutes (72.8±52.7). The operative time was 1.3 to 8.5 hours (3.0±1.7). There were no operative deaths and 3 late deaths. Follow-up was complete in all survivors (6 to 16 months, mean 8.7). Most of them were found to be in NYHA functional Ⅰ or Ⅱ. CONCLUSIONS Our preliminary experiences demonstrate that VACS is simple and effective in surgical correction of selected cardiac lesions. Short-term results show good outcomes.

OBJECTIVE Familial hypertrophic cardiomyopathy (FHCM) is a primary myocardial disease characterized by unexplained ventricular hypertrophy. The application of the techniques of reverse genetics has identified at least five chromosomal loci as the major causes for FHCM in diverse ethnic populations, suggesting substantial genetic heterogeneity for FHCM. Recently, the defective gene loci of two Chinese families with FHCM have been mapped to chromosome 11 and 14q1, respectively. For further understanding of the molecular basis of FHCM in Chinese, we analyzed the linkage between four other Chinese kindreds and DNA markers from chromosome 14q1. METHODS Six unrelated Chinese families with FHCM, including two previously reported, were studied. Totally 90 family members were included for analysis. DNA from 80 individuals was extracted and polymerase chain reactions were performed using the primers designed according to the sequences derived from the α and β myosin heavy chain gene. Totally four polymorphisms were studied, including three polymorphic microsatellite sequences and one single strand conformation polymorphism. Genetic linkage analysis were performed using the Linkage program. RESULTS In the six studied families, 39 of the 90 family members were found to be affected diagnosed either by echocardiography or by clinical evaluation. The pattern of inheritance in all six studied families was most consistent with an autosomal dominant trait with a high degree of penetrance. Genetic linkage analysis using polymorphisms on the α and β MHC genes showed a combined maximal lod score of 6.2 for trinucleotide repeat polymorphism AMHC-I 15 at θ=0.00 for three studied families without recombination. Exclusion of linkage to the chromosome 14q1 location was noted in two of three other families with the maximal lod score of -2 or less. CONCLUSIONS These results provide further evidence that FHCM in Chinese is genetically heterogeneous. Chromosome 14q1 locus, probably the β myosin heavy chain gene, is important as the molecular basis for FHCM in Chinese.

OBJECTIVE To assess the progress in the treatment of advanced childhood neuroblastoma. METHODS From 1981 to 1996, there were 32 children with neuroblastoma (NB) diagnosed, staged and treated in our institution. There were 4 patients with stage II NB (12%), 5 stage III (16%), 21 stage IV (66%) and 2 stage IV s (6%). The NBs were excised if CT scan indicated that the tumors were operable. For advanced NB, stages III and IV, multiple drug chemotherapy was started first and operability was assessed with serial CT scan examinations. Once the X-ray imaging indicated the tumors were operable, surgical interventions were done. The medical records of the advanced NB were reviewed. RESULTS In the initial period of the study, 9 patients were treated using the VAC protocol [vincristine (vcr), adriamycin (adria) and cyclophosphamide (cyc)]. No patient was convertible to operable and all died with a mean survival of 10 months. OPEC [vcr, cyc, VM26, cisplatin (cis)], Rapid COJEC (carboplatin, VP16, vcr, cis and cyc) and more recently N6 protocol (cyc, adria, vcr, VP16, cis) was used for 17 patients. 80% of them were converted to operable. In 4 patients, surgical specimens showed only necrotic tissue without viable tumor tissue and 6 (35%) tumors were converted to ganglioneuroma or ganglioneuroblastoma. Although 2 (12%) patients died of fungal septicemia and 1 (6%) developed Fanconi's syndrome after chemotherapy, the mean survival period increased to 27 months. In the 10 survivors (60%), 4 had megatherapy with melphalan followed by autologous peripheral blood stem cell (PBSC) transplantation and 2 were waiting for transplantation. CONCLUSIONS There is a high percentage of advanced NB on presentation in Hong Kong. With more potent multiple drug chemotherapy for advanced stage NB there are (1) improvement in the survival of these patients, (2) opportunities for more operations for tumor excision and (3) opportunities for autologous PBSC transplantation for better tumor eradication.

OBJECTIVE To develop a diagnostic framework that would help defining clinical problems by the expanded understanding with traditional Chinese medicine (C Med) and western medicine (W Med). METHODS The basic attributes of diagnosis and the use of diagnostic techniques of W Med and C Med are reviewed. Some of the various diagnostic labels and their meanings are also preliminarily reviewed. A consolidatory approach is made to synergize the usefulness of the two disciplines based on the principles of the two schools. RESULTS A synergized basic diagnostic framework is developed. The disease (the disease diagnosis, 病症), the state of the inner core (the core diagnosis, 本候) should be defined. The term "systemic clues" is used to describe the symptom complex and conglomerate evidence describing the transient or sustained reaction of the inner core to environment. This is an analytical summary of its pathophysiological changes in reaction to the environmental insults. CONCLUSIONS The application and use of the framework are discussed and propositions are made. The synergized diagnostic platform represents a starting effort to form a unified basis to exchange clinical diagnosis between W Med and C Med. Such framework may facilitate looking for new treatment modalities and results can be compared across different centres.

Recent studies showed that a type of insertion/deletion (I/D) polymorphism of angiotensin converting-enzyme (ACE) gene was associated with coronary heart disease (CHD) and essential hypertension (HTN). It was also found that this polymorphism was related to the susceptibility of microvascular complication in type 1 diabetes-nephropathy (DN). We report here 233 Chinese cases to clarify if ACE gene I/D polymorphism attributes to the development of type 2 diabetes and its renal complication.

Tined endocardial steroid-eluting leads in the ventricle have demonstrated long-term, very low acute and chronic stimulation thresholds and recently, this work has been extended to the atrium. The objective of this study was to compare two bipolar atrial J leads from one manufacturer: one passive fixation tined lead, and one steroid-eluting lead.

Data sources All reference data originated from related Chinese- or English-language literature in Chinese journals. Study selection Twenty-three original articles published in 1992-1996 were selected according to the stated purpose and 9 of them were written by myself. Data extraction The present paper dealt with 5 subtopics, i.e. epidemiology, parasitology, pathology, diagnosis, treatment and prognosis. Results Five hundred and eighty-four patients with alveolar echinococcosis (AE) have been reported from 7 provinces or autonomous regions. Human infection rate was 19.2% or 2.8%, and the morbidity was 2.4%-5.0%. The intermediate hosts of Echinococcus multilocularis included 7 species of rodents and 3 species of livestocks, and the final hosts of that were fox, dog or wolf. Diagnosis of AE was chiefly based on imaging examination (ultrasound and CT) and immunological test. The operative resection rate for liver AE was only 10.5% (27/258). Albendazole was a certain remedy for the chemotherapy of AE, and TCM "Xiao-Bao" pill may be a hopeful drug. Conclusion In the past 30 years, a lot of work concerning basic and clinical studies has been done in China and some achievements have been achieved. However, some important problems such as how to conduct further research on molecular biology, how to make early diagnosis, how to improve the chemotherapeutic effect, and how to control the prevalence of AE, need to be studied more deeply in the 21st century.