[Microbiology of soft contact lens-related keratitis]

Among 385 specimens of presumed microbial keratitis cultured at Beijing Institute of Ophthalmology from April 1988 to December 1990, 21(6%) were associated with extended-wear contact lenses. Of the latter, 10(48%) were cultured bacterio-positive, including 8(80%) of gram-negative and 2(20%) of gram-positive bacteria. Pseudomonas aeruginosa was found in 6 specimens, accounting for 60% of the bacterio-positive cultures. In the meantime, among the 364 specimens not associated with contact lens wear, 87(24%) were cultured positive, including 27(31%) of gram-negative bacteria, 32(37%) of gram-positive bacteria and 20(23%) of fungi, while mixed cultures and nocardia each accounted for 4(5%). 9 contact lens containers and all cleaning solutions of 11 cases of pseudomonas corneal ulcers were cultured to find them 100% positive of P. aeruginosa.

[Combination of radiotherapy and surgery for advanced cancer of the vulva]

From 1970-1985, seventy-six patients with advanced carcinoma of the vulva were treated. It accounted for 58.9% of all vulvar cancers seen in the same interval. According to the revised FIGO Staging System of Vulvar Cancer, 64 had Stage III, and 12 had Stage IV lesions. Fourty-eight patients had tumor extending to the distal urethra, vagina or anus. Fifty-one were treated by radiotherapy combined with radical vulvectomy and inguinal lymphadenectomy, 10 by surgery alone, 9 by radiotherapy alone and 6 by palliative radiotherapy. In 20 (55.6%) patients the tumor was reduced > or = 50% and in 4 (20%) patients the tumor completely disappeared after pre-operative radiation as shown in pathologic examination of the resected specimens. The 5-year survival rate was 46.9% for Stage III, 33.3% for Stage IV disease, with an over-all 5-year survival of 60.8% on the combined group. Surgery alone gave a 5-year survival rate of 30%. All the patients died of cancer within 5 years in the radiotherapy and palliative radiation groups. It is suggested that combined radiotherapy and surgery be preferred for advanced cancer of the vulva. Technique of encompassing the vulvar and inguinal areas needs to further studied and improved.

[Effects of electrical lesioning of hippocampal CA3 region and anterior commissura hippocampi fornix on plasma insulin level and islet cells in the rat]

Bilateral electrical lesioning of the hippocampal CA3 region (HCA3-EL) or anterior commissura hippocampi (ACHF-EL) caused marked elevations in plasma basal levels of insulin. 2 weeks later, fasting blood glucose levels were also augmented with decreased glucose tolerance. In contrast, the secretory response of pancreatic B cells to glucose stimulation was markedly enhanced. Following intravenous glucose tolerance test (IVGTT), the relative amounts of glucagon-like and insulin-like immunoreactants were reduced in the pancreatic islets of both HCA3-EL and ACHF-EL rats in comparison with the controls. In the HCA3-EL group, the relative amounts of somatostatin-like immunoreactants and gross numbers of such immunostained cells in islets were also decreased as compared with the control. No difference was seen in pancreatic-polypeptide-like immunoreactivities as assessed by immunohistochemistry plus microphotometry method. The above results suggest strongly that HCA3 and ACHF exert a tonic inhibitory action on the insulin secretion in the rat.

[Role of colposcopy in the diagnosis of human papillomavirus infection of the uterine cervix]

Among 6706 women screened by cytology, only 9 (0.13%) showed evidence of human papillomavirus infection (HPVI). In 133 women examined by colposcopy for abnormal cytology or/and suspected lesions on the cervix, 41 (30.8%) showed subclinical papillomavirus infection (SPI) while 17.4% and 5.3% showed HPVI by histopathology and cytology, respectively. The conformation rate between colposcopy and pathology was 69.6%. Sixty-nine specimens out of 133 colposcopy guided biopsies were assayed by HPV-DNA dot hybridization with 6B/11, 16, 18 probes to detect the presence of HPV-DNA in the cervical specimens. Thirty-nine (56.5%) gave a positive result. The colposcopic predictive value of positive result for HPVI was 76.7%. The difference between colposcopy (59%) and pathology (20.5%) is statistically significant (P less than 0.01). These results suggest that colposcopy is superior to cytology and histopathology for the detection of SPI in the cervix. In colposcopy HPV-DNA positive women, aceto-while-epithelium was most common (28.2%). As it is difficult to differentiate SPI from cervical intraepithelial neoplasia especially the Grade I lesion by colposcopy, discrimination criteria are proposed together with the chief colposcopic features of SPI.

[Malignant mesodermal mixed tumor of the uterus--a study of 37 cases]

37 patients with malignant mesodermal mixed tumor of the uterus treated from 1958 to 1987 were reviewed. It accounted for 38.5% of all uterine sarcomas during the same period. Six were homologous and 31 were heterologous in origin. The mean age was 56.8 years. 75.5% of the patients were postmenopausal. Nine (24.3%) patients had previous pelvic irradiation. There were 13 Stage I, 4 Stage II, 5 Stage III, 2 Stage IV and 13 unstaged (including 11 misdiagnosed and 2 operated in other hospital) lesions as classified according to the FIGO Staging System for malignant tumors of the Endometrium and Cervix. Twenty-six patients were treated by combined surgery and radiotherapy or chemotherapy and radiotherapy, 5 by radiotherapy alone and 6 by surgery alone. The overall 2-year survival rate was 35.1%. Twenty-two (59.5%) patients developed recurrence and/or metastasis and 86.4% (19/22) did so within 2 years after treatment. The most significant prognostic factors were: the depth of myometrial invasion, extent of lesion and method of treatment. The best 2-year survival rate (83.3%) was seen in patients treated by the combined use of surgery, radiotherapy and chemotherapy which is considered the treatment of choice for this malignancy.

[Value of colposcopy in diagnosing recurrent gynecologic malignancies]

From 1983 to 1988, colposcopic follow-up examination was done in 82 treated gynecologic tumor patients (68 cervical cancer, 7 vulval cancer and 7 other cancers) comprising 10% of all examined by colposcopy during the same period. Twenty-one cases were found to have recurrence or metastasis in the cervix, vagina or vulva proven by pathology. Ten of these 21 cases were initially diagnosed by colposcopy. The conformation rate between colposcopic examination and pathology was 85.7%. An accuracy of 86.7% was achieved by combination of cytology and colposcopy for recurrent tumors. The results suggest that tumor recurrence can be detected earlier by colposcopy than by clinical examination. Colposcopy combined with cytology as follow-up examination can improve the clinical diagnosis and treatment of treated patients.

Cadmium exposure and health effects among residents in an irrigation area with ore dressing wastewater

About 0.05 mg Cd l-1 was found in the irrigation water contaminated by the wastewater discharged from tungsten ore dressing plants, and about 1 mg Cd kg-1 was found in irrigated acid soils. The main sources of cadmium intake by residents of the polluted areas are agricultural products. The average intake of cadmium was 367-382 micrograms day-1, and for smokers 417 micrograms day-1. Among the residents who have been exposed to cadmium for more than 25 years, cadmium absorption (urinary cadmium greater than or equal to 10 micrograms g-1 creatine) was 60% and an early effect on the target organ (urinary cadmium greater than or equal to 15 micrograms g-1 creatinine and urinary beta 2-microglobulin greater than 500 micrograms g-1 creatinine) was detected in 17% of the sample of 433 persons. Levels of urinary cadmium and blood cadmium exceeded the critical value in the exposed group. The concentrations of urinary calcium, beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase were significantly higher in residents of contaminated areas than in those of control areas. Case-control study of the residents shows that many have suffered from a nephropathy with tubulo-interstitial abnormalities. Owing to the combined cadmium effect, the cases with fractional beta 2-microglobulin excretion greater than 0.10 were 46% in the exposed population, and were much higher than that in the control group (20.3%).

Clinical evaluation of the 99mTc-CPI myocardial perfusion imaging

99mTc-CPI myocardial perfusion scintigraphy including planar images in 35 patients and SPECT images in 16 patients has been studied. Scintigraphic data revealed that high quality 99mTc-CPI myocardial perfusion images were obtained. The sensitivity and specificity of 99mTc-CPI planar images in detecting CAD was 92% and 80% respectively. There was no significant difference in sensitivity for detecting CAD between planar and SPECT. However, the specificity of SPECT was much better than that of planar imaging.

Investigation on monoclonal antibodies against two serovars of the icterohaemorrhagiae serogroup of Leptospira

By means of the cell fusion technique, two hybridoma cell lines, V-1 and H2-1 have been obtained. V-1 cells secrete monoclonal antibody against serovars icterohaemorrhagiae and dakota. The H2-1 cell line secretes serovar-specific monoclonal antibody against serovar H2. These monoclonal antibodies have been successfully used in serovar-typing of leptospires isolated in China. The results of identification of leptospires by using monoclonal antibodies showed total coincidence with that by the traditional cross agglutinin absorption test and factor antiserum method. It was confirmed by using monoclonal antibody that the serological agglutination totally paralleled with animal protection. On the basis of the study, a concept was proposed that the agglutination in vitro and the protection in vivo are different manifestations in different reaction systems from the same antibody (antibodies) stimulated by a component(s) of the surface antigen of leptospires.

Papillomavirus and cervical cancer: a clinical and laboratory study

It is now widely accepted that HPV types 16, 18, 31, and 33 are associated with the development of high grade intraepithelial neoplasia and malignant lesions in the cervix. On this basis, the identification of HPV types in cervical scrape samples has been advocated as a supplement to cytological screening tests. However, little is known of the distribution of the virus at different sites in the lower female genital tract or of how this distribution may change during the natural course of HPV infection. In this survey, HPV DNA dot hybridizations and, in some instances, Southern blot hybridizations with mixed HPV 6/11 and 16/18 probes were undertaken to detect HPV DNA in cervical scrapes and biopsies of the cervix, vagina, and vulva. A total of 92 women attending a Sydney hospital were screened: 59 of these patients had cervical disease, either invasive cervical carcinoma (CaCx) or cervical intraepithelial neoplasia (CIN), grades I-III. A group of 33 women who lacked evidence of cervical abnormalities served as controls. HPV DNA, predominantly type 16/18, was detected in the cervical biopsies of 96% of the CaCx patients, 80% of the CIN III patients, and 65% of the CIN I-II patients. In contrast only 9% of the cervical biopsies from the control group contained detectable HPV 6, 11, 16, or 18 DNA. A high proportion of the women with cervical abnormalities had evidence of concurrent vaginal and/or vulval papillomavirus involvement. The significance of these findings for routine screening and subsequent management of patients with HPV-associated cervical disease is discussed.

[Report on 114 primary vaginal carcinomas]

114 patients with primary carcinoma of the vagina were treated in our hospital from 1958 to 1978. It accounted for 0.83% of all gynecological malignant tumors in the same period. The youngest was 26 years of age, the oldest 75. Patients 40-59 years comprised 61.4%. 33% of patients had wedding age under 17. 63.4% had more than 4 pregnancies and 58.4% gave more than 4 births. 89.69% was diagnosed as squamous cell carcinoma, 7.2% as adenocarcinoma, 2.06% as undifferentiated carcinoma and 1 as embryonic carcinoma. The tumor occurred frequently in the upper third and posterior wall of the vagina (60% and 68%). In this series, there were 21 stage I, 29 stage II, 61 stage III and 3 stage IV lesions. 110 patients were treated by radiotherapy in different schemes. Intracavitary radium or caesium plus 60Co external irradiation by four fields gave better result with a 5 year survival rate of 66.1%. Only 2 out of 12 patients were cured by 60Co rotation alone but if supplemented by intracavitary radium or caesium, the cure rate was increased. The 5 year survival rate was 71.4% for stage I, 62.1% for stage II, 42.6% for stage III and O for stage IV. After the radiotherapy, rectovaginal fistula developed in 1 patient, vesicovaginal fistula in 1. 14% was complicated with rectal bleeding and 8.18% with hematuria.

[Relation between human papillomavirus (HPV) and cancer of uterine cervix]

HPV-DNA fragments were detected in biopsy specimens (29 cases of cancer of uterine cervix, 2 cervical dysplasia and 9 normal cervix) using DNA hybridization technique. It was demonstrated that 52% of biopsy specimens of the cancer of uterine cervix was positive for HPV 16 DNA probe, while 9% was positive for HPV 18 DNA probe. 11% of non-cancerous biopsy specimens had a positive result for HPV 16 DNA probe. It was also demonstrated that the positive rate of HPV 16 DNA was 75% in grossly cauliflower and nodular type tumors but only 25% in erosion type. It seems that the positive rate of HPV 16 DNA is correlated to gross appearance of the tumor. The positive rates of HPV 16 DNA were different in 6 provinces in China. It was 64% in Shanxi Province, a high incidence area but 36% in Sichuan Province, a low incidence area. These results suggest that the carcinogenesis of cancer of the uterine cervix, be related to HPV infection.

[Preliminary study on the nucleic acid hybridization technic in detecting HSV-2 DNA corresponding sequence of cancer tissues of the uterine cervix]

In this paper, 34 samples, 25 from 18 cervical carcinoma patients and 9 from 8 non-cervical carcinoma patients, were assayed using (alpha-32P) dCTP HSV-2 DNA probe and nucleic acid hybridization technic. It was shown that the positive rates of HSV-2 DNA corresponding sequence were 50% (2/4), 36% (5/14) and 12% (1/8) in the in situ cancer, invasive cancer and non-cervical cancer tissues. No HSV was isolated from 7 cancer specimens which showed a positive reaction by nucleic acid hybridization.

[Intracavitary afterloading radiotherapy--preliminary clinical report on 44 patients]

This report describes the 2 year results of the treatment of 44 patients (1 vaginal carcinoma, 3 endometrial carcinoma and 40 cervical carcinoma) by Buchler afterloading equipment. One patient with vaginal carcinoma and two with endometrial carcinoma are live without disease over 2 years. There were 40 patients with cervical carcinoma: 1 stage I, 21 stage II (52.8%) and 18 stage III (45%). The dose-rate of the source is 10-25 cGy/min. A total dose of 41-55 Gy was given at point A in 87.5% of cases. The measurement of the bladder and the rectum were made in all the 40 patients during the treatment. The dose at the bladder was less than 30 Gy and only 10% of patients had a dose of over 30 Gy at the rectum. A dose of 40-45 Gy external irradiation by 8MV X-rays was delivered to the parametrium in each patient. One died of cancer, 2 were lost in follow up and 3 had local recurrence and metastasis. The two year survival rate was 92.5%. Only 4 had mild rectal reactions during the treatment and 2 had mild rectal bleeding after treatment.

[Verrucous carcinoma of the cervix]

An extremely rare case of verrucous carcinoma of the uterine cervix is reported. The most outstanding pathologic feature of this malignant tumor is the benign picture of the proliferative squamous epithelium, with remarkable hyperkeratosis and dyskeratosis. Therefore it is difficult for the pathologist to make an accurate diagnosis on the basis of the biopsy material. Surgery may be best treatment of this special tumor for its behavior of slow invasiveness and rare metastasis.

Effect of autonomic mediators in recurrent shedding of herpes simplex in the rabbit eye

After recovery from primary herpes simplex virus (HSV) infection of the eye in rabbits, recurrent shedding of virus in the external eye can be produced by the local application of 6-hydroxydopamine (6-HD) and epinephrine. Surgical sympathectomy did not prevent shedding of HSV with 6-HD/epinephrine so the source of the virus in the outer eye induced by adrenergic stimulation is not just the superior cervical ganglia (SCG). Chemical sympathectomy with 6-HD prior to HSV infection of the cornea led to decreased viral replication in the SCG during acute infection but did not interfere with uptake of the virus and latent or low grade infection of the ganglion. Shedding of virus in the outer eye induced by 6-HD/epinephrine was reduced by treatment with the beta-adrenergic blocker, timolol. These experiments strongly suggest that recurrent HSV shedding in the eye induced by catecholamines is due in part to effects on the peripheral (i.e. post synaptic) cells. While the peripheral neurons are the source of virus, it is possible that not all HSV detected in the external eye is due to release of preformed virus from nerve endings.