Objective To study the clinical and pathological features of idiopathic membranous nephropathy(IMN),which has not been able to diagnose only by light microscopy.Methods Nine cases which has not been diagnosed as IMN only by light microscopy from January 1998 to March 2005 were selected.We analyzed their clinical manifestation and pathological findings.Results One case was 6-year old child,who had nephrotic syndrome(NS).The other 8 cases were 45~70 year old adult,their clinical diagnoses being chronic glomerulonephritis or asymptomatic hematuria and /or proteinuria.Light microscopic diagnoses were minor glomerular abnormalities and focal proliferative glomerulonephritis.Immunofluorescence demonstrated scattered granular deposits of IgG along the capillary walls.Under the electron microscopy,small high density deposits were observed along the basement membrane,mainly stage Ⅰand Ⅱ.2 cases were complicated with thin membrane disease.Conclusion Chronic glomerulonephritis or asymptomatic hematuria and /or proteinuria often mixes slightly with IMN which is difficult to be diagnosed clearly depending on simple light microscopy.Therefore,it is very important to diagnosis to perform immunofluorescence and electron microscopy further.

Objective To realize the value of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) in diagnosing vertebral arterial insufficiency of cervical spondylosis. Methods From Nov. 2001 to Feb. 2004, 35 vertebral arterial insufficiency of cervical spondylosis was diagnosed clinically. There were 11 males and 24 females with a mean age of 58.3 years(range, 23 to 76 years). All the patients were examined by MRA and DSA to investigate the tracks, diameters, and stenosis locations of vertebral articles. Results DSA was positive in 32 patients with 19 ipsilateral and 13 bilateral. Meanwhile, MRA positive were in 29 patients, 14 ipsilateral and 15 bilateral. Among MRA positive patients, excepted 5 cases, all the others were also positive with DSA. Accordance of both methods in the diagnosis of thin veterbral artery was 100%. DSA was better than MRA in the diagnosis of localized stenosis and unilateral veterbral artery absence. MRA was much more useful than DSA in the diagnosis of veterbral artery twisting caused by vertebral instability and bone spurs. Conclusion 1) DSA had more accuracy in diagnosis and distinguishing the source of veterbral artery localized stenosis. Posture changing didn't disturb the examination. Its disadvantages, however, were invasive detection, side-effect and dose limitation of contrast medium. 2) As a non-invasive method, MRA was a useful tool in diagnosing diffused, long segmental artery stenosis and obstruction, and especially available for diagnosing the cervical spondylosis combinated with other type. MRA can scan vertebral disc, spinal cord and other vessels at the same time. The indication of MRA was indefinite diagnosis, aged patients with bad tolerance to DSA. The disadvantage of MRA was its low sensitivity in detecting mild stenosis, non-obstruction artery disease, and posture demand during examination.

Objective To investiga te the relationship,diagnosis and thera peutic meth ods of degener-ative diseas es of lumbar and lower extremity joints in middle and aged patients.Methods Fr omNovember1997to May2002,50patients suffering from lum bar and hip or knee degenerative diseases concur rently were reviewed.In this group,there w ere14males and36females,ag ing from45to76years old(with an average of 60.5years).In lumbar degenerative disease,13cases were diagnosed as spi nal stenosis of lumbar,and12cases were diagnosed as spinal stenosis of lumb ar accompanied by degenerative spondylolisthesis,25cases spinal stenosis of lumbar accompanied by degenerative scoliosis.While in the degenerative diseases of joints,ostoarthritis was involved in58knee joints of 40cases,10hip joints of 6cases,and both6knee and5hip joints of 4cases.Results Allof the patients were operated upon;anterior lumbar decompression,bone grafting and Z-plate fixation to L1in5cases,posterior decompression and pedicle screws f ixation for insta-bility of spine in45cases.Of 50patients,11cases(1 4joints)underwent arthroscopy or joint replacement prior to lumbar operat ion,with an average interval period of 9.7months(1.5to29months);3ca ses(3knees)underwent joint replacements after lumbar operation,with an ave rage duration of 17.3months(4to36months);3cases(3hip joints)had hi p joint replacement simultaneously with lumbar operation in one setting.For the other33cases no articular operation was performed,and12cases had relief of the symptoms of osteoarthitis after lumbar opera tion;21cases were tre ated with conservative therapy for degenerative dis-eases of joint and allev iated the conditions satis factorily.The average follow-up period was14.2m onths(3to45months).Compared to pre-operation,the average HSS,Harris sco re of joint and JOA score of lumbar were improved by48.2,42.5and14 .3respectively.Conclusion In middle and aged patients with both lumbar and jo int degenerative dis eases,it is very important to make definite diagnosis an d distinguish symp-toms caused by lumbar or joint disease.The major diseas e portions should be treated firstly;if necessary,both joint and lumbar opera tion could be carried out in one surgical setting.

AIM: To investigate the change of connective tissue growth factor(CTGF) expression and its role in streptozotocin-induced diabetic rat kidney. METHODS: Male SD rats were randomly divided into two groups: control(sham operated rats, group C,n=32) and diabetic rats (group DN,n=35). Rats in each group were sacrificed at 1, 2, 4, and 8 weeks respectively after induction of diabetes. Body weight(BW), blood glucose(BG), 24-hour urine volumn(UV), kidney weight, KW/BW,24-hour urinary albumin excretion (24Ualb), creatinine clearance (Ccr), kidney weight (KW), KW/BW, glomerular area (AG), proximal tubular area (AT) and the width of GBM、TBM at each time point were measured. Expression of CTGF and ?-SMA were detected by immunostaining. RESULTS: There was a significant increase of 24 h Ualb, Ccr, KW/BW, AG, VG and the expression of CTGF in glomeruli and tubuli from week 1 onward in diabetic rats compared with those in group C (P