1990年 · 第103卷第11期

From 1958 through 1988, 87 patients with primary sacral tumor were treated surgically. The lesions consisted of benign tumors (17 patients) such as neurofibroma, chordomas (41), giant cell tumors (21), and malignant growths (8). Fifty-nine patients sustained destruction of S1-3 vertebrae, and 28 had the neogrowth below S3. A total of 99 operations including 13 total and 17 subtotal excision of the sacrum, as well as 12 for recurrent tumors in 99 cases were performed. Ten operations for primary tumors resulted in 3 intraoperative and 7 postoperative deaths. Thus, 89 surgical attempts were stood by the patients. Sixty-seven patients were followed up with an average interval of 5.5 years. Sixty patients showed good functional results and resumed normal life and work, whereas urinary incontinence, constipation and weakness of ankles and feet occurred in 7. The factors conducive to surgical success were stressed. We conclude that with the exception of frank malignancy, surgery should be advised and actively adopted for primary sacral tumors.

476 cases of paroxysmal nocturnal hemoglobinuria (PNH) were analysed and compared with PNH patients in foreign countries and its classification was discussed. The clinical characteristics in Chinese PNH patients were: males were affected more; the age of onset was young; more common in north China; hemoglobinuria as an initial symptom was less common; thrombosis as a complication was relatively rare; the common causes of death were heart failure, infections and hemorrhage; and bone marrow picture might show mild dyshematopoiesis.

131 cases of epidemic hepatitis from two villages in Xinjiang, were admitted to the provisional infectious diseases hospital from February to April 1987. In 125 (95%) patients neither anti-HAV IgM nor anti-HBc IgM were positive. 118 (90%) were drinking water from a local stream of the Hotan River. The study was conducted on 125 patients aged from 5 to 90 years, with a mean of 26.4 years. There were slightly more males than females, a ratio of 1.5 to 1. The incubation period was roughly estimated to be 17 to 37 days (mean 24.8 days). All subjects were jaundiced. 12 patients (including 6 pregnant women) had cholestatic symptoms. Except one woman who died of postpartum bleeding, all patients ran a benign course without fulminant hepatic failure. Pathologic changes of liver biopsies from 35 cases included lobular damage and inflammation, ballooned hepatocytes with clear cytoplasm and delineated cell membrane which were named "clear cell". There were cholestasis of different degrees in the acute icteric stage and fatty changes in the convalescent stage. It was seen under the electron microscope that the livers of 8 cases had neither tubular structure nor sponge-like inclusions, but had nuclear changes including curled edge of nuclear membrane and nuclear heterochromatin condensed in masses. Liver biopsies were repeated in 7 cases followed up for 6-13 months, and hepatohistology was normal in 5. Of the other two cases there was one of each.

The electron spin resonance (ESR) spectra of active oxygen radicals produced during the respiratory burst of PMA-stimulated leukocytes and oxygen consumption are studied by ESR spin trapping and spin probe oxymetry for 31 times in 17 cases of malignant lymphoma. The results showed that the spectra produced from PMA-stimulated patients' leukocytes were predominantly spin adducts of DMPO-hydroxyl radicals (DMPO-OH). The decrease in oxygen consumption during respiratory burst suggested that respiratory burst function was inhibited. Kinetic observations of patient condition showed that respiratory burst and oxygen consumption were improved and even approached normal, when the patient was in remission or the condition was ameliorated. This paper is the first of its type and helps clarify the mechanism of malignant proliferation and metastasis.

Nine patients with rare epithelioid leiomyosarcoma in gastrointestinal tract studied in this series showed a long course of disease and survived for over 5 years even after evident metastasis occurred. Morphologically, the neoplasm was similar to epithelial tumors, so often misdiagnosed as carcinoma unless special strains such as reticulum, Van Gieson and Masson trichrome or immunohistochemical staining were given. Prognosis cannot be predicted only on the basis of histologic appearance because of its slow development, late metastasis and long survival time.

In the past three decades, among 831 staff (over 6,862 staff-years) under regular chest radiographic survey in the Grantham Hospital, Hong Kong, the cumulative incidence of active pulmonary tuberculosis requiring treatment was 27 (belonging to 23 staff). Number of cases detected per year ranged from 0 to 3. The mean duration from the beginning of employment to the first evidence of disease was 6.43 years. Although this incidence is low, yet the hospital caters for quite a large number of patients with bacteriologically confirmed tuberculosis, we feel that the active screening program for hospital staff should be maintained, and that review of the situation is also recommended.

We analysed the clinical and pathological features of 8 patients with spindle cell carcinoma of the conjunctiva and/or cornea. Four tumors arose from the cornea of atrophic eyes that had previous corneal ulcers. The tumors could be divided into 3 types according to their histopathological findings: fibrosarcomatous type, fibro-histiocytomatous type, and rhabdomyosarcomatous type. The 8 patients were misdiagnosed clinically and pathologically. Careful retrospective histopathologic examination using serial sections and in some tumors the addition of ultrastructural and immunohistochemical studies revealed the correct diagnosis. Follow-up data were obtained in 5 patients. Four of them were alive for 20, 10, 3, and 2 years respectively after surgery. One conjunctival tumor recurred 10 months after local excision.

Vertical frontal subtotal laryngectomy, a procedure that can remove as much as 90% of the larynx, was used to produce a functionally acceptable neolarynx with adjacent cervical skin flaps. Thirty-four patients with laryngeal carcinoma underwent this operation. All patients were staged according to their physical findings before operation. Of these patients, 1 was lost to follow-up and 2 died from other causes 6 months and 4 years after operation respectively. The remainder are living and well without recurrence. The longest follow-up was 8 years and the shortest 14 months. Laryngeal functions were restored completely in 27 patients and partially in 7. We conclude that the procedure is best suited for the removal of anterior commissure tumor extending from both vocal cords to the anterior 1/3 or the entire length of the true cords and that if the tumor extends to the supraglottis or subglottis, this procedure is adequate as long as the posterior part of the larynx is not involved, leaving a sufficient safety margin.

This paper reports the experience in the application of modified epiglottic laryngoplasty in 20 extended hemilaryngectomies for glottic carcinoma. The Kambic-Sedlacek-Tucker (K-S-T) technique using the epiglottis in glottic reconstruction can lead to early decannulation with an excellent airway, but a wide glottis formed after operation will increase the chance of aspiration and poor voice. Sphincteric function preservation of the glottis is a key point to success in partial laryngectomy. In order to prevent aspiration and to improve the quality of voice, the reconstructive technique as modified as follows: (1) Lateral margin of the epiglottis was sutured to the cricoid. (2) The superior edge of the epiglottis was lowered to reconstruct the ventricular band. (3) A cut was made at the anterior aspect of the epiglottis to reconstruct the anterior commissure. It is the experience of the authors that modified epiglottic laryngoplasty is better than the K-S-T technique for preservation of laryngeal function after extended hemilaryngectomy.

The effect of ginsenoside Rg1 and Rb1 on memory in mice and rats were studied using one trial avoidance learning method. The results showed that Rg1 and Rb1 improved acquisition, consolidation and retrieval of memory improved by amnestic agents. For the elucidation of the antiamnestic mechanism of Rg1 and Rb1, HPLC-ECD, isotope labelling technique, radioligand binding assay, RIA and oxygen radical generating systems were employed in experiments. Rg1 and Rb1 were shown to increase protein bisynthesis of brain and ACTH level of plasma and decrease 5-HT level or slow down the 5-HT turnover rate in rats. No specific binding of Rg1 and Rb1 to α1, α2 and beta-adrenoceptors, or to DA, 5-HT, GABA and M-cholinergic receptors was detectable. However, 5 days after ip Rg1 and Rb1, higher Bmas values were obtained for the brain membranes from treated mice than those from control mice. In the mean time, Rg1 and Rb1 did not lower and might even increase the contents of acetylcholine in the brain. Besides, Rb1 could antagonize lipid peroxidation in the brain. Besides, Rb1 could antagonize lipid peroxidation and scavenge oxygen free radicals as well as increase catalase and GSH-PX activities. Clearly, these data may serve as the basis for the elucidation of the antiamnestic mechanism of Rg1 and Rb1.

Blood and plasma viscosity, hematocrit and erythrocyte sedimentation rate were examined in 146 cases of chronic hepatitis and liver cirrhosis. In addition, blood fibrinogen and blood flow of the tongue and skin were studied in 123 and 46 of them respectively. The same indices were observed in 39 cases before and after treatment. The results showed definite hemorrheological patterns in different syndromes and therapeutic efficacy was also correlated with the changes in the mentioned indices. Thus it is believed that these indices of hemorrheology may serve as supplementary means for the differentiation of syndromes, evaluation of therapeutic effect and prognosis in chronic liver diseases.

It has been reported that the prevalence of cataract is much higher in plateau than that in plain regions. But the data are incomplete and can not be compared because of different examination methods and different diagnostic criteria. A small group of ophthalmologists was sent to Ganzi, Sichuan Province at the altitude of 3.393 m, and to Qinpu in the suburb of Shanghai which is at the sea level. In Ganzi 3,905 (91.97%) people including 822 Hans and 3,083 Zang and in Qinpu 3,101 (93.20%) were studied. Age-related cataract was diagnosed when there are cortical or nuclear, or mixed opacities; and aphakia due to previous extraction of age-related cataract. Direct method was used to standardize the data. The prevalence of age-related cataract in Ganzi is about 82% higher than that in Qinpu in all age groups; from age 16-60, the prevalence of age-related cataract in Ganzi is about 180% (in Hans) and 160% (in Zangs) higher than that in Qinpu. There is no significant difference in the prevalence of age-related cataract between the ethnic groups in Ganzi. In Ganzi, the sunshine hours per year are 1.28 times that in Qinpu, and the global radiation in Ganzi is 1.47 times that in Qinpu. The higher prevalence of cataract in Ganzi than in Qinpu may be due to the greater exposure to the sunshine on the Tibetan plateau. The differences in prevalence between males and females and between indoor and outdoor work are discussed.

A new embedding method in tendon suture was designed for interembedding of tendon ends to obtain interlock and strengthen antitension strength. Experiments showed that the embedding method might result in greater antitension strength than the conventional end-to-end method (Bunnell's method) or weaving method. Statistically, difference was significant. Dynamic studies on tendon healing showed that a prominent reaction of surrounding tissues occurred in 3 to 5 days after operation. In this period the antitension strength is likely to decrease and be broken with a rate of 28.1% in Bunnell's method, 5.25% in weaving method and 0% in embedding method. Clinically, the embedding method has been used in 125 cases of tendon-broken repair in which a 87.8% of good and excellent effect was resulted.