1980年 · 第93卷第11期

81 cases of insulin resistant diabetes classified into idiopathic and secondary types are presented. Resistance remission manifests crisis or lysis. Identification of serum insulin antibody and antagonist is briefly presented. Based on the series and the literature data, the criteria, classification, pathogenesis and treatment of insulin resistance are discussed. The principle of treatment is that control of the primary disease should be stressed in the management of secondary insulin resistance and at the same time adequate insulin dosage is indicated to bring the disease under control. As for idiopathic insulin resistance, particularly the hypersensitive type caused by insulin antibody or autoantibody to insulin receptors, oral hypoglycemic agents, glucocorticoids, immunosuppressive agents and tris buffer may be employed in addition to various insulin preparations.

Three cases of bone tumors or tumor-like lesions are reported. They are resected radically and the massive bone defects are filled with vascularized free fibula transfers. All achieve early union. No atrophy or nonunion between the graft and recipient bone occurs. Early functional restoration is gained. Graft isolation and surgical procedure are discussed. The authors believe that this procedure has bright prospects not only in bone tumors but also in bone defects or nonunion due to other causes.

Taylor reported clinical use of vascularized bone grafts first in 1975. 212 dried human fibulae for total length, circumference and nutrient artery were studied. Angiographies were then done on fresh limb specimens after 6 amputations to locate the branches of posterior tibial vascularization, find out the peroneal artery diameter, etc, locating the favorable spot for anastomosis. Bone deficiencies after osteomyelitis, tumor or trauma in 7 patients in which free vascularized bone grafts were used, the length of isolated fibula varying from 10-20 cm are reported and postoperative 113M In-EDTMP examination showed that blood supply to the grafts were adequate and bone healing and limb functional restoration satisfactory. The vascular supply of living bone and heterogenous living fibula grafts for limb tubular bone loss as the procedure of choice are discussed.

From 1965 to 1976, lobectomy was performed in 29 cases of choriocarcinoma with pulmonary metastasis resistant to chemotherapy. Following surgery 17 survived, 9 of whom have been followed up for more than 5 years, they are in good health The factors favorably influencing prognosis are: a. solitary lesion on chest film, b. negative urinary HCG determination by toad concentration test or hemoagglutination inhibition test after chemotherapy, c. improved surgical procedure-ligation of the pulmonary veins first to prevent dissemination during surgical manipulation, d. presence of fibrotic tissue capsule around the lesion on pathologic examination of the resected lung specimens and e. no elevation or only temporary elevation of urinary HCG level after surgery. Metastasis to other organs did not contraindicate lobectomy provided the metastatic foci had been already controlled by chemotherapy. In our series, among the survivors there were 3 with metastasis to the brain, 1 to the bladder and 1 to the rectum.

Eleven elderly patients with immunoblastic lymphadenopathy or angio-immunoblastic lymphadenopathy with dysproteinemia (AILD) are presented. The disease is characterized by acute onset of constitutional symptoms, generalized lymphadenopathy, hepatosplenomegaly and immunologic abnormalities. The prognosis is unfavorable. Four patients in this series died of infection, which is a serious and often fatal complication due to inadequate defense mechanisms in these patients. The diagnosis is verified by lymph node biopsies in all 11 cases. Histologically, diffuse obliteration of the nodal architecture due to pronounced proliferation of small blood vessels and immunoblasts is the distinctive feature.

Decapitating decompression of polycystic kidney relieves local distension aching pain and renal hypertension satisfactorily, all 52 patients in this series being relieved of pain and the great majority with complicating hypertension having their blood pressure lowered. Some with bilateral decompression had blood pressure controlled at normal for 7 to 12 years. We believe that if the patients are properly selected, this operation relieves symptoms, delays progression of the polycystic condition and prolongs life.

This paper presents 30 cases of cor pulmonale in children, showing that the condition has poor prognosis, progresses rapidly and death occurs in 40.0% within a short period of hospitalization. In our country the most common causes of pediatric cor pulmonale are chronic pneumonia, bronchiectasis and pulmonary tuberculosis after measles and whooping cough. The fundamental measures to be taken in the prevention of pediatric cor pulmonale are therefore prevention and treatment of measles, whooping cough and other infectious diseases aiming at complete resolution of pulmonary complications.

30 male and 8 female peasants were divided into 4 dietary groups: eating opaque-2 maize, conventional maize, conventional maize plus 0.6% sodium bicarbonate and conventional maize plus 10% soybeans. They were allowed 600 gm maize a day as the only staple. The fasting 2 hour morning urine was collected once in the pre-experimental period and every 10-15 days during the 40 days of experiment. The protein content of opaque-2 was 23% higher than conventional maize and equivalent to that of conventional maize plus 10% soybeans. The free niacin content of opaque-2 maize was 3 times higher than that of conventional maize and 50% higher than conventional maize plus 0.6% sodium bicarbonate or plus 10% soybeans. The tryptophan content of opaque-2 maize was about twice that of conventional maize. The total amount of free niacin from niacin plus tryptophan derived niacin in the experimental diets were measured and only the opaque-2 maize group consumed more than 8.8 mg niacin equivalents and the opaque-2 maize and conventional maize plus 10% soybeans groups consumed more than 6.6 mg per 1,000 kcal. After the 40 day experiment, there were significant differences (p<0.05) in the levels of urine N-methyl niacinamide (N-M N) in the opaque-2 maize group (0.22±0.03 mg) and conventional maize group (0.12±0.01 mg). The average excretion in 16 healthy staff members consuming high niacin diets in a local institution was 0.24±0.04 mg. There were no significant differences in N-M N excretion in the other 3 groups. Therefore, opaque-2 maize should be a valuable source of niacin for populations subsisting on large quantities of maize. It is recommended that animal husbandry be encouraged in all areas where pellagra is endemic to increase the production and therefore consumption of meat, milk and milk products as a long-term project. However, encouraging the planting of opaque-2 maize or adding 10% soybeans to a conventional maize meal would supply enough niacin and may be the simplest economical way to fight against pellagra just now.

Lymphocyte E rosette formation in cerebrospinal fluid (CSF) and blood samples from 23 patients with different neurologic disorders is investigated. 6 individuals, not diagnosed as having immunopathologic disease with normal CSF, were selected as controls. The percentage of rosette forming cells (RFC) was within the range of 58-78% (mean 66.3±7.6%) which is very similar to the blood values. A very significant correlation between CSF and blood values was observed (p<0.01). However, no evident correlation between CSF and blood values (p>0.05) was found in 16 samples from the remaining 15 patients with autoimmune diseases of the nervous system and neurologic disorders possibly causing immunologic abnormalities. Among 9 patients with autoimmune diseases of the nervous system, 1 case of optic neuritis showed increased RFC values with very high CSF values (86% and then 93%) and no amelioration was observed. The RFC values in 5 idiopathic polyradiculoneuritis patients seemed to change with the severity and course of the disease, i.e. patients in the acute stage or who were seriously ill had increased percentages in CSF and/or blood and recovered patients or those with mild illness had values within normal range. Two patients with systemic myasthenia gravis had very low CSF RFC values of 3% and 39% but 1 with only ocular symptoms had an increased CSF RFC value of 86%. Among 8 patients with neurologic disorders possibly causing immunologic abnormalities, 1 with viral encephalitis had the highest CSF value of 95% and 1 with glioma of the temporal lobe had an increased CSF value of 85% but a lowered blood value of 32.5%. The authors suggest that not only the abnormal RFC values but also the abnormal differences between CSF and blood values may be of significance. The evident differences between CSF and blood values in pathologic conditions may be caused by the sequestration of blood-brain barrier. Abnormal rosette formation is considered to be due to changes in cyclic nucleotides (cAMP and cGMP) levels in different diseases.

An evaluation of population screening to detect hepatocellular carcinoma (HCC) is made by comparative study of 66 cases of pathologically proved mass survey HCC and 220 of pathologically proved clinical HCC treated during the same period from 1972 to 1978. Remarkable ultimate outcome is obtained in mass survey HCC, compared with clinical results. 1 year survival rate is 64.2% vs 14.8%, 2 year is 39.3% vs 7.4% and 3 year is 28.9% vs 5.5%. These encouraging results are attributed to changes in patients' disease stage patterns as well as therapeutic measures employed. The proportion of subclinical HCC is much higher in the mass survey group (71.2% vs 0.9%), as is the proportion of small HCC (56.8% vs 7.7%). Resection is successfully performed in 56.1% of mass survey found HCC, compared to 17.7% in clinically treated HCC. It is concluded that alpha feto-protein (AFP) screening by high sensitive assay is of significant value in early HCC detection and prognosis is improved with early treatment, especially after early tumor resection, its 1, 2 and 3 year survival rates being 79.1%, 67.8% and 61.6%. The pathologic and immunologic basis of early resection are described.