1983年 · 第96卷第05期

From June 1959 to December 1980 1,187 consecutive cases underwent vantricular septal defect (VSD) closure in our department. The operative mortality was 4.8% (VSD with pulmonary hypertension 13.1%, VSD without pulmonary hypertension 1.8%). 80% of early deaths in the series were due to postoperative complications. 572 have been followed up from 6 months to 19 years (mean, 3.5 years). The late results are divided into 3 groups: good (84.2%), fair (11.3%) and poor (4.3%). We analyzed the causes of early and late poor results which were largely related to VSD with pulmonary hypertension and postoperative complications with the major technical factors. The operative technic of repairing membraneous VSD through a right atrial incision and treatment of VSD with pulmonary hypertension are discussed, with proper patient selection in the latter category stressed. Improvements in equipment and surgical technic are necessary.

The relationship between HBsAg and HBcAg distribution in cancer cells and hepatoma grading is reported. On the basis of the morphology, atypia and frequency of mitotic figures etc, primary hepatocellular carcinoma is divided into 3 grades (well, moderately and poorly differentiated). Among 125 cases of hepatoma, 2:4 (19.2%) are Grade I, 62 Grade II (49.6%) and 39 (31.2%) Grade III. Positive HBsAg and HBcAg cancer cells are detected not only in well differentiated hepatoma, but also in moderately and poorly differentiated forms. Among 12 hepatoma cases (9.6%) with positive HBsAg demonstrated by immunofluorescence, 2 are Grade I and 5 each Grades II and III. Of 11 positive HBcAg (8.8'70) cases de- monstrated by immunoperoxidase, 1 is Grade I, 7 Grade II and 3 Grade III. This suggests that HBAg can be replicated not only in well differentiated hepatoma, but also in the poorly differentiated. Hepatitis B virus (HBV) is probably a kind of biologic carcinogenic substance, or an associated carcinogenic substance. Thus, prevention of HBV infection can minimize hepatoma incidence.

28 cases with urinary tract X-ray examinations after renal transplantation are reported. The purpose, method and findings of the X-ray examination are discussed. Measurement of the vertical length of the transplant is helpful in demonstrating compensatory hypertrophy, rejection or renal atrophy. As compared with the length of transplant in the film taken on the day of operation, a 15% increase in length may suggest acute rejection, but increase under 15% does not rule rejection out. If the length increases over 5 mm in 2 weeks, or over 10 mm in 3 weeks, rejection should be considered. Contrast examination of the urinary tract is of value in detecting postoperative complications. It is also valuable in the differential diagnosis of renal dysfunction and chronic rejection. Large-dose media urography is the method of choice. Arteriography demonstrates postoperative stenosis or renal artery obstraction. It is indicated in patients with postoperative hypertension and renal function impairment. It is also useful in evaluating the degree of rejection, the prognosis and in choosing the proper method of treatment.

A case of congenital ectopic intrathoracic kidney is reported. The diagnosis is confirmed surgically. As operation is usally unnecessary for most cases, misdiagnosis should be avoided by more precise examination.

Based upon recent anatomic concepts of the right suprahepatic space, 37 cases of right supra-hepatic space abscess (RSSA) are analysed by correlating the roentgenologic features with the operative findings, emphasizing the roentgenologic characteristics of gas within the abscess and liver rotation. The characteristics are crucial to RSSA diagnosis and localization. The mechanism of liver rotation is discussed with special reference to the roentgenologic features of localized RSSA. Correct interpretation of these features improves RSSA diagnosis and localization.

The epidemiologic complexity of influenza in 1977 was not known before. This paper describes influenza surveillance from 1977 to February 1978 in Shanghai through the establishment of influenza monitoring stations, isolation and antigenic analysis of influenza virus strains and serologic investigations. When the number of cases with upper respiratory tract infection and high fever recorded at the monitoring stations exceeded the critical level of the weekly nonepidemic period peak of the early months of 1977 it was predicted from antigenic and serologic studies that the influenza B and H3N2 viruses being antigenically similar to A/Beijing/75 would not cause a pandemic. After the new H3N2 variant A/Shanghai/56/77 appeared, the weekly incidence again exceeded the critical level in June. Taking into consideration the results of antigenic analysis and the antibody level in the population, an epidemic was predicted. This virus strain was isolated from a sporadic case l month before the epidemic. This is favourable for obtaining a vaccine strain in time and for taking preventive measures. The influenza A (H1N1) epidemic was chiefly limited to young people. The epidemic curve may persist above the critical level and show no significant peak. From January to February 1978, 2 subtypes (H1N1 and H3N2) were found to occur together for the first time in Shanghai. Problems in surveillance and prediction of influenza epidemics are discussed.

Slitlamp biomicroscopy and photomicrography show the conjunctival plexus, anterior ciliary arteries, emissary veins and episcleral plexus. Their morphologic characteristics, aqueous vein distribution, superficial and deep aqueous vein classification and examination methods are preliminarily described. Dilation and microaneurysm formation are valuable diagnostic signs in hypertension.

The authors introduce a new, convenient and precise method for localizing multiple metallic intraocular foreign bodies. It has the advantages of less superimposition of bony shadows of extraorbital foreign bodies avoiding difficulty in correlating each multiple foreign body on frontal and lateral view films. This method has been proved accurate by simulation of orbital multiple foreign body localization and clinical application. It is a new way of solving the problem of localizing multiple metallic intra-ocular foreign bodies which are not able or hard to locate by other means. It can not locate some foreign bodies of lower density casting indistinct shadows.

A case of gastric leiomyoblastoma aSSOCiated with multiple pulmonary chondrohamartomas is reported with a review of the literature. Diagnosis is confirmed by thoracic operation, suggesting that gastric leiomyoblastoma patients with chest film shadows should not be diagnosed arbitrarily as metastatic tumors. The possibitity of chondrohamartoma should be considered and exploratory thoracotomy performed. Prognosis is good in most cases (80%).

A genetic factor is found in late stage schistoisomiasis japonica, a greater number of blood group A patients being found.