1983年 · 第96卷第07期

This article reports 310 cases of Behcet's syndrome seen from 1958-1981 in the Dermatology Department, now the Institute of Dermatology, Shanghai First Medical College. The syndrome is considered to be a multi-systemic disease affecting 4 chief areas: the oral cavity (99.0%), skin (96.8%), external genitalia (73.6%) and eyes (39.4%). In this series, joints are involved in 189 (60.9%) among which 157 (83.1%) have knee joint involvement. Therefore, the joint may also be included in the chief affected areas. Other systems such as the cardiovascular, gastrointestinal and neurologic systems or other organs are less commonly affected. In the 310, a group of 26 in which the 3-4 chief areas are simultaneously or successively affected within 3 months accompanied by more severe general condition, is considered the acute type while the rest, with areas affected in 6 months to 21 years with milder symptoms, are chronic type. Both types run a chronic course with a tendency to ameliorate after 14 years and chiefly involves simultaneous or successive attacks on 3-4 chief areas, repeated recurrence, and chronic course. Characteristics of erytheinatous halo around the nodules, folliculitis-like lesions, atrophy of tongue tip fungi-form papillae and positive needle puncture phenomenon are helpful in diagnosing the disease. Laboratory findings reveal increased ESR, mucoprotein and ceruloplasmin in the majority with some positive cryoglobulin determinations. Immunologic examinations show decreased cellular immunity. Hemorrheologic determination and microcirculation of nail fold and tongue tip show increased microcirculatory blood viscosity. Histopathologic examination of nodular skin lesions show that the disease process is located mainly in the connective tissue of interlobular septa of subcutaneous tissue and primary vasculitis of arterioles, venules and capillaries of the middle and lower dermis with abscess-like formation. The etiology remains obscure.

Acupuncture is a safe and effective conservative treatment for acute appendicitis. 633 acute appendicitis cases were treated by acupuncture in this hospital during September 1958 to June 1961. The immediate effects were 62.4% cured, 31.3% improved and 6.3% results unavailable, total effective rate 93.7%. As of June 1980, 461 had been followed up and the long-term results were 179 (38.8%) retained their appendix, 272 (59.0%) had undergone appendectomy, of which 39 (8.5%) were due to acupuncture treatment failure, 227 (49.2%) to recurrence and 6 (1.3%) had appendectomy incidentally when operated upon for other abdominal diseases. 10 (2.2%) died of other diseases. Among 179 intact cases, 145 (81%) remained well without further recurrent symptoms after discharge, while 34 (19%) had recurrence without operation during follow up. 227 underwent appendectomy due to recurrence, 62.2% within 2 years and 81.9% within 5 years. Factors influencing long-term effect are analyzed.

Acute myocardial infarction (AMI) and sudden coronary death (SCD) were studied in a Beijing western suburban community from 1974-1980, having an annual average population of 70,688 with equal sex distribution. The average annual AMI incidence is 27.9 per 100,000 population with a higher rate in males (36.7) than in females (19.0). A tendency towards increased incidence in later years is noted. The average annual mortality rates for AMI and SCD are 6.9 and 7.1 per 100,000. 9 of the 34 AMI deaths and 32 of the 35 sudden deaths occurred outside hospitals. About two thirds of the patients died suddenly before even reaching either a health station or local outpatients clinic. The data further supports the importance of primary prevention of coronary heart diseases and better prehospital care of those with acute coronary attacks.

Among the recent development in cardiology the most important is in technology. These include two-dimensional echocardiography, cardiac nuclear imaging, percutaneous transluminal coronary angioplasty and dynamic spatial reconstructor. Other significant advances are the introduction of new pharmacologic agents such as calcium-ion antagonists and antiplatelet agents in the treatment of coronary artery spasm. Certainly, further progress will be made through close integration of technology, pharmacology, basic science and medicine.

Malate dehydrogenase (MDH) isozymes in S japonicum (Chinese mainland strain) are separated by disc electrophoresis using polyacrylamide gel, 3 sharp bands referred to as MDH1, MDH2 and MDH3 are obtained. This shows that the MDH isozyme pattern in the Chinese mainland strain of S japonicum is quite different from those of the Yamanashi, Taiwanese, Philippine and Indonesian strains and also from that of S mansoni (Puerto Rican strain).

This paper presents nasopharyngeal malignancy incidence rates in a high risk area of the Pearl River Delta, Guangdong province. The mean standardized incidence is 18.12 per 100,000 population per year for both sexes, 25.60 in males and 11.05 in famales. Carcinoma predominates (99.65%), sarcoma (0.26%) ranks second with 0.09% unclassified. Poorly differentiated nasopharyngeal carcinoma accounts for 93.13%. Well differentiated undifferentiated and others are rare (6.52%). The poorly differentiated is subdivided into poorly differentiated squamous cell carcinoma, vesicular-nucleus cell carcinoma and poorly differentiated adenocarcinoma, the former being the principal type.

From a review of 60 cases of tarsometatarsal dislocations or fracture dislocations, the authors realize that careful X-ray analysis can detect incomplete dislocation. X-rays with the foot in 60° eversion help in diagnosing dorsal displacement of the first or second metatarsal base. For exploring vessels in cases complicated by circulatory embarrassment, the dorsalis pedis artery must be explored first from the dorsal foot wound in compound injuries, while the posterior tibial vessels must be first explored in closed injuries. Internal fixation with Kirschner wire is insufficient to counteract the tension exerted by muscular pull. Percutaneous suture with stain- less steel wire provides sufficient force for good reduction. Following tarsometatarsal joint arthrodesis, care must be taken to mould the cast so that immobilization ensures good foot alignment preventing deformity.

This paper reports a case of refractory amebic liver abscess resistant to treatment and reviews the literature briefly. The causes of difficult cure were multiple. First, thickened pus cavity wall prevented drug penetration resulting in insufficient drug concentration to kill the ameba, so the disease persisted. Immune deficiency and drug resistance were also considered. Direct emetine injection into the pus cavity is recommended.

The diagnostic and therapeutic experiences of 13 reoperated cases of insulinoma and islet hyperplasia are reported. Among a total 82 cases, 13 (15.9%) were reoperated upon, but this rate was as low as 6.1% in the hands of the authors. The causes for reoperation are: failure to find the tumor in the first operation 6 cases; mistaking lymphnode for tumor on frozen section 2; missing 1 of multiple tumors 1; new insulinomas developed many years after removal of the first tumor 1; no tumor was found at reoperation in 3, 2 of whom were identified as islet hyperplasia, while the reason for hypoglycemia in the other case was unexplained. Analysis shows that in 8 of these 13 cases, reoperation could have been avoided had the first operation been managed properly. Measures to prevent unnecessary reoperation are directed toward tumor localization before exploration using such technics as selective abdominal arteriography, percutaneous transhepatic or intraoperative portal blood sampling for insulin assay. However, thorough examination of the entire pancreas during operation remains the fundamental and key measure to finding insulinoma.

12 polycythemia vera (PV) patients treated with iv drip harringtonine in 14 treatment courses all achieved complete remissions (CR) in a median 60 days. 4 relapsed, 2 of these retreated with harringtonine alone again achieved CR. The harringtonine median total dose is 98 mg. Follow up shows that harringtonine is a safe reliable new PV therapy, comparing favorably with the other PV treatments. It has not caused acute leukemia sequelae as some other anti-PV drugs.