1984年 · 第97卷第03期

55 cases of von Willebrand's diseases (VWD) were studied on the basis of factor VIII related activities (VIII:c, VIIIR:Ag, VIIIR:WF/RCF) determinations. Apart from typical VWD, many variants were found with one or more normal factor VIII related activities, making classification of the disease very complex. Crossed immunoelectrophoresis (CIEP) performed in 15 cases revealed both quantitative and/or qualitative VIIIR:Ag defects. Among 25 families with available pedigree information, 21 showed autosomal dominant inheritance, one autosomal recessive inheritance and 3 negative family history. The variability in the clinical, biochemical and genetic aspects indicates that VWD is not a homogeneous disease, but a syndrome which represents a group of disorders related to factor VIII complex abnormality.

The anticomplement immunoenzymatic method (ACIE) is used to detect nasopharyngeal carcinoma in EBV IgA/VCA antibody positive individuals in a high risk area. Carcinoma cells with EBNA were found in 4 of the 64 antibody positive individuals. Cytological and histological examinations showed that stage I poorly differentiated carcinomas were in 4 cases. The intervals between the first bleeding for serology and nasopharyngeal carcinoma (NPC) diagnosis were 8-9 months. No further elevation of IgA/VCA antibody appeared during this period. The result of this study confirm the value of anticomplement immunoenzyme for detecting early stage NPC.

A patient with a sporadic mild case of typhus fever assume on epidemiological and clinical grounds to be murine typhus was tested for his infectivity for normal adult human body lice, Pediculus humanus var corporis, during a period of 5 days from the 9th through the 13th or last day of the disease. One out of 105 mice (0.95%) was later found to have developed a small number of morphologically and tinctorially typical rickettsiae. A guinea pig, which was inoculated in succession with two suspensions of ground lice showing and not showing definite rickettsiae in smears, twice gave negative complement fixation with epidemic antigen but positive fixation with murine antigen at a titer of 1:40. As far as the authors are aware, this is the first report to show that by feeding on a mild case of murine typhus, lice became infected with typhus rickettsiae which proved serologically to be R mooseri. It is therefore suggested that under natural conditions when lice feed continuously on severe cases of murine typhus throughout the febrile disease, a sufficiently higher percent of lice may become infected with sufficiently larger numbers of typhus rickettsiae to give rise to outbreaks of louse-borne typhus in louse-infested communities.

Blood phenobarbital (PB) and diphenyhydantoin (DPH) levels are determined by a China-made Model 751 ultraviolet spectrophotometer in the series of 343 cases of epilepsy, with the relationship between dosage, blood level and clinical results studied. Drug blood level is considered more accurate than dosage in reflecting the clinical effect. The pharmacokinetic indices including the therapeutic blood level and toxic blood level of PB and DPH, time required to reach stable blood level and blood level fluctuation after each dose, serve as the basis for working out a reasonable, individualized drug regimen. The epilepsy complete control rate reached 78.9 to 83.3% in new cases and 55.7% in recurrences. Monitoring blood level of antiepileptics is a critical parameter in pediatric treatment. Our study shows that ultraviolet spectrophotometry is suitable for clinical application, it simultaneously determines both PB and DPH levels, the most commonly used antiepileptics. It should be popularized so that more epileptic children can be treated properly. High pressure liquid chromatography and enzyme multiplied immunoassay are not yet available in China.

25,597 cases of heart disease admitted to 3 general hospitals in Shanghai in the years 1948-1979, were analysed. This analysis showed a remarkable rise of the relative proportion of ischemic heart disease (IHD) from 6% in the first period (1948-1958) to 29% in the third period (1972-1979). Among the various factors which might be held responsible for this increased proportion of IHD in the total of hospital admissions, our observations on the recent rise of the serum cholesterol levels in healthy Chinese, compared with those in the 50s and 60s may bear certain relationship to this problem.

We performed end-to-side mesocaval shunt for 20 portal hypertensive patients with rebleeding after splenectomy. The bleeding was immediately controlled in 7 treated by emergency mesocaval shunt. There was no operative death, and none of the patients developed encephalopathy. Follow-up from 4 months to 7 years revealed that 3 deaths were due to acute massive hemorrhage, hepatic failure and carcinoma of the stomach respectively. Two patients with rebleeding treated by partial esophagogastrectomy are living and well. The conditions of the other 15 patients are fairly good too. Our experience shows that mesocaval shunt is effective in the treatment of rebleeding in portal hypertensive patients after splenectomy. But to further study the hemodynamic changes and long-term results, more patients and longer period of follow-up are required.

Although trench fever is now known to be almost worldwide in distribution, it usually exists unrecognized in louse-infested communities in peace time, and the disease may flare up in epidemic form in wartime. Inasmuch as physicians are generally unfamiliar with trench fever, the literature on the history, geographic distribution, symptomatology, pathology, etiology, immunity, diagnosis, epidemiology, prevention and treatment of the disease is briefly reviewed. Certain obscure phases of trench fever are noted and lines for further studies of the disease suggested. The question is entertained whether R rocha-lima, a rickettsia of hitherto undefined status, may represent a variant of R prowazeki acquired by lice feeding on typhus convalescents living under natural conditions and an intermediate stage in the transformation of R prowazeki in the direction of R quintana.

We surveyed the menstrual patterns of 131,410 Chinese women over 9 years old in 29 provinces, municipalities and autonomous regions. 129,226 (98.34%) had menstruated. Their age at menarche ranged from 9 to 21 years and averaged 15. Menarche occurred one year later on the average in rural than in urban women. The interval between menarche and second menstruation averaged 35 days, and a normal menstrual cycle usually was established within six months. The length of menstrual cycle averaged 31 days and was related to such factors as health status, weather, nutrition, psychiatric factors and physical labor. Menstrual periods ranged from 1 to 10 days and averaged 5 days. On the average, menopause began at age 49.5 in urban women and two years earlier in rural women. The age of menopause differed slightly between regions. The duration of climacteric symptoms after or before menopause averaged 2 years and varied among regions; but about 50% of women had no climacteric symptoms or dysmenorrhea. In general, the menstrual patterns of minority women were similar to those of Han women. However, in Korean women, the age at menarche averaged 16.56 years, and that at menopause averaged 47.46 years. In Tibetan women, the age at menarche averaged 16.84 years and duration of menstrual flow was 3 to 4 days.

It is now accepted that endotoxin cannot account for all the manifestations of septic shock. Moreover, endotoxic shock in dogs is quite different from septic shock in man. The consensus of opinion is that the clinical condition should be simulated in animals by inducing a s septic state with both septicemia and shock. We successfully produced such a model by injecting CaCl2 together with a mixture of E coli and enterobacter aerogenes into the hind limbs of dogs. Sequential observations on hemodynamics, respiratory function, oxygen delivery, acid-base balance, serum and RNC Na+ and K+ in model animals were done while they were conscious. Septic shock progresses from a high output-low resistance state (compensatory phase) to a low output-high resistance state (decompensatory phase) with a final low output-low resistance state (terminal state). Severe extrapulmonary infection demages the lungs morphologically and functionally, but lungs morphologically and functionally, but the severity of change varies. The relationship between cardiac index, oxygen consumption between cardiac index, oxygen consumption and arteriovenous difference in oxygen varies. Acid-base disturbance is closely related to the extent of lung injury. RBC cannot be considered a sensitive model for detection of cellular damage during sepsis.

The diagnosis of middle ear and temporal bone carcinoma continues to be difficult until the advanced stage, but with the development of complete temporal bone resection, patient survival is improved. This paper analyses 22 cases treated by this method from 1961 to 1980. Five patients (3rd stage) are living and well. Of the remaining 17 (4th stage), 6 are still surviving, a survival rate of 35.3%. The indications, contraindications and complications are discussed.