1984年 · 第97卷第05期

In high incidence areas of esophageal cancer the epithelial hyperplasia of upper digestive tract is also prevalent. Esophageal carcinoma usually develops through the mild and severe stages of hyperplasia, although reverse changes or recurring processes are frequently encountered. It was found that carcinogenic nitrosamines (dimethylnitrosamine, diethylnitrosamine, methylbenzylnitrosamine, N-l-methyl-acetonyl-N-3-methylbutylnitrosamine, etc.) were formed in fungus-contaminated foods from Linxian, and the Fusarioum moniliforme inoculated cornbread induced forestomach carcinoma in rats following prolonged feeding experiment. Trace amounts of B(a) P and PAH, and a nitroso compound, Roussin red methylester, were found in the home-made pickled vegetables (PV). Experiments showed the presence of a mutagen and/or carcinogen and promoter in PV extracts. Carcinogenesis of esophageal epithelium appears to undergo multiple stages. The epithelial cells may be initiated first by chemical carcinogens, nitrosamines and/or other fungal metabolites in moudly foodstuffs and those formed by reaction of nitrites and amines in vivo. The action of carcinogens, promoters and cocarcinogens or some other factors in food results in epithelial hyperplasia, and severe cases may finally develop into an early squamous carcinoma and invading cancer of the esophagus. It is important, therefore, to detect and to treat the precancerous lesions in order to bring esophageal cancer under control in high-risk areas.

55 patients (24 were male and 31 female; age range 12-75 years) with Crohn's disease were treated surgically. The lesions were single in 32 (58.2%) and multiple in 23 (41.8%). The distribution was: the small intestine, 26 patients (48.2%); the colon 20 (35.7%); and both 9 (16.1%). Most patients were operated upon for acute abdominal pain, intestinal obstruction, abdominal mass and intestinal bleeding. Five patients (9.1%) died during hospitalization, 49 were followed up for 0.5 to 32 years. Clinical cure was obtained in 22 (54.6%) of the resection group and in 4 (30.7%) of the nonresection group. Indications for surgical treatment are described and complications discussed.

An investigation on 40,824 cases of chronic stomach diseases carried out in 6 relatively high-risk and 4 low-risk areas of stomach cancer showed that adjusted prevalence rate of atrophic gastritis in the high-risk areas was evidently higher than that in the low risk-areas, and was significantly correlated with the mortality of stomach cancer. The free acid contents in fa.sting gastric juices in patients in the high-risk areas were decreased significantly, but the pH, the positive rate of nitrate-reducing bacteria and nitrite content were predominantly elevated. The correlation between the nitrite concentrations in gastric juices and adjusted mortality rates of stomach cancer was highly significant. Aspergillus versicolor was more frequently found in the gastric juices in these patients in the high-risk areas than in the low-risk areas and its presence was positively correlated with the severity of pathologic changes in the gastric mucosa. These findings showed that intragastric formation of carcinogenic N-nitroso compounds and mycotoxins and/or its metabolites produced in the hypochlorhydric and achlorhydric stomach may play major roles in the etiology of stomach cancer in China.

The wound bearing an infected synthetic vascular graft is considered to be impossible to heal until the graft iS removed. However, here is a report of a caSe with infected dacron graft exposed in the wound of left upper arm which was successfully treated by a skin-deep fascia flap graft with good result. The healing mechanism was discussed.

We treated a patient with primary huge cavernous hemangioma in the right atrium. The tumor body (10×8×5 cm) occupied about 75% of the right atrial chamber. It was resected successfully with cardiopulmonary bypass.

This article describes the epidemiology and antigenic drift of influenza A (H3N2) virus in Shanghai from 1968 through 1981. There was clear evidence of change in epidemiological characteristics around 1977. The epidemic due to influenza A (H1N1) virus in August 1977 affected mainly youngsters and children, but the HINI epidemic in 1981 affected mostly adults. The process of antigenic variation. of H3N2 virus and the relationship between H1N1 and H3N2 influenza epidemics are discussed on the basis of an analysis of influenza surveillance data in this city during these years.

The in vitro activity of furbenicillin and ampicillin against 383 strains isolated by clinical laboratories in Beijing was studied. β-lactamases were prepared from 62 resistant gram-negative organisms selected from clinics. The β-lactamase extracts were identified by the method of iso-electric focusing for studying enzyme stability of furbenicillin, ampicillin, cefazolin, cefamandole, and cefotaxime in a biological system. The results showed that the antibaoterial activity of furbenicillin against Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa and Enterobacteria cloacae was better than that of ampicillin. Cefotaxime was most stable compound to the β-lactamases among all of the antibiotics examined. The stability of furbenicillin and ampicillin to the β-lactamase extracts in the presence of clavulanic acid was similar to that of cefataxime. The synergism of furbenicillin and clavulanic acid against the resistant gram-negative bacilli was better than that of ampicillin combined with clavulanic acid. The results of the identification of β-lactamases used were similar to those reported in the literature, TEM-1 enzyme type being the most common type of the β-lactamases extracted from enzyme producing resistant gram-negative bacilli.

The prevalence of mitral valve prolapse in Chinese was determined by screening 156 healthy subjects and by patholobic examination of 86 adult autopsies. Mitral valve prolapse was found in 7.7% in the clinical study and 5.8% in the autopsy study. A slight female preponderance was noted.

100 patients with duodenal ulcer (84 men and 16 women) operated on by the authors with modified highly selective vagotomy (HSV) have been followed up for 8 years. There were no operative deaths. One patient suffered from gastric fistula due to ischemic necrosis of the lesser curvature, but had no other serious complications. The last follow-up after 8 years showed that 86% had excellent or good results. Of 3 patients classified as Visick Grade IV, 2 had recurrences and one was strongly suspected of recurrence, which was not proved by duodenoscopy. Good results followed abstinence from tobacco and salicylates. The corrected recurrence rate was 2%. In 2 patients recurrence was probably related to excessive antral denervation and gastric retention. Operation on patients with early stasis or pyloric obstruction enhances the possibility of gastric ulcer recurrence. The authors suggest the modified HSV as an initial elective surgical method for duodenal ulcer.

The research work on toxemia of pregnancy in Shanghai is reported, including the incidence of severe toxemia of pregnancy, pathogenesis, fetal placental function in toxemic patients, etc. The incidence of severe toxemia of pregnancy was 1.6% (severe preeclampsia 1.45% and eclampsia 0.15%) among 538,887 deliveries from 1975-1979. 60 cases of severe toximia were treated with full dosage of magnesium. sulfate 30 gm/24hr. In hemoconcentrated patients (hematocrit 35%) plasma expanders were used and their symptoms and signs improved rapidly. This may be due to the improvement in perfusion of viscera. Alertness must be maintained for symptoms of cardiac overloading. 22 pregnant women accompanied by essential hypertension were treated with Chinese herbal drugs for "invigorating blood circulation and eliminating blood stasis". We also treated 83 cases with combined traditional Chinese and western medicine with fairly good result.