1984年 · 第97卷第07期

Sixteen patients (6 males and 10 females with a mean age of 38) were diagnosed as having pulmonary thromboembolism, except one case of pulmonary veno-occlusive disease. Baseline hemodynamic parameters were measured. Then after inhalation of 100% oxygen, measurements of the following hemodynamic parameters, e.g. pulmonary artery pressures (PAP), including systolic pulmonary artery pressure (SPAP), diastolic pulmonary artery pressure (DPAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), and total pulmonary resistance (TPR) were repeated at 10 minutes and 20 minutes. When the hemodynamic changes returned to the baseline9 20 ml of Salviae miltiorrhizae compound was injected slowly through catheter and showed a direct vasodilator effect on the pulmonary arterioles. The vasodilator effect persisted over 20 minutes and was better in mild and moderate groups of pulmonary hypertension than in severe group, so it is important to diagnose and treat these patients, as early as possible in order to prevent or postpone the development of pulmonary hypertension. As for the long-term effect of Salviae miltiorrhizae further investigation is needed.

Frequency distributions of sister chromatid exchange (SCE) and chromosomal breakage of the peripheral lymphocytes were studied in 25 patients during the treatment and 50 patients after recovery in order to know the effect of chemotherapeutic agents used for the treatment of choriocarcinoma and invasive mole. The 25 patients were observed consecutively for three courses. The results showed that there was no statistical difference between the patients with choriocarcinoma and invasive mole (p>0.05), and also no difference between different types of drugs used (p>0.05). However, SCE was higher after the first course. The incidence of chromosomal breakage after chemotherapy was twice as high as that before treatment. These indicate that during treatment, chemotherapeutic agents did induce some damage to the peripheral lymphocytes. This damage, however, would only last for 2 years, because observation made on the 50 recovered cases revealed a return to normal in SCE and chromosomal breakage 2 years after recovery.

Twenty-seven brains of patients with cerebrovascular disease were examined by computed tomography (CT) and studied correlatively with neuropathological findings. CT was done shortly before death in three cases. Twelve hemorrhages in the cerebral hemisphere and four of seven hemorrhages in the brain stem were detected by CT respectively. The three hemorrhages in the brain stem, not revealed by CT, were less than 0.2 cm in diameter. Seven of the 12 hemorrhages in the hemisphere showed hypodense zones on CT, and were proved microscopically to be necrosis instead of edema. The other 5 failed to show hypodensity on CT. Of these, 3 were due to small hemorrhage without necrosis, and 2 were hemorrhage with surrounding necrosis in repair with glial scar and gitter cells containing iron granules. Of 37 cerebral infarcts, only 19 were revealed by CT, a positive rate of 51%, and 18 missed by CT as they were small in size, special in shape and different in constituents. The significance of the presence of atrophy of the pes pedunculus on one side on CT is discussed in detail.

A patient with multiple intracranial hematomas, complicated by respiratory arrest, is presented. He was successfully treated by emergency craniotomy with removal or a large flap of the parietal bone for decompression.

74 patients undergoing mitral valve replacement with porcine heterograft were followed up. Before operation, 49 patients were in cardiac function Class III, and 25 in Class IV. Five patients (6.8%) died during the perioperative period. Of the survivors, 64 were followed up for more than 3 months and 3 for 4 years, averaging 24 months. Cardiac function was improved to Class I in 40 patients, Class II in 23, and Class III in 1. The mean value of cardiothoracic ratio before and after operation was 0.64±0.0,662 and 0.55±0.0,543 respectively (p<0.001). In 14 patients examined with two dimensional echocardiography preoperatively and 1 to 3 months postoperatively, reduction in size of the left atrium was more significant than that of the left ventricle. Nevertheless, the size of the right atrium and ventricle and the ejection fraction remained unchanged. Five patients underwent cardiac catheterization before and 3 to 5 months after operation. Their pulmonary capillary wedge pressure declined to normal, and the pressure and resistance of the pulmonary artery and the cardiac index were also improved. Thus, all-round judgement on the therapeutic effect of valve replacement should be made. As to the cardioversion of atrial fibrillation, our patients were compared with those who underwent mitral valvulotomy and those who did not undergo any operations in our hospital. The successful rate of cardioversion was similar to that of the latter two groups, but the recurrence rate was much lower than that of the two groups. The mechanisms of above findings are discussed.

Twenty-two cases of chaotic atrial tachycardia (CAT) in infants and children are presented. The features were as follows: the patients were all small infants; most cases were associated with respiratory disease; unless the CAT was associated with severe disease, the patients appeared well after the infection was controlled other than in a patient with ventricular septal defect and one with endocardial fibroelastosis, no evidence of congestive heart failure was noted; CAT reverted spontaneously to sinus rhythm after various lengths of time; other manifestations of atrial ectopic rhythm were also noted; antiarrhythmic treatment was ineffective; and prognosis was good in cases without associated se vere diseases. The electrophysiologic mechanism of this dysrhythmia remains unknown.

This article presents the clinical results of surgical treatment of symptom recurrence after curative radiotherapy for esophageal carcinoma in 54 patients. The overall resectability rate was 75.9% and the resection mortality rate 21.0%. Pneumonia, anastomotic leakage, and empyema were the three major complications, occurring in 26.8%, 17.1%, and 17.1% of the cases. Pneumonia was the main cause of postoperative death. The 5-year survival rate was 26.1% after surgical resection and 30.4% after radio therapy. These results compare favorably with those achieved by radiotherapy alone and may strengthen the rationale for combined preoperative irradiation and surgery in esophageal carcinoma. Whenever recurrence is suspected or severe stricture occurs after curative radiotherapy, surgery is necessary for localized lesions and should be done if the patient's general condition is satisfactory and there is no sign of distant metastasis.

Mitochondria from 20 patients with acute leukemia were studied ultrastructurally and compared mainly with those from patients with non-leukemic disorders. The cristae/diameter (qiD) ratio was used to quantitate the destruction of cristae. The C/D ratio in patients with acute leukemia (Mean 0.921, SD=0.31) differed significantly from that in normal controls (Mean=1.553, SD=0.389, p<0.01) and even more from that in patients with non-leukemic disorders (Mean=1.877, SD=0.281, p<0.001). No significant difference in C/'D ratio was found be tween acute leukemia and preleukemia (Mean=0.956, SD=0.144, p>0.8). We believe that when the C/D ratio is less than 1.332, a diagnosis of acute leukemia or preleukemia can be made if the clinical findings are consistent. This is the first time that a quantitative criterion for electron microscopic diagnosis of acute leukemia and preleukemia is available. The C/D ratio is also of prognostic value (r=0.9 p<0.01) in acute leukemia.

This paper reports 21 cases of eosinophilic fasciitis and emphasizes that localized inflammatory and sclerotic changes in the deep tissues characterize this disease. We propose the name sclerotic fasciitis for this condition to reflect its specific pathologic changes. This disease is an especially deeply situated type of scleroderma, somewhat similar to localized scleroderma. The ultrastructural study of myofibroblasts in this condition indicates that it may be closely related to proliferation of collagen fibers in the fascia. Patients were treated with traditional medicinal herbs in accordance with the traditional Chinese medical principle of stimulating blood circulation to end blood stasis. Therapeutic results were satisfactory.