1984年 · 第97卷第08期

A modified technic of jejunojejunal anastomosis was used in treating a patient with severe ascending infection due to reflux following Roux-en-Y common-bile-duct-jejunostomy in 1975. Since then this technic has been applied in 116 patients without occurrence of ascending infection due to reflux. In 22 patients, postoperative barium meal examination revealed no reflux of barium. Another patient who had a liver cyst and severe ascending infection after Roux-en-Y cystojejunostomy was treated in 1981 by the modified technic of jejunojeunostomy. The reflux was prevented and the infection was controlled. Observations at the operation confirmed the author's explanations for the mechanism of reflux.

Based on an intensive study of the process of development of malignant gestational trophoblastic neoplasms, a clinical staging is proposed. The process of development involves 4 steps. The disease begins in the uterus and then invades the parametrium, adnexa and/or vagina. From the pelvic organs the tumor spreads along the venous pathway to the lungs. From the pulmonary metastases, the tumor cells may further disseminate through general circulation into other organs and tissues all over the body. These observations constitute the basis of the present staging system for malignant gestational trophoblastic disease. When the lesion is limited to the uterus, it is categorized as Stage I. When it has extended outside of the uterus but is still confined to the genital organs, it is categorized as Stage II. As it metastasizes into the lungs, it is categorized as Stage III. When it develops into generalized metastases following pulmonary lesions, it is categorized as Stage IV. Through long-term clinical use and recent reevaluation, this classification has proved to be simple, rational and practical and will meet all the purposes of a clinical staging system.

Since 1964, we have used an electro-controlled heating chamber in treating chronic lymphedema of the extremities for 1,045 patients. The effective rate of such treatment was 68.3%, better than any other surgical methods used today. Lymphangiography, 131I-HSA clearance test, radioactive Au scanning of lymphnodes and measurement of deep tissue tem perature were carried out before and after heating, verifying recovery of the damaged lymphatics, regeneration of new lymphatics, recovery of normal function of lymphatic wall to absorb the large molecules of serum albumin, and reestablishment of 1ymphatic drainage.

346 surgically verified cases of tetralogy of Fallot were reported, in which 316 had subcristal VSD and 30 subpulmonary VSD. After reviewing literatures and correlating the surgical with angiocardiographic findings, the authors put forward the characteristic angiocardiographic appearances of these two types of VSD. Image of crista supraven tricularis is present in subcristal type while absence of this image and high position of the aortic root indicate subpulmonary VSD. A knowledge of these features is absolutely essential in accurate localization of the defect before operation.

The acute attack of congestive angle-closure glaucoma is often accompanied by a moderate aqueous flare and cellular response of the anterior chamber, but complication with hypopyon is rare. So far as I know, no cases of hypopyon during the advanced stage of glaucoma in patients who had undergone anti-glaucoma operation previously, have ever been reported in the world literature.

Dipygus is a rare malformation. We encountered a case in 1980, and it is reported here-with.

19 species of mycobacteria cultivated both in Löwenstein-Jensen and Dubos medium and observed by electron microscopy and ultrathin section are reported. The pathogenic mycobacteria in Löwenstein-Jensen medium are rodlike or short rodlike in shape, whereas the nonpathogenic mycobacteria grown in the same medium appear thick, short rodlike or spherorodlike. EM 400 energy dispersive X-ray spec troscopic analysis of mycobacterial cells reveals that the elementary potassium and calcium content is somewhat higher in metachromatic granules than in cytoplasm. In addition, mesosome within mycobacterial cells grown in liquid medium is more frequent than in those grown on solid medium. The mesosome outline is well-defined on oblique sections but on longitudinal or transverse sections, the outline is somewhat less clear.

The in vitro effect of thymic polypeptide (TP) on active E rosette forming cells (EaRFC) was studied in 30 children with asthma and 15 with respiratory virus infections. 16 patients were treated with TP. The baseline average percentage of EaRFC in 31 normal controls was 27.1±3.4%. EaRFC % was significantly decreased in asthmatics (19.1±5.0%, p<0.01) and patients with respiratory virus infections (17.4±3.9%, p<0.01). The average percentage of EaRFC showed a significant increase after incubation with TP in vitro in the two groups of patients, and their stimulation rates were 63.1±26.8 (p<0.01) and 64.7±23.3 (p<0.01) as compared with 28.4±8.4 (P<0.01) in the the controls. The results suggested that a depression of T cell function and a high response to TP in vitro existed in these diseases. The fact that TP exhibited a better short term clinical effect in patients with low EaRFC level and high stimulation rate in vitro suggests that TP plays an important role in correcting immune imbalance and enhancing body defense against viral infections by ameliorating cellular immune dysfunction.

A girl suffering from primary hyperparathyroidism associated with tuberous sclerosis was reported. The cutaneous manifestations of the latter syndrome had been apparent since the age of two. Brain lesions were demonstrated by computerized tomography. A parathyroid adenoma was excised on neck exploration. The association of these two diseases is apparently very rare, we have seen no reports of these cases. This case may represent a rare variety of the so-called apudoma category.

The frequency of HLA antigens was studied in 30 advanced cases and 30 early chronic cases of schistosomiasis japonica, and was compared with that in the healthy controls. The study showed that HLA-A1 813 were closely associated with the advanced cases (X2=36.90, CP=1.631×10-10; X2=3.39, CP=0.00898, respectively) and the frequency of HLA-B8 was comparatively higher in the early cases, but the difference was not statistically significant. This finding indicates that the involvement of immunogenetic factors is possibly related with the development of the advanced-stage schistosomiasis japonica.