1985年 · 第98卷第01期

Between 1974 to 1982, more than 500 anterior route multi-level diskectomies and interbody fusions were performed under acupuncture anesthesia for cervical spondylotic myelopathy in our department. Among them, 214 were followed up one year or more, averaging 3 years and 11 months. The ratio of male to female was 7:1. The mean age of onset was 50.1, while 81.3% of the patients were between the ages of 41 and 60. The disease mainly affects the middle aged. The previous belief that the incidence of the disease increases with age is misleading. The rate of excellent and good results was 74% in patients with less than 1 year's disease duration. This rate fell to 36% in those with more than 2 years' disease duration, best surgical results were achieved in cases of less than 2 years' duration. Myelography was valuable in diagnosing and localizing the lesion. The surgical results did not differ significantly in complete or partial block cases. The number of discs removed in 214 patients averaged 3.1. Three patients needed further anterior route operations as the number of discs removed at the previous operation seemed insufficient. 16 had ossification of the posterior longitudinal ligament (OPLL) and disc protrusion, the latter being the main cause of spinal cord compression and surgery should be aimed at the latter. In 5 cases the disease was associated with congenital anomalies of cervical spine. Protruded discs below or above the congenital anomalies were proved by myelography and removed. In all but one, who had platybasia, the result were good. In 9 cases extensive laminectomies were done due to narrowing of cervical spinal canal. No infection or injury of the recurrent laryngeal nerve or other important organs occurred. The rate of excellent and good results was 59.3%, fair 29%, no change 7.9%, worsening 3.8%. 40% of the patients returned to full-time work, 30% to part-time work or housework, 23% were independent but not working. The remaining 7% were dependent. The satisfactory results in our series lead to the conclusion that anterior route multi-level diskectomy and interbody fusion under acupuncture anesthesia is the operation of choice for cervical spondylotic myelopathy.

A new technic of one stage total auricle reconstruction was reported. The authors planned a skin flap with its pedicle from the preauricular region. The distal part of the flap, the subcutaneous tissue of the head skin, was used to cover the framework which was made of autogenous rib cartilage. From 1980 to April of 1982, 50 patients had been operated upon with satisfactory results.

55 cases of atrial septal defect (ASD) (5 ostium primum defect and 50 ostium secundum defect) diagnosed echocardiographically and surgically were reported. The important echo discontinuity of the interatrial septum, essential factor in the diagnosis and classification of the defects, was observed on the apical, parasternal and subxyphoid four chamber view with an incidence rate of 92.7%. The cardiac parameters obtained echocardiographically and surgically were highly correlated with r=0.72. The cardiac characteristic contour in patients with ASD, the differential diagnosis of different types of defects and the determination of the echo discontinunity are also discussed.

The immuno-enzymatic method was used and serum VCA-IgA antibody was detected in mass surveys. The relationship between the antibody level and nasopharyngeal carcinoma (NPC) and non-NPC lesions were studied. The results showed that in the NPC or non-NPC antibody positive group, the occurrence of atypical hypereplasia or metaplasia was higher than in the antibody negative group of non NPC patients and the antibody level in NPC atypical hyperplasia or metaplasia was higher than in simple hyperplasia or metaplasia, the increase being related to the mucous lesion stage. Thus we presume that NPC is closely related to atypical hyperplasia or metaplasia and that EB virus may play an important role in nasopharyngeal mucosal transformation or the development of malignancy.

Based upon the data obtained, the theory of bone marrow (BM) hemopoietic cells (seeds) and bone marrow microenvironment (BMM soil) was applied in clinical diagnosis and a new BM cytologic examination method, which includes hemopoietic BM free cells (by examining the differential count) and BMM (by examining the BM particle smear and its non-hemopoietic cells) was designed. In this way more information was obtained from routine BM examination.

This article presents 77 cases of African human trypanosomiasis found in Southern Sudan from 1980 to July 1981. They account for 6.1% of the total panosomiasis account for 6.1% of the total 1,252 patients found during this period. African human trypanosomiasis is classified into two types: Gam-biense sleeping sickness and rodesiense sleeping sickness. There is no definite difference in shape between the two types. But clinically, they are not the same; the former is chronic and the latter acute. Both have the same clinical symptoms characterized by irregular fever, frequent severe headache, marked fatigue and drowsiness during the day. The chief signs include anemia, frigid expression, somnolence, enlarged lymph nodes, tachycardia and arrhythmia, and hepatosplenomegaly. The laboratory findings are reduced hemoglobin and increased ESR. Trypanosoma is found during blood film, bone marrow film, lymph gland puncture fluid and cerebrospinal fluid examinations, which are essential to the diagnosis of trypanosomiasis. Experiments have proved that non-arsonate suramin and arsonate melarsoprol are the ideal medicines for the treatment of trypanosomiasis at present. The cure rate of the 77 cases is 92.2%, the improvement rate 3.9% and the death rate 3.9%. We believe that it is of special importance to train the local medical and health workers with epidemiological knowledge, diagnostic and curing skills of African sleeping sickness; to carry out mass health campaigns; to build up the people's health; to combine treatment with prevention; and to set up medical and health networks for the control of the outbreak and spread of trypnosomiasis.

This article deals with changes in serum glycine-conjugated cholic acid in various chronic liver diseases as measured by radioimmunoassay and com pares its value as a parameter with that of conventional liver function tests in the diagnosis of chronic active hepatitis and posthepatitis cirrhosis.

Extracrainial vertebral artery theoencephalo graphy shows definite differences in the middle aged and geriatric patients with cerebral arteriosclerosis and healthy young people. The method is of clinical value in diagnosing cerebral arteriosclerosis and estimating cerebral blood supply, but the full value of the formulae used in evaluating the test results must be studied further.

Fifteen cases of male breast cancer were found among 725 cases of breast cancer treated during the 10 year period ending in December 1983 at Nanjing Gulou Hospital and the Jiangsu Cancer Institute. The average age of this group was 59.3 years with peak incidence 68 years later than in females. A breast mass was the earliest, most important symptom. The duration of symptoms before treatment ranged from a few days to 6 years, averaging 31.33 months. Differentiation of male breast cancer from gynecomastia is important, especially in males beyond middle age. Male breast cancer is of the same pathological types as seen in females. As with female breast cancer, surgical excision, especially radical mastectomy seems to be the treatment of choice. Supplementary therapeutics including radiotherapy, chemotherapy, hormone therapy and traditional Chinese medicine are beneficial in appropriately selected patients. Factors influencing patient prognosis include type of treatment, clinical stage of the disease, histological type of tumor, grade of malignancy, presence or absence of axillary lymph node metastasis, degree of pericancerous lymphoid reaction and elastic fiber reaction. In other words, the prognosis is deter mined by many factors, all of which should be considered when evaluating patient's outcome. How these factors influence the prognosis is not entirely clear and requires further elucidation.

Light microscopy study of direct smear of cells cultured in vitro revealed definite cellular atypia, abnormal mitoses and gland-like arrangement of the cells. In cells of the original human gastric carcinoma specimen, PAS positive secretory granules were present, but no AB positive ones. Tumor tissue obtained after animal inoculation showed the presence of glandular structure with HE stain, and nest-like structure was demonstrated electronmicroscopically. Also revealed were a few "A cells" secretory granules as well as junctional complexes characteristics of epithelial tissue. In addition, Leuchtenberger's inclusion bodies were found within the in vitro cultured cells. This also supported their epithelial origin and malignant nature. The original human gastric carcinoma was differentiated adenocarcinoma, which manifested with dedifferentiation after prolonged culture in vitro. It might be concluded that the in vitro cultured cells assayed were adenocarcinomas, and, when considered with the clinical data, gastric adenocarcinoma.