1985年 · 第98卷第07期

From 1949 through 1975, 429 patients with choriocarcinoma and 441 with invasive mole were treated. In these patients vaginal metastasis occurred in 119(27.7%) and 70(15.9%) respectively. According to the location of lesions, vaginal metastases were divided into two types (189 patients), metastasis to the lower vagina (172 or 91.0%) and metastasis to the vaginal fornix (17 or 9%). The metastatic tumors were mostly located in the anterior wall underneath the urethra or at the urethral orifice. Of the 172 patients, 114 had single metastasis, and 58 multiple metastases. The size of tumor mass varied greatly. but tumors of 1-3 cm in diameter were common (50%). The small metastatic tumors caused no symptoms, and were found only by digital palpation, whereas the big ones often ruptured, giving rise to severe bleeding. Dysuria occurred owing to pressure of the tumor underneath the urethra. The metastatic tumors in the vaginal fornix were seen only in 17 patients, of which 15 were secondary to parametrial or pelvic metastasis. Pathological examinations of 62 patients showed that the metastatic tumor of the lower vagina was initiated from tumor emboli inside the veins of the vagina. On further development, tumor cells damaged the veins and invaded the neighboring tissues, thus developing into a metastatic tumor. Hence, this type of metastasis may be called "venous metastasis", which is different from the other metastases such as metastases to the brain, liver, spleen and lungs. All of the latter conditions were initiated from embolism of the arteries, and were called "arterial metastasis". Slow intravenous infusion of 5-FU is the most preferable method of treatment. When rupture occurs, vaginal packing with gauze is employed to stop bleeding. Usually after 5-6 days of 5-Fu treatment, bleeding is stopped and after 1-3 courses, the metastatic tumor disappears. AlI patients treated have been followed up periodically for over 5 years, and of them 16 over 20 years. No recurrence was found.

From 1973 to 1983, 900 cases of painful heel were treated with traditional Chinese medicine and western medicine, which consisted of local steroid injections, herb medicine and acupuncture. 650 cases were cured by the conservative methods. 250 cases which had been treated with the same method for more than half a year without response were grouped as persistent painful heels. Of them, 52 cases were treated with drilling operation which was effective in most of the cases. In only a small number of cases the etiology was clearly due to trauma, extreme obesity or rheumatoid periostitis. In the majority, causes of the disease were unclear and the condition was considered idiopathic. X-ray films of the os calcis were taken for the 250 persistent cases and calcaneal spurs were observed in 229 cases. However, further analysis revealed no direct relationship between the spurs and the heel pain.

From 1981 through 1983, we performed three allogeneic bone marrow transplants for the treatment of leukemia. They were the first three cases of sustained bone marrow engraftment in China. The sustained engraftment was proven by cytogenetic, isozyme, and blood group analyses. The patients are all well at the time of writing this report.The first patient was a 19-year-old female with acute monocytic leukemia. After she had attained complete remission, she was treated with a protocol including intravenous cyclophosphamide (1.8 g/m2/day × 2) and total body irradiation (TBI) of 600 rads followed by a bone marrow transplant from her brother. MTX and daily intravenous placental γ-globulin were administered after narrow infusion. Although moderate acute and chronic graft versus host disease (GVHD) did occur, they were controlled by treatment. The second patient was a 12-year-old boy with early relapse of acute granulocytic leukemia. He received essentially the same protocol as the first patient. Acute and chronic GVHD, as well as septicemia, occurred after transplanatation but were controlled. The third patient was an adult woman with chronic granulocytic leukemia in the chronic phase. She received essentially the same protocol except that the TBI was 700 rads and much less MTX was given. Her ph chromosome disappeared gradually after bone marrow transplantation. She had mild acute and chronic GVHD, which were controlled. Cytogenetic analysis provided evidence of a graft versus leukemia effect. We hold that intravenous placental γ-globulin in large dosages, which had not previously been used in BMT recipients, might help to control GVHD by exerting an immunosuppressive effect through a feedback mechanism.

The preliminary results of 25 patients undergoing gas-CT cisternography were presented. The method is simple, sensitive and reliable for detecting small acoustic neuroma. The technique of this method is described and its advantages and potential limitations are discussed.

A simple, efficient and safe method for the reuse or hollow fiber dialyzers by manual procedure is introduced. 697 dialyses were performed using 57 reused dialyzers, a mean 12.2±10.0 times each. Among the 57, 44 were Filtryzer B1 used for 616 times (88.4%). Two thirds of the dialyzers were reused for more than 10 times (11-53). The efficacy in removing BUN, creatinine and MMs appeared to be related more closely with the residual fiber bundle volume of the reused dialyzer rather than the number or usages. A hollow fiber dialyzer should be discarded when its residual volume faIls by 20%, not the 15% usually adopted. This change has been suggested because of our inadequate supply of dialytic devices. Deterioration of reused dialyzer efficacy may be compensated by prolongation of each dialysis. No pyrogenic reactions, infections, formalin intoxication, acidosis, pulmonary embolism or lupoid syndrome was encountered clinically in this series. Further laboratory studies are required for reuse of HF dialyzers.

Two hundreds cases of cysticercosis cellulosae (89 were subcutaneous and 111 cerebral) were treated with praziquantel between 1980-1982. Of these, 167 (83.5%) were markedly improved, 29(14.5%) moderately improved after follow-up for 1-3 years, and 4 (2%) not improved. The effective rate was 98%. Side reactions seen in 1952 cases were mild and transient. The dosage, course, and precautions taken in the treatment of cerebral cases to forestall or obviate unforeseen serious cerebral complications are discussed.

A method for rapidly determining levels of urinary fluorescent compounds in cancer detection is evaluated. While 60 healthy human subjects excreted fluorescent compounds at a mean level of 0.252 μg/ml urine, 50 patients with various types of cancer excreted significantly higher levels ranging from 0.28 to 2.21 μg/ml. The mean excretion of 50 patients with various non-malignant diseases was 0.346 μg/ml. This method is simple and noninvasive in detection of prevailing malignancies.

213 0utpatients with psoriasis seen during the years 1949-1976 were reported. The severity of the disease was not related to the sex, age, mode of onset, the time the patient first sought medical advice, and family history (with or without psoriasis and alcohol addict). It was, however, markedly related to the course of the disease and the anticancer drugs used. Of the 213 cases, 7 (3.29%) developed malignant tumors, an incidence 8.4 times higher than in the normal population of the same age in the locality (p<0.001). Of the 11 deaths, 5 were due to malignant tumors. Hence in clinical practice the relationship between malignant tumor and psoriasis deserves par ticular attention.

The plasma levels of PGE, PGF2a and 6-keto-PGF1a in the canine model of endotoxic shock were determined with radioimmunoassay. Following endotoxin injection, the PGF2a levels were rapidly increased to peak at 5 minutes. There was a negative correlation between the PGE level and the change in total systemic peripheral resistance at early stage of shock. The administration of anisodamine 2 hours after endotoxin injection showed no effect on the changes of PGE and PGF2a levels in the shocked dogs. The plasma levels of PGE and PGF2a in the shocked children with fulminating epidemic meningococcal meningitis were also markedly elevated during shock but fell within normal range at convalessence. After the dogs were given endotoxin the plasma level of 6-keto-PGF1a increased slowly during the first hour, reached a peak at 2 hours and remained high for 12 hours. There was a negative correlation between the 6-keto-PGF1a level and the blood pressure. The plasma 6-keto-PGF1a level was decreased and the blood pressure improved correspondingly with a negative linear correlation as a result of administration of anisodamine 5-10 minutes after endotoxin injection. These results suggested that PGE and PGI2, as one of the humoral factors, might participate at least partially in the endotoxin induced hypotension, and that the inhibition of PGI2 synthesis was considered contributable to certain degree to the antishock effect of anisodamine.

The results of determination of plasma testosterone, estrone and estradiol levels by radioimmunoassay in 47 patients with breast cancer and 65 healthy controls are reported. The plasma testosterone level in patients before operation was 4 times as high as in the healthy controls (p<0.001) and the estrone, 2.5 times. No significant difference was found, however, in estradiol, nor in these three hormones between patients (after operation) and healthy controls. The results suggest that testosterone is likely to be a tumor marker, and thus may help determine existence and judge regression or relapse of tumor.