1985年 · 第98卷第08期

Hypperprolactinemia and its relation to galactorrhea, amenorrhea and pituitary tumor were studied in 355 cases. Hyperprolactinemia was found in 135 cases, and its incidences in the 3 groups (galactorrhea with amenorrhea, galactorrhea with menstruation and amenorrhea without galactorrhea) were 78.2% (111/142), 21.7% (18/83) and 4.6% (6/130) respectively, the differences being statistically significant (p<0.01). Of the hyperprolactinemia cases 9570 had galactorrhea, and about half of them were discovered during examination. Therefore, pressing the breasts for milk should be a routine procedure during gynocologic examination. There were 60 pituitary macroadenomas in this series; the incidence of hyperprolactinemia was 39.3% (53/153) and amenor thea with galactorrhea was 37.3%(53/'142). There fore, prolactinoma is the most important cause of galactorrhea, amenorrhea and hyperprolactinemia. Some prolactinomas may not be accompanied by amenorrhea, galactorrhea or hyperprolactinemia. 42 cases of hyperprolactinemia, half with pituitary tumors, were treated with bromocriptine. Menstruation resumed in 95.2%, biphasic basal body temperature (BBT) in 90.5%, and 70.6% infertile patients became pregnant. The present study shows that the important cause of amenorrhea is functional disturbance in the hypothalamic-pituitary-ovarian axis. Once prolactin level is lowered, functional disturbances can be corrected very quickly.

Sixty-five cases of massive pulmonary hemorrhage were diagnosed in our Department of Pathology in 1980 and 1981. The primary diseases were severe asphyxia, prematurity, pulmonary immaturity, hyaline membrane disease, aspiration penumonia, infectious pneumonia, septicemia, scleredema and congenital heart diseases. Thirty-one of them were low-birth-weight infants, 27 had histories of intrauterine distress or asphyxia, and 45 had rectal temperature below 35 C. Almost all the patients manifested respiratory symptoms and finally blood tinged exudate oozed from the nose and mouth. The red cell count was over 6,000,000/mm3 in 24 of the 40 patients. The lung tissue of 16 cases were examined by immuno-fluorescence method, 15 had deposition of IgG and C3. Nine cases were found to have antigen-antibody complex granules on the basement membrane of the capillaries by electron microscopic examination. The causes of pulmonary hemorrhage include polycythemia of the blood, terminal stage of severe infection, and pulmonary congestion of congenital heart disease. Hypothermia, anoxia and acidosis are considered to be predisposing factors for hemorrhage. Preventive measures for pulmonary hemorrhage are iscussed.

Analysis of the surgical results of 27 patients with A-V syndrome came to the following conclusions: a. If the V-exotropia was 30 prism diopter (p.d.) or less without obvious misalignment in down gaze, a bilateral 8 mm recession with 5 mm elevation of lateral rectus insertions would usually be sufficient to correct the misalignment or at least to eliminate it in primary position and down gaze. b. If the V-esotropia or V-exotropia was more than 30 p.d. with some deviation in down gaze, surgery on three horizontal muscles was necessary. c. When V-exotropia was accompanied by overacting inferior oblique, weakening of the latter at the same setting would further reduce the deviation in upward gaze. In the 27 patients, the vertical displacement of horizontal muscle insertions did not cause any substantial torsional disturbances.

Fetal lung maturity was studied in 108 singleton pregnancies. Placental grades and biparietal diameter measurements were recorded. Of these, 58 also had amniocentesis for lecithin-sphingomyelin ratio, phosphatidylglycerol and foam test. Factors such as maternal age, race, parity, and fetal sex were also studied to see if they influenced the placental grading. Placental grading appeared to be more advanced among those with first gravida who subsequently gave birth to a male offspring. When the placental grade was I, II, or III and the biparietal diameter ≥ 8.7 cm, fetal lungs were all biochemically mature and none of the neonates developed respiratory distress syndrome after delivery. Utilizing both placental grading and biparietal diameter, fetal lung maturity could be predicted accurately, making amniocentesis unnecessary.

Sixty-eight sudden cardiac deaths (10.6%) in 642 autopsied cases of cardiovascular diseases were studied. The incidence was highest in ischemic heart disease (29.6%). Cardiac arrest was the most frequent direct cause of death in ischemic heart disease with or without acute myocardial infarction. Embolism was an important immediate cause of sudden death in theumatic heart disease, pulmonary heart disease and infectious endocarditis.

In 16 cases of paroxysmal supraventricular tachycardia (PSVT), A-V nodal dual pathways were found in nine, and PSVT was initiated with programmed stimulation in seven of the nine cases. In the remaining two cases, atrial echo was seen in one, but in another, PSVT could not be initiated, and atrial echo was not seen. Among the nine cases, there was an unusual one which showed antegrade conduction through fast pathway and retrograde conduction through slow pathway. In seven of the nine cases, there was interruption of H1H2/A1A2 curve and jump phenomenon of H1H2, while in one case the curve was smooth. In electrophysiologic studies, A-V dual pathways were not seen in 53 cases without PSVT for various reasons. The authors believe that A-V nodal dual pathways are functional abnormality affected by autonomous nervous system. Whether PSVT may be initiated in cases with nodal dual pathways or not depends upon the equilibrium between the rates of coduction in these two pathways and the length of the refractory period.

We studied the ultrastructure of 62 specimens of primary hepatic carcinoma collected between 1974 and 1980. Of the 62 specimens, 15 had lesions smaller than 3 cm in diameter and belonged to the category of small hepatic carcinoma. The biological characteristics were studied by electron microscope. Emphasis was put on the study of the ultrastructure of 1iver cell dysplasia and cancer cell, sensitized lymphocytes and cancer cells and lysosomes and cancer cells. Most of the liver cells around the cancer nodules were normal in appearance but a few scattered liver cell dysplasia might be precancerous. The infiltrating lymphocytes had lethal effects on the target cells in the following three ways: a. Being possibly T lymphocytes in nature, they closely attached them selves or were fused with the hepatoma cells and liberated lymphotoxin to kill or to dissolve the target cells. b. Those which might be B lymphocytes in nature showed transition to plasmacytes producing antibodies against the antigenic materials released by the cancer cells or degenerated cells. c. In some cases with actively proliferating cancer cells, the organelles in the lymphocytes were so sparse that only a few scattered mitochondria were observed in the cytoplasm.

For the purpose of finding a rational basis for nutrition therapy in burns, we performed experiments in male rats. It was noted that the plasma tryptophan level was decreased when the scalded area was 15% or 20% of the total body surface. The drop began on the 1st, 3rd, and 7th day and returned normal on the 14th day of experiment. The tryptophan content was increased in the brain on the 1st and 14th post-scald day, in the liver at the 6th hour (turning to decrease thereafter), and in the muscle at the 6th hour and on the 1st day after injury. The urinary excretion of tryptophan remained normal. The causes of decline of the plasma tryptophan are discussed.

The liver tryptophan pyrrolase activity, the urinary excretion of xanthurenic acid and the con tent of serotonin of the brain were determined in rats with third degree burns (20% BSA by scalding). Their contents were all significantly increased during the early period after scalding. This indicates that the degradation of tryptophan was increased through both kynurenine and serotonin pathways. It is probably a main cause for the decline of plasma tryptophan in that period.

Seventy-six cases of vesicular nucleus cell carcinoma (VNCC) were diagnosed pathologically in 1,706 nasopharyngeal carcinoma (NPC) biopsies according to the following criteria: a. Nuclear vesicular change was present in more than half of the carcinoma cells with a few giant vesicular nucleus cells scattering in carcinoma nests. b. Though the amount of vesicular nucleus cells was less than half (about 40-50%) of the total carcinoma cells on the slide the giant vesicular nucleus cells were very conspicuous. c. More than half of the carcinoma cells underwent vesicle-like transformation without any giant vesicular nucleus cells. In comparison with poorly differentiated squamous cell carcinomas (PDSCC) which accounted for the majority of NPC, the authors found that: a. The cytological appearance of VNCC on smears had some morphological characteristics, coincident with its histological features. b. The VCA-lgA antibody level of VNCC was not significantly different from that of PDSCC. c. The five-year survival rate of VNCC (61.86%) was higher than that of PDSCC (43.39%) statistically. So it is reasonable to separate VNCC as a subtype of NPC.