1985年 · 第98卷第12期

This article introduces a new method of reconstructing a lost thumb by transplanting a free skin-nail flap from the big toe and the bones, joints and tendons of the second toe. The reconstructed thumb is not only cosmetically similar to the normal one, but also has very good movement. Covered with the skin-nail flap of the second toe, the donor big toe has good skin coverage and a small nail. Citing the experience in 10 cases, the authors describe the operative technic and discuss some of the problems.

The authors have designed a new technique of reconstruction of thumb and finger for a fingerless hand using one donor foot. Based on the common pedicle of the dorsalis pedis artery and the saphenous vein, the big toe skin-nail flap, the adjacent second or the second and the third toes are transplanted to reconstruct the thumb, the index or the thumb, the index and the middle fingers. The phalanx of the reconstructed thumb is an iliac block. This article reports three cases with very good results. The loss of one or two toes does not impair the jumping ability of the donor foot.

Aneurysm as a complication of Behcet's syndrome is rarely seen. This paper reports a case of this entity with axillary, popliteal, and femoral aneurysms resulting in rupture, bleeding and infection, which was successfully treated in this hospital. The surgical approach to these aneurysms and method to control infection are discussed.

In August 1980, we first used a free sural nerve graft attached with its small saphenous vein, which was arterialized, for the repair of a long segment nerve defect. Favourable results were obtained in 14 cases. Experimental study and clinical follow-up have proved that this procedure is simple, donor material is easily obtained, and the result is satisfactory.

In order to initiate a prevention program for β-thalassemia by prenatal diagnosis in China, we first analyzed the DNA polymorphism haplotypes of the β-globin gene cluster in normal β gene (βA) and β-bearing chromosomes. We found seven different haplotypes for 30βA chromosomes and ten different haplotypes for 20βA chromosomes. Several new haplotypes were observed, three for βT and six for βA chromosomes. Complete prenatal diagnosis of β-thalassemia could be carried out in four of nine families by haplotype analysis alone.

Valve failure is rate after using glutaraldehyde stabilized bovine pericardial bioprosthesis in the mitral position. This article reports a case of spontaneous disruption of bovine pericardial xenograft after mitral valve replacement five years after operation.

In two groups of mongrel dogs, ten cach, end-artery-to-side-vein arteriovenous fistulas were formed respectively between the right superficial saphenous or deep anterior tibial arteries and their accompanied veins after the completion of ischemic limb preparations by global ligation of ipsilateral collaterals. Two weeks later, arteriovenous fistulas were converted into true arteriovenous reversals by ligation of the central venous limb of the fistulas. A11 experimental dogs survived. The monitoring criteria such as skin temperature, impedance plethysmography, venous oxygen content, arteriography, radio active isotopes test, and microcirculation and electro magnetic blood flow determinations showed adequate blood inflow to the tissue cells of the ischemic limbs. Satisfactory results suggest that staged arterio venous reversal on the small artery and vein may be an effective method for the treatment of extensive and diffuse occlusive arterial diseases of the lower extremities.

This paper reports three cases of carcinoma developing in the diverticulum at the middle third of esophagus (parabronchus). The incidence of this malignancy was l.77% (3/169). The patients who had carcinoma in the diverticulum had had a long history of diverticulosis. Prognosis of these patients was poor because the carcinomas were already advanced when they were found. Therefore, patient with esophageal diverticulum should be checked with esophagram, fiber esophagoscopy and biopsies, considering the possibility of malignancy. We suggest that carcinoma in the diverticulum be treated with radical esophagectomy.

The changes of progesterone nuclei receptor concentration in 65 endometrial specimens in the proliferative and secretory phases and decidua up to the 10th weeks of pregnancy were determined by extracting nuclei receptor with 0.6 M KCL. The levels of serum estradiol and progesterone in the normal menstrual cycle and in the early stages of pregnancy were measured and the histological changes of decidua studied. The three parameters in 10 cases of amenorrhea with vaginal bleeding were observed and compared to those in the control group. The results showed that the decidual progesterone receptor was mainly distributed in the nuclei and the concentration of the progesterone nuclei receptor gradually increased up to the 10th week of pregnancy, which conformed with decidual development. Progesterone receptor concentration is regulated by serum estradiol and progesterone levels. It is proposed that looking for a chemical agent which can block the decidual progesterone receptor may be one of the approaches to terminating pregnancy at the early stage.

Acute atherosclerosis in vessels of placental bed in toxemia of pregnancy has been documented, but its pathogenesis is still unclear. Alterations in serum lipid and lipoprotein levels, including total cholesterol (TC), triglycerides (TG), 1ipoperoxides (LPO), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and the LDL-C/HDL-C ratio (L/H ratio) were studied in forty patients with toxemia of pregnancy. The results were compared with those of two control groups consisting of twenty six nonpregnant women and forty pregnant women with normal last trimester. There was an overall increase of serum levels of lipids and lipo-proteins, including TC, TG, HDLC, LDL-C in normal pregnant women compared with those in non- pregnant women (p<0.01, p<0.001). Owing to the elevation of both HDL-C and LDL-C levels in normal pregnant women, no significant difference of L/H ratio was found between the two groups, suggesting that there were some protective mechanism against atherosclerosis in the physiological lipometabolism changes during normal pregnancy. The HDL- C level (p<0.001) was much lower and the L/H ratio (p<0.001) was obviously higher in toxemic patients than in normal pregnant women while changes in serum levels of TC, TG, HDL-C were similar to those in normal pregnant group. The determination of serum LPO levels showed there was also a significant rise in LPO levels in toxemic patients compared with nonpregnant (p<0.001) and normal pregnant women (p<0.05). These revealed that there was an overall dyslipometabolism in toxemia of pregnancy and it may be an important risk factor for acute atlierosclerosis in vessels of placental bed in toxemia of pregnancy.