1986年 · 第99卷第02期

Twenty-two cases of leukemia of the nervous system treated in our hospital from 1962 to 1982 are analyzed. They account for 10% of all leukemic cases hospitalized during the same period and all were acute leukemia with diagnoses confirmed by myelograms. According to the data, leukemia of the nervous system is classified as cerebral parenchymal infiltration type, including leukemic intracranial hemorrhage (12 cases) meningeal infiltration (4 cases), leukemic infiltration of the spinal cord (3 cases), leukemic neuropathy (8 cases) and chloroma (4 cases). All these types can exist singly or in combination. Clinical manifestations are discussed in details with reference to the literature. In 12 0f the 22, neurologic defects were the initial and predominant symptoms and led to the diagnoses of intracranial tumors, spinal cord com pression, sellar region lesions, intracranial metastasis etc. and in 2 unnecessary cranial explorations were performed. The diagnosis is analysed in detail with reference to typical cases.

Noradrenaline (NA) content in CSF and plasma is found to be statistically significantly elevated in patients with strokes accompanied by severe neurological deficits. It is hypothesized that control of nor adrenaline levels would be useful in treating acute cerebrovascular diseases.

Newborn screening for phenylketonuria (PKU) shows significant progress in genetics and has greatly contributed to the prevention of mental retardation in many countries. A collaborative screening program was organized for the first time in our country in March 1982. Guthrie's bacterial inhibition assay was used for determining blood levels of phenylalanine (Phe). Up to January 1985, a total 198,320 newborns were screened. Classical PKU was detected in 10 infants and hyperphenylalaninemia in two. The overall incidence was 1/16,500, which was about the same as that in many other countries. There was an obvious uneven distribution of cases in different areas of our country. Five of the 10 cases of classical PKU were treated with low-Phe milk and developed normally. The remaining 5 cases were on low protein diet, but 3 became mentally retarded. Our preliminary work showed the importance of instituting a mass screening laboratory which is a prerequisite for successful development of the program.

We report the first two known cases of maple syrup urine disease (MSUD) in Chinese. Diagnosis was based on elevation of leucine, isoleucine, valine and their corresponding α-ketoacids in the plasma and urine. One patient had neurological symptoms and metabolic acidosis in the neonatal period while the other one was diagnosed on routine metabolic screening for mental retardation in early infancy. Neither responded to megavitamin therapy with thiamine. The occurrence of MSUD in Chinese calls for alertness to its diagnosis, conducting a pilot neonatal screening, nationwide provision of earliest antenatal diagnostic service within two days of birth and proper diet.

This paper reports a long term follow-up study of therapeutic effects in 271 cases of early cancers of the uterine cervix. There were 244 Stage I and 27 Stage II cases, both categories were divided into 4 Substages. The operative method included 4 different types of different extent. Pelvic lymphadenectomy was performed in 158 Stage I cases and 27 Stage II cases. The metastatic rates were 1.26% and 37.03%. The 5-year survival rate in the series is 95.13%, 10-year rate is 94.25%, 15-year rate is 91.54% and 20-year rate is 84.3%. The 5 and 10-year survival rates are 98.3% and 99% for Stages II-4 and 65.4% and 57.7% for II-1 and II-2, respectively. The commonest complications are urinary bladder paralysis, urinary infection and lymphocysts. Two cases had unilateral ureterovaginal fistulas. There were 2 operative deaths. The different operative methods for patients in various stages are discussed and preferred methods recommended. Among 227 survivals, 202(88.98%) achieved complete recovery of working capacity. Bilateral ovarectomy was performed in 252 cases with no metastases found, so it is desirable to preserve one or two of the ovaries in patients under 50 years of age.

Transmission electron microscopic investigation of standardized fractures of radii in 50 rabbits revealed that fibroblasts took part in the formation of bony callus. The osteogenetic role played by the fibroblasts can be categorized into the following 5 aspects: a. Fibroblasts synthesize and secrete Type collagen fibrils and induce deposition of calcium salt crystals in the collagen fibrils. b. Fibroblasts produce matrix vesicles in their surroundings. These matrix vesicles become calcified and turn into flocculent calcospherules which coalesce and fuse into bone tissues. c. Fibroblasts harbor calcium granules in their mitochondria, thus providing calcium for calcification of the intercellular matrix and bone formation between the cells. d. Fibroblasts can transform directly into osteocytes; there is bone formation around the fibroblasts, the bone tissues surround the fibroblast in the form of bony lacuna, then the fibroblast in the lacuna transforms into osteocyte. e. Fibroblasts can undergo degenerative changes leading to decease and replacement by bone tissues.

42 cases of nonunion and 29 cases of delayed union were treated with continuous direct current in association with conventional external fixation in five hospitals. 15-20 µA per cathode was applied by semi-invasive means for 1-6 months. The rate of healing in the nonunion group was 88.1% and that in the delayed union group 96.6% Complications appeared rare and trifle. The indication of therapy for non-union consisted of a fairly good or permissible alignment of the fragments with the gap no more than 0.5 cm, and evidence of relatively firm fibrous union between the fragments. It was postulated that the electricity acts more likely as a stimulator to reactivate the healing and calcifying process rather than a mobilizer and organizer of minerals.

11,734 cases of gastric cancer treated during the years of 1971-1981 were studied retrospectively. Of 9,602 cases underwent various operations, 5,829 cases had resection, a resectability of 60.7%. The prognosis for the young patients under 30 years was remarkably poorer than for those above 30 years. Early diagnosis as well as a more rational and effective surgical treatment is emphasized.

Ascaris lumbricoides is in world-wide distribution. In an endemic area, biliary complication is common in adults as indicated in 54 patients. From June 1981 to August 1984, the 54 patients were diagnosed as having biliary ascariasis by endoscopic retrograde cholangiography (ERC) or ultrasonography (USG). In 14 patients (1981-1983), an endoscopic snare was used to remove the worms from the main bile duct under radiological control, with a success rate of 7l.24%. In the rest 40 patients (1984), real time ultrasonic examination was used instead of ERC for diagnosis and treatment-monitoring of this disease, with a success rate of 92.5%. All patients were treated in the outpatient department without significant complications. We conclude that the endoscopic worm removal combined with ultrasound monitoring is a quick, reliable and safe method for the treatment of biliary ascariasis.