1986年 · 第99卷第03期

Between January 1960 and April 1984, resections of primary liver cancer were performed in 400 patients. Of these 361 were male and 39 female; their ages ranged from 6 months t0 71 years (84.5% of the patients between 30-60 years). Pathological findings showed that 94.5% of the patients had primary liver cell carcinoma, 3.5% bile duct cell carcinoma, and 2.0% mixed type carcinoma; 77.8% of tumors were associated with cirrhosis; and 82.5% (330/400) of tumors measured over 5 cm in diameter and 17.5% less or equal to 5 cm in diameter (70 patients). Of the 400 patients, 11 underwent ex tensive right hemihepatectomy, 106 right hemihepatectomy, 64 left hemihepatectomy, 12 middle lobectomy, 112 left lateral lobectomy, and 95 partial resection. During the operation, 6 types of operations were employed to control hemorrhage, with the best one being the intermittent interruption of porta hepatis, which was used in 280 patients without any complications. There were 17 deaths within one month after operation. The overall operative mortality was 4.2%, but it was 14.8% in the 1960s and 2.4% in the 1970s; there was no death since 1980. The causes of death were hepatic failure (14 patients), bleeding from injured hepatic veins (2), and subphrenic abscess (1). Follow-up results showed that the cumulative survival rates of 1, 3 and 5 years in patients with tumors over 5 cm in diameter were 60.3%, 40.4% and 25.8% respectively, and those in patients with tumors less than or equal to 5 cm in diameter were 83.1%, 73.9% and 64.0% respectively.

This paper reports the study on cyclic AMP and cyclic GMP levels in blood plasma and cerebrospinal fluid in patients with transient ischemic attacks.

Serum cholesterol values are significantly lower in China than in Belgium in both females and males. The maximum mean values in China are very close to the minimal mean values in Belgium. This is attributed to the much lower consumption of saturated fat in China. The influence of age, height and weight on cholesterol in China and Belgium is qualitatively similar but quantitatively different. The high-density lipoprotein (HDL)-cholesterol values in Chinese females are markedly lower than those in Belgium and very similar to those of Chinese males. There fore the difference in HDL-cholesterol value is not a factor for the lower incidence of ischemic heart disease (IHD) in China. The Chinese diet appears to be very protective against IHD but not against cerebrovascular disease.

The free medial thigh flap, first reported by Baek in March 1983, is supplied by an unnamed artery arising from the medial side of the superficial femoral artery. We have successfully used this in 6 burned cases and found that there are some anatomical differences between Baek's findings and ours. We consider that the medial thigh flap has more advantages than disadvantages, and a much greater flap could be designed if one is not attempting to close the donor wound merely by approximation.

Twelve cirrhotic patients underwent subtotal splenectomy. The operative technique involved preservation of anatomic segments and suture of an omental patch to the residual spleen. With knowledge on segmental vascular anatomy in splenomegaly, sub-total splenic resection can be readily accomplished with ease and safety. Follow-up of the 12 patients showed that the preserved spleen had normal uptake of 51Cr denatured erythrocyte isotope, high grade serum IgM, and effect of alleviating fever after splenectomy. Splenic scan and clinical immunologic survey revealed the functional capacity of splenic remnant, and the lower percentage of "pocked" RBCs, an important clue to eusplenia. Thus, the normal function and size retained of the residual spleen were saved. If long-term follow-up confirms the value of segmental splenectomy, it may become an adjuvant treatment in lowering portal hypertension in cirrhotic patients.

Juxtarenal aortic occlusion is an important but less frequently seen disorder. Sometimes, it is confused with Buerger disease, leading to patient's disability or death. Five patients, who had been misdiagnosed as having Buerger disease, were treated by aortoiliac or femoral bypass in the past two years. Early recognition and rational surgical intervention are mandatory to avoid serious consequence. A temporarily infradiaphragmatic control of the aorta during revascularization is recommended in dealing with this entity.

Polarized microscopy was performed on 100 urinary stones, 18 of which were simultaneously studied by scanning electron microscopy. Structure, nuclei, relationship of compositions of urinary calculi, etc. were observed. Based on observations of the composition and structure of urinary calculi, we think that the process of supersaturation crystallization is the main and first step of stone formation with colloid increasing gradually. Apatite plays an important role in stone formation. After stone formation the processes of recrystallization, metasomatosis and formation of solid bridges facilitate changing urinary stones from loose and unstable objects to compact and stable ones. These changes in composition and structure occurrng during stone formation may be of significance in the prevention and treatment of urolithiasis.

In the course of development of non-union from excision of a 6-mm osteoperiosteal segment of rabbit radius, there emerged abnormalitism on the part of the cellular activities. The osteoprogenitor cells persisted for a much longer period. The macrophages increased in number, persisted longer and were immature. The fibroblasts became elongated like fibrocytes, were haphazardly arrayed and showed emptying of the cytoplasm. The osteoblasts assumed olive or spindle configuration and showed vacuolization. Several vacuolized osteoblasts could be besieged in a single lacuna and eventually disintegrated. Chondrocytes revealed unusually high activities. The osteoclasts appeared early, increased in number and many were immature. In the marrow cavities there were special fat structures to block the healing between the two fragments.

The simultaneous combination of retrograde fluorescent neuronal tracing and catecholamine histo-fluorescene was used to label neurons in the contralateral substantia nigra projecting to the striatum and to determine biochemical characteristics of these neurons. The labeled neurons of crossed nigrostriatal projections were found primarily in the lower part of the contralateral substantia nigra. These neurons were mainly dopaminergic and did not project to the ipsilateral striatum.

Tumoral calcinosis is a rare disease. Recently we found a typical case and thereby report it in the following.