1987年 · 第100卷第07期

Among the 581 cases of brachial plexus injuries seen from 1960 to 1984, 108 were root avulsions. Transfer of the phrenic nerve, accessory nerve, motor branches of the cervical plexus and intercostal nerves was used with good results. A detailed discussion is presented of the therapeutic value of nerve transfer, comparison of difrent nerve transfers and the factors influencing effects. From 1960 to 1984, 2 152 cases of peripheral nerve injuries were encountered; among them, 581 were brachial plexus injuries, accounting for 26.9% of the total admissions, and 108 were root avulsions (preganglionic injuries). Transfers of the phrenic nerve, accessory nerve, the motor branches of the cervical plexus and intercostal nerves (2 to 6) have been used since 1973, with satisfactory functional recovery of the upper limb.

Since 1979, the Roux-en-Y choledocho-jejunostomy with the afferent jejunal loop placed subcutaneously in the abdominal wall has been performed here for 116 patients with intrahepatic stones. Cholangiography and/or choledochoscopy can be done through the subcutaneous conduit of the choledocho-jejunostomy to follow the course of the disease post-operatively. Retained stone(s), worm(s), ductal stenosis, or suppurative cholangitis were found 41 times in 33 cases over a period of 2 months to 6 years postoperatively. Except for 4 failures, the rest were treated successfully by Dormia basket or other instruments through this route. Results were satisfactory. This route has advantages over T-tube tract for nonoperative management of intrahepatic residual stones, so it is recommended for intrahepatic lithiasis.

The relationship between systolic loading conditions at rest and left ventricular (LV) functional response to exercise was assessed in 31 patients with aortic regurgitation (AR) and 10 controls. The peak and end systolic wall stress determined from echocardiography and cuff systolic pressure at rest were used as indirect measures of LV systolic loading, and compared with LV ejection fraction response to handgrip and bicycle exercise by radionuclide ventriculography. Both peak and end systolic wall stress were significantly higher in asymptomatic (164±33 and 90±25×l03 dynes/cm2) and symptomatic (196±33 and 134±17×103 dynes/cm2) patients with AR than in the controls (125±22 and 61±14×103 dynes/cm2, p<0.01), and correlated inversely with the changes in LV ejection fraction during handgrip (r=-0.63 and r=-0.73) and bicycle (r=-0.68 and r=-0.87) exercise. In patients with AR, resting systolic loading conditions appear to reflect LV functional reserve during exercise.

A new operation of "spur-valve artificial bile duct" for congenital choledochus cyst is introduced. The main procedures include: a bleeding-saving cystectomy, that is the free part of the cyst wall is excised in full-thickness while only the mucosa is peeled off from the rest small part of the wall adherent to the portal vessels; a short jejunal loop of 10 cm is interposed between the hepatic duct and duodenum; an.d a spur-valve is made at the duodenal anastomosis. Thirty one operations of the type were performed in 1983-1985 with satisfactory anti-reflux effect and follow-up results. From the experiments wiLh 35 dogs, it was concluded that a 5-cm spur is the optimum one in maintaining a normalintrabiliary pressure (15 mm Hg) and also in protecting from the reflux due to intestinal obstruction (back-pressure 20-41 mm Hg); the anti-reflux effect is decreasing in the first month after operation but recovering by the second month; postoperative gastric analysis revealed normal findings; and autopsies disclosed no food particles or inflammation in the artificial bile-duct, nor ulcers in the stomach or duodenum. However, a long-term evaluation should be made after follow-up of a larger number of cases.

A case of idiopathic inflammation of optic nerve (perioptic neuritis) simulating optic nerve sheath meningioma is reported with a review of the literature. Idiopathic inflammation of optic nerve causes the enlargement of optic nerve and sheath, the radiologic feature of which may be fusiform or tubular uniformly diffuse thickening with a central hypo-dense area as is shown typically in this case (socalled tram-tracking sign). Idiopathic perioptic neuritis is an important condition in the differential diagnosis of visual loss when CT demonstrates enlargement of optic nerve.

Sixty-six patients with patent ductus arteriosus (PDA) were prospectively studied by 2-DE and 2 DCE with 106 patients suffering from other heart diseases as control. In the diagnosis of PDA by 2-DE, the parasternal long axis view of pulmonary artery, parasternal sagittal view and suprasternal view were satisfactory concerning their sensitivity, specificity and accuracy. Of the three planes, the best one appeared to be the parasternal long axis of pulmonary artery, the sensitivity of the other two was not as good as the first. 2-DE false positive diagnosis of PDA could be corrected by 2-DCE, which can furnish information in regard to hemodynamic changes. A diastolic negative contrast effect at the distal end of pulmonary artery pointed to a large left-toright shunt, and an early systolic positive contrast effect in the PDA and descending aorta pointed to a pulmonary hyper tension. A regression equation which is capable of assessing Qp/Qs noninvasively in children with PDA was derived from parameters calculated from 2-DCE and M-ECHO by means of stepwise regression procedure. The accuracy of calculation of Qp/Qs by the regression equation was 80％

The inhibitory effects of selenium yeast on the metastasis of Lewis lung carcinoma (LLC) were investigated in C57BL mice. 105 of C57BL mice were randomly divided into two groups, one group was supplemented with 2 ppm of selenium yeast in their diet and another group was fed with basal diet for control. All mice were inoculated with suspension cells of LLC into their left hind limb muscles and killed after 21 days. The results showed that both the metastatic rate and foci of metastatic tumors in lungs were significantly decreased in selenium yeast group than those in the control group (p<0.01). The activities of acid phosphatase and the ultrastructural pictures of LLC were different between the two groups. The enhanced immune function was observed by histo-chemical method and fluorescein examination. The possible mechanisms of the inhibitory effects of selenium yeast are discussed.

By using indirect immunofluorescence antibody test, we detected adrenal, thyroid and antinuclear antibodies in 40 patients with Addison's disease and 91 patients with other endocrinopathies. In 25 patients with idiopathic Addison's disease antiadrenal autoantibody (AA) was found to be positive in 68%, whereas in 15 patients with tuberculous Addison's disease it was positive in 13%. There was significant difference between the two. In 91 patients with other endocrinopathies, AA was positive in only 1.1%. The antibody detected in all the positive cases was IgG. AA positivity in patients with idiopathic Addison's disease was unrelated to age, sex, duration of disease and treatment. In patients with idiopathic Addison's disease the titer of thyroid and antinuclear antibodies was significantly higher than that in those with tuberculous Addison's disease, particularly in the female. We believe that positive AA in some degree is helpful in the diagnosis of idiopathic Addison's disease, particularly in suspected cases. Besides, in patients with Addison's disease but no evidence of tuberculosis positive AA indicates that anti tuberculous therapy might not be used as conventionally.

Five batches of Anopheles dirus, after taking blood meal from 3 Plasmodium falciparum infected patients were dissected 10-17 days later. 46 midgut specimens of these infected mosquitoes were examined with the scanning electron microscope (SEM). The surface features of early and late stage oocysts were similar to those described for other species of P. but those of the sporoblast and sporozoite appeared somewhat different from those described by us earlier for P. yoelii yoelii, P. cynomolgi and P. vivax. It seems that the SME morphological characteristics, especially those of sporoblasts and sporozoites can be utilized in differentiating these Plasmodium species.

A study of treatment of 304 cases of nonlymphocytic leukemia with the ester alkaloid of harringtonine is reported. Among them, 216 patients were given the ester alkaloid of harringtonine or semisynthetic harringtonine alone. There were 93 acute myelocytic leukemia cases, of whom 22 achieved complete remission (23.7%); 97 chronic myelocytic leukemia cases were treated, of whom 93 attained complete or partial remission (95.9%). The ester alkaloid of harringtonine also appeared to possess a better curative effect in treating 4 APL, 3 AEL, and 9 AMMOL and AMOL cases. 88 ANLL and CML-BC cases were treated with a combined HOAP chemotherapeutic regimen and the curative effects were even better than using ester alkaloid of harringtonine alone. Moreover, its side reactions are less than those of the conventional anti-ANLL drug Ara-C. We believe that harringtonine is a good agent against nonlymphocytic leukemia.