1988年 · 第101卷第06期

In order to find suitable classification methods for clinical practice, a scoring classification method was designed on the basis of criteria suggested by the French-American-British Cooperative Group in 1981 with regard to nuclear cytoplasmic ratio, nucleoli, nuclear shape, and blast size. Using the criteria, the bone marrow films of 100 patients with ALL were reviewed morphologically. They were classified into 3 types: L1 in 52 cases; L2 in 40 cases; and L3 in 2 cases. Six cases could not be allocated to any types. The first analysis showed a total agreement (5:0) in 49 cases, a concordance of 4:1 in 28 cases and disagreement in 23 cases. Diagnoses could be made in 77 cases. The second analysis gave a total agreement in 57 cases and a concordance of 1:1 in 37 cases. Diagnoses could be made in 94 cases. The overall concordance rate was 94%. The scoring system was considered distinct, simple, practical and easy for classification. The correlation between classification and prognosis was analysed.

Otoneurological operations were performed successfully by retrosigmoidal approach on 280 patients, of whom 86 had trigeminal neuralgia, 180 hemifacial spasm, 12 glossopharyngeal neuralgia, and 2 severe Meniere's disease. The approach, by which the anatomical structures in the cerebello-pontine anglecan be clearly exposed, is easily manipulated with less trauma, as compared with the suboccipital or retrolabyrinthine approach. On the other hand, its indications can be extended and complications reduced.

Clinical hepatitis caused by Epstein-Barr virus (EBV) has been recognized in the past and is usually benign. We described two children, 2 and 6 years of age with severe EBV hepatitis and hemolysis. One child died of hepatic failure. A liver biopsy obtained during the recovery stage in the other child showed focal necrosis of hepatocytes with mononclear cell infiltration. Fever and atypical lymphocytes were not found in either patient. An anti-VCA-lgM identified by indirect immunofluorescence was strongly positive in both patients. Herpes simplex antibody and HBV markers were negative. EBV infection as a cause of severe hepatitis may be missed in children lacking an infectious monocytosis-like syndrome unless this diagnosis is considered and serological examination is done.

In this paper, 14 indices for hypercoagulability were determined in 58 acute leukemias (AL) and 55 normal controls, It was found that there was adecrease in blood platelet counts (BPC) and intraplatelet B-thromboglobulin (IpBTG) contents and an increase in plasma BTG ratio, thromboxane B2(TXB2) ratio and 6-keto-prostaglandin F1α (6-keto-PGF1α) ratio, plasma TXB2, 6 keto-PGF1α, von Willebrand factor (VWF) and fibrinogen (Fbg) concentrations and serum fibrinogen degradation products (FDP) levels in AL, while no difference in plasma BTG, antithrombin III activity and antigen (ATIII:A and ATIII:Ag), and plasminogen (PG) levels between AL and normal controls. BPC, Fbg, PG levels in bleeding cases, including minor and major bleeding groups, were lower than non-bleeding group. IpBTG, TXB2 ratio and FDP values in major bleeding patients were different from non-bleeding ones, there was no difference between the minor bleeding and the non-bleeding groups. With the help of IBM-PC/XT computer, the discriminatory equations for diagnosing disseminated intravascular coagulation (DIC) of AL were obtained. In conclusion, AL patients usually have hypercoagulability, clinical minor bleeding is due to BPC reduction, but major bleeding is due to consumptive coagulopathy resulting from hypercoagulability. The sensitivity of the indices reflecting AL hypercoagulability is, in Succession, TXB2 ratio>FDP>Bleeding>VWF>IpBTG or BTG ratio>PG or Fbg. It is possible to make early and correct diagnosis of DIC complicated AL, by using the discriminatory equations.

Dialysis is an insufficient depurative procedure since many substances are poorly removed. To improve the depuration, uremic patients were daily treated with 3-hour perfusion on uncoated granular charcoal (0.5 Kg) followed by 1-hour dialysis for 16 times for the removal of urea and electrolytes not absorbed by charcoal. The results showed that a granular uncoated charcoal removed from uremic ultrafiltrates many chemical species which were scarcely removed by dialysis. The conditions of the patients were improved and could be maintained for one-week charcoal treatment between two dialyses. This depurative procedure has been well documented by chromatography on Biogel P2.

The levels of serum high density lipoprotein cholesterol (HDL-C) were observed in 33 patients with acute myocardial infarction (AMI) and were found to be significantly lower than that in patients with coronary heart disease and in normal subjects. The HDL-C level decreased by about 25.4% within the first week of AMI. There was no relationship between HDL-C decrease and the infarct location. The decrease was more marked in patients with infarct of larger size and cardiac failure.

124 patients, aged from l to 5 years, with congenital dislocation of the hip were subjected after close reduction to limited immobilization. They were followed up for 2-5 years (mean, 3.6 years) after operation. A total of 171 hips but 2 were reduced with a successful rate of 98.82%. The advantage of this method is to free the child from conventional immobilization of plaster casts so that the patient can move during the whole period of treatment. We conclude that limited immobilization making physical and radiological examination easy may accelerate the development of the hip and prevent most of the complications induced by conventional method.

Local application of 0.03% camptothecine cream and 0.03% camptothecine in DMSO ethanol in 92 cases of psoriasis vulgaris showed a statistically significant therapeutic effect in comparison with topical 1% hydrocortisone cream. Mouse vaginal epitheliumin estrogenic phase and mouse tail scale epidermis were used as experimental models to study the therapeutic mechanism of the drug. It was found that camptothecine not only could inhibit the mitosis of epithelial cells, but also alter the process of epidermal keratinization. With these pharmacologic activities it is thought to probably play a role in correcting the essential pathologic process of psoriasis. In addition to promoting the formation of a granular layer, use of the drug led to appearance of Langerhan's cells in mouse tail scale epidermis, suggesting that these cells may involve in the process of epidermal Keratinization.