1991年 · 第104卷第02期

Eight hundred and two digits (592 complete amputation and 210 incomplete amputations) of 549 patients were replanted. The male to female ratio was 3:1 and the age range 1-63 years. 728 digits survived and 74 digits failed. The overall survival rate was 90.8%. Special varieties of complicated amputation were encountered in this series: (1) distal segment replantation, 139 digits, 131 digits (94%) survived; (2) digital replantation of children, 45 cases, 78 digits, average age 3.8 years, the youngest being 1 year old, 68 digits survived (88.7%); (3) rotational avulsion amputation of thumb, 26 digits, 23 digits (88.4%) survived; (4) bilateral digit amputation, 8 cases, 44 digits amputated, 38 digits replanted, including 9 digits of a ten-digit guillotined case. All the digits were salvaged. We conclude that thorough debridement, meticulous anastomosis of blood vessels and timely management of vascular crisis are keys to high survival rate, while judicious selection of indication, proper internal fixation of bone, anastomosis of as many blood vessels as possible, attentive repair of nerves and tendons, sound rehabilitation program are important measures in improving postoperative function.

Correlation of the X-ray manifestation and the en bloc sections of 52 wrists of infants and children aged from 0-4 years from autopsy was carried out to identify the real X-ray signs of rickets. Simple ill-defined provisional calcified zone (PCZ), enlargement of head of ulna, shallow saucer-shaped and undulant or multilaminar PCZ are normal in variation. The signs of early rickets included marginal spur, saucer-shaped deformity, ill-defined and disordered trabeculae under PCZ, mild brush appearance and osteoporosis. However, only when five of the above mentioned criteria were met at the same time, can early rickets be diagnosed.

Indigenous rubber silicon gel soft tissue expanders were used to treat 5 preschool children with scar alopecia. The scar resection rate wa 100%; no severe complication happened. The average healing time was 25 days after the improvement of technical method. This method is simple, effective and the expansion duration is short.

Piperaquine and hydroxypiperaquine seem to be successful candidates of antimalarial drugs in China. Their antimalarial efficacy, experimental resistance, combination, mode of antimalarial action and clinical trials are described briefly.

From 1948 to 1985, a total of 630 cases of choriocarcinoma and invasive mole were treated in our hospital. The methods of treatment varied in different periods of time. In the third period (1972-1985), 5 Fu and/or KSM were the main therapeutic agents used in the treatment of 110 cases of choriocarcinoma and 99 cases of invasive mole. Metastases were observed in more than 90% of cases of choriocarcinoma and nearly 1/4 belonged to stage IV. The mortality of choriocarcinoma decreased from 84.3% to 32.7% after treatment and that of invasive mole from 32.4% to 8.1%. 43 of 80 patients treated with chemotherapy alone conceived after recovery, resulting in a total of 50 pregnancies including 31 term deliveries by 28 women. All the children are normal and healthy, the eldest being 11 years old now.

During the formation of sporozoites, the nuclei formed after mitotic division in sporoblast enter sporozoite buds. The spindle appears in the nucleus of the sporozoite bud, while its nuclear membrane disappears. The spindle is an evidence of the second meiosis of the life cycle of plasmodium.

Kinetic changes of viremia were observed in 287 cases of hemorrhagic fever with renal syndrome (HFRS) in whom ribavirin was administered with double blind random control studied by means of virus isolation, indirect immunofluorescence assay and enzyme-linked immunosorbent assay. The positive rate of viremia was 79.7% (Sp = 3%) and positive rate of HERS IgM was 85% (Sp = 3.1%) before treatment. Viremia could be interrupted by ribavirin as in the ribavirin treated group, the viremia positive rate decreased, duration of viremia was shortened, viral antigen products, virus titer and HFRS IgG antibody level were reduced as compared with the control group. This showed that viremia was very frequent in patients in the febrile phase and ribavirin is an effective antiviral drug in HFRS during the febrile phase. Dosage and course of treatment of this drug are discussed.

108 patients with acute myocardial infarction (MI), aged 70 years or younger, underwent left ventriculography and coronary arteriography (mean one month) after infarction and were followed up for an average period of 22 months (range 5-47 months). The contribution of angiographic variables to a first cardiac event (death, recurrent infarction, coronary artery bypass grafting or congestive heart failure) was evaluated with Kaplan-Meier survival curve analysis and long-rank test. Patients with cardiac events had left ventricular dilation, systolic dysfunction, multivessel coronary disease and lack of residual flow to the infarct region. Multivariate analysis showed that left ventricular end-systolic volume (P less than 0.001), end-diastolic volume (P less than 0.01) and the number of the diseased coronary vessels (P less than 0.05) were of significance in predicting the outcome. This prospective study indicates that in survivors of first acute transmural MI, cardiac catheterization performed one month after infarction can provide additive prognostic information that can be used to stratify risk.

Twenty-seven infants with cytomegalovirus hepatitis were followed up for 15-40 months after onset of the illness. They had recovered from the hepatitis, but microcephaly was present in 2 (7.4%), sensorineural hearing loss in 5 (18.5%), quadriplegia, mental retardation, ventricular septal defect and tooth defects in 1 (3.7%) each. The patients with congenital infection had more severe and complex defects, some with perinatal infection had mild defects, those with postnatally acquired infection had no sequelae. The mean MDI and frequency of expressive language delay in the former group differed significantly from those of the other 2. Five patients still excreted cytomegalovirus in the urine at follow-up.

A prospective study on consecutive fetal monitoring in 559 deliveries was carried out. The difference between the first 30-minute and the last 30-minute monitoring was compared. Abnormal fetal heart rate (FHR) pattern in the last 30 minutes combined with abnormal fetal scalp blood pH has a good predictability of 1- and 5-minute Apgar scores. The correlation of fetal heart rate-uterine contraction (FHR-UC) monitoring (525 cases) and fetal scalp blood pH determinations (FSB-pH) (79 cases) with the fetal condition was assessed. It is indicated that the first 30-minute FHR tracing can reflect the fetal status in labor, and FHR-UC monitoring assessment is evidently superior to FSB-pH in the prediction of a vigorous fetus. Whereas, FSB-pH is superior to FHR-UC monitoring in the prediction of a compromised fetus.