1978年 · 第N4卷第06期

Of 188 cases of shock due to infection admitted during the years 1964-1965 and 1972-1974, 133 (70.7%) were induced, by severe pneumonia and bacillary dysentery. 15 cases were closely observed, with the object of comparing the clinical changes before and after the vasodilators. Most patients had pale and cyanotic skin, clammy extremities and narrow pulse pressure before treatment. After treatment they had warm and normal or flushed skin, fullness of the pulse and increased urine output. 12 patients in the vasoconstrictor group (71 cases) died, a mortality rate of 16.9%. No death occurred in the group (62 cases) given vasodilation therapy. A number of therapeutic problems were discussed, particularly prevention and treatment of acute renal failure and pulmonary edema. Anisodamine was recommended for clinical use.

In our investigation we dissected 20 cadavers and examined 100 skeletal specimens. The chief findings are: a. The intermediate structure between the mammillary and accessory processes of lumbar vertebrae can be divided into 3 types, mammillo-accessory groove, mammillo-accessory notch and mammillo-accessory foramen/canal. Notch and foramen are most frequent in L4 and L5, b. All the medial branches run through the osseo-fibrous canal between the mammillary and accessory processes. Our findings on this canal's location differ from Bradley's; c. There are widespread anastomoses between the posterior rami and their branches, we divide these into 4 types.

A case of long Q-T syndrome is reported. The patient, a 2½-year-old boy, suffered from convulsive fits, fever and mild gastrointestinal upset for 1 year. Agitation, crying and straining at stool triggered the attacks. Long Q-T, prominent U and alternation of T-wave were recorded. Ventricular premature beats with R on T phenomen of preceded the fits. Serum potassium, calcium and magnesium were all within normal limits. Propranolol combined with scopolamine yielded satisfactory results. Inquiry revealed that among the 5 siblings in the family, 1 was normal, 1 died of unknown cause at the age of 6 months, and 2 with long Q-T and prominent U waves were free from deafness and convulsive fits. The parents who were near relatievs and their other relatives did not exhibit any of these clinical features. The authors are inclined to regard the Jervell and Lange-Nielsen syndrome and Romano-Ward syndrome as one, namely, the long Q-T syndrome. A new phenomenon hitherto not mentioned in the literature is that in our case alternation of the T wave was precipitated by an intravenous calcium gluconate injcction. This is attributed to calcium potentiating the already heightened inotropic effect of left stellate ganglion which is thought to be responsible for alternation of T wave.

The acupuncture anesthetic effect of Jizhong point of the Dumai 督脉 channel in 140 cases of abdominal hysterectomy was evaluated. It was found that electric needling of Jizhong was good for relieving pain perception, tension of abdominal muscles and intestinal bulging during operation. To obtain this effect, the tip of the needle must be deep enough to reach the yellow ligament. The relationship of the hand feeling of the acupuncturist and the subjective feeling of the patient induced by electric needling during acupuncture to the depth of the impaling needle was analyzed. Neurological examinations given postoperatively to 51 patients after prolonged stimulation of Jizhong showed no neurological sequelae except for temporary impairment of cutaneous sensation at the local thigh region in 2 cases. On the basis of Jizhong stimulation, some improvements were made by inserting the bare tip of the insulated needle directly onto the porous bony structure of the triangular area at the rim of the vertebral lamina. The effect thus obtained was comparable to needling Jizhong point.

94 cases of old limb fractures with malunion, delayed union and nonunion were treated with combined traditional Chinese and western medicine. In 64 cases, treatment followed refracturing of the old fractures accomplished by manual osteoclasis or chiselling. Treatment of malunion and nonunion consisted of reduction, intra- and extra-medullary bone grafting, lower limb traction and splint fixation. Delayed union was treated by splint fixation plus functional exercise. All 94 cases attained union and functional restoration.

An analysis of 1,006 consecutive cases of acute intestinal obstruction observed in the 7 hospitals affiliated with the Tientsin Acute Abdominal Diseases Coordinating Group is presented. Patients were classified into 3 groups and different managements were adopted. 71.8% of the cases were cured by the combined nonoperative method, using mainly Chinese herb medicine with adjuvant therapy when needed. The most satisfactory results in patients treated nonoperatively was obtained in cases of obstruction due to fecal inpaction or adynamic ileus. Intestinal obstruction due to adhesions also responded well to treatment without surgery. Mortality in this series was 3.4%, the causes of death are discussed.

In order to find out the correlation between lipid levels and carbohydrate and lipid metabolism, a study on the glucose tolerance and fat tolerance is made in 44 normal subjects, 21 cases with asymptomatic hyperlipidemia and 35 cases with coronary heart disease (CHD). Results show that decreased glucose tolerance is found in 15.9%, 47.6% and 57.2% of the normal, the hyperlipidemic and the CHD groups respectively; decreased fat tolerance in 18.2%, 47.6% and 42.9% of the 3 groups respectively. The plasma glucose in the normal group 2 hours after the oral intake of 100 gm of glucose returns to the fasting level, while in the CHD and hyperlipidemic groups the readings remain significantly higher than the fasting levels (p<0.01 and p<0.001). The plasma lipid levels keep close to the fasting levels. With the normal and CHD groups, plasma free fatty acid levels are significantly lowered (p<0.001 and, p<0,01). 14 hours after the intake of the high fat meal, plasma glucose and lipids in the normal group tend to return to the fasting levels, while in the hyperlipidemic and CHD groups triglyceride level is 40.7 mg% and 53.8 mg% higher than the fasting levels respectively. Only in types IV and V of hyperlipidemia deos the glucose level exceed 120 mg% 2 hours after sugar diet. With type IIa of the hyperlipidemic group, plasma cholesterol level tends to fall 14 hours after the high fat meal. The significance of the results is discussed.

Galactography using 60% urografin etc. was done in 86 cases, most with nipple discharge, 70 showed marked abnormalities such as intraductal papilloma, duct ectasia, cystic hyperplasia, intraductal and infiltrative carcinoma. False negative results were found in 2 cases, only 1 had mild complication. This examination is a simple, safe and reliable diagnostic method for secretory breast diseases and especially valuable for intraductal benign or malignant lesions. However, negative results do not exclude the presence of breast disease and the X-ray should not replace other roentgenologic diagnostic procedures. The method of selection of contrast medium and galactographic features of various breast diseases and their diagnostic value are fully discussed.

2,810 cases of epilepsy seen from 1955 to 1976 were analyzed statistically. 66.5% were male and 33.5% female. 28.39% of the cases occurred in childhood (0-14 year group), 13.27% during adolescence (15-20) and 52.63% in adolescent and middle age (21-50). 21.13% were cadres, 20.17% children, 17.50% students and 15.51% workmen. The duration of illness was 1-10 years in 49.3% and less than 1 year in 31%. 89% were idiopathic and 11% symptomatic. The common causes of symptomatic epilepsy were brain tumor (15.48%), cerebral developmental defect (15.48%), brain trauma, acquired (14.84), rheumatic heart disease (12.58%), infection and encephalopathy of the brain (10.97%) and cerebral parasitism (10.32%). Generalized epilepsy accounted for 58.8%, minor attack 4.3%, psychomotor attack 18.6%, combined attacks 6.0%, focal attack 8.7% and, vegetative epilepsy 3.6%. Of the 120 minor attack cases absence accounted for 68.33%, myoclonia 17.5% and infantile spasm 14.17%. Of the 102 vegetative epilepsy cases abdominal epilepsy accounted for 17.65%, epileptic cephalgia 78.43% and diencephalic epilepsy 3.92%. Among the 2,810 cases 21.5% had normal EEG findings, 36.5% mild abnormality, 31.9% moderate abnormality and 10.1% high abnormality. The younger the patient and the closer the tracing made to the last attack, the higher the incidence of paroxysmal specific abnormality.