1981年 · 第94卷第07期

Direct measurements are made of 996 lumbar vertebrae of 200 Chinese adult dried skeleton specimens. Morphometric values support the view that developmental vertebral canal stenosis is a type of borderline stenosis with slight shortening of canal mid-sagittal diameter and/or interpedicular diameter compared with the norms. It is a predisposing factor leading to vertebral canal stenosis syndrome, but not the determining factor. During diagnosis of lumbar vertebral canal stenosis, measurement of the canal mid-sagittal diameter is very important. Calculating the spinal index and measuring the length of the vertebral arch-pedicles, especially those of the upper lumbar vertebrae, are of definite significance for clinical reference. Using the spinal index for calculations, we found the vertebral canal volume of the vertebrae with mid-sagittal stenosis insufficient, whereas that of vertebrae showing interpedicular stenosis was normal. In our series of 996 lumbar vertebrae, there was an apparent positive correlation between the length of vertebrae arch-pedicles and canal mid-sagittal diameters, but the coefficient of correlation gradually decreases from L1 to L5.

Three cases of malignant bone fibrous histiocytoma are reported. They were identified on the basis of characteristic histopathologic features, i.e. neoplastic histiocytes, fibroblast-like cells and multinuclear or mononuclear tumor giant cells, generally appearing very pleomorphic and bizarre and fibroblastic cells and collagen fibers arranged in storiform or matted fashion, as well as active phagocytosis, prominent mitosis and sprinkling of lymphocytes and plasma cell infiltration. The storiform pattern is considered the most characteristic feature, which may be of great help in differential diagnosis. The clinical manifestations, roentgenologic pictures and surgery results in 3 cases are also described.

The effects of a bean diet on serum cholesterol and triglycerides were investigated in 123 cases, with hyperlipidemia. The subjects were asked to take a meal of beans containing 50-100 gm of whole beans (including Phaseolus vulgaris L 菜豆, Phaseolus radiatus L. 蔓黑绿豆, Vicia faba L 蚕豆 or Glycine max (L) Merr 黄豆 (soybean) in this order of frequency, every 1 or 2 days for 3-6 months. Results showed serum cholesterol was significantly lowered 1-3 months after taking over 1,000 gm bean every month. Significantly lowered serum cholesterol levels were found in 77% of those with hypercholesterolemia (lowered from 281.8±40 mg% to 234.9±33.7 mg%, p<0.001). The triglycerides level remained unchanged 1-3 months after taking the meal.

73 cases of congenital anomalies of the atlanto-occipital region are diagnosed and treated operatively. Clinical appearance, symptoms and signs of cranial nerves, upper cervical cord and cerebellum, radiologic findings and operative technic are presented. Long term surgical results are Grade I 39 cases, Grade II 12 cases, Grade III 4 cases and Grade IV 3 cases. Differential diagnosis, time of surgery and operative complications are discussed.

From May 1976 to January 1980, 100 cases of cardiac valve replacement performed at Fuwai Hospital are reported. Chinese made heterogenous bioprosthetic bovine pericardial (Model BN) and porcine aortic valve with elastic stent (Model BZ) were used. 21 aortic valve replacement (AVR), 72 mitral valve replacement (MVR) and 7 double valve replacements were done. A total of 106, (81 BN and 25 BZ) bioprosthetic valves were used. The characteristics of the BN and BZ prostheses are discussed. Among the patients operated upon, 34% had Class IV cardiac function (the New York Heart Association criteria). The operative mortality Q3 cases) was 13%. There were 8 cases with Class IV function among the fatalities, 87 cases are living, 45 of 50 had Classes I-II improvement in cardiac function during 6-42 months follow-up (mean 14.8 months). Postoperative radiograms showed marked reductions in cardiac size. The early results of these 2 types of Chinese made bioprostheses are rather satisfactory. Study of the bioprostheses in vivo and improvement of cardiac function evaluated by echocardiography are briefly presented. No prosthetic dysfunction has been observed, but long term durability of these valves remains to be established.

40 cases of enterocolonic Crohn's disease (CD) resected were studied clinicopathologically and were compared with 53 cases of enterocolonic tuberculosis (TB). There are many symptomatic and morphologic overlaps between the 2 diseases. Nevertheless, fissuring ulcer, widening of submucosa and cobblestone appearance are distinctive diagnostic features of CD, while caseous necrosis and/or presence of acid-fast tubercle bacillus are the hallmark of TB. Antituberculous therapy may alter the histologic characteristic of TB leading to scarring of the granuloma, yet caseous necrosis never completely disappears even after massive doses of antituberculous therapy. In our series, caseous necrosis in the lymph node and bowel wall was still prominent in 21 cases of enterocolonic TB receiving preoperative antituberculous treatment.

This paper summarizes the experience in 4,466 cases of craniocerebral operations carried out under acupuncture anesthesia (AA). The. success rate was over 90%. The technic, case and acupuncture point selection, preoperative medication, use of adjuvants during operation and problems remaining to be solved are described. It has been found that AA has effect against pain, shock and infection. Seldom attended by complications. The anesthesia is effective, simple, safe and economical and especially suited to elderly patients and those in poor health or in shock. The AA mechanism is discussed.

Two cases of low-grade malignant orbital chemodectoma successfully treated by exenteration are reported. The clinical and pathologic characteristics, possible originating sites and treatment of choice are discussed.

The data on 117 new diabetics treated from March 1 to August 30, 1978 and 1,000 inpatients treated from 1958 to 1977 show that the frequency of diabetic nephropathy, coronary heart disease (CHD), diabetic retinopathy, cataract, peripheral neuropathy and cerebrovascular disease is several times higher than previous data reported in Shanghai. The data also show that the frequency of diabetic microangiopathy in China is essentially the same as in western countries, with the exception of CHD and gangrene of the lower limbs. In 55 cases followed up from 1963 to 1973, there is a close relationship between the development and progress of retinopathy, nephropathy and the control of diabetes.