1982年 · 第95卷第01期

Diabetes affects the heart not only through coronary atherosclerosis, but also in the earlier phase by autonomic neuropathy and cardiomyopathy. Functional, structural and metabolic aberrations as a result of chronic diabetic neuroendocrine disturbances have been demonstrated in the diabetic heart. This may explain the probable mechanism of pathogenesis and high incidence of cardiogenic shock and congestive heart failure with or without myocardial infarction.

An epidemiologic investigation on endemic goiter and cretinism in southeastern Guizhou province was carried out in 1979. The incidence of goiter in Shilong, Heba and Pingliang communes was 23.2%, 31.5% and 30.4% respectively. Qianling commune was taken as a nonendemic control with a goiter rate of 0.97%. The incidence of endemic cretinism was 5.2%, 3.1% and 2.8% for Shilong, Heba and Pingliang communes respectively. No endemic cretinism was discovered in Qianling commune. Female goiter patients were more than the male with a F/M ratio varying from 2.13 to 2.68. As an index of iodine nutrition, urine iodine excretion was very low, being 23.3 and 11.8 μg/gm creatinine for inhabitants of Heba and Pingliang communes, while that for the inhabitants of Shilong commune was normal (110.6 μg/gm creatinine) due to iodized salt prophylaxis. Qianling commune was also within the normal range (75.2μg/gm creatinine) not only because of the slightly higher drinking water iodine content but more important was the fact that they continued to use the iodine rich salt supplied from Sichuan province which contained as much iodine as 3.0-5.2 mg/kg. The thyroid 131I uptake figures obtained in the 3 endemic communes correlated every well in a reversed fashion, that is, in the untreated Heba commune, the 24 hr thyroid 131I uptake ran up to 72.5% and 68.3% for the children and adults. The 24 hr thyroid 131I uptake was normal in Qianling commune being 48.3% for children and 37.7% for adults. Still lower figures (26.7% for children and 27.2% for adults) were obtained in Shilong commune after iodine repletion. The endemic maladies, goiter and cretinism can be easily prevented by persistent practice of iodization of the common sea salt in regions of iodine deficiency.

Comprehensive medical (Chinese herbs and western), acupuncture and surgical treatment are used in this disease of the young with fairly good results. Conservative treatment alleviates stasis and controls vasculitis and surgery improves distal blood flow by vascular reconstruction.

This paper deals with Japanese B encephalitis (JBE) virus isolation from and JBE virus neutralizing antibody levels in horses immigrating from Zhaowudameng, Inner Mongolia Autonomous Region to the National Vaccine and Serum Institute, Beijing. Based upon the data, Zhaowudameng is classified as a JBE semiendemic area, the epidemiologic and climatologic features of which are covered.

The surface and internal ultrastructure of multinuclear giant cells and stromal cells are studied in 3 cases of giant cell tumors of bone by means of scanning electronmicroscope and transmission electronmicroscope. The fibroblast-like type of stromal cells was the principal stromal cell and has the function of forming collagen. Like the fibroblastic type of stromal cells, the multinuclear giant cells can also be deemed as true tumor cells. Various surface ultrastructural configurations of the multinuclear giant cells can be attributed more to heightened metabolism than to manifestation of malignancy.

This is a prospective study to identify the effectiveness of low energy direct cardiac defibrillation in a series of 100 cardiac operations under cardiopulmonary bypass. The success rate was 21% with 3-5 watt/second (W/S). 45% with 6-10 w/s and up to 100% with 20. The factors of success are analyzed.

Interest in the surgical treatment of acute hemorrhagic pancreatitis has increased in recent years. Evidence of rising surgical militancy is the willingness of some surgeons to undertake pancreatectomy or conduct a tour-de-force of multiple drainage in patients desperately ill of hemorrhagic necrosis of the pancreas. A complete protocol for the treatment of acute pancreatitis and its complications is presented. The advantage of having an adequate flow sheet cannot be underestimated.

The healing process of a standardized radial fracture was studied under scanning electron microscope (SEM). The active cellular activities of all main kinds of "osteogenesis cells", the collagen fibrils they produce and the three dimensional configurations of various calli are described. In the process of calcification, calcium salt moves from intracellular to the intercellular milieu throughout the whole course of fracture healing. In the early stage, calcium s.alt crystals deposited within the collagen fibrils in an unhomogeneous manner. As union is attained, the callus turns into finer homogeneous and becomes denser and more compact. It is concluded that the SEM is of value in the study of fracture healing mechanism.

70 cases of pediatric femoral head avascular necrosis were treated as far as we know for the first time by synovectomy from 1962 to 1976 with excellent results in 82% and 92% efficacy (excellent plus good results) in the 50 cases followed up for an average of 3 years and 2 months. Operative results are best in the second and third disease stages, spontaneous recovery may be expected in stage 1 and the operative result is poor in stage 4.

Long term follow up observations are carried out in 103 cases of avascular necrotic femoral head collapse after transcervical fractures. A method of detecting minimal femoral head collapse and classification of its stages and types are presented which helps early diagnosis, estimation of prognosis and selection of treatment. Criteria and radiologic signs for the detection of femoral head collapse are: time of occurrence, appearance of nail trace, recurrence of pain, gradual lowering of femoral head height and appearance of a sclerotic-radiolucent zone. A method of measuring femoral head height is devised and reported. Correct interpretation of the criteria and radiologic signs during minimal collapse is considered the key to increasing the efficacy of treatment. Femoral head collapse after transcervical fracture is classified into 3 types, weightbearing area collapse, total collapse and subtotal collapse. Subtotal collapse is a new type proposed by the authors with its own clinical features. During the progressive stage, weightbearing area collapse retains the best function, subtotal collapse the next and total collapse the worst. Features of the quiescent stage of collapse are also classified into 3 types, prognosis of the repair type is the best, sclerotic type the second and absorption type worst.