1984年 · 第97卷第07期

The incidence of goiter in two villages of Shijiu Commune situated along the sea coast was 31.3 and 41.7%, and the average urine iodine excretion was 1,423.0 and 2,097.0 μg/g creatinine, respectively. Their average iodine contents in drinking water were 35.5 and 26.0 μg/L, respectively. Because the inhabitants in the villages consumed large quantities of kelp salt and its pickled vegetables, we believed that goiter was caused by excessive intake of iodine. The other two villages in Taole Commune had similar geographical conditions as Shijiu Commune did, but their inhabitants took iodine deficient common table salt. Their goiter incidence was 6.7% and 8.0%, respectively. Goiter in these villages is considered as mild iodine excess goiter. The goiter incidence in Mazhao Commune of a hilly region 15 kilometers away from the sea, and in Huangdun Commune of a mountainous region 30 kilometers away from the sea, was 29.4% and 23.5%, respectively. The average urine iodine excretion was low (46.5 and 23.96 μg/g creatinine); it was associated with the low iodine content of drinking water (1.5 and 0.65 μg/L). The inhabitants in both regions were all peasants consuming iodine deficient table salt. Therefore, goiter in the latter two communes is considered as the common iodine deficient goiter.

Forty cases of stump gastric cancer (SGC) (6 found in Xian) were reviewed. The detection rate of this cancer by fibergastroscopy in China was 2.24%, and in Xian 3.16%. The cancer was more frequently observed in the patients over 40 years of age at first operation than in patients below 40. Cachexia and exhaustion were common. Besides the anastomotic stoma, the cardia was frequently in volved. Polypoid type (Borrmann IV) was more common. In patients with advanced gastric cancer, however, the condition was different. For the diagnosis of SGC, fibergastroscopy is better than barium meal examination.

The molecular heterogeneity of serum alpha-fetoprotein (AFP) in 36 patients was studied by lectin affinity-radioimmunoelectrophoresis. Two variants of AFP, concanavalin-A (Con-A) reactive and the Con-A nonreactive, were obtained. AFP in all 13 patients with hepatoma consisted of the two variants, but the Con-A reactive variant was the major one. In 8 patients with benign liver disorder, however, only the Con-A reactive variant of AFP was detected. Over 50% of AFP in 5 patients with yolk sac tumor was Con-A nonreactive. Thus, there were three different patterns of AFP variants. The clinical implications are discussed.

A modified method for histamine release from basophils test (HRBT) has been developed. Only 2.5-3.0 ml of whole heparinized blood is required for detecting allergens in vitro. For one year the modified method has been used in 142 patients with allergic disorders and 42 healthy controls. The HRBT results in these two groups are consistent with the clinical diagnoses, with coincidence rates of 87.5% and 95.2%. The method is convenient, specific and sensitive.

The parameters of cell cycle were determined with 3H-thymidine (3H-TdR) incorporating into epithelial cells in vitro and with autoradiographic technique in chronic gastritis and gastric cancer. The labeling index was used as a measure of the proliferating activity of epithelial cells of the stomach, It varied among diseases of the gastric mucosa. No correlation was found between the labeling index in the fundus and that in the antrum. Atrophic gastritis with intestinal metaplasia and gastric cancer both were associated with high labeling indices and with proliferation spreading to the surface of the mucosa. The durations of the S phase and cell cycle were measured with a double-label procedure. The S phase in gastric cancer was longer than that in atrophic gastritis. The S phases of vicinity cancer tissues was shorter than that in atrophic gastritis. Further investigation is needed to determine the significances of the S phase variations.

This paper reports 21 cases of eosinophilic fasciitis and emphasizes that localized inflammatory and sclerotic changes in the deep tissues characterize this disease. We propose the name sclerotic fasciitis for this condition to reflect its specific pathologic changes. This disease is an especially deeply situated type of scleroderma, somewhat similar to localized scleroderma. The ultrastructural study of myofibroblasts in this condition indicates that it may be closely related to proliferation of collagen fibers in the fascia. Patients were treated with traditional medicinal herbs in accordance with the traditional Chinese medical principle of stimulating blood circulation to end blood stasis. Therapeutic results were satisfactory.

Mitochondria from 20 patients with acute leukemia were studied ultrastructurally and compared mainly with those from patients with non-leukemic disorders. The cristae/diameter (qiD) ratio was used to quantitate the destruction of cristae. The C/D ratio in patients with acute leukemia (Mean 0.921, SD=0.31) differed significantly from that in normal controls (Mean=1.553, SD=0.389, p<0.01) and even more from that in patients with non-leukemic disorders (Mean=1.877, SD=0.281, p<0.001). No significant difference in C/'D ratio was found be tween acute leukemia and preleukemia (Mean=0.956, SD=0.144, p>0.8). We believe that when the C/D ratio is less than 1.332, a diagnosis of acute leukemia or preleukemia can be made if the clinical findings are consistent. This is the first time that a quantitative criterion for electron microscopic diagnosis of acute leukemia and preleukemia is available. The C/D ratio is also of prognostic value (r=0.9 p<0.01) in acute leukemia.

This article presents the clinical results of surgical treatment of symptom recurrence after curative radiotherapy for esophageal carcinoma in 54 patients. The overall resectability rate was 75.9% and the resection mortality rate 21.0%. Pneumonia, anastomotic leakage, and empyema were the three major complications, occurring in 26.8%, 17.1%, and 17.1% of the cases. Pneumonia was the main cause of postoperative death. The 5-year survival rate was 26.1% after surgical resection and 30.4% after radio therapy. These results compare favorably with those achieved by radiotherapy alone and may strengthen the rationale for combined preoperative irradiation and surgery in esophageal carcinoma. Whenever recurrence is suspected or severe stricture occurs after curative radiotherapy, surgery is necessary for localized lesions and should be done if the patient's general condition is satisfactory and there is no sign of distant metastasis.

Twenty-two cases of chaotic atrial tachycardia (CAT) in infants and children are presented. The features were as follows: the patients were all small infants; most cases were associated with respiratory disease; unless the CAT was associated with severe disease, the patients appeared well after the infection was controlled other than in a patient with ventricular septal defect and one with endocardial fibroelastosis, no evidence of congestive heart failure was noted; CAT reverted spontaneously to sinus rhythm after various lengths of time; other manifestations of atrial ectopic rhythm were also noted; antiarrhythmic treatment was ineffective; and prognosis was good in cases without associated se vere diseases. The electrophysiologic mechanism of this dysrhythmia remains unknown.

74 patients undergoing mitral valve replacement with porcine heterograft were followed up. Before operation, 49 patients were in cardiac function Class III, and 25 in Class IV. Five patients (6.8%) died during the perioperative period. Of the survivors, 64 were followed up for more than 3 months and 3 for 4 years, averaging 24 months. Cardiac function was improved to Class I in 40 patients, Class II in 23, and Class III in 1. The mean value of cardiothoracic ratio before and after operation was 0.64±0.0,662 and 0.55±0.0,543 respectively (p<0.001). In 14 patients examined with two dimensional echocardiography preoperatively and 1 to 3 months postoperatively, reduction in size of the left atrium was more significant than that of the left ventricle. Nevertheless, the size of the right atrium and ventricle and the ejection fraction remained unchanged. Five patients underwent cardiac catheterization before and 3 to 5 months after operation. Their pulmonary capillary wedge pressure declined to normal, and the pressure and resistance of the pulmonary artery and the cardiac index were also improved. Thus, all-round judgement on the therapeutic effect of valve replacement should be made. As to the cardioversion of atrial fibrillation, our patients were compared with those who underwent mitral valvulotomy and those who did not undergo any operations in our hospital. The successful rate of cardioversion was similar to that of the latter two groups, but the recurrence rate was much lower than that of the two groups. The mechanisms of above findings are discussed.