Volume N4 · Issue 05 · 1978

A pair of newborn xiphopagus twins, with internally joined liver were successfully separated surgically in December 1975. Both babies are living and well. The operation was done at 37 days of age with a total body weight of 3,000 gm, when both twins were suffering from life threatening pneumonia to facilitate treatment. The emergency operative technique and management of the pneumonia are described. Well organized teamwork contributes most to the success of treatment.

The responsiveness of the pituitary gland to stimulation by synthetic luteinizing hormone-releasing hormone (LRH) was observed in 107 subjects: 13 normal subjects, 40 cases with endocrine disorders and 54 women receiving steroid contraceptives. According to the magnitude and time of increment of serum human chorionic gonadotropin (representing the value of serum luteinizing hormone due to immunological cross-reaction) after administratiotn of an intravenous bolus of LRH, the results of response are classified into normal, delayed and low patterns. Most patients with pituitary lesions did not respond or responded poorly to LRH and with hypofunction of the hypothalamus, responses were in general active or delayed. Adverse side effects were not observed, during testing. The mode of action of steroid, contraceptives and the effect of peripheral hormones on the response are discussed. It is suggested that the test be conducted in 2 stages so that assessment of pituitary gonadotropic reserve function may be refined.

This article reports the discovery of a new type of pathogenic lung fluke which the authors designated as Paragonimus westermani ichunensis. Despite its gross resemblance to Paragonimus westermani, it has the following characteristic features permitting its differentiation, not only from P. westermani, but also from P. westermani var. szechuanensis [Paragonimus westermani (Szechuan variety, Chung and T'sao, 1962)]: a. the oral sucker is greater than the acetabulum; b. the cuticular spines are of mixed-growth pattern; c. the ova are smaller than those of P. westermani and their opercula are much flattened; d. the second generation rediae are smaller in size than those of P. westermani; e. the number of microcercous cercariae present in each second generation redia is only about 13 as aganist 20 or so in P. westermani; f. the average size of the metacercariae is markedly smaller than that of P. westermani found in Liaoning province, but is considerably bigger than that of P. westermani in Fukien; g. the first and second intermediate hosts are Semisulcospira amurensis and Cambaroides schrenckii as well as C. dauricus respectively, whereas the first and second intermediate hosts of P. westermani in other parts of China other than the 3 north-eastern, provinces are 4 species of melania snails and 8 Potamon species of fresh water crabs. Albeit the natural and experimental final hosts of this new lung fluke are the same as those of P. westermani, the clinical manifestations are quite different in many respects from those caused by P. westermani.

Jaundice, the most common symptom with periampullary tumors is often mistakenly believed to be their early clinical, manifestation. Actually only about 20% of carcinoma of ampulla of Vater patients and 15% of cancer of pancreatic head patients complain of jaundice as their first subjective symptom. Jaundice is clinically manifested only when the intrabiliary pressure exceeds the hepatic secretory pressure and before its appearance the biliary tract has already considerably dilated. Thus it is possible to diagnose periampullary tumors in the prejaundice stage by finding an enlarged gallbladder or screening with ultrasound for biliary tract dilation.

229 cases of granulomatous disease of the large intestine secondary to schistosome infestation were studied. All the cases were characterized by mucosal hyperplasia, pseudopolyposis, ulceration, thickening of the intestinal wall and bowel stenosis coupled with involvement of the mesentery. Diffuse involvement of the large intestine and a history of symptoms of 10 years' duration were common. The rectum and sigmoid colon were most frequently affected. Tumefaction was seen in 54 cases. Complications included schistosomiasis dwarfism, intestinal fistulae or free perforation, perianal fistulae, intussusception, massive intestinal, hemorrhage and urinary troubles. Roentgenologically, the condition was classified into ulcerative colitis type, localized narrowing type and polypoid and extraneous type; and pathologically, into mucosal hypertrophy type, transmural type, extraneous type and mixed type. Pseudopolyposis, ulceration and ectopically proliferating glands were thought to be conditions predisposing to malignant transformation. Complete excision in the precancerous state is considered helpful to the control of carcinoma.

170 cases of acute perforation of peptic ulcer were treated with combined traditional Chinese and western medicine. Of these, 137 (80.6%) underwent nonoperative treatment and 33 (19.4%) immediate surgery. The treatment of 120 patients in the nonoperative group was successful a success rate of 87.6%. The remaining 17 cases failed to respond and were transferred for operation, a transfer rate of 12.4%. The overall mortality was 2.9% and morbidity 1.8%. The therapeutic results for this series were better compared with the series reported 3 years ago. Due expansion of the scope of nonoperative therapy and appropriate application of emergency surgery were emphasized in rational selection of indications. Oral administration and local application of traditional herbal medicine were considered essential in prevention of complications. Electroacupuncture and efficient decompression, proved effective in promoting resolution of peritonitis secondary to peptic ulcer perforation.

Long term follow-up of 73 patients with arteriovenous malformation of the brain, surviving various surgical operations, revealed that 40 had recovered without noticeable defects, 13 had mild degrees of neurological deficits, 10 needed care by others and 19 died. Among the operative procedures performed, complete or subtotal lesion, resection gave the best long term result, whereas feeding artery ligation, simple evacuation of hematoma, biopsy and cranial decompression were less satisfactory. In cases with intracerebral hematoma, although the operative procedure was easier to perform, neurological, functional recovery was less satisfactory than in those without hematoma.