Volume 92 · Issue 05 · 1979

Thumb reconstruction with a free second toe transplant using microsurgical technic is a highly recommended method. It can be completed in one operative stage, the thumb so reconstructed has good circulation and sensation as well as powerful movement of flexion-extension and an acceptable appearance. It can be used not only for simple loss of thumb, but also for all sorts of badly injured hands associated with thumb loss. Since 1966, we have employed microsurgical technic for reconstruction of thumb with free toe transplantation in 78 patients. The operation was successful in 73 patients, partial necrosis in 2 and complete failure in 3.

Sex chromosome and chromatin examinations with hormone determinations were done on 41 cases seen at the gynecologic clinic suspected of having sexual developmental abnormalities. 22 (53.7%) had genetic, gonatlal or hormonal abnormalities, including ovarian dysgenesis 9 cases, superfemale 1 case, XY pure gonadal dysgenesis 4 cases 3 of whom had already developed gonadal malignancy, pseudovaginal perineoscrotal hypospadias 1 case, androgen insensitivity syndrome 2 cases and congenital adrenal hyperplasia 3 cases. The values and limitations of sex chromosome and chromatin examinations as well as the prevention of gonadal malignancy are discussed.

A consequence of congenital aortic media hypoplasia, idiopathic aortic aneurysm is usually one of the manifestations of Marfan's syndrome frequently seen in children and adolescents. In this paper an analysis is made of 33 cases of this disease with regard to its clinical symptoms and signs as well as electrocardiographic, X-ray, angiocardiographic and pathologic manifestations. A brief account of the cardiovascular, skeletal and ophthalmic manifestations of Marfan's syndrome is given along with a discussion of the criteria for the diagnosis of this particular type of aneurysm in an attempt to facilitate differentiation from syphilitic, arteriosclcrotic and mediastinal tumors. The prognosis, and surgery are also described.

Experience in diagnosis and total excision of acoustic neurinoma in 31 cases is reported. All operations were carried out with meticulous dissection and strict hemostasis and the surrounding neurovascular structures were saved to the maximum extent. The facial nerve was preserved in most patients, the acoustic nerve was saved in 1 case. It is best during surgery to preserve the facial nerve intact. If this is impossible, intracranial facial nerve anastomosis is considered far better than extracranial cross nerve anastomosis. The postoperative results have been gratifying even in late cases.

This article deals with preliminary observations on the immune reaction of schistosomiasis patients and suggests that the immune function of schistosomiasis japonica may be related to the delayed type hypersensitivity reaction. During the transitional period, cell-mediated immunity plays a certain role. It is also suggested that the decreased cell-mediated immune function during the late period of the infection may be adjusted by giving traditional Chinese medicine with specific transfer factors for adopted immunity. The results are reported.

Histopathologic changes induced by Pingyangmycin 平阳霉素 (A5 component of Bleomycin) on esophageal squamous cell carcinoma treated preoperatively are analyzed. The main features of the degenerative changes observed are the enhancement of keratinization as well as massive coagulative necrosis of cancerous tissue which differ from the cellular vacuolization and liquifactive necrosis seen in ordinary chemotherapeutics. Besides this enhancement of keratinization, clusters of keratohyalin granules are found in some degenerative cancerous cords suggesting the probability that the selective therapeutic action of this agent on squamous cell carcinoma may be due to the ability to promote keratinization of squamous epithelium at various sites and help normalize the abnormal keratotic process to normal direction in some degree, thus the cancerous tissue becomes more differentiated and its growth retarded. The significant lymphoid cell infiltration in the stroma around the tumor mass indicates that the cellular immunity of the host is not suppressed by this agent, which accords with the opinion that Bleomycin does not inhibit the immunologic function of the tumor bearing host.

29 cases of chronic empyema complicated by bronchopleural fistula were treated by pleuro-pulmonary resection consisting of pleuropneumonectomy, 25 cases and lower pleurolobectomy, 4 cases. Postoperative complications included empyerna, 7 cases; empyema with bronchial stump fistula, 2 cases and secondary intrathoracic hemorrhage, 1 case. The short-term therapeutic effect was: 25 cured, 1 not cured and 3 died. The 25 cured were followed up from 6 months to 11 years, 22 of them did well and 3 developed tuberculous empyema or tuberculosis of the chest wall on the ipsilateral side which were cured after thoracoplasty or debridement. The indications for the operation, preoperative thoracic drainage, prevention of postoperative intrathoracic infection and secondary intrathoracic bleeding are discussed.

228 female mammary cancer specimens were selected in this analysis, not including the cases which had received preoperative radiotherapy and preoperative chemotherapy. In the series, 7,586 lymph nodes were examined which averaged 33.3 from each case. We classified the sinus histiocytosis (SH) of the axillary lymph nodes into three grades: mild (SH+), moderate (SH++) and marked (SH+++). The 5- and 10-year survival rates of the series are 58.8 and 46.9%. The 5-year survival rates of the SH+, SH++ and SH+++ grades are 22.9, 45.7 and 83.2% while their 10-year survival rates are 12.5, 38.4 and 90.9%. Whether there exists lymph node metastasis or not, the survival rate rises with the intensity of the SH reaction. This indicates morphologically the importance of the body's reticuloendothelial system immunity reaction in fighting tumor. The author also holds that after radical treatment of mammary cancer it is not necessary, it there is no metastasis, to resort to preventive chemical and radiation therapy, lest this lowers host immunity. It is preferable to adopt measures to raise or at least support host immunity, such as traditional Chinese and western medicine therapy.

The integration of traditional Chinese and western medicine in modern balanced anesthesia is still in progress. With our ever increasing knowledge of factors concerning favorable and unfavorable effects of anesthetics as well as by gaining more experience in using the principles of traditional Chinese prescription, we think that the purpose of building up a new school of anesthesiology will be achieved in the future.