Volume 92 · Issue 07 · 1979

Globoroseomycin, a new antifungal antibiotic, has high inhibitory action on Candida albicans and Cryptococcus neoformans at 3.1 µg/ml or even lower. It also has definite effect against such fungi as Aspergillus, Sporotichum, etc. Serum concentrations of globoroseomycin with usual clinical dosages are at least 3-5 times the minimal inhibitory concentration (MIC) of most of the strains of Cardida albicans and Cryptococcus neoformans. Its concentrations in the bile, liver, kidney and lungs are relatively high but loweri the brain tissue and cerebrospinal fluid (CSF). Of 55 cases of deep mycotic infections, including meningitis and septicemia treated by intravenous globoroseomycin infusion, the results were excellent 60.0% and effective in 92.7%. This antibiotic can also be given by the oral route, aerosol, bladder instillation, suppository, local application or infiltration for treatment of fungal infections of the gastrointestinal, respiratory and urinary tracts, mucous membrane and skin. Local use of globoroseomycin is also very effective. In 226 cases so treated the effective rate was as high as 85.4%. Compared to amphotericin B, globoroseomycin is less toxic and has fewer and milder side effects.

A new technic, the "raise-up" procedure for cleft palate repair, is described. Since 1965, 200 cases have been treated by this method. The results are quite encouraging, about four fifths of the patients have found improvement in speech and some can speak normally.

30 small hepatocellular carcinoma (HCC) cases are reported. Of these 23 were detected by alpha-fetoprotein (AFP) in mass survey and 7 clinically. Resection was successful in 22 cases. There was no operative mortality 8 cases underwent cryosurgery with ligation of the hepatic artery or radiation. The 1, 2 and 3 year survival rate of the entire series was 80.4%, 55.4% and 46.9%; in the resected group it was 83.3%, 70.5% and 70.5% and in the non-resected group 63.8%, 26.6% and 7.l%. The difference between the 2 groups is highly significant. Prognosis is markedly improved with early treatment, especially early resection. It is concluded that AFP screening is the method of choice for mass detection of small HCC. In this series, reliability of AFP diagnosis was 98.0%. Generally, diagnosis was made 7.9 months before symptoms occurred. However, long-term results are limited due to associated cirrhosis, multicentric development and the location of the neoplasm. Therefore research on the etiologic approach is important.

56 cases of jejunum syndrome are presented with a discussion of their roentgenologic and pathologic features. Among the salient X-ray menifestations are jejunal dilatations, spastic narrowing of the lumen, abnormal configuration and position of intestinal loops, coarsening of mucosal folds, hypomotility with prolonged emptying time and intestinal ileus with fluid levels. Pathologic findings in this syndrome are infiltration of the mcosa by plasma cells, eosinophilic cells, monocytes and lymphocytes, edema of the submucosa, coarsening and thickening of Kerkring's folds, atrophy of the tunica muscularis and degenerative edema in the intramuscular myenteric plexus.

To evaluate the efficacy of sodium selenite in Keshan disease, a study was carried out among children in Mianning county, Sichuan province, from 1974 to 1977 inclusive. The morbidity of Keshan disease in Selenium (Se) supplemented children was found to be 2.2‰ and 1.0‰ in 1974 and 1975 respectively while that in the control groups was 13.5‰ and 9.5‰, the difference being highly significant in both years. In 1976, both groups were given sodium selenite and the rate was further decreased to 0.32‰. In 1977, no new cases of Keshan disease were discovered among the treated children. Of 36,603 Se supplemented children, 21 cases of the disease occurred during the 4 years of investigation. Of these, only 3 died and 1 became a chronic. Among 9,642 children in the control group, 107 cases occurred, of which 53 became fatal and 6 had insufficient heart function. These results indicate that sodium selenite could not only lower the morbidity of Keshan disease but also alleviate its clinical signs and improve its prognosis. The role of selenium in the etiology of Keshan disease and the possible mechanism of sodium selenite in its prevention are discussed.

The distribution of Keshan disease has its own endemic characteristics. It shows a belt-like regional distribution throughout the country and a focal distribution within the affected belt. The disease is generally found in hilly and mountainous country and nonsalted areas. Sometimes there are "safety islands" surrounded by affected areas. These endemic epidemiologic characteristics are consistent with the hair Se level of the local people and the Se contents of their staple grains. All affected areas are relatively Se poor. For various reasons, Se is believed to play an important role in the etiology of Keshan disease. First, its occurrence is invariably associated with a lower hair Se content of the population, usually below 0.12 ppm. Wherever the level exceeded 0.2 ppm the district is free from this disease. Second, results of urinary Se loading tests and whole blood glutathione peroxidase activity measurements reveal that the populations in the affected areas are in a Se poor status. Third, sodium selenite supplementation is effective in preventing Keshan disease. Absence of correlation between the seasonal prevalence of Keshan disease and the variations in hair Se contents suggest that in addition to Se there may be other factors including biologic agents. The interrelationships which may be present among the pathogenic factors of the disease are discussed.

Studies on 66 cases of volvulus of the sigmoid colon are reported. Some problems in roentgen diagnosis and treatment are discussed. Consideration is given to a number of factors: a. A few cases of sigmoid volvulus are of the non-closed loop obstruction type which can be confirmed by barium enema. Its clinical manifestation, method of treatment and prognosis are quite different from those in the closed loop obstruction type. b. When the torsion of the closed loop type is less than 360°, the direction and degree of torsion can be inferred from the direction of the tapered end of the barium column and the location of barium which has partly entered the twisted loop. With a 180° clockwise torsion, the beak points to the left, and the small amount of barium in the twisted loop is shifted to the left. With a counter-clockwise torsion near to 360°, the beak points to the right, and a few barium in the twisted in approaches to the right. c. The X-ray findings may be helpful in prognosis and selection of treatment. d. There are 6 atypical signs which may be seen on plain films in the closed loop obstruction type. Some of these signs may be observed simultaneously. So long as the basic characteristics are kept in mind, most cases can be diagnosed by plain films of the abdomen.

Afferent loop obstruction after gastrectomy may occur following proximal loop to lesser curvature anastomosis especially in antecolic gastrojejunostomy. The etiology of obstruction is the disarrangement of the anatomical relationship between the proximal jejunal loop and its mesentery and is engendered following proximal loop to lesser curvature anastomosis. Prevention consists of simply performing a proximal loop to greater curvature anastomosis after gastrectomy in the great majority of cases. In this way, the retromesenteric space can be closed completely to avoid herniation of the efferent small bowel by suturing the jejunal mesentery to the mesocolon without compromising any portion of the afferent loop. Early diagnosis and operation are mandatory to prevent fatality in this complication, Recognition of this complication is imperative to avoid an attempt at complete reduction of the afferent loop which is inappropriate, as the condition is not internal herniation. Decompression by aspiration of the distended afferent loop and a simple enteric anastomosis performed between the two loops is the proper management when the bowel is viable.

Ganoderma has been considered to be valuable tonic and ingested as a panacea. The results of our investigations in mice indicate that the alcohol-water soluble preparations of Ganoderma possess sedative and anti-cholinergic properties, whereas its ether soluble preparations increase the detoxicating ability of the liver.

Furbenicillin is administered to 35 patients with severe gram-negative infections. Organisms isolated were Pseudomonas in 27 patients and Escherichia coli in 7. All these bacterial pathogens were highly susceptible to furbenicillin. Clinical study shows that furbenicillin at 8 mg/day is equivalent to 1/3-1/4 dose of carbenicillin and it is 90.9% effective against Pseudomonas and E. coli infections. No untoward effects were noted clinically in the liver or kidneys.