Volume 92 · Issue 08 · 1979

This paper deals with the experience with endoscopic retrograde cholangiopancreatography (ERCP) in 100 consecutive patients (105 examinations). Successful ERCP via the papilla of Vater was obtained in 80 patients (85 times) and via choledochoduodenal fistula in 4, giving a total success rate of 84.7% (89/105 examinations). There were no serious complications. Of these 84 cases, 40 had normal and 44 abnormal radiograms. Among the normal 2 were proved at surgery and 38 by clinical data and follow-up study. Of the abnormal 6 had radiologic evidence of chronic pancreatitis (1 proved by surgery), 7 had choledoeholithiasis (4 proved by surgery), 11 had pancreatic or biliary carcinoma (7 proved by surgery or autopsy), 19 had post-cholecystectomy syndrome revealed by pathologic lesions (11 had postoperative stricture of the bile duct, 2 had diffuse dilation of the bile duct, 5 had residual biliary stones, 1 had an over long remnant cystic duct) and 1 had obstruction of the cystic duct. The literature concerning normal and abnormal ERCP findings are reviewed; preferred technics, indications and contraindications and complications are analysed.

104 eyes with fundus disease treated by ruby and argon laser photocoagulation from 1974-1978 are reported. The methods and results of treatment are described. The problems in laser treatment of retinal breaks, retinal holes within the coloboma of the choroid and hemangioma of the choroid were discussed.

Cellular activity in rabbit radius fractures is studied and observed by electron microscope. After fracture, polymorphonuclear neutrophils, macrophages, fibroblasts, chondroblasts and osteoblasts and osteocytes appear at the fracture site in succession. They represent the following stages of fracture healing: inflammatory stage, debridement stage, fibrous caUus stage, primary bony callus stage and secondary bony callus stage. Fibroblasts participate in and possess the action of osteogenesis.

30 rabbits were used. 7 out of 10 rabbits in the silicotuberculosis group and 2 out of 9 in tuberculosis group developed pulmonary cavities. No cavity formation was seen in the 11 rabbits of the silicosis group. Silicotuberculous cavities are multichambered, irregular and large. They contrast sharply with the simple tuberculous cavities, which are few in number, small in size and spherical in shape. Morphologically, experimental and human silicotuberculous cavities are very similar.

Previous investigations suggest that the caudate nucleus plays a part in acupuncture analgesia. The present work studied the effect of electroacupuncture on the rabbit's caudate neurons sensitive to acetylcholine (ACh), serotonin (5-HT) and dopamine (DA), recorded by multimicropipettes and examined by microiontophoresis. In testing 110 units, 35 were activated by electric needling, 43 depressed and 32 not significantly affected. Most ACh, 5-HT and DA sensitive neurons responded to electric needling exhibiting an increase or decrease in the frequency of spontaneous discharges. The result demonatrates that the afferent impulses arising from a needled acupuncture point can reach the caudate and modulate the neuronal activity.

Inflammatory pseudotumor of the lung is a kind of tumor-like inflammatory hyperplasia of the lung parenchyma. In this paper 41 cases are analysed. Of these 15 were male and 26 female, the youngest patient was 7 years old and the oldest 57, an average of 43.4. According to their chief configurations and cell types, the authors have classified them into the following 4 types: pseudopapillary tumor 29 (70.7%) case, histiocytie 8 (19.5%) cases, plasma cell 2 (4.9%) cases and pseudolymphoma 2 (4.9%) cases. The clinical behavior, X-ray appearance, operative findings, pathologic and differential diagnosis, etiology and prognosis are discussed.

The effect of hypothermic cardioplegia in protecting myocardial function during cardiac surgery under extracorporeal circulation was clinically investigated in 525 cases. The lowest myocardial temperature after coronary perfusion with the cardioplegic solution precooled to about 4 C was about 15 C. Supplemented with other local cooling methods to keep the heart in a deep hypothermic state, complete cardioplegia and excellent myocardial protection were obtained as shown by the spontaneous return of sinus cardiac beat without need for electric defibrillation occurred in about two thirds of the cases and much less vasopressors were needed after the operation. Extract of a Chinese medicinal herb, Radix astragali 黄芪 was tried in part of the cases and it's pharmacology is briefly presented. Compared with other myocardial protection methods, it was found to be a simple and very efficacious technic. Even better results might be achieved if the serum potassium level and acid-base balance were well regulated throughout anesthesia and perfusion and the body temperature rewarmed to nearly normal at the end of surgery.

Of 74 cases of primary cardiomyopathy seen over a period of 20 years, 52 (70.2%) were diagnosed as congestive cardiomyopathy, 14 (19%) as obstructive cardiomyopathy and 8 (10.8%) as restrictive cardiomyopathy. In this paper the 52 cases (37 males and 15 females) of congestive cardiomyopathy are analyzed. Of these, 26 were admitted for heart failure, 24 for cardiac arrhythmia, 1 for cardiogenic shock and 1 for cardiac enlargement. Roentgenologic examination revealed enlargement of heart shock in 48 cases. Electrocardiogram displayed sinus rhythm in 44 cases in which various cardiac arrhythmias appeared on and off and ectopic rhythm in 8. Thromboemboli phenomena were seldom seen. The hospital fatality rate was high, being 42.3% among cases with heart failure and 8.3% among cases with cardiac arrhythmia. The etiology of this disease is unknown. The prognosis was poor in cases with congestive heart failure. The mean duration of cardiac enlargement prior to onset of symptoms was 4.5 years. Differential diagnosis between congestive cardiomyopathy and pericardial effusion and coronary, rheumatic, pulmonary, and congenital heart diseases are emphasized. Maintaining heart function in the compensatory stage is considered effective in the prevention of this disorder. Treatment is as a rule palliative, consisting of rapid-acting glucosides and diuretics.

14 cases of obstructive cardiomyopathy and 8 cases of restrictive cardiomyopathy are analyzed. Of the 14 cases of obstructive cardiomyopathy 3 had positive familial history. Typical angina pectoris occurred in 3 and fainting occurred in 2 cases. A grade II-III systolic murmur was audible in all, mostly at the left lower sternal border. Electrocardiogram displayed abnormal Q wave in 10 cases and left ventricular hypertrophy with strain in 7 cases. Left heart catheterization in 5 cases disclosed a significant systolic pressure gradient between the left ventricle and aorta at rest in 2 cases; in the other 3 cases systolic pressure gradient occurred after injection of isopropylnoradrenaline. Left ventriculography revealed narrowing of the ventricular cavity and thickening of the interventricular septum and free ventricular wall in 5 cases. Echocardiography in 2 cases and phonocardiography with simultaneous administration of vasoactive drugs or performance of physical maneuvers in 5 cases all showed characteristic diagnostic features. Adrenergic blocker was given in 4 cases with satisfactory results. There was no fatality during hospitalization although all the patients had a long history of cardiac symptoms (averaging 5.8 years) on admission. Of the 8 cases of restrictive cardiomyopathy, 7 showed symptoms and signs of cardiac tamponade on admission. Roentgenologic examination revealed marked enlargement of heart shadow in all cases. Electrocardiography displayed signs of myocardial damage in most cases. Right heart catheterization in 4 cases disclosed early diastolic dipping and late augmented diastolic plateau of the right ventricular pressure pulse. Autopsy was performed in one case. Differential diagnoses of restrictive cardiomyopatby, constrictive pericarditis, congestive cardiomyopathy, rheumatic heart disease, cirrhosis of liver, endomyocardial fibrosis and idiopathic mural endomyocardial disease are emphasized. Treatment was usually cardiac glycosides and diuretics. 2 patients died during hospitalization, the duration from the appearance of symptoms to death averaged 3.8 years.

An improved tail flick test, suitable for experimental study of acupuncture analgesia is introduced. It is simpler to conduct and the tail flick response is better recognized than the conventional method. Electroacupuncture of bilateral Zusanli 足三里 and Sanyinjiao 三阴交 point equivalents on the rat resulted in prolongation of the tail flick latency which involved descending inhibition from higher centers. The effect of electroacupuncture in this model varied directly within certain limits with the intensity and duration of electraacupuncture and was fairly stable in a group of 9 to 12 or more rats. The importance of room temperature and constancy of rat tail temperature are emphasized.