Volume 92 · Issue 10 · 1979

Cardiovascular diseases were comparatively rare in old China Since liberation in 1949 with continuing improvement of the people's living conditions, acute infectious diseases, tuberculosis, malnutrition, etc. have been put under control, but on the other hand cardiovascular and cerebral diseases have become one of the most important health problems in our country. As in many other medical fields, in the past 2 decades much work has been done in China in the control of hypertension, stroke and coronary heart disease. This paper is a general review of the prevalence of these diseases and the work done in their prevention and treatment in certain regions, urban and rural, in the past, 20-30 years with tabulations. Certain points concerning future efforts to improve cardiovascular disease epidemiology and community control are emphasized.

A series of 156 cases of meibomian gland carcinomas are studied pathologically with 100 cases followed up. This represents the largest series of original cases so far reported in the literature available to us. This tumor is apparently one of the most malignant tumors of the eyelids as evidenced both by lymphatic spread and blood-borne metastasis, resulting in a high mortality rate of 41%. The histologic structure of the tumor is extremely variable. It may simulate squamous cell carcinoma, basal cell carcinoma, adenocarcinoma or spindle cell carcinomas. Therefore in dealing with the large number of cases in our ophthalmic clinic, we have evolved a tentative pathologic classification of this tumor into 5 different types: the differentiated, squamous cell, basal cell, adenoid and spindle cell. According to the follow-up data of 100 cases, the pathalogic classification appears to have some bearing upon its clinical manifestations, the differentiated type being the least malignant, while the basal cell and squamous cell types are the most malignant. Cases of the adenoid type and spindle cell type are too few to warrant any conclusions concerning their clinical manifestations.

Since 1958, a search for new methods of treatment of gestational trophoblastic diseases has been carried out. Through repeated trials, several effective chemicals, such as 6-Mercap-topnrine, 5-Fluorouracil, Kengshengmycin, Tisupurine and Nitrocaphane were found. By using them either alternately or in combination, the therapeutic results were very encouraging. From 1949 to 1975, a total of 392 cases of choriocarcinoma and 414 cases of malignant mole were treated consecutively. The rate of complete remission of choriocarcinoma was raised from 10.8% to 78.6% and that of malignant mole from 74.l% to nearly 100%. Not a few very late patients of choriocarcinoma with generalized metastases survived and returned to work. Many young women treated with drugs alone gave birth to children after recovery. All the survivors were followed up periodically. About 85% of them have survived for more than 5 years and 60% for more than 10 years, the longest being nearly 20 years in 15 cases. Repeated examinations revealed no evidence of residual disease, indicating that these patients were cured. The therapeutic efficacies of the different drugs are evaluated. 5-Fluorouracil is especially recommended. A clinical staging is proposed.

Osteoblasts and chondroblasts turn fibrous callus into bony callus through intramembranous and endochondrial ossification, completing fracture repair. In fracture repair, with its special demands, the fibroblasts form bone, so calcium salt crystal deposition takes place in the collagen fibrils surrounding them. Depositian of calcium salt crystals takes place not only in the typical collagen fibrils with 640 A periodicity, but also in the atypical collagen fibrils which are produced by chondroblasts and are irregular in size and array and present no 640 A periodicity. Calcium salt crystals are not deposited throughout the whole length of the collagen fibrils at long one and the same time, instead they appear in segments before they coalesce into single ones in the fibril. There is an earlier deposition of calcium salt crystals in the coarser and more mature and remote collagen fibrils than in the fibrils which are finer, younger and nearer to the cells. Calcium salts exist in the form of granules in the membranes of mitochondria, rough surfaced endoplasmic reticulum and in other intracellular membranous structures. These granules provide essential raw materials for calcium salt deposition in extracellular collagen fibrils.

The results of 426 hydrogen peroxide contrast echocardiographic studies in 100 patients are reported. The peroxide is given intravenously through a peripheral vein and the contrast effect is rather satisfactory. There are no marked untoward reactions when adequate doses were given. This procedure is used in the identification of cardiac structures, determination of whether a right to left shunt is present in congenital heart disease and measuring circulation time. The results are quite satisfactory and the method is simple and noninvasive. The technic of clinical application and way of preventing untoward reactions are described.

Two patients with total anomalous pulmonary venous return (TAPVR) to the coronary sinus are described. Both patients were neonates, cyanotic and had heart murmurs. In each case the diagnosis was suggested on the echocardiogram, but a definitive diagnosis required angiography. The echocardiogram of each patient demonstrated an additional chamber posterior to the left atrium in the region of the atrioventricular groove which subsequently proved to be an enlarged coronary sinus. At the time of catheterization, cardio-green dye was injected and the results observed on A-mode in the catheterization laboratory. Recordings could not be obtained of the A-mode display.

Serum samples from asymptomatie HBsAg carriers and patients with various forms of liver diseases were studied by agar gel diffusion technique for the incidence rate of e system and correlation with other markers of HBV infection. 5% of eAg and 30% of eAb in 181 asymptomatic HBsAg carriers and 24% of eAg and 0.7% of eAb in 583 cases with various forms of liver diseases were detected. Presence of eAg was associated with DNA-polymerase activity and in the majority of circulating Dane particles. 91% of e system positive sera belonged to AD-subtype of HBsAg which had been reported to he the dominating subtype of HBsAg in this part of the country, 99% eAg-positive sera of 11 HBsAg(+) liver cancers and 50% eAb in 2 such cases tested had high level (80,000 ng) of AFP in their sera. Although AFP was detected in 66% of 18 HBsAg(+)·eAg(+) chronic hepatitis patients and in 20% of 20 HBsAg(+)·eAg(+) healthy carriers, the level of AFP was very low (>100 ng). Anti-HBe was detected in 100% of HBsAg(+)·eAg(+) sera tested, and DNA-polymerase activity (<70 ng) was also detected in all of these sera. Anti-HBe was detected in all 6 HBsAg(+)·e system(-) sera tested, but DNA-polymerase activity was shown in only half of these sera. From the above results it seems justified to conclude that eAg is highly associated with chronic hepatitis and eAb does so only with asympfomatic HBsAg carriers, and that anti-HBc is a sensitive indicator of HBV infection, regardless of whether e system is present or not. It is noticeable that both eAg and eAb were associated with HBsAg(+) primary hepatocellular carcinoma. The generation of e system and results of our e system test in comparison with that of others are briefly discussed.

Results of survey and control of hypertension in a group of 10,450 steel workers for a period of 5-7 years are briefly reported. Under the type of health care system as available in the People's Republic of China, screening and follow-up of hypertensives on a community basis appears to be feasible with the aid of medical health assistants. In this study a large proportion of subjects with diastolic pressure between 90 and 100 mm Hg were found to have their blood pressure spontaneously changed to normal at a subsequent examination 5 years later. It is therefore considered appropriate to have simply followed them up without giving anti-hypertensive drugs. Further studies are necessary to determine the precise level of diastolic pressure below which drug therapy is to be considered unnecessary on a community basis.

or 24 cases of primary orbital varices, 6 advanced cases were treated by removal of dilated vessels through the lateral orbital approach with satisfactory results in all but 1. Adequate and careful preoperative examinations, including venography and ultrasonography, are emphasized. Segmental ligation of the dilated veins is thought to be a safeguard against profuse bleeding and the lateral orbital approach is the route of choice. Operative technic and precautions are described in detail.

33 cases of early lung cancer were studied and divided into 3 types: intraluminal type 17 cases; bronchial wall infiltration type 4 cases and peripheral globular type 12 cases. Classification, pathologic characteristics and a control group of 11 cases with lymph node metastases are also studied. The diagnostic criteria, classification, morphology and biologic characteristics of early lung cancer and "occult" lung cancer are discussed.