Volume 92 · Issue 11 · 1979

Much progress has been made in the surgical treatment of esophageal carcinoma in China as well as in many other countries in the past 20 years. With reasonably early diagnosis, it is within the ability of thoracic surgeons today to achieve a resectability rate of 75-85%, an operative mortality rate below 5% and a 5-year survival rate of 30-40%. With careful selection of patients for operation and proper use of radiation and other adjunct therapy. oven more encouraging results are possible. Efforts for further improvement may be directed toward early diagnosis and refinement in operative technics, such as the use of microsurgery in reconstruction of the esophagus and further development of instruments for esophagogastric anastomosis.

A series of 340 cases of carcinoma of the lung was treated surgically from 1961 through 1976 with a resectability of 79.7%, a resection mortality of l.1%, a 5-year survival of 44.6%, and a 10-year survival of 31.9%. In the resection group of 271 cases, the tumor size was greater than 5 cm in diameter in 35.6% and positive lymph node metastases were found in 36.l%.

The geographical distribution of liver cell cancer in China is very uneven. The areas of high frequency are restricted to the coastal zones in Jiangsu Province and southwards of this area and the Guangxi Autonomous Region. The data are mainly collected from 4 counties (Qidong, Haimen, Nantong and Rudong) of Jiangsu Province. For many years the border lines of the high rate areas have remained unchanged. The method of study employed is primarily comparing the environmental factors of adjacent areas with significantly different rates of liver cell cancer, comparing the liver cancer death rates of same area inhabitants using different kinds of drinking water and observing changes in liver cancer incidence in vil1agers before and after changing the type of drinking water. Inhabitants who drink stagnant and highly polluted ditch water usually incur a higher prevalence rate while those who drink well water seldom contract liver cancer. In a sample study, more than 80,000 inhabitants, who were surveyed twice in 1973 and in 1078 showed a reduction of approximately 20% in liver cancer incidence in the 5 year interval between surveys, while the proportion of ditch water drinkers was reduced from 79% in the first survey to 54% in the second, a reduction of approximately 32%. If all the inhabitants ceased drinking ditch water the menace of liver cancer could be wiped out in Qidong county. It seems that neither hepatitis nor aflatoxin can be considered as an important causative factor of liver cell cancer in China.

From 1965 through 1976 the authors treated 14 cases of osteogenic sarcomas by adjuvant nitrogen mustard chemotherapy followed by amputation 3-4 weeks later. The 3-year survival rate was 66.6%. In comparison with 13 cases treated by amputation alone, the 14 cases treated by perfusion plus amputation showed more extensive destruction of tumor tissue and better chance of survival.

A simple slide centrifuging method for concentrating cerebrospinal fluid cells has been carefully studied. The apparatus, technic and results are described in detail and compared with those of Sayk's sediment chamber method. The apparatus designed and employed by the author includes 2 pairs of very small sediment chambers which can be used in the existing laboratory centrifuge. Very satisfactory results both in quantity and morphology of cerebrospinal fluid cells are reported.

824 patients of clinically and mycologically proved dermatomycoses of various kinds were treated with 1% clotrimazole cream and 556 cases were followed up for more than 1 month, with cure or improvement in 87.9% of the patients. The predominance of Trichophyton rubrum as the causative organism of dermatophytoses and the slow response of hyperkeratotic tinea mannum and pedis to clotrimazole therapy may partially explain the relatively low cure and improvement rates of dermatophytoses (87.2%) as compared with those in cutaneous candidiasis (95.1%) and pityriasis versicolor (94.4%). The treatment was well tolerated with only 1% of the cases developing contact dermatitis and having to discontinue therapy.

Reports on the study of cerebral cysticercosis with the aid of EEGs are not numerous and come chiefly from neurosurgical clinics. The topic is only briefly mentioned in standard works on EEGs. This article deals with clinicoelectroencephalographic study of 158 proven cases of cerebral cysticercosis from a general hospital in Beijing. Epilepsy with various types of manifestations occurred in 112 (70.9%) patients and was the sole complaint in 95 (60.1%). Symptoms of increased intracranial pressure and/or meningoencephalitis were seen in 28 patients (17.7%). 19 patients (12.0%) suffered from myalgia, arthralgia, feverishness and transient urticaria, occurring singly or with other nervous manifestations. Psychoneurotic complaints only were found in 16 patients (10.1%). 53.8% of the patients had a history of passing segmented worms. Subcutaneous nodules were seen in 78.5%. Various indications of involvement of the nervous system were found with the aid of clinical, hematologic, spinal fluid, serologic, radiologic, EEG, pneumoencephalographic and ventriculographic examinations. 61.4% presented normal EEG tracings and 38.6% abnormal ones with no characteristic features. There appeared to be no strict correlation between the degree of EEG changes and severity of illness. Aside from a relatively small number of patients with permanent psychoses, blindness, increased intracranial pressure and severe meningoencephalitis, most patients were without much incapacity. There was only 1 death. Epileptiform convulsions could be controlled by anticonvulsants. Prevention by rigid meat inspection, prohibition of selling insufficiently cooked foods, periodic examination of food handlers, proper disposal of human excreta and good personal hygiene is emphasized.

Patients with an unusual hemoglobin H (Hb H) disease were found among members of 3 families living in Guangxi province. In addition to Hb H, a small amount of slaw-moving abnormal Hb was found in these patients. As a rule, 1 of the patients' parents was found to have α-thalassemia-1 and another had this detectable slow-moving component. Patients' siblings may be divided into 3 groups: normal persons, patients with α-thalassemia-1 and carriers of the slow-moving Hb. This slow-moving component is identified as an α-chain variant by the hybridization method. According to biochemical, genetic, anthropologic and medical knowledge, the α-chain variant is characterized as Hb CS and this unusual disease as CS type Hb H disease. The significance of detecting Hb CS in unmarried young adults for premarital advice is discussed.

In a series of 6 experiments, 5 show that central catecholamines (CAs) exert an antagonistic effect upon acupuncture analgesia (AA) and elsewhere it has been shown that central 5-hydroxytryptamine (5-HT) facilitates AA. This leads to the hypothesis that AA efficacy may be partly determined by the relative strength of these contradictory neurotransmitters in the central nervous system, although this 5-HT/CAs interrelationship may not be the only decisive factor controlling AA.

During 1971-1976, among l,967,511 subjects aged 16-66 years screened by α-fetoprotein (AFP) test in Shanghai, 300 cases of primary hepatocellular carcinoma (PHC) were detected (mass survey group). This paper describes the diagnosis and treatment of 134 early cases (early stage group) without symptoms or physical signs among the 300 PHC cases. When the mass survey group is compared with the clinical group of l,200 patients seeking medical advice at various hospitals in the same district, the proportion of early eases in the 2 groups is found to be 44.7% and 0.4%. In the early stage group, exploratory laparotomy revealed that 81.6% of cases had small hepatoma with tumor diameters ≤5 cm. The end results after extirpation of the tumors are superior io those after other modalities of treatment, the 1-year, 2-year and 3-year survival rates in the former group being 86.7%, 75.0% and 57.l% respectively. AFP test is believed to have definite diagnostic value in early detection of PHC in mass surveys. The long term survival rate has increased after treatment of early cases especially after resection Some unsolved problems are discussed.