Volume 95 · Issue 07 · 1982

A 20-year experience with surgery in 576 lung cancer patients is reported. The tumor was resectable in 459 cases, a resectability rate of 79.7%. With increased experience and refined surgical technic, the resectability was 81.4% in the latter 10 years as compared to 74.3% in the first 10 years. In the entire series, regular lobectomy was done in 343 (74.7%), bronchoplastic lobectomy in 50 (10.9%) and pneumonectomy in 58 (12.6%) cases. The relatively low percentage of pneumonectomy is due partly to the strict indications used and partly to the practice of bronchoplastic lobectomy which virtually precludes the need for pneumonectomy in most instances. Of the 459 resection cases extrapulmonary tumor invasion was found in 97 (21.1%) and lymph node metastasis in 174 (37.9%). There were 5 deaths within 30 days of operation, an overall operative mortality of 0.87% (5/576) and a resection mortality of 0.87% (4/459). The 3-, 5- and 10-year survival rates post resection were 56.2% (172/306), 43.4% (102/235) and 37.6% (38/101). Analysis shows that the presence or absence of extrapulmonary invasion and lymph node metastasis, tumor size, and TNM disease stage are of statistical significance in affecting the 5-year survivals.

The incidence of extrasellar extension of pituitary adenoma ranges from 4.3 to 21.8% and is l7% in this series. Two unusual giant pituitary adenomas 10×7×7 cm and 8×6×6 cm in size are reported, the latter weighing 150 gm. The authors point out that pituitary adenomas of unusually large size are not contraindications to surgical excision because they are usually well encapsulated and affect the neighbouring structures mainly by compression rather than invasion. Classification, topographic anatomy and technical data are detailed.

This paper presents preliminary results with autotransplantation of pancreatic tail to ameliorate carbohydrate metabolism disorders following total pancreatectomy. The early results are satisfactory. The operative technic, management of graft changes in regulating carbohydrates and other essentials are discussed.

1,226 cases of colorectal cancer were treated surgically between 1956-1978. 798 (65.09%) were rectal, 74.3% 0f which were located below the peritoneal reflection. Dukes' C2 cases and cases with distant metastasis constituted 39.15% and Dukes' A cases 9.22%. Resectability rate was 75.1% (77.6% for rectal cancer). 32.96% of 619 cases of rectal excision had restorative resection. 84.8% of the combined excision for extraperitoneal lesions in female patients were posterior pelvic exenteration. The overall operative mortality rate was 2.93%. Mortality rate of resection was, 1.73% and that of rectal resection 0.8% and curative rectal resection 0.63%. Follow up rate was 94.13%. The 5- and 10-year survival rates for rectal resection were 53.08% and 47.65%, for curative rectal resection 66.91% and 60.27%, and for Dukes' A cases 98.05% and 96.39%. The 5- and 10-year survival rates for colonic resec- tion were 59.79% and 52.18%, for curative colonic resection 72.79% and 62.06%, and for Dukes' A cases both 100%. Among factors affecting therapeutic results, local immunologic reaction of the host is also important, showing that the more lymphocytic infiltration in and around cancer, and the more follicular hyperplasia and sinus histiocytosis in regional lymph nodes the better the prognosis. Anal preservation in radical resection of rectal cancer and improving results in the treatment of extraperitoneal rectal cancer are discussed in detail.

The successful rate of ketamine anesthesia in this series of war casualties is 95-98%, identical with that reported by Chinese civilian hospitals. This anesthesia seems to be one of the choices, producing adequate analgesia, minimal physiologic disturbance, with simplicity of administration, speedy postoperative recovery and few side-effects.

Praziquantel, a new effective anti-schistosomal, is studied in the salmonella/microsome system for mutagenicity and in rats for teratogenicity. Using the plate test, the drug's, mutagenic effect was studied on 5 histidine-requiring mutant strains of Salmonella typhimurium (TA 100, TA 98, TA 1535, TA 1537 and TA 1538) with or without activation by liver microsomes. In teratogenicity assay, praziquantel was administered q.d. orally in doses of 210 mg/kg for 6 days or 450 mg/kg for 3 days, beginning at the earlier or later period of gestation. The results showed that praziquantel did not induce mutations at the test dosages of l µg/plate to 1,000 µg/plate in all 5 tester strains with or without activation by liver microsomes and did not cause dysmorphoses of appearance, viscera and skeleton in rat fetuses in any of the test groups. Therefore, the drug may be considered quite safe in chemotherapy of schistosomiasis.

Serum IgA, IgG, IgM, C3 CH50, RF, ANF and the percentage of rosette-forming cells in peripheral lymphocytes are determined in specimens collected from patients with chronic bronchitis and normal controls. It is shown that the patients have a tendency to a reduction in percentage of peripheral T-lymphocytes, increase in levels of IgG and IgA, decrease in serum complement activity and appearance of RF and ANF. The positive correlation between the increasing levels of IgG and IgA, RF positive rate, 24-hr sputum DNA-concentration and sera bacterial antibody titers suggest the importance of respiratory tract bacterial infection in RF pathogenesis and increasing immunoglobulin levels. Whether the declined serum complement activity is due to infection or autoimmune mechanism is still unknown.

A transnasal approach to the hypophysis is described and illustrated. Our experience with 3 cases suggests that this procedure is simple, expedient, inexpensive and has no adverse influence upon function or cosmesis, although it may leave a faint linear external scar.

In 20,915 normal married women, the position of their uterine cervices was measured by the distance from the cervix to the hymen ring and also from the cervix to the plane of the ischial spine. Figures show that taking the ischial spine as the landmark, the normal level should be below it with the lowest location 2.5 cm below the ischial spine. Mean cervix ring conjugate is 4.92±0.88 cm with straining. Therefore, it is reasonable to take the standard cervical position as more than 4 cm above the vaginal orifice or 3.5 cm from the hymen ring. Statistical analysis reveals that in uterine atrophy among old menopausal and lactating women, the uterine position is virtually higher and the position of the retroposed uterus is lower. The descent of the uterus is more marked in the retroposed uterus during straining. The cervical location is lower in multiparas with increasing in number of delivery and so multipara is an important cause of uterine prolapse.

From June 1978 to 1979, 1,097 sphygmograms of normal, pregnant and sick women were recorded with a diagnostic sphygmograph simulating an electrocardiograph through a strain gauge transducer device. 18 varieties of pulse in 24 kinds of diseases were studied and analyzed. With a multitransducer sphygmograph modified from the original monotransducer apparatus, pulse wave pattern, vessel caliber and depth of vessel location were recorded in 40 other cases. Various pulse wave patterns are demonstrated with distinct features, fundamentally matching the theory of traditional Chinese medicine. Sphygmograms are of clinical value, providing objective data for diagnosis.