Volume N4  ·   Issue 03  ·  1978

The results of dopamine therapy of 16 cases of heart disease with edema and various kidney diseases are presented. The results of GFR determination (in 15 of 16 patients dopamine administration significantly increased urine output and GFR) after dopamine administration were satisfactory clinically. It is recommended for wide clinical use as a cardiotonic and diuretic, especially in cases with intractable heart failure and digitalis poisoning.

Of 30 cases of sinus node failure reported in this paper, 4 showed persistent sinus bradycardia with S-A block or sinus arrest frequently accompanied by escape rhythm or parasystole, premature beats, A-V or intraventricular block. 26 showed alternative bradytachyarrhythmias and atrial flutter is most common (13 cases). No marked cardiac enlargement or decompensation and no EKG evidence of myocardial ischemia were observed in 27 patients aged 15-59. The chief lesions were dysfunction of sinus node and atrial and ventricular conduction system. Therefore, it is suggested that it may be a specific cardiomyopathy of unknown etiology. Clinical manifestations are vagus and may easily be misinterpreted as neurosi. Syncope or Adams-Stokes seizure is chiefly caused by brady-tachyarrhythmias. Therapy aims mainly at the prevention of bradycardia. Servere cases require the use of artificial pacemaker. Electric defibrillation is not indicated for termination of tachyarrhythmias in these cases.

The authors join the debate on how to diagnose bronchial adenoma. They feel that mant criteria for morphological classification of the disease presented in the literature are irrational, especially as they include too many carcinoid tumors. The disease is not diagnosed in accordance with the WHO criteria which favors the carcinoid tumor theory here as the same histological picture is found in tumor of the salivary glands and to the author's knowledge, no carcinoid tumor of the salivary gland has been reported in the literature. In a paper to be published they classify the case as a bronchial adenoma of solid type instead of carciniod tumor.

Few cases of filarial nodule of the female breast have been reported. We present 57 cases with pathologic specimens and clinical histories seen from 1964-1973. This disease is often found clinically in country women of around 40 years of age. Usually a horse-bean size, single nodule is located under the skin of the exterior-superior breast quadrant. Clinically it is easily mistaken for breast cancer. The basic pathologic change is caused by tuberculoid granulomatous lymphangitis due to filaria in the lymphatic vessel. Pathologically it is easily misdiagnosed as tuberculosis. The causes of filarial tuberculoid granulomatous lymphangitis include filaria and their metabolic products and vaginal exudates and expelled microfilaria. The disease is common in endemic areas in China.

211 patients cured after 131I therapy for thyrotoxicosis between October 1958 and December 1964 are studied. The period of observation ranged from 10 years and 4 months to 16 years and 6 months. The incidence of recurrence was 1.0%. The rate of permanent hypothyrodism was 2.8% in the first year and increased to 5.2% in the seventh year, much lower than reported in the world literature. No new cases were found thereafter. Overdosage might be the cause of early hypothyroidism, but there was no significant correlation between 131I dosage and development of late hypothyroidism. Not a single case of leukemia or carcinoma of the thyroid gland was observed following treatment, and the offspring in the series were all healthy.

The various methods commonly employed to treat hemorrhoids such as susgical operation, injection necrosis therapy, cryophemorrhoidectomy, rubber band threading and ligation can give good results in internal piles. When they are used to treat circumferential mixed hemorrhoids, the results are not so satisfactory. This article reports the results of comprehensive treatment in 202 cases of circuferential mixed hemorrhoids. The comprehensive treatment includes separation of the external piles, injection of 8% alum solution at the root of the primary pile artery and ligation of the internal piles with thick silk on a round needle by "8" shape transfixion stitches. All cases in this series were clinically cured in an average of 20 days without anal stricture.

Mesentexic-caval shunt was performed on 24 patients, there were no operative deaths in the 14 patients with selective shunt, and 5 of the 10 emergency shunt cases died post-operatively. Follow-up of the 18 surviving cases showed that only 1 patient developed mild encephalopathy, suggesting that this type of operation does not result in much interference to hepatic hemodynamics. The operative technic, as described in this paper is not difficult and is suitable for postplenectomy or postshunt patients with recurrent hemorrhage from esophageal varices.

A newly-designed surgical instrument for esophagogastrostomic anastomsis is fully described. It works on the principle of a "stapler". It had been tried on isolated pig organs for nearly a hundred times and experimental esophagogastrostomy on 16 dogs, before it was actually used clinically in 1975. It has been used clinically with success ever since and has been approved unanimously by noted surgeons as an effective new surgical instrument. It is supperior to the conventional way of such operation by manual suture in achieving good exposure and relatively accurate apposition of the mucosal layers, and thus in reducing complications, such as leakage or stricture at the anastomosis site.