Volume 92  ·   Issue 02  ·  1979

Rectal mucosa of 17 cases with Hirschsprung's disease was used for histochemical study of acetylcholinesterase (ACHE). It was found that stenosed aganglionic bowel segments were predominately characterized by varying numbers or ACHE-positive nerves, proliferative parasympathetic preganglion fibers which branched in the lamina propria, usually formed particularly dense networks near the museularis mucosae and then extended upwards between the tubular glands sometimes coiling around them. Some of them ascend to the area beneath the superficial epithelium and the turn back with a sharp bend or crest. But the parasympathetic postgauglion fibers in mucosa of both dilated ganglionic segment and "normal" bowel of controls (4 cases) were ACHE-negative. No ganglion cells were demonstrated in the wall of bowel segments in which nerves of the lamina propria were ACHE-positive. In cases from whom biopsy were taken at 3, 6, 9, 11 cm above the anus ACHE-positive nerves were always present in mucosa at the 3 cm level and when the stenotic segments of patients were situated at similar levels, for example, at the distal part of the rectum, cases with more severe symptoms showed stronger ACHE activity, while cases with mild symptoms possessed weaker activity. Thus it is considered the ACHE-histochemical method in which only a piece of wheat grain-sized mucosa is needed for testing is advantageous in diagnosis of Hirschsprung's disease.

Treatment of acute volvulus of the small intestine by combined traditional Chinese and western medicine is reported. Animal experiments with rabbits demonstrate that induced volvulus can be successfully treated by manipulation and jolting therapy without recourse to surgery. Roentgenologic studies are made on 100 cases of small bowel volvulus, emphasizing on diagnosis and observations in the course of jolting treatment, namely, signs of reduction after manipulation, X-ray indications for surgery, X-ray appearance after reduction, X-ray findings where manipulation is contraindicated and differential diagnosis.

Simultaneous measurement of stroke volume by both the impedance method and electromagnetic flow method was carried out in 10 dogs. A total number of 191 paired parameters were obtained. The correlation coefficient between the two methods was 0.80. This study suggests that the impedance method is relatively reliable in reflecting the ascending aorta blood flow changes. The results provide a good basis for measurement of the stroke volume by noninvasive method, clinically and physiologically.

Numerous methods have been used to repair nasal defect, but they usually need several operative stages. This paper presents a single stage method for total nose reconstruction which was initially used by the author in 1961, 9 cases of total loss of nose have been treated by this method with results as good as those obtained by the conventional procedures. The operative technic and its advantages are discussed.

This forehead island tunnel skin pedicle operation for total reconstruction of the nose shortens the period of hospitalization. Patients can usually be discharged 2-3 weeks after operation, reducing expenses. Nasal configuration remains stable long after operation, its hue closely matches the adjacent tissues and the frontal donor area often shows little, if any, deformation. This one-stage total rhinoplasty was performed on 30 cases with good results in 27. The operation failed in 3, 1 of them had total necrosis as a result of vascular damage to frontal flap during operation. The remaining 2 with insufficient arterial blood supply following vascular spasm, resulting in loss of the columella and alae. A split thickness or full-thickness skin graft is routinely used to close the forehead donor area wound with unsatisfactory result. In recent years the forehead skin is completely excised and covered by skin grafting to repair the depressed area for better cosmetic effect.

Experiments on restrained rats showed that the pain responses thresholds (tail-flick and vocalization) induced by noxious, stimuli were increased markedly after electroacupuncture. Following electrolytic lesions or specific 5-HT neuronal intoxication by 5,6-dihydroxytryptamine in nucleus raphe magnus, dorsalis or medianus, the acupuncture effects were significantly reduced on the early postoperative days. It is inferred that the raphe serotonergic system may play an important role in the analgesic effect of acupuncture. A neural mechanism in acupuncture analgesia is hypothesized.

Since 1973 we have used the cryoprobe in the treatment of giant cell tumors of bone with good results, particularly those deeply seated in the spine and pelvis. The operations were carried out by alternating freezing with chiselling, the former lasting 2-3 minutes each time. The mechanism of the treatment and 3 cases are discussed.

The clinical and roentgenologic data of 22 cases of acute pulmonary mycosis are analyzed, with special emphasis on the X-ray manifestations. Of the 22 cases, 12 were roentgenographically shown the so called "cottonball" nodular opacities in the chest, 4 cavitation and 6 pneumonia-like presentation. Furthermore, in 3 cases there were many small, snow-flake-like patchy opacities of heterogeneous density over 60% of both lung fields. The lesions, both unilateral and bilateral, were more concentrated in the middle and lower lung fields. These lesions when enlarged with aggravation of the disease would join to form large patches within a few days or even hours.

A total of 454 cases of colorectal carcinoma (289 associated with and 165 unassociated with schistosomiasis) were studied pathologically. It was found that further schistosoma was an etiologic factor in bowel malignancy in patients with diffuse involvement of the large intestine and a 10-year or more history of symptoms. The results of the study also showed that diminutive polyps, pseudopolyps, ectopically proliferating glands, disintegrated muscularis mucosae, denudation and multicentric carcinoma were frequently encountered in the schistosomiasis-associated group, while in the other group, papillary and adenomatous polyps were most common. Pseudopolyposis, ectopically regenerating glands and multicentricity are thought to play an important role in the development of malignant degeneration.