Volume 94  ·   Issue 12  ·  1981

During a period of 20 years between 1960 and 1979, 91 cases of renovascular hypertension were diagnosed by reno-aortography, most of them were confirmed by operative findings and/or pathologic examinations. 55 cases (60.4%) were found to be due to primary arteritis of the abdominal aorta, the so-called "panaortitis", involving one or two renal arteries. The age of these 55 patients ranged from 11 to 57 years, averaging 26.5 years. 30 patients were female and 25 male. There were 18 cases with bilateral involvement and among those with unilateral lesions 18 were on the left side, 19 on the right. The duration of the disease varied from 3 months to 8 years. 49 patients presented with the usual manifestations of chronic hypertension including 18 severe cases who had symptoms of cardiac failure, cerebral accident or paraplegia. The remaining 6 individuals were accidentally found hypertensive during a routine physical examination. An audible bruit was heard in 47 cases, constituting 85.4% of this group. This disease entity is pathologically characterized by the presence of inflammatory changes of all layers of the aorta, especially in the media. Destruction of varying degrees, of the elastic fibers and muscle bundles may be seen. The involvement of the renal artery is mainly confined to the ostium, resulting in stenosis of the lumen and ischemia of the affected kidney. 22 of 55 cases were managed medically as their conditions were not suitable for any surgical procedure. One patient associated with a huge aortic aneurysm was only explored. The remaining 32 cases were operated upon, including vascular reconstruction 17, renal autotransplantation 10 and nephrectomy 5. 43 cases were followed up from 1 year to 18 years, half of them 5-10 years. Among the cases treated medically, only 6 were alive, their blood pressure remained at high levels. Of 32 cases treated surgically by various methods, 19 were alive. The results of renal autotransplantation seemed to be gratifying. The authors believe that renovascular hypertension associated with panaortitis should be treated surgically. However, when acute manifestations are present the patient should be treated medically until a complete subsidence is assured and the condition well stabilizes.

103 patients with systemic lupus erythematosus were successfully treated with the Chinese herb Tripterygium Wilfordii Hook F (TWHF) 雷公藤. 94 (91.2%) were effectively treated to varying degrees. There was improvement of symptoms, signs, laboratory findings and immunologic changes. This suggests that TWHF may influence immune function and stimulate blood circulation and relieve stasis.

Three patients are presented who at some time during their illness were alert but had complete paralysis of all voluntary movement other than of the eyeballs and eyelids by which they communicated with others Two of these patients had massive hemorrhages in the basilar part of the pons and the third might also have had pontine lesion as determined clinically. The pathologic basis of this syndrome involves the bilateral basilar part of the pons. It is emphasi- zed that the clinical manifestation of locked-in syndrome, even though it may be transient, pos- sesses diagnostically localizing significance. The term pontopseudocoma is recommended instead of locked-in syndrome.

Acute pediatric leukemia 49 of 82 acute pediatric leukemia cases have chest X-rays showing 71.4% abnormalities, pulmonary changes 27, mediastino-hilar glandular enlargement 19, pleural effusion 3, cardiac enlargement 10, rib destruction 2. Bronchopneumonic appearance is the most common pulmonary manifestation, but nodular lesion is more characteristic. Five autopsies are reviewed and the relation of the X-ray findings to the possible pathologic basis. is discussed. The X-ray findings are varied and seem to have no rules. If bronchopneumonic or pneumonic consolidation is manifested and concomitant respiratory symptoms and signs are present, infection should be considered the cause. The following conditions may herald leukemia: pulmonary changes not responsive to treatment for infection, but responsive to antileukemic treatment with signs of mild respiratory tract involvement, pulmonary changes associated with mediastino-hilar glandular enlargement, pulmonary nodular lesion associated with glandular enlargement, moderate to large amounts of bloody pleural effusion accumulating quickly after paracentesis and responsive to acute leukemic therapy, cardiac and bony changes.

Coronary artery disease due to arteriosclerosis is the most common cause of death in the United States and the western world. Surgical bypass of the obstructive arterial lesions, introduced in 1968, has become a common method of treatment. Relief from angina petoris has occurred in a high percentage of patients. Prolongation of life by operation as contrast!ed to medical treatment is still debated. A prospective study was carried out in the authors' hospital of coronary artery bypass over the last 9 years. The study shows improved quality of life and exercise capacity in operative patients. There was no difference in the survival. The results are compared with more recent data which do show improved survival by operation.

This paper describes the technic of trans-catheteral bronchial brushing. A small nylon brush passes through the catheter into the lung lesion to obtain specimens for cytologic examination. This is a simple and reliable method for diagnosis of peripheral lung lesion. The author reports 45 cases and obtains satisfactory results.

This paper presents the clinical and pathologic material of 37 cases of catecholaminism including 34 cases of pheochromocytoma and paraganglioma and 3 cases of hyperplasia of adrenal medulla. Among the 34 cases with tumor, 36 tumors were found, 1 patient had multiple tumors. Except for 6 tumors located beside the abdominal aorta and extra-abdominal cavity, most were found in the adrenal glands on both sides. Tumor size varied from 1.5×1.5×1.2 to 16×13×16 cm. Of the 34 cases, 28 had benign tumors, 3 malignancy and 3 suspected malignancy. There were no differences in manifestations of tumors or hyperplasia. The series was classified into paroxysmal hypertensive type 16, persistent hypertensive type 20 and asymptomatic type 1. During attacks 3 exhibited hypotension and 3 were associated with obesity. In diagnosis, patients with the disease manifest notably hypertension associated with polymorphic vegetative nervous symptoms like sweating, pallor and vomiting. Laboratorily, determination of urinary catecholamines and 3-methoxymandelic acid or vanilmandelic acid (VMA) is recommended preferentially, the results being conspicuously elevated in the disease. In this series, VMA determination was more advantageous than catecholamine determination. In tumor localization, retroperitoneal pneumography with aortic angiography seem to give satisfactory results. In some patients with pneumographic negative findings the tumor site may be shown by aortic angiography. The diagnostic criteria of medullary hyper- plasia are: a. clinical manifestations and estimation of urinary VMA and catecholamines support presence of hypercatecholaminism, b. perirenal pneumography and aortic angiography fail to show a space-occupying lesion.

Sequential observations of activation of the first component of complement (Cl), quantitative assays of hemolytic complement activity (CH50), serum immunoglobulins (IgM, IgG, and IgA), E-rosette, lymphocyte transformation and serum proteins as well as laboratory tests relevant to clinical therapy were carried out in 38 patients with epidemic hemorrhagic fever (EHF). Data obtained showed that there was no significant difference (P>0:05) in serum Cl concentration between patients and controls, but the difference in Cl activation between them was statistically significant (p<0.001), i.e., the mean value of patient Clr:Cls ratio was 50.7±23.9% of normal. As compared with the control, in all 38 patients, the levels of IgM and γ-globulin were elevated (p<0.001 and 0.05) and lymphocyte blastogenesis was depressed (p<0.01) and in severe and moribund types CH50 was markedly reduced (p<0.001). It is found that Cl activation closely correlated with the severity and course of the disease. Results presented here strongly suggest that both activation of the classical complement pathway and formtaion of immune complexes play an important role in the pathogenesis of the major clinical manifestations of EHF such as hypotension, hypovolemic shock, hemorrhage, renal damage and secondary bacterial infections. It is postulated that activation of the alternative complement pathway also occurs in EHF.