Volume 95  ·   Issue 05  ·  1982

This presentation of a case diagnosed by pathologic examination, deals with the incidence, clinical picture, pathologic features and treatment of arrhenoblastoma. The authors believe that the reported case has characteristics typical of its location with complications of portal hypertension and splenoparectasis. At the same time, it is consistent with teratoma, though this has been dismissed by some reports.

Pentagastrin gastric secretory testing is studied in a total 138 subjects including normal controls and patients with various gastric and duodenal diseases. Our results show that the basal acid output (BAO) and the maximal acid output (MAO) of patients with duodenal ulcer are higher than that of the control group. The gastric acid concentration is also high. There is no significant difference between gastric ulcer patients and normal controls. BAO and MAO are lower than normal in patients with atrophic gastritis and gastric carcinoma, their gastric acidity is also low. Since superficial gastritis and antritis are usually not simple and are usually secondary to peptic ulcer and other lesions, they present no typical pattern on testing. In this latter group of patients, interpretation of gastric secretory testing should be combined with the other clinical data. This study proves that pentagastrin as a gastric secretory stimulant has many advantages, including creating a strong response, early appearance of peak value and few side effects, so it is superior to the conventional histamine drugs. It is the stimulant of choice in clinical gastric secretory testing. We recommend the hypodermic route at 6 µg/kg. The indications for the procedure and precautions entailed in the test and its elicitations in some gastric and duodenal diseases are discussed.

In a survey of l,041 children using the Denver Development Screening Test (DDST) for over a year, it proves to be practical and thrifty in making developmental assessments in genetic counselling, pediatric OPD work and pediatric ward service. Holt recommends the DDST as the chief instrument for early detection of delay in developmental patterns. It is remarkable that on l single sheet of paper, all the developmental data of infancy and early childhood preschool years (1 month to 6.5 years) can be reviewed at a glance, giving the clinician or child health worker a comprehensive picture of the child's behavioral development. Perhaps testing 2-3 times the first year, 1-2 times the second year, and 2-3 times the third to sixth years may suffice. Such a demand on the child health worker is not too burdensome and may become routine. While we find DDST adaptable for Shanghai use, we suggest that each Chinese geographic locality and nationality should have its own standardized version of the DDST. We standardized the age ranges for each item to suit Shanghai. As our country covers such a vast area and has more than 50 nationalities a single uniform standard DDST for the whole country is not feasible. The test stimulates child health care through surveys in different localities making comparison and emulation throughout the country possible.

This paper presents the results of diagnosis of postoperative syndrome after biliary surgery by ERCP in 40 patients. Of the 40 cases, diagnostic cholangiography by ERCP was successful in 37 (92.5%). No complications were seen. The cholangiographic findings in the 37 cases are: residual stones 19; stricture of the bile duct 6; dilated cystic duct remnants 2; diffusely dilated bile ducts 2; normal 7 and failure of hepatic duct to opacity l. Hence in 29 (72.5%) of the 40, cholangiograms revealed definite abnormalities. A comparative study of ERCP findings with previous surgical and T-tube cholangiographic findings indicated that in some cases stricture of the biliary tree was due to surgical accidents, but in others due to unduly tight closure of the common duct or trauma to the duct wall by an inappropriately long horizontal T-tube limb. Such strictures are usually not demonstrated in postoperative T-tube cholangiograms. By the time symptoms become obvious, ERCP is extremely useful in clarifying the nature and extent of such lesions.

A rare case of urinary bladder malakoplakia is presented. The formation of microscopic calculi discovered in tissue sections is considered to be the direct cause of the disease.

Measuring serum magnesium ion concentration of 15 random and 10 serial specimens and comparing with the clinical data of severe pre-eclampsia and eclampsia, the authors conclude that parenteral administration of large magnesium sulfate doses (at least 30 gm/24 hours) is safe and effective, while with small doses (10-20 gm/24 hours) serum therapeutic levels cannot be obtained. An initial loading dose of 4-5 gm is given intravenously followed at once by 5-10 gm intramuscularly and thereafter a maintenance dose of 1 gm/hour is given by continuous drip. Since safeguard tendon reflex suppression occurs before respiratory depression, monitoring the patellar reflex is of utmost importance for adjusting the therapeutic dose and preventing magnesium intoxication.

Monthly semen samples of 28 fertile men treated with 15-20 mg/day enteric-coated gossypol tablets, formic acid gossypol or acetic acid gossypol were examined by light microscope and electron microscope until antifertility was reached. Some cases were also studied ultra-histochemically for adenosine triphosphatase activity. The controls were the subjects own samples before treatment. By counting the morphologic changes of the spermatozoa, it was found that gossypol may cause marked 30% to 69% increases in abnormalities l.5 months after the start of administration. Electron microscope showed that the heads of aberrant spermatozoa often presented with large vacuoles with membranous structures in the nuclei and the acrosomes of some cells were abnormal or even completely lacking. The middle-pieces had irregularly arranged mitochondria and the cristae were decreased or even absent and the matrix became paler. The mitochondria were vacuolated. Control ATPase positive reactions on the outer and inner mitochondrial membranes were in general stronger than in the gossypol treated and the vacuolated mitochondria always were negative. As the drug took effect, the spermatogenic cells, mainly spermatids, were markedly increased to 10-100% and some spermatids had 2 to 4 nuclei. Sertoli's cells were seen in the semen. In general, the higher the cell differentiation, the more gossypol sensitive it is.

In 30 therapeutically aborted fetuses at the intrauterine ages of the fourth to eighth month from an endemic goiter region, the thyroid gland was examined morphologically. Fetal and maternal serum T3, T4 and TSH were assayed. The results were compared with the data of 20 other therapeutically aborted fetuses of the same intrauterine ages from a nonendemic region. 13 fetal goiter cases from the endemic region group were studied. The thyroids were markedly increased in weight and size and showed the following histologic features: Follicular hyperplasia with high cuboidal or columnar epithelia lining acini containing little or no colloid; cellular hyperplasia with formation of solid cell masses; prominent hyperemia of perifollicular capillaries and presence of foci of enlarged follicles distended with colloid. Enlargement of the thyroid gland occurred early in fetal life. The cause of fetal goiter in this series was presumably iodine deficiency, as was true for endemic goiter in the same region. The morphogenesis of fetal goiter was presumed to be similar to that of acquired iodine deficiency goiter. Changes of the thyroid gland are apparently the result of increased serum TSH, a feedback stimulation of decreased serum T4 concentration. The fact that the serum TSH was markedly elevated and T4 decreased in the goitrous fectuses of this series strongly supports this hypothesis.

The author reports laryngeal functional restoration after total laryngectomy in 20 cases, 15 with total restoration, 4 partial restoration and 1 failure, with emphasis upon operative technic, indications, postoperative decannulation, mechanism and factors affecting laryngeal functional restoration.

Time lapse cinemicrographic observations of 9 bone giant cell tumors cultured in vitro were undertaken during 2 years. Features of multinucleated giant (MG) cell migration are recorded. First, a tongue-like cytoplasmic process with a ruffled or semicircular border protrudes from the edge of the ex-plants. It takes about 10 hours for a MG cell to move out of the explants completely. These isolated free MG cells usually showed active ameboid movements. The veil-like cytoplasm with an undulating membrane incessantly changes contour. The nuclei of MG cells mostly collect in the central portion and only occasionally in the peripheral cell zone. Vacuoles of varying size are frequently found in the cytoplasm, but most of them resolve in a short time. An outspread MG cell at times contracts, forming a spherical or oval cell in which the nuclei are no longer seen distinctly. Vigorous MG cell and stromal (St) cell pinocytosis and phagocytosis are visible. St cell mitosis has been recorded, but this process is not seen in the MG cell in this study. Cellular contact accompanied by intracytoplasmic granule delivery exchange through the intercellular gap junction is shown. This phenomenon probably represents cellular direct communication. The most interesting finding observed is natural fusion of 2 MG cells. The fused giant cell dies in 24 hours and St cells soon gather around it and vigorously phagocytize the remains which clear up in 7 days.