Volume 95  ·   Issue 11  ·  1982

A rare case of double light chain disease with its clinical symptoms and laboratory findings is reported.

This study deals with the quantitative dif- ferential diagnosis of coronary heart disease (CHD) angina pectoris, acute myocardial infarc- tion, old myocardial infa.rction and prima.ry myocardiopathy. 245 cases. of the 4 heart diseases are analysed clinically. DJS Model 14 computer was used in collect- ing 72 samples of the 4 heart diseases. Quan- titative differential equa.tions were obtained and a diagnosis calculation table worked out through stepwise discriminant analysis and stepwiSe re- gressiion analysis. The rate of coincidence with correct diagnosis by stepwise discriminant analysis was 87.5%, compared with 60.5% with stepwise regression analysis. This study shows that by using the quantitative differential diag- nostic equation derived from stepwise discri- minant analysis, a digital computer can be used in diagnosis. In ho.spitals with no computers the calculation table may be used with hand ca.l- cujation or calculating machine - 861 -

21 cases of intraorbital varices are discovered by contact ultrasonic B-scanning, among these 17 are primary type and 4 secondary type. The article describes demonstration of the special patterns seen in primary and secondary orbital varices by applying neck pressure. The cause and clinical picture of intraorbital varices and key points of ultrasonographic differential diagnosis are discussed.

Liver pathologic changes in 30 cases of beryllium (Be) poisoning are reported. Aspiration biopsies showed dot necrosis, acidophylic degeneration, WBC infiltration, fibrosis (1 portal cirrhosis) and Kupffer cell proliferation. In some cases Kupffer cell granulomatous proliferation can be seen. We consider that these changes are distinguishable from thOSe of other poisoning. Changes commonly seen in infectious hepatitis are not found in our cases, so most acute Be poisoning can be differentiated from hepatitis.

It is postulated that the combination of a very low protein diet, with low pancreatic tryptic activity plus the continual consumption of sweet potato or other trypsin inhibitors leads to inadequate proteolysis when a meal containing meat contaminated with Clostridium perfringens Type C and its beta toxin is consumed. The necrotizing pathogenesis process concluding as segmental gangrene is set in motion by toxin produced under altered dietary conditions first by motor paralysis via beta toxin, followed by villous attachment and colonisation by ingested or resident C perfringens Type C in the gut. Necrobiosis is maintained by further toxin production which may be blocked in immune individuals. The endemicity of the disease is governed by the amount C perfringens Type C in both the general and gut environments, the latter determined by dietary influences and the protein nutrition of the host. A hypothesis put forward is that the organism is carried and dispersed by the domestic pig and man becomes an incidental host. Infectivity only occurs when critical ecologic factors exist mans. Prevention in in the small gut of humans. Prevention in the short term is possible with a toxoid vaccine using 3 injections given at 1 month and 12 month intervals. This paper alerts readers to the possibility that this preventable disease is prevalent in China.

During a lipid profile examination of 729 hospital staff members, bilateral diagonal ear lobe crease sign was investigated. Of 50 persons with ear lobe creases 25 had blood cholesterol levels above 220 mg% and 25 below thiS level. 20 ear crease positive subjects with blood cholesterol above 220 mg% and 20 positive subjects with blood cholesterol below 220 mg% were human leukocyte antigen (HLA) typed. 23 subjects with serum cholesterol above 220 mg% and negative ear crease sign were also HLA typed and the results compared. Another 124 crease negative subjects previously HLA typed were taken as controls. There was a negative correlation between serum cholesterol and ear lobe crease sign. HLA Bw 54 was significantly in- creased in crease positive subjects (R-R=4.26). If the ear lobe sign is taken as a coronary risk factor, then HLA Bw 54 has linkage disequilibrium with one of the many factors inducing coronary artery disease.

Insulin secretion and carbohydrate and lipid metabolic changes were studied in 31 normal subjects, 11 with maturity onset diabetes mellitus (MODM) and 59 with various degrees, of glucose intolerance. The plasma glucose, triglycerides, cholesterol, high density lipoprotein-cholesterol, free fatty acids, cAMP and immuno-reactive insulin response to an oral load of 100 gm glucose were evaluated. Significant insulin resistance was observed in subjects with various, degrees of glucose intolerance and those with MODM. The results are discussed.

Of 13 cases with precordial pain needled at Neiguan 内关 bilaterally 7 were alleviated and 6 greatly improved immediately after acupuncture. Blood cAMP, ECG and STI were studied before and immediately after needling. Of 10 cases, 8 showed cAMP reducation averaging 10.1 pm/ml (P<0.05). In 2, the elevated cAMP did not show any reduction, 1 of these developed cardiogenic shock and the other died suddenly of ventricular fibrillation. 10 of 14 showed STI shortening (p<0.05) and 5 of 6 showed reduction of ΣST elevation averaging 5.1 mm right after needling. Acupuncture at Neiguan may be effective in relieving precordial pain and improving cardiac function.

Four patients with Rieger's syndrome had global anterior segment dysgenesis (i.e. abnormalities of the pupil and mesodermal remnants in the chamber angle), posterior embryotoxon, iridocorneal adhesions and secondary glaucoma. Other physical signs were maxillary hypoplasia and anodontia. Diurnal curves of intraocular pressure (IOP) measured every 4 hours by Schiøtz's tonometer revealed peaking during the day and with drop at night. A review of the literature and discussion of the characteristics of the disease, its etiology and treatment show that correct diagnosis and surgical treatment may control IOP and retain useful vision.

This report is based on data obtained in blindness screening in 7 rural areas throughout China and presented at the Second National Conference of the Chinese Ophthalmologic Society in 1979. This comparative study of the incidence of senile cataract in relation to geographic and meteorologic factors, with special reference to solar radiation, indicates that cataract incidence increases with decrease in latitude or increase in altitude due to increased solar radiation. Zedang in Tibet, with the highest altitude and low latitude (29°) has the highest incidence (1.32%) of the areas surveyed, followed by Aleitai, Xinjiang (0.25%) and Zhongshan, Guangzhou (0.23%), whereas the incidence in lowland areas are between 0.12% and 0.14%, the lowest surveyed being in Zhongmou (0.066%). From an epidemiologic point of view, the differences in cataract incidence are apparently associated with solar radiation, therefore these findings furnish some evidence supporting the theory that sunlight enhances cataract formation. The association of increased serum lipids with cataract in Guangdong is also discussed.