Volume 97  ·   Issue 05  ·  1984

The appropriate treatment of primary pigmented gallstones, which occur mainly in the common bile duct and are the kind of gallstones most commonly seen in the coastal areas of China, differs from that of cholesterol stones. An analysis of 1,425 cases of bilirubin stones treated during the past 20 years disclosed that choledochostomy with T-tube drainage is useful only in simple cases. In more complicated cases (i.e., those in which the stones consisted of soft concretions or muddy substance or the bile duct or sphincter of Oddi was narrowed), the reoperations rate after concurrent cholecytectomy and choledochostomy (5.69%) was much lower than that after cholecystectomy (13.84%) or choledochostomy (15.18%) alone but still far greater (P<0.01) than that after internal drainage (0.82%). Thus, during the initial operation the gallbladder should be extirpated, the biliary system thoroughly explored, and the proper procedure chosen. Each different mode of biliary-intestinal anastomosis is indicated in some types of cases. Roux-en Y choledocho- or hepatico-jejunostomy is called for when there is associated hepatic duct stricture; in such cases ordinary choledochoduodenostomy usually is not feasible after the stricture is repaired. Sphincterotomy or sphinctproplasty is indicated in patients with impacted stones in the ampulla of Vater and with strictures of the sphincter of Oddi. For mud-like stones in the common bile duct, choledochoduodenostomy is still useful, provided the anastomotic stoma is large enough and will remain patent. In particular, posterior choledochoduodenostomy with round or oval anastomotic stoma, an operation that we devised is quite satisfactory.

Preventive mass screening was conducted every l-2 years in 42 textile factories from 1958-80 in Shanghai. A total of 846,104 examinations was made, and the percentage of women examined was 70-90%. In 23 years the age-standardized prevalence rate was lowered by 97.6%. 520 cases of cervical cancer were found, among them 465 patients are still alive. The 10-year survival rate (life-table method) was 93.1%, and the 20-year, 86.1%. There were no stage IV, III and II cases in recent 18, 8 and 7 years, respectively. In the past 8 years, all 45 cases except one were of subclinical type. The average incidence rate of cervical cancer ranked 5th among all malignant cases at these factories, whereas the mortality rate came down to the last. The prevalence rate of cervical cancer in the ≥40 year old group was over 3 times higher than in the<40 year old group. During the 23 years the median age of cervical cancer patients was postponed by 8.7 years. The disease has not been discovered in<40 year old women in the last 3 years. Carcinoma in-situ was not detected in the<40 year old group in the last 8 years. The prevalence rate of cervical atypical hyperplasia in the ≥40. year old group was 7.5 times higher than in the group. of<48 years. Therefore women ≥40 years, old are the high risk group in our series.

We treated 30 patients with intractable ascites by LeVeen peritoneo-venous shunt. The short-term results were satisfactory. Complications included subcutaneous bleeding, 5 patients; disseminated intravascular coagulation, 2 patients; and upper gastrointestinal bleeding, acute pulmonary edema, heart failure, and chill and fever, each one patients. Methods of reducing or controlling these complications are described. The rate of venous tube obstruction was high. We consider that peritoneo-venous shunting is safe and less traumatic, and is effective in terms of short-term results.

Thirty-five insulin-dependent diabetes mellitus (IDDM) patients and fifty-three normal individuals were HLA-A, -B, -C, and -DR typed. Typing reagents were provided by the 2nd Asia and Oceania Histocompatibility Workshop Conference. Phenotype frequencies of the HLA-linked genetic marker variants including GLO, Bf and C2 were also determined. The results showed that All and CW4 were significantly decreased in patient group, DR2 was decreased with marginal significance after correction, DR3 was increased with a deviation not significant after correction, and most interestingly the frequency of DRw9 was very significantly increased in patient group after correction of the P value. The results suggest that DR3 and DRw9 appear to be two DR antigens linked with two IDDW susceptibility genes in Chinese population.

In order to study the status of abdominal metastases, we examined 25 specimens of middle and lower-middle esophageal carcinomas in 25 patients. Among them, 24 were squamous cancers (96%). The 24 squamous tumors were located in the superior border of the azygos vein and the diaphragmatic esophageal hiatus. Of 181 abdominal lymph nodes examined, 18 (9.4%) were positive in 8 cases (34.7%). Abdominal dissection is considered necessary to raise the survival rate.

The research work on toxemia of pregnancy in Shanghai is reported, including the incidence of severe toxemia of pregnancy, pathogenesis, fetal placental function in toxemic patients, etc. The incidence of severe toxemia of pregnancy was 1.6% (severe preeclampsia 1.45% and eclampsia 0.15%) among 538,887 deliveries from 1975-1979. 60 cases of severe toximia were treated with full dosage of magnesium. sulfate 30 gm/24hr. In hemoconcentrated patients (hematocrit 35%) plasma expanders were used and their symptoms and signs improved rapidly. This may be due to the improvement in perfusion of viscera. Alertness must be maintained for symptoms of cardiac overloading. 22 pregnant women accompanied by essential hypertension were treated with Chinese herbal drugs for "invigorating blood circulation and eliminating blood stasis". We also treated 83 cases with combined traditional Chinese and western medicine with fairly good result.

100 patients with duodenal ulcer (84 men and 16 women) operated on by the authors with modified highly selective vagotomy (HSV) have been followed up for 8 years. There were no operative deaths. One patient suffered from gastric fistula due to ischemic necrosis of the lesser curvature, but had no other serious complications. The last follow-up after 8 years showed that 86% had excellent or good results. Of 3 patients classified as Visick Grade IV, 2 had recurrences and one was strongly suspected of recurrence, which was not proved by duodenoscopy. Good results followed abstinence from tobacco and salicylates. The corrected recurrence rate was 2%. In 2 patients recurrence was probably related to excessive antral denervation and gastric retention. Operation on patients with early stasis or pyloric obstruction enhances the possibility of gastric ulcer recurrence. The authors suggest the modified HSV as an initial elective surgical method for duodenal ulcer.

The prevalence of mitral valve prolapse in Chinese was determined by screening 156 healthy subjects and by patholobic examination of 86 adult autopsies. Mitral valve prolapse was found in 7.7% in the clinical study and 5.8% in the autopsy study. A slight female preponderance was noted.

The in vitro activity of furbenicillin and ampicillin against 383 strains isolated by clinical laboratories in Beijing was studied. β-lactamases were prepared from 62 resistant gram-negative organisms selected from clinics. The β-lactamase extracts were identified by the method of iso-electric focusing for studying enzyme stability of furbenicillin, ampicillin, cefazolin, cefamandole, and cefotaxime in a biological system. The results showed that the antibaoterial activity of furbenicillin against Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa and Enterobacteria cloacae was better than that of ampicillin. Cefotaxime was most stable compound to the β-lactamases among all of the antibiotics examined. The stability of furbenicillin and ampicillin to the β-lactamase extracts in the presence of clavulanic acid was similar to that of cefataxime. The synergism of furbenicillin and clavulanic acid against the resistant gram-negative bacilli was better than that of ampicillin combined with clavulanic acid. The results of the identification of β-lactamases used were similar to those reported in the literature, TEM-1 enzyme type being the most common type of the β-lactamases extracted from enzyme producing resistant gram-negative bacilli.

This article describes the epidemiology and antigenic drift of influenza A (H3N2) virus in Shanghai from 1968 through 1981. There was clear evidence of change in epidemiological characteristics around 1977. The epidemic due to influenza A (H1N1) virus in August 1977 affected mainly youngsters and children, but the HINI epidemic in 1981 affected mostly adults. The process of antigenic variation. of H3N2 virus and the relationship between H1N1 and H3N2 influenza epidemics are discussed on the basis of an analysis of influenza surveillance data in this city during these years.