Volume 98  ·   Issue 04  ·  1985

124 consecutive elective mitral valve replacements were performed with Shanghai-made tilting disc prosthesis without early mortality. All patients had chronic theumatic valvular diseases with mitral valve stenosis and insufficiency. Functional classification revealed that 96.78% of the patients belonged to Class III and IV. 66% had moderate and severe pulmonary hypertension, of these 14.51% (18 patients) had early postoperative complications with out sequalae. Follow-up for 4-36 months (mean: 18.39±8.03 months) showed 6 late deaths (3.15% one year). The causes of two deaths were bleeding due to overdose of anticoagulant and septicemia respectively, whereas the rest four died of unknown cause. 118 patients were long-term survivors, 113 of them have been living more than 6 months. The cardiac function of most patients was improved from Class III or IV to Class I or II postoperatively. 74 (89.15±) of 83 patients have been living more than one year and resumed their work. We consider that there are many reasons for the achievement of excellent results, and seven of them are described in detail.

Iliac graft pedicled with circumflex deep iliac vessels was used in 2 patients undergoing hip arthrodesis for traumatic arthritis secondary to fracture-dislocation and in 2 patients having hip shelf operation for paralytic dislocation due to poliomyelitis. The procedure is easy, and ensures carly union.

23 renal transplant recipients were found to be sensitive to CMV and EBV infection. The infection began early after transplantation, with increase of the titer of antibody to CMV. The peak infection with CMV occurred in 8-12 weeks in most cases, while EBV infection occurred mainly in the 3rd month.

Based on our 30 years' data, we studied the characteristics of laryngeal cancer patients. The number of such cases diagnosed in our department has increased more quickly than the total of other cases of otorhinolaryngeal cancers. This trend is still developing. The ratio of man to woman patients was 1.8 to 1, the female proportion being comparatively higher than that of the other provinces except Heilongjiang and Jilin. The supraglottic region and the epiglottic laryngeal surface are frequently involved.

CT scanning with pressure exerted on the patient's neck vein is of clinical significance in the diagnosis of primary orbital varices. It is simple and effective. The method may show orbital varices that cannot be detected by conventional CT scan.

Sixty-two patients with end stage renal disease were selected for continuous ambulatory peritoneal dialysis (CAPD) from Sept 1980 to March 1983, CAPD was performed with plastic bags containing 2-liter dialysate solution. Most patients commenced with 4 bag exchanges per day, with good results. The total treatment time was 558 patient-months in 31 months. 42 patients were treated for more than 6 months and 24 for more than 12 months. The longest survival was 24 months. 22 patients died. 30 had CAPD at home for 2-16 months. The mean peritoneal clearance of urea nitrogen and creatinine was 7.5±2.8 ml/min and 13.4±5.3 ml/min, respectively. Plasma middle molecules were significantly lower after CAPD. Clinical features of heart failure and pericarditis disappeared within 1-4 weeks. The mean protein and FAA losses in the dialysate were respectively 14.4±8.0 and 2.1±0.5 g per day. The most outstanding complication was peritonitis. Gram positive organisms predominated. There was one episode of peritonitis per 8.2 patient-months. Bacterial peritonitis was early treated with prolonged peritoneal lavage and drainage without the addition of antibiotics. The possible development of ventricular arrhythmias due to hypopotassemia resulting from long-term use of potassium-free dialysate and from glucose in take through the peritoneal route is discussed.

Lymphocyte subpopulations (T, B, D and N cells) in both CSF and peripheral blood (PB) in 23 patients with sporadic encephalitis were studied. They were detected by E+YC mixed rosette assay and determination of immunoglobulin and complement 3. 22 patients with Japanese B encephalitis and 40 with demyelinating disease (Guillain-Barré syndrome and Devic's disease) were selected for comparison. The immunologic abnormalities in sporadic encephalitis differed significantly from those of viral encephalitis, but were similar to those of the demyelinating diseases. This, combined with the pathologic findings published, suggests that sporadic encephalitis in China may be mostly a type of allergic encephalitis with immunologic pathogenesis, better known as autoimmune encephalitis. The value of examination of the CSF lymphocyte subpopulations is discussed.

Five cases are reported including three with perpetuation of functional BBB and two with alternation of BBB. In conjunction with the illustration of these ECG manifestations, the mechanism of transseptal concealed bundle branch conduction is dis cussed. As a normal phenomenon of cardiac electrophysiology, concealed bundle branch conduction may either occur in normal physiologic situations or complicate a pathologic process. Our Cases 2, 3 showed LBBB patterns at cycle lengths of 500 and 700 msec, which was much longer than the usual cycle lengths associated with intraventricular aberrancy, suggesting a pathologic prolongation of refractory period in left bundle. Case 1 maintained a complete RBBB patterns until the cycle length gradually prolonged up to 1,330 msec, indicating an abnormal recovery time in the right bundle.

Following HB vaccine inoculation, neonates developed immune response and gave a high anti-HBs seroconversion rate (range 92-100%). The comparison of the 7.7% (1/13) HB infectivity rate in the vaccinated group with the 80% (8/10) in the placebo group showed that HB vaccine is effective in interrupting maternal HBsAg carrier transmission. Since there is neither HBsAg nor anti-HBc in vaccinated neonates born to HBsAg-negativc mothers, we consider that the HB vaccine is safe to the neonates.