Volume 98  ·   Issue 12  ·  1985

Planned delivery was done in 70% of the high risk patients in this department. In order to prevent neonatal respiratory distress syndrome (RDS) by enhancement of fetal lung maturity, intra-amniotic instillation of dexamethasone sodium phosphate was done in 50 high risk patients before planned delivery was attempted. Check-up tappings were performed in 32 cases after 24-72 hours of medication. L/S ratio increased in 29 cases, the average increase being 53.17%, and foam tests improved in 24 cases. There was no neonatal RDS in this study. Adrenocorti-costeroids were used via intra-amniotic route particularly when there is maternal contraindications to this drug, such as diabetes mellitus and severe pre-eclampsia, the common indications for planned delivery. Ninety instillations and 127 tappings were performed in 50 cases. No maternal or fetal damage. Thus repeated tappings and medications are advisable if necessary.

Sixty-two patients with pregnancy induced hypertension (PIH) were analysed retrospectively and 32 randomly selected normal healthy pregnant women from 16th gestational week till full term were studied for prospective PIH. The results showed that severe preeclampsia was characterized by he moconcentration and high blood viscosity several weeks before the clinical manifestation of hypertension as indicated by serial theological determinations. Four cases of preeclampsia with stormy courses had persistant hemoconcentration. Two cases with pro gressive increase of theological parameters developed eclampsia. This denotes that hemoconcentration is pathological and requires plasma volume expansion following adequate treatment with antispasmotics. Severe PIH patients are prone to be complicated by pulmonary edema. To minimize the risk, it is necessary to give effective and adequate dose of MgSO4 first, followed by expansion therapy if indicated. Colloids are preferable to crystalloids. Following this rule, we have not encountered any iatrogenic pulmonary edema in severe preclampsia.

Acute atherosclerosis in vessels of placental bed in toxemia of pregnancy has been documented, but its pathogenesis is still unclear. Alterations in serum lipid and lipoprotein levels, including total cholesterol (TC), triglycerides (TG), 1ipoperoxides (LPO), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and the LDL-C/HDL-C ratio (L/H ratio) were studied in forty patients with toxemia of pregnancy. The results were compared with those of two control groups consisting of twenty six nonpregnant women and forty pregnant women with normal last trimester. There was an overall increase of serum levels of lipids and lipo-proteins, including TC, TG, HDLC, LDL-C in normal pregnant women compared with those in non- pregnant women (p<0.01, p<0.001). Owing to the elevation of both HDL-C and LDL-C levels in normal pregnant women, no significant difference of L/H ratio was found between the two groups, suggesting that there were some protective mechanism against atherosclerosis in the physiological lipometabolism changes during normal pregnancy. The HDL- C level (p<0.001) was much lower and the L/H ratio (p<0.001) was obviously higher in toxemic patients than in normal pregnant women while changes in serum levels of TC, TG, HDL-C were similar to those in normal pregnant group. The determination of serum LPO levels showed there was also a significant rise in LPO levels in toxemic patients compared with nonpregnant (p<0.001) and normal pregnant women (p<0.05). These revealed that there was an overall dyslipometabolism in toxemia of pregnancy and it may be an important risk factor for acute atlierosclerosis in vessels of placental bed in toxemia of pregnancy.

The changes of progesterone nuclei receptor concentration in 65 endometrial specimens in the proliferative and secretory phases and decidua up to the 10th weeks of pregnancy were determined by extracting nuclei receptor with 0.6 M KCL. The levels of serum estradiol and progesterone in the normal menstrual cycle and in the early stages of pregnancy were measured and the histological changes of decidua studied. The three parameters in 10 cases of amenorrhea with vaginal bleeding were observed and compared to those in the control group. The results showed that the decidual progesterone receptor was mainly distributed in the nuclei and the concentration of the progesterone nuclei receptor gradually increased up to the 10th week of pregnancy, which conformed with decidual development. Progesterone receptor concentration is regulated by serum estradiol and progesterone levels. It is proposed that looking for a chemical agent which can block the decidual progesterone receptor may be one of the approaches to terminating pregnancy at the early stage.

This paper reports three cases of carcinoma developing in the diverticulum at the middle third of esophagus (parabronchus). The incidence of this malignancy was l.77% (3/169). The patients who had carcinoma in the diverticulum had had a long history of diverticulosis. Prognosis of these patients was poor because the carcinomas were already advanced when they were found. Therefore, patient with esophageal diverticulum should be checked with esophagram, fiber esophagoscopy and biopsies, considering the possibility of malignancy. We suggest that carcinoma in the diverticulum be treated with radical esophagectomy.

In two groups of mongrel dogs, ten cach, end-artery-to-side-vein arteriovenous fistulas were formed respectively between the right superficial saphenous or deep anterior tibial arteries and their accompanied veins after the completion of ischemic limb preparations by global ligation of ipsilateral collaterals. Two weeks later, arteriovenous fistulas were converted into true arteriovenous reversals by ligation of the central venous limb of the fistulas. A11 experimental dogs survived. The monitoring criteria such as skin temperature, impedance plethysmography, venous oxygen content, arteriography, radio active isotopes test, and microcirculation and electro magnetic blood flow determinations showed adequate blood inflow to the tissue cells of the ischemic limbs. Satisfactory results suggest that staged arterio venous reversal on the small artery and vein may be an effective method for the treatment of extensive and diffuse occlusive arterial diseases of the lower extremities.

Valve failure is rate after using glutaraldehyde stabilized bovine pericardial bioprosthesis in the mitral position. This article reports a case of spontaneous disruption of bovine pericardial xenograft after mitral valve replacement five years after operation.

In order to initiate a prevention program for β-thalassemia by prenatal diagnosis in China, we first analyzed the DNA polymorphism haplotypes of the β-globin gene cluster in normal β gene (βA) and β-bearing chromosomes. We found seven different haplotypes for 30βA chromosomes and ten different haplotypes for 20βA chromosomes. Several new haplotypes were observed, three for βT and six for βA chromosomes. Complete prenatal diagnosis of β-thalassemia could be carried out in four of nine families by haplotype analysis alone.

In August 1980, we first used a free sural nerve graft attached with its small saphenous vein, which was arterialized, for the repair of a long segment nerve defect. Favourable results were obtained in 14 cases. Experimental study and clinical follow-up have proved that this procedure is simple, donor material is easily obtained, and the result is satisfactory.

Aneurysm as a complication of Behcet's syndrome is rarely seen. This paper reports a case of this entity with axillary, popliteal, and femoral aneurysms resulting in rupture, bleeding and infection, which was successfully treated in this hospital. The surgical approach to these aneurysms and method to control infection are discussed.