Volume 100  ·   Issue 10  ·  1987

This article mainly deals with the frequency of occurrence of Aschoff bodies in the left atrial appendages seen in the excised specimens at various valvular operations in 126 cases, among which biopsy was done in 121 cases and autopsy in 5 cases. Aschoff bodies were observed in 37 0f 126 patients (29.4%). It iS found that the frequency of occurrence of Aschoff bodies is higher (u=2.69, p<0.01) in the group with a history of acute theumatic fever than in other groups. Aschoff bodies were found in patients with sinus rhythm in 27 of 111 cases (24.3%), and in those with atrial fibrillation in 10 of 15 cases (66.6%), showing a significant difference between the two groups (u=3.29, p<0.01). The clinical significance of occurrence of Aschoff bodies in the left atrial appendages is discussed.

Four cases of polymyositis undergoing muscle and sural nerve biopsy are reported. A11 4 patients presented typical clinical pictures of primary poly-myositis. A slight impairment to superficiall and vibration sensation was found in 2 cases during neurological examination. Fibrillation in electromyogram was revealed in all 4 cases, in 3 of which, there was reduction of conduction velocity. Biopsy of the sural nerve also showed segmental demyelination in all cases. Thus one may assume that patients with poly-myositis accompanied by the fibrillation would most probably have demyelinated changes in peripheral nerves even if there was no reduction of conduction velocity. No lymphocytic infiltration can be found in the nerve tissue. Organized thrombi were seen in a few arterics in the interfascicular tissue in 2 cases. In addition, vessels in fascicles appeared much less in number than in the normal sural nerve. All points mentioned above suggest that the occluded artery might be responsible for the degenerative changes in the nerves, but more observation is required to draw the conclusion.

Five patients with malignant fibrous histiocytoma (MFH) in the retroperitoneal region were treated in 1985 and 1986. MFH, a tumor of low malignancy, consists of histiocytes and fibroblast-like cells. Abdominal pain and fever are its early symptoms and are usually associated with prominent signs of a tumor mass. The local recurrence rate is relatively high and distal metastasis rare. Early tumor resection is the treatment of choice.

Tracheopharynx anastomosis, an important advance in reconstructive laryngectomy, is indicated in patients with glottic carcinoma and some of those with supraglottic carcinoma. From 1977 to 1981 we treated 55 patients with laryngeal carcinoma by Arslan's and Vega's methods, in which tracheopharynx anastomosis was used. The patients were followed up for 3-7 years, showing a 5-year survival rate of 70%, which is comparable to that reported by others.Aspiration pneumonia after operation is a problem precluding extensive use of this method. If the principles of strict selection of patients, further improvement of operative techniques, and careful observation after operation are followed, aspiration and other complications may be prevented.

Displaced split fracture of the radial head is generally treated by surgical excision or open reduction and internal fixation. Since 1981 we have used percutaneous poking reduction for this condition. When the fracture is associated with severe swelling and ecchymosis at the medial aspect of the elbow joint, severe injury of the elbow joint medial collateral ligament is indicated. This requires surgical repair of the ligament for joint stability. Of 34 patients, 26 were treated merely by percutaneous poking reduction, 6 by percutaneous poking reduction and surgical repair of the medial collateral ligament, and 2 with fragments displaced less than 2 mm by surgical repair of the medial collateral ligament only. Of the 32 patients, 27 had excellent results, 4 fair, and 1 poor. The 23 patients followed up for more than one year had more satisfactory late results than those treated nonoperatively or by complete excision of the radial head, and at least they had results as satisfactory as those treated by open reduction and internal fixation. Even if percutaneous poking reduction fails, open reduction and internal fixation or complete excision of the radial head can still be carried out.

Studies were carried out by contrast immuno-fluorescent staining on the distribution of D and G cells in the gastric antrum of patients with gastric and duodenal ulcer, chronic gastritis or normal antral mucosa. No significant differences were found iii the number of D or G cells of duodenal ulcer patients and normal controls, but in those with comparable degrees of antral atrophic gastritis, G cells seemed to be more numerous in patients with duodenal ulcer than in those without. The percentage of G cells containing more gastrin (as judged by the intensity of fluorescence) was much higher in the duodenal ulcer group. This may indicate that G cell with augmented activity played an important role in stimulating secretion of gastric acid in these patients. The number of D and G cells in gastric ulcer patients was significantly reduced, but the ratio between D and G cells was essentially the same in both gastric ulcer patients (3.37) and duodenal ulcer patients (3-17). This demonstrates that the quantitative variation of D cells may not be an important factor in maintaining gastric acidity.

Dot-ELISA with monoclonal antibodies specific to different leishmania species was used for the identification of promastigotes from naturally infected sandflies. In the experiments, monoclonal antibodies L9E4, L9F5 and L7E12 were tested by Dot-ELISA. One of the hybridomas, L9E4 was selected for further analysis. The highest titer of the ascites fluid with promastigotes of MHOM/CX/77/PD, determined by Doc-ELISA, was 1:655 360. Promastigotes obtained from naturally infected sandflies and grown in NNN culture medium were identified by monoclonal antibodies from three clones via Dot-ELISA. Promastigotes IPHL/CX84/PD-10,-11 tested with hybridoma L9E4 ascites fluid showed a titer of 1:81 920 and was 3-20 times higher than that shown by indirect fluorescence. No positive reaction was observed when antigen discs were incubated in negative SP2/0 ascites fluid. The reaction was completed in 2-3 hours. So Dot-ELISA as described proved to be very sensitive, specific and fast in identifying promastigotes from naturally infected sandflies.

The concentrations of streptomycin, isonicotinic acid hydrazide, rifampin, and ethambutol in cold abscess and serum were assessed microbiologically in 40 patients with bone and joint tuberculosis. The specimens of abscess aspirations and venous blood were collected from each patient at 2,4,8,12 and 24 hours after administration of these 4 drugs. The laboratory data showed that the concentrations of the drugs in cold abscesses could be maintained at bacteriostatic levels for 12-24 hours, which were effective for the treatment of bone and joint tuberculosis. We conclude that systemic intermittent chemotherapy rather than routine local use of these drugs is applicable.

Holoprosencephaly is a rare defect in the formation of midline structures resulting in a rare spectrum of disordered organogenesis of the prosencephalon, often associated with facial anomalies. In this article a case of holoprosencephaly is described and its etiology, embryology, classification, pathology, and prognosis are briefly discussed.

Based on the results of previous ncuroepidemiologic studies and the present one in 6 cities of China, the authors suggest the following major risk factors for epilepsy in developing countries: Age, less than 10 years old; and more than 50 years old; sex, males more than females; race, blacks more than whites; poor health care in prenatal and perinatal period; head trauma; poor socioeconomic status; first-degree epileptic relatives; and other conditions such as diseases of the central nervous system, illnesses of gravid women, febrile convulsions, and maternal age at parturition.