THE TREATIWEDPT OF TETANUS-BY COLE'S . METHOD

The article on the treatment of traumatic tctanus by Dr. H. C. Fang in the Journal for February 1938 prompted- me to describe a case of advanced tetanus which was successfully treated by Cole''s method commenced two days aftcr true op.isthotonos. and trismus c''f the jaw. had developed. Case No. 3489, Miss Jitij.aL Chinese" girl aged''17,. sustained on 16.9137 a pcne- traring wound of the right ankle by a ruscy nail. On the following day she took part in a procession to celebrate some festival, and the wound became infecred. No doctor was consuked however untiliabout a week later when the paticnt nociced that her jaw was swollen and painful; and that stiff cramplike pains were oc- curring in che abckmiual muscles;     

VOLKMANN'S CONTRACTURE WITH A REPORT OF A CASE

Richard Volkman n, in 1809, first referred to a severe contracture of the hand which he ascribed to tigbt bandaging in the treatment of fractures about the elbow; and, in bis classical article (1) in 1881, reaf- firmed his belief in the ischemic nature of the affection which he thought due to deprivation of arterial blood and to venous obstruction. Thomas (2), in 1909, reviewed the literature and found record of 103 cases from the time of Volkmann''s original report to that of Quinby''s report in 1908. To these he added four cases of his own. In 1908, Jones (3) stated he had seen 24 cases. In 1914, Murphy (4) presented six cases, but stated tliat he had seen ''a large number'' of others. From 1910 t0 1930 nurr.erous reports of this condition have entered the literature (5, 6, 8, 9).     

SENILE DISCIFORM DEGENERATION OF THE MACULA. REPORT OF THREE C.ASES.

SeniIe disciform degeneration of the macuIa Iutea was first describ- ed by Oeller (iO) in his atlas of ''Rare Ophthalmoscopic Conditions". Later on he admitted that another case described in the same atIas under the title of "Choriorehnitis centralis with arteriovenous an- astomosis" was a variety of the qame discase. Since that time this morbid condition has bcen observed and reported by many authors but the most comprehensive work on this subject has been done by Junius and Kuhnt (9).     

AN OUTBREAK OF PELLAGRA IN NANKING A REPORT OF 30 CASES

The first report of pellagra in China was that of Jouvean-Dubrcuil (I), wbo in 1920 0bserved foiir cascs in Szechuan. In 1923 six cases were observed by Tyau in Shanghai (2), one c:ase by Wu in Wuhu (3) Four years later Lambert (4) describcd one case of undoubtcd pellagra he saw in Honan. This was in a girl who had suffercd from a recto- vaginal iistula and dyscnter31 since ~25, the skin eruption appcarcd from that clatc. Foster and Andcrdon commenting on the above paper, rr.entioned this disease they saw in Hunan anci Hong Kong. Jn the same year Mu (5) gave an account of the thirteenth authentic case observed in Peiping. In :r930 0ne of uq (C.S.Y.) (6) described three cases which xvere associated with disea.ies of the gastro-intestinal Lract. It was discussed that the orRanic lesions oi'' the digeitive system may interfere with adequate assimilation of food and absorption of nutrition and thercfore they are of causative importance in the development of this deficiency disease. Many similar cases have been previously iioted by othcr writers, and O''Leary (7) coined the term "secondary pdla:相似文献   

DAVIDSON BLACK PROFESSOR OF ANATOMY

Under the care of Dr. Paul H. Stevenson and with the kind permission of the Editors of this Journal, a number of articles have been collected in this issue in honor of the late Davidson Black, Pro- fessor of Anatomy, Peiping Union Medical College. These articles are on a variety of subjects and this very well reflects the wide range of Dr. Black''s own studies. A complete bibliography of Dr. Black''s scientific writings constitutes the first of-.the papers published herc. From this it may be learned that Dr. Black has written on the qubjects of histology, anatomy, neuro-anatomy, comparative ana- tomy, and anthropology, until he finally reached his greatest achieve ments in the domain of human palacontology. It truly may be said that Davidson Black was an "all round" anatomist, aIthough he abstained from experimental work, and everywhcre he was an example to all of us by his keen power of observation, his evaluation of details, his marvellous technical skill, his thorough knowledge of literature, and his constructive imagination, leading to a profound understanding of his problems and their solutions. Davidson Black shall remain an exampIe to those who have known him.and to those who become acquainted with his work.     

PERNICIOUS ANAEMIA IN SZECHWAN A CASE REPORT*

The relative frequency of cases of Pernicious Anaemia in China is something I have no opportunity to ascertain. In Szcchwan I know the disease to be rather rare and since I can ftnd no trace of a case being reported I think it worth while to report one occurring recently under Dr. Anderson''s service which came under my observation. CASE REPORT The patient is a mak twenty-eight years of agp whose puffy face has an icteric tinge. He is a tailor Ioy trade and a native of Shansi, having been some years in Szechwan. He comes complaining of dizziness and weakness the commencement of which he can not defintely remember but says "More than a month:''. He is well nourished, slow of cerebratiort and movement and apprehensive concerning his condition.     

AN,UNUSUAL FORM OF ARSPHENAMINE POISONING SIMULATING ACU'I'E DISSEMINATED SCLEROSIS

On the Sth August l(J31 a Cbinese gentleman who gave his age as 43 came to the O. P. D. of the C. M. S. Hospital. Yannanfu. He was suffL''ring from an acute exudative dermatitis of the face which had the distribution of I.upus Erythematosis. This was treated with Calamine lotion and when seen the following day the condi- tion was much improved. He was not seen again until Nov. 7th when he again came to the O. P D. He was then cornpIa.ining of ditficulty in walking and of numbne3s of both lower limbs. He wai admitted into bospital and on examination was found to be suffeting from definite organic lesions of the cerebro-spinal system. He gave a history which appears to Imve an important bearing on the cliagnosis though at first the writer did not think so. He stated that his facial condition had got better bat thcre had remained some prungo and after a time some friend had suggested to him the dcsirability of having salv_rsan treatment-the therapeufic refuge far so many ills in moclern Cbina. He had therefore had three injections into the veins of the forearm. The first of these was without any untoward effect but the second given by the same Chinese pracLitioner in September praduced a few days later a gcneralised rash which the patient said was hke measles:. He had gone to another practitiouer for third injection. This made him very ill. He was confined to bed with high fever which lasted four days. There was vomiting during this time.     

Acute renal failure in a case of paraquat poisoning with relative absence of pulmonary toxicity.

A 37 year old male presented after the ingestion of paraquat (''Gramoxone'', 20% w/v). Plasma paraquat concentrations indicated that he had a greater than 50% probability of death. The patient survived following a period of acute oliguric renal failure and with only mild pulmonary toxicity.     

陈小宁教授辨治喉喑经验

喉喑是指声音嘶哑、高声难发的喉部疾病,为耳鼻喉科的常见病,多发病。陈小宁教授继承国医大师干祖望教授学术思想,擅长用中医中药治疗咽喉部疾病。文章就陈小宁教授从"肺、肝、脾"出发治疗喉喑作一报道,以期对该疾病的临床及研究有所裨益。     

以“转氨酶升高”为首发表现的飞行员干燥综合征1例

目的 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征，并讨论体检鉴定及航医工作。方法 报告 1 例以“转氨酶升高”为首发表现的飞行员干燥综合征的诊治过程及后续体检鉴定工作，讨论体检鉴定及航医工作。结果 该飞行员因“常规年度大体检发现转氨酶升高”入院，白细胞总数偏低；肝功能受损，抗“O”偏高、类风湿因子偏高。自身抗体谱：ANA、抗SSA、抗SSB、抗RO-52(+)；EBV壳抗原IgA、IgG(+)：巨细胞病Ig抗体(+)。结合唇腺活检结果，干燥综合征诊断明确，给予“暂时飞行不合格，地面观察1个月”结论。经过规范治疗后，抗“O”及类风湿因子降低，血液指标恢复正常，肝功能恢复正常。规范治疗和健康指导3个月后，血常规、肝肾功能均无异常。考虑其为青年男性，既往体健，飞行意愿强烈，无口干眼干、无腹痛黄疸等症状，予“飞行合格”结论。结论干燥综合征能够引起全身多器官免疫性损伤，早期诊断和治疗存在较多困难，常导致病情迁延难愈，累及各器官系统并造成功能损害，可能影响到飞行员飞行安全。全面的康复指导、细心的病情观察是预防并发症、决定患者预后的关键。规范治疗和健康指导后，若复查血常规、肝肾功能均无异常，无特异性症状，可予“飞行合格”结论。     

DECOMPRESSION OF THE GASTRO- INTESTINAL TRACT* 1. THE USE OF CFRTAIN SIMPLE MECHANICAL APPLIANCES FOR THE CONTROL OF ABDOMINAL DISTENTION

Departmcnt of 5:urgery, Peipi7zg Union Medital College, Peiping Distention of the abdomen due to a coIlection of gas and fiuid within the intestinal tract ahvays has been an alarming symptom to surgeon and patient alike. Under the most favorable circumstances it is a source of great discomfort to the patient, who in years gone by was schooled to expect gas pains as the inevitable accompaniment of every abdominal operation. The surgeon also accepted the occurrence of such distention very calmly, just as at one period in the evolution of his art he accepted as Jaudable the appearance of suppuration in the majority of supposedly clean sutured ''wounds. Efforts to prevent ''distention consisted largely in the administration preoperatively of dras- tic cathartics ''and postoperatively of irritant enemas or purges. When vomiting appeared and became persistent the old-fashioned stomach mbe was employed. If today this treatment appears rather heroic, we need but''reinember that it was routine in most hospitals within the memory of us all and that it is still practised more widely than it should be in view of our present knowledge of the physiology of the gastro- intestinal tract. In this paper it is our purpose to describe certain simple procedures which we have found effective in the prevention and     

CEPHALIC AND GENERALIZED TETANUS A CASE REPORT

Liu"Shatze", 41, inpatient No. 6505, a male matshed erector,was admitted to the T''ungchow Hospiial October 21, 1941. He had been deaf frum childhood and was so nearly mute that his speech was almost unintelligible. and the hisrory "as obtained JargeIy from his rm)ther. Twenty days and more before he had ialhn while at hia work and had suifered an abrasion of the right eyebrow regiun. He had not been given any trcatmtnt ior the injury. Ten days later he began to noiice ihat he could not open his mouth as widely as before, and by the time he presemed himself at the hospital he considered that he had become much worse. t''xamination 8howed a welldeveloped and nourished man, conscious and rational. unable ia t,pea his mouth more than l cm., his lega were stiff, he had hyperactive rellexfs every. vuhere and so stiff a neck that he could not even begin to get his chin down to his sternum. There was a deep open infected abrasion, 3 cm wide from right to left and l cm. from above downwards, on his riSht eyebrow, with a J:tcle pocket undermined under the slim of the right vpper lid, containing brownish thin pus. He had,intermittently,a half nsus sardonicus, which was peculiar in tl,at there was a heavy crease running from the left side of his nose downwards towards he lefr angle af the mouth, but hardly any aimilar crease on the right. His mouth drooped on therightand was pulled to the left. The tory:ue protruded in the miCline. The right side of his face was flat and flaccid, but ther waa no paralysis of the eyelids on the affected side. He and his family had not particuIarly noticed the facial paralysia and the duration wa! unknown.     

HYDROPHTIIALMOS IN RELATION TO NAEVUS REPORT OF A CASE, WITH A REVIEW OF LITERATURE*

Glaucoma in association with naevus is always of great intercst on account of its rarity and its clinical aspects. It was first observed and reported by Schirmer (22) in 1860. A few cases were described later but it was in 1902 that Steffens (20) reported a case of angioma of choroid in connection with telangiectasis of the face, and referred to seven other cases of the same nature, three of which (reported by Jenning-Miller,12; Wagenmann, 29; and Lawford, 15) were definitely statecl to be associated with naevus of the face. Two years later (1904) Beltman (2) made an extensive study of the Iiteratureand published an article on "uber angeborene Teleangektasien des Auges als Ursache von Galucoma Simplex". in which he stated that fifteen cases had been known up to that time. Salus (2J) wrote on "Glauco. ma und Fuermal" in 1923, describing briefly nine cases (Schirmer, 22; Beltman, 2; Cuperus, 3; Elschnig, 5; Nakamura, 18; Preesc. 6; Daschnitz, 4; Komoto, 14; and Salus, 21). He made no mention, however, of the cases reported by Sturge (26, known by the name of Mackenzie), Horrocks (11) and others, probably because these cases had not been worked out complctely at that time. In his ar- ticle on Naevus flammeus mit Glcichseitigen Glaucoma" Yamanaka (31) in 1927 stated that up to that year altogether 14 cases of glaucoma associated with cutaneous naevus had been reported [Kiranoff (12), Zaun (32), Bar (1), Ginzburg (7>, and Vogele (28) in addition to Beltman''slist], without mentiODing, howcvcr, the cases reported by Safar (20) in 1923 and Marchesani (16) in 1925 and the two cases reported by Salus in J923. In addition to these cases, we have found ten new cases recorded in the literature of recent years. .     

A study of the effect of povidone-iodine on wound healing.

The effect of dry powder povidone-iodine (Disadine D.P.) on wound healing was assessed experimentally and clinically. It did not interfere with wound healing macroscopically, histologically or mechanically in Wistar rats. One hundred and one patients undergoing ''clean'' elective surgery were included in the controlled clinical study and povidone-iodine did not affect wound healing in any way. In the control group 4% of patients developed infection compared with none of those sprayed with povidone-iodine. No adverse reaction to povidone-iodine was seen in either study. This antiseptic offers a safe alternative to antibiotics for use at operation whenever there is risk of wound infection from operative bacterial contamination.     

Malignant change in a chronic skin lesion induced by an intravenous cannula.

A cutaneous wound subjected to continuous irritation has an increased potential for malignant degeneration. The types of trauma that may give rise to the initial injury are diverse and have been well documented. We report a case of one such lesion in a 65-year-old man who had a persistent right forearm wound for over three years. The wound arose from the site of venous cannula puncture. Malignant transformation occurred in a manner comparable to that seen in other chronic lesions (Marjolin''s ulcer).     

肾移植术后双侧乳头状肾癌1例

With the continuous development of kidney transplantation technique, the survival time after kidney transplantation is gradually prolonged. Thus, the malignant tumor has been the important influencing factor on the long-term survival for kidney transplantation patients. Renal cell carcinoma is a relatively common tumor after kidney transplantation. Besides, clear cell renal cell carcinoma and papillary renal cell carcinoma are the relatively common pathological types for renal cell carcinoma following kidney transplantation. However, bilateral renal cell carcinoma following kidney transplantation is comparatively rare. In this article, we presented a case of bilateral papillary renal cell carcinoma, which occurred after kidney transplantation. And the diagnosis and treatment were introduced in detail. The patient was 37 years old, and he underwent kidney transplantation 13 years ago in our hospital, because of kidney failure. After kidney transplantation, he had regular medical check-up every year. In this year, his urological ultrasound results indicated bilateral renal tumors. And then, he received abdominal and pelvic computed tomography, and the result also showed bilateral renal tumors, which were likely to be malignant tumors. After adequate consultation, the patient chose surgical treatment. The patient received long-term immunosuppressive therapy, because of kidney transplantation. Considering this, the surgeon decided to choose a staging surgical treatment, in order to reduce the bad influence of one-stage surgery. Then, the patient first underwent retroperitoneal laparoscopic radical nephrectomy for right renal tumor in our hospital, and he had no complications after operation. The pathological results showed papillary renal cell carcinoma. He was discharged successfully. He underwent retroperitoneal laparoscopic radical nephrectomy for left renal tumor in our hospital one month later, and he had no complications after operation. The pathological results also showed papillary renal cell carcinoma. He was discharged successfully two days after surgery. In the 3-month follow-up, the patient was recovering well. To sum up, the incidence of bilateral renal cell carcinoma following kidney transplantation is relatively rare, and bilateral radical nephrectomy is effective and safe treatment. Above all, it is the patient''s condition that determines the choice of staging surgery or simultaneous surgery.     

POSTOPERATIVE ANALGESIA: A LOCAL SOLUTION

A simple, safe, and effective technique of postop analgesia using wound perfusion with bupivacaine 0.25% via an indwelling intracatheter inserted in the depth of the wound was carried out on 25 ASA grade I/II patients of varying age groups reporting for a variety of surgical procedures. The first dose was given prior to shifting the patient from the OT. Subsequent doses were administered on patient demand basis. The intracatheter was kept in position for 48–72 hours postop. An analysis was made on the patients'' pain relief using a visual analogue scale, dose/frequency of bupivacaine required, dose/type of supplemental analgesia needed, haemodynamic changes during infiltration, wound healing, and patient satisfaction. In this study only 12% of patients required opioids on Day One postoperatively. There were no adverse effects of infiltration either systemically or on wound healing, and all the patients had excellent postop analgesia.KEY WORDS: Analgesia, Bupivacaine, Postoperative, VAS