EFFECTS OF ATRACURIUM AND VECURONIUM ON THE LATENCY AND THE DURATION OF THE NEGATIVE DEFLECTION OF THE EVOKED COMPOUND ACTION POTENTIAL OF THE ADDUCTOR POLLICIS

The effect of atracurium or vecuronium on the depolarizationphase of the evoked compound action potential of the adductorpollicis has been investigated in 30 adult patients. Patientswere studied using single supramaximal stimulation of the ulnarnerve at the wrist. The evoked compound action potential wasmeasured over the adductor pollicis muscle. When blockade byatracurium exceeded 80%, a significant decrease in latency wasrecorded (P < 0. 05). There was no significant change inlatency after vecuronium. During the onset of blockade, depressionof the amplitude of the evoked compound action potential wasassociated with a prolongation of its duration (P <0. 05).The mean maximum increase in the negative deflection time wasfound to be similar after atracurium and after vecuronium. However,this phase was prolonged to a greater extent for a given degreeof amplitude depression during the onset of blockade by atracurium(P < 0. 05).     

SQUAMOUS CELL CARCINOMA OF THE SKIN OF THE TRUNK AND LIMBS: THE INCIDENCE OF METASTASES AND THEIR OUTCOME

The incidence and outcome of metastatic squamous cell carcinoma of the skin is poorly documented. This study, undertaken in a population accessible to long-term follow-up, documents the metastatic aspects of squamous cell carcinoma of the skin of the trunk and limbs. In a review of 695 cases, metastases occurred in 34 cases, with a metastatic rate of 4.9%, an overall mortality of 3.4%, and a 70.6% mortality in the metastatic group. Forty-six per cent of overall mortality was associated with inoperable or recurrent regional disease without evidence of distant metastases. The risk factors associated with the development of metastatic disease were; delayed presentation: large neglected lesions: misdiagnosis; and multiple treatments to the primary lesions. In this series no correlation was found between the histological degree of differentiation of the primary tumour and the development of metastases. The mean latent period between treatment of the primary and the diagnosis of metastases was 11 months. Histopathological review of the regional lymph nodes in the operable group showed that adverse pathology such as multiple nodes, extracapsular spread, vascular and perineural invasion. were associated with regional recurrence and short survival. Twenty-one patients with operable metastases had a mean survival of 53.8 months. This was compared with 13 patients with inoperable disease, in whom the mean survival was 12.2 months (P< 0.05).     

胰体尾癌（附112例报告）

本文报告112例胰体尾癌,均经BUS、CT、ERCP以及剖腹探查术确诊。胰体尾癌出现症状至确诊时间3~4个月,其中111例因延误早期诊断而发展为进展期癌,仅1例为早期胰体尾癌。作者认为凡有上腹痛、腰背痛及食欲不振症状者,应警惕早期胰癌的存在。应用BUS、CT、ERCP进一步检查,必要时行细针穿刺细胞学检查及剖腹探查术均可确诊。本组105例不能切除,仅7例能切除,切除率极低,但早期诊断,力争早期根治性切除胰体尾癌,效果是理想的。     

瘢痕疙瘩和增殖性瘢痕的超微结构观察

对１４例瘢痕疙瘩和７例增殖性瘢痕的超微结构进行了观察分析。该两种病变均可见到不同时期的成纤维细胞、巨噬细胞和疏密不等的胶原微纤维以及呈不同闭塞状态的微血管。多数成纤维细胞功能很活跃，胞浆内充满了大量扩张的粗面内质网和发达的高尔基复合体，胶原微纤维排列紊乱。但在瘢痕疙瘩中还常见到肌纤维母细胞。其胞质中除了粗面内质网和高尔基复合体以外，还可见大量的肌微丝、密体、密斑以及不完整的基板。该特征拟作鉴别瘢痕疙瘩和增殖性瘢痕的依据。