Papillary fibroelastoma of the aortic valve in a patient with an acute myocardial infarction

We describe a patient with a myocardial infarction in whom a tumor near the aortic valve was identified by routine transthoracic echocardiography. Transesophageal echocardiography proved to be particularly useful in identifying the attachment of the tumor to the aortic valve and enabled a surgical approach through the ascending aorta. On microscopic examination, the tumor appeared to be a papillary fibroelastoma.     

腹腔内放置复合补片原位修补巨大造口旁疝八例

目的总结应用复合补片腹腔内修补巨大造口旁疝的经验。方法回顾性分析复合补片经腹腔内修补巨大造口旁疝8例的临床资料,其中男性6例,女性2例,年龄46～63岁,平均54.7岁。患者均因直肠癌行Miles手术后发生造口旁疝,疝病史3～8年,其中复发性造口旁疝2例。疝环最大径11～15 cm,平均12.6 cm。根据疝环大小选择合适补片,补片边缘均超出疝环缘3 cm以上。在补片中心剪-3 cm直径的孔,并在孔的一侧剪开补片,将补片中心孔套入造口肠管,补片其他部分覆盖住腹壁缺损,补片聚四氟乙烯面朝向腹腔,聚丙烯面朝向腹壁。用2-0的Prolene线连续缝合补片被剪开的一侧裂口,并将补片中心孔的聚四氟乙烯材料缘与造口肠管用3-0的可吸收线间断缝合固定4～5针。然后用1-0的Prolene线经全腹壁穿刺缝合方式,将补片铺平并固定于腹壁,间隔距离5 mm。多余皮肤行适当整形。结果手术时间97～146min,平均109 min。伤口均一期愈合,1例发生浆液肿,2例发生术后近期修补区刺痛。随访3～27个月,平均20个月,无复发。结论复合补片经腹腔内修补巨大造口旁疝是一种安全有效的方法。     

Treatment of severe cervical spine injuries by anterior interbody fusion with early mobilization

Summary A follow up study of 24 patients treated for severe injury of the cervical spine is presented. The dislocation was initially reduced by skull traction, which was later replaced by anterior fusion using a tibial graft. Solid fusion occurred in all patients. The neurological improvement was unaffected by the operation.Our conclusion is that anterior fusion as opposed to conservative treatment leads to earlier mobilization, shorter hospitalization, and less costly rehabilitation.     

The Applicability of Simple Blood and Bone Marrow Variables in Prediction of Acute Leukaemia in Patients with Acquired Bi- or Pancytopenia

A retrospective study of 44 patients presenting with acquired bi- or pancytopenia (B/PC) and no evidence of any causal disorder was carried out. 12 patients developed acute non-lymphoblastic leukaemia after 2–51 months. Compared to the nonleukaemic subjects the preleukaemic patients at the onset of B/PC had significantly higher counts of myeloblasts and other myelopoietic cells in the bone marrow, more cellular marrows due to more dense cellularities of all compartments, higher blood granulocyte and monocyte counts, more pronounced anisocytosis, and in some cases a small number of circulating myeloblasts. A stepwise multiple logistic regression analysis identified 3 combinations of variables displaying significant simultaneous association with subsequent leukaemic transformation. Among these the combination of marrow myeloblast percentage and blood granulocyte count might be applicable to early prospective identification of patients with preleukaemic B/PC.     

Heterogeneity of the haemoglobin-A1c-band in isoelectric focussing

Summary A double HbA_1c-band was demonstrated in isoelectric focussing of blood from diabetics with a fasting blood glucose above 11mmol/l. The same band-doubling was also demonstrated after incubation of erythrocytes in glucose/saline solutions. This finding may reflect the presence of the initial condensation product between haemoglobin and glucose, the Schiff-base intermediate.     

Immunotherapy with dog and cat extracts in children

Hypersensitivity to dogs and cats causes asthma in many children. In this open controlled clinical study we wanted to establish whether immunotherapy can be recommended as a supplement to conventional medical therapy in dog- and cat-induced asthma in children. Twenty-seven children with mean age 10 7/12 years and with allergy to dog or cat according to anamnesis, skin prick test (SPT), specific IgE (RAST) and bronchial provocation test (BPT) entered the study. On the basis of age and bronchial sensitivity they were randomly allocated to either immunotherapy with dog or cat extract (active group, n = 14) or conventional medical therapy (control group, n = 13). Immunotherapy comprised subcutaneous injections with an alum-adsorbed depot extract (Alutard-SQ), and a maintenance dose of 100,000 SQ-U or the maximum tolerated dose. Before entering the study and after 9 months' therapy the patients were evaluated by BPT, SPT, RAST - and IgG4 analyses. The active group showed statistically significant change in bronchial tolerance (P less than 0.02), whereas no such change was found in the control group (P greater than 0.05). The change in skin sensitivity was significantly greater in the active group than in the control group (P less than 0.05), whereas no significant differences were found in RAST and IgG4. However, a significant (P = 0.05) increase in IgG4 was seen in the active but not in the control group. Frequency and degree of side effects in this study were acceptable.     

Redundant nerve roots of the cauda equina

Summary Five personally examined cases of redundant nerve roots of the cauda equina are added to the 13 hitherto on record. Except for segmental neurological deficits, intermittent claudication-like symptoms of the cauda equina dominated the histories of four of our five cases. The diagnosis was confirmed at surgical exploration, which included laminal and dural decompression. At follow-up (two months-three years) the neurological deficit, or the intermittent claudication, or both, had improved in all our patients. The pathogenesis of root redundancy is obscure. It seems that the symptoms arise through the action of at least two factorsviz compression of the spinal content and the existence of one or more redundant roots. Wider use of diagnostic aids and surgical exploration would probably show that redundant roots are more common than hitherto supposed.