Areas for safe percutaneous nephrocentesis--a study of practical anatomy

The safest percutaneous nephrocentesis route is through the posterolateral aspect of the kidney. From study of 160 kidneys from adults at autopsy, we conclude that the most favorable nephrocentesis area is the lower major renal calyx and its minor calyces or the upper minor calyces. We believe that the lateral aspect of the middle calyces may be an area for safe nephrocentesis.

[Indication of radical surgery (R2, R3) based upon the pattern of lymph node metastasis from gastric cancer]

From Jan. 1980 to June. 1984, radical operation was performed in 156 patients with gastric cancer according to the "protocol" introduced by the Gastric Cancer Research Society of Japan. There were 24 early and 132 advanced gastric cancers. Seventy patients were treated by type R2, 86 by R+2 and R3. Radical distal subtotal gastrectomy was done in 116, proximal subtotal gastrectomy in 7, simple total gastrectomy in 13 and subtotal or total gastrectomy combined with neighbouring organ resection in 20. According to TNM staging, 24 (15.4%) lesions were stage I, 9 (5.8%) stage II, 100 (64.1%) stage III and 23 (14.7%) stage IV. Twenty four lesions were within the mucosa or submucosal layer, 11 in proprius muscle layer, 18 to subserosa, 15 to serosa, 46 beyond serosa, 42 involving the surrounding organs. Lymph node metastatic rate was 66% (103 cases), metastatic degree was 21.5% (558/2593). The metastatic degree of lymph node line I, II and III was 24.7%, 20% and 8.3%, respectively. Basing on lymph node metastatic rate and degree as well as the line degree, it is proposed that, in the early stage of gastric cancer, type R1 be performed for cancer limited to the mucosa, especially the minute type, R2 for cancer invading the submucosa, in which, R+2 be indicated for some isolated patients. In the advanced gastric cancer, type R+2 be performed in the majority of patients and R3 in a few. R3 or total gastrectomy combined with neighbouring organ resection be carried out only in a part of cases with the limited type infiltrating beyond the serosa or invading the neighbouring organs.

[Surgical treatment of carcinoma of the gingiva]

78 patients with squamous cell carcinoma of the gum were treated in our hospital from 1964 to 1982. 54 were male and 24 female, the sex ratio was 2.3:1. The peak age ranged from 50 to 59 years. 19 (24%) patients had lesions of stages I-II and 56 (71.7%) of stage III. All the patients were treated with surgery only or radiotherapy plus surgery. In 72 treated by surgery only, the lesions of the upper and lower gingival carcinoma without regional lymph node metastasis gave 5 year survival rates of 50% and 83.3%, while those with regional lymph node metastasis gave 5 year survivals of 20% and 58.5%, respectively. The rest 6 patients receiving radiotherapy plus surgery gave a 5 year survival rate of 50%. The results indicate that the prognosis is better for the carcinoma of the lower gum without regional lymph node metastasis.

[Malignant melanoma of the head and neck--a clinical analysis of 46 patients]

46 patients with malignant melanoma of the head and neck as treated in our hospital from March 1964 to December 1981 are reported. 29 were male and 17 were female. The sex ratio ws 1.7:1. 56.5% of patients were 40-60 years old. The tumor occurred most frequently in the nasal cavity, next in the oral cavity. Lesions originating from the eye and skin in the head and neck region comprised 15.2% of cases. Melanoma of the nasal cavity and eye rarely metastasized into the cervical lymph nodes but melanoma arising from the skin of head and neck had a metastatic rate of 57.1%. 50% of melanoma of the gingiva metastasized to the neck glands. In this series, 29 patients were treated by operation. The overall 3 and 5 year survival rates of these 46 patients are 38% and 15.7%. The 3 and 5 year survival rates of those without regional lymph node metastasis are 51% and 28%. The 3 and 5 year survivals of those with regional lymph node metastasis are 13% and 0%. Other methods, such as surgery plus chemotherapy, chemotherapy alone and radiotherapy plus surgery or chemotherapy were used only in a few cases which could not be evaluated.

Measles vaccine in the People's Republic of China

The strains of measles virus and the method used in the production of further attenuated live-virus vaccine in the People's Republic of China were studied. Observation of clinical reactions and serologic responses to immunization with Shanghai-191 measles vaccine, which is produced on a large scale with a locally isolated viral strain, revealed that this vaccine is adequately safe and immunogenic. Epidemiologic data showed a significant decrease in measles-associated morbidity after the introduction of mass vaccination in 1965. The duration of immunity induced by Shanghai-191 measles vaccine was studied for eight years in a region in which interference due to natural measles infection had been minimized by mass vaccination of children. Although immunity appeared to persist for at least eight years, the results suggested that primary vaccination does not confer lifelong immunity. Reactions and antibody responses to this vaccine were compared with those to two vaccines from abroad, the Schwarz and Leningrad-16 strains. The hemagglutination-inhibiting (HAI) antibody titer induced by Shanghai-191 vaccine was higher than that induced by Leningrad-16 vaccine and lower than that induced by Schwarz vaccine; however, these differences were not significant. Preliminary studies on the preparation of measles vaccine in human diploid cells have yielded promising results.