[Application of pectoralis major myocutaneous flap in laryngectomy for laryngeal carcinoma]

The experiences in reconstruction of surgical defects by pectoralis major myocutaneous flap after extensive cancer resection in 12 patients with advanced laryngeal carcinoma or recurrences are reported. The defects of different sites were reconstructed in one stage operation successfully. By this method, surgical indication is extended, therefore, reducing the patients' suffering and prolonging the survival. The preparation of the flap is described.

[External skeletal compression fixation and lengthening for shortened limb with non-union and deformity]

From Oct. 1982 to Dec. 1988, external skeletal compression fixator of half-ring sulcated type was used on 12 patients, aged 8 to 12, for treatment of shortened leg with non-union and bone defect, 7 of which were in tibia and 5 in femur. Scar tissue between fragment ends that interfered contact was cleared off for proper apposition and stability. 12 the non-union healed up in 4 to 6 months. In 5 patients with open epiphyses, distraction epiphysiolysis for lengthening was simultaneously performed in addition to compression at the non-union site; the lengths gained range from 4 to 13.5 cm, with an average of 9.8 cm. The lengthened region got repaired with in-growing bone in 5 to 10 months. In 7 patients with closed epiphyses; metamyseal osteotomy was done in combination for lengthening too; the lengths obtained were 3 to 16 cm, averaging 7.8 cm. The distraction gap was obliterated by in-growing bone in 4 to 16 months. In one case, metaphyseal osteotomy was performed on both ends of the tibia to get longer length to make up the tibial shaft defect of 8 cm; both non-union and lengthening segments healed up in 6 months. Neither neural nor vascular damage has occurred in any case, advantages and indications of the operation was discussed, and the surgical procedure was described.

Value of postoperative radiotherapy for thyroid cancer

A series of 405 patients with thyroid cancer treated by surgery with or without postoperative radiotherapy from February 1958 through 1979 is reported. The immediate evaluation of the operation was that it was either incomplete or complete. Incomplete surgery implied that there was (1) possible residual tumor in the operative field, the result of difficult dissection of the tumor off the neighboring organs or tissues, as assessed by the surgeon; (2) multiple (more than five) lymph nodes involved; (3) positive border of the removed lesions; or (4) microscopic evidence of tumor in the operative field. Complete surgery implied through extirpation of cancer grossly and microscopically. In 297 patients who had complete surgery, 238 patients treated by surgery alone had a 5-year survival rate of 92% (218/238), while 59 patients who received postoperative radiotherapy had a 5-year survival rate of 78% (46/59). The optimum dose of postoperative radiotherapy was 50-70 Gy in 5 to 8 weeks, with the spinal dose kept under 40 Gy. Our experience shows that postoperative radiotherapy did not improve the survival of patients who had had complete surgery. Yet, in 108 patients who had incomplete surgery, surgery alone yielded a 5-year survival rate of 33% (19/57), while surgery plus radiotherapy yielded a 5-year survival of 71% (36/51). Our observation shows a remarkable benefit with postoperative radiotherapy in patients who have had incomplete surgery (P less than 0.05). According to pathologic criteria, postoperative radiotherapy was more effective in well-differentiated cancers than in poorly differentiated ones. It was equally effective in untreated as well as recurrent lesions. The prognosis for younger patients was better, but the sex of the patients did not affect prognosis.

Preliminary studies on antigenic variation of poliovirus using neutralizing monoclonal antibodies

Cross-neutralization assays were done using 85 strains of poliovirus type 1 with five groups of monoclonal antibodies. These strains were classified into 10 subgroups which had marked differences in antigenicity. Subgroups P1-2 (28%) and P1-5 (43%) were dominant and have been epidemic in China in recent years. These two subgroups were antigenically different from the Sabin-1 strain, but according to their responses to one group of monoclonal antibodies they had antigenic epitopes in common with the Mahoney and Brunhilde strains. Similarly, 91 strains of type 3 poliovirus were classified into six subgroups with another five groups of monoclonal antibodies. The results showed that strain P3/Yunnan/2/84, which was isolated from cases of poliomyelitis in a local epidemic in the Yunnan province of China in 1984, and strain P3/Finland/23127/84, which was isolated in Finland in 1984, were both antigenically different from the Sabin-3 strain and the reference virulent strain.

Study on the association of HLA with pulmonary tuberculosis

The association between HLA and pulmonary tuberculosis was investigated in 50 Chinese patients. The frequencies of the HLA-A11 and -B15 antigens were increased (P less than 0.025) in patient group. Relative risks (R.R.) were 2.13 and 2.39, respectively. In contrast, the frequency of the HLA-Cw3 antigen and the R.R. (0.29) were decreased (P less than 0.005) in the patient group. These results are different from those reported by other researchers for Caucasian and Chinese tuberculosis patients. Moreover, it was found that the frequency of the A11-B15 haplotype in all patients with cavitation was 3-4 times higher (P less than 0.01) than in control individuals. The R.R. was 3.57.

Study on the association of HLA with malignant lymphoma

The association of HLA with malignant lymphomas in 50 Chinese patients of the HAN nationality was investigated. The frequencies of antigens HLA-A and -C and the majority of HLA-B phenotypes were not significantly different between the patient and control groups, whereas the antigen frequency of HLA-B16 was increased significantly (P less than 0.025) in the patient group. The relative risk associated with HLA-B16 was 2.5694. The association of this antigen with malignant lymphoma might be unique for Oriental patients.