Chinese Medical Journal

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RECENT ADVANCES IN DIAGNOSIS OF PARAGONIMIASIS 1

PATHOLOGICAL EXAMINATION. Chest cavity. There were extensive fibrous adhesions between the right lung, chest wall, diaphragm and pericardium, and between the left upper lobe and the lingula. ;

Lungs. A triangular scar was present about 1 cm from the lower margin of the left upper lobe. On section it showed an old fibrous tubercle.

Brain. Fibrous adhesions were present in the meninges of the anterior portion of the left frontal lobe. The surface of the left frontal lobe was rather soft, and the sulcus shallow. f

_ Sections of the brain showed dilatation of both lateral ventricles. The foramen of Monro was 1.3 cm in diameter. The inner surface of the ventricles was smooth and glistening. :

There were five abscess-like lesions in the anterior end of the left frontal lobe, the largest measuring 1.2 by 0.8 cm. :

In the calearine fissure of the left occipital lobe were scattered smaller lesions of the same kind.

The left half of the midbrain was enlarged with loss of its normal structures. There was a tunnel-like cavity at the lateral margin of the central part of the midbrain, containing dark yellowish pus-like material. Near the medial end of the tunnel there was another tunnel, 1.7 by 0.3 em, containing a degenerated grayish parasite. The aqueduct of Sylvius was compressed.

There was an abscess measuring 1.5 em in the superior reticular formation of the pontine nucleus.

Microscopic examination. The microscopic changes of the above mentioned lesions were similar to those of Case 1. Ova were also found.

In the left cerebellum, in the region of the dentate nucleus, there was a soft lesion measuring 0.7 by 0.5 em; 1.5 em below this lesion there was an abscess, measuring 1.5 by 0.6 cm, which extended from the vicinity of the fourth ventricle below to the margin of tonsillar lobe above.

Pathological diagnosis. Extensive fibrous adhesions between the right visceral pleura, the entire right chest wall, the diaphragm and the outer surface of the pericardial sac. Abscess formation in the left frontal lobe, midbrain, pons, and cerebellum with moderate hydrocephalus. Some acute splenitis and fatty degeneration of liver. Cause of death was extensive necrosis of brain tissue due to paragonimiasis. (No evidence of tuberculous meningitis.)

CASE 3. Chiang, a Korean schoolboy of 14 was admitted on March 26, 1954 for intermittent pulsating pain of the forehead since April, 1953. Simultaneously he felt pain in both thighs and knee joints. After resting for three to four days he became better. However, about a month later he developed paroxysmal headache and illusion of seeing flying flies. He also frequently had abdominal pain with watery stools two to five times per day without blood or pus. In July 1953 he entered a hospital in Changchun for treatment on account of fever, cough and expectoration of yellowish-white sputum with blood streaks. By January 1954 the patient had developed numbness of the right upper extremity. The grip of the right hand was weak. A sudden attack of mental confusion accompanied by stiffness of the extremities appeared and lasted about five minutes. The same symptoms occurred several times later and were associated with incontinence of urination and white foam from the mouth. There was no convulsion or biting wound of the lips and tongue. The patient had severe headache after each attack. Prior to hospitalization, he had often had headaches but only occasional cough with