Chinese Medical Journal

92 THE CHINESE MEDICAL JOURNAL

majority of the patients (97.75 per cent) had splenomegaly. Only 96 patients (2.25 per cent) had no splenomegaly, probably because they were early cases. Enlargement of the liver occurred in only 40.2 per cent of all the patients. The white blood cell count was within normal limits in 26.1 per cent of the cases, and low in the remaining cases, among which 45.9 per cent had a count of between 2,100 and 4,000. Leukopenia was due chiefly to depression of polymorphonuclear cells. Although the relative percentage of lymphocytes showed an increase, the absolute number was less than normal. Anemia was common. Red blood cell counts between 2,010,000 and 4,000,000 occurred in 77.2 per cent and hemoglobin values between 41 and 60 per cent occurred in 51.36 per cent of the cases. Fever occurred in 95.99 per cent of the cases. Bleeding from the nose and gums was found in only 38.96 and 43.38 per cent of the cases respectively.

Free treatment of kala-azar patients since Liberation has greatly reduced serious complications. Agranulocytosis was very seldom seen. The incidence of noma also ’ dropped; there was only 0.84 per cent in the present series, and no death was encountered following the institution of penicillin therapy for this condition.

Tumors of the Urinary Bladder. Shen Chia-Li, Hsiung Ju-Ch’eng, Ch’en Chia-Piao and Ho Tzu-Ming. Chinese J. Surg. 3(11):814-820, 1955.

Among 93 cases of tumors of the urinary bladder 82 (88 per cent) were primary and 11 (12 per cent) secondary, mostly metastatic growths from carcinomas of the cervix of the uterus. Of the primary tumors, 80 were of epithelial origin. There were 56 males and 24 females. The ages were between 41 and 60 years in 61.3 per cent. The main symptoms were gross hematuria, frequency and urgency of urination. The period from the onset of symptoms to the time of treatment varied from three months to over two years. No positive physical findings were elicited among most of the patients. Pathological examinations showed that most of the cases were carcinomas. Thirty-four cases or 45 per cent were of single growth, located mostly over the trigone region, lateral and posterior walls of the urinary bladder.

X-ray examination of the upper urinary tract was done in 44 cases and secondary lesion was seen in 23 cases. Of the 56 patients treated, 20 had local excision and electric cauterization, 14 had partial cystectomy, 13 had total cystectomy, 6 had palliative treatment in the form of anastomosis of ureters to sigmoid colon and 3 had deep x-ray therapy. j

Thirty-eight patients were followed up for from half to five years. Of these, 15 had excellent results without recurrence, 7 had recurrence, and 16 died. These results are not satisfactory; the patients usually. came for treatment too late. The authors believe that in tumors of the urinary bladder cystoscopic examination is the best method of early diagnosis and total cystectomy is the procedure of choice. iP. Ee (Ehien

Partial Nephrectomy. Ho Shang-Chih, Ts’ao Yii-Féng, Ch’en Pang-Tien and An ShihYuan. Chinese J. Surg. 3(11):837-841, 1955.

Partial nephrectomy was first introduced by Tuffier in 1891, but owing to the lack of adequate facilities and improper selection of cases, postoperative complications such as hemorrhage and urinary leakage were difficult to control, and the operation was soon discarded. Today, with the progress in surgical technic and the use of sulfonamides and antibiotics, partial nephrectomy has proved a safe and useful procedure. Criteria for this operation are: 1. the lesion is localized over a single pole of the Kidney; 2. adequate renal tissue is left to maintain a normal excretory function of urine, if the opposite kidney is absent; 3. adequate blood supply and normal urinary drainage can be maintained for the remaining renal tissue. The authors used two types of operative procedures, one for partial hydronephrosis as described by Landes, and the other for non-hydronephrotic lesions as described by Lattimer. One case of bilateral double kidney, 4 cases with renal stone and 1 with renal tuberculosis were operated on with good results. Pa TEs (Chien:

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