1983年 · 第03卷第01期

This article reports 22 patients with nonparasitic cysts of the liver admitted during August 1968 to March 1981. Two patients were male and 20 female. The youngest was 12 yr old and the eldest 70, and 19 patients were over 40. Single cyst of the liver was found in 12 patients, including 8 on the right and 4 on the left, and multiple cysts in 10 patients, including 2 with concurrent polycystic disease of the kidney and pancreas. The clinical manifestation showed a painless and asymptomatic mass over the upper abdomen. The cyst(s) could grow up to compress the adjacent viscera. Ultrasonography was performed in 16 patients, demonstrating cystic masses of at least 2 cm in diameter. Liver nuclide scintigraphy was done in 8 cases, space-occupying lesions were observed in 7. Of the 22 patients, 3 were misdiagnosed as infection of biliary tract, liver abscess and pancreatitis respectively. According to the characteristics of different cysts, resection, drainage or marsupialization of the cyst or hepatic lobectomy was performed with satisfactory results.

This paper reports 78 patients with surgically proved pyogenic liver abscess, among them 32 cases were of multiple abscess and 46 of single abscess. Of the 32 cases, 30 were originated from biliary diseases, with acute onset, high fever, colic, jaundice and usually associated with shock. The mortality was 18.8%. In 46 cases of single abscess, only 4 were originated from biliary infection. The onset in majority of the 46 cases was insidious with slow progress. Its mortality was only 4.3%. Extraperitoneal drainage was performed in 4 cases and transabdominal drainage was done in 74 cases.

Lappaconitine is the main alkaloid isolated from the root of Acontium Sinomontanum Nakai. It was used to relieve severe pain in 40 patients with GI cancer and 22 with peptic ulcer. The total effective rate was 95.2%, in which 64.5% was markedly effective, 30.7% slightly effective and 4.8% not effective at all. The pain began to be relieved at 16.80±6.59 min after administration and it lasted 6.20±4.75 h. There was no significant difference between the cancerous and non-cancerous cases, whether the drug was given orally or parenterally, and the administration of lappaconitine hydrobromide and dolantin. This drug has neither addiction nor toxicity so far. The pharmacogenesis of analgesic and ’body-supporting' effect of the drug is dissussed.

Biopsy tissue gastrin concentration of antral mucosa (AGC) of 110 patients were determined. The mean AGC of 8 control patients with normal endoscopic findings was 15.02±3.55 (mean ± SE) ng/mg tissue. AGC of 40 with chronic superficial gastritis was 13.45 ± 1.53, 7 with duodenal ulcer 11.57 ± 1.89, 11 with gastric ulcer 9.9 ± 1.65, 5 with type A chronic atrophic gastritis 21.8 ± 8.75 and 9 with mild atrophic gastritis of type B 15.9 ± 1.59. The above data were not significantly different from the control value (p>0.05). AGC of 24 with moderate and severe antral atrophic gastritis of type B was much lower (6.49 ± 0.98) than the control value (p<0.005). AGC of 2 with gastric body carcinoma was 13.15 ± 2.0, similar to the control value. AGC of 4 with antral carcinoma was 1.40 ± 0.43, obviously less than the control value (p<0.05). The level of the fasting serum gastrin of 72 patients did not correlate with AGC (r = 0.15, p>0.20), while integrated gastrin response (IGR) in 26 with chronic atrophic gastritis orrelated with AGC (r = 0.45, p<0.05). The determination of AGC might reflect the seriousness of atrophy of the antral mucosa. It could therefore be used as an index when follow up the course of atrophic gastritis and might be useful in assessment of the treatment and prognosis.

The biopsy specimens of gastric mucosa of 26 cases with chronic gastritis were studied by electron microsope scanning. Among them, 6 cases with their gastric mucosa appeared normal under endoscopy but were diagnosed as mild superficial gastritits with conventional histological sections. The other 7 cases were of moderate or severe superficial gastritis and 13 of atrophic gastritits. The observations can be summerized as follows. 1. The electron microscope scanning is not able to show the fine changes on the surface of gastric mucosa in chronic gastritis. The gastric mucosa is usually transformed into antral mucosa-like pattern at first and subsequently into intestinal villi-like pattern. 2. There are two forms of epithelial intestinal metaplasia, the complete and incomplete. The complete form mucosa is indistin guishable from that of small intestine and is probably developed from incomplete form. 3. The gastric mucosa of chronic atrophic gastritis has some lesions (e. g. intestinal metaplasia and pseudo-pyloric metaplasia) which are indiscernible by naked eyes but easily recognizable by electron microscope scanning.

Histopathologic scrutinization was carried out in 55 resected specimens of gastric cancer, with special reference to the rate and extent of lymph node (LN) involvement. A total of 1,172 LN was picked out with an average of 21.3 LN per patient. The incidence of LN metastases was found to be 23.9% (280/1,172). In 20 cases of cardiac tumors (C), the rates of involvement of groups V & Ⅵ LN were found to be 25.0% and 20.0%; in 9 cases of tumors of the body (M), the incidences of metastases of the groups Ⅰ, Ⅱ, Ⅴ and Ⅵ were found to be 33.3%, 11.1%, 22.2% and 33.3% respectively. Thus in C and M tumors, metastasis was frequent in group Ⅰ-Ⅵ LN and the curative goal could not be attained without doing total gastrectomy. Of the 26 cases of antral tumors, the group Ⅰ LN was positive only in one case and no group Ⅱ LN was involved, so that for antral tumors a near-total gastrectomy is justified. It was also found that 11.1-20.0% of the nodes in the splenic hilum and 22.2-30 0% of the nodes around the splenic artery were invaded, therefore, the spleen and the body and tail of pancreas should be included in the en bloc resection. The results of this study also demonstrate that for early lesions, subtotal gastrectomy with eradication of regional LN is an adequate operation, and extended radical operation is indicated for Stages 2 & 3, while Stage 4 cases should be treated by simpler procedures.

Three hundred eleven patients with lower gastrointestinal bleeding were admitted during the period of 1964 to 1980. Among them 2 cases were caused by vascular malformation and hemangioma of small intestine histiocytic medullary reticulosis involving small intestine and colon in 1, pneumatosis cystoides intestinalis of the colon in 4, Behcet's disease complicated with hemorrhagic ulcerative enteritis in 1 and multiple lymphosarcoma of the ileum in 1. All the rare lesion were proved pathologically.

This paper analyses the clinical data of 1,078 cases with amoebic hepatic abcess. Fever, pain in the liver arca and epigastrium, and hepatomegaly were importain features, present in 92.8%, 89.2% and 87.8% of patieuts respectively. Abscesses were mostly at the right lobe (86.8%). Three complications were more commonly encountered, namely, rupture of abscess, secondary bacterial infection and blood-borne dissemination, nevertheless, rupture was mostly seen, it occurred in 16.1% of patients. In general, the liver abscess ruptured into thorax, bronchus and peritoneal cavity. The typing, rupture and therapy are briefly discussed. It is noteworthy for clinicians to recognize the complicated manifestations due to the rupture. Metronidazole is found to be effective, safe and convenient in the treatment of this disease and is therefore a drug of choice.

One hundred forty-four cases with amebic liver abscess were admitted and treated during 1972-1982. The following amebacidal drugs were used in sequence according to the need of each patient: (1) metronidazole 1.2 gm/day for 10-30 days; (2) chloroquine 0.75 gm/day for 21 days; (3) atebrine 0.3 gm/day for 10 days and (4) emetine HCl 1mg/kg/ day, im, for 7-10 days. Needle aspiration of pus was done in 114 cases (79%). 30 mg of emetine HCl was ingjected routinely into the abscess cavity after aspiration without side reaction. Antibiotics were given im, iv, and injected into the abscess cavity in cases suspected of having secondary infection. Repeated small amount of blood transfusion was given in 26 cases (18%). The overall mortality was 5.6% (8 cases). One hundred and seven cases received metronidazole as the first round of treatment showed a lower mortality (4.7%) than that of 35 cases receiving chloroquine, although not significant statistically. The mortality in 1979-1982 was further reduced to 2.3% (1/44) as a result of routine use of metronidazole for the first round of treatment supported by more frequent blood transfusions in 41% of cases. It is concluded that metronidazole should be the first drug of choice for its higher efficacy and milder side reaction. It should be supplemented by the alternating use of other amebacidal drugs, routine pus aspiration and antibiotics as indicated and other supportive measures.