1983年 · 第03卷第03期

A clinical analysis of 142 cases of duodenal diverticula is presented. There were 97 males and 45 females, with age ranging 22-75 yr. Diverticula developed at any portion of the duodenum with a highest prevalence at the second portion. Thirteen cases were admitted for diseases not of the digestive system. Of the 129 cases with GI symptoms, 76 were in concurrence with other GI diseases. The commonest symptom was epigastric pain, and other symptoms included melena, belching and sour regurgitation, nausea and vomiting, hematemesis, and diarrhea. Eighteen cases had diverticulitis. Bleeding occurred in 11 cases. Nineteen cases were complicated with biliary tract diseases and 4 with pancreatitis. Fifty-five cases underwent surgical intervention. None in this series died from complications or surgical operations.

In 84 patients and 30 normal volunteers, small intestinal mucosal specimens were obtained through peroral biopsy with Watson capsule. The thickness of mucosa, height (H) and width (W) of villi, depth of crypt (C), inter-epithelial lymphocyte count (L), mitotic rate of crypt cells (N), etc. of each specimen were measured under microscope. The results showed a significant increase in L, C, and N, and decrease in H/C ratio in specimens obtained from patients with chronic diarrhea. A significant increase in L existed in specimens from patients with steatorrhea. A significant increase in W and decrease in H and H/C ratio were observed in specimens from patients with systemic scleroderma. However, in specimens from ulcerative colitis patients, no significant change was observed. Unexpectedly, only one case of nontropical sprue was encountered in this group. The authors consider that the Watson capsule is simple, efficient and easy to manipulate, but its chief shortcoming is only one specimen could be obtained each time.

This paper reports 215 pathologically proved cases of smooth muscle tumors of the alimentary tract, including 121 cases of leiomyoma, 5 of leiomyoblastoma and 89 of leiomyosarcoma. The male had an incidence twice that of female, and the age frequency was higher during 5th-6th decades. All but 5 cases had a single tumor with size varied from 3 cm to more than 30 cm, and frequently accompanied with cystic degeneration and ulceration. The majority of malignant tumors had a diameter greater than 8 cm, while benign ones less than 8 cm, with significant difference statistically. Of 77 cases of leiomyosarcoma with good record, 19 showed metastatic changes in the liver (8), peritoneal cavity (5) and regional lymphnodes (6). The symptoms of esophageal tumor were characterized by dysphagia (30/36) and post-sternal discomfort or pain (14/36), and that of gastrointestinal tumor by abdominal pain (93/179), intraabdominal mass (93/179) and GI bleeding (90/179). X-ray appearance was rather non-specific and of little diagnostic value, and endoscopic exam was also not helpful. Diagnosis was usually made by exploratory laparotomy. Enucleation or resection of the tumor was the only effective treatment. The prognosis of the disease is generally good even in malignant form, if active surgery is taken.

Twenty-eight cases of familial adenomatosis of colorectum were treated by a new two-team operation with direct eradication of the adenomata in the transanally everted rectum in one stage. Eight cases were treated by total colectomy, partial proctectomy and ileo-proctostomy with preservation of 9-10 cm of rectum, 20 by subtotal proctocolectomy and ascending colo-proctostomy with preservation of the ileo-cecal segment and 6 cm of rectum. Follow-up study with sigmoidoscopy and fulguration every 6 months for 1-25 yr (average 11 yr) revealed one patient developed early cancer in the retained rectal segment 8 yr after operation, and was treated by curative rectal excision. Four patients developed numerous adenomata in the retained rectal segment needed further operation. The advantages of this new operation over the conventional total colectomy and ileo-proctostomy are: (1) For subtotal proctocolectomy with direct eradication of adenomata in the everted rectum in one stage, repeated preoperative proctoscopic fulguration is not necessary. (2) Eversion of rectum allows direct visio-manual examination of adenomata and intervening mucosa. (3) Direct eradication of adenomata on the everted rectum is much easier, safer and more complete than proctoscopic fulguration, especially if rectal adenomata are numerous. (4) This operation preserves the ileocecal segment and 8 cm of the ano-rectum, which enables nearly normal defecatory control.

Lymphocyte-plasmacyte infiltration surrounding the colonic cancer in 559 patients was examined. It was found that the 5-yr and 10-yr survival rate in patients with infiltration being 87.08% and 75.77% respectively, but in those without infiltration the 5-yr and 10-yr survival rate being 19.6% and 13.88% only respectively. In addition, the immunoreaction of regional lymph nodes in respect to germinal centers hyperplasia in 457 out of 559 cases was also studied. The 5-yr and 10-yr survival rate in patients with numerous germinal center were both 86.15%, while in patients with less hyperplasia of germinal center the 5-yr and 10-yr survival rate were only 50.30% and 39.80% respectively. Lymphocyte-plasmacyte infiltration and germinal center hyperplasia may be considered as the host's immunologic defence against the colonic cancer and may be taken as the prognositc immunologic marker in cases of colonic cancer. In this series, 172 cases were followed up for more than 10 yrs. It was found that the greater the combination of lymphocyte infiltration and germinal center hyperplasia the higher the 5-yr and 10-yr survival rate. However, the degree of sinus histiocytic infiltration was found of no value in assessing the prognosis of the disease.

This paper reports the X-ray study with barium enema on 53 cases of proved ulcerative colitis, in which the sigmoid colon and rectum were involved in 21, left hemicolon in 19, whole colon in 12 and right hemicolon in one. Double-contrast barium enema examination can reveal mucosal change more closely and in this study the early signs of mucosal damage of chronic ulcerative colitis in the form of granular appearance was discovered in 44 cases and of shallow multiple ulcerations in 43. The authors conclude that the double-contrast barium enema examination in experienced hands is an effective means in detecting early changes of ulcerative colitis.

One hundred ninety-one cases of gastroscopically diagnosed chronic erosive gastritis (CEG) from Jan 1979 to June 1982 were analysed. The lesions could be classified into 3 categories: a varioliform type (58.1%), a segmentalth ckened-fold type (40.8%) and a polypoidal type (1.1%). Of the 72 patients examined radiologically prior to gastroscopic examination, 23 (31.9%) showed thickening and nodularity of antral folds. Gastric biopsies were performed in 93 cases and early gastric cancer was detected in one. Examination of resected specimen of this cancer patient disclosed the existence of an anaplasic zone in-between the early cancer lesion and the mucosal hyperplasia of CEG. Of the 24 patients followed up for 1-38 months, 9 gave no significant change, 9 showed either aggravation or diminution or disappearance of the lesions, and 6 advanced to irregular mucosal folds or papular elevations of mucosa. The CEG seems to be a rather benign condition but may have a chance proceeding to polyp formation and eventually malignant change.

A comparative study of 40 patients using either cholecystokinin-pancreozymin (CCK-PZ) or a fatty meal after oral cholecystography is described. The CCK-PZ group was also compared with another 40 patients who received iv cholangiography. The group using CCK-PZ presented a quicker and clearer cystic and/or common bile duct visualization and had a higher bile duct visualization rate and stronger intensity of gallbladder contraction than the other two groups (p<0.001). The maximum contraction of gallbladder and the optimal visualization of bile duct appeared at 23-33 min after im CCK-PZ. Pain over the upper abdomen after injection may indicate a diseased gallbladder (10 cases). This study demonstrated that the application of CCK-PZ to cholecystography is a safe, reliable and effective means in diagnosing the non-calculi chronic cholecystitis, biliary cystic duct syndrome and disease of ampulla of Vater.

The therapeutic value of disodium cromoglycate was evaluated in 26 cases of probable irritable bowel syndrome by a self-cross over double-blind control method. The irritable bowel syndrome was diagnosed by exclusion of any organic cause of diarrhea and was reassured of no bacterial infection by prescribing metronidazole for one week. Twenty-six patients were then randomly allocated to treatment with either oral disodium cromoglycate or placebo for 4 weeks, and afterwards, the treatment was alternated for another 4 weeks. The dosage of oral disodium cromoglycate was 200 mg in capsule 4 times daily. Placebo capsule contained an equivalent amount of glucose. Eleven of 26 patients (42%) were noted to have significant improvement while taking disodium cromoglycate irrespective of the history of allergic disease or any food intolerance. This indicates that cromoglycate may be useful in some patients with functional diarrhea in which subtle intestinal hypersensitivity may play as a contributing role.