1983年 · 第03卷第04期

Serum T₃, T₄, FT₃, FT₄ TSH and TBG concentrations were measured in 27 clinically euthyroidal patients with hepatic cirrhosis. In spite of clinical euthyroidism, the serum T₂ was below the lower limit of the normal range in 21 cases (77.8%), there was low FT₃ in 12 cases (44.4%), and low T₃ in 4 cases (14.8%). Low T₃ in the presence of normal T₄, designated as "low-T₃-syndrome", was present in 17 cases (63%); low T₃, with low T₄, designated as "low-T₄-syndrome", was present in 4 cases (14.8%). Serum FT₄ and TSH concentrations were in normal ranges with the exception of a few cases in which serum FT₄ or TSH levels were slightly elevated. Serum T₃/T₄ ratio was markedly decreased, FT₃% and FT₄% were distinctly increased, TBG concentration was elevated. The presence of low serum T₃ was significantly correlated to ascites and collateral circulation. In the cirrhotic patients with complications, such as bleeding due to rupture of the esophago-gastric varicosities, hepatic coma and cancer of liver, serum T₃ concentration and T₃/T₄ ratio were much lower than those without such complications. Serum T₃ concentrations was positively correlated with serum albumin concentration, and negatively correlated with serum bilirubin. It is concluded that determinations of serum T₃, FT₃, T₄ are helpful for the estimation of severity of illness and prognosis in hepatic cirrhosis, and measurement of serum FT₄ is useful for the differential diagnosis of euthyroidism and hypothyroidism.

Ninety-four cases of intrahepatic cholestasis of pregnancy (ICP) admitted into 8 hospitals from 1951 to June 1983 are reported. The morbidity rate of ICP of in-patients has been increased from 0.08% in the 1950s to 0.32% in 1981 to June 1983. The diagnosis was chiefly made on the typical clinical pictures. Liver biopsy has been performed in 4 patients showing mild cholestasis without liver cell damage. The occurrence of abortion, stillbirth, intrauterine distress and low-birth-infants in ICP group were 37.2%, 8.2%, 2.1% and 33.8% respectively, which were higher than those of control group of 156 non-ICP pregnant women (P<0.001). The incidence of postpartum hemorrhage (> 500 ml) was 7.9% for the ICP patients and 1.9% for the control group. The authors emphasize the fact that the ICP is rather common and harmful to infants and mothers.

Oral glucose tolerence test (OGTT), oral glucose insulin release test (OGIRT), determination of insulin antibody and serum phosphorus as well as liver function test were performed in 94 cases of chronic liver disease. The results were compared with those of 20 normal subjects and 20 primary diabetes. OGTT was abnormal in 65.9% of 30 patients with liver cirrhosis, 73.7% of 44 patients with late schistosomiasis and 20% of 20 patients with chronic hepatitis. Hepatogenous diabetes was found in 50%, 43.4% and 5% of these 3 groups respectively. The mean fasting immuno-reactive-insulin (IRI) level of chronic heaptitis and late schistosomiasis in particular was higher than that of normal subject. After oral administration of glucose, insulin release curves in patients with liver cirrhosis mostly showed ’high slope' and/or ’high peak delayed' form. The IRI at 180’ in cirrhosis and 120’ in late schistosomiasis were significantly higher than those of chronic hepatitis and normal subjects. The characteristics of OGIRT between primary diabetes and hepatogenous diabetes were entirely different, but the low value of serum phosphorus and the presence of insulin antibody were of no value in the differential diagnosis between the two. The prevalence of hepatogenous diabetes was not influenced by ascites as well as severe damage of liver function.

The lower esophageal sphincter pressure (LESP) of 56 normal adults, 17 patients with reflux esophagitis, 69 with hiatus hernia, 12 with scleroderma and 16 with achalasia were studied. LESP and length of high pressure zone (LHPZ) of normal adults was found to be 17.89 ± 4.42 mmHg and 4.78 ± 1.18 cm respectively. LESP and LHPZ were significantly lower in the patients with reflux esophagitis and scleroderma, and significantly higher in the patients with achalasia than in normal adults. The special manometric configuration of the LESP was observed in the patients of hiatus hernia, and the mechanism is discussed. The effect of metoclopramide and nitrates on LESP of normal subjects and patients with hiatal dysfunction and achalasia were studied. These results indicate that the continuous withdrawal manometric method is a simple, rapid and safe test for esophageal motility.

The CT manifestations in 36 patients of pathologically proved pancreatic carcinoma are analyzed. The most prominant CT finding was localized enlargement of the pancreas in 33 patients, while generalized enlargement of the organ observed in 2 cases only. Although no mass was seen in the remaining case, autopsy showed a pancreatic carcinoma with a diameter of 2 cm. The other important CT findings included obstructive dilatation of the biliary tree in 17 cases, dilatation of pancreatic duct in 13 cases, and hepatic metastases in 10 cases, etc. The diagnosis was accurately made by CT as pancreatic carcinoma in 30 cases, diagnosis in 4 cases was uncertain on account of obscure contour of pancreas, and 2 cases were erroneously diagnosed. In other group of 10 chronic pancreatitis, one was diagnosed as pancreatic carcinoma and one as suspected pancreatic carcinoma by CT. The authors conclude that differentiation between pancreatic carcinoma and chronic pancreatitis with localized pancreatic enlargement by CT is difficult.

The main clinical manifestations of digestive system in this series were hepatomegaly (66.6%, splenomegally (37.3%), anorexia (73.3%), diarrhea (37.3%), abdominal pain (37.3%), nausea (24.4%), vomiting (17.7%), ascites (8.8%), lower intestinal hemorrhage (2.2%), jaundice (6.6%) and abnormality of hepatic function. Pathologically the liver showed mild to extensive fatty changes, dilatation and engorgement of sinusoids, infiltration of lymphocytic cells, fibrosis in and around portal areas and parenchymal space and small focal necrosis of liver cells. Spleen was enlarged with decrease of splenic bodies, dilatation and engorgement of sinusoids, "onion skin lesions" change, hematoxylin bodies, infiltration of polymorphonuclear cells and periarteritis appeared in some cases. Three cases were misdiagnosed as viral hepatitis, intestinal tuberculosis and reticulosis with hepato-splenomagly respectively. The authors emphasize the importance of recognizing the variable digestive manifestations of this disease.

This paper deals with 36 cases of viral hepatitis complicated by diabetes mellitus. The clinical characteristics of the disease were as follows. 1. Clinical manifestations were those of the different types of hepatitis and associated with those of diabetes. 2. Clinical severity of the disease was correlated with hepatitis. 3. Although the prognosis of the diseases chiefly depended on the types of hepatitis, the diabetes (especially the severe form) was also influential in hepatitis. The authors suggest that oral antidiabetics are contratindicated, insulin therapy is beneficial and corticosteroid therapy should be applied with caution.

Five hundred and twenty-nine cases of chronic atrophic gastritis (CAG) were encountered during the period of September 1977 to March 1981, Eighty-one cases (15.31%) complicated by anemia were studied. Among them 12 cases (14.82%) were found simple CAG complicated by anemia with no other cause. Of the remaining 69 cases, 57 (70.36%) were found associated with other causes such as bleeding, malabsorption and chronic infection, etc. The 12 anemic cases associated by CAG were clinically characterized by: 1, most were elderly patients (9), predominently female; 2, the type of anemia could be divided into iron-deficiency anemia (8), megaloblastic anemia (3) and the mixed type (1); 3, the characteristics of CAG were longer tendency of the disease (5 yr in 8), the areas of the lesions were extensive, involving the gastric antrum and body, and the lesion was severe enough to induce marked hypochlorhydria or achlorhydria (6); 4, anemia appeared in late period. The cause, mechanism of anemia and criteria of diagnosis are briefly discussed.

Among 151 autopsies of hepatic failure cases, 34 were complicated by pulmonary edema. The clinical pictures of this type of pulmonary edema were atypical and overlapped clinical pictures of hepato-renal failure and cerebral edema, only 3 of the 34 cases had typical manisfestations. The pulmonary edema may be related to hypoxemia resulting from compression of lungs by large amount of ascitic fluid present in most cases. Eight of the 18 cases with brain examined were complicated by cerebral edema which might lead to neurogenic pulmonary edema. Other contributing factors were hypoproteinemia, myocardial lesions, endotoxemia and disturbances of electrolytes and metabolism

Experiments were performed in rats anesthetized with urethane to study the functional connection between the satiety and feeding centers, and gastric vagus nerve and gastric motility. The results revealed (1) stimulation on the satiety center usually increased the efferent activity in the gastric vagus nerve and inhibited gastric motility, (2) the effect elicited by stimulation on the satiety center was not affected by guanethidine, (3) stimulation on the feeding center generally caused a rise of gastric vagus nerve activity and excitation of gastric motility and (4) atropine abolished the excitation of gastric motility induced by stimulation on the feeding center but did not affect the efferent activity of the gastric vagus nerve. The results suggest that the satiety center is connected with non-adrenergic inhibitory neuron by gastric vagus nerve, which inhibits gastric motility; while the feeding center connects with cholinergic neuron, which excites gastric motility.

Circulating anti-pancreas antibodies were present in the rat serum of the experimental pancreatitis induced by ethionine. The antibodies appeared after daily intraabdominal injection of ethionine (50 mg/day) consecutively for 4—14 days. The rate of appearance was 83%.

Anti-pancreas antibody is an iso-antibody, with the properties of species-specificity and organ-specificity. Being produced as a result of pancreatic damage, it plays a role in the prolonged process of the disease. The presence of anti-pancreas antibody may be thus considered as an indicator of the recovery of pancreatits.

D-galactosamine (D-G1) was administered intraperitoneally to 35 male Wistar rats using a wide range of doses. A D-Gl dose of 1.9 g/kg resulted in >80% mortality within the desired period. The experimental approach together with the 2-wk survival are summarized as follows:

In view of the results obtained, it is presumed that hepatocyte transplantation might influence the survival of the fulminant hepatic failure rats.