1984年 · 第04卷第02期

Serum prealbumin (PA) in 238 cases with various hepatobiliary diseases and 50 healthy persons were studied. Normally, serum PA is amounted to over 2% of total serum protein. In hepatocellular diseases serum PA values decrease in accordance with albumin levels in most of the cases, and PA values relate inversely to the severity of the disease. In patients with subacute hepatic necrosis whose albumin levels remained within normal, while PA values usually fall dramatically. PA is considered more sensitive than albumin in cases of rapid or extensive liver damage, especially during the first week of illness. Serum PA values also decrease in patients with hepatic amoebiasis, hepatoma, benign or malignant obstruction of biliary truct. Accordingly, in patients without obvious hepatocellular damage, the possibility of inflammation or malignancy of the liver should also be considered in condition of PA declination.

The relationship between acid secretory function and histopathologic changes of gastric mucosa shown by the fiber-gastroscopic biopsy had been investigated in 40 cases of chronic atrophic gastritis (CAG) . Acid secretory studies were performed in 20 normal adults as controls.

Acid secretory function in patients with CAG was markedly reduced as compared with that of normal individuals. The more severe are the atrophy of gastric glands and intestinal metaplasia, the less is the acid secretion. In cases of CAG where atrophy occurred in both antrum and body of the stomach or these mainly in the antrum, acid secretory function is closely related to the histopathologic changes of gastric glands in the body as well as in the antrum.

The parameters of cell kinetics of gastric mucosa from 102 patients with different diseases measured by ³H-Thymidine (³H-TdR) autoradiography in vitro incubation, and proliferative zones were observed. The labeling indices (LI) of injured mucosa of gastric ulcer and gastric cancer were the highest, and LI of atrophic gastritis were closely approximated to that of gastric cancer. LI of poorly differentiated adenocarcinoma were higher than that of well-differentiated ones.

The DNA synthesis time (Ts) and cell generation cycle time (Tg) of the gastric mucosa in atrophic gastritis and tissues around the cancerous lesion were shorter than normal. Ts of gastric cancer cells and Tg of well-differentiated adenocarcinoma were longer than normal.

In atrophic gastritis, gastric ulcer and tissue around the cancerous lesion, the proliferative zones were found enlarged, and spreading to the surface of the mucosa. However, in the cancerous tissue, labelled cells were distributed over the whole region.

The relationship between gastric cancer and precancerous lesions, and the biological significance of dedifferentiated cells are discussed.

One thousand six hundred ten cases of chronic atrophic gastritis collected from 22 medical institutions were followed up endoscopically for 2—8 years. Of these cases, 901 had lesions mainly located in the antrum, 149 mainly in the body of the stomach, 522 involving both the antrum and the body, and the remining 38 cases were not described clearly. 78% of the patients were followed up for 2—5 years, 22% for more than 5 years. During the follow-up period, 19 cases of gastric cancer were detected. The average detection rate of gastric cancer in this group was 1.2%. Of the 22 medical institutions surveyed, the highest and the lowest incidence of gastric cancer was 4% and 0% respectively. Eight out of 19 gastric cancers detected were early cases. In 3 cases the malignant lesions were limited to muscular layer, and the remaining 8 cases were advanced cancers. The detection rate of early gastric cancer could be raised, if endoscopic examination is performed annually.

The autorosette-forming cell (ARFC) level was determined by the modified Caraux's method. In the group of normal control (122 cases) , benign gastric diseases (95 cases) , gastric carcinoma resected more than 6 months (27 cases) , cancers other than gastric carcinoma (67 cases) and gastric carcinoma (131 cases) , the values of ARFC were 21.22±3.11, 18.83±3.78, 17.19±3.32, 16.03±3.81 and 14.89±3.93 respectively. The values obtained in the groups of gastric carcinoma and other cancers, as compared with those of other three groups, showed significant statistical difference. Furthermore, there were also statistical difference between the data obtained from the groups of benign gastric diseases and resected gastric carcinoma, as well as between those of these two groups versus the normal control. The authors agree with Palacios and believe that ARFC, being post-thymic precursor cells, may in the presence of serum thymic factors differentiate, mature and become immuno-active T_μ and T_γ cells; thus, they might have an important position in the immuno-regulation network of human organism.

The relationship between the intestinal metaplastic changes and ³H-TdR lymphocyte transfer rate and plasma cAMP level in 57 cases of chronic gastric diseases has been observed. The cAMP level and ³H-TdR lymphocyte transfer rate in patients with active phase of chronic gastric diseases were lower than those in normal subjects, (p<0.05-0.001) .There was Significant difference in these between those patients with and without metaplasia (p<0.05-0.001) , between those with severe and mild metaplasia, and between those in active and remission periods (p<0.05-0.001) . The rate and severity of metaplasia increased in the order of chronic superficial gastritis, atrophic gastritis, gastric ulcer and gastric cancer, while the plasma cAMP level and ³H-TdR lymphocyte transfer rate decreased in the same order. We consider, thus, the estimation of cAMP, ³H-TdR lymphocyte transfer rate may be of clinical significance in determining the course of the disease and therapeutic efficacy.

Thirty-three cases of carcinoid tumor of GI tract admitted from 1950 to 1982 are reported. The carcinoid tumors were located in the stomach (8) , duodenum (1) , colon (2) , appendix (3) and rectum (19) . Three cases of rectal carcinoid tumor had multiple lesions. One case of appendiceal carcinoid tumor had simultaneous stomach cancer. In three cases the carcinoid lesions were coexisted with adenocarcinomatous elements. Seven cases of carcinoid tumor < 2 cm in diameter were found to have no muscular infiltration or lymphatic metastasis. All of them survived at the time of follow-up-study (average 7.5 yr) . Twenty cases having the tumor >2.0 cm in diameter, all showed serosal or muscular infiltration and 15 had lymphatic metastasis. Eight of them died within-1 yr and 4 died within 1-4 yr after operation. Surgical procedures for the appendiceal and rectal carcinoids, including the indication of cautery, local excision as well as the radical operation are discussed.

Both PCA and GCA from 100 cases of chronic gastritis (superficial 63, atrophic 37) diagnosed by gastroscopic biopsy were assayed by indirect immunofluorescence, together with histopathological observation of the gastric mucosal lesions. The results indicated that PCA and GCA could be found in both superficial and atrophic gastritis with same incidence. Histopathologically these 2 types of gastritis presented with infiltration of lymphocytes and eosinophils as the basic pathologic changes, but atrophy, hyperplasia and intestintal metaplasia of gastric mucosa differed in degree in these two conditions. It appeared, thus, that the 2 types of gastritis were of same nature and closely related to autoimmunity. We also found that the lesions of gastric mucosa developed progressively from the surface down to the muscularis mucosae. Thus, it is speculated that chronic gastritis might be caused by regurgitation of intestinal contents into the stomach, causing destruction of the gastric mucosa, which induce an autoimmune response. This favors development of chronic gastritis.

"Purgation method" of Chinese traditional medicine combined with western medicine has been used in treating digestive diseases, such as acute pancreatitis, cholecystitis, liver abscess, bacillary dysentery and upper GI bleeding. Good clinical results were observed, especially in regard to the subsidence of fever and reduction of toxic symptoms. Animal experiment showed that the antipyretic effect was attributed to the chief component of the purgative mixture, rhubarb. Further experiment revealed that rhubarb could significantly reduce the activity of prostaglandin in CSF drained from the third ventricle near the thermoregulation center. The purgative mixture also increases the phagocytic function of PMN and the activity of total serum complement. It can also counter-act endotoxin in the blood. The hemostatic effect is due to the local effect of Rheum as well as some changes of the coagulation factor.