1984年 · 第04卷第03期

Splenic embolization is a new treatment for patients with hypersplenism, portal hypertension and bleeding varices to whom splenectomy is contraindicated. Ten cirrhotic patients with hypersplenism were thus treated since May 1982. All cases had severe leucopenia, thrombocytopenia and apparent bleeding tendency with an enlarged spleen. Some had anemia and portal hypertension. About 30-85% of splenic parenchyma was resected by embolization.-Antibiotics were routinely used before and after embolization. After treatment the patients' WBG and platelet counts increased signifienatly within 2 weeks, then a slight decline was observed. Four patients were followed up for more than one yr, 3 of them showed normal peripheral blood counts. The reduction of the splenic volume and the decrease of splenic arteries and veins were also observed. The bleeding tendency disappeared in most of the patients. A moderate fever lasting about 3 weeks and a slight or moderate pain in the left upper abdomen were noticed in all cases. Severe complications included pleural effusion, upper GI bleeding, acute renal failure and deterioration of liver function occurred in 3 patients, 2 of them died.

The hepatitis B virus (HBV) markers in 138 cases of primary liver cancer (PLC) , 26 cases of chronic hepatitis and cirrhosis and 32 cases of other liver diseases had been detected. The positive rates of HBsAg, anti-HBs, anti-HBc and one or more of the 3 markers were 69.6%, 5.1%, 76.19% and 92.89% respectively in PLC, they did not differ significantly from the positive rates in chronic hepatitis and cirrhosis but differed significantly from those in other liver diseases. This suggests a close pathogenetic relationship between PLC and HBV infection.

The positive rates of HBV markers in clinical PLC did not differ significantly from that in subclinical PLC patients in whom the host immunity usually remained intact. In spite of deficiency of host immunity in patients with secondary liver cancer, their positive rates of HBV markers were much lower than those of PLC. Thus, the authors consider that the deficiency of host immunity has nothing to do with the high positive rates of HBV markers in PLC.

This paper presents the study on liver biopsy samples and clincial data of 86 patients with chronic hepatitis, 62 of them were of hepatitis B. The main pathological lesions in 53 cases (61.6%) were of chronic persistant hepatitis (CPH) , and 28 (32.6%) of chronic active hepatitis (CAH) . The pathological lesions of 5 (5.9 %) chronic lobular hepatitis (CLH) were seen in parenchyma, but were not remarkable in portal zone. Liver fibrosis in chronic hepatitis was studied. Fibrosis may or may not be present in GPH and GAH, while no fibrosis was observed in GLH. It is considered that the difference in morphology, frequency and degree of fibrosis between CPH and GAH has prognostic significance. The authors suggest that chronic hepatitis might be stratified into subtype A (without fibrosis) and subtype B (with fibrosis) .

From 1962 to 1982, 11 cases of hepatic cirrhosis associated with chylous ascites were admitted. The incidence of hepatic cirrhosis as a cause of chylous ascites was significantly higher than that hitherto reported (1.4—16.2%). Auto-ascitic fluid concentration reinfusion therapy was given to 8 patients with favorable results. Of them 3 underwent meso-caval shunt operation, one was given LeVeen-tube drainage and one had a thoracic duct-internal jugular anastomosis subsequently. The incidence, pathogenesis and therapeutic measures of chylous ascites due to hepatic cirrhosis are briefly discussed.

Forty-three cases with various mesenteric diseases proved either by surgery or by pathology were analysed. Among them 32 were males and 21 females, and their ages ranged from 18-86 years. According to the pathologic findings, these patients could be divided into following groups: mesenteric tumors in 18 cases (41.9%) , inflammatory disorders of the mesentery in 7 (16.3%) , mesenteric vascular disorders in 14 (32.5%) and congenital or idiopathic mesenteric disorders in 4 (9.5%) . Basing upon the clinical and pathologic features of the mesenteric disorders described, the authors emphasize that the mesenterial disease is often neglected in the differential diagnosis and the mesenteric disease must be suspected in case of fever, abdominal discomfort and/or abdominal mass of unknown origin.

Seventy cases of biliary disease were observed endoscopically, and 40 cases with negative cholecystographic findings served as control.Fifty-five out of the 70 had superficial gastritis involving the antrum,and 11 of them were associated with peptic ulcer. The patients with biliary disease showed significant bile reflux and it was found that the bile reflux was related to the xtent of gastritis, suggesting the gastritis was induced by bile reflux. The appearance of symptoms of "dyspepsia" indicated the presence of bile reflux gastritis.

Twenty-six patients with primary hypothyroidism, 5 males and 21 females, age ranged 19 to 21 years, were studied. Endoscopic examination and mucosal biopsy were performed in all patients and their thyroid antibodies, gastric parietal-cell antibodies, plasma gastrin and gastric analyses were determined. Out of the 26 patients of primary hypothyrodism 14 were found to have atrophic gastritis of type B. These results show that the incidence of atrophic gastritis type B is particularly higher in primary hypothyroidism. The relationship between primary hypothyroidism and atrophic gastritis is discussed.

Twenty-seven patients, 20 males and 7 females, age ranged 14-64 years, with GI bleeding of unexplained nature were examined by selective celiac angiography. The chief clinical features were hematemesis and/or melena in 21patients, bloody stool in 5, and repeated bleeding for more than 3 occasions in 23. Selected celiac angiography was performed successfully in all patients except one. Pathological changes were found in 22, GI neoplasm in 11 (benign in, 8, malignant in 3) , hepatic or intestinal vessel diseases in 5, peptic ulcer in 3, Crohn's disease in 2 and jejunal diverticulosis in 1. Twelve patients underwent surgical intervention, 8 of them showed agreement between pre and postoperative diagnoses. The indication of selected celiac angiography, radiological manifestations and the value in detecting unexplained GI bleecing are discussed.

Three cases of adenoacanthoma of stomach were discovered among 1,237 cases of gastric cancers during 1958—1982. All of them were males and the mean age at operation was 49.4 years. This is a very rare disease, with an incidence of 0.27-0.55% among all types of gastric cancers. The main clinical and histopathological features are as follows: (1) The incidence in male is the highest, and the age of patient is usually younger than those of other types of gastric carcinoma. (2) Its location is mostly at the pyloric antrum. (3) Histologically, it is composed of 2 components; glandular and squamous. (4) the glandular components have a greater tendency to metastasize to regional lymph nodes. (5) The histogenesis of gastric adenoacanthoma is most liekly derived from squamous metaplasia of an adenocarcinoma. (6) Its prognosis is worse than other types of gastric carcinoma.