1985年 · 第05卷第02期

One thousand four hundred fifty-one cases of carcinoma of cardia collected from 49 major hospitals in Shanghai were reviewed. An incidence of 24.86% was found among the total number of gastric cancer examined during that period. Males were predominent (80%) with majority of them were over 50 years of age. Epigastric pain, dysphagia and bleeding were the major claimed pictures which aroused the suspicion of the disease. The fibrogastroscopic examination is a very reliable method for the accurate and early detection of the cancer. If the instrument is impeded during its passage, the diagnosis of cardiac cancer should be strongly suspected.

Etiologic study including clinico-laboratory-morphologic examination was made in 55 cases of "chronic colitis" diagnosed by fibercolonoscopy with biopsy. Etiologic factors were discovered in 49 cases (89.1%) . They were irritable bowel diseases in 19, chronic bacterial dysentery 16, ulcerative colitis 5, Schistosoma japonica 3, fungal colitis 2 and one each of intestinal amebiasis, intestinal tuberculosis, lead intoxication and chronic pancreatitis.

Eighty cases of ulcerative colitis were examined by colonoscopy from 1974 through 1984. The locations of the lesions were: rectum in 10 cases, sigmoid colon 40, left hemicolon 19 and whole colon 11. The colonoscopic manifestations were hyperemia and edema in 78 cases, friable or easily bleeding mucosa 59, multiple ulcerations 60, fine granularity 47and pseudopolyps 27. Biopsy was performed in 54 cases. 36 cases were proved to be ulcerative colitis, 15 showed nonspecific inflammatory changes and 3 adenomatous polyps. Only one case had colonic malignancy. In conclusion, colonoscope gives a higher diagnostic rate (85%) for ulcerative colitis as compared with that (50%) of barium enema.

Seven hundred fifteen cases of lower digestive tract bleeding were studied by fiber-endoscopy. The causes of bleeding were detected in 489 cases (68.4%) . The major causes were; chronic colitis in 169 cases (23.6%) , ulcerative colitis 91 (12.9%) , colonic polyps 139 (19.4%) and colonic cancer 66 (9.23%) . The minor causes were vascular dilatation, Crohn's disease, diverticulum of colon, pseudopolyposis of colon and amebiasis, etc. For searching the site of lower intestinal bleeding, colonoscopy is superior to barium enema not only for the higher detection rate but also for the direct visualization and verdict through biopsy.

Nd-YAG laser exposure via percutaneous transhepatic cholangioscopy has been used in successful destruction of bilirubin stone in 3 patients suffered from huge common bile duct stone or intrahepatic stones. Experimental studies were designed to observe the changes of temperature of stone surface and the surroundings in air or in water during laser exposure. In addition, in order to observe the correlation between elevation and recovery of temperature of the surrounding water and the speed of water infusion during the procedure, a plastic tube of 6 mm in diameter was used as a model. The peak rising temperature of the stone surface 5 mm close to the contact point of the quartz fiber at A point was 51° C, at B point was 30° C and the surrounding air about 5 mm close to the contact point of the quartz fiber attained 158° C. Almost no variation of temperature was demonstrated at 3 points (A, B, C) when a similar experiment for bilirubin stone-was done but in a beaker with 400 ml of water.

Basic and clinical research work by making use of the tissue specimens obtained through gastroscope are illustrated. The studies and observations on the biopsied gastric mucosa in various gastric diseases were, for example, the number and distribution of T-lymphocytes and various immunoglobulin-producing cells, demonstration and counting of G-cells and D-cells in the antral mucosa, determination of the contents of gastrin and carcinoembryonic antigen in gastric mucosa, cytokinetic study on the epithelial cells of gastric mucosa, and electromicroscopic studies on the gastric cancer cells. The cheif advantages of utilization of gastroscopy are also discussed.

Immunofluorescent study of immunoglobulin-secreting cells was performed in 31 cases of diseased gall bladder. Immunoglobulin-secreting cell density in the gall bladder mucosa was: IgA 78,889±70,566; IgM 35,556±29, 396 and IgG 32,222±33,665 cells/mm³. Populations of immunoglobulin-secreting cells in patients with biliary tract infection and nepatolithiasis were found higher than those of cholecystolithiasis especially IgA-secreting cells (p<0.05) . IgA-and IgM-secreting cells were also increased in patients with fever and jaundice (p<0.05) . These indicate the contribution of bacterial infection to the local immunity as evidenced by increasing IgA-secreting cells.

Fluorescence stained IgA were found at the intercellular space of the epithelium, apex of cells and mucosal surface of the gall bladder mucosa. This suggests that the IgA-secreted by the plasma cells of mucosa may be one of the sources of IgA in the bile.

Erythrocyte acetylcholinesterase and serum cholinesterase activities were observed in 37 cases with duodenal ulcer and 13 with gastric ulcer. Twenty-seven healthy persons, 15 patients with chronic gastritis and 28 with gastric carcinoma were likewise studied as controls. The levels of erythrocyte acetylcholinesterase were significantly decreased in patients with duodenal ulcer (63.3 ± 16.2 u/ml) as compared with the normal healthy individuals (86.1 u/ml), chronic gastritis (82.0±10.8 u/ml) and gastric carcinoma (84.2±15.1 u/ml) . On the other hand, the levels of serum cholinesterase showed no significant difference between the patients with duodenal ulcer and other controls. Such a change of erythrocyte. acetylcholinesterase activity tends to suggest hyperactivity of parasympathetic nervous system in this particular disorder. Thus, in addition to other factors, this change may be of much significance in the causation of peptic ulcer.

Forty-six patients with tuberculous peritonitis underwent laparoscopy since 1954. Forty-three cases were accurately diagnosed as TB peritonitis, an accuracy rate of 93.5%. The endoscopic features of the 46 cases were whitish or pale peritoneum in 36 cases (78.26%) and congestion of peritoneum with ecchymosis 10 (21.74%) , indistinguish of vascular distribution 40 (86.96%) , coarse and cloudy appearance of peritoneum 36 (78.26%) , white nodules in peritoneum and / or visceral organs 38 (82.6%) , irregular nodulation with necrosis 9 (17.56%) , localized adhesions 7 (15.26%) , atrophied omentum 17 (36.95%) . greenish yellow exudative ascites 37, cholesterol ascites 2 and bloody ascites 7. The laparoscopic diagnositc criteria of tuberculous peritonitis and differential diagnosis from malignancy are discussed.