1985年 · 第05卷第04期

One hundred fifty-one foci of gastric mucosa with intestingal type of lesions (incluing simple intestinal metaplastia 31; intestinal dysplasia in different grades: mild 26,moderate 42,severe 29;intestinal type gastric carcinoma 32) have been submitted to morphometric analysis by using automatic image analysis system (Quantimet 900). The ratio of the area of glands to the area of stroma per unit area was measured by image analysis, and was referred to index of stucture atypism (ISA) which represented the extent of glandular density and irregular arrangement in histological sections. The mean values and standard deviations of ISA measured in each group specimens were as follows: (1) simple intestinal metaplasia (as control group) 1.11 ± 0.23; (2) mild dysplasia 1.53 ± 0.25; (3) moderate dysplasia 2.21 ± 0.49; (4) severe dysplasia 3.02±0.41; (5) tubular adenocarcinoma 3.96 ± 0.67. In addition, the ISA values showed a normal distribution in each group, and statistically significant difference among them by T-test (p<0.01). Thus, ISA is a useful parameter for the diagnosis of various grades of intestinal types of gastric dysplasia and adenocarcinoma.

Selective angiography was performed in 30 cases with sus tained low levels of alpha fetal protein (AFP) . Among the 20cases with primary liver cancer (PLC) , 13 showed the evidence of irregular tumor vessels and tumor stain and 7 revealed the signs of intrahepatic space-occupied lesion. In 8 cases with liver cirrhosis, 6 of late stage showed thinner and tortuous intrahepatic arteries, and the livers were normal or smaller than normal in size. Two of early liver cirrhosis had diffused spread of intrahepatic arteries with enlarged liver and portal hypertension. However, there was no evidence of space-occupied lesion. Two cases of secondary liver cancer (the metastasis of pancreas carcinoma) showed the signs of malignant liver tumor (indistinguishable from PLC) with obstructive evidence of the portal and splenic veins. The authors have experienced that the selective angiography in those cases is benefit in detecting or ruling out PLC and in considering whether the surgical intervention is necessary.

The pH, nitrite and the count of bacteria were measured in the fasting gastric juice obtained from 55 cases with partially resected stomach for benign ulcer and 77 cases non-operated ulcer as control. On the other hand, vitamin C was given to the hypochlorydric and achlorydric patients and its effect on nitrite level in the fasting gastric juice was observed. The results showed that: (1) the pH, nitrite level and the count of bacteria in fasting gastric juice of gastric stump group were significantly greater than those of duodenal ulcer, gastric ulcer and complexed ulcer groups (p<0.05-0.001) ; (2) vitamin C could significantly reduce the nitrite level in hypochlorydric or achlorydric patients who had undergone gastric resection (2.81 ± 2.24 ppm→1.18 ± 0.99 ppm,p<0.01) ; (3) there was no significant difference in intragastric milieu between Billroth I and Billroth II resections.

Pancreatic endocrine functions and plasma amino acid profiles were studied in 65 cases of hepatic cirrhosis and 30 casse of late schistosomiasis, with 53 healthy normals as controls. Higher values of basal plasma glucose concentration (BS) and plasma immunocreative glucagon (IRC) were observed both in cirrhosis and late schistosomiasis patients as compared with-those in normal controls. Following an oral glucose loading (OGTT) , IRG responded greater in cirrhosis than in late schistosomiasis. Both basal and glucose-stimulated plasma C-peptide (CP) and insulin (IRI) were also significantly higher in cirrhosis than in late schistosomiasis. All plasma CP, IRI and IRG seemed to be positively correlated with serum bilirubin level, but inversely correlated with serum albumin. The magnitude of hyperinsulinemia and hyperglucagonemia seem ed mainly attributed to the degree of liver dysfunction irrespective of the presence or absence of portal-systemic shunting. Elevation of plasma AAA and reduction of plasma BCAA were common in liver function impairment and the molar ratio of BCAA-AAA was also reduced both in hepatic cirrhosis and in late schistosomiasis, with the reduction more profound in cirrhosis. Significant correlations were also observed between plasma IRG add AAA, and between plasma IRI and BCAA.

From 1983—1984, we have made experimental and clinical studies on determining the levels of prostaglandin E (PGE) in plasma and in biopsy specimens of intestinal mucosa and the relationship between PGE and bowel inflammatory diseases is explored. The results showed that the levels of PGE in the blood plasma ileocecum and sigmoid mucosa in patients with active ulcerative colitis and active Crohn's disease were elevated as compared with that of normal control and the patients with colitis, irritable colon and chronic ileitis. PGE levels were decreased after successful treatment. The increasing or decreasing tendency of PGE level in plasma coincides with that of intestinal mucosa. These findings are helpful to the understanding of pathophysiology of the condition.

Monsell's solution was effective in the treatment of severe GI bleeding reported in past liteatures, but it was only used for local infusion through a tube, and oral administration was not indicated. Nevertheless, the authors have infused 5%, 10%, 25% Monsell's solution into 27 rabbits by mouth with no mucosal damage. Thus, 5% and 10% of the Monsell's solutions were administered per os to control successfully the severe variceal bleeding in 7 patients.

The patient should be usually kept in sitting or semireclining position and take 30 ml of this solution once as soon as active bleeding happened. However, 20 to 40 ml of 4% sodium bicarbonate should be used as gargle immediately after the Monsell's solution.

In order to prevent serious complications after ERCP, we have performed extrinic biliary drainage through nose in 20 cases, among them 10 were benign obstructive jaundice, and 10 malignant. During ERCP, a retaining catheter (Olympus PR—5E) was left in the bile duct, with the other end connecting to a bottle out of nose. Among the 10 benign cases, this kind of drainage was successfully done, while only 5 were satisfactorily drained in the 10 malignant cases. Fever and leucocytosis subsided after the procedure. The average duration of catheterization was 12.5 days with the longest of 38 days.

Before this procedure was started, 1.96% of benign cases had serious complications, while it was 11.8% in 34 malignant cases. With this procedure, no complication ever happened after ERCP, should it be successfully done. In those cases of failure, PTCDis indicated.

Hydrogen breath tests for lactose malabsorption were performed in 20 Chinese adults. Seventy-five percent of the subjects demonstrated malabsorption of 25g of lactose. Thirteen out of fifteen of these subjects experienced gastrointestinal symptoms during the test. Elevated hydrogen levels in exhaled breath were usually observed by one to two hours after lactose loading. Symptoms first occured from 0.5 to two hours after ingestion of the lactose test solution and usually lasted less than four hours. These findings in the present study confirm prior reports of lactose malabsorption in overseas Chinese and the advantages of simplicity, sensitivity and specificity of the method.

Gastric specimens from 55 patients with gastric discases including superficial gastritis, atrophic gastritic shronic ulcer and carly gastric carcinoma have been carefully and patho-morphologically examined. Gastric specimens from 6 autopsied patients without gastric disease served as control. Various minikin lesions were found in the gastric diseased group The area involved never exceeded a small gastric sulcus or small gastric area. These lesions were frequently found in the small gastric sulcuses than in the small areas. The detection rates in the superficial gastritis, intestnal metaplasia, dysplasia and carcinoma were 92.4, 62.3, 80.7 and 80%, respectively. It seems that small gastric sulcus is the initial site of gastric mucosa lesion, probably due to the accumulation of barmful material in sulcus.