1986年 · 第06卷第02期

Serum alpha₁-antitrypsin (A₁AT) concentrations were determined by trypsin inhibitory capacity, rocket immunoelectrophoresis and single immunodiffusion in histologically proved 250 cases of hepatocellular carcinoma, 16 cholangiocarcinoma, 17 liver metastasis, 100 benign hepatic "space occupying lesions", 50 hepatitis, and 50 cirrhosis. A₁AT﹥157 u or 420 mg / dl suggested malignant hepatoma. A₁AT positive rates of the three methods were 58.4%, 65.9% and 66.2% respectively in malignant hepatoma, and only 11.9%, 6.3% and 7.5% in benign liver diseases.

There was no correlation between A₁AT and A₁FP. The serum A₁AT concentrations of the 3 methods ranged 164.43 ± 53.68u, 438.01 ± 117.35 mg / dl and 436.93 ± 121.55 mg/dl respectively, and the positive rates of A₁AT were 60.0%, 70.2% and 71.5% in 90 cases with AFP-negative primary liver cancer. The main factors affecting A₁AT levels were the clinical stage of primary liver cancer, tumor size tumor capsule and tumor thrombus. In addition, A₁AT assay may predict the resectability of this cancer and appraise the operative effect.

From 1961 through 1972, 595 cases of advanced gastric cancer (AGC) were admitted to our department, among which 343 underwent an extensive radical operation. The main factors influencing the prognosis of AGC were studied. Monofactorial analysis was carried out in clinical factors as age, sex, size and location of tumor. A stepwise regressive multifactorial analysis with the aid of a computer was used to campare the different pathological data pertaining to long (≥10 yrs) and short survivors (≤2 yrs). The conclusions are: (1) The clinical factors are not so important in making assessment: (2) The main pathological factors influencing the prognosis AGC are the growth pattern of the tumor, the lymph node metestasis and the invasion of the lymphatics; in the equation obtained according to the high standard (F = 9), the accuracy rate for assessing the prognosis is 81% in the intra-group check-up; (3) The stepwise regressive equation is a simple and reliable means for evaluating the postoperative prognosis of AGC.

On the basis of our experience through surgical practice, we consider the operation of choice for early gastric cancer should be R₂. For advanced gastric cancer, R₃ operation is indicated in the following cases: (a) Ho and Po; (b) P₁ and S₃ if radical operations are possible and (c) in certain patients of stage 4, in whom either T_4b, N₃ or M₁ alone is the case and radical operation is possible. However, for those cases whose group 16 lymph nodes cannot be cleared away, R₃ is not indicated.

In patients with cancer of gastric antrum, if radical resection is to be performed, all the nodes belonging to the first and second stations and also of 11—16 groups (of third station) should be cleared away thoroughly. While in patients with cancer of body of stomach, all the nodes of these three stations should be cleared away.

Twenty three cases with small hepatocellular carcinoma (HCC) were studied by real-time ultrasonography. All cases were proved by operation and histopathological examination. The accuracy in detecting the tumors was 23/23, whereas the accuracy for locating the tumor was 86.96%. The characteristics of the designed machine and its proper setting, the series sequence and maneuver of ultrasonic examination, and the experience of hepatic ultrasonic anatomy are the three most essentials in the HCC ultrasonic diagnosis. The echopoor occupied lesion less than 3 cm in diameter is more frequent in sonogram, whereas the tumor size larger than 3 cm in diameter has the tendency towards echogenic pattern.

The serum copper and zinc levels were measured in 116 subjects. Forty-two of them had GI carcinoma, 22 were of large bowel cancer and 20 of gastric and esophageal cancer. Forty-three had benign lesion, and 31 were free from disease. The serum copper level increased significantly in patients with GI cancer and in those with benign lesion. The Cu /Zn ratio in patients with GI cancer was significantly higher not only than in normal subjects, but also than in patients with benign lesion. It is concluded that the monitoring of serum copper level and copper / zinc ratio is of clinical value in patients with GI carcinoma.

The oral glucose tolerance test and blood levels of insulin, c-peptide and glucagon were determined in 65 patients with posthepatitis cirrhosis, 23 with hepatic coma and 53 controls. The posthepatitis cirrhotics had (1) glucose intolerance (44.7%), (2) elevated levels of insulin, c-peptide and glucagon at fast and 1, 2, 3 hours after taking glucose as compared with controls, (3) a breakdown of the normal negative feedback regulation between glucagon and glucose, and (4) decreased insulin / glucagon molar ratio. Serum bilirubin related positively with insulin, c-peptide and glucagon while albumin negatively with them. Shunt operation did not affect these hormones. It is suggested that in posthepatitis cirrhosis, hepatocellular damage is the main cause of glucose metabolism and its regulative hormones impairment, and elevated levels of insulin and glucagon were the results of both decreased intraheptic degradation and hyperfunction of alpha and beta islet cells.

The authors summed up 2 groups (altogether 36 patients) of patients with duodenal white spot syndrome. This represented roughly 4% of those who underwent upper GI endoscopic examination. The main clinical manifestations were dull epigastric pain, lose in appetite, dyspepsia and increase in stool fat. The lesions on duodenal mucosa presented as scattered miliary pale or milky white spots under endoscope and at close-up view looked like white villi. Frequent associated disorders were duodenitis (27.8%), superficial gastritis (22.2%), atrophic gastritis (16.7%) and superficial-atrophic gastritis (13.9%). Histopathologic examination of the lesions revealed inflammation with predominant lymphocytic infiltration. Disordered round-up and shortened villus, accumulation of abundent fat within absorptive epithelium of duodenal mucosa and degeneration of its organelles were seen under electromicroscope. The authors postulate that as a result of inflammation, fat deposit in absorptive epithelium or lamina, which turns villi into white color.

Percutaneous transhepatic internal biliary drainage (PTD) is a new therapeutic method for obstructive jaundice. Devices and techniques for PTD are described in detail. The use of Lunderquist guidewire, which has excellent torque, is recommended. Successful catheterizations were achieved in 4 cases with serious obstructive jaundice. Indications, contraindications and complications are discussed.

The disinfectants "Utensil cleaner 333", iodophor, urea, chlorhexidine and bromo-geramine were investigated for: 1. damage to endoscope, 2. sterilizing effect on endoscope artificially contaminated with bacteria and fungus, and 3. in-activation of HBsAg positive serum contaminating endoscope. All the five disinfectants showed no damaging effect on the tip of endoscope after 48 hours of immersion. When dismounted parts of the fiberscope tip and immersed in the solutions, detachment of the prism was noted after 24 hours in "Utensil cleaner 333", and 4 days in bromogeramine. Except urea, other 4 disinfectants were effective in sterilizing endoscope contaminated with S. aureus, E. Coli, Psudomonas and Candida after 3—5 minutes of immersion. Effective inactivation of HBsAg was accomplished with "Utensil cleaner 333" in 3 minutes. Other three, iodophor, chlorhexidine and bromogeramine had very little or no effect of inactivation of HBs-Ag.