1986年 · 第06卷第03期

In recent 4 years, we have observed the mucosal lesion of jejunum in 9 cases with postinfection malabsorption syndrome by enterofibroendoscopy and mucosal biospy. It was found that all patients had various degrees of pathological changes, including villus atrophy, hyperplasia of crypts, infiltration of chronic inflammatory cells in the lamina propria, fusion of villus, damages of epithelial cells and increase of intraepithelial lymphocytes. The lesions were improved by the combination therapy of tetracycline and folic acid, but the improvement was slow and the recovery was relatively long. Our observation is consistent with the suggestion that the pathological mechanism of mucosal lesions may have some correlation with certain pathogenic immunoreaction. The lesion of villus was commonly seen under the light microscope. It appeared as network which might play a role in inducing malabsorption. The increase of intraepithelial lymphocyte was generally parallel with the degree of the epithelial damage. It is suggested that the shift of intraepithelial lymphocytes may be influenced by the chemotaxic substances in intestinal contents. A simple criterion for the estimation of the degree of infiltration of chronic inflammatory cells is presented in this paper.

Glucose Hydrogen Breath test was perfo rmed in 37 liver cirrhotic patients and 3 patients with liver diseases causep by schistosomiasis by hydrogen micro-analyser. All of them had ascites. The results were compared with these of 30 normal controls in order to check whether there was bacteria overgrowth in those patients. Nine of the 40 patients were positive, a rate of 22.5%. They were cured by antibiotics. According to the available data, the mechanism, harmful effect and management of bacteria overgrowth in small intestine of patients with liver cirrhosis and ascites are discussed. Early diagnosis and management of bacterial overgrowth not only increase the patients' absorption of nutrition but also prevent severe infection caused by bacteriaover-growth in small intestine.

Thirty-nine out of 66 patients (59.1%) with pathologically demonstrated colorectal carcinoma and 16 of 32 patients (50%) with gastric carcinoma had elevated levels of tumor-associated antigen. In comparison with the carcinoembryonic antigen (CEA) measurement in those patients, the serum levels of CEA were not correlated with the titers of CA-Hb3 (Rs 0.289, P﹤0.1) and the positive rate of CEA in patients with colorectal carcinoma was lower than that of CA-Hb3 assay (33.3% versus 59.1%). Thus, we suggest that monoclonal antibody Hb3 could be defined as a new circulating tumor marker and it is useful for the detection of gastrointestinal carcinoma.

Thirty cases of chronic appendicitis were identified by colonofiberscopy during the period of August 1979 to July 1985. Six of them were demonstrated by exploratory laparotomy and histopathology. The endoscopic appearance of chronically inflamed appendices showed congestion, edema, exudation, erosion and morphologic changes of the appendiceal internal opening. The opening was generally tender in nature. The authors have found that the inserting-tube radiography of appendix is beneficial to the diagnosis of the disease. In addition, correct recognition of the normal shape of appendiceal internal opening is important for the diagnosis.

Acomparative study of the relationship among T cell subsets, as defined by monoclonal antibody and suppressor cell function by concanavalin A induced suppressor cell assay and short lived suppressor activity assay simultaneously, is reported. Tenty-two chronic hepatitis B patients and 20 health controls were studied. Peripheral mononuclear cells were separated by Ficoll-Hypaque densitygradient centrifugation. The T subsets were determined by monoclonal antibody (Coulter) by immunofluorescent method. The relative numbers of T3, T4, T8 and the ratio of T4 / T8 were of no significant difference between chronic hepatitis B and controls. The Con A induced suppressor cell function index in chronic hepatitis B patients was significantly lower than that of controls, 26.3 ± 22.6 and 38.8 ± 13.9% respectively (p﹤0.05), and the short lived suppressor cell activity index was also lower in chronic hepatitis B patients (15.5 ± 49.4%) than that of controls (66.7 ± 17.0%) (p﹤0.01)

A comparative study on the humoral immune reactions in serum and cancer tissue was made in 78 patients with hepatocellular carcinoma (HCC). The serum immunoglobulin levels obviously increased both in the HCC and cirrhosis groups, and there was significant difference between HCC or cirrhosis group and normal control group (p﹤0.01). In addition, the serum immunoglobulin in HCC (III stage) was far higher than that in cirrhosis group. C₃ positive rate also increased in HCC (p﹤0.01), however, it was slightly reduced in cirrhosis as compared to the normal control group. There were specific antibodies against HCC in serum and cancer tissues of the patients with HCC. These antibodies, mainly IgG could not combine with complement. The direct immunofluorescent positive rate was the highest in the tumor tissues of HCC patients with metastasis (87%). On the contrary, indirect immunofluroescent result indicated that the positive rate of serum antibody against HCC was far lower in the HCC patients with metastasis than in the HCC patients without metastasis. These antibodies, when combined with cancer cells, can facilitate HCC growth and metastasis. The relationship between the changes of circulating antibodies against HCC in serum and HCC recurrence or prognosis should be further explored.

A clinicopathologic analysis of 12 patients with superficially spreading type of early gastric carcinoma (SSEGC) is presented. Their main features were as follows: (1) the age of patients was much younger, the mean age at operation was 41.5 years; (2) macroscopically, they all belonged to the superficial flat and depressed type; (3) the size of the lesion was ﹥ 4 cm in diameter, but the inffiltration was superficial, the muscularis mucosae were not destroyed or only partially infiltrated; (4) histologically, most of them were mucous cell carcinoma; (5) histochemically, mixed type of mucin, both neutral and acid, was demonstrated; and (6) the metastasis rate was low and the prognosis was rather good. The histogenesis and clinic significance of SSEGC are discussed.

Intraventricular pressure (IVP) of 14 post-craniotomy head injury patients was monitored half an hour every morning for 3 days. At the same time, 12-hr nocturanl gastric secretions were collected to determine their pH and titrable acid. Coefficient of correlation between IVP snd titratable acid was remarkable significant (p﹤0.001). It indicats that increased titrable acid might be related to increased intracranial pressure (ICP) in patients with head injury. Four of the 14 patients were complicated by acute upper GI tract bleeding. Mean IVP and concentration of titratable acid were all higher in the bleeding group than that of nonbleeding group (p﹤0.001). It is suggested that gastric acid hypersecretion plays a coordinated role in the pathogenesis of Cushing's ulcer due to increased ICP.

Thyroid hormones were measured in 43 cases with gastric cancer. In comparison with the control group. T₃ was significantly lower, and rT₃, T₄ and FT₄ were significantly higher. T₃ was definitely decreased (M-2SD) in 35% of the cases, and rT₃ definitely increased (M-SD) in 85%. When the patients were divided into three groups according to the operative and pathological findings, it was found that the magnitude of thyroid hormones changes was proportional to the severity of the illness. In severe cases with metastases, the T₃ / sT₃ ratio was generally lower than 1 (normal value: 2.6—0.68). It is concluded that the thyroid hormones modifications could be used as indexes for evaluating the severity of gastric cancer.