1986年 · 第06卷第04期

¹³C-methacetin breath test was performed in 17 normal volunteers and 69 patients with various liver diseases. Samples of expired air were collected before and at 15, 30, 60, 90, 120 and 180 min after the ingestion of a single dose (1.5mg/kg) of ¹³C-methacetin. The difference between the ¹³CO₂ / ¹²CO₂ ratios of the sample and reference (as delta value) was measured by an isotope ratio mass spectrometer (MAT251). The peak of delta, t1/2, the λ decay constant (0.693/t1/2) and 2-hr recovery were obtained from the time course curve of the delta values. It was found that the peak delta values were significantly lower, t1/2 s were significantly prolonged, the λ values and the 2-hr recoveries were significantly smaller in group with liver diseases as compared with normal group. It was also found that the decrease of Ω value was parallel to the severity of cirrhosis (10.14 ± 3.19 in well compensated, 3.76 ± 1.90 in decompensated cirrhotics and 0-3.24 in patients with encephalopathy). The Ω was different between CPH and CAH (9.34 ± 6.4 vs 21.06 ± 5.49, p﹤0.01). Significantly different values of Ω were also noted between cases with parenchymal liver diseases and cholestasis

Twelve cancers of the stomach in 252 various precancerous conditions (4.33%) were discovered since 1976. Gastrofiberscopic follow-up study was performed in 2-9 years. One out of 97 patients with superficial gastritis (1.03%), 6 of 73 with atrophic gastritis complicated by intestinal metaplasia (8.21%), 4 of 63 benign ulcerations (6.34%) and one of 19 adenomatous polyps became carcinoma of the organ. It is concluded that the key of early diagnosis of gastric cancer lies to the increased recognition of precancerous conditions and follow-up study with gastroendoscopy.

The thin layer polyacrylamide gel isoelectric focusing method was used to demonstrate the genetic variants of α₁-antitrypsin. 32 male and 23 female infants with infantile hepatitis syndrome were studied with 368 normal blood samples as control. There was no PI*Z discovered in both groups, and only one case of PI MS was found in disease group. The results suggest that the PI*Z is not the common etiology in infantile hepatitis syndrome in China.

The gastric transmucosal potential difference (PD) was measured through the fiber-gastroscope in 20 patients with gastric ulcer. The findings were compared with that of 20 normal adults. It was found that patients with gastric ulcer had significantly lower PD level (14.6 ± 5.3mv) than that of normal adults (30 ± 5.3mv). The results suggest that the PD is an objective parameter for evaluating the integrity of gastric mucosal barrier. The method and clinical value of the measurement are also discussed.

Seventy-two cases of para-papilla duodenal diverticulum documented by ERCP were analysed. The incidence was 6.2% of cases undergoing ERCP. In all of the 72 cases, the diverticuli were located on the medial wall of the descending portion of the duodenum. The papillae were lower to the diverticuli in 46 cases (63.9%) and within the diverticuli in 8 cases (11.1%) 88.9% had single diverticulum.

Among the 8 cases having papilla within the diverticulum, 6 were associated with biliary calculi, 2 of them had biliary tract operations and ultimately died of biliary tract infection, 2 other cases were complicated by cholangitis. Among the 64 cases with papilla beside the diverticulum, 44 cases (68.8%) had biliary calculi and cholangitits, 5 cases (6.9%) were complicated by chronic pancreatitis.

Papillae located within the diverticulum would often have papilitis or stricture. If the papilla is located beside the diverticulum, the lower end of the common bile duct could be compressed to cause bile stasis, secondary infection and calculus formation. Hence, in biliary disease related to para-papilla diverticulum, papillotomy or biliary tract reconstruction operation is recommended.

Eighty-two cases of early gastric cancer were admitted to 9 hospitals and confirmed by endoscopy, surgical operation and pathological examination. In elevated lesions of early gastric cancer (type I, type IIa), central depression, erosion and / or nodule on the surface of the elevation lesion could be considered as the signs of submucosal invasion. On the other hand, most of the elevated lesion with normal surface was mucosal cancer. In depressed lesions of early gastric cancer (type IIc, type III, type IIc + III), small nodules formation and drumstick formation and / or fusion of interrupted folds at the depressed margins were signs of submucosal cancer. In addition, submucosal invasion was frequently observed in cases with irregular mucosa, erosion with or without bleeding and stiff surface on the depressed mucosa. In cancer having simple depression and almost normal mucosal surface, the cancer was most probably limited within the mucosa.

The clinical course and gastric mucosal changes in 160 patients with benign gastric disorders after subtotal gastrectomy were followed up for 1-30 yrs. Most of the patients (93%) suffered from various symptoms including dyspepsia (70%), abdominal fullness (43%), belching (34%), melena (27%), regurgitation (18%), bilious vomiting (16.3%), anorexia (15%), weight loss (10%), hematemesis (6.3%) and diarrhea (5.6%). Under gastroscopic examination, the lesions were stoma gastritis (77.5%), stump gastritis (41.9%), stoma ulcer (5.6%), jejunal ulcer (3.8%) and esophagitis 3.1 %). One patient usually could have one or more lesions. Three cases developed cancer of gastric stump proved by gastroscopy biopsy and pathology. The severity and distribution of gastric mucosa lesion and reflux of bile were more prominent in Billroth type II gastrectomy patients than in those of Billroth type I gastrectomy. Histopathologically, the gastric mucosa revealed chronic inflammation, atrophy, intestinal metaplasia, fibrosis and dysplasia. The changes were more prominent in Billroth type II gastrectomy cases. In the gastric stump carcinoma specimens, the non-cancerous areas showed marked dysplasia, suggesting those lesions were the pre-cancerous changes.

Biopsy specimens were examined under electron microscope in 20 cases of GAG. The preparation of the SEM surface mucosa and cut plane specimens are simple. The ultrastructural changes of chief cells and parietal cells revealed the morphology and pathogenesis of the "Intracisternal Sequestration" of RER. When the cell function is low, "Intracisternal Sequestration" of RER is one form to exclude surplus RER by the cell. Furthermore the relationship between the hypochlorhydria and gastric cancer is discussed.

The authors found that the activity of erythrocyte sodium pump in patients with primary hepatic cancer exhibited a positive correlation to AFP level, and negative correlations to serum albumin, erythrocyte counts, hemoglobin and serum postassium. The comparison between two groups with different levels of γ-GTP, alkaline phosphatase and prothrombin time showed a higher activity of erythrocyte sodium pump in advanced patients. The statistical analysis of survival rates of hepatic cancer patients with high activity of erythrocyte sodium pump either before or after treatment revealed a poorer prognosis. An increase of erythrocyte sodium pump activity might be correlated with cachexia liver cancer patients. The measurement of erythrocyte sodium pump activity may be helpful in predicting prognosis, and reflect therapeutic effects of hepatic cancer patients.