摘要:

ABSTRACTGastric carcinomas usually occur in older people. Those occurring in the young are uncommon. The pathological and clinical features of gastric carcinomas were reviewed in 42 Chinese patients who were 35 years of age and younger. The data were obtained from the record files of the University Department of Pathology, Queen Mary Hospital for the period 1976–85. The patients comprised 4% of the total cases of gastric carcinomas in that period. These patients (age range: 20–35 years, mean: 30 years) showed a male to female ratio of 1: 2.5 which differs from the usual male preponderance seen in gastric carcinoma. Among the 27 cases with known staging, 22 (81.5%) were stage III or IV. Twenty‐five cases had an ulcerative appearance. All were adenocarcinomas and the majority (83.3%) were poorly differentiated. Associated dysplasia was found in 35 (83.3%) cases, although only 14 of these were in association with poorly differentiated adenocarcinomas. Intestinal metaplasia was found in 13 cases and, when present, involved less than 30% of the mucosa. Only two cases were of type III metaplasia. The findings show that gastric carcinoma in young Chinese tended to occur more frequently in females, presented at late stages, showed poor glandular differentiation, was frequently associated with gastric dysplasia and had minimal association with intestinal metap

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00994.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTPrevious studies have suggested that abnormal expression of enzymes characteristic of the intestinal brush border might accompany colonic neoplasia and possibly facilitate identification of epithelium at risk of malignancy. To test this possibility, the distribution of the brush border enzymes sucrase‐isomaltase (SIM), maltase‐glucoamylase (MGA), aminopeptidase‐N (APN) and diaminopeptidylpeptidase‐IV (DPPIV) were studied by the immunoperoxidase method in biopsies from the rectum and caecum of normal subjects, and neoplastic and non‐neoplastic tissues from patients with adenoma or cancer. Brush border enzymes were detected by immunohistochemistry more frequently in the caecum than the rectum (P<0.05) of normal subjects. Diaminopeptidylpeptidase‐IV and APN were present in highest concentration at the brush border of the most mature colonocytes on the luminal surface with less staining in the crypt, whereas SIM and MGA staining of the brush border was as prominent on crypt cells as surface cells. While all cancers expressed at least one enzyme, there was heterogeneity of staining within tumours and a tendency to lose polarity of enzyme expression in cells, sometimes with dense staining of the cytoplasm. Distally situated adenomas uncommonly expressed a brush border enzyme (25%) and the only enzyme expressed in them was SIM. These findings indicate that these brush border enzymes are not exclusively expressed in the small intestine; DPPIV and APN are markers of the normal mature colonocyte and should prove useful as markers of differentiation. However, the changes associated with neoplasia would not appear to be of clinically predictive value. The low expression in adenomas suggests a block in the differentiation process early in tumourigenesis, whereas the patchy re‐expression, accompanied by a loss of cellular polarity in cancers, suggests derepression of gene expression for

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00995.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTA prospective case controlled study was conducted to evaluate the role of fluoride as a possible aetiological factor for non‐ulcer dyspepsia (NUD). Twenty patients with NUD and 10 age and sex matched healthy controls were subjected to clinical evaluation, upper gastrointestinal endoscopy and biopsies from the gastric antrum and duodenum. The antral and duodenal mucosa was subjected to a rapid urease test forHelicobacter pyloriand histological and electron microscopic examinations. Fluoride levels in the drinking water, serum and urine were estimated using a ION 85 ionanalyser. These levels were significantly higher in patients with NUD than in controls (P<0.05). Histological abnormalities in the antral and duodenal mucosa were seen in 14 patients (70%) with NUD and 1 control subject (10%) (P<0.05). Electron microscopic abnormalities in the mucosal cells were seen in all patients with NUD but in none of the controls (P<0.01). The fluoride levels in serum and urine correlated with the symptoms, histological and electron microscopic abnormalities (P<0.05). It was concluded that chronic exposure to fluoride may result in NUD and should be considered in patients where other known causes of dyspepsia have been exclude

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00996.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTFifty patients with inflammatory bowel disease (ulcerative colitis, 40; Crohn's disease, seven; indeterminate colitis, three) treated in one gastroenterology unit in Singapore over a 10 year period were reviewed. Clinical features were similar to those described in Western patients. Of the three main races of Singapore it was found that Indians are more susceptible to these diseases than Chinese or Malays. A survey of all gastroenterologists in Singapore indicated a possible prevalence of 8.6 per 100 000 people for ulcerative colitis and 1.3 per 100 000 people for Crohn's disease. These prevalence rates are much lower than those reported for Western populations.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00997.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTThe value of serum C‐reactive protein, lactate dehydrogenase isoenzymes and erythrocyte sedimentation rate in predicting the outcome of acute pancreatitis was evaluated for 57 episodes in 54 patients. Serum C‐reactive protein levels on day 2, 4 and 7 after admission were significantly higher in 19 episodes of severe attacks than in 38 episodes of mild attacks (13.71±9.68, 9.00±7.54, 6.02±3.83vs4.78±3.91, 3.30±3.61, 1.43±2.08 mg/dL;P<0.0001,P<0.005,P<0.0001, respectively). The sensitivity, specificity and accuracy of predicting a severe attack were 94, 76 and 82% using C‐reactive protein ≥ 8 mg/dL on day 2; 67, 92 and 84% using C‐reactive protein ≥ 5 mg/dL on day 7; and 59, 76 and 70% using Ranson's criteria ≥ 3. Increases in LDH‐4 and LDH‐5 isoenzymes were found in both groups, with LDH‐4 being slightly higher in severe attacks than in mild attacks. There was no significant difference of erythrocyte sedimentation rate between both groups. When compared with Ranson's criteria, lactate dehydrogenase isoenzymes and erythrocyte sedimentation rate, C‐reactive protein is more valuable in the early assessment of the sev

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00998.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTA case of persistent ileitis following the refashioning of a Kock ileal pouch into a Brooke ileostomy for severe pouchitis is reported. Preserving the terminal ileum by a salvage procedure may not be a safe alternative to pouch excision with the formation of a new end ileostomy in the surgical management of pouchitis refractory to medical treatment.

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb00999.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTThe cases of three young children (mean age 5.8 years) in whom fulminant hepatic failure and acute intravascular haemolysis were the presenting manifestations of Wilson's disease are reported. Although diagnosis was made ante‐mortem and chelation therapy instituted, the course was relentlessly fatal in all three cases. This presentation of Wilson's disease at such a young age is noteworth

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb01000.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTα‐Fetoprotein (AFP) levels were studied in 51 consecutive patients with hepatocellular carcinoma that presented to the Surgical Hepatobiliary Unit at Westmead Hospital over 12 years. Twenty‐three were hepatitis surface antigen (HBsAg) positive and 13 of those patients were Asian. Thirteen patients drank more than 60 g of alcohol each day. A significantly raised level of AFP was defined as more than 20 ng/mL, and 31 of the 51 patients had AFP levels exceeding this at some stage during surveillance. Twenty‐five demonstrated levels above 200 ng/mL. Univariate statistical methods suggested that men were more likely to express raised AFP than women, Asians more likely than other races, patients with chronic active hepatitis more likely than those without and those with chronic hepatitis B infection more likely than those who were HBsAg negative. Those who drank more than 60 g alcohol each day were less likely to demonstrate a raised serum AFP than those who drank less. Multivariate logistic regression demonstrated that HBsAg carriage was the only statistically significant independent determinant of a raised AFP. Age 65 years or more was associated with a chance of a rais

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb01001.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTThe safety and feasibility of ultrasound guided percutaneous aspiration (USPA) of bile, for bile crystal analysis was assessed critically. Forty‐four patients about to undergo elective cholecystectomy underwent intended transhepatic USPA 1 h before their operation. At laparotomy a careful inspection for bile and blood leakage was made and a further sample of gall‐bladder bile collected.Successful USPA occurred in 40 of the 44 patients. The four unsuccessful cases each had a gall‐bladder packed with stones and contained virtually no bile. Three patients developed bile leak after transperitoneal (n= 2) and transhepatic (n= 1) puncture of the gall‐bladder and another patient lost 100 mL of blood. Microscopic analysis of paired bile samples confirmed that gall‐bladder bile (as opposed to hepatic bile) had always been aspirated.Ultrasound guided percutaneous aspiration of bile offers a simple and promising alternative to duodenal intubation, but considerable experience is required before it can be recommended as its re

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb01002.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

ABSTRACTPortal venous flow velocity (PFV) was measured with duplex‐Doppler equipment in 50 normal subjects and in 117 patients with suspected chronic liver disease who showed no evidence of decompensation such as ascites, hepatic encephalopathy, jaundice or oesophageal bleeding. All the patients underwent percutaneous liver biopsy which demonstrated non‐cirrhotic liver disease in 58 cases (CH‐patients: steatosis 8, persistent chronic hepatitis 8, active chronic hepatitis 42) and liver cirrhosis in the other 59 cases (LC‐patients).The normal subjects and the CH‐patients had similar values of max‐PFV and mean‐PFV (max‐PFV 26.7±3.2 and 25.7±3.4 cm/s respectively; mean‐PFV 22.9±2.8 and 22.4±3.8 cm/s respectively). The LC‐patients’ values (max‐PFV 19.3±3.5; mean‐PFV 16.9±2.9) were significantly lower than those of the normal subjects (P<0.001) and of the CH‐patients (P<0.001). Considering the normal max‐PFV to be in the range 20–33.1 cm/s (mean±2 s.d. of the normal subjects, 95% confidence limits), max‐PFV was reduced in 0/50 normal subjects, 1/58 CH‐patients and 39/59 LC‐patients (66.1% sensitivity; 98.2% specificity).In conclusion, the duplex‐Doppler measurement of PFV is of great interest in the diagnostic study of patients with suspected chronic compensated liver disease and in the early diagnosis of cirrhosis. A low max‐PFV is a reliable pointer to liver cirrhosis, whereas a normal max‐PFV indicates a non‐cirrhotic liver disease but is less probative. Each centre should standardize normal PFV values in order to establish thei

ISSN:0815-9319    

DOI:10.1111/j.1440-1746.1992.tb01003.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY