The aim of our study was to determine whether Urografin has the potential to offer surgeons a way of differentiating complete from partial small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. Altogether 116 patients who had postoperative small bowel obstructions without any toxic signs underwent Urografin studies. Urografin (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 2, 4, and 8 hours later. A total of 74 patients (63.8%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 42 patients (36.2%) in whom the contrast medium failed to reach the colon within the first 8 hours were regarded as having complete obstruction, and 34 of those patients (81.0%) underwent surgery; 8 (19.0%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 34 patients (100.0%) during laparotomy. Regardless of the presence of an air-fluid level on a plain abdominal radiograph or abdominal pain, a liquid diet followed by a soft diet could be given to those patients whose Urografin emptied into the colon. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. The presence of Urografin in the colon within 8 hours of ingestion as an indicator for nonoperative treatment had a sensitivity of 90.2%, a specificity of 100%, and an accuracy of 93. 1%. Urografin, a safe and reliable water-soluble contrast medium, can be used to differentiate partial intestinal obstruction from complete intestinal obstruction. Early oral intake was found to be a major advantage of Urografin use in this study, and the potential of Urografin use to shorten the period of conservative treatment for postoperative small bowel obstruction needs further investigation.

We conducted a prospective study to evaluate the value of abdominal sonography in the diagnosis of acute appendicitis and determine the need for abdominal sonography before operation. Altogether 191 patients with clinically diagnosed or suspected appendicitis underwent an abdominal sonography examination performed by a staff surgeon before operation. The sonographic findings are classified into three categories: appendicitis, other diseases, or normal screening. A total of 158 patients (82.7%) with positive findings of appendicitis proceeded to surgery; 18 patients (9.4%) were found to have other diseases, and they were treated for their conditions; and 15 patients (7.9%) with normal screening were discharged from the hospital and were reevaluated 2 weeks later. Only one patient had a false-negative finding. Of the 158 patients undergoing operation, 143 (90.5%) were proved to have appendicitis by the pathologic reports. A total of 32 negative appendectomies (16.8%) were prevented after sonographic examination. Abdominal sonography for detecting acute appendicitis had a sensitivity of 99.3%, a specificity of 68.1%, an accuracy of 91.6%, a positive predictive value of 90.5%, and a negative predictive value of 97.0%. The value of meticulous history-taking, physical examination, and laboratory tests cannot be overemphasized. Our experience suggests that patients with clinically diagnosed or suspected acute appendicitis should routinely undergo abdominal sonography examination, performed by an experienced surgeon, to further decrease the negative appendectomy rates.

A retrospective study of 954 resectable gastric cancers in a single institute of Taiwan from 1971 to 1990 was performed to evaluate improvements in gastric cancer surgery. The patients were divided into four time periods representing an overall experience of progressive implementation of aggressive resection and increased extent of systematic lymph node dissection. The clinicopathologic data and survival rates were statistically compared and the significance of the extent of resection on survival analyzed. A significant increase in the proportion of upper one-third tumors (from 14.8% to 20.4%) and a decrease in the incidence of intestinal type (73.6% to 41.5%) was found within the overall period. The proportion of patients with early gastric cancer increased from 11.5% to 19.4%. Patients who underwent total gastrectomy and combined visceral resection increased from 13.7% to 27.4% and 19.8% to 41.1%, respectively. An increase of both total dissected lymph node number and the incidence of detected lymph node metastases in early gastric cancer were associated with more extensive lymphadenectomy. An improved 5-year survival rate following aggressive resection was found for all stages except stage IV and T4 lesions, and the surgical mortality decreased from 5.5% to 2.0%. Patients with earlier stage lesions benefited more from radical resection, especially those with stage II and T2 lesions. Systematic lymph node dissection increased the 5-year survival of patients by about 10% for stage III or T3 lesions but not for patients with stage IV or T4 lesions. Multivariate analysis confirmed the significance of the improved technique of lymphadenectomy on the prognosis of gastric cancer following resection in Taiwan.(ABSTRACT TRUNCATED AT 250 WORDS)

This study evaluated the effects of glucose or fat on liver regeneration after partial hepatectomy in rats. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed on three rat groups. Two groups were infused with high-glucose (HG) or high-fat (HF) solutions intravenously 2 days before surgery. The control (C) group was allowed to eat instead of receiving intravenous infusions. Another group with sham operation only was also allowed to eat. Rats were killed 6, 24, 48, or 72 hours after the operation. Remnant liver weight, DNA synthetic rate, DNA content, and mitotic index were chosen as comparing indicators. Blood glucose, serum free fatty acid (FFA), total ketone bodies, and ketone body ratio were measured. Transmission electron microscopy was also used to observe the remnant liver. The results showed that the HG rat group had a better regenerative condition than did the HF rat group (p less than .01). Glucose is the predominant energy substrate when enough is offered during the immediate posthepatectomy phase. FFA utilization occurred only very early after partial hepatectomy, and it was remarkable in the control group, moderate in the HF group, and low in the HG group. Shifting of the energy substrate to FFA occurred only when glucose was not available for utilization. The disappearance and reappearance of glycogen, and accumulation of fat in cytoplasm as shown by transmission electron microscope pictures support this conclusion.

The lymphocytes and their subsets were determined in the peripheral blood of 62 gastric cancer patients and 68 controls using fluorescent conjugated monoclonal antibodies and flow cytometry (FACScan method). A significant increase in the total number of white blood cells from gastric cancer patients was noted in comparison to controls, but the percentage of lymphocytes was the same. The percentage of suppressor (cytotoxic) T cells (CD8) showed no difference in all stages of gastric cancer patients evaluated, but the percentage of helper (inducer) T cells (CD4) and the CD4/CD8 ratio decreased significantly in the advanced stages III and IV. Depression of the CD4/CD8 ratio was well correlated with tumor invasion, lymph node metastasis, and tumor size but not with sex, age, tumor location, gross type, or histologic differentiation. It appeared that the immune defect of gastric cancer patients was associated with the afferent arm (CD4) and worsened as the disease advanced. These results suggest that immunotherapy to stimulate the deficient immune system may play an important part in the multimodality treatment of patients with advanced gastric cancer.