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金益洙,李圭白,閔珖植 順川鄕病院 1976 順天鄕醫報 Vol.1 No.2
Small bowel neoplasms account for about 1.5 per cent of all gastrointestinal tumors; about half of the lesions are malignant, representing 2 per cent of all gastrointestinal tumors whi1e they represent a small percentage of all tumors, small bowel neoplasms constitute an important clinical entity for significant delay in diagnosis often leads to fatal outcome. The factors causing delayed recognition are : (1) vague symptoms occurring insidiously; (2) abscence of early physical findings; (3) relative inaccuracy of diagnostic test, including X-ray examinations, and (4) a low index of suspicion. About 20 per cent of benign tumors arise in the duodenum, 30 per cent in the jejunum, and 50 per cent in the ileum. Malignant lesions occur with equal frequency in the duodenum and jejunum, whereas the ileum is the site of twice as many as either of the other parts. In most series, over 50 per cent of the malignant tumor have already metastasized. In the clinical features of the leiomrosarcoma and leiomyoma, melena, abdominal pain, palpable mass, nausea & vomiting and intestinal obstruction will be found but it was frequently abscent in phyiscal examination and history taking. The writers have observed each one case of leiomyoma and leiomyosarcoma of the jejunum in a relatively short period of time which led to intestinal obstruction.
許景渤,金益洙,兪熙,閔珖植 順天鄕病院 1977 順天鄕醫報 Vol.2 No.1
Carcinoma is one of the most frequently observed malignant tumor in Korean patients. Result of surgery, for instance, in early stomach carcinomais encouraging and it is reported to be about 45% of five year survival rate but cases are few and rare. The majority of cases are that of either unresectable or metastatic regional lymphnode involvement of carcinoma. Their prognosis is poor. In those who had regional lymph node metastasis two year and three year survival rates are reported tobe each 37.1% and 17.9% respectively. Development of tumor immunology of the malignant disease made us greatly interested on the immunotheraly on the post resection stomach carcinoma. Studies on immunological competency by way of D.N.C.B. skin test started from 1971 and few cases those who may understand the new development of additional immuno therapy were selecter for B.C.G. innoculation after the subtotal gastrectomy. Recently monitering of peripheral thymus depentent lymphocytes (T-cell) count were undertaken to correlate the clinical course of the patients with the immunotherapy. In order to evaluate the immunological competency of healthy and all kind of malignant deseases of different stages, study with D.N.C.B. sensitization was undertaken in 264 cases. In healthy men of 53, only one man showed anergy, this anergic man is still healthy after three year observation. Table 1 further demonstrate the incedence of D.N.C.B. anergy in each group of patients, it notes that the unresectable malignant patients showed anergy 77 out of 105 cases(73.3%). From the D.N.C.B. sensirtization studies it may be clear to state that patient's immunological competency inthe malignant disease is severly deteriorated in the advanced tumo patients. The peripheral T-cell count also showed that the advanced malignant patients had lower T-cell count and it is progressively decreasing at the terminal stage(Table 2). In few cases who has B.C.G. after the subtotal gastrectomy the T-cell count are increasing after the treatment(Table 4). In 1971 five partients received B.C.G. therapy after the subtotal gastrectomy and three patients are sill living well. These 5 had all regional lymph node metastasis. The usual three year survival ratein similar patients is about 17 to 20%. Number of B.C.G. cases are not sufficient to a statistical significance but it may suggest a good deal of implication. Chance of two year survival after the B.C.G. therapy may be also far better than non-B.C.G.group(Table 5). The immunotherapy on malignant patients may be controversial, and yet we understand that the malignant tumor patients had impared immunity or immnological ability and that B.C.G. or immunotherapy may be effective on microscopic malignant lesion. In a selected case an immunotherapy after subtotal gastrectomy for gastric carcinoma may offer a beneficial effects on clinical course of the disease.