Jiin-Yu Wang

Hepatitis B vaccination in healthy Chinese adults with low dose regimens

Three hundred seronegative healthy Chinese adults were divided randomly into three groups to receive 5, 2 and 1 micrograms of Pasteurs hepatitis B vaccine on a four dose schedule. No difference between the three groups was observed in the antibody to hepatitis B surface antigen (anti-HBs) response rate (96, 92 and 94%, respectively) a month following the fourth dose of vaccination. Young vaccinees had a faster and higher anti-HBs response than older ones. There was no difference in antibody response rate by sex. This study shows a good immunogenic effect for low dose hepatitis B vaccine in Chinese adults. The use of low dose (1 microgram) hepatitis B vaccine in susceptible adults would make mass hepatitis B vaccination more economically feasible.

Expression of Aspartic Proteinases in Gastric Cancer: An Immunohistochemical Study

We used the immunohistochemical method to localize the aspartic proteinases, including pepsinogen Ⅰ (PG Ⅰ), pepsinogen Ⅱ (PG Ⅱ), and cathepsin E in 45 gastrectomy specimens from patients with gastric carcinoma. Positive staining for PG Ⅰ, PG Ⅱ and cathepsin E were 46.7%, 88.9% and 97.8% in normal glands or epithelial cells, and 4.4%, 26.7%, and 66.7% in cancer cells respectively. The distribution of PG Ⅱ and cathepsin E varied from diffuse to sporadic, but only a few cancer cells were positive for PG Ⅰ in 2 specimens. There was no relationship between the locations and differentiation of cancer and the positive staining of aspartic proteinases in cancer cells. Cancer without concomitant intestinal metaplasia had a higher incidence of PG Ⅱ staining than cancer with intestinal metaplasia (36.7% vs 6.6%, P=0.031). In addition, higher incidences of PG Ⅱ positive cancer cells were found in the intestinal type than in diffuse type carcinoma, with greater presence of metastasis than absence of metastasis, but their differences did not reach statistical significance. Among the 45 specimens, cancer cells were positive for the following: Cathepsin E only: 19 specimens; cathepsin E and PG Ⅱ: 9; both three aspartic proteinases: 2; PG Ⅱ only: 2. Cancer cells were negative for all three proteinases in 14 specimens. The distribution of aspartic proteinases in our gastric cancer indicated that most of those cancers arose from surface or foveolar epithelial cells, and rarely from PG Ⅰ producing cells. There is a tendency to have more PG Ⅱ staining in metastatic cancer, intestinal type adenocarcinoma and cancer not associated with intestinal metaplasia. Thus, the role of PG Ⅱ in carcinogenesis and cancer spreading needed further investigation.

Afferent Loop Obstruction with Perforation: A Report of Three Cases

Three cases of afferent loop obstruction with perforation after Billroth Ⅱ gastrojejunostomy are presented. They had different clinical pictures according to different causes of the obstruction. Two cases with acute onset were seen due to adhesion bandinduced obstruction or internal hernia-lion of the afferent loop as in previous reports. One case with intermittent form of loop obstruction followed by sudden complete obstruction was observed due to acute angulation obstruction of the afferent loop. Early laparotomy is strongly suggested for this clinical entity. Serum amylase raised in all three cases. Also, two of three had elevated serum lipase when the clinical course became prolonged and perforation supervened. Obstructed afferent loop can easily be differented from pseudocyst of the Pancreas if this is a U-shape distended loop with visible valvulaes, dilated common bile duct and normal echogenic and normal contour of the pancreas were showed by sonography. Ultrasonography sounds to be an easy and useful tool for the differential diagnosis of suspecte dafferent loop obstruction from pancreatitis with pseudocyst for mation.