[Study of color scale B-ultrasonography in syndrome differentiation of biliary tract diseases]

OBJECTIVE

To evaluate the relationship between modern medical detective method of imaging and Syndrome Differentiation of TCM.

METHODS

Two hundred and sixteen biliary tract diseases patients were observed with color scale B-ultrasonography and fat meal tests.

RESULTS

Eighty-four cases (38.89%) of damp-heat type in the Liver-gallbladder among the 216 patients had widened gallbladder, higher tension and weak bile echo-penetration through, 39 cases (18.06%) of type of Liver-Qi stagnation and Spleen deficiency had small transection, hypotension, slender type and low contraction rate, 13 cases (6.02%) of Blood-stasis type had small gallbladder volume and the contraction rate decrease significantly. There were 71 cases (32.87%) of Liver-Qi stagnation type and 9 cases (4.17%) of Liver Yin-Deficiency type, whose characters of the gallbladder were not prominent, so the identification of these cases depended largely on clinical differentiation.

CONCLUSIONS

This study will facilitate the further extending the principle of inspection in the specific organs which may provide us with the objective basis for the differentiation of biliary tract diseases.

Clinicopathologic study of gastric carcinoma with duodenal invasion

Clinicopathologic features of 319 patients who underwent gastrectomy for adenocarcinoma of stomach were studied whether disease involved duodenum or not. Thirty-eight patients (11.9%) had duodenum invasion. Gastric carcinoma with duodenal invasion was most often Borrmann III or Borrmann IV (65.8%) type, with pylorous invasion by endoscopy (39.5%), large tumor size (73.7% > or = 5cm), lymph node metastasis (78.9%), serosal invasion (97.4%) and the incidence of the resection line not being free was high (13.2%). Duodenal invasion was most often (55.3%) direct through the deep layer or through lymphatics or venules. We need to pay more attention to finding duodenum invasion. More than 3 cm width of duodenal resection is recommended if duodenum invasion is suspected.

High seroprevalence of IgG against Helicobacter pylori among endoscopists in Taiwan

A prospective survey to investigate the seroprevalence of IgG against Helicobacter pylori among endoscopists in Taiwan was conducted by analyzing blood samples of 70 study subjects and 64 nonendoscopist physicians with quantitative ELISA. Personal information and the practices of infection control related to gastroscopy examination were obtained by a self-administered questionnaire. Significant differences were detected in the IgG prevalence between study and control subjects (80.0% vs 51.6%; P < 0.05). The serum level of antibody in endoscopists (385.2 +/- 36.1 unit/ml) was significantly higher than that of nonedoscopists (211.8 +/- 33.0 unit/ml; P = 0.018). Endoscopists performing 30 or more sessions of gastroscopy per week had higher seroprevalence than those performing less than 30 sessions (90.9% vs 70.3%; P = 0.0126). In conclusion, endoscopists in Taiwan had a high prevalence of H. pylori infection. The cause might be related to the frequency of gastroscopies performed.

Utility of brushing cytology in the diagnosis of Helicobacter pylori infection

OBJECTIVE

We performed brushing cytology during routine gastroendoscopic examinations to evaluate the utility of gastric brushing cytology in the diagnosis of Helicobacter pylori infection.

STUDY DESIGN

The brushing cytology materials were obtained from the antrum of the stomach in 107 patients. The urea breath test, biopsy urease test and histology with hematoxylineosin staining were also performed on each patient. We then compared the results of brushing cytology with those of the three other tests (13C urea breath test, biopsy urease test, histology).

RESULTS

Fifty-nine of 103 patients (57%) were diagnosed as positive for H pylori organisms using brushing cytology. Using positive or negative results from any two of the other three tests as the gold standard, a true positive result was found in 57 cases, a true negative in 43 cases, a false positive in 2 cases and a false negative in 1 case. The sensitivity and specificity of brushing cytology were 98% and 96%, respectively.

CONCLUSION

Gastric brushing cytology provides an accurate, inexpensive and easy technique in the rapid detection of H pylori infection. Brushing cytology also has the advantage of being applicable to diagnostic endoscopy without waiting days for results.

Computed tomography, endoscopic ultrasonography and intraoperative assessment in TN staging of gastric carcinoma

In a prospective study from November 1989 to December 1993, the accuracy of computed tomography (CT), endoscopic ultrasonography (EUS) and intraoperative surgical assessment were compared for the evaluation of the depth of invasion (T category) and involvement of lymph nodes (N category) in patients with gastric carcinoma. Sixty-nine consecutive patients who received preoperative CT and EUS underwent subsequent surgery. CT and EUS results were compared with histopathologic staging of tumor invasion depth and regional lymph node metastasis (pT and pN categories). T categories were staged correctly in 42% of the cases by CT, 71% by EUS and 55% by intraoperative surgical assessment. CT correctly staged 49% of N1 and N2 lymph nodes compared with 65% for EUS and 45% for intraoperative surgical assessment. CT was more accurate for advanced cancer but had a tendency to understage the T and N categories. EUS was more accurate for serosal cancer and displayed a tendency to overstage T categories and understage N categories. Intraoperative surgical assessment overstaged early T stages, understaged the T4 stage and had a tendency to overstage N categories. CT and intraoperative surgical assessment of T and N categories were of limited value in the staging of gastric carcinoma compared to EUS. EUS is a valuable form of assessment to evaluate gastric cancer staging before surgery.

Evaluation of the severity of Helicobacter pylori infection with urease test: its correlation with histopathology and bacterial density

In 69 patients, the severity of Helicobactor pylori (H. pylori) infection was evaluated by bacterial density of tissue implants and inflammatory responses by histology. The specimens were taken from gastric angle and antrum (greater and lesser curvature sides) by gastroduodenal endoscopy. In urease test, the severity was measured in 3 grades according to color change of the agar: those change are within 30 minutes (grade 3), 30 minutes to 3 hours (grade 2), and 3 to 6 hours (grade 1), respectively; while the grade 0 indicated no color change occurring 6 hours after tissue inoculation. The severity of infection was assessed according to the bacterial density under high power microscopic fields (Gram's stain). Grade 0 indicated no bacterium seen; grade 1, only 1 to 10 bacteria at all fields; grade 2, 1 to 3 bacteria in each high power field; and grade 3 was 4 bacteria or more on average in each high power field. The degree of inflammatory response was evaluated by inflammatory cell infiltration (H & E stain) and classified into grade 0, 1 and 2, which indicated the inflammatory cell infiltration below 50%, between 50% and 75%, and above 75%, respectively. There are no positive relationships among urease test reaction time, bacterial density grading and degrees of inflammatory cell infiltration. Clinically, the reaction time of urease test cannot reflect the severity of H. pylori infection semi-quantitatively, either in terms of bacterial density or cellular inflammatory response.

Does Helicobacter pylori infection play a role in the pathogenesis of non-ulcer dyspepsia--a study of gastric emptying time

To investigate the relationship between gastric motility and Helicobacter pylori infection in patients with non-ulcer dyspepsia, 28 patients and 10 asymptomatic healthy persons underwent gastroduodenal endoscope examinations and scintigraphic test of solid phase gastric emptying time using Chinese fried rice as a test meal. Clinical symptoms were also recorded using questionnaires for scoring. Half emptying times for ingested food (t1/2) between H. pylori infected (190.86 +/- 112.53 minutes) and uninfected patients (227.69 +/- 179.29 minutes) were not different statistically. Seven of the 15 patients with H. pylori infection (46.6%) had delayed gastric emptying time (t1/2 > 197.7 minutes), compared to 4 out of 13 without infection (30.07%) (p > 0.05). There was also no association between the status of H. pylori infection and severity of clinical symptoms (total symptoms scores: H. pylori positive: 10.07 +/- 3.84; H. pylori negative: 7.62 +/- 2.25) (p > 0.05). Seven patients from whom H. pylori was found to have been eradicated using triple therapy (colloid bismuth subcitrate 120 mg q i d, tetracycline 500 mg q i d and metronidazole 250 mg q i d for 14 days) did not show significant changes in gastric emptying time (before: 171.14 +/- 128.13; after: 158.57 +/- 182.49 minutes) but showed improvement in total symptoms scores (before: 9.28 +/- 3.85; after: 3.85 +/- 4.22) (p = 0.0277).

CONCLUSIONS

infection by H. pylori in patients with non-ulcer dyspepsia did not influence solid phase of gastric emptying time and was not associated with clinical symptoms. Eradication of H. pylori infection relieved the clinical symptoms of the patients with non-ulcer dyspepsia.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term follow-up and serological study after triple therapy of Helicobacter pylori-associated duodenal ulcer

OBJECTIVE

The purpose of this study was to monitor the change of IgG antibodies to Helicobacter pylori during the course of a long-term follow-up after the eradication of H. pylori, as well as to evaluate the efficacy of triple therapy in preventing the recurrence of duodenal ulcer (DU).

METHODS

Twenty-three DU patients with positive H. pylori were studied; among those patients, 20 ulcers healed after initial treatment of triple therapy. Each patient received a follow-up endoscopy and biopsy examination every 3 months for 1 yr, or whenever the ulcer symptoms recurred. Serological tests for IgG antibodies were performed with a commercial ELISA.

RESULTS

Of the 20 patients with healed ulcers, one dropped out of this study; the recurrence rate of DU at 1 yr was 5% (1/19). There was no recurrence of ulcer in 17 H. pylori-negative patients and only one recurrence out of two H. pylori-positive patients. After the eradication of H. pylori, the seroconversion rates of IgG were 5%, 21%, 42%, 76%, and 94% at 0, 3, 6, 9, and 12 months, respectively. After 6 months, 95% (18/19) of the patients in which H. pylori was eradicated had at least a one-grade fall in IgG titers (p < 0.001). One patient had a relapse of H. pylori which was accompanied with re-elevating IgG titers.

CONCLUSIONS

We conclude that seroconversion, which usually occurs after 1 yr, indicates complete eradication of H. pylori. Furthermore, we suggest that the success of the eradication of H. pylori can be judged without endoscopic examination, 8 months after treatment by triple therapy, according to the fall of IgG titers or seroconversion. Re-elevating IgG titers may be a warning of the possibility of relapse or reinfection of H. pylori.

Active optical feedback in a dual-diode laser configuration applied to displacement measurements with a wide dynamic range

The principles, experimental apparatus, and advantages of the use of an optical feedback technique for extended displacement measurements based on the use of a dual-diode laser configuration are described. This device is capable of creating a synthetic wavelength from the two lasers simultaneously through the frequency selectivity of the individual lasers, which respond only to their own wavelength. Theoretical analysis and experimental evidence are presented to show the feasibility of the measurement method and the simplicity of its operation.

Reappraisal of gastroduodenal lesions after transcatheter arterial chemoembolization of liver neoplasms--selective versus superselective method

Twenty-six patients with liver neoplasm receiving transcatheter arterial chemoembolization (TAE) therapy underwent gastroduodenal endoscopic examinations before and after TAE. The balloon was inflated in the common hepatic artery before chemoembolization if superselective cannulation beyond the gastroduodenal artery could not be done. Sixteen of the 26 patients (61.5%) showed new gastroduodenal lesions, with superficial gastritis in six, one or more erosions in nine, and hemorrhagic gastritis in five. The frequency of lesions detected was no different when the common hepatic artery was obstructed (60.0%) than when superselective embolization was done in more peripheral branch(es) (60.0%). No clinical events indicating upper gastrointestinal bleeding were noticed after TAE. The presence of esophageal and/or gastric varices and session(s) of TAE performed before did not affect the occurrence of gastroduodenal lesion(s). We conclude that TAE produces erosive gastroduodenal lesions that are detected by endoscopic examination but are clinically unimportant; balloon catheter occlusion of the common hepatic artery did not result in more frequent gastroduodenal complications than the ordinary superselective chemoembolization method.

Percutaneous transluminal excimer laser coronary angioplasty. Clinical report of six cases

Six patients with 95% to 100% occluded atherosclerotic lesions underwent percutaneous transluminal excimer laser coronary angioplasty (PTELCA). Among them, 5 were male and 1 was female; their age ranged from 28 to 66 years. Four patients had LAD stenosis and 2 LCX lesions. Acute angiographic and clinical success was achieved in all patients but one, with a success rate of 83.3%. It was demonstrated that PTELCA is a safe and effective therapy for selected patients with coronary artery disease.

Eradication of Helicobacter pylori infection and the recurrence of duodenal ulcers

The purpose of this study was to compare the performance of different regimens on Helicobacter pylori (H. pylori) eradication and duodenal ulcer recurrence. During a four-week period, 59 patients with duodenal ulcers who were positive for H. pylori infection were randomly treated with one of three regimens. Seventeen patients were treated with ranitidine, 19 with colloidal bismuth subcitrate (CBS), and 23 with triple therapy (CBS, tetracycline and metronidazole). Forty-six patients with healed ulcers after treatment received follow-up for six months without maintenance therapy. The recurrence rates of duodenal ulcers confirmed by endoscopy in these three groups were 64%, 33% and 0% at the third month, and 73%, 67% and 5% at the sixth month, respectively. In the ranitidine therapy group, H. pylori infection was still present at the final follow-up. In the CBS therapy group, H. pylori was suppressed initially, but recurred in all cases. In the triple therapy group, there was only one case in which H. pylori infection persisted and where ulcer recurrence occurred after 3.5 months. The remaining cases were all H. pylori negative and had no recurrence of duodenal ulcers during the six months of follow-up. Overall, 19/27 (70%) patients positive for H. pylori had a recurrence of duodenal ulcers, while none of the 19 patients who were negative for H. pylori had a recurrence of ulcers at the sixth month. This study shows that triple therapy is more effective than the other two regimens in the eradication of H. pylori and in reducing the recurrence of ulcers. H. pylori may play a role in the recurrence of the duodenal ulcer.

[Experimental observation of high portal venous resistance in dogs]

To study the relationship between portal resistance and formation of portal hypertension, we designed a high portal systemic resistance model by injecting bletilla hyacinthina into the intrahepatic portal venulae through the portal vein in 9 dogs. The portal pressure was measured and the portal hemodynamics studied by ultrasonic Doppler before operation, and the data were collected with re-laparotomy after 10, 20 days respectively. Liver function, portal collateral circulation and liver histology were also observed. Our results suggest that the portal high resistance could cause portal hypertension. The elevation of FPP was maintained and portal blood flow was increased constantly in different degrees. The veins of the abdominal wall and esophagus were dilated slightly. Histological study of the liver showed fibrotic hyperplasia in the portal area. Liver function was not markedly changed except elevation of ALP. It seems that the combination of portal resistance and portal hyperdynamics are the necessary pathogenic factor of formation of portal hypertension.

Self-mixing interference in a diode laser: experimental observations and theoretical analysis

The experimental results of an investigation of self-mixing effects or backscatter modulation in diode lasers coupled with a simple theoretical analysis are presented. The laser is used to send light, either in free space or through an optical fiber, to a movable target from which the optical backscatter is detected and fed back into the laser. In the experiment three significant conclusions are drawn: (1) self-mixing interference is not dependent on the coherence length of the laser, (2) the interference is not dependent on the use of a single-mode or multimode laser as the source, and (3) the interference is independent of the type of fiber employed, i.e., whether it is single mode or multimode. A comparison of this kind of interference with that in a conventional interferometer shows that self-mixing interference has the same phase sensitivity as that of the conventional arrangement, the modulation depth of the interference is comparable with that of a conventional interferometer, and the direction of the phase movement can be obtained from the interference signal. The above factors have implications for the optical sensing of a wide range of physical parameters. Several applications of the method are discussed that highlight the significant advantages of simplicity, compactness, and robustness as well as the self-aligning and self-detecting abilities of fiber-based self-mixing interferometry when compared with the use of conventional interference methods.

[Flow cytometric analysis of DNA in esophageal cancer]

Malignancy is the first of the ten leading causes of death in Taiwan area, however, since 1978, esophageal cancer is on the first ten causes of malignancy. Esophageal cancer is an aggressive neoplasm with a generally poor prognosis. This is usually related to the advanced stages of the neoplasm at presentation and at diagnosis. In this study, the DNA content in tumor was analyzed by flow cytometry, and compared it with clinical- pathological data, especially the survival time. All thirty seven cases (36 male, 1 female, mean age: 56.5 +/- 10.3 y/o) received operation at Kaohsiung Medical College Hospital in the past 11 years and 29 cases (27 male, 2 female, mean age: 62.2 +/- 9.6 y/o) proved to be esophageal cancer by endoscopic biopsy were assayed in this study. The formalin fixed-paraffin embedded block is used to analyze DNA content by flow cytometry. After comparing these results with clinical-pathological data, there were no significant difference in sex, age, duration, tumor location and length. However, there is a significant correlation between ploidy and tumor cell differentiation, that is, most of the diploid cells were well differentiated while most of the aneuploid cells were poorly differentiated. The median survival time of diploid cases was 325 days which was longer than the 277 days in aneuploid group, but there was no significant difference between these two groups. The same result was noticed in DNA index. Multiple variables analysis of prognostic factors disclosed that there were significant difference in correation with age tumor location tumor length, and whether there was combined radiotherapy and operation. But there were no significant relationship between survival and DNA ploidy DNA index distant metastasis surrounding tissue invasion sex duration and tumor cell differentiation. These data suggest that DNA folw cytometry analysis alone, may not provide a sueful biologic basis for the variable prognosis seen with esophageal tumors.

Comparison of omeprazole and nizatidine in the treatment of duodenal ulcers

This study compares the efficacy and side effects of omeprazole and regular- and double-dose nizatidine in the treatment of duodenal ulcers. Duodenal ulcer healing rates in these three groups (omeprazole, 20 mg qd; nizatidine, 300 mg hs and 600 mg hs) were 81.8%, 19% and 30%, respectively, after two weeks of therapy; and 90.5%, 70% and 84.2%, respectively, after four weeks of treatment. Omeprazole had a significantly better healing rate than nizatidine, 300 mg or 600 mg, after two weeks of treatment (p < 0.01), but not after four weeks of treatment. Omeprazole relieved the ulcer pain sooner than nizatidine (p < 0.05). Smoking decreased the duodenal ulcer healing rate in the omeprazole group, but not in the nizatidine groups. Clinical features, such as sex, age, alcohol consumption, ulcer size, past history of upper gastrointestinal bleeding and duration of peptic ulcer history, did not collate with the healing rate. Patients with double-dose nizatidine did not show any benefits over those with a regular dose in this study. Adverse effects were minor, and there were no significant changes in biochemistry after therapy in these three groups of patients.

Fiber-optic Doppler velocimeter that incorporates active optical feedback from a diode laser

A fiber-optic Doppler velocimeter that incorporates the effect of self-mixing in a diode laser is described. A theoretical model, based on self-mixing interference theory, is presented, and a simple experimental arrangement is constructed. The results of the experimental research are found to be in good agreement with the theoretical analysis. A Doppler velocity of as much as 3 m/s was measured directly, and a good linear relationship between the Doppler velocity and the Doppler-shifted frequency was obtained, which can be used to determine the speed of a moving object.

Evaluation of urease test, gram stain, culture, and histology in the detection of Campylobacter pylori

To evaluate the commonly available tests for detection of Campylobacter pylori infection in the human stomach, we prospectively performed endoscopy and biopsy from the antrum of the stomach in 121 consecutive patients. Four tests, including the urease test, Gram stain, culture, and the hematoxylin and eosin (H & E) stain were used to detect the presence of C. pylori. A C. pylori positive was defined by a positive culture or positive results in two of the other three tests. The sensitivity of the urease test, Gram stain, culture, and H & E stain was 95%, 95%, 71%, and 97%, respectively, and the specificity of those tests was 96%, 100%, 100%, and 73%, respectively. For diagnosis, theoretically, all four tests should be performed from the biopsy specimens. In our experience, the culture was less sensitive, and the H & E stain was less specific, while the urease test and Gram stain were more rapid and had high sensitivity and specificity in the detection of C. pylori infection.

Central nervous system infection after endoscopic injection sclerotherapy

Central nervous system (CNS) infection is a rare complication of endoscopic injection sclerotherapy (EIS) for esophageal varices. We report two patients, one of whom developed a solitary brain abscess, and the other, acute meningitis, after EIS. They presented with high fever initially, and then with changes in mental status. In the case of the solitary brain abscess, the CSF revealed evidence of infection, and CT scan disclosed a brain abscess in the left temporo-parieto-occipital region. This patient received EIS six times and developed the CNS complication 4 wk after the last EIS. There was no growth in either the CSF or the abscess cultures in this case. The other patient with acute meningitis, which developed on the second day after the second session of EIS, had a positive CSF culture of Klebsiella pneumoniae. Both of these patients died despite antibiotic treatment, and craniotomy with drainage in the patient with a brain abscess.

Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies

Gastrointestinal tract involvement with hepatocellular carcinoma was observed in 8 out of 396 patients (2%) during the course of the disease. Histological involvement was confirmed in 6 cases. All 8 patients were men. The most common clinical presentation was frank gastrointestinal bleeding, which became evident in all cases. Esophageal varices were not seen in any patient. The sites of involvement were the stomach (3), duodenum (4), and jejunum (1). The median time between the diagnosis of primary tumors and gastrointestinal tract involvement was 4.5 months (range: 0 to 12 months). Hematogenous spread was presumed to have occurred in two patients with diffuse-type hepatocellular carcinoma, one of whom had main portal vein thrombosis. Direct invasion by contiguous neoplasm was the major mode of gastrointestinal tract involvement. This complication is more likely to develop in patients with large, subcapsular, massive type hepatocellular carcinoma treated by transcatheter arterial embolization and/or intra-arterial chemotherapy. The median survival after the diagnosis of gastrointestinal involvement was 1 month (2 weeks-4 months).

Incidence of massive rebleeding from nonbleeding visible vessels in benign gastroduodenal lesions and prospective study in assessing the efficacy of endoscopic hemostasis with local ethanol injection for prevention of rebleeding

Twenty-seven patients presenting with massive upper gastrointestinal bleeding in whom endoscopy revealed nonbleeding visible vessels in benign gastroduodenal lesions were prospectively and nonrandomly allocated to receive endoscopic injection therapy with pure ethanol or conservative treatment. Those who received conservative therapy were used as a control group. The purpose of this study is to evaluate the incidence of massive rebleeding from the nonbleeding visible vessel which was defined by a more rigid criteria and to evaluate the efficacy of endoscopic pure ethanol local injection to prevent rebleeding. Nine out of the 10 (90%) controls had recurrent major bleeding, in contrast to the 2/17 (12%) of those who received hemostatic endoscopy (p less than 0.0002). Pure ethanol local injections also minimized further transfusion requirements (p less than 0.03). The complications of hemostatic endoscopy in this study are negligible. It is concluded that 1) by restrictive definition nonbleeding visible vessels in benign gastroduodenal lesions carry a high potential of recurrent massive bleeding; 2) rebleeding can be safely and effectively prevented by pure ethanol local injection.

[Gastroduodenoscopic findings and clinical analysis in patients with dengue fever]

The following is a report of the recent Dengue Fever epidemic in Southern Taiwan. From Sept, 1988 to Nov, 1988, 76 patients were clinically diagnosed with fever, leukopenia, thrombocytopenia and other classical signs and symptoms of Dengue Fever. Among them 26 cases were proven by serology. Analysis and discussion were emphasized on the gastroduodenoscopic findings, histopathologic findings and relationship between upper gastrointestinal tract bleeding and thrombocytes, oral medication and clinical symptoms. 655 patients having undergone endoscopy within the same period were used as a control group. It was concluded that: 1) 58.5% of the Dengue Fever Group disclosed hemorrhagic gastritis in their endoscopic findings and in the control group only 8.9% was noted. 2) Patients with thrombocytes less than 50000/mmc suffered from UGI bleeding at a detection rate of around 48.6%. On the other hand, the detection rate was around 29.7% in those patients with thrombocytes over 50000/mmc. Thus a significant difference was shown (p less than 0.025). 3) The thrombocyte count decreased significantly in patients who had had oral medication before endoscopy compared to those without oral medication. The detection rate of UGI bleeding was 40.6% and 26% respectively (p less than 0.025). 4) Most upper G-I bleeding cases occurred after the 4th day of onset, especially in the group without oral medication. 5) There was no significant relationship between UGI bleeding and symptoms of epigastralgia or cutaneous eruption. 6) In cases of presenting hemorrhagic gastritis and superficial plus hemorrhagic gastritis by endoscopy, the detection rate of UGI bleeding seemed higher but there was no statistical difference.(ABSTRACT TRUNCATED AT 250 WORDS)

O-acetyl sialomucin and differentiation of stomach cancer: a histochemical study

In one hundred surgical specimens with stomach cancer, 78 cases contained intestinal metaplasia (IM) in the outer margin mucosa nearby carcinoma focus, while the remaining 22 had no IM. IM was histochemically classified into small intestinal type, sulphomucin colonic type (S), O-acetyl sialo-sulphomucin colonic type (OS) and O-acetyl sialomucin colonic type (O). The incidence of OS and O in well differentiated carcinoma (WCa) (22/27) was obviously higher than in poorly and undifferentiated carcinomas (PUCa) (17/51) (X2 = 14.5011, P less than 0.001). This suggests that O-acetyl sialomucin in IM may be correlated with the differentiation of gastric cancer, that is, OS may often be transformed into WCa if malignant change of IM occurs.