There has been a tremendous information explosion about esophageal and lower esophageal sphincteric functions during the past decade.
There has been a great interest concerning the effect of gastrointestinal hormones on the sphincter.
Recent advances of these studies were reviewed.
Many factors influencing results obtained by esophageal function tests, especially opentipped method were discussed. Motor functions of the esophagus and the lower esophageal sphincter in health and diseases were also reviewed.
Effect of gastrointestinal hormones, such as gastrin, secretin and motilin, on the lower esophageal sphincter was reviewed. However, the role of these endogenous gastrointestinal hormones on the maintenance of lower esophageal sphincteric pressure remains unsolved. Further extensive studies will be expected.

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Immunological aspect of patients with primary liver carcinoma (PLC) were presented in this article.
It demonstrated depression of delayed cutaneous hypersensitivity to tuberculin protein derivate, phytohemagglutinin (PHA), and streptococcal polysaccharide (PS-E), decrease of the percentage of peripheral rosette forming cells (T-cell) and active T-cells, increased of the percentage of peripheral null cells bearing neither T-nor B-cell markers, and decreased responsiveness of peripheral lymphocytes to PHA stimulation. Impaired cell-mediated immunity was severe in the late stages of illness. It indicates that these clinical tests are useful to evaluate the host's immunological status in patients with PLC.
Lymphocytes from the peripheral blood of patients with PLC were cytotoxic to cultivated cells from the human fetus, but not cytotoxic to cultivated adult cells. Positive results were demonstrated in 20% of the patients and more frequent in the late stages of illness. This studies on cell-mediated immunity to foetal cells, using microcytotoxicity assay of Hellstrom, suggest that the membrane of hepatoma cell has antigen shared with foetal cells.
It would be possible to provide direct information about the specific cell-mediated immunity to tumor-associated antigens.
The liver tissues obtained from patients with PLC were stained by immunof luorescent technique using anti-human thymocyte antiserum. T-cells were located around hepatoma cell nest, in the interstitial tissues, and in the lumen of the sinusoid of the liver bearing PLC. Occasionally they were found to adhere to the surface of tumor cells and to be arranged more or less in a row between proliferating connective tissue and tumor cells.
It suggests that T-cells play an important role as effectors in the local host immune response to tumor cells.

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We experienced adhesion ileus of the upper jejunum after gastrectomy (Billroth II) of a 50-years-old-man.
After release of the adhesion of jejunum near the gastro-jejunostomia under laparotomy, we detained the Saito's ileus tube in the intestine far beyond the part of the adhesion in order to induce the intestinal adhesion without causing intestinal obstruction by means of splint action of this tube, in addition to the stomach tube.
Because of persistent vomiting as the result of remarkable alkalosis still after the 2nd operation, we put the stomach juice, which was brought out every 2 hours by means of the stomach tube, into the ileum via the Saito's ileus catheter.
By an application of this procedure, vomiting ceased and alkalosis was corrected rapidly and in the course of 4 days vomiting stopped completely without aid of this procedure, which means the restoration of passage of stomach juice via the anastomosis ostium.
We think that the cause of this rapid restoration of the passage is release of edema around the anastomosis ostium and normalized peristalsis of the intestine due to normalization of electrolytes balance and correction of pH by this procedure.
We recommend this method in the case of the upper intestinal adhesion ileus, when the recurrence will be suspected at the time of operation.

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A survey was undertaken of 135 patients with duodenal ulcer who had been treated by different operations, including eighty vagotomies in past 7 and half years.
The letters were sent to all these patients after three months following operation. Questionnaires had been allocated to three groups according to the type of operation; thirty-three gastrectomy patients, twenty-three vagotomy-antrectomy patients and thirty-two vagotomy-drainage patients. These operations had mainly consisted of thirty-one partial gastrectomies with Billroth II anastomosis, ten truncal vagotomy-antrectomies, thirteen selective vagotomy-antrectomies, fifteen selective vagotomy-pyloroplasties and fourteen selective proximal vagotomy-pyloroplasties.
There were no statistically significant differences in operating time, intraoperative bleeding and postoperative complications between three groups. The recurrence rate, proven, was 6.2% after vagotomy-drainage, but did not achieve statistically significance at p=0.05 level. Vagotomy-drainage was found to reduce MAO by a mean 77.9% and had a mean 73.4% reduction of PAO. Compared with vagotomy-drainage, both resective procedures gave appreciably better results, the differences being statistically significant at p<0.05.
There had been no statistically significant differences in appetite, weight, returning to occupation, working, postoperative changing of personality and reducing of symptoms between various forms of operation. As for the incidence of dumping, the result of vagotomy-drainage did not achieve statistical significance at p=0.05 level, except for vagotomy-drainage as compared with vagotomy-antrectomy.
After vagotomy-drainage, 83.9% patients secured a good and excellent clinical results (Visick grade I+II). The patients grade Visick I+II were statistically significantly less after vagotomy-drainage than after gastrectomy (p<0.05). but difference between vagotomy-drainage and vagotomy-antrectomy was not significant. In regard to Visick grade I, the differences were not statistically significant.
The advantage of vagotomy-drainage procedure appeared to reduce preoperative symptoms and gain a satisfactory clinical result.

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^99mTc-E-HIDA is a new ^99mTc-labeled radiopharmaceutical predominantly excreted through the biliary tract. Thin-layer chromatographic examinations showed no significantly pertechnetate anion or radiolabeled colloid. Scintigraphic studies and hepatograms were performed in 28 patients; nine with cholelithiasis comprising patients of postcholecystectomy, two with carcinoma of bile duct, two with carcinoma of head of pancreas, 11 referred for the investigation of right upper quadrant abdominal disease, and 4 miscellaneous cases. A normal hepatobiliary scintigraphy showed the early liver uptake of tracer followed by the visualization of intrahepatic bile duct and gallbladder, and consequently was visualized the duodenum. In cases of hepatoceliular disease, the hepatic accumulation and excretion into the bile duct was delayed. The differential diagnosis between incomplete obstructive and hepatocellular disease can be done using ^99mTc-E-HIDA. The only criterion that may contribute to differential diagnosis between a severely hepatocellular jaundice and a complete mechanical obstructive is the finding that in cases of a hepatocellular jaundice, the liver is homogenously seen for long time, whereas in cases of mechanical obstructive jaundice, it is visualized inhomogenously.

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Serum OCT and GLDH activities, well known as the enzymes of hepatic mitochondrial origin, were determined in 222 chronic alcoholics admitted to the Kurihama National Hospital. Blood samples were also analysed for other serum enzyme activities such as GOT, GPT, Al-Pase, LDH and GGTP. Liver biopsy was performed in 52 patients with alcoholic liver disease and histological findings were compared with serum OCT, GLDH and GGTP activities.
The frequency of abnormalities of serum OCT level was 76% and that of serum GLDH was 78%, whereas that of serum. GOT and GGTP levels were 73% and 94% respectively. On admission the mean level of serum OCT was 26.56+23.49 IU L (mean+SD: contorol value; 3.12+1.71 IU L) and that of serum GLDH was 19.92+5.82 U, whereas on discharge the OCT activity was decreased to 6.70+3.90 IU L and the GLDH activity was also decreased to 3.85+1.87 U.
When serum OCT, GLDH and GGTP levels were compared with histological findings, there were some correlation between the OCT and GLDH levels, and the presence of central hyaline sclerosis, fatty metamorphosis and spotty necrosis, whereas there was little correlation between the GGTP level and the presence of them.
In conclusion, the determination of serum OCT and GLDH activities appears to be a more useful marker for the diagnosis of hepatic involvements in chronic alcoholics than other enzymes, such as GOT and GGTP.

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The systemic endotoxemia was detected in the patients with liver diseases. The detection of endotoxin was performed by the method of the limulus amoebocyte lysate test. Eighty three patients and twelve normal subjects were included in the study, 15 with acute hepatitis, 32 with chronic hepatitis, 15 with liver cirrhosis, 6 with hepatoma, 6 with alcoholic liver diseases and g with other liver diseases.
Following results were obtained:
1. The positive limulus lysate tests were found in 3 of 15 patients (20%) with liver cirrhosis and 1 of 6 patients (17%) with alcoholic liver diseases.
2. The negative limulus lysate tests were found in either patient with acute hepatitis, chronic hepatitis, hepatoma, other liver diseases and normal subjects.
3. Any significant difference was not shown in the intestinal flora between positive patients and negative ones, nor between pre-and post-administration of Lactulose.
4. No significant difference was shown in some laboratory findings (I. C. G., serum albumin, serum gamma globulin, platelet count, prothrombin time and ascites) between positive and negative patients with liver diseases.
5. The serum mitochondria GOT was significantly higher in the positive patients of limulus lysate test than in the negative ones.
6. The serum mitochondria GOT in the positive phase was significantly higher than the negative phase of the limulus lysate test in same cases.
According to these results, the systemic endotoxemia in the patients with liver diseases was resulted from the dysfunction of the reticuloendothelial system, and the endotoxin injured the mitochondria of liver cells.

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Clinically diagnosed 27 cases with primary hepatoma were studied. There was no case under 30 years old and peak frequency was observed from 50 to 59 years old. Ratio of male to female was 2.9: 1. Chief complains at admission were pain and abdominal tumor in the order. Diagnosis of hepatoma was established within 6 month before death in many cases and the survival was to be 3.1 monthes in the average after diagnosis. Diagnosis was given on the basis of positive abnormality of hepatic scintigram and α-fetoprotein in many cases. Slightly lower rate was obtained in the appearance of jaundice and ascites than the former reports. Anemia with under 12g/dl of hemoglobin was found in about 40% of the cases. In serum biochemical abnormality, more than a half of the cases showed over 2 in the ratio of GOT/GPT, over 20 KA units in alkaline phosphatase and 400 in lactic dehydrogenase. Positive HBs-antigen was showed in one case (3.7%) . Appearance of proeinuria was found in 4 cases (18.2%) and no abnormality was noted in serum creatinine concentration. There are no case with paraneop'.astic syndrome, that is, hypercalcemia, polycythemia and thrombocytosis etc.

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The patient was 44-years-old-man, whose submucosal tumor of the esophagus was enucleated under the preoperative diagnosis of esophageal leiomyoma. But the postoperative pathological examination revealed that the tumor was low grade malignant leiomyosarcoma or between benignancy and malignancy.
2 years and 1 month after operation, the patient is in good health without obvious evidence of recurrence under careful observation.
The definite preoperative diagnosis of early stage or low grade malignant leiomyosarcoma of the esophagus is considerably difficult, therefore the surgical treatment of these cases has been discussed.

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It is generally accepted that “porcelain gallbladder” is a calcified gallbladder wall and a rare disease. Recently, we experienced to operate a case of porcelain gallbladder. The patient, a 71-years-old man, was admitted with a complaint of discomfort at epigastrium.
The plain film of the abdomen showed a pearshaped area of calcification in the gallbladder area. The patient had underwent a simple cholecystectomy. The extirpated gallbladder was white, 4 cm in diameter, hard like a cartilage and it had a cholesterin stone. Histologically, the mucosa of the gallbladder was disappeared and the wall was fibrous.
Calcification, and bilirubin and cholesterin crystals were found on the internal surface of the gallbladder. There was no sign of malignancy. The post-operative course was uneventful.

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Investigations were made on the 9 patients with obstructive jaundice, who had not shown any elevation in serum alkaline-phosphatase (Al-p) activity. The values of γ-glutamyl transpeptidase (γ-GTP) activity were, however, increased in all 9 cases. Choledocholithiasis was observed, in 5/9 cases by ERCP technique, and confirmed later at operation. Intrahepatic cholestasis was revealed in 3/9 by both ERCP and laparoscopy with liver biopsy. In one patient liver cirrhosis was observed at operation, in association with the biliary tract stricture complicating a massive adhesion of the tract. From these findings, it was concluded that the serum γ-GTP increment indicates a possible presence of biliary tract lesions even if serum Al-p activity was not increased at this stage of the diseases. Accordingly, such increase in γ-GTP activity suggests an application of further examinations such as ultrasonography, PTC, ERCP and laparoscopy to make an accurate diagnosis, when the patients complained of abdominal pain and vomiting even if jaundice was not evident.

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Over twenty years have already passed since LaDue, J. S. et al. reported the method For the estimation of GOT·GPT in a number of patients.
It remains, even nowadays, to play an important role to know the liver-function, especially in the leprosy patients, who are generally used to continue on the sulfone-treatment. But the combined sulfone with phenobarbital (luminal) has been found to make the two values normal and the single sulfone-therapy has been found to make them abnormal in the most cases of leprosy patients.
On the contrary, the leprosy patients with the abnormal GOT. GPT who have received the sulfones only, once given them luminal, their abnormal two values easily return to the normal ranges.
It is one of the simplest ways by which one can make the leprosy patients' abnormal two values to normal purposely is to give an adequate quantity of luminal to the patients.
It is thus concluded that the exsistence of internal organ-leprosy or liver diseases can not be denied only by the reason that the two values of the leprosy patients are normal, as determined by our clinical experiences described in this paper.

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