Okayama Igakkai Zasshi (Journal of Okayama Medical Association)

Studies on endoscopic retrograde cholangiograms

Part I Studies on normal cholangiograms

Takeshi KIKUCHI

1975 Volume 87 Issue 3-4 Pages 173-182
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_173

JOURNAL FREE ACCESS

Show abstractHide abstract

The following conclusions were made on the basis of studies on endoscopic retrograde cholangiograms of 94 cases among which diseases originated from the pancreas and biliary tract were excluded.
1) Intrahepatic bile ducts were satisfactorily visualized by supine and prone position with the head down. The normal intrahepatic bile ducts showed tapering-off smoothly. Conflux of the intrahepatic bile ducts were divided into seven types.
2) The common hepatic duct and bile duct measured 4 to 9mm in the maximum diameter. The extrahepatic bile ducts tended to be dilated in diameter with aging.
3) The Vaterian bile duct was within 10 to 20mm in the length and the papilla-orifice 1 to 1.5mm in diameter. With the normal cholangiogram, the Vaterian bile duct was slightly irregular in the contour. The Vaterian segment showed contraction and relaxation rhythmically; one cycle of the movement averaged 11 to 15 seconds. A common channel was observed in 73% of 94 cases. It was difficult to observe “the ampulla of Vater” on X-ray photographs.
4) The cholecystogram looked like a pear with smooth contour, showing various changes in shape according to position of patients. The cystic duct, in most cas es, connects with the extrahepatic bile duct at the mid-portion. The cystic duct was the longer in length the shorter became the choledochus.
5) As for endoscopic findings, the major papilla appeared smooth on surface and slightly red in color. According to the shape, the major papilla can be classified as hemispherical, hemielliptical and flat types and, less frequently, peculiar type having a separate orifice.

View full abstract

Download PDF (1553K)
Studies on endoscopic retrograde cholangiograms

Part II Studies on cholangiograms in cases with stones in the biliary tract

Takeshi KIKUCHI

1975 Volume 87 Issue 3-4 Pages 183-195
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_183

JOURNAL FREE ACCESS

Show abstractHide abstract

Following conclusions were obtained on the basis of studies on endoscopic retrograde cholangiograms of 104 cases with stones in the biliary tract.
1) The biliary tract was successfully visualized in 104 cases (89.6%). The rate of success was high in cases of choledocholithiasis with a dilated bile duct.
2) Most frequently seen were cases of choledocholithiasis, cholelithiasis, or combination of both.
3) In the intrahepatic bile duct, stones were usually found in one of the first branches. In extrahepatic bile ducts, gallstones were usually impacted at the confluence of the common hepatic, cystic and common bile duct, or at the intraduodenal bile duct. Diagnosis of stones in the biliary tract were easily made due to the typical appearance of shadow-defect.
4) In cases with impacted gallstones in the neck of the gallbladder, cystic duct was disrupted.
5) Stones were found in 10 of 16 cases with a past history of cholecystectomy.
6) Dilatation and various abnormalities of the intrahepatic and extrahepatic bile ducts and the gallbladder were frequently observed in cases with choledocholithiasis.
7) Deformity, atrophy and stiffening of the gallbladder were frequently observed in cases with cholelithiasis.
8) Morphological and functional abnormalities of the Vaterian bile duct were frequently observed in cases of stones in the biliary tract.
9) As for endoscopic findings, the longitudinal and covering folds of the duodenal papilla wer swollen frequently in cases with choledocholithiasis, dilated bile duct and abnormal Vaterian bile duct.
10) Stones were found in 10 out of 16 cases with a spontaneous choledochoduodenal fistula.

View full abstract

Download PDF (3607K)
Studies on endoscopic retrograde cholangiograms

Part III Studies on cholangiograms in cases with malignant tumors of the biliary tract, pancreas and duodenum

Takeshi KIKUCHI

1975 Volume 87 Issue 3-4 Pages 197-206
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_197

JOURNAL FREE ACCESS

Show abstractHide abstract

Following conclusions were obtained on the basis of studies on endoscopic retrograde cholangiograms in 56 cases with malignant tumors of the biliary tract, pancreas and duodenum.
1) The rate of success of a retrograde cholangiography was high in cases with cancers of the intrahepatic and extrahepatic bile ducts, and was low in cases with carcinomas of the pancreatic head, duodenal papilla and ampulla of Vater.
2) Characteristic irregular stenosis or obstruction with proximal dilation was found in a case with carcinoma of the intrahepatic bile duct.
3) Carcinoma of the extrahepatic bile duct was divided into two types, i.e. papillary and infiltrative growths. The former revealed irregular stenosis and obstruction of the bile duct, or filling defect with dilatations of the proximal portion of the bile ducts, and the latter irregular stenosis of the bile ducts.
4) The cholangiogram of the patient with carcinoma of the pancreatic head revealed compression and infiltrations of the intrapancreatic common bile duct.
5) The cholangiogram of a patient with carcinoma of the duodenal papilla and ampulla was characteristic by showing an irregular filling defect at the end of the common bile duct.
6) Endoscopically, the carcinoma of the duodenal papilla and ampulla were divided into the following three types.
(i) Type I is the malignant lesion localized at the major papilla.
(ii) Type II is marked swelling found at the longitudinal fold.
(iii) Type III showed the major papilla and longitudinal fold almost normal. Endoscopic pancreato-cholangiography is mandatory for types II and III.
7) The cytological examination of the pancreatic juice and bile is very useful to make the diagnosis of carcinomas of the extrahepatic bile duct, pancreatic head, duodenal papilla and ampulla, whereas the method was not so efficient in carcinomas of the intrahepatic bile buct and of the body and tail of the pancreas. Biopsy is also helpful to make the diagnosis of malignant tumors of the duodenum and carcinoma of the duodenal papilla and ampulla.

View full abstract

Download PDF (2077K)
Analysis by differential curve of flow volume curve, using flow volume curve recorder attached with differential circuit

Tadamichi Meguro

1975 Volume 87 Issue 3-4 Pages 207-209
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_207

JOURNAL FREE ACCESS

Show abstractHide abstract

In order to do precise analysis of flow volume curve, the newly devised curves (differential flow volume curves) which are drawn dy a new recorder attached with differential circuit and indicate differential value of flow volume curve, were investigated.

View full abstract

Download PDF (135K)
Studies on Lipoprotein Lipase

I. Studies on Post-heparin Lipolytic Activity in Man and Rabbits

Hiroyuki Makihata

1975 Volume 87 Issue 3-4 Pages 211-223
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_211

JOURNAL FREE ACCESS

Show abstractHide abstract

Plasma lipoprotein lipase activity following intravenous injection of heparin or post-heparin lipolytic activity (PHLA), is generally believed to function as a lipemia clearing factor and there have been many reports of studies concerning its changes associated with the progress of atherosclerosis or aging. The findings in my clinical investigation that normal subjects showed PHLA values significantly lower than those in atherosclerosis and that PHLA declined pysiologically with the advancing age prompted me and experimental study in three diet groups of rabbits (vegetables, bean-curd refuse, and lanolin) with the purpose of clarifying the underlying mechanism.
1) Normal subjects showed PHLA values (553.0±125.0μEq/L, N=33) significantly lower than those in atherosclerosis (252.0±41.0μEq/L, N=15, P<0.05) and that PHLA diclined physiologically with advancing age.
2) There was evidence of progressive physiological decline of PHLA over a six-month period of continuous observation in all diet groups of animals. In rabbits with hyperlipidemia maintained on lanolin diet, the fall of PHLA was earlier in onset along with development of lipemia.
3) The pattern of PHLA decline was observed to differ noticeably among the three diet groups.
4) Rabbits fed bean-curd refuse diet and those receiving lanolin diet were sacrificed after six months of observation and histopathologic examinations made of slides prepared from the thoracic and abdominal aorta revealed definite arteriosclerotic changes in lanolin-fed animals but no such microscopic evidence in those fed bean-curd refuse. The lanolin diet group displayed a significantly greater decline of PHLA, as compared with the bean-curd refuse diet group.

View full abstract

Download PDF (1490K)
Studies on Lipoprotein Lipase

II. Changes in Endogenous Lipoprotein Lipase Activity and Lipids of Man and Rabbit Plasma in Oral Glucose Tolerance Test

Hiroyuki Makihata

1975 Volume 87 Issue 3-4 Pages 225-241
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_225

JOURNAL FREE ACCESS

Show abstractHide abstract

The previous finding noted in man of significant difference in endogenous lipoprotein lipase (ELPL) activity of plasma in oral glucose tolerance test (OGTT) between diabetic state and non-diabetic state has been confirmed and attested by experiments in rabbits. Observations were also made of plasma lipid changes associated with OGTT and of those in rabbits with developing steroid-diabetes by corticosteroid injection, with the results as follows.
1) In OGTT, non-diabetic state exhibited a bi-peaked curve for plasma ELPL activity with maxima at 90 and 150 minutes after an oral dose of glucose whereas diabetic state showed an activity curve with a single peak at 90 minutes after oral glucose administration.
2) In OGTT, non-diabetic rabbits (maintained on bean-curd refuse diet or lanolin diet) exhibited a bi-peaked curve for plasma ELPL activity with maxima at 30 and 120 minutes after an oral dose of glucose whereas rabbits with alloxan-or steroid-diabetes showed an activity curve with a single peak at 90 minutes after oral glucose administration.
3) During the OGTT the animals displayed prominent changes in plasma nonesterified fatty acid levels while such other plasma lipid factors as triglycerides, total cholesterol, phospholipid and total lipid remained virtually unchanged.
4) Steroid-induced diabetes was faster in onset in lanolin fed rabbits with hyperlipidemia, compared with animals maintained on bean-curd refuse diet.
5) The most prominent feature of abnormal lipid metabolism observed in rabbits with developing steroid-diabetes was elevation of serum triglycerides.
6) Principal fatty acid levels in the plasma of rabbits receiving a corticosteroid were determined at certain time-intervals during the OGTT. All these fatty acids showed changes with time, being particularly marked at 180 minutes after glucose administration; changes of palmitic acid, oleic acid and linoleic acid concentrations were conspicuous in both the bean-curd refuse fed group and the lanolin fed group.

View full abstract

Download PDF (1386K)
Studies on relations of temperature of topically used cortico-steroid hormone (beta-methasone) to its therapeutic effect

Part I. Clinical investigation on acute otitis media cases

Takeshi Maeda

1975 Volume 87 Issue 3-4 Pages 243-248
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_243

JOURNAL FREE ACCESS

Show abstractHide abstract

Otic rinderon solution, a preparation of cortico-steroid hormone for topical use, is frequently used on clinical patients of various ENT diseases with favorable effects. However, on application of the medicine to patients, esp. to acute otitis media, it seems that temperature of the agent influences its therapeutic effects.
Then, the author tried some clinical experiments using the agents under various temperatures, and observed the difference on therapeutic effects.
The patients were divided into three groups. Group I of 12 cases were treated with otic rinderon solution of 37°C, Group II of 23 cases, with the agent of 15°-25°C, and Group III of 10 cases, with the agent of 10°C.
The results obtained are as follows: In Group I, the therapy appeared to be highly effective in seven cases (58.3%), fairly effective in four cases (33.3%), and not effective in one case (18.3%). In Group II, highly effective in ten cases (43.4%), fairly effective in ten cases (43.4%), and not effective in three cases (13.1%). In Group III, no highly effective cases, fairly effective in five cases (50.0%), and not effective in five cases (50.0%).
Consequently, the best therapeutic effects were obtained with the topical use of otic rinderon solution under the temperature of 37°C.

View full abstract

Download PDF (347K)
Studies on relations of temperature of topically used cortico-steroid hormone (beta-methasone) to its therapeutic effect

Part II. Experimental studies on rabbit ear steel chamber technique

Takeshi Maeda

1975 Volume 87 Issue 3-4 Pages 249-258
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_249

JOURNAL FREE ACCESS

Show abstractHide abstract

Using the rabbit ear steel chamber technique devised by Williams and modified by Ohsaki, biopharmacological reaction of topically applied cortico-steroid hormone was investigated.
Solutions of cortico-steroid hormone (beta-methasone) kept under three thermal conditions, e.g., 37°C, 20°C, and 4°C, respectively, were poured into steel chambers with a microsyringe, and the changes of microcirculation of the vascularization in the chamber were observed chronologically. Changes of microcirculation were stasis, hemorrhage, sludge, and exsudate; and were set as the criteria of grade of inflammatory process.
The results obtained were as follows:
1. Strong anti-inflammatory effects was showed by administration of beta-methasone at 37°C.
2. Beta-methasone at 20°C showed less anti-inflammatory action than those at 37°C.
3. Application of beta-methasone at 4°C acted as a vigorous inflammatory agent. This phenomenon may be attributed to the stimulating effect of cold solutions.
Consequently, it seemed that topical application of beta-methasone was most effective when used at 37°C.

View full abstract

Download PDF (2844K)
The physicochemical studies on salt-resistant mechanism of Staphylococcus aureus

Takeshi Katayama

1975 Volume 87 Issue 3-4 Pages 259-270
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_259

JOURNAL FREE ACCESS

Show abstractHide abstract

To clarify salt-resistant mechanism of Staphylococcus aureus from the standpoint of the passive transport, attempts were made to establish the experimental system of artificial model membrane, liposome, and to measure permeability of Na⁺ to it. The liposomes were prepared from phospholipids of S. aureus cultivated in normal and 10% NaCl media and NaCl-sensitive mutants.
1. In physiological conditions, it is possible to form the stable liposome comprised of phospholipids or total lipids of S. aureus. The preparation methods give a remarkable difference in the shape of vesicles. In the case of particles produced by hand or mechanical shaking, the diversities in the size and shape of individual particles can be observed. Sonicator-prepared liposomes are small and homogeneous of particle size, and consist of unilamella rather than multilamella.
2. Salt concentration affects liposome formation. Cardiolipin containing abundant branchedfatty acid form stable vesicles even in a high concentration of NaCl solution.
3. The liposome prepared from phospholipids of 10% NaCl S. aureus suppresses more markedly in the rate of Na⁺ diffusion than that of normal S. aureus. The experiments on the liposomes prepared from fractionated individual phospholipids indicate that cardiolipin containing branchedfatty acid contributes to salt-resistance of S. aureus as a barrier.
4. From optical measurements, it has been elucidated that the liposome of phospholipids prepared from S. aureus acts as an ideal osmometer, and non-electrolyte, glycerol, shows a similar behavior to Na⁺ in permeability.

View full abstract

Download PDF (1102K)
Cellular Immunity of Mice Bearing Ehrlich Cancer

II. Time Lapse Changes in Antitumor Activity of Lymphatic Tissues at Various Sites After Tumor Removal

Satoshi Tomoyasu

1975 Volume 87 Issue 3-4 Pages 271-278
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_271

JOURNAL FREE ACCESS

Show abstractHide abstract

For the purpose to elucidate changes in common immunity of cancer-bearing body after tumor removal, after transplanting 500×10⁴ cells/mouse of Ehrlich ascites tumor cells to the back between the scapulae of DD mice, tumors were removed with lapse of time as thoroughly as possible, and on the 23 rd day of tumor transplantation regional axillary lymph nodes, distant mesenterial lymph nodes and spleen were removed and lymph node cells were prepared from them and these cells were tested for their antitumor activity to JTC-11 cells (derived from Ehrlich cancer cell). The results are briefly summarized as follows:
1. In the group removed of tumors on the seventh day after Ehrlich cancer transplantation none of the tissues showed antitumor activity.
2. In the group removed of tumors on the tenth day there was observed a strong antitumor activity remaining only in the regional lymph nodes.
3. In the group removed of tumors on the fifteenth day, antitumor activity was found in practically all lymphatic tissues inclusive of regional lymph nodes.
4. In the group removed of tumors on the 20th day, antitumor activity could be observed in none of the lymphatic tissues. Considering the antitiumor activity of lymphocytes from the aspect of common immunity in cancer-bearing body, when tumor mass is removed as thoroughly as possible at the time when there is sufficient antitumor activity, such an activity remains in the body for a long time after tumor removal.

View full abstract

Download PDF (372K)
Changes of Mitochondrial Function by CCl₄

AKAHORI Fumihiko

1975 Volume 87 Issue 3-4 Pages 279-288
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_279

JOURNAL FREE ACCESS

Show abstractHide abstract

It has been reported that the liver intoxication by CCl₄ is primarily caused from damages in mitochondrial functions. The present systematic investigation revealed some changes in mitochondrial functions, and the results are presented as follows.
With mitochondria isolated from the liver of rat with CCl₄ intoxication an investigation was carried out on changes of the energy metabolism on the lipid peroxidation which is thought to have an important bearing on the onset of liver damages, as well as on changes of related substances. Simultaneously, changes in mitochondria isolated from normal rat liver were studied in vitro in the presence of CCl₄. For the intoxication group the mixture of 0.4ml CCl₄ and 1.6ml salad oil was injected into the rat peritoneal cavity and the liver was taken out of the animal 16 hours later when CCl₄-intoxication was most marked, and mitochondria were isolated to be used for the experiment. For the control group 2.0ml salad oil alone was injected intraperitoneally, and mitochondria isolated from the liver taken out 16 hours later were used. In the in vitro experiment the mitochondria isolated from normal rat liver served for this purpose. The results may briefly summarized as follows: 1) In the CCl₄-intoxicated liver the dehydrogenase system of mitochondria is most markedly damaged. 2) The energy conversion system is so damaged that the ATP synthesis is markedly decreased. 3) Ion-transport system which acts synergistically with the energy conversion of early stage is damaged. 4) The lipid peroxidation induced by Fe²⁺ is markedly diminished. 5) The phospholipid content of mitochondria and arachidoic acid content of phospholipid are decreased, while the content of tryglyceride is increased. 6) CCl₄ acts on the oxidative phosphrylation of the normal rat liver counter-synergistically, though only weakly. 7) When CCl₄ is added to normal rat liver in vitro, the lipid peroxidation is enhanced, on the contrary to the situation of CCl₄-intoxicated rat liver. These findings suggest that the onset mechanisms of mitochonrial functional disturbances may be explained as due to the damage to the mitochondrial membrane, the damage to the membrane system and energy metabolic system brought about by CCl₄ as well as by the by-products of membrane disintegration.

View full abstract

Download PDF (1012K)
Regulation of Human Growth Hormone Secretion in Patients with Various Endocrine and Metabolic Disorders

Norio OGAWA, Jiro TAKAHARA, Tadashi OFUJI

1975 Volume 87 Issue 3-4 Pages 289-293
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_289

JOURNAL FREE ACCESS

Show abstractHide abstract

The basal plasma human growth hormone (HGH) levels and the plasma HGH response to insulin in 126 patients with various endocrine and metabolic disorders have been compared with the results found in 40 control subjects.
In patients with acromegaly and anorexia nervosa, basal plasma HGH concentrations are high and fluctuated widely when measured frequently in their clinical courses.
In all patients with panhypopituitarism, pituitary dwarfism, Cushing's syndrome and hypothyroidism, an absent HGH response to insulin-induced hypoglycemia was obtained.
The HGH response to insulin proved of value in differentiating patients with hypothalamic or pituitary hypofunction and those with anorexia nervosa.

View full abstract

Download PDF (1448K)
Vectorcardiographic Studies on Congenital Heart Disease by means of Frank's Lead System

Part I Vectorcardiograms of Ventricular Septal Defect. Special reference to its hemodynamics

Shigemitsu Moriwaki

1975 Volume 87 Issue 3-4 Pages 295-311
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_295

JOURNAL FREE ACCESS

Show abstractHide abstract

The vectorcardiograms and data from cardiac catheteriztion of 64 patients with VSD were analyzed and the following results were obtained.
(1) The vectorcardiographic patterns of combined ventricular hypertrophy are found in 40% of the patients with mild cases.
(2) QRS loops with delayed terminal conduction are found dominantly in severe cases; in 40% of VSD with pulmonary hypertension and in 75% of Eisenmemger Complex.
(3) In 5 cases (7.8%), frontal QRS loops have counterclockwise rotation, and they direct superiorly and to the left. Four cases of them belong to severe group.
(4) The vectorcardiograms of the second type in Kirklin's classification showed the overloading of right ventricle more sensitively than the first type. i.e.
I) Of 16 cases with the terminal conduction delay, only one case is the first type, 13 cases are the second type and 2 cases belong to the second plus third type.
II) In mild cases, 18 out of 20 patients with the rightward deflection of the posterior portion belong to the second type and only 2 cases belong to the first type.
(5) The elevation of right ventricular systolic pressure results in an increase of the magnitudes of both maximum upward and rightward deflections of the terminal portion.
(6) Large shunts from left to right result in an exceeding increase of the magnitude of spatial maximum QRS, T vectors, the maximum rightward deflection of the initial portion and the maximum leftward deflection.
(7) The magnitudes of the maximum anterior deflection and the maximum inferior deflection increase correlatively with both hypertrophy and dilatation of the right ventricle.

View full abstract

Download PDF (899K)
Vectorcardiographic Studies on Congenital Heart Disease by Means of Frank's Lead System

Part II Vectorcardiograms of Patant Ductus Arteriosus. Special comparison with vectorcardiograms of ventricular septal defect

Shigemitu Moriwaki

1975 Volume 87 Issue 3-4 Pages 313-322
Published: April 30, 1975
Released on J-STAGE: March 30, 2009

DOIhttps://doi.org/10.4044/joma1947.87.3-4_313

JOURNAL FREE ACCESS

Show abstractHide abstract

The vectorcardiograms and data from cardiac catheterization of 38 patients with PDA were analyzed and compared with VCGs of VSD. The following results were obtained.
(1) The patients whoes QRS loops are inscribed counterclockwise rotation in left sagittal plane have large left to right shunts. There are no relations between the inscription of QRS, T loops in another plane and th severity of the disease.
(2) Large shunts results in an increase of the magnitude of the maximum posterior deflection and result in a significant posterior displacement of the maximum QRS vector in the horizontal plane.
(3) The VCGs of PDA differ from the VCGs of VSD in the following vectorcardiographic findings which are closely related to right ventricular overloading.
I) Vectorcardiographic CVH patterns are appeared in 10% of mild PDA, on the other hand, in 40% of mild VSD.
II) According to increase of the left to right shunt, the magnitude of the maximum anterior deflection of QRS loop of VSD increases, but, that of PDA does not correlate to shunts.
III) The terminal conduction delay, the maximum upward deflection and the maximum posterior deflection of the terminal portion which are caused by pertrophy of right ventricular outflow tract, have correlation with right ventricular systolic pressure in VSD, but not in PDA.

View full abstract

Download PDF (492K)

Register with J-STAGE for free!