The state of abdominal adhesion and its frequency were examined in 21 autopsies by accident and 92 operated cases. It was known that in these autopsies and operated cases, the adhesion near the stomach or duodenum was unexpectedly many. In these autopsies, adhesion of the gallbladder was most, frequent and it was mostly between the first part of duodenum and the gallbladder. In radiography by gallbladder puncture, there were some adhesions which deformity did not appear. In operated cases, cancer and ulcer of the stomach or duodenum were many, and also the adhesion was a great many in antrum and the first part of duodenum. In the mutual adhesion, it was seen most between antrum and mesocolon and pancreas, and between the first part of duodenum and gallbladder. By classifying these diseases, the adhesion was most often seen in ulcercancer, it was less frequent in ulcer, and was comparatively rare in cancer. 19 cases with gastroenteric symptoms caused by adhesion, which were apt to be diagnosed wrongly cancer or ulcer, were collected from 92 operated cases. These were named tentatively “abdominal adhesion disease”. Before operation 4 cases of 19 were suggested to be cancer, 8 cases of them ulcer, 7 cases could be diagnosed correctly. And the clinical significance of them was studied.
Hepatotonics including sodium hippurate and sodium dehydrocholate were injected to mice to stimulate their hepatic function. Nephrectomy was also performed on rabbits for the same purpose. Their livers were excised and subjected to electron microscopy after the conventional fixation and section. The results obtained in this study are summarized as follows. 1) There was no appreciable change in the morphology of mitochondrias in the polygonal cells of the liver. 2) There was an increase in the number of endoplasmic reticulum and its associated Palade's particles, in the polygonal cells which was thought to be related to the accelerated functional state of the liver. Increased number of endoplasmic reticulum and Palade's paticles may be a prominent morphological indicator of accelerated hepatic function. 3) Injection of sodium dehydrocholate which is a cholagogue resulted in the enlargement of the endoplasmic reticulum and the appearance of small vesicular components in the polygonal cells. These changes were understood as the morphological picture of accelerated secretion of bile.
Verf. hat diesmal bei Asthmapatienten in anfallsfreiem Zuatande durch Acetylcholininhalation den Anfall hervorgerufen und dabei bronchographishe Untersuchungen angestellt, um sicherzustellen ob and in welchem Grade bronchiale Verengung im Anfall entsteht. Verf. hat eine Bronchographie in den beiden Respirationsphasen (im hoechsten Inspirations- und Exspirationszustand) durchgefuehrt, sowohl waehrend des durch Acetylcholininhalation hervorgerufenen Anfalls, als auch zur Kontrolle waehrend der anfallfreien Zeit gemaess den Versuchen von Mueller and Valsalva. Von 10 Faellen zeigten in der Exspirationsphase 6 Faelle nirgendwo eine Verengung, von denen ein Fall stellenweise sogar Erweiterung zeigte. Von den Uebrigen 4 Faellen zeigte ein Fall allgemeine Erweiterung neben im unteren Lungenfeld befindlichen vereinzelten Verengungen, ein Fall im unteren Lungenfeld allgemeine leichte Verengung, ein Fall stellenweise Verengung und ein Fall im oberen and unteren Lungenfeld Verengungen. In der Inspirationsphase zeigte kein Fall ein Verengungsbild. Bis auf 2 Faelle die keinen Unterschied in der Bronchialschattenweite zeigten, bemerkte man deutliche allgemeine Erweiterungen bei 3 Faellen, leichte Erweiterung bei 2 Fallen and bei weiteren 2 Faellen gleich weite oder erweiterte Schattenbilder, was sehr bemerkenswert ist. Verf. bemerkte, dass das Einstroemen des Kontrastmittels in die Alveolen beim Anfall ebenso schnell wie normalweise geschieht, was das Aufsuchen der entsprechenden Bronchiolen erschwert. Verf. hat trotzdem in 56 Faellen die Bronchiolen identifizieren and bei beiden Versuchen je 28 miteinander vergleichen koennen. Davon 11 mal inspiratorisch gleich, 4 mal exspiratorisch gleich, im Anfall Imal exspiratorisch deutlich erweitert, 1 mal inspiratorisch deutlich erweitert, 2 mal inspiratorisch stellenweise erweitert, 5 mal exspiratorisch erweitert, 1 mal nur inspiratorisch verengt, 2 mal inspiratorisch stellenweise verengt und 1 mal nur exspiratorisch verengt. Verf. eroertert die Bedeutung der Verengungen fuer den Anfall and gelangt zum Schluss, dass these keine nennenswerte Ursache fuer den Anfall darstellt.
For a reliable measurement of vibratory sensation, the amplitude of the minimal perceptible vibration-the threshold values of the vibratory sensation-should be employed. Employing a moving coil type vibrator with a BaTi O3 ceramic element to determine the absolute values of amplitude, changes of vibratory sensation with advancing age and in diabetes mellitus were investigated. The threshold value of vibratory sensation was expressed as the logarithm of the minimal perceptible vibration amplitude expressed in 10-4mm. Frequency of 150c/s was used because it was easily perceptible giving accurate results. As an intimate correlation was found among volar sides of the tip of the first, second and fifth finger and among plantar sides of the tip of the first toe of right and left side, volar side of the tip of the right second finger and plantar side of the tip of the right first toe were selected for the test. Among 2000 subjects between 10 and 82 years of age, the threshold values of finger tip were distributed between 0.1 (1.25×10-4mm) and 0.8 (6.31×10-4mm) in normal group and above 0.8 in abnormal group, which increased with advancing age. The threshold values of toe tip were distributed between 0.8 (6.31×10-4mm) and 1.9 (79.5×10-4mm) and values above 1.9 was observed in increasing frequency with advancing age. Those who had high threshold values of vibratory sensation were found to have arteriosclerosis, abnormal tendon reflexes, and decreased mental activity in many cases. In 93 diabetic subjects of less than 59 years of age, decreased vibratory sensation was observed more frequently than the non-diabetic group of similar age, while in persons of more than 60 years of age, such difference was not recognized between a group of 49 diabetics and non-diabetic control.
The cardio-pulmonary dynamics were studied in 8 cases of obstructive pulmonary emphysema, 2 cases of non-obstructive pulmonary emphysema and 3 cases of bronchial asthma before, during and after IPPB (intermittent positive pressure breathing) for 10 minutes using room air, and 2 cases of obstructive pulmonary emphysema before and 3 weeks after IPPB therapy and 2 cases of bronchial asthma before and 1 week after the same treatment. We also compared the changes in cardiopulmonary function by IPPB with those by inhalation of 100 percent oxygen. The alveolar hypoventilation was corrected by IPPB causing mechanical hyperventilation, with resultant improvement of ventilation-perfusion relationships. Thus hypoxemia and hypercapnia were corrected. As for the acid base balance, respiratory acidosis was markedly improved. As far as the hemodynamics are concerned, the cardiac output was increased, while the pulmonary arterial pressure and the pulmonary blood volume were decreased, which could be considered to show the therapeutic effect of IPPB on cor pulmonale. The same tendency was observed after treatment with IPPB for 1 or 3 weeks. A danger of respiratory acidosis could be avoided when inhalation of pure oxygen was done by means of IPPB. The conclusion is that IPPB is not a symptomatic treatment, but a therapeutic measure aiming to correct disturbed pulmonary function, and is at present the most effective treatment for chronic pulmonary insufficiency, for which there had not been good therapeutic means.
The author's colorimetric assay method of serum transaminase (T) and its modification for tissue T were used in these studies. The results were indicated as γ of oxalacetic acid or pyruvic acid, which was formed after the incubation time under definite conditions. RESULTS A. Clinical Studies: 1. Normal values of serum T were as follows: The mean of serum glutamic-oxalacetic transaminase (SGOT) was 8.10±2.15γ (180 cases) and that of serum glutamic-pyruvic transaminase (SGPT) was 4.10±1.63 γ (120 cases). 2. SGOT was elevated but SGPT was unchanged in a case of acute myocardial infarction. In various kinds of liver diseases, especially in acute hepatitis, both were markedly elevated. 3. The clinical course and examination data of six representative cases were described and briefly discussed. 4. The difference of mobility between SGOT and SGPT was clinically and experimentally established from paper-electrophoretical studies. B. Experimental Studies: 1. Not only an increase of serum T activities but a decrease of liver T activities was found in CC14 treated mice. With these findings and the histological examination of the liver, it was confirmed that serum T activities was a good indicator of acute liver damage. 2. Localization of T in cellular fractions of liver homogenate was studied by Schneider's method. The decrease of T activities was most remarkable in the mitochondrial fraction, in CCI4 treated rabbits. 3. The increase of serum T activities was compared with the decrease of liver T activities in CC14 treated rabbits. In this study, total amount of increased serum T activities was calculated from the serum T activities per 0.1cc and the circulating plasma volume which was determined by radioactive phosphorus method. The ratio of increased SGOT to decreased liver GOT was 17.3% and it was 41% in GPT. Dr. Wroblewski's presentation, in which SGPT was clinically more useful than in SGOT in the detection of acute liver damage, was experimentally confirmed with these data.
The course of development of lesions in pulmonary tuberculosis varies, depending on the nature of infiltration and the position of the affected lung field. As a rule, the prognosis of the disease is influenced by such conditions as individual resistance, the bacterial virulence and the number of bacilli in the infection; but in some cases with a certain type and/or situation of infiltration, the infection is destined to get worse in spite of any other various individual conditions. One such case is that in which the lesion is in the upper left lung field. Apical lesions ordinarily have good prognosis, but a cavity in the apical field makes the lesion take a turn for the worse. The upper left location of the lesion is more serious than cavitation of the infiltration; that is, the upper left lesion will not only have poor prognosis, even if it has no cavity, but will also exert influence on the course of the lesion in the opposite right field if such exists. Generally, cases with TBB-positive sputum in culture show a tendency to worsen more than those with negative sputum; and the TBB-positive sputum is found most frequently in upper-left lesion cases and left cavity cases. Consequently, patients of left infiltration type with cavity and with bacilli-positive sputum will be most poor in prognosis. Cases in which sputum is found to be TBB-positive in smear tests are more serious than those in which the positive occurs only in culture tests. However, the occurence of cavity or concormitant lesion is of more serious import than bacillary findings, as factors related to prognosis of the disease. In particular these factors seriously affect the course of the left apical lesion; and it has been found that smear findings themselves are closely related with the presence of cavity in the lesion. As to haemoptysis, its seriousness depends on the stage in the clinical course in which it occurs. Haemoptysis, after chemotherapy has been applied to some degree, is a bad sign. When haemoptysis occurs in the middle and late stages of cases with left cavity, such cases will become more serious in the long run.
Normal subjects and patients with heart diseases, chronic pulmonary emphysema and other chronic pulmonary diseases were selected for this study. Samples of blood were taken simultaneously from pulmonary artery (mixed venous blood) and brachial artery (arterial blood) at rest, in anoxic state and under other conditions. Glucose, lactic acid, pyruvic acid, serum lipoprotein index, total serum cholesterol and serum phospholipid were checked up. Cardiac output was also measured by Fick as well as dye dilution methods. Carbohydrate and fat metabolism in the lung was studied from the aspects of the arterio-venous differences of the blood substances stated above, and the differences of values of cardiac output determined by two different methods (Fick and dye) were also studied from the standpoint of O2 consumption in the lung tissue. 1) Ratio of two values of cardiac output determined respectively by Fick method and dye dilution method was higher in the chronic pulmonary diseases than in the non-pulmonary diseases. 2) But there was not statistical significance in the arterio-venous differences of glucose, lactic acid and pyruvic acid at rest in general, including non-pulmonary diseases and pulmonary diseases. 3) In the chronic emphysema lactic acid showed higher concentration in the arterial blood than in the mixed venous blood and glucose had a tendency to show higher concentration in the mixed venous blood. 4) During exercise the concentration of lactic acid was decreased after the passage of the lung, and the concentration of glucose and pyruvic acid showed the same tendency to be decreased. But during IPPB/I using room air and during inhalation of 100% O2 or anoxia test, any significant changes were not observed in the concentrations of these 3 substances. 5) The ratio of coefficients of changes in cardiac output by Fick method and dyedilution method produced by exercise seemed to be higher than the ratio of coefficients of changes produced by the other conditions stated above. 6) Serum lipoprotein index and the concentration of total serum cholesterol were increased after the passage of the lung, and on the contrary they were decreased after the passage of myocardium.
Although a number of studies have been made on the respiratory reflex from the pressoreceptor, no one has ever proved the existence of the reflex from the renal vessels. In 1953 Page denied the existence of such reflex on the basis of his experiments on dogs. Thirty three dogs were used for this experiment: Under anesthesia with Ravonal, I have inserted cannula into the renal artery and renal vein and raised the pressure in the renal vessels up to 150-200 mmHg in order to observe influences on respiratory system. I have also conducted the same experiments after cutting in turn the nerves of carotid sinus, the vagus, the splanchnic nerves and all the nerves around the kidney. The results obtained are as follows: 1. The reflex of respiratory inhibition and the paradoxical respiratory reflex were observed by giving pressure to renal vessels. 2. The pattern of the reflex is markedly similar to the respiratory reflex of carotid sinus pressoreceptor. However, the degree of reflex is lower. 3. The reflex is antagonistic to the respiratory reflex of the carotid sinus pressoreceptor. 4. The centripetal nerves related to the reflex are mostly the nerves included in the abdominal vagus and the splanchnic nerves.