Chronic pancreatitis has been drawing much attention recently, and its diagnosis has been made clinically not infrequently. For diagnosing chronic pancreatitis, the usual means are amylase determination in urine and serum, glucose tolerance test, Vagostigmin test and Secretin test, pancreatic tender point test and the evaluation of subjective symptoms. In chronic pancreatitis, amylase activity in urine and serum was within normal limits and had no diagnostic significance. As to subjective symptoms, indefinite abdominal signs were noticed in the majority of the cases with chronic pancreatitis; however, since they were commonly found also among other disorders of the digestive organs, they did not seem to be characteristic for chronic pancreatitis. KUDO proposed the method of testing pancreatic tender point which was reported to be valuable as a supplementary diagnostic procedure. Further more, the author evaluated both Vagostigmin and secretin tests with the methods of Van-Loon-Yanaga. In chronic pancreatitis, Vagostigmin test was reported to be positive in 72-92% of the cases with chronic pancreatitis. The author compared it with the pancreatic tender point test. Vagostigmin test modified by Ottenstein-Baltzer-Yamagata, and anterior abdominal tender point of KUDO method, agreed in 86%. In comparison with Vagostigmin test modified by Van-Loon-Yanaga, they agree in 85%. Glucose tolerance test agreed i1181%of the cases studied with the anterior abdominal pancreatic tender point test of KUDO method. In addition, glucose tolerance test agreed in 88%of the cases studied with Vagostigmintest. The author compared the result of secretin test with the anterior abdominal pancreatic tender point test of KUDO method among 20 cases showing the positive tender point test. As far as the volume of the pancreatic juice obtained is concerned, they agreed in 65%, the maximum bicarbonate concentration in 65%, and amylase activity of the pancreatic juice in 55%. The secretin test was positive when two out of the above mentioned three compohents were abnormal. Thus, the result of the secretin test agreed with that of the pancreatic tender point test in 65%. As mentioned above, the pancreatic tender point paralleled well to the results of vagostigmin, glucose tolerance test and secretin test. Therefore, the pancreatic tender point test proposed by KUDO is simple and practical for diagnosing chronic pancreatitis and helpful to practitioners poorly equipped for various laboratory tests in their daily examination of many patients. Further more, it is an important supplementary diagnostic method for screening purpose. KUDO method The method of palpating the abdomen on recumbent position with both legs bent up and the lower back elevated.
Bromsulfophthalein (BSP) has been used extensively for testing hepatic function. Brauer and Pessotti discovered that a metabolic transformation of the BSP occurred in liver. Relatively little was known regarding its transport and metabolism. It is effected by the interrelated functions of hepatic uptake, stroage, conjugation, biliary excretion and bachward flow into the blood. These dynamic factors of BSP in the physiology of normal and of pathologic states have not yet been clearly established. This report presents BSP transport and metabolism in normal individuals and in patients with hepatic disorders. Blood samples were drawn at timed interval for 2 hours after single injection of 5 mg og BSP per kg of body weight. Plasma specimens were submitted to chromatographic analysis for the determination of free BSP (f-BSP) and conjugated BSP (c-BSP) using ascending paper chromatography with the solvent system of t-butanol: water. Metabolic ratio of BSP (per cent of c-BSP in total BSP) at timed interval exhibited rising value on a straight line for 45 to 60 minutes. Metabolic index (metabolic ratio per minute) was calculated during the straight line segment of metabolic ratio curve. Decay of f-BSP and c-BSP in plasma showed characteristic curves in normal subjects and in patients with cirrhosis and with obstructive jaundice. Metabolic index of normal subjects was distributed from 0.25 to 0.35. In acute phase of hepatitis it showed 0.10 and in convalescent phase of acute hepatitis was a return to normal. In most cases of cirrhosis metabolic index showed under 0.10 and in obstructive jaundice it showed within the normal range. From these results, decay of f-BSP and c-BSP in plasma and metabolic index seem to be excellent means of differentiating hepatocellular dysfunction and cholestasis.
Littoral cells constitute a considerable mass of the liver but their function has not been separated from that of the hepatocytes. In view of the possibility that the earliest changes might involve the former type of cells in diseases like viral hepatitis, the present study was carried out to elucicate the role the reticuloendothelialsystem in alterations of certain enzymes of the serum and tissue. Rats and rabbits were used and they were given intravenously either Thorotrast, india ink or glucan and serum and tissue GOT, GPT and alkaline phosphatase were determined in comparison with the control. Furthermore, histological studies after colloid administration, of the liver and spleen, as well as determinations of these enzymes in separated Kupffer cells were carried out. Kupffer cells were separated from hepatocytes by forced uptake of carbonyl iron colloid and magnetic collection of iron particle containing cells. The results indicated that serum GOT, GPT and aklaline phosphatase levels increased shortly after colloid administration and all colloids tested had more or less similar effects. Separated Kupffer cells were shown to contain considerable amounts of these enzymes as expressed per unit of nitrogen. These results seem to suggest that early changes in serum enzymes in certain diseases might reflect some alterations of the littoral cells of the liver.