A study was made on fibrinolytic activity in the plasma ofl83patients consisting of 70 gastric ulcer, 58duodenal ulcer, and55gastric cancer patients. The plasma plasmin activity, as indicated by euglobulin lysis time, was generally elevated in the patients with gastric ulcer or duodenal ulcer, but less generally in the gastric cancer patients.In the gastric ulcer patients, the plasma plasmin activity appeared to be related to the size of the ulcer, i.e., the larger the size of the ulcer, the higher the activity.In the duodenal ulcer patients, the activity was higher in the cases in which the presence of niche was clearly evidenced by radiological examination, as compared with the cases in which only indirect evidence pointed to the ulcer.In contrast, the plasma plasmin activity had no definite relation to the type and size of the gastric cancer in the advanced cases, though, in 6 of the 7 cases of early gastric cancers with ulcer was it as high as in the cases of peptic ulcers. The plasma whole plasmin activity, as measured by streptokinase-activated euglobulin lysis time, also showed a similar tendency. Twenty gastric ulcer patients were periodically subjected to radiological and endoscopic examinations as well as the measurement of plasma plasmin activity during medical treatments. In160f them, the treatment was successful and in11of these16cases, the plasma plasmin activity returned to the normal value as the ulcer disapPeared, but in the rest5cases did the activity fractuate and showed no difinite tendency.In4cases in which the treatments were of no effect for more than6months, the plasma plasmin activity was persistently high.Similar findings were also obtained in21duodenal ulcer patients observed for a comparable period. The plasma anti-plasmin activity was measured by the fibrin plate method on18gastric ulcer, 20duodenal ulcer, and20gastric cancer patients.It apPeared low in the peptic ulcer patients and was nearly normal in the gastric cancer patients. The plasma fibrinogen level was within a normal range in all instances, irrespective of the diseases.
It was confirmed experimentally using 10 mature dogs that the scopic biopsy of the stomach by the forceps could be done successfully in yielding sufficient tissue for diagnosis without the risk.Then, the punch biopsy of the stomach under the observation with B type of F. G. S. was performed on 185 patients of the gastric cancer. The results: 1) The correct diagnosis of the gastric cancer with the scopic biopsy could be made on 156 cases among total of 185 cases (84.3%).Restricting to the early stage of the gastric cancer, the ratio became 26/28 (92.9%). 2) The percentages finding out the gastric cancer by the scopic biopsy were relatively low in type I and IV of Borrmann's macroscopic classification.There was not observed a high correlation between the spread of lesions and the possibility of the correct diagnosis of the gastric cancer. 3) Concerning the locations of the gastric cancer the correct diagnosis was easily made in the cases with the lesions at the lesser curvature of the inferior portion of the stmach body (97.1%), while it was difficult (66.7%) for example at the lesser curvature adjacent to the cardia, the anterior wall of the antrum or the pyloric canal, and generally at the greater curvature. 4) It was effective to take from 3 to 5 pieces of tissue from thelesions, avoiding to make the biopsy at the same location. 5) The relationship between the size of specimen and the possibility of the correct diagnosis of the gastric cancer was not recognized.If the several pieces of specimen with the diameter ranging from 1 to 4 mm were collected on one case, the hit percentage became 53.4-58.6%. Referring to the layers from which the specimen was taken there was only a small difference of the hit percentages between the pieces of specimen with (59.4%) or without (52.0%) muscularis mucosae.It can be suggested that the other than gastric mucosa is not neccessarily required for the biopsy diagnosis of the gastric cancer. 6) The percentages finding out the gastric cancer by the biopsy became as high as 53.8-73.1%, if the specimen was taken at the retracted portion or the edge of the concave form (II or III) of the early gastric cancer or at the top or the inner side of the thickened border surrounding the malignant ulcer (II or III type of Borrmann's classification);while the confidence of the diagnosis was obliged to turn vague if it was taken from theulcer floor covered by the necrotic degenerative tissue. 7) There was no accident such as haemorrhage or performation among 197 patients to whom the scopic biopsy of the stomach was performed.Only the slight fever was recognized in 2 cases. 8) As the factors leading to the misdiagnosis of the gastric cancer, the location of the lesions in the stomach was enumerated.As above-mentioned, at the adjacent portion to the cardia or at the greater curvature side of the antral region, the collection of the specimen is often failed because of the difficulty in handling of the B type F.G.S. or the forceps. The percentages of the correct diagnosis became also low, if the specimen was taken from the necrotic ulcer floor, the outer side of the thickened border of the ulcer or the surface of the tumor.The scopic observation was occasionally disturbed by haemorrage or refluent bile. 9) The scopic biopsy was considered to be very important for the diagnosis of the gastric cancer especially in earlier stage, as the other methods such as roentogenographic, endoscopic or cytologic examinations.
From my experience during 1963-1967 obvious steatorrhea was observed in 6 patients after entero-enterostomies using the method of I131 triolein test or analyzing fat content of feces in these patients. To elucidate ill effect of blind loop the following experiments were made in dogs: The test meal was consisted of 1000gm of dog food “Ken-L-Meal” manufactured by Quaker Oats Co. U. S. A., 2 gms of Cr203 and 50ml of soya-bean oil in mixture. The test meal was fed to dogs for 4 days and 4th day's feces was analyzed for its fat content and its Cr2O3 content by the method of van de Kamer (fat) and by the method of Dansky-Hill (Cr3O3). Dogs were operated as follows; (Group 1) Small intestine one meter distal from the dudeno-jejunal flexure was anastomosed side-to-side to the end of the ileum. So the small intestine was short-circuited. (Group 2) The small intestine between one meter distal from the duodeno-jejunal flexure and the end of the ileum was resected. (Group 3) The small intestine forming the loop in group 1 was resected after about three months postoperatively. Results; 1.Change of body weight; The dogs of group 1. lost their body weight gradually. On the contrary no body weight loss was observed in group 2. 2.Fat content of the feces and fat absorption; The fat content of feces was 0.81gm/100 gm wet feces in normal dogs, 4.50gm/100 gm wet feces in dogs of group 1 and 2.62gm/100 gm wet feces in dogs of group 2 on an average. The fat absorption coefficient were 94.1% in normal dogs, 52.3% in dogs of group 1 and 86.4% in dogs of group 2 on an average. 3.In autopsy and in surgery no remarkable stasis of intestinal content was observed. 4.The villi of the intestine showed no remarkable change. There are recently some studies concerning the cause of steatorrhea, but its mechanism is not fully clear. From my experiments I think that steatorrhea in group 1 was not only due to short-circuiting of meals in the intestinal canal but also due to existence of blind loopitself. In other words the blind loop per se is an important factor causative of Steatorrhea.