The author studied enzyme activity of the gastrointestinal mucosa. The materials consisted of surgically obtained specimens and peroral or peranal biopsy specimens. The human specimens examined included normal and pathological conditions, (gastritis with or without intestinal metaplasia, gastric ulcer, gastric carcinoma, gastric polyp, duodenal ulcer, exudative gastroenteropathy, primary and secondary malabsorption syndrome, postgastrectomy syndrome, rectal carcinoma, rectal polyp, ulcerative colitis, etc.) The study was made also in animals: intestinal metaplasia of the stomach in rats (induced by 20-methylcholanthrene), gastric ulcer (by lanthanum-gel) and acute gastritis (by aspirin) in dogs. The following enzymes were studied histochemically: alkaline phosphatase, acid phosphatase, adenosine triphosphatase, 5' nucleotidase, glucose-6-phosphatase, cytochrome oxidase, lactate dehydrogenase, succinate dehydrogenase, glutamate dehydrogenase and leucine aminopeptidase. The activity of alkaline phosphatase, 5' nucleotidase, lactate dehydrogenase and leucine aminopeptidase was measured also biochemically. The results were as follows: 1) The normal mucosa of the gastrointestinal tract had its organ-specific enzyme pattern. 2) In atrophic gastritis without intestinal metaplasia, enzyme pattern did not change. In the area of intestinal metaplasia, however, enzyme distribution changed from gastric to intestinal pattern. This change was found also in the experimentally induced intestinal metaplasia in rats. 3) The floor and edge of peptic ulcer showed high activity of alkaline phosphatase and other phosphatases, but this phenomenon was not observed in experimental acute ulcer of dog stomach. 4) Enzyme activity in carcinoma cases showed no unanimous pattern. The enzyme pattern varied from case to case. 5) In exudative gastroenteropathy and malabsorption syndrome, the activity of several enzymes, especially alkaline phosphatase, acid phosphatase, adenosine triphosphatase and succinate dehydrogenase, decreased in the jejunum. 6) In some post-gastrectomy cases, the activity of some enzymes decreased in the jejunum. 7) In ulcerative colitis, the enzyme activity varied according to the stage of the disease.
Although normal human serum alkaline phosphatase is known to be divided into, c.everal fractions by electrophoresis, the number of fractions may vary from 2 to 8 according to different investigators. The disagreement, however, is generally tought to be due to the difference in supporting media of the electrophoresis. Through the studies on the supernatant of organ homogenatesandimmunoelectrophoresis, these fractions are considered to derive from bones, small intestines, and liver. Utilizing polyacrylamide as a supporting medium for discphoresis and staining according to the method of Burstone, the author has found that the alkaline phosphatase of normal human serum can be stained into 2 bands, i.e. one in the proximity of beta-2 globulin, and another between beta-2-globulin and transferrin. The alkaline phosphatase of normal rat serum was stained also into 2 bands, one near transferrin, and another near fast-alpha-2 globulin. The author has named them “slow band” and “fast band”, respectively, according to the mobility of electrophoresis. The location of slow band corresponds to the faster part of the bands obtained from small intestine homogenates; and that of fast band similar to the one from liver homogenates. The bands of akaline phosphatase of bone and kidney homogenates did not correspond to those of serum alkaline phosphatase, namely the enzyme by author's method can be stained into 2 bands similar to those of liver and small intestine homogenates. When the 2 bands were expressed in terms of density ratio, the slow band of normal human serum gave 21±4.4%(mean±standard deviation); that of healthy rat serum 23±4.9%. Accordingly, it was demonstrated that the fast band of alkaline phosphatase as predominant both in human and rat sera.
To elecidate the mechanism of serum alkaline phosphatase elevation in obstructive jaundice, the author has investigated activities of intrahepatic alkaline phosphatase, serum total alkaline phosphatase, and 2 fractions of the serum enzyme by disc-phoresis in rats after the ligation of biliary ducts with or wihtout resection of the small intestines. The activity of intrahepatic alkaline phosphatase was found in the wall of sinusoids and Glisson's sheaths. There was no significant difference in the activity in sinusoidal wall between the control group and the treated groups; a strong stainability was demonstrated in Glisson's sheaths in the group of biliary duct ligation after 4 days. The activity of total serum alkaline phosphatase in treated groups was elevated. In the group with biliary duct ligation alone, the activity reached its maximum on the 3rd day, reducing rapidly thereafter to the lowest on the 7th day, then tended to increase again. In the group with biliary duct ligation with small intestine resection, the activity was obviously lower than the other treated group, and reelevation of the activity was not observed. The stainability of the 2nd bands of the enzyme obtained by Disc-phoresis was characterized by an initial increase of fast band after treatment followed by a reduction associated with a gradual increase of slow band in the group of biliary duct ligation. In the group with biliary duct ligation and small intestine resection, there was a moderate initial posttreatment increase with a gradual reduction thereafter; there was little increase in the intensity of slow band. From the foregoing data it was concluded that the elevation of the activity of serum alkaline phosphatase in obstructive jaundice in rats can be divided into initial and latter phases, and that small intestines are playing some role in the latter elevation of the enzyme in Glisson's sheaths of the liver.
In the serum of the patients with obstructive jaundice, the phospholipid levelswere remarkably elevated, and they were significantly lowered in the patients with chronic hepatitis and liver cirrhosis. Those who showed low serum phospholipid levels in spite of severe jaundice had far advanced hepatocellular damages and died within few months after the measurements. The serum phospholipids were fractionated with silicic acid impregnated paper-chromatography. The decreased level of lysolecithin reflected the hepatocellular damages. Lecithin, which occupies the majar part of serum phospholipids, are responsible for the alteration of total serum phospholipid level. Fatty acid compisition of these serum phospholipids were studied with gas-chromato graphy. Linolecic and arachidonic acid levels were significantly decreased in the patients of chronic hepatitis and liver cirrhosis, which suggested the distrubed metabolism of these essential fatty acids in these patients.
Materials and Purpose: Comparing the x-ray findings of 63 lesions in 58 cases of early gastric cancer with those of 105 cases for control experiment, I have studied x-ray diagnosis of early gastric cancer, especially of superficial types of early gastric cancer. The technique in detecting early gastric cancer, the interpretation of films, the diagnostic ability of x-ray examination, the limitations of x-ray diagnosis and the differential diagnosis were investigated. Results: 1) In order to find a lesion of superficial, elevated type, compression which belongs to our fluoroscopic table can satisfactorily demonstrate a lesion up to 2 cm. in diameter. 2) For the purpose of detecting a superficial, depressed type, it is the best to use the double contrast method effectively. To get satisfactory radiographic details with double contrast method the stomach of the patient should be distended moderately with an adequate amount of air. 3) A lesion of superficial, depressed type larger than 4 cm. is easily detected with the double contrast method. In detecting a lesion of superficial, depressed type with the size of 2 to 4 cm. in diameter a strict taking of films and a strict interpretation of films should be required. The double contrast method which is effectively performed can clearly demonstrate the findings of the central part of the lesion and the gastric mucosa surrounding the lesion. 4) The double contrast method in the prone position is not only indispensable but very effective to find a lesion on the anterior gastric wall. 5) Supplemental endoscopic examination is needed in order to find a small early cancers and early cancers on the anterior wall of the stomach. 6) All kinds of lesions which have to be differentiated roentgenologically from early gastric cancer have been noted. When we encounter the x-ray findings that suggest an early gastric cancer hereafter, we have to deal with these x-ray findings considering the lesion which have to be differentiated from early gastric cancer.