Achalasia of the esophagus is one of very common diseases of the esophagus, even thoughits etiology remains obscure yet. Although many hypotheses about its cause have been proposed since last century, therehas been no hypothesis which has been generally accepted except one that a feature of achalasiamight be neuromuscular disturbance. This study was undertaken to define the neuropathological changes of the esophagus inachalasia. The specimens of the esophagus taken from twenty six patients of achalasia at the time ofoperation and total esophagus which was taken from three necropsy caseswere studied.The eso phagus, the stomach and the intestine of normal three adults were also investigated as acontrol. The specimens obtained from operative cases were cut at 5mm intervals and the esophagusof necropsy cases was also cut in same fashion from the cardia to the pharynx. All sectionswere stained with hematoxylin-eosin solution. Results were summarized as follows: 1. Thirty five per cent of ganglion cells of Auerbach's plexus in normal gastrointestinal tract was observed to be morphologically abnormal and these cells could not be differentiatedfrom degenerated ganglion cells in achalasia. Therefore, quantitative analysis of ganglion cellswas very important. 2. Degeneration or complete absence of myenteric ganglion cells was observed in theesophagus, especially in the middle and lower esophagus. In the upper part of the esophagusa few ganglion cells remained in normal or various degenerative forms. 3. Small round cells were observed infiltrating into the myeteric plexus which ganglioncells almost disappeared or were degenerated. This finding was seen in 27 out of 28 cases, especially in early cases. This phenomenonmight be postulated due to specific inflammatory changes of the Auerbach's plexus of the esophagus, because in surrounding tissue of Auerbach's ple, cus there was no small cell infiltration. 4. There was no morphological or quantitative difference of myenteric ganglion cells ofthe stomach and the intestine between in achalasia and controls 5. The hypertrophy of the inner circular muscle layer of the esophagus, which was possiblydue to compensatory hypertrophy, was observed especially in the middle part of the esophagus.
The main bile constituents, cholesterol, phospholipids and bile acids were determined inbile both from the gallbladder and the common duct in cases of cystic duct occlusion by animpacted calculus. The concentration of these substances were markedly decreased in bladderbile, the degree of which corresponding with the appearance of the bile and the structuralchanges of the gallbladder wall. The changes were not proportional, but, phospholipids andbile acids decreased more than cholesterol and made the condition of cholesterol solubilityworse. In common duct bile, all of cholesterol, phospholipids and bile acids were increasedstatistically significantly, compared to cholecystolithiasis without cystic duct occlusion. Thedefection of concentrating activity of the gallbladder could be substituted by liver or bile ductto some extent.
100 cases of early gastric cancer had been found in the periad of approximately 3 yearsfrom May 1962 to June 1965 at the National Cancer Center Hospital, Tokyo, Japan. Meanwhile, the total number of out-patients including the patients who complained of no gastrointestinaldisorder, were 46, 384.968 gastrectomy hed been performed and then 542 gastric cancer, 222 gastric ulcer and 62 gastric polypi were disclosed pathohistologically. Clinically 53 casesof early gastric cancer had been detected and diagnosed correctly by means of only X-rayexamination applied double contrast technique. Comparative study on the findings of thepre-operative X-ray films with the findings of the roentgenograms of their specimens (X-raypictures of the specimens filled with adequatea mounts of barium meal and air for demonstratingvery minute changes of gastric mucosa) in cases of 243 resected stomach including 43 earlygastric cancer had been done. According to the result, s, the diagnostic criteria on X-rayfindings for early gastric cancer excluding the cases of Type IIb has been established satisfactory.It has been also emphasized that the X-ray examination with double contrast techniquewas more effective and conclusive for detecting and demonstrating such flat lesion asearly gastric cancer, especially Type IIc. In addition, review of X-ray films in the cases of the 100 early gastric cancer induced thatthe barium filled stomach in upright position was very important and effective to detect suchsmall and flat gastric lesion as early gastric cancer. of 89 casesovt of the 100, cirtain deformitystomach such as widened gastric angle, shortened lesser curvature or unusual indentationof gastric wall et cetra, has been noticed on the X-ray films taken with the patient in uprightposition.