The dogs equipped with gastric fistula received one of the test solutions by the intravenous administration at the body weight dose of 50ml/Kg. The test solutions were 0.9% NaCl, 5% glucose, 5% mannitol, 4.5% NaCl, 20% glucose and 20% mannitol. After the administration, gastric secretion of the dog was stimulated by histamine. Consecutive 15 minute gastric juice samples were collected, and for each samples, total acidity, free acidity, [Na+], [K+], [Cl-], osmolarity of the gastric juice and that of the plasma were measured. The following results were obtained. 1) When dogs were loaded with isotonic solutions followed by the histamine stimulation, there were littel changes of [Cl-] and the osmolarity of the gastric juice. But at the case of hypertonic solutions, rising of [Cl-] and the osmolarity was observed. 2) Loadings with one of the three hypertonic solutions, which all caused the elevation of plasma osmolarity, differently influenced each other on the gastric secretion. Hypertonic solutions of NaCl and glucose, which are able to penetrate easily into the glandular cells, seemed to inhibit the rise of acidity at the histamine stimulation. However, this effect was never seen in the case of by pertonic mannitol solution. The same could be said about the acid output of gastric secretion. 3) When the plasma osmolarity was elevated, there were decreased volume and increased osmolarity of gastric juice in all cases studied. In the same experiments, deceased acidity of gastric juice was seen in the cases of NaCl and glucose. 4) Loading with 5% glucose solution promoted the gastric acid secretion.
It has been said that the function of the external secretion of the pancreas is related both to nervous control and humoral control. Study along these lines has been remarkably developed in the field of physiology and patho-physiology in recent years. In our series of experiments on the external secretion of the pancreas, gastrointestinal hormones (secretin, pancreozymin, ) nervous stimulants (epinephrine, pilocarpine, atropine), and pancreatic secretion inhibitors (acetazolamide, anti-kallikrein substance, trasylol), were used and the relationship between pancreatic secretion and pancreatic blood flow were studied. Plethysmogramm was used to measure the blood flow. Furthermore, observations of the influence of the above-mentioned drugs by electron-microscopy and histo-pathological methods, were carried on pancreas tissue. The following results were obtained: 1) Secretin increased the quantity of pancreatic blood flow and pancretic secretion at the same time, however, from the morphologic point of view, no progress was observed in the process of enzyme secretion in a pancreatic cell. 2) Pancreozymin increased the quantity of pancreatic blood flow and pancreatic secretion, however, it caused a lower ratio of increase compared with secretin. Also, from the morphologic point of view, enzyme secretion was observed to be remarkably similar to the electronmicroscopic findings of pilocarpine. Further, there may be some relationship between pancreozymin and nervous control. 3) In the use of epinephrine, decrease of pancreatic blood flow and decrease of pancreatic secretion were observed, however, in case of pilocarpine, the pancreatic blood flow decreased while pancreatic secretion increased indicating that the amount of pancreatic blood flow was not parallel to pancreatic secretion. 4) Histological findings indicated that pancreozymin has the function of stimulating pancreatic enzyme secretion. 5) The process of pancreatic external secretion, has both secretin function and pancreozymin function, and the functioning point of secretin is located in the centro-acinal cell and pancreatic ductal cell, while that of pancreozymin is located in the acinal basal cell.
Since the report on the gastroduodenal ulcers of dogs with the administration of"Cinchophen"was described by Churrchill in 1930, several studies have been reported on the experimental methods producing the ulcers. In this study, the gastroduodenal ulcers of dogs were experimentally produced by"Cinchophen"because they were easily produced and almost similar to those of human, macroscopically as well as microscopically. The recurrent process of the experimentally produced ulcers was precisely observed through the"per-peritoneal"gastroscope and compared with the endoscopic findings of human ulcers obtained in the clinical field. 1) The gastric ulcers could be made experimentally in almost 90% of the cases with the administration of 1g of"Cinchophen"daily during about 20 days. The ulcers were mostly found in the area with the pyloric gland in the stomach. Speaking how deep layers these ulcers reach, they were ranked as the grade of"Ul II"or"Ul III". Referring to the ulcers found in the marginal region between two areas with the fundic gland and with the pyloric gland or those found in the adjacent part of pyloric ring, most of the ulcers were deeper, being cassified to"Ul III"or"Ul IV". 2) Although the similarity of the endoscopic findings of the initial gastric ulcers between dogs and human seemed to depend partly on their stadium to be observed or their existing area, they found at the lesser curvature of the mid portion of stomach of dogs were almost similar to those of human. There were some differences in the surrounding conditions of the ulcers between dogs and human, that is, the abnormalities of the border of ulcers and the rugal convergence were less in dogs. The coagulated blood and the pieces of food were often found on the ulcer floor which was sometimes covered with white coat in dogs. 3) The recurrence or the aggravation of the ulcers could be produced experimentally by the re-administration of"Cinchophen"in 88% of the cases. 4) The recurrent ulcers were often found at the border section between the area with the fundic gland and the area with the pyloric gland and were observed to be deeply concave. This might be explained with the concept of"locus minoris resistentiae". The incurable ulcers in the clinical field could be also specified by their form, their marginal status and their location in which they were found. 5) The relationship between the initial ulcers and the recurrent ulcers was discussed. The recurrent ulcers were developed more frequently from the outer side of the border of the initial ulcers or riding on the margin of them than being coincident with them. 6) The comparison of the recurrent ulcers of dogs was made with those of human. The recurrent ulcers of dogs developing at the border of the scar of the initial ulcer could be easily differentiate from the early stage of the cancer of human be their form or their surroundings, while those recurred eccentrically to the scar could rather be confused with the early cancer (III+IIc). It has to be the prudential problem to differentiate the recurrent ulcer from the early stage of the gastric cancer in the clinical field. 7) In 6 of 17 dogs, 7 linear ulcers could be made recurrently. It was proved experimentally that the linear ulcers were produced through the repitition of the recurrence or the aggravation.
Operative cholangiography was performed selectively on 86 cases: 30 cases with choledocholithiasis, 23 cases with cholecystitis with or without stones, 13 cases with postcholecystectomy syndrome, 13 cases with malignant tumors of the bilary tract system, and 7 cases with other diseases of the biliary tract system. Marked dilatation of the cystic duct was noted very frequently in the operative cholangiograms of choledocholithiasis. This was confirmed by measuring the diameter of the cystic duct directly at cholecystectomies. Mean diameter of the cystic ducts without stones in the common bile duct was 3.4mm, while 19 cases of choledocholithiasis showed the diameter of 7.4mm. In patients with cholecystitis with or without stones, the most frequent indication for operative cholangiography was dilatation of the common bile duct. Dilatation of the cystic ducts, history of jaundice and small gall stones in the gall bladder were the next frequent indications. In a few cases, the anatomical location and the relation of the biliary tract to the surrounding organs were confirmed by operative cholangiography. Clinical studies of patients with postcholecystectomy syndrome revealed that if previous operations had been done carefully, the occurance of the syndrome could be minimized. Operative cholangiography was helpful in obtaining important findings of the syndrome necessary for the proper treatment. In malignant tumors involving the common bile duct, such as cancer of the head of the pancreas, cancer of the papilla Vaterii, and cancer of the gall bladder, typical cholangiographic patterns of V or U shaped endings were observed. No specific patterns were showen in the benign stricture of the common bile duct. From studies of 86 cases, the importance of operative cholangiography in the diagnosis and the treatment of biliary tract diseases was emphasized.
Reports of double primary lesion in esophagus and stomach are rather scarce and incidences have been reported between 0.3 and 0.5% of solitary esophageal carcinoma. Such cases have been seen in this hospital and incidences are 2.3% (8 cases among 346 cases of primary esophageal carcinoma). Considering the fact that gastric carcinoma is the commonest malignant tumor among Japanese, the incidences of double primary carcinoma should increase by careful and through examinations of the stomach.