Electronmicroscopic observations were made on parietal cell of 39 cases of gastric diseases (gastric cancer 16, gastric ulcer 5, gastric and duodenal ulcer 3, duodenal ulcer 5, polyp 3, gastritis 3). The purpose of the present paper is to elucidate the cytopathological significance of lysosome like body, myelin figure, large vacuole and lipid droplet. Relationship between parietal cell number, gastric acidity and these structures were also discussed. The results were as follows: 1) The ultrastructure of normal appearing parietal cell were similar as those observed by the most other investigators. 2) Nuclear deformity, mitochondrial deformity, lysosome like body (especially, secondary lysosome), myelin figure, large vacuole and lipid droplet were the changes or the structures rarely observed in normal appearing parietal cell. 3) Lysosome like bodies were identified ultrastructurally in 39 cases as lysosome, the most of which were the secondary lysosome. The parietal cell number was closely related to the presence of secondary lysosome. 4) Myelin figures were observed in parietal cells of 37 cases. In these cells, focal cytoplasmic degradation might be present. 5) The presence of large vacuole in 35 cases and the presence of lipid droplet in 28 cases were also thought to have some relationship with cell degradation. 6) Regarding to gastric acidity, decreased number of parietal cell was thought to be a more important factor than the presence of such an unusual structures as lysosome like body.
Much difficulty has been encountered in the diagnosis of lesions in the upper part of the stomach by ordinary X-ray or gastroscopic observation. The development of a backward photographing technique by using a flexible head gastrocamera enabled us to make a great improvement in diagnosis of lesions in this area. A review of my experience in 63 cases, which had been surveyed by combination of this technique and X-ray observation is reported in this paper. In most of the cases the observation was confirmed by surgical operation or by autopsy findings. The upper part of the stomach comprises cardia, fornix and the proximal third of the body of the stomach. Ordinary manipulation of gastrocamera or gastroscope is not suitable for seeing lesions in the upper part of the stomach because most of this region makes a blind area of the scope. Flexible head gastrocamera becomes useful for diagnosis of lesions in this part, when these apparatus are manipulated with a balloon inserted in the stomach so that the scope head faces cardiac area. The use of an apparatus equipped with a head which can be manipulated from outside was found to be most applicable. By using this technique, one can even see the oral boundery of the gastric cancer in this area. Unevenness of lesions in the upper part of the stomach is often exaggerated in a close up figure by ordinary techinique, but an exact figure can be obtained by using a flexible gastrocamera. About 10% of all the gastric ulcers were located in the upper part of the stomach. About one half of these distributed on the lesser curvature, one tenth on the anterior wall and the rest on the posterior wall. Kissing ulcers were very frequently found in the upper part of the stomach. Average age of the patients having ulcers in this part was higher than the average age of those having ulcers in the other part of the stomach. The upper gastric ulcer seems to be relatively difficult to heal. However, the upper gastric ulcer never resulted in perforation. Bleeding around the ulcer was seen in 35% of the cases with lesions in the upper part, while it happened only in 7% of the cases with lesions in the other part of the stomach. High folds and gothic arch formation of the high fold are valuable indirect signs for gastric ulcer. These were found in 36% of the cases of the upper gastric ulcer. Deformity of the cardiac ring, which can be seen only by use of a flexible head gastrocamera, was found to be another important indirect sign of the ulcer in cardiac area.
The purpose of this study was to clarify the interaction between pancreozymin (PZ) and cholinergic agents on the pancreatic and gastric acid secretion. In the experiments of the exocrine pancreas, continuous secretin infusion was done to sustain basal pancreatic flow and the effect of PZ on pancreatic enzyme secretion was observed on 16 conscious dogs with or without simultaneous administration of a cholinergic agent, methacholine. On the other hand, the effect of PZ on gastric acid secretion was investigated using three different kinds of gastric pouches on 17 concious dogs. Results obtained were as follows I Exocrine Pancreas 1) There was no significant difference in pancreatic enzyme secretion between vagal innervated group and denervated group. 2) PZ stimulated enzyme secretion from the gland when administered with methacoline simulatneously if doses of both stimulants were not so large; and if they were administered in large amounts, a mutual inhibition on pancreatic enzyme secretion was observed. 3) Atropine, an anticholinergic agent, remarkably blocked the pancreatic enzyme response which was provoked by the intravenous administration of PZ. II Gastric acid secretion 1) Regardless of the difference of gastric pouch, (Simple gastric fistula, Heidenhain pouch or Double pouch) PZ stimulated gastric acid secretion. 2) PZ, when given with methacholine brought more amount of gastric acid secretion than when it was administered alone. 3) PZ remarkably inhibited gastric acid secretion induced by extrinsic administration of gastrin or by intrinsic release of gastrin. 4) PZ also inhibitted gastric acid secretion induced by histamine. These observations lead us to a conception that nervous and humoral factors keep an intimate co-relation on the pancreatic enzyme secretion because it was suggested that both stimulants worked on the same receptor-site in the gland. As for the effects of PZ on gastric acid secretion, it was suggested that PZ itself stimulated oxyntic cells of the stomach and that PZ had a possibility to be enterogastrone as it inhibitted the gastric acid secretion induced by gastrin or by histamine.
The linear type of ulcer has been reported to be observed in the chronic course of the gastric ulcer. This study was made on the developing process of the linear ulcer of the dog with the administration of "Cinchophen" comparing two groups; one of which was given a single course and the other was given several courses of the administration of it. Additionally, the various types of the deformation of the ulcer in the healing stage was also observed. 1) Fifty adult dogs weighing 5 to 15kg were used. "Cinchophen" was administered to the dogs per os, in doses of 1-2gm. daily during 16.2 days on the average. The mean total dosage amounted to 16.6gm. The ulcer was found in 45 among 50 cases by necropsy. 2) Gastroscopic examination was often performed in 5 of 50 cases during the first course of the administration of "Cinchophen". In 2 of the 5 cases, the multiple longitudinally-lined-up erosions with hemorrhage were found and some of them developed to the linear ulcers. From this observation, the intensified tension of the stomach wall caused by high inner pressure due to the repeated vomitting was considered to be the most important factor inducing these lesions as rarely observed in the clinical field. This view would be supported by the similarity of genesis of Mallory-Weiss Syndrome. 3) The form of the ulcers produced by the first course of the administration of "Cinchophen" was mostly round or oval. The linear ulcer was found in 9 of 50 cases (18%), and in 5 of 9 cases the lesion was located in parallel with the stomach axis. In 2 cases, the linear ulcer was combined with the round ulcer. 4) Eighteen adult dogs weighing 5 to 14kg were provided for the study of the healing stage of the ulcer. The ulcer became smaller centripetally in most of the cases, while it contracted partly eccentrically in few cases. 5) Forty six adult dogs weighing 6 to 15kg were given several courses of "Cinchophen" administration. In this period, the healing and the aggravation were alternately observed especially by per-pertoneal endoscopy. The linear ulcers and the prodronal stage of linear ulcers were found in 21 of 46 cases. The ulcer often recurred adjacent to the preceding ulcer and the combination of the round ulcer and the linear one was also often observed. And these lesions experimentally thus produced were located at the border section between two areas with the different type of glands and were lined-up in the cross direction against the lesser curvature axis as usually observed in the clinical field. It is concluded that the various processes should be considered in the linear ulcer formation. For example, some of the ulcers located across the lesser curvature started in the linear type and some others changed their form from round to linear during the chronic course of the ulcer. The local factors would much influenced to the development and the deformation of the ulcers.