Since Bayliss and Starling discovered secretin in 1902, humoral factors have been considered to play major role in the regulation of pancreatic secretion, but nervous factors have been supposed to play only a minor role. There are few studies on the relationship between the central nervous system and pancreatic secretion, though many experimental and clinical experiences are encouraging to reevaluation nervous controls on pancreatic secretion. Influence of the central nervous system on pancreatic secretion was studied on 36 cats in the present work. Experiments consisted of the following three parts. 1) Observation on pancreatic secretion by means of electrical stimulation to the anterior part of the hypothalamus and to the anterior cingulate, using the stereotaxic apparatus. 2) Observation of pancreatic secretion after administration of neostigmine. 3) Gross and histological studies on the pancreas and other organs by means of chronic electrical stimulation to the anterior part of the hypothalamus and administration of reserpine or acetylcholine. Results obtained from these experiments are; 1) Each cat showed different level of basal pancreatic secretion, maintained by intravenous administration of 0.1unit/min secretin. Neostigmine increased amylase activity but did not change the flow rate of pancreatic juice. 3) Slight decrease of the flow rate of the juice began one hour after the stimulation of the anterior part of the hypothalamus, and amylase concentration and output began slightly increase immediately after the stimulation to reach the maximum after four hours. 4) The flow rate of the juice slightly decreased till the third hour but increased through after the fouth hour of the stimulation of the anterior cingulate, while concentration and output of amylase decreased through after the stimulation. 5) As for chronic experiments using permanent implanted electrodes into the anterior part of the hypothalamus, neither gross nor histological changes in the pancreas were observed after the electric stimulation and after the simultaneous or alone administration of reserpine or acetylcholine. 6) Ulcers in the stomach or the duodenum were observed after the administration of reserpine or acetylcholine, but no ulcer was induced by the electric stimulation of the anterior part of the hypothalamus.
As a method of gastric lavage cytology, a washing method with acetate buffered solution containing α-chymotrypsin has been used widely because of a simple apparatus and easy technique and good results. Therefore this procedure became a routine method for gastric cytology. However washing by this procedure was not so effective to obtain cells from a small lesion such as early gastric cancer because the washing was blind. In order to improve this procedure we invented a new apparatus which was a Hirschowitz's fiberscope attached a nasogastric tube, and presented an idea and procedures of lavage cytology under direct vision, which was a method to obtain cells by direct washing observing the lesion by this apparatus. In 1965 Fiberscope-K type based on our ideas for gastric lavage cytology under direct vision was made by Machida Company. With this Fiberscope-K type excellent results were obtained. As a new apparatus in which the angle of a nozzle to spout washing solution can be changeable was invented in early 1966, direct washing for any lesion of the stomach became possible without any difficulities. Thereafter GFC with an angle and FGS-C were made and recently FGS-CL with a light-guide was invented. Diagnostic accuracy had increased remarkably by this procedure. The diagnostic accuracy was 96.4% for all stomach cancers and 94.4% (corrected diagnostic accuracy 97.1%) for early cancer respectively. In the early time when this procedure was begun, the location of a lesion in the stomach affected greatly making an accurate diagnosis. But this problem regarding the location of a lesion was resolved with the improvement of instruments. The advantages of this procedure are as follows. 1) As the lesion can be washed directly, good results in diagnosis of a small lesion such as early cancer can be obtained. 2) Cancer cells are easily exfoliated for strong washing, and many cancer cells as group can be obtained. 3) Degeneration of cancer cells is little because enzyme is unnecessary as physical power is used for washing and washing time is short.
Studies on 131I-triolein absorption in patients with various diseases revealed that malabsorption occured in many patients after gastrointestinal surgery. In patients with intestinal resection or anastomosis, gastrojejunostomy by Billroth II after gastrectomy resulted in more marked malabsorption than by Billroth I, and a severe one after total gastrectomy. In patients with postoperative diarrhea, or malabsorption syndrome, chiefly of fat, total fatty acids and phospholipids in serum were measured; resection of stomach and small intestine brought about lowering of total fatty acids down to nearly 150mg/dl, whereas phospholipids were low in cases with Billorth II gastrectomy or cases with resection of the small intestine 3 years or more previously and high in cases with hemicolectomy. Studies of changes in each fatty acid showed only the same difference except in case of gastroilesotomy. Decrease of unsaturated fatty acids, particularly of linoleic acid, was seen, thereby ensuing a marked lowering of L/O ratio. Total fatty acids in the liver and mucosa of terminal ileum of the dogs undergone various operations were measured. A prominent lowering of fatty acids was seen in the liver after resection of lower jejunum and upper ileum, and after resection of lower jejunum and total ileum. Fatty acids in the mucosa of terminal ileum were lowered in all cases not related to types of operation. In the liver stearic acid was high whereas oleic acid and palmitoleic acid were low. Stearic acid was high in the mucosa of terminal ileum. Oleic acid was not affected, but linoleic acid was raised, though to a minor extent, while palmitoleic acid was lowered. Further postoperative studies with dogs revealed that in the liver the amount of phospholipids was lowered to various extent in all cases not related to the types of resection. However, the amount was raised in the mucosa of terminal ileum, on the contrary, particularly in the two groups where total fatty acids were low. Cholesterol was definitely high in the liver, especially of the cases with upper gastrointestinal operation. A similar result was obtained in the mucosa of terminal ileum though changes were less marked than in the liver. Changes in the amount of fatty acids, phospholipids and cholesterol in serum and in the liver and the mucosa of terminal ileum indicate that a significant change in the metabolism of fat is taking place in cases of postoperative malabsorption. It is interesting that changes of serum fatty acids in postoperative malabsorption have similarity to that seen in the development of arteriosclerosis.
It has been pointed out that in protein-losing gastroenteropathy there is often generalized anomalies of the entire lymphatic systems of the body (Pomerantz, M. & Waldmann, T.A., 1963). The authors have recently experienced a typical case of primary protein-losing gastroenteropathy in which very interesting lymphographical findings were observed. The mechanism of development of this disease is discussed in the light of these lymphographical abnormalities. 1) Thoracic ductogram: Two thoracic ducts were visualized with marked tortuosity and partial sinusoidal dilatation, indicating the presence of obstruction at the inflow site of the thoracic ducts in the vein and their consequent backward saccular dilatation. 2) Retroperitoneal lymphogram: The characteristic abnormalities included marked dilatation of the citernal chyli, obstruction at the beginning of the thoracic duct next to the cisterna chyli, marked dilatation of the retroperitoneal lymphatic vessels with many fine, tortuous lymphatic nets and retrograde lymphography, suggestive of communication with the intestinal lymphatic vessels. The lymph nodes were poorly outlined, of grossly punctate internal structure or moth-eaten. These findings were consistent with wide-spread hypoplasia or destruction of the lymph nodes. 3) Lymphography of the lower extremities: The left side is almost normal. The right side showed obstruction at the inguinal region with marked dilatation, increase and tortuosity of the peripheral lymphatic vessels and formation of the collateral lymphatics as well as dermal backflow. On the basis of these findings, it is stressed that abnormalities of the entire lymphatic systems play an important role in the development of the protein-losing gastroenteropathy.
One hundred and twelve patients with gastric diseases (46 gastric carcinoma, 40 gastric ulcer, 11 duodenal ulcer, 9 chronic gastritis, 2 gastric polyp, 1 sarcoma and 3 normal stomach) who had gastrectomy at the 1st Department of Surgery, Tokyo Medical and Dental University were chosen for this study. The specimens were silver-impregnated by Kubota's method and intramural nerves were observed together with the other pathological changes of the stomach, clinical signs and symptoms. 1) The pathological changes of intramural nerves in gastric carcinoma were varied with the types of infiltration by carcinoma (INF) and were minimal in INF γ, and/or scirrhous carcinoma. 2) Normal myelinated nerve fibers were identified in the center of carcinoma in 13 cases and were interpreted as regenerated sensory fibers. They were seen more in INF γ and/or scirrhous carcinoma and were correlated with clinical complain of pain. 3) The pathological changes of intramural nerves adjacent to gastric ulcers (Ul II & III) revealed that they were not primary factor for the genesis of ulcer. 4) Neuroma or bundles of normal appearing nerve fibers were seen at the base of ulcer and were interpreted as regenerated sensory fibers as seen in gastric carcinoma. 5) The pathological changes of submucosal nerves were varied with degrees of mucosal changes in cases with gastritis and were interpreted as secondary to gastritis. 6) The intramural nerves in gastric polyp were not identified. The pathological changes of intramural nerves in gastric lymphosarcoma were less than those with carcinoma. 7) The pathological changes of intramural nerves were correlated with clinical signs and symptoms such as anorexia, nausea, vomiting and low proteinemia. 8) The abnormal tension and peristalsis of the stomach and the abnormal HCl secretion were due not only to changes of muscularis propria and gastric mucosa but also to those of intramural nervous changes.