A study was made of 669 foci in 628 cases of gastric cancer surgically resected and 23 foci of gastric cancer in 23 autopsies on the basis of Japan Gastroenterological Endoscopic Society classification and Borrmann's classification at the Center for Adult Diseases, Osaka, during the past 7 years. The obtaned results were as follows: (1) Non-superficial cancer cases did not show a lesion resembling a flat type (IIb type)superficial cancer in gross appearance. A flat type (IIb type) superficial cancer was likely to develop into other cancerous types. (2) In non-superficial cancer, there were many lesions macroscopically resembling a depressed type with co-existing ulcer (IIc with converging folds, IIc+III and III type) of superficial cancer, suggesting that IIc converg, (+), IIc+III and III types might maintain their appearance throughout malignant progression. (3) By the gross appearance of lesion and findings of histologic malignant distribution in the gastric wall, gastric cancer was classified into 4 groups: A-group which mainly showsa protruded lesion without converging folds; B-group which shows a depressed lesion surrounded by marginal elevation without converging folds; C-group which mainly shows a depressed lesion with converging folds; D-group which is flat in appearance. A-group consisted of a protruded type (I type) and an elevated type (IIa type) in superficial cancer, and mainly Borrmann I and Borrmann II types in non-superficial cancer. B-group consisted of a protruded type with defect of the top (I defect (+) type) and a depressed type without converging folds (IIc converg. (-) type), and mainly Borrman II type, C-group consisted of depressed and concaved types with co-existing ulcer (IIc converg. (+), IIc+III and III type), and mainly Borrmann III type, D-group consisted of flat type (IIb type), and mainly Borrmann IV type, respectively. (4) Types in the same group resembled to each other on clinicopathological findings. But these findings were extremely different between superficial cancer and non-superficialcancer in D-group only. Such resemblance leads to a probability that there is a shift or interchange among the types in the same group, except for D-group. D-group of non-superficial cancer clinicopathologically resembled C-group of superficial cancer, suggesting that a certain depressed type (IIc type) might develop into Borrmann IV type. (5) C-group showed a very high incidence of advanced cancer. The incidence of A- and B-groups in advanced cancer was lower than that in superficial cancer, suggesting that A- and B-groups in superficial cancer transformed into C-group in advanced cancer, and all gastric cancer finally transformed into Borrmann III type.
The effect of antacids on gastric pH was observed using telemetering pH capsules and phenol red test meal method. 1. The comparative observations in vitro on the pH of the various buffer solutions (pH 2-7) and various foods were done between the Heiderberger's pH capsule and glass electrode. The error within pH 0.5 was occasionally detected in case of buffer solutions, and that ranging pH 0.5-1.0 was seen in case of various foods. 2. The secretory volume and the acid out put measured by means of phenol red test meal (50ml) were proved to be applicable to judge the effect of the drugs and the diet on the gastric functions, although those values were calculated somewhat higher than those with Kay's method. 3. The gastric pH pattern was different from one antacid to another. After oral or intragastric administration of each usual dosis of the various antacids, the antacid effect was seen as long as 40 minutes or less in most cases. Effect of the commercial granules containing Aluminium hydroxide was not so marked, and the duration of the effect was shorter. 4. The alkali time by means of alkalitest (50ml of 1% Na. bicarbonate) could not be appreciated as the index of the secretory function. In vitro observations showed that the alkali time was dependent not only on the acid secretion but on the emptying of the stomach, the influence of the latter being especially marked in cases of the acidity between 10-30 mEq/l.
The bile of resected gall bladders was drawn off and cultured both aerobically and anaerobically (by Steel-Wool Method) in 100 cases of cholecystitis and/or cholelithiasis. 1) The bacilli are isolated in 46 cases (46%) out of 100 cases: 13 cases (13%) of anaerobic, 29 cases (29%) of aerobic and 4 cases (4%) of combined infection. 2) The average count of bacilli in 0.5ml of bile are 104.3 in anaerobes and 106.6 in aerobes. 3) The strains of isolated anaerobes were 6 strains of Corynebacterium, 5 of Eubacterium, 2 of Clostridium welchii, 1 of Bacteroides, 2 of Peptostreptococci and 1 of Veillonella. The ratio between rods and cocci was 82.3% to 17.7%. 4) High fever is seen in aerobic (34.5%) anaerobic (30.8%) and combined infections(25.0%). 5) Upon histological examinations of removed gallbladder, it is concluded that non-spore forming anaerobes may participate in causing acute and chronic cholecystitis. 6) The non-spore forming anaerobes are proved to be highly sensitive to TC, DMC-TC, DOTC, AB-PC, MCI-PC, CER, CET, Fs, AT and moderately sensitive to PC, CP, EM, OM, LM, LCM and GM. Low sensitivity is encountered in KM, SM, NA, SX and CL. 7) Anaerobes are highly sensitive to various bile acid such as cholic acid, desoxycholic acid, Sodium taurocholate and sodium glycocholate, compared with aerobes. The difference of the sensitivity to the bile acids between aerobes and anaerobes may reflect upon the difference of the detection rate (7:3) between both organism groups in bileduct infections.
I Morphological characteristics of exfoliated gastric cells. Exfoliated gastric cells in advanced carcinoma, early carcinoma, ulcer, polyp, and normal lining epithelium were studied by means of phase contrast microscopy and morphological characteristics of each disease entity were disclosed. (1) Irregular nucleoli appeared most frequently in cancer particulary in early carcinoma of the type IIa. (2) Mitochondria was small in size and number in carcinoma cells. (3) In fresh specimen, the nuclear membrane of advanced cancer cells appeared thickened, whereas that of benign cells were usually not thickened, and the cells of early carcinoma were placed in the middle. In an early period of degeneration, the increase in nuclear wall material showed different appearances in malignant and benign cells; it appeared irregulary serrated in the former whereas smooth thickening was noted in the latter. (4) The appearances of halo around the nucleoli and of chromatin about the nucleoli are also of diagnostic value. In most of malignant cells the halo is clear with little chromatin granules within the area, whereas in non-malignant cells chromatin agrregates towards the nucleoli with some decrease in volume in the area of halo.