Etiology of gastric ulcer has remained as a subject of further investigation and few papers so far reported dealt with the systematic study concerning the etiologic factor of local circulatory disturbance. In this study, an experimental production of gastric ulcers was attempted by ligating gastric vessels accompanied with or without histamine injections. A total of 62 adult mongrel dogs were divided into five groups and after each preparation specific to the group, macroscopic findings of the gastric mucosa, microscopic findings, incidence of ulcer production and gastric acidity were observed. Duration of observations ranged from one to four weeks. Group I dogs were given a daily histamine injection only. In Group II dogs, all the gastric and gastroepiploic arteries were ligated. Group III dogs were subjected to the same preparation as in Group II followed by a daily histamine injection. Group IV dogs were subjected to the ligation of all the gastric as well as gastroepiploic vessels. In Group V dogs, daily histamine injection was given following the same preparation as done in Group IV. Single injection of histamine contained 50mg of histamine dichlotride mixed in beeswax and the injection was continued daily until the date of sacrifice. The results obtained are summarized as follows: 1) Microscopic findings of ulcers: Experimental gastric ulcers produced either by histamine injection or by ligation of vessels, or combination of both were well similar to those seen in human. However, proliferation of the connective tissue at and adjacent to the ulcer base was absent and yet most of them were shallow ulcers. 2) Incidence of gastric ulcer: Incidences of gastric ulcer production were 15.4% in Group I, 50% in Group II, 0% in Group III, 30.8% in Group IV and 100% in Group V. 3) Gastric acidity in relation to ligation of vessels: Gastric acidity in group IV was much lower than the one in Group I which was not subjected to the ligation of gastric vessels. These results obtained in the present experiment suggest the importance of decrease in mucosal resistance as an etiologic factor of gastric ulcer rather than a factor of gastric acidity.
The histochemical study was made on human gallbladder, surgically resected due to cholelithiasis. Eight enzymes, alkaline phosphatase (Al-P), acid phosphatase (Ac-P), adenosinetriphosphatase (ATPase), non-specific esterase (Est), leucine aminopeptidase (LAP), monoamine oxidase (MAO), lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) were stained. In slightly inflammed gallbladder epithelium, Al-P and ATPase did not show activity, but LAP and MAO were faint or slight; Ac-P, Est, LDH and SDH were clearly positive. Rokitansky-Aschoff sinuses were observed in 86.0% of surgically resected gallbladders. The epithelium of RA sinuses had the same activity (or a little weaker) as the epithelium of villi. Glands were observed in 41.2% in body and fundus. In glands, Al-P, ATPase and LAP did not show activity, but Est, MAO and SDH faint; Ac-P and LDH slight in activity. In strawberry gallbladder, foam cells showed moderate or strong activity, on the other hand, the epithelium showed the same activity in every enzyme as the slightly inflammed gallbladder.
In a series of 143 selected patients on abdominal surgery, the cholecystic bile, choledochal bile, duodenum, jejunum, ileum and transverse colon contents were collected. From each of the specimens, Escherichia coli were isolated and antibiotic sensitivity of them were determined, and the ecology and physiopathology of E. coil in the human digestive system were discussed. 1) In most of cases in whom E. coli were detected in the biliary tract, E. coli were also detected in the duodenum and jejunum. 2) In the group of stomach cancer, the incidence of E coli in the duodenum was 25%, in jejunum 28.1%, cholecystic bile 8.8% and choledochal bile 3.1%. 3) In the group of peptic ulcer, E. coli were not frequently detected in the upper digestive tract, including biliary tract. 4) The detection rate of E. coli in the terminal ileum is varied with the kinds of disease. 5) There was no difference in the detection rate of E. coli in the transverse colon in all kinds of disease. 6) 68.6% of all isolated strains of E. coli was drug resistant to tetracycline, 66.0% to chloramphenicol, 41.2% to streptomycin, 34.6% to colistin and 31.1% to kanamycin. 7) There was no difference in the drug resistance in all strains of E. coli isolated from different anatomical parts. 8) Two-drug resistant to tetracycline and chloramphenicol was 60.1% with the highest rate, and 27.3% to kanamycin and colistin with the lowest rate. 9) Three-drug resistant to tetracycline, chloramphenicol and streptomycin was 37.1% with the highest rate, and 23.1% to kanamycin, streptomycin and colistin with the lowest rate. 10) Four-drug resistant to tetracycline, chloramphenicol, kanamycin and streptomycin was 26.6% with the highest rate, and 21.7% to kanamycin, streptomycin, colistin and tetracycline with the lowest rate. 11) The resistance to all tested drugs was found in 19.5% of all isolated strains of E. coli.
In 20 selected cases of acute viral hepatitis, which showed typical onset with jaundice, serial biopsies were carried out. The first biopsy was done within the initial 3 months and the second one was done during the next 2 to 36 months. Histologial findings of the first biopay specimens were diveded into 2 types according to the characteristics of the fibrotic tissues surrounding the bile duct and vessels (fibrotic area), especially the number of vessels included within the fibrotic area. This area was supposed to represent the size of the necrotic area of the liver at the initial stage. The histological criteria of each type was as follows: Type I: Number of the fibrotec areas including one vein within it was over 60% of the total fibrotic areas of each biopsy specimen, but fibrotic areas including more than three veins were quite rare (less than 5% of the total area). Type III; Over 25% of total fibrotic area included more than three veins within it. Type II; Intermediate characteristics between Types I and III. The type found on histological study in the first biopsy and the second one were unchanged in 17 cases (85%), indicating that the character of each type do not change greatly during the course of acute hepatitis. Twenty cases of acute viral hepatitis were divided into 8 cases of type I, 9 cases of type II, and 3 cases of type III. Seven out of 8 cases classified as type I showed the normal levels of the various liver function tests within the initial 4 months (normal course). The initially abnormal hepatic tests in one case of type I and 6 out of 9 cases with type II returned to the normal levels in 4 to 12 months (protracted course). Three cases of type II and all cases with type III still showed abnormal levels of the hepatic tests after 12 months and showed histological features of chronic hepatitis (chronic course). The histological findings such as: focal necrosis, hepatic cell regeneration, acidophilic body, Kupffer's cell mobilization, and increased number of intralobular bile ducts, were most prominent in type III. The histological features of type II or III were more frequently found in the cases of posttransfusion hepatitis, which showed protracted or chronic course, than in the cases of infectious hepatitis. These results suggest that the clinical course or prognosis of acute viral hepatitis is strongly affected by the size of destructive area of the liver occurring at the initial stage. Histological classification during the initial stage is very useful in evaluating the prognosis of acute viral hepatitis.
Case Report.-A 76 years old woman was admitted with a palpable mass in the epigastric region and post-prandial discomfort of the stomach. One year prior to admission, the patient had noted a small mass in the epigastric region wich gradually grew in size. This was followed by post-prandial discomfort of the stomach (fullness). She had not complained of weightloss, abdominal pain, anorexia, nausea, vomiting, or bloody stool. At the time of admission, an apple-sized mass was palpable in the epigastric region. Blood picture showed no anemia, but stool examination was positive for occult blood. Gastrointestinal roentgenogram revealed an out-pocketing filling defect suggesting a large ulcer of the lesser curvature. Gastroscopic examination confirmed that this ulcer was formed in the gastric tumor and cancer with ulceration was suspected. Subtotal gastric resection was performed. Pathological examination disclosed an exogastric leiomyosarcoma of the stomach with ulceration of the overlying mucosa and located on the somewhat anterior aspect of the lesser curvature and measuring 10×10×8cm. in size. No metastasis was found. The patient is alive and well at present, a little over 2 years post-operatively. Discussion.-Leiomyosarcoma of the stomach is very rare in Japan, constituting only 0.8% of all gastric malignancies. It is probably because of the high incidence of gastric cancer. The majority of leiomyosarcoma of the stomach are not diagnosed before operation. The differential diagnosis of cancer and this tumor is of great importance, because the prognosis of this tumor, post-operatively, is better than that of cancer. We emphasize that the indication for surgery should not be determined only by the duration of the course and size of the tumor.