Recently medium chain triglyceride has been used for the treatment of fat malabsorption syndromes, as it has been widely thought that MCT is more easily hydrolyzed and absorbed than LCT. The purpose of this study is to investigate the mechanism by which MCT is more readily absorbed than LCT. The intestinal lipolysis and absorption of MCT were compared with those of LCT under various experimental conditions. Male albino rats weighing 120-150g were used in four groups, that is normal, bile duct ligated, pancreatic duct ligated, and both bile and pancreatic duct ligated group. Test meals containing trioctanoin-1-14C or tripalmitin-1-14C were administered into the duodenum. Lipids of intestinal contents, intestinal wall and portal blood were extracted, assayed for radioactivity and then analyzed by thin-layer chromatography and autoradiography therof. In the other series of experiments in vitro, trioctanoin-1-14C or tripalmitin-1-14C were incubated with albumin solution (phosphate buffer, pH 7.4), varying taurocholic acid concentration, varying steapsin concentration at 37.5°C and analyzed with florisil column chromatography. In the further experiments, steapsin was replaced by the rat pancreatic juice or the rat intestinal mucosal homogenates. MCT is in need of intraluminal lipolysis prior to the intestinal absorption. Both MCT and LCT are injured in absorption in the case of insufficiency of the flow of bile or pancreatic juice. But the extent of disturbance in absorption is smaller in MCT than LCT. Taurocholic acid and steapsin show lipolytic activity to MCT as equal as to LCT. Retention ratio in intestinal mucosa of MCT and that of LCT are very low, but the former is lesser than the latter. MCT is mostly hydrolyzed by pancreatic lipase with the aid of bile acid in the intestinal lumen, and a small amount of intact MCT and its lower glycerides, which are not hydrolyzed in the intestinal lumen, are hydrolyzed completely by intestinal lipase in mucosa. Most of released FA from MCT enter the portal vein. It is thought that a little of intact MCT enter the intestinal mucosa, but it cannot enter the portal vein. The mechanism, by which MCT is more easily and rapidly absorbed than LCT, is that the released FA from MCT is transported via portal flow, which is more rapid than lymphatic flow.
Seventy hundred and sixty one patients of cholelithiasis, who had been operated at twenty two hospitals in Aomori prefecture from 1964 to 1969, were investigated into the distribution of area, age, sex, occupation and so on. 1) Gallstones were classified into cholesterin stones, and pigmented calcium stones. Generally speaking, cholesterin stones and pigmented calcium stones were found in equal ratio in Aomori prefecture. In western part of the prefecture faced the Japan Sea, pigmented calcium stones got an advantage over cholesterin stones, but in some cities of the eastern part of the prefecture, cholesterin stones were predominant. In other districts, both stones were found in nearly equal ratio. 2) On the basis of vital statistics classified in age, 60 to 69 years old were the most frequent age to have gallstones. Pigmented calcium stones were less common than cholesterin stones among patients of age between 10 to 49 years old. Among older patients, pigmented calcium stones were almost equally frequent as cholesterin stones. 3) Women had much tendencies to have gallstones especially cholesterin stones. Pigmented calcium stones were equally distributed in men and women. 4) Divided the patients with cholelithiasis into professional and laboring groups, the laboring group existed in between 30 to 80 per cent of the patients, which were nearly equal to the ratio of inhabitants in these area. We should confirm that one of the reason why cholestrin stones were increasing at some cities in the prefecture recently might be the result of the increase of the number of professional group. Whereas, decreasing of pigmented calcium stones in other area might be the result of the decrease of the number of laboring group in the area.
Clinical and histopathological studies were made on 39 cases of erosive gastritis among the 227 cases of resected stomach specimen of benign ulcer. The results are as follows: 1) Erosive gastritis accompaning ulcer was observed in 17.2%. Highest incidence was observed in gastroduodenal ulcer, followed by duodenal ulcer, gastric ulcer respectively. 2) Erosive gastritis was more common in the male and most of the cases were the patients. between the age of 20 to 60. 3) Commonest complaint of the patient with erosive gastritis was abdominal pain. Bleeding was approximately 10%. Duration of complaint was about 6 months in average. 4) Examining occult blood, the positive rate was greater in the erosive gastritis with ulcer in comparison to the control. 5) Most of the cases of erosive gastritis showed hyperacidity of gastric juice. 6) Macroscopical observation revealed that most of the cases were diffuse protruded verioliform type and no cases of mixed type (protruded and excavated) were present. An exceptional case demonstrated diffuse protruded lesion on all over the mucosal surface from cardia to pylorus. Sometimes it is difficult to differentiate erosive gastritis from early stomach cancer and careful caution is necessary to establish the diagnosis. 7) Histologically, atrophy of pyloric gland and intestinal metaplasia is less common in erosive gasgritis. Lymphfollicular hyperplasia was observed in some degree. 8) It can be considered that erosive gastritis may appear during the course of mucosal atrophy. Repeated changes between erosion and regeneration may finally produce high grade of mucosal atrophy.
The clinical course of acute infectious hepatitis was studied in 49 patients, in special references to the significance of initial values of liver function tests, and to the evaluation of effectiveness of essential phospholipid. Fifteen patients of them were treated with essential phospholipid and compared with another 34 control patients. Essential phospholipid is now well recognized as an important component of cell membranes, mitochondria and microsomes, and an indispensable substance for the maintenance of various enzyme activities. It was considered that the changes of GPT had the advantage of representing the course of acute infectious hepatitis. Then, the relationship was investigated between the initial values of liver functions and the duration of disease (period of abnormal GPT values), and the following results were obtained. 1) Both sex and age were not correlated to the duration of disease, in either group. 2) Initial value of serum total bilirubin was not exactly related to the duration of disease in either group. 3) Initial value of GPT was correlated to the duration of disease in the group treated with essential phospholipid. The result was contrasted to the finding of the control group. 4) GOT changed in parallel with GPT. 5) De Ritis ratio was determined to show the value less than 1.0 in all cases. 6) Initial values of Al-P, LDH, CCF, TTT, ZTT and γ-globulin were also determined. It appeared that there was no relationship between any of these values and the duration of disease. 7) It was observed that GPT returned to the normal level earlier in the group treated with essential phospholipid than in the control group.