1) A patient, 46-year-old man, with liver cirrhosis and a large stone in the common bile duct, who had been under severe control of dietary fats for a long time, was given tricaprilic acid triglyceride (MCT) instead of fatty meal. During four months' administration of MCT his body weight increased from 46.5kg to 53.5kg and his troubles such as intermittent high fever and abdominal pain attack occurred less frequently than before, so that a less contractive effect of MCT on the gallbladder was presumed. 2) To ascertain this presumption, 22 subjects showing positive cholecystogram with Telepaque were studied as follows. Half of them was given MCT as the contract agent of the gallbladder and the other half was given cotton seed oil, one of long chain triglyceride (LCT). Cholecystographic examination was performed in three steps in each case; the first was carried out by an ordinary technique with Telepaque. Immediately after that, MCT or LCT was given, followed by the second shot 40 minutes later. Yolk tablets were then given and the third was carried out further 40 minutes later. The spell of the gallbladder shadow on each upright spot film was measured. These results indicate that the gallbladder is less influenced by MCT than by LCT regarding to its contraction. 3) Based on the above findings, Meulengracht value in duodenal fluid was examined in ten subjects using MCT or LCT as the contract agent. It was also shown by this method that MCT was lower than LCT in the contracting potency. 4) In conclusion, MCT have far less contractive effect on the gallbladder and is useful in the management of patients with biliary disturbances.
The diagnosis of chronic pancreatitis remains difficult in spite of the various methods of examination. In this report, the diagnostic value of the cholangiogram in chronic pancreatitis is studied from clinical observations of 107 cases of miscellaneous disease including 25 cases of chronic pancreatitis, and to clarify the significance of the cholangiogram the histological relationship between the duodenal papilla and the pancreas from autopsy materials is studied. The results are as follows: 1. Cholangiograms associated with chronic pancreatitis are classified into the four types from deformities of the pancreatic segment of common duct. 1) Type of rigidity and straightening 2) Type of rigidity and spindle-form 3) Type of reversed C curve 4) Type of localized stenosis 2. The cholangiographic types concern the pathogenesis of chronic pancreatitis. The rigidity and straightening type closely correlates with alcoholic pancreatitis and the rigidity and spindle-form type closely correlates with biliary pancreatitis. 3. Concerning the diagnostic validity of chronic pancreatitis from cholangiograms classified into the four types, the false negative is observed in 13.0% and the false positive is observed in 28.6%. 4. The duodenal papillae with cholelithiasis freqently show diffuse fibrosis and round cell infiltration. 5. Diffuse chronic inflammatory changes in the duodenal papillae correlate with the pancreatic round cell infiltration.
There are many unsolved problems on the pathogenesis of splenomegaly in portal hypertension. A hemodynamic study on the spleen was carried out in experimental and clinical portal hypertension using trapezoidal-wave electromagnetic flowmeter of our own device. 1. In 8 control dogs, splenic arterial flow (SAF) was 193.8±49.4ml/min (mean± S.E.) and a significant correlation was observed between SAF and spleen weight (SW) (r=0.97, p<0.001). The SAF/SW averaged 1.82±0.283ml/min/gm. 2. In 5 dogs with presinusoidal obstruction induced by Amberlite particles, SAF indicated a significant increase and splenic enlargement was observed. The correlation coefficient between SAF and spleen length was r=0.93 (p<0.001). On the contrary, there was neither SAF increase nor splenic enlargement in 3 dogs with postsinusoidal obstruction by hepatic vein constriction, while portal venous flow (PVF) was significantly increased due to increase in mesenteric venous flow. 3. Clinically, SAF was measured in 13 patients with portal hypertension (prehepatic obstruction 2 presinusoidal obstruction 6, postsinusoidal obstruction 5 and 3 controls). A significant degree of correlation was found between SAF and SW (r=0.90, p<0.001) regardless of the type of portal hypertension, and the mean SAF/SW was 0.415±0.040ml/min/gm. 4. There was a fair degree of correlation between the calibre of splenic artery and SW as well, as measured on celiac arteriograms in 15 patients. The ratio of the calibres of splenic and portal veins was found to be related to the degree of portosystemic collateral development on portograms. These observations support that the determinant of the splenic arterial flow (SAF) is the degree of the splenomegaly.
It was reported that in the radiographic findings a gastric ulcer scar in simple round form was composed of a convergence of mucosal folds and mucosal pattern of the ulcer scar. This mucosal pattern was considered to be less than 7mm in diameter. It is indicated in this study that an ulcer scar with more larger size was observed and showed complicated findings on X-ray. These ulcer scars, which have histologic ruptures of muscular layer being 10mm or more in short diameter, were named as a zone of ulcer scar by the author here in this paper. In this paper X-ray and microscopic findings of resected stomach were compared. Out of 116 patients with resected stomach operated as benign gastric ulcer in our hospital, 8 cases were found with zone of ulcer scar. The long axes of these zones of ulcer scar were from 18 to 48mm in diameter, and the long axes were crossed rectangularly by the long axis of the stomach. The form of the zone of ulcer scar were elliptical and were located at or near the gastric angle, and 7 cases of which had small ulcers in it. These small ulcers proved to be uncurable through long term radiographic observation. In the zone of ulcer scar in resected stomach were macroscopically found an interruption of convergence of mucosal folds, a slightly depression of the mucosa and irregularity of the gastric area. In addition, there were changes of color and lustre in the mucosa. The X-ray findings of zone of ulcer scar showed an interruption of convergencing mucosal folds and an irregularity of gastric area on double contrast radiography, and also limited rigidity of gastric margin on barium filled film. A macroscopic observation and a radiographic examination were compared with histologic findings of zone of ulcer scar. The zone of ulcer scar was detected more easily on radiographic examination than on gross observation of resected stomach.