Endoscopic pancreatocholangiography (EPCG) with the fiberduodenoscope was successfully performed in 73 cases with a rate of 85%. Of these 65 were pancreatographies, 25 were cholangiographies and both were obtained on 17 examinations. 1) The mean maximum diameter of the main pancreatic duct (MPD) in 50 pancreatograms interpeted as normal was 3.3±0.8mm. As a rule, the ducts were wider in male and patients over the age of 50 than in female and younger subjects. 2) Type of the course of the main pancreatic duct was classified into the ollowing four types. The ascending and horizontal types were most often observed, while the sigmoid and decending types were less often found. 3) The mean length of MPD in 50 pancreatograms interpreted as normal was 16.3± 2.6cm. A tendency to be longer in the length of the duct in male and younger subjects was noted. 4) The ampulla of MPD was found in four cases or 8.0% of 50 cases. 5) The duct of Santorini was visualized in 20 cases or 40% of 50 cases, and the mean length of the duct was 2.4±0.5cm and the mean maximum diameter of the duct was 1.4±0.5mm. Ampulla-like dilatation of the duct of Santorini was seen in 7 cases or 35% of the 20 cases and the mean length was 3.0±1.3mm and the mean maximum diameter was 2.7±1.4mm. 6) Opacification of the fine pancreatic ducts and acinar tissue were successful in 23 or 35.4% of 65 pancreatograms and in 15 or 65.2% of the 23 cases complate opacification of the whole pancreatic glands was obtained. 7) Of 25 cases with endoscopic cholangiogram (ECG) the gall bladder was visualized in 17 cases, the hepatic ducts and the intrahepatic bile ducts in 15 cases. The mean maximum diameter of the common bile duct in normal ECG was 6.7±0.9mm, 5.3±1.2mm in normal EPCG. 8) The common channel was revealed in 13 or 76.5% of 17 cases with EPCG, and the separate type of the ducts in 4 cases or 23.5%. The mean length of the common channel was 12.2±4.1mm, the mean maximum diameter of the channel was 4.8±2.0mm. 9) In about half the cases with opacified MPD and the branches and in all cases demonstrating the fine pancreatic ducts and acinar tissue a trandient, mild to moderate elevation in serum amylase occurred after the examination. However, all elevations of serum amylase returned to normal within 48 hours and the clinical picture of acute pancreatitis was presented in none. Antibiotics were administered to all cases and trasylol was also given to some cases. 10) Abnormalities of pancreatic duct system were seen on 9 or 13.8% of 65 EPG; four of pancreatic carcionma, one of pancreatic tumors, one of compression by an extrinsic tumors mass, two of advrnced chronic pancreatitis and one of minimal chronic pancreatitis. In 6 or 24% of 25 ECG abnormal findings were demonstrated; four of cholelithiasis and choledocholithiasis, one of tumor of the common bile duct and one of metastatic liver carcinoma.
The cause of vitamin B12 malabsorption has not as yet been understood. The role of increased bacteria in the intestine has been emphasized because of the effect of antibiotics. However, various other hypotheses have also been proposed because of inconsistency of the effect of antibiotics. The present study aimed at elucidating the role of intestinal flora. In rats, a filling or an emptying loop was prepared at 1/4 position of the small intestine either proximally or distally. In the dog, only a filling loop was prepared. 57Co-B12 wa given orally and feces were collected for absorption at timed intervals from the operation. It was found that absorption was reduced increasingly with time in rats with the filling loop made proximally. The bacterial counts were significantly greater in the area where the loop was attached. In the dog, similar reduction of B12 absorption was seen. The small intestine was removed after the administration of radio-B12 and the distribution of radioactivity was determined. It was found that the control dogs took up much greater amounts of B12 in the ileal mucosa than the loop dogs. The radioactivity in the intestinal sediment was insignifant in both groups. Furthermore, the radioactivity in the supernatant was all nondialyzable, suggesting that B12 given per os was bound to the gastric binder. It seems that the difference in the ileal uptake was caused not so much by the bacterial uptake but rather by a difference caused by bacterial population in the capacitiy of the mucosa to take up B12.
Ultracentrifugal separation and analysis of chylomicron, very low, low and high density lipoproteins in the sera from patients with metastatic liver cancer were carried out. A study was made on the relationship between lipoprotein and alkaline phosphatase (Al-P) on cellogel electrophoresis. 1) On cellogel electrophoresis, the serum Al-P isozyme of a patient with metastatic liver cancer was divided into Band I and II. Band I which corresponds to macromolecular Al-P is characteristic of matastatic liver cancer. 2) Band I was determined only in the high density lipoprotein (HDL) fraction. This result indicates that the density of Band I is very close to that of HDL. 3) Electrophoretic mobility of macromolecular Al-P was the same with that of HDL. 4) No relationship was found between Band II which corresponds to small molecular weight Al-P and lipoprotein. 5) By treatment with receptor destroying enzyme of the serum, the electrophoretic mobility of the lipoproteins remained unchanged. However Band I was detached from HDL and moved toward the origin. Band II, unrelated to lipoprotein, moved also toward the origin. This results suggest that Al-P bands contain a large quantity of sialic acid.
The distension of the gastric wall gas great influence on the endoscopic appearance of the chronic gastritis. The aim of this investigation is to analyze the fundamental relation between them. The author believed that the tension of the gastric wall would be reflected more correctly by the intragastric pressure than by the insufflated volume of the air. The endoscopic findings, such as mucosal visible vessels, flat elevation of the intestinal metaplasia and thickness of the gigantic folds, were analyzed dynamically in relation to the changes of the intragastric pressure by the help of a manometric recorder. As the result, intragastric pressure showed liniar co-relation to the insufflated volume of the air in every case. The visualization of the mucosal vessels were conventionally classified into three groups. A-1; visual vessels with the pressure more than 10mmHg. A-2; visualization within the pressure 5-10mmHg. A-3; visualization only below 5mmHg. The histological investigation through biopsy was also carried out to evaluate the grade of atrophy. The influence of intragastric pressure on the appearance of the flat elevation of intestinal metaplasia was classified into three grades. D-1; visualizztion of this elevation with the pressure below 15mmHg. D-2; visualization within the pressure 15-20mmHg. D-3; visualization with the pressure even more than 20mmHg. Histological confirmation of metaplasia was done by biopsy. The groping of the gigantic folds were as follows: F-1; complete flattening of folds within the pressure of 15mmHg. F-2; incomplete but noticable flattening of the folds with the pressure more than 15mmHg. F-3; maintenance of initial thickness of folds with maximum tolerant pressure. Only this F-3 would be regarded as real"giant rugae". In conclusion, the effect of the intragastric pressure should always be borne in mind during the endoscopic diagnosis of chronic gastritis.