Though the diagnosis of early gastric cancer has recently been made more and more accurate, there are still difficulties remaining in the recognition of small and early malignant changes or in differential diagnosis of some atypical morbid conditions from other common gastric diseases. In order to remove these difficulties, a highly magnificated fiber-gastroscope has recently been developed, but it is frequently disturbed by mucous covering the gastric surface. We tried to clean the mucous by Gascon drop and the cleaning efficacy was checked by scanning electron microscope. We also observed gastric spirillum appearing on the gastric surface by scanning electron microscope. Materials and Methods: Two rhesus monkeys were used, whose stomachs were immediately removed and washed in 150ml of 10% Gascon drop-water solution, once in one monkey and twice in the other. The specimens were taken at corpus and antrum, fixed with 2.5% buffered glutaraldehyde (pH7.5) and then dehydrated with acetone and coated with gold about 100A thick. They were examined with the scanning electron microscope, type JSM-U3. Results: Gastric area, sulcus, and the surface of the surface mucous cells were successfully observed and photos were taken clearly in the specimen washed twice, but not in the specimen washed only once. In the cleansed surface, the large number of microvilli of 400 or 500A in diameter were recognized all over surface mucous cells. In the specimen washed only once, these characteristic features were not observed so distinctly, while microspirals sized 60μ in length and 0.95μ in diameter were clearly observed in them.
The mechanisms of hyperbilirubinemia caused by obstructive jaundice, intrahepatic cholestasis and acute hepatitis were studied experimentally and clinically. For obstructive jaundice which is a typical disease of conjugated hyperbilirubinemia, they were investigated in animal experiments, where after intravenous injection of 3H-bilirubin to bile duct ligated rats, the changes of plasma 3H-bilirubin concentration and the liver microautoradiograms were observed. For intrahepatic cholestasis and acute hepatitis, they were investigated with obstructive jaundice in clinical cases, where conjugated and unconjugated bilirubin concentrations in the sera were determined by use of Weber-Schalm's method and the proportions of the conjugated to the unconjugated were observed. From the results, it could be concluded that 1) the conjugated hyperbilirubinemia of obstructive jaundice is due to the disturbance of the liver cell's biliary excretion so that conjugated bilirubin overflowing the liver cell directly enters the blood stream, 2) the conjugation of bilibubin by the liver is not disturbed in obstructive jaundice, 3) the disturbed uptake of bilirubin by the liver takes part in the unconjugated hyperbilirubinemia of obstructive jaundice, 4) the mechanism of jaundice in intrahepatic cholestasis is similar to that of obstructive jaundice, 5) the uptake and conjugation of bilirubin by the liver is more disturbed in acute hepatitis than in obstructive jaundice, 6) the grade of the conjugated hyperbilirubinemia is closely related to that of the unconjugated hyperbilirubinemia in these three diseases, 7) Weber-Schalm's method is practically useful to determine conjugated and unconjugated bilirubin in the serum.
The present paper deals with the results of follow-up study of patients underwent various types of gastrectomies on benign disease of stomach and duodenum at our surgery department with special reference to the chemical balance study. The subjects of the present studies are 28 cases of pylorus-preserving gastrectomy, seven cases of segmental gastrectomy, 19 cases of Billroth 1 operation and 20 cases of Billroth 11 operation. The result of present chemical balance study may lead to the following conclusion. Pylorus-preserving gastrectomy is the most physiological operation followed by segmental gastrectomy and Billroth 1 operation. Billroth 11 operation is not a physiological operation when compared with other types of gastrectomies since the procedure diverts the duodenum from the passway of the gastric contents and empties them directly into the jejunum.
Clinical and pathological relationship between the biliary diseases and the liver changes was studied by the percutaneous transhepatic cholangiography, the liver biopsy and the liver scanning using radioactive colloidal gold. Results: (1) The dilatation of intrahepatic bile ducts was correlated intimately with the levels of icteric index, serum alkaline phosphatase, and the degree of bile stasis with ductular proliferation of the liver. (2) Sclerotic figures of intrahepatic bile ducts were found in the biliary diseases especially choledocholithiasis, in which fibrosis of the liver was remarkable. (3) Central filling defect of the liver scanning was found in the biliary diseases, in which intrahepatic bile ducts were markedly dilatated.