1.ΣXyli. was quite high in the liver disease groups in contrast to the control, and there was no significant difference among ΣXyli. in liver cirrhosis, chronic hepatitis and acute hepatitis. 2. T-1/2 was significantly longer in liver cirrhosis than in the other liver diseases and in healthy controls. 3.ΣXyli. and T-1/2 had good correlation with BSP excretion, ICG disapperance rate, cholin esterase and A/G.ΣXyli. had a positive relation with S-GPT, whereas T-1/2 had no relation with it. 4. The amount of urinary excretion of xylitol in oral test was small and had a good correlation with ΣXyli. 5. After oral and intravenous administration of xylitol, there was almost no change in serum glucose level in healthy controls and in patients with liver diseases, while the serum glucose level showed remarkable elevation in diabetics. For the further studies on xylitol metabolism with relation to glucose metabolism in hepatic disorder, the experiments were carried out both in vivo and in vitro, using the normal and acute CCl4-damaged rats. 6. Both xylitol and glucose metabolism were disturbed in hepatic disorder, experimentally. 7. The gluconeogenesis from xylitol was disturbed in hepatic disorder. 8. Both in normal state and in hepatic disorder, xylitol metabolism was not depressed by the co-existence of glucose, and xylitol was more readily metabolized than glucose. 9. Glucose metabolism was considerably depressed by the co-existence of xylitol in normal state, but this depression was not clearly demonstrated in hepatic disorder
The pathogenesis of cinchophen gastric ulcer is a topic of interest and many factors have often been considered over the past years. However, no clear explanation has yet been given. Among all the factors affecting cinchophen-induced erosion and ulcer, gastric juice is one which cannot be overlooked. As the etiology index for stress-induced gastric ulcer in dog, mucosal pepsin was determined in the same way as gastric juice and the use of pepsin remnant ratio (PRR) was publicized. There exists an obvious quantitative relation in the ratio between normal and damaged surface of the gastric mucosa. It is convenient to apply the formula to clarify the mechanism of stress-induced superficial mucosal damage when large doses of cinchophen are administered to a dog. The formula is the ratio of mucosal pepsin unit per 0.1g of fundic mucosa divided by the pepsin unit per 1 ml of gastic juice. The following may be used in defining degrees of mucosal damage:(a) functionally normal, less than 5;(b) border zone, 6 or equal to 9;(c) fundic mucosal disorder, greater than 10. The result is that there are peak ratios, greater than 30, in dogs treated with large doses of cinchophen and dexamethasone. On the other hand, non-stimulated dogs as well as histamine and insulin-stimulated animals showed a ratio less than 5. Mean ratios of the former two groups are about 5 to 10 times as great as those of the latter. The importance of the role of corticosteroid in relation to gastric pepsin secretion was sufficiently estimated from the result of PRR measurements.
The differential diagnosis of obstructive from non-obstructive jaundice continues to be a problem for physicians. For this purpose percutaneous transhepatic cholangiography (PTC) is the most valuable procedure, but it used to be performed only prior to surgery because of its complications. Since 1968, the author has improved the technique in such a way that PTC is now safe method as performed by a physician in his ward. The site of puncture, decided after a cholangiotomographic study is on the lateral thorax in the seveth or eighth intercostal space at 11-12cm from the board on which the patient is lying. A needle, 15cm in length and 0.7mm in diameter, is directed toward the mid point between the vertex of the diaphragm on X-ray image and the superior flexure of the duodenum, easily visualized by a duodenal tube that has been passed beforehand. Five hundred and fifty-four examinations have been performed under X-ray television control using this new procedure, and satisfactory cholangiograms were obtained in 512 cases (92.4%). Even in non-obstructive jaundice the author succeeded in 36 (70.6%) out of the total 51 cases. The main complications were as follows, probable bile leakage in 2 cases, bleeding into the peritoneal cavity in 1, continuous high fever for several days after PTC in 4, lowered blood pressure in 4 and pneumothorax in 2. However, no fatal or severe complications requiring urgent surgical treatment have been experienced.
Roentgenological findings of 70 cases of gastric cancers in type Borrmann IV were studied comparatively with those of 30 cases of atrophic gastritis. The following findings were observed more frequently in cases of gastric cancer than in cases of atrophic gastritis. The findings were: 1) Granular irregularities of the stomach wall in barium-filled roentgenogram. 2) Increased width, caliber variation and granular irregularities of the mucosal fold. 3) Fine granularities, islets, irregular networks, wavings or fine filamentous findings in fine reliefs. The findings such as granularities, networks or verrucae of fine reliefs were more frequently observed in atrophic gastritis. The observed roentgenological findings of fine reliefs characteristic in gastric cancer, such as fine granularities, islets, irregular networks, wavings or fine filamentous findings might be usuful in detecting early gastric cancer.
Mallory body was very rarely encountered in alcoholic livers in Japan. Reason for this has been assumed to be a difference of race, nutrition, drinking manner and custom from those of western peoples. Recently 4 cases of alcoholic liver with Mallory bodies were found; two alcoholic hepatitis and two cirrhosis. All patients were under quite normal nutrition. According to Mallory's classification predominant type of Mallory bodies in three livers was a fine delicate form and in one liver exclusively a highly hyalinized coarse form. Coarse form of Mallory bodies was histochemically demonstrated to contain pyloninophilic, acidfast, PAS-negative substances associated with hydrophilic phospholipid and basic proteins. Clear demonstration of such substances except basic proteins was not obtained in a majority of fine form. This indicated that there were some differences in chemical composition between in coarse form and fine one. Statistical observation revealed that damage of hepatocyte with coarse form of Mallory bodies was more pronounced than that with fine form and extent of parenchymal destrution was correlated with a number of Mallory bodies in parenchyma. A liver from non-alcoholic patient of PBC and of diethylaminoethoxy hexoestrol-induced cirrhosis also revealed a presence of many fine and coarse form of Mallory bodies in hepatocytes. There were virtually no morphological and histochemical differences between in Mallory bodies of nonalcoholic livers and those of alcoholic liver, suggesting that Mallory bodies were not alcohol specific.
There were 10 cases of the Mallory-Weiss syndrome encountered in our hospital during the past five years. All of them were diagnosed by endoscopy. Four cases were thought to be caused by alcoholic vomiting. The incidence of the Mallory-Weiss syndrome caused by alcoholic vomiting is 18% of 43 cases in Japan, while 33% of 121 cases reported by Holmes. It has been said that the emetic action of alcohol is not exerted locally on gastrointestinal tract but rather on the nervous system. We have studied the endoscopic aspects of gastric mucosa before and after alcohol intake. Neuman reported the effect of intravenous injection of alcohol in 1954. These results indicated that the nervous system has an important role in the mechanism of alcoholic emetic action. In our 23 cases of upper gastrointestinal bleeding induced by alcohol intake, 17.4%(4 cases) showed the endoscopic finding of the Mallory-Weiss syndrome. The possible sources of the Mallory-Weiss syndrome should be considered in every patient who shows bleeding from the upper gastrointestinal tract after alcohol intake. X-ray examination is usually valuable only in ruling out other possible sources of bleeding. Endoscopy is the most successful in demonstrating the lesion. Endoscopic differential diagnosis between the artifical tear by endoscope and the real Mallory-Weiss syndrome will be another problem. The Malloy-Weiss syndrome can often be treated conservatively. But when bleeding continues under medical management, surgical intervention becomes necessary.