Author studied hypotonic duodenograms taken from 18 cases confirmed to be carcinoma of the head of the pancreas by pathohistological findings and gross pathology either at autopsy or surgical operation. Of the 18 cases, 12 were the ones who only underwent exploratory laparotomy to whom pancreaticoduodenectomy proved to be impossible. Of them 7 cases had cancer invasion of the entire head of the pancreas. The remaining 5 cases, though the cancer was localized in a portion of the pancreas head, were the ones not operated on because of metastasis to other organs. Therefore, these 12 cases include the cases developing to ampullary carcinoma, and choledochus carcinoma aside from carcinoma of the pancreas. Their roentgenograms may briefly be summarized as follows. 1) The angle of the flexura inferior duodeni tends to become an arc shape at the supine posture. 2) Looking at the mobility of various portions of the duodenum by roentgenograms taken at the supine and upright postures, in most cases the mobility was limited to the direction horizontal to the body axis. 3) By the duodenograms 39% of the cases showed signs of compression of the duodenal bulb due to the swelling of the gall bladder, and this was confirmed by surgical operation. This was also found to be related to jaundice. In the majority of them there could be observed signs of compression and filling defects on the marginal regions of duodenal bulb due to the tumor of the head of the pancreas. The wall of the second portion of the duodenum was compressed by the tumor of the pancreas head making the margin and mucosal pattern as well as filling defects clearly visible, and this picture agreed well with findings at surgical operation. The barium double contrastradiographs demonstrated clearly the inward compression of the duodenal mucosa, and the conditions of compression due to the tumor coincided well with surgical findings. The localization of tumor could be determined by counting the number of duodenal circular folds. Likewise, in the case of infiltrative carcinoma of the head of the pancrease the duodenal wall showed clearly rigid and compression signs. The double contrastradiograph revealed distinctly the circular mucosal folds converging towards ulcerated area of the deudenum, and these findings were confirmed surgically. Of the 18 cases two had carcinoma of the pancreas head complicated with duodenal diverticula, one of which gave normal roentgenogram of diverticulum while the other revealed the rigidity on the deformed wall in the roentgenogram of the diverticulum. In hypotonic radiography of carcinoma of the head of the pancreas, stiffness, straightening and compression of the postero-medial wall, which result from tumour compression or carcinoma infiltration, are generally well depicted. Diagnosis of diseases accompanying these morphological changes should be made with the aid of selective angiography and radioisotope photoscanning.
Determination of amylase activities of human saliva and pancreatic juice was carried out using a chromogenic method, Amylase Test Daiichi (ATD) method. The assay showed a linear correlation between amylase activity and enzyme concentration below 3, 500 iu/l. Substrate differentiation of human pancreatic and salivary amylases was studied using the methods of ATD, Remazol Brilliant Blue R Starch (RBB), and Caraway. Human salivary amylase digested the substrates used in the ATD and Caraway's methods more easily than human pancreatic amylase when both amylase activities were assayed simultaneously by the three methods. Super-normal amylase values caused by increase of salivary amylase could become definite above-normal values when assayed by the ATD or Caraway's methods instead of RBB method. On the other hand, human pancreatic amylase hydrolyzed the RBB starch more easily than the substrates of the ATD and Caraway's methods. This suggests that supernormal values caused by increase of pancreatic amylase could become above-normal when determined by the RBB method instead of the ATD or Caraway's method.
Pathogenesis of a peptic ulcer in patients with hepatic cirrhosis is still unknown. In order to elucidate this pathogenesis the present study was performed, in which endogenous histamine metabolism was investigated in rats with injured liver by carbon tetrachloride and the following results were obtained. 1) The number of degranulated mast cells and the histamine content were higher in rats with injured liver than those in intact rats. The pH of gastric juice was lower in rats with injured liver than that in intact rats. 2) Following an administration of an accelerant to the secretion of gastric juice the number of degranulated mast cells and the histamine content have increased and the pH of gastric juice has lowered both in rats with injured liver and in intact rats. However these findings were more markedly seen in rats with injured liver as compared with those in intact rats. 3) Following an administration of a suppressant to the secretion of gastric juice the number of degranulated mast cells, histamine content and pH of gastric juice did not change markedly in rats with injured liver as well as in intact rats. 4) The stress such as fasting or restraint gave rise to an increase in the number of degranulated mast cells and in the histamine content of the grandular stomach and a lowering in the pH of gastric juice in rast with injured liver as well as in intact rats. However there was no marked difference between the two groups. On the basis of these observations it is supported that an in-activity of histamine in the liver has an important role on the pathogenesis of a peptic ulcer in patients with hepatic cirrhosis.
In order to study the relationship between the hepatic diseases and the aerobic bacterial flora of the small intestine, first, five kinds of small intestinal tubes newly deviced by us were tested and compared with Miller-Abbott tube. Second, the aerobic bacerial flora in small intestinal juice were examined in 23 non-hepatic and 28 hepatic diseased patients, and the changes of the flora in patients with hepatic diseases, liver function tests abnormalities and high values of gastric juice pH were investigated. The results: 1) A double lumen tube with a rubber cover on the tip deviced by us was the best suited for aspirating the fluid aseptically from the small intestine. The rubber cover was blasted off with the air or saline just before aspiration at the desired site in the small intestine. 2) Aerobic bacterias, especially gram-negative bacilli were more frel uently found in the small intestinal juice of hepatic diseased patients than non-hepatic diseased patients. 3) Gram-negative bacilli were more frequently found in patients with abnormality of liver function tests, especially zinc-sulfate turbidity test, alkaline phosphatase, A/G ratio and thymol turbidity test. 5) The average value of gastric juice pH was higher in hepatic diseased patients than in non-hepatic diseased patients. 6) Gram-negative bacilli were also found more frequently in patients with gastric juice pH higher than 4.
Carcinoma of the major bile duct and carcinoma of the gallblader are not rare. Nevertheless, a correct preoperative diagnosis is rarely made. Special procedures, such as percutaneous cholangiography may be such of help but are not in general use. Since a majority of patients with jaundice, a barium meal examination is done, in such cases, positive roentgenological findings are easily misjudged, perhaps because of bias in favor of the more common disease of the liver. Inorder to determine whether these errors could be avoided, all cases of the common bile duct stone and carcinoma of the gallbladder and the common bile duct at the division of the radiology of the Internal Medicine Okayama University over a period of five years were reviewed. This report summarized the clinical, pathological and radiological examination of gastro intestinal tract, including the hypotonic duodenography and intravenous cholecystography of these regions. In 9 cases of common bile duct stone, the customary upper gastro intestinal series of roent- genograms and hypotonic duodenograms showed pathological signs on the duodenum in all cases such as dilatation of the ampulla, the enlarged papilla, regurgitation of the barium into the common bile duct, sign of extrinsic pressure of the duodenal bulb and the diverticulum of the duodenum. In 8 cases of the carcinoma of the common bile duct, the positive diagnostic contribution of gastro intestinal series was minor, except the compression sign of the posterior wall of the duodenum by the carcinoma. In the 2 cases of the carcinoma of the gallbladder, the radiograms showed the eccentric compression associated with displacement and streching of the second portion of the deudenum