To clarify the function of circulating bilirubin and the mechanism of urinary excretion of bilirubin, dissociation of bilirubin protein binding serum was studied. A new bilirubin fraction was separated as slow eluting fraction by gel filtration. The fraction was detected only in conjugated hyperbilirubinemia with value over 10mg/dl. The fraction was protein free, dialyzable, ninhydrin reaction positive, diazo positive and had two peaks in 285nm and 445nm. There was correlation between the amount of the fraction and total bilirubin concentration in obstructive jaundice, however in convalescence stage of acute hepatitis disappeared early. Inspite of value over 10mg/dl. of bilirubin the fraction in unconjugated hyperbilirubinemia such as Icterus neonatorum was not detected. The addition of bile acid to the first fraction (protein bound bilirubin) separated a new non protein bounded fraction. The fraction bound collagen and elastin as well. There was close correlation between the amount of the fraction and dialyzable bilirubin and urinary bilirubin excretion. It was proved that 1g of moderately purified albumin has ability to bound approximately 28.5mg of bilirubin and same amount of beta lipoprotein bound 0.36mg in this method. From these results it was concluded that 1) there was a part of serum bilirubin of patient associated with conjugated hyperbilirubinemia which was dissociated or easily dissociated from the protein bound bilirubin, 2) the dissociation was accelerated by bile acid, 3) the protein free fraction passed through the glomerulus and is excreted as urinary bilirubin.
Thirty two cases including 17 clinically normal pancreas and 15 cases with so-called chr. pancreatitis were subjected to our evaluation on the correlation between radioisotope images and exocrine functions based on Pancreozymin-Secretin Test (P. S. Test). At this early series, only scintiscanner (3×2 inch crystal) was used, but later on, scintillation camera was installed and both scintigrams and scintiphotos became available. The results of our studies are as follows: 1) Normal images were obtained in 11 out of 17 normal pancreas and in 3 out of 15 cases with chr. pancreatitis as well. In these 14 cases with normal images there were no abnormal exocrine functions judged by P. S. Test. 2) There were 10 cases with normal P. S. Test, showing rather abnormal images. These patterns were found in 6 out 17 normal pancreas and in 4 out of 15 chr. pancreatitis. Therefore, abnormal images do not always indicate decreased exocrine functions based on P. S. Test. 3) Diagnostic accuracy on the radioisotope images was 11/17 or 64.7% in normal pancreas and 12/15 or 80.0% in chr. pancreatitis. Although these results show higher percentile in chr. pancreatitis than in normal pancreas, it is more difficult to diagnose chr. pancreatitis on their radioisotope images than normal pancreas because there are various patterns in the former whereas high incidence of normal pattern in the latter. 4) In cases with calcification in pancreatic head, all P. S. Tests were abnormal and their isotope images were visualized quite poorly. 5) So far as 32 cases are concerned, there was comparatively close correlation between R I images and exocrine functions based on P. S. Test. In conclusion, it can be said that R I images give us fairly adequate informations about the pancreatic exocrine functions (P. S. Test).
Local measurement of gastric mucosal temperature was undertaken as a method to study the patho-physiology of the stomach. 1) Gastrothermometer with the thermistor at the tracing tip was devised for the purpose. Its minimum possibility to discriminate the temperature difference was found to be 5/1000°C within 0.5 second. 2) The local mucosal surface of the affected stomach was clinically observed through endoscope. In the case of gastric ulcer, its fundus showed lower temperature compared with its surrounding wall. In proportion to ulcer healing, the temperature difference between their fundus and circumscribing mucosa diminished. In the case of cancer the distribution of local temperature did not appear to be so regular as that of ulcer. The top of the polypoid lesion showed higher temperature than its stalk or its base. 3) Basic study was made using the canine stomach in order to make sure the clinical result.
Fourteen cases of pancreatic cancer were subjected to detailed study on serum y-glutamyl transpeptidase (GT). Increased GT level has been observed in all cases of pancreatic cancer and the increase was found to be more pronounced when jaundice was present. Agar gel electrophoresis revealed the presence of three isoenzyme bands, i.e. named GT-1, GT-II and GT-III from anode side. In case of pancreatic cancer GT-II was found to be dominant and thus GT-I/GT-II ratio being always smaller than unity. In contrast, the augmentation of GT-I with the resulting GT-I/GT-II ratio over 1.0 was found to be associated with chronic pancreatitis as well as with normal subjects. Appearance of GT-III was seen when obstructive jaundice was present and they are probably closely associated. Diagnosis of pancreatic cancer in its early stage, when jaundice is still absent, is of serious diagnostic problem. When used in combination with newer diagnostic procedures such as pancreatic scintigraphy, celiac angiography and endoscopic pancreatography, malignancy pattern in GT isoenzyme will offer a great help in differenting between benign and malignant pancreatic disease.