In order to investigate the chronological trend of atrophic gastritis, the stepwise biopsy of the lesser and greater curvatures of the stomach was performed on 570 subjects. The histological findings were analyzed in relation to the age and the site of the biopsy. Atrophic gastritis was found to expand proximally with advancing age, more rapidly extending on the lesser curvature than the greater curvature. The chronological expansion of atrophic gastritis may be considered a normal aspect of the ageing process of the stomach. The observation would reasonably suggest the existence of the stomach age as to the expansion of atrophic gastritis, indicating that the diagnosis of atrophic gastritis should be restricted to the certain subjects whose stomach age precedes its chronological age.
During the 10 year period from 1960 to 1969, 697 patients who had been treated surgically for Cholelithiasis were studied on clinical significance of jaundice in the postoperative results, devided in four groups with or without jaundice and presence or absence of the stone in the common duct. Severe jaundice was not seen in the patient with cholelithiasis. Majority of jaundiced patients show abnormal liver function, positive bacterial culture of the bile and the severe inflammatory changes of the gallbladder and the liver. Almost of jaundiced patients showed decrease of jaundice on the early postoperative course and their postoperative result is satisfactory as well as the patients who have had no jaundice. Postoperative results are not satisfactory in the choledocholithiasis and mortality increase with age, common duct stone and the acute inflammatory changes of the gallbladder. Elevation of icterus index is not related to mortality. Severe jaundice is characterized of severe liver damage, infection of the biliary tract and surgical conditions on the operation. Such conditions as the liver damage, infection, the lesion which caused jaundice make the postoperative results unsatisfactory as well as the indication to the surgical intervention.
The purpose of this study is to observe the spontaneous gastric secretion during twentyfour hours and to develop a physiologically rational therapy for peptic ulcer. The changes in pH of the gastric contents during the twenty-four hour period were studied in 100 hospitalized patients including 23 cases of duodenal ulcer and 34 cases of gastric ulcer. In order to apply the study to the practical treatment of duodenal ulcer, the effect of secretin on fasting pH and postprandial pH of the stomach was observed in 9 patients with duodenal ulcer. The results were as follows: 1) As for the variation of gastric pH during the twenty-four hours, differences in the patients and differences in the disease were observed. 2) The pH curves of the stomach were classified into 5 types. According to this pH pattern classified by the author, the changes in the gastric secretion are easily understood; furthermore this pattern is very convenient to determine the most suitable time to administer medicine to patients. 3) As to the lowest pH during the twenty-four hours, there were no differences between duodenal ulcer and gastric ulcer patients, and also there were no differences between ulcer patients and other patients. As to duration of the pH below 2 or above 5, there were some significant differences among them. 4) This suggests that one of the most important pathogenesis of duodenal ulcer is the continuous action of high degrees of acidity during the night. Judging from the therapeutic points of view, I have come to the conclusion that we should consider the pH pattern and the duration of high acidity for medical treatment. 5) The effects of intramuscular administration of secretin on fasting pH of the stomach was stronger than the effects on postprandial pH. I supporse this fact was caused by the regurgitation of pancreatic juice. I believe we can use synthetic secretin in the treatment of peptic ulcer.
Transthoracic esophageal transection was performed in a total of 23 cases of portal hypertension with esophageal varices, i.e., 12 cases of cirrhosis, 4 cases of intrahepatic portal obstruction, and 7 cases of extrahepatic portal obstruction. There were 5 postoperative deaths, in most of which the emergency operations were underwent under the severe hepatic dysfunction with advanced cirrhosis. The hepatic function test revealed the extremely high values of glutamic oxalacetic transaminase and bromsulfalein retention compared with these in survivors where no noticeable changes in hepatic function were demonstrated. Esophageal varices were disappeared in 16 cases of 18 ones (88%) with conspicuous improvement in other two cases. The late outcome of the patients which survived more than 6 months after the operation showed appreciable disappearance of the esophageal varices. Besides, no variation in hepatic function test was exhibited. All the patients were adjusted better to normal life than preoperatively. Moreover, in only one case with recurrent varices it was fairly dispapeared after the second stage operation of splenectomy and ligation of the coronary vein. It can be seen that esophageal transection is to be indicated primarily as an emergency operation for the bleeding esophageal varices because of both its effectiveness of protection against for the further hemorrhage and its minor surgical interventions. The effectiveness was enhanced by performing splenectomy and ligation of the coronary vein together with the transection, however, these procedures should be done secondarily for the patients with poor risk as advanced cirrhosis or the emergency cases.
The close relationship between Australia antigen (Au antigen) and viral hepatitis is well established. However, it is not clear how Au antigen does relate to the clinical feature of acute hepatitis. The present study deals with the possible role of Au antigen on the course of acute hepatitis. The results are as follows: 1) Protracted case of acute hepatitis is defined as one having the abnormalities in clinical and/or laboratory findings which persist for more than six months after onset. 2) No difference was seen in the frequency of protracted cases between Au antigen-related and -unrelated hepatitis. However, in cases without blood transfusion the rate of protraction in Au antigen-related hepatitis was higher than that in Au antigen-unrelated hepatitis, especially in patients younger than thirty years old. 3) Frequency of protraction was significantly higher (7/7) in those who showed Au antigen in the serum persistently for more than six months.