A. Relationship between histological findings of the liver and BSP or ICG test. In forty-nine patients with hepatocellular disorders were performed histological examination of liver through needle biospy, Indocyanine Green (ICG) and Bromsulphalein (BSP) excretion test. The patients with intra- and extra-hepatic cholestasis were excluded from this study. The plasma concentrations of ICG and BSP were determined for at least sixty minutes after an injection. Plasma disappearance rate (K) and transfer rate constants (a, b, h) were calculated from the plasma disappearance curves by means of two compartment analysis. The results were summarized as follows: 1. Decrease of KICG had a significant correlation with progress of acini-reconstruction, and aICG decreased in proportion to extent of fibrosis in Glisson's sheaths. 2. Decrease of KBSP had a significant correlation with progress of inflammatory cell infiltration in Glisson's sheaths, of destruction of limiting plates and of reconstruction of acini. Changes of aBSP had the similar correlation as KBSP. B. Relationship and discrepancy between ICG and BSP test. Although apparent discrepancy was observed between ICG and BSP test in 7 cases among forty-nine patients with hepatocellular disorders, four patients were excluded because of the significant difference of theoretical value by the ICG and BSP space. Therefore, forty-five patients were comprised the subjects of this study. The correlations between BSP and ICG test were examined on the following items: plasma disappearance rate of BSP (KBSP)-plasma disappearance rate of ICG (KICG), KBSP-retention rate of percentage at 15 minutes of ICG (R15ICG), retention rate of percentage at 45 minutes of BSP (R45BSP)-KICG, and R45BSP-R15ICG. Values of KBSP-KICG and KBSP-R15ICG had a significant relationship (p<0.01). From the statistical examination of rejection elipse on these two items two cases of active type of chronic hepatitis and one of active form of liver cirrhosis were recognized as the cases with discrepancy between BSP and ICG excretion. In these three cases KBSP was lower than KICG, aICG was higher than aBSP and bBSP was higher than bICG. From these results it was suggested that the hepatocellular inflammatory change was one of causes of discrepancy between BSP and ICG.
The exocrine pancreatic function in 19 patients with external pancreatic duct drainage was studied from the points of the nasogastric suction, ingestion and the overall postoperative recovery pattern after upper abdominal surgery. In addition, the correlation between averaged daily pancreatic secretion and the pancreatic histology was investigated by means of histometry, having taken the resected volume of pancreas into consideration in pancreatoduodenectomy or distal pancreatectomy. The results are as follows: 1) The postoperative pancreatic function recovered in 10th to 14th day after surgery and its secretory recovery pattern was indifferent to the type of operation. 2) The change of exocrine pancreatic function caused by ceasing of nasogastric suction or by starting of ingestion did not influence the postoperative recovery pattern, at least concerning in the postoperative period of this study. 3) Daily outputs of both bicarbonate and enzymes were minimal in the nocturnal fraction of 6 hour collections. 4) The mean daily values of the normal pancreas in the adult were determined. These were 891ml in volume, 85.79mEq in bicarbonate, 25323U in amylase, 294297IU in lipase and 52569IU in trypsin. 5) It was revealed from the histometrical examination of the pancreas that the parenchyma in microscopically normal pancreas occupied over 90% of its tissue. 6) Under the endogenous stimulation of the pancreas, i.e., dietary stimulation, the pancreatic exocrine function was well correlated with its parenchymal volume. It was so, even under the exogenous stimulation by secretin and/or pancreozymin.
In an attempt to clarify water, potassium and sodium transport in the rat intestine, the Na and K equilibrium concentration, electrical potential difference (PD) were measured. The K efflux and water net flux were also determined respectively. The following results were obtained from the isotonic solution: (a) K equilibrium concentration in the rat intestine was higher than the serum potassium concentration, particularly at the lower intestine. (b) Na equilibrium concentration was lower than serum sodium level, especially in the colon, (c) PD was largest in the colon, (d) K efflux from glucose-free solution, in which K concentration was 10mM/L was 5.92×10-6 in jejunum, 2.82×10-6 in ileum and 1.50×10-6mM/cm2 min in colon. (e) K efflux was significantly influenced by solvent drag in jejunum. (f) net water flux was greater in the colon in comparison with small intestine. It is conculuded that potassium appears to be passively absorbed and the amount of K absorption was greater in the upper intestine. Active potassium secretion appears to be available in large intestine. In addition, sodium absorption is presumably active process and the amount of absorption is greater in the colon.
The selective arteriography of the abdominal aortic branches is very useful to the diagnosis of abdominal organs, particularly, selective coeliacography or superselective coeliacography is very valuable at the diagnosis of the liver, spleen, pancreas and gall bladder disease. It is impossible, however, for selective coeliacography to catch the abnormality of the blood flow of the hepatic and splenic artery. For the purpose of grasping this blood flow exactly, radioisotope (M.A.A.131I) is infused into the celiac artery through the catheter after coeliacography and the distribution of the radio-isotope is measured at the liver and spleen with the scanner at prone and supine position one or two hours after infusion, and then calculated the ratio of the blood flow at these organs. The normal arterial blood flow ratio of the liver and spleen, that is, at the case without anatomical abnormality and the organic change of the hepatic and splenic artery exists within the limits of 0.7-1.3, but at the case of various diseased findings or anatomical anomaly of the hepatic and splenic artery, the ratio changes beyond this limits.
In order to assess the morphological abnomalities of villi in malabsorption syndrome, tissue specimens obtained from jejunum by biopsy were studied by our method of measurement. The influence of administration of the medium chain triglyceride upon the blood lipid components and villi were studied. Morphological changes of villi were assessed by measurement of the height, width, cut surface and surface area of villi, of which mutual relationships were also evaluated. In the cases with malabsorption syndrome morphological changes of villi, mainly consisting of atrophy in comparison with those in healthy subjects may be speculated to take place at first probably around the glandular duct. The decrease of areas of cut surfaces and superficial surfaces may suggest to show the decrease of absorptive area. Administration of medium chain triglyceride for those cases with malabsorption syndrome resulted in improvement of blood lipid abnormality and in recovery of atrophied mucosa. For the treatment of these diseases, medium chain triglyceride appears to be more effective than long chain triglyceride.
On the 198 patients with multiple adenomatous polyps diffusely distributed throughout the colon, the informations of clinical and pathological features and their family history have been accumulated by means of the nationwide inquiry in two time (in 1961 and 1972) and direct examination at our hospital. The female case was less in population than the male (m:f=1:0.7) and younger in avarage age (35.7 years old and 30.4 years old). An age distribution curve showed a typical double peak pattern with a valley at the younger half of the thirty. Association of colonic cancer was detected increasingly higher incidence in older age: the highest of 92% at over the fifty and the lowest of 29% under the twenty. The composition of pedigree and family history are being ascertained by the clinical genetical practices. In 69 propositi with affected parents and/or siblings who have been found in the total of 157, the cumulative incidence of the affected siblings was 38.1% (135/354). The data will be contributable for further analysis of genetics of this disease and for early detection of the carrier and long term follow up of the patents.