Eight gallbladders with cholesterosis were investigated with light and electron microscopes, and at the same time the specimens were treated with digitonin containing fixatives to trace the transportation of free cholesterol at the ultrastructural level. Cholesterol solubilized in the gallbladder bile is absorbed into the epithelial cells without involving any ultrastructural changes of the apical cell membranes, possibly by diffusion. The free cholesterol entered into the epithelial cells is thought to have the following three fates: 1) Some part of it is taken into lysosomes and is digested there. 2) Some part of it is taken into endoplasmic reticulum systems and is esterified there to become lipid droplets. 3) The rest is excreted from the cell through the lateral and the basal cell membranes without receiving any metabolic changes. Lipid droplets synthesized in the epithelial cells are excreted from the cells and are phagocytized by macrophages. It is also imagined that macrophages may have the ability to esterify the free cholesterol. In the case when lymph vessels are obstructed for some reason, the lymph vessels become to be filled with macrophages containing numerous lipid droplets. Consequently, destruction of the lymph vessels occurs and the macrophages begin to deposit in the lamina propria because of being unable to be carried away through the lymph vessels. Therefore, the cholesterosis of the gallbladder are considered to be originated.
The clinical significance of α-fetoprotein was studied on 395 cases of various diseases according to radioimmunoassay method. As a result, it was found that α-fetoprotein appeared not only in primary hepatic cell cancer but also in the other various hepatic diseases: 95% in primary hepatic cell cancer, 40% in cholangioma, 24% in liver cirrhosis, 38% in chronic hepatitis (active type), 75% in fluminant hepatitis, 100% in subacute hepatitis. α-fetoprotein was found ranging from 20mμg/ml to 3000mμg/ml in the positive cases of the acute hepatitis or chronic hepatitis and liver cirrhosis. We thought especially in this group that there were α-fetoprotein positive cases with severe hepatic necrosis in the perilobular area. In the animal experiment, α-fetoprotein was measured by radioimmunoassay method in the sera of rats with liver damage caused by CC14. As a result α-fetoprotein concentration was found in these serums varied from 40mμg/ml to 200 mμg/ml. The α-fetoprotein (synthesis) may be rapidly regenerated by the hepatic parenchyma cells. More directly, this was supported by immunofluorescence studies of α-fetoprotein in the liver of adult rats after CC14 damage. Furthermore, the specific localization of α-fetoprotein was observed in the normal hepatic parenchyma cells.
A radiological study of the gastric malignant lymphoma was made on 44 advanced lesions of 33 cases and 10 early lesions of 10 cases which had been operated upon in the period of 27 years from 1946 to 1973 at the Cancer Institute Hospital. The early malignant lymphoma was defined just samely as early gastric carcinoma, and the concept of early malignant lymphoma was considered to be significant because its 5-year survival rate was 71.7% in contrast to 21.7% of advanced malignant lymphoma. The macroscopical finding of the advanced malignant lymphoma was classified into four types by Kumakura's classification; namely polypoid type, ulcerating type, intermediate type and infiltrating type. A new classification was employed for the macroscopical finding of early malignant lymphoma. It was classified into four types; namely superficial depressed type, polypoid type, ulcero-polypoid type and giant rugal type. Radiologically, the superficial depressed type was characterized by multiple ulcers and slight convergence of the mucosal folds in an area of a depressed lesion or sometimes by smoothly elevated margin of a depression or clubbing of the folds. The polypoid type usually reveals a smooth elevation of the mucosa with a bridging fold or sharply demarcated multiple elevations of the mucosa suggesting a nature of submucosal origin. The ulceropolypoid type reveals a combination of multiple elevations of the mucosa simulating submucosal tumor and a large, shallow ulceration. The giant rugal type reveals a rather smooth, obscured pattern of the mucosal folds with absence of narrowed lumen of the stomach. An existence of so-called “malignant cycle” proposed by Murakami for gastric carcinoma was confirmed also in the clinical course of early malignant lymphoma by a short-term observation of three cases until surgery and by an analysis of coexiting mode of tumors and ulcerations of the other lesions.
A case with squamous cell carcinoma of the pancreas is now reported. The case with squamous cell carcinoma is the first among 90 cases of pancreatic carcinoma in our departments. The carcinoma originated from ductal cell of the pancreas and occupied the head of the pancreas with the tumor size, 5×6 cm. There was infiltration of the cancer cell into the body of the pancreas. Metastasis to liver, lung, peritoneum, intestines, gall bladder, and various lymph nodes were evident. Residual pancreas was fibrotic with chronic pancreatitis secondary to the tumor. The result of pancreozymin-secretin (PS) test revealed normal water, bicarbonate and amylase output, but abnormally low output of trypsin and lipase. The dissociation of the digestive enzymes was also seen in the pancreatic tissue. The dissociation of the digestive enzymes indicates the importance of measuring trypsin and lipase in addition to amylase during PS-test.
Recently the colonoscopy has been located in a part of the routine examination for the patients who complained of any bowel symptoms. However, it is difficult to say definitely that the complete observation could be done in the colon and rectum using colonoscope. Advancing the colonoscope to the proximal colon is different from getting a complete observation. Limitation of the colonoscopic observation has to be recognized enough. Parts where seemed to be very difficult or impossible to observe completely are as follow; 1) during insertion: rectosigmoid, splenic flexure, right half of the transverse colon, and hepatic flexure, 2) during withdrawal: hepatic flexure, distal end of the transverse colon, proximal end of the sigmoid colon. Countermeasure for the possible complete observation was described. Suggesetion concerning the double angulation mechanism of the colonoscope has been described elsewhere. In this paper, the bending point should be moved as close to the tip as possible for the removal of the blind area, proposed additionally.
Forty patients with hepatocellular carcinoma (hepatoma) were devided into two groups according to α-fetoprotein (AFP) levels, AFP positive group and AFP negative group by means of immunoelectrosyneresis (IES). These two groups were compared about weight of the liver, histological features and the incidence of hepatitis B (HB) antigen. Although there was no correlation between AFP levels and macroscopic findings (gross types) in hepatoma, most cases of IES positive group showed nodular type, irrespective of diffuse type seen in some cases of IES negative group. Histological classification of hepatoma tissues according to Edmondson's grading revealed that 90 per cent of 40 hepatoma patients were in the groups of grade II or III, and IES positive group included the patients of 62.5 per cent of grade II and 75 per cent of grade III. Four cases were included in grade IV, 3 cases of which were in IES negative group and one case included in IES positive group showed relatively low AFP level. A tendency was found that the weight of the liver was less than 2kg when a case of hepatoma was in the IES negative group. The incidence of positive HB antigen was higher in IES positive group than in IES negative group in the patients with hepatoma.
This paper reports the way of meal and the nutritional condition on 37 cases being out of hospital who had been operated upon by five different methods for esophageal carcinoma of various sites from the hypopharynx to the cardia. The complaints after resection of the carcinoma and reconstruction (on 35 cases) had a tendency to be improved except for the cases who were operated for the carcinoma of the esophagogastric junction and were more or less suffered from the refiux esophagitis. But all complaints were not so bad as those of preoperation. The nutritional condition was recovering in all cases. Mild or moderate anemia was noticed in many cases, and we could not ignore the nutritional cause because of the way of their food which was simple and plain. However, the majority of the cases enjoyed their life. In the by-pass operation, the results were satisfactory.
The influence of maltitol, a hydrogenated derivative of maltose, on the absorption of glucose and amino acids was tested using isolated intestinal loops of rats. Maltitol was also given to a patient with alcoholic cirrhosis to test its effect on her hepatic coma. The isolated jejunal loop with intact blood supply were prepared by the method of Cocco. Two ml of normal saline containing 5 mg of glucose or 123 μmole of amino acid mixture was infused in the loop for 5 to 30 minutes, and about 50 to 90% of the materials were absorbed from the loop. Glucose disappeared from the loop was confirmed to be in the blood by tagging it with glucose-14C. When 150 mOsmNaCl of the solution was replaced with 150 mOsm maltitol, about 30% decreases in the absorptions of both glucose and amino acids were seen. A 52 years old female, known as an alcoholic liver cirrhosis for many years, was admitted to our University Hospital in comatous state. On admission, all the clinical data were compatible with those of liver cirrhosis. Her blood ammonia level increased gradually up to 260 μg/dl when lactulose therapy was discontinued, and she was found in deep coma with triphasic EEG. 60 ml of 75% maltitol solution was given every day, and she recovered from coma on the second day of maltitol therapy. On the tenth day, she was fine with normal blood ammonia and EEG. It was concluded that maltitol interferes with the intestinal absorptions of glucose and amino acids, and has some effects in improving the hepatic coma, probably by interfering the absorption of some toxic substances liberated by intestinal flora.