Three cases with discrepancy of ICG and BSP test had been reported as “constitutional ICG excretory defect” These cases showed apparently low disappearance rate of ICG and relatively normal rate of BSP. Familial occurence was observed in one case of these three cases. In this paper the microscopic observations of the liver tissue which were obtained by needle biopsy were reported. By light micrographs there were no inflammatory changes and no increase of fiber in portal areas. There were some lipofuscin pigments and fat in hepatic cells, but these were within normal limits. Electron micrographs showed increased reticulum fiber in Disse's space. The mitochondria swelled, deformed and included paracrystalline. The smooth endoplasmic reticulum was appeared on the irregularly branching complex of small tubulus and vesicles. The unstratified rough endoplasmic reticulum showed fragmentations and dilatation of parallel arrays of ergastoplasm. The relations between constitutional hyperbilirubinemia and this disorder were discussed.
The parotid saliva test was made on 88 subjects in total, consisting of 54 patients of nonpancreatic disorders, 26 of pancreatic disorders, and 8 remote postoperative cases of pancreatolithiasis, and the following results were obtained: 1) The secretion volume of, and the maximum bicarbonate concentration and amylase secretion amount in, the parotid saliva of patients with pancreatic disorders were significantly less than those of patients of non-pancreatic disorders. 2) Three of the 8 remote postoperative cases of pancreatolithiasis and a case with cancer of the pancreas head showed abnormally high salivation volume and amylase secretion amount. 3) The saliva test gave an accuracy of 86.2% in diagnosing patients of pancreatic disorders. 4) No significant correlation was observed between the degree of parasympathicotonic response to pilocarpine and the finding in the parotid saliva test. 5) Histologic changes of the parotid glands were atrophic and degenerated in patients with hypofunction of salivary test, and hypertrophic in patients with hyperfunction of salivary test.
The topographic relationship between collagen fibrils and acid mucopolysaccharides (AMPS) has been disclosed to a certain extent since the introduction of ruthenium red stain, which had been used by botanists to demonstrate pectic substance in plant cell walls, into the field of electron microscopy. Not many works, however, have been reported on this subject, and practically no papers are encountered dealing with the ultrastructure of AMPS in collagen fiber formation and resorption in hepatic fibrosis. AMPS is noted as amorphous substance inbetween collagen fibrils and filaments. It is also observed as amorphous coat surrounding immature collagen fibrils. In areas it is observed as granules within the collagen filaments. Ruthenium red positive granules around 100 Å in diameter are placed fairly regularly on the surface of the mature collagen fibrils at the intervals around 640 Å. In some portion of the collagen fibrils ruthenium red positive material is noted as cross striation corresponding to the cross striation of mature collagen fibrils. These ruthenium red positive granules are absent in the degraded collagen fibrils. AMPS appears to be phagocytosed by macrophages in the resorption of collagen fibers.
In order to know clinical significance of endoscopic pancreatocholangiography (EPCG), 278 cases were studied. The results were as follows: 1) EPCG was successfully performed in 96.9% of 278 cases (including 105 Pancreatography (PG), 37 cholangiography (CG) and 127 pancreatocholangiography). Among themsucceeded rate of PG tried endoscopically was 96.1% and that of CG 73.5%. 1) EPCG was successfully performed in 96.9% of 278 cases (including 105 Pancreatography (PG), 37 cholangiography (CG) and 127 pancreatocholangiography). Among them succeeded rate of PG tried endoscopically was 96.1% and that of CG 73.5%. 3) PG suggested normal pancreas when the diameter of MPD at head was less than 4.0 mm, at body less than 3.0mm, at tail less than 2.0mm; MPD and the branches were smooth; the diameter of the branches was less than 1mm except the chief ones and no cystic dilatation of the branches was found. 4) Chronic pancreatitis was suggested when the diameter of MPD at head was more than 6mm, at body more than 4mm and at tail more than 3mm; the diameter of the branches was more than 1mm except the chief ones; cystie dilatation of the branches was clear or MPD or the branches were of “wavy or beads-like type”. 5) PG findings of pancreatic carcinoma were classfied into four types. The stenosis (III type) or obstruction (IV type) of MPD was found in advanced carcinoma of the pancreas, the rigid outline of MPD (II type) or the interruption and straightening of the branches (I type) were found in relatively early carcinoma of the pancreas. 6) Diameter of the biliary tract became wider as aged. 7) In cases of the stone of the common bile duct, the diameter of the common bile duct was remarkably wide and the stone was shifted upwards by the infused contrast medium and floated in it as a transparent shadow. 8) X-ray features of carcinoma of the common bile duct were the obstruction or the stenosis with rigid outline of the bile duct or the interruption of its outline. 9) X-ray feature of carcinoma of the gallbladder was defect of the fundus of the gall bladder. 10) Generally, severe side effects were not found. After EPCG, serum amylase activity elevated according as how the ductal system was visualized by the contrast medium. The elevation was slight in most instances, but the remarkable stimulation of serum amylase activity occurred in 5 cases out of 6 where even the acinar fillings were obtained.
It has long been known that the increased fibrinolytic activity in man is accompanied with gastrointestinal ulceration or bleeding, and many investigations have been done concerning to the fibrinolytic activity of blood in patients with gastric and duodenal ulcer. But, fibrinolysis in blood is easily affected by emotional or surgical stress, or by various physical conditions, estimation of fibrinolysis in tissues seems to give us more accurate informations. Immune reaction in the gastric mucosa has been reported by Kondo (1969) by the technique called Passive Mucosal Anaphylaxis (PMA), and also by producing experimental ulcer using immune complex. In experimental dog stomach ulcer produced by immune complex, fibrinolytic activity in the mucosa was localized around the ulcer, and increased to maximum between 2 to 12hours after the injection of immune complex, while the specimen obtained by surgical operation from human stomach ulcer did not have the tendency to increase or localize. This discrepany was explained due to difference of the phase of ulcer, since the biopsied mucosa from patients with short history of ulcer showed relatively high fibrinolytic activity. Furthermore, fibrinogen in the mucosa around the human stomach ulcer determined by single radial immunodiffusion was decreased compared to that in the distant area, suggesting the fibrinogen was converted to fibrin at the affected area, and was used up by the interaction with increased fibrinolytic activity.