This study was intended to clarify the incidence and clinical pictures of chronic pancreatitis in Hokuriku district during recent five years. Questionnaires about the cases with chronic pancreatitis seen from Jan. 1970 to Dec. 1974 were sent to 59 hospitals which had more than 100 beds in Toyama, Ishikawa and Fukui prefectures. Informations were obtained from 30 of them. Fifty two cases were chosen as apparently having chronic pancreatitis by the following criteria; calcification of pancreas on x-ray, positive P-S test or histological proofs of chronic pancreatitis. Male: female ratio of these cases was 2.25:1, and average age was 46.3 years old. As to etiology, 34.6% were regarded as being related to alcohol intake and 46.2% as having no apparent cause. It is remarkable that more than half of the cases who had glucose tolerance test showed the patterns of borderline or diabetes mellitus. Regarding prognosis, 50% of our cases were reported to show favorable course, but only 5.8% were said to have healed and 3 cases were reported to have expired.
The respiratory control index and oxidative phosphorylation of the isolated rat liver mitochondria were measured by an oximeter to examine the metabolic abnormalities of the liver during the development of hypertrophic nodular liver cirrhosis from the hypertrophic fatty liver. The results were as follows: 1. The impairment of oxidative phosphorylation of the isolated liver mitochondria was first observed at 3 to 4 weeks after the rats were placed on the diet. The histological investigation indicated a hypertrophic fatty liver. 2. Marked impairment of mitochondrial function such as reduced respiratory control index and decreased oxidative phosphorylation, was observed in rats with hypertrophic nodular cirrhosis. 3. The metabolic abnormalities induced by the hypertrophic nodular cirrhosis from the hypertrophic fatty liver were shown to arise in the energy synthesis system of mitochondria. The abnormalities were accentuated to a nodular fatty liver when the rats were placed on the choline-deficient for more than 6 months. 4. The isolated mitochondria of rats on the choline-deficient diet partially supplemented by sucrose with xylitol for 6 to 9 months showed nearly normal respiratory control indices and oxidative phosphorylation. The restoration of mitochondrial function is thought to be closely related to the inhibition of fat accumulation and subsequent cirrhosis.
The oxidation of long-chain fatty acids is an essential function of the mitochondrion. To examine the metabolic abnormalities of liver mitochondria during development of choline-deficient fatty liver cirrhosis was investigated the oxidation of palmitic and oleic acid in the presence of isolated liver mitochondria during the stages of normal, hypertrophic fatty liver and hypertrophic nodular fatty cirrhosis in rats. The results were as follows: 1. At the stage of hypertrophic fatty liver, β-oxidation in the isolated mitochondria was normal. 2. At the stage of hypertrophic nodular cirrhosis, β-oxidation in the isolated mitochondria was impaired remarkably. 3. It was concluded that the metabolic abnormalities in the hypertrophic fatty liver were not so prominent, but the abnormalities were intense in cirrhotic livers. Long-standing impairment of lecithin synthesis in relation to cholinedeficiency was shown to induce a marked structural change in the mitochondria. Therefore, impairment of the electron transport system of the mitochondria leads to reduced β-oxidation. The overall change in metabolism is thought to be the cause of the transition to cirrhosis. 4. Rats fed a choline-deficient diet, partially supplemented by sucrose with xylitol, remained normal or showed atypical livers. Such rat liver mitochondria showed general restoration of the electron transport function, but β-oxidation was not restored.
One autopsy case who had an unusual clinical course of a diabetic ketoacidotic coma and died of free perforation at just the proximal portion of the non-specific ulcers of the small intestine following internal fistula causing tight adhesion of 3 intestinal loops is reported. This 55 year-old obese female patient had been well untill one month ago when she began to complain of thirst, anorexia, nausea, and recurrent vomiting. She fell into disturbance of conciousness in the morning on admission and was admitted in a preliminary diagnosis of impending diabetic coma. The patient soon recovered from diabetic ketoacidotic coma. Insulin dose was decreased gradually and the patient went into a good controlled state by diet therapy alone without insulin on the 54th day after admission. However, her abdominal distress persisted and upon examination of the abdomen, we found that the multiple intestinal ulcers had caused internal fistulas which created the adhesion of the intestinal loops. From a clinical standpoint, Crohn's disease could not be diagnosed and even histologically, there were no granulomes. Therefore, this lesion could be said to be non-specific ulcers of small intestine with fistula formation. We could not clarify the relationship between diabetic ketoacidotic coma and these rare intestinal lesion. By autosy, chronic pancreatitis was found. We believe that no relationship existed between the diabetic ketoacidotic coma and the chronic pancreatitis.
It is known that the incidence of primary sarcoma of the stomach is smaller than that of cancer of the stomach, however, the clinical findings remain unclear. In this study, 27 sarcomas of the stomach, consisting of 13 myogenic sarcomas and 14 lymphoreticulogenic sarcomas, were studied with special reference of their symptoms. The duration of symptoms averaged 6.6 months. Epigastric pain was the most frequent early symptom, and sensation of fullness was the second most frequent one. On admission, the patients with myogenic sarcoma (53%) had lost weight and the patients with lymphoreticulosarcoma (59%) had epigastric pain. Marked bleeding was seen in about one fourth of all patients, in whom melana was more frequent than hematemesis. Objective findings included fever (56%), palpation of masses (41%) and epigastric tenderness (22%) in all patients with sarcoma of the stomach.
Three cases of carcinoma of the pancreas associated with pancreatolithiasis are presented. The coexistence of the two conditions was found in three cases out of 54 cases of pancreatolithiasis (5.7%) and out of 106 cases of carcinoma of the pancreas (2.8%) in our series. Clinical features of cases of carcinoma of the pancreas in association with pancreatolithiasis were investigated by reviewing 12 well-documented cases including nine cases collected from Japanese literatures. In the 12 cases, the sex ratio was 11 men and one woman, and the average age of onset was 46.8 years old. Radiological findings of pancreatic stones obtained in nine cases did not show a pattern of diffuse small stones, but of multiple large stones. Considering from their clinical histories, it is suggested that pancreatolithiasis preceded onset of carcinoma of the pancreas in over half of cases.
Mucous barrier was searched by the histochemical method of a covering mucous layer and by the measurement of precipitated mucus of gastric juice. The mucous barrier should be considered dividing into two components. The neutral polysaccharide stored within the surface epithelial cells must be a source of the mucus of the gastric juice. The storage of the polysaccharide was decreased by a long-term stimulation by histamine, and the precipitated mucus volume was also decreased shortly after the stimulation. Therefore, some kinds of the stimulation for the gastric secretion must be avoided for prevention of peptic ulcer. The oral administration of the sulfuric polysaccharide extracted from seaweed prevented the occurrence of experimental ulcer. It may be concluded that the exogeneous polysaccharide can take place of the endogeneous polysaccharide. These concepts can be applied to the treatment of peptic ulcer.