Endoscopical, histological, enzymohistochemical and electronmicroscopical studies on gastric metaplasia in the mucosa of the duodenal bulb were performed. Materials were consisted of 70 cases of resected duodenal ulcers, 100 cases with endoscopical ulcerative lesions of the duodenum and 120 cases with non-ulcerative lesions of the organ. The results obtained were as follows: 1. Gastric type epithelium was observed in high frequency in the duodenal ulcer group, and rarely in the non-ulcerative disease group. 2. The appearance of gastric type epithelium occurred in higher frequency as the progression of healing of the ulcerative lesions. 3. The gastric type epithelium in the duodenum showed the same features with the gastric surface epithelium in its enzymohistochemical and electronmicroscopical studies. 4. The gastric type epithelium seemed to arise metaplastically in the course of regeneration of ulcerative or erosive lesions in the duodenal mucosa. 5. The gastric metaplastic lesions were identifiable endoscopically as villus-like structures with redness and swelling.
The factors to influence the healing of gastric ulcer were examined by Kruskal-Wallis test. In patients with single, round ulcer in which healing process was obvious were selected as the subjects, and 20 factors were examined. Seven factors were piked up by kruskal-Wallis test, and then the contribution of each factor to the healing of gastric ulcer was evaluated by Hayashi's theory of quantification. As the results, it was concluded that the 1st class factors to influence healing of gastric ulcer were healing stage of ulcer, and size of ulcer nische. The 2nd class factors were convergence of folds, marginal swelling, and duration of epigastric complaints. Shortening of the lesser curvature and location of ulcers were also suspected as the 2nd factors. The subjects were classified into the following groups by healing time: the 1st group (within 60 days), the 2nd group (61 to 90 days) and the 3rd group (more than 90 days). For each group, cumurative-distribution polygon was made. Using data of the 1st examination, the 1st group was discriminated from the 2nd and 3rd groups with error of 22%. It was presumed that discrimination one month after the therapy can be done between the 2nd and 3rd group with error of 6% and it can be done between the 1st and 2nd group with error of 32%, using the reducing rate of ulcer nische one month after the therapy with data of the 1st examination.
This study attempted to investigate the regenerative capacity of the differentiated glandular cells in the gastric mucosa. Adult rats of Wistar strain were used. For the purpose of removing undifferentiated cells from the gastric mucosa, upper side of the fundic mucosa on greater curvature were stripped (400μ in thickness; 10mm in diameter). In order to barricade the movement of cells from the intact mucosa to "erosive areas", the surrounding mucosa of the erosive areas were completely removed, thus annular ulcers were made. At intervals of from 12 hours to 14 days, animals were killed and the lesions were investigated histologically. From 12 hours to 7 days, the annular opening ulcers were observed in all animals, and 14 days later, in half of the animals, the ulcer still remained open. In these animals, no cells from the intact mucosa were observed in the erosive areas. At 12 hours, the differentiated chief and parietal cells in the erosive areas seemed unchanged. Two days after, the differentiated cells transformed into undifferentiated cells. The undifferentiated cells spreaded to the surface of the erosion, and changed to foveolar- liked cells at 5 and 7 days. At 14 days, well differentiated foveolar epithelium appeared in the erosive areas. It is concluded that the differentiated cells of injured gastric mucosa regenerate to the foveolar epithelium.
Morphologic and functional alternations of the pancreas following attack of acute pancreatitis were studied in 29 cases by pancreatic scintigraphy, standard Secretin test and oral glucose tolerance test (GTT). At the time of acute attack the diagnosis as acute pancreatitis had been confirmed at laparotomy in 27 cases and in 2 cases on clinical pictures and the serum amylase level. The mean duration of follow up was 56.3 months. The result of this studies are following: 1) Normal images were obtained in 17 of 29 cases. 4 of these had slight to moderate decreased exocrine function judged by secretin test. In the remàining cases exocrine function was within normal limits. 12 of 16 cases with normal image had abnormal oral glucose tolerance curve of mild to moderate diabetes. The remaining cases had normal curve. 2) There were 12 cases with abnormal scintigram. 10 of these cases had abnormal images with decrease of isotope uptake in part or the whole of the pancreas and 2 cases with absolute failure of isotope uptake by the pancreas. In general these changes were shown to be more apparent in the tail than the head of the pancreas. Ten of 12 cases with abnormal image had to some degree decreased function but in the remaining 2 cases pancreatic exocrine function was within normal limits. On GTT all of 12 cases with abnormal image had abnormal curve of diabetes. Especially 4 of these cases had severe diabetes with not only marked decreased exocrine function but quite poorlyvisualized image of the pancreas. 3) In 4 cases histopathological findings were obtained at the time of the study by laparotomy, and they were shown very consistent with scintigraphic features. 4) On the scintigraphic procedure as well as function test of the pancreas, it was shown that alcoholic factor played a very important role in influencing the prognosis of acute pancreatitis. 5) So far as 29 cases are concerned, it can be said that acute pancreatitis resulted in chronic pancreatitis in the 4 cases, or 14%. In the remaining 8 cases with abnormal scintigram, it is postulated that the inflamatory process subsided and allowed time for cicatrical fibrosis to occur. But it should be necessary to trace and study these alternations of the pancreas in future.
Bile acid and lipid composition of bile in hepatobiliary disease was estimated in 20 patients with gallstones and 9 patients without gallstones. Patients with gallstones showed a significant decrease in molar percentage of total bile acids out of total lipids in bile and a significant increase in molar percentage of cholesterol compared with patients without gallstones. The molar percentage of taurine conjugated trihydroxy bile acid out of total bile acids was lower and the molar percentage of glycine conjugated dihydroxy bile acid was higher in bile from atients with gallstones than in bile from patients without gallstones. When bile acid and lipid composition was plotted on the phase diagram of Admirand & Small, 11 among 20 cases with gallstones fell in the lithogenic zone, while all cases without gallstones fell in the micellar zone. A choleretic agent, 4-methylumbelliferone was given to the patients with gallstones in order to improve the abnormal bile composition. Among 11 patients with gallstones, whose biliary lipid composition fell in the lithogenic zone on the phase diagram, 9 patients showed a complete normalization, that is a shift from the lithogenic to micellar zone, and 2 patients showed a moderate improvement, that is an increased molar percentage of total bile acids and a decreased molar percentage of cholesterol. Worsening of the liver function and other side effects were not detected. A possibility of gallstone dissolution due to an improvement of bile composition is expected by long time treatment of 4-methylumbelliferone. A spasmolytic action of 4-methylumbelliferone was clinically observed and a decrease insecretory volume with an increase in concentration of each A, B and C bile was confirmed after treatment. Blood chemistry and liver function tests revealed a remarkable improvementin several patients. 4-Methylumbelliferone seems to have an effect on cholangitis and liver parenchymal disturbances besides an improvement of chemical composition of bile.
A gastric cancer was found in a 77-year-old male who had a previous history of the lobectomy of the right lung for the squamous cell carcinoma 21 years ago. He has been completely well until August, 1972 when he was admitted to Keio University Hospital with chief complaints of vomiting and epigastric pain. Upper G.I. series revealed a filling defect at the prepyloric portion of the stomach. He died of pneumonia of the left lung 9 days after the admission. The postomortem examination disclosed an adenocarcinoma of the stomach. There was no finding of relapse of lung cancer. The thymic medulla was still present which is rather unusual finding for his age. The relationship between thymus and carcinogenesis was briefly discussed with a review of 36 cases of double cancer of lung and stomach.
As a part of an epidemiologic survey of cholelithiasis in northern Japan, 423 cases of this disease treated during 1964-1972 at five hospitals in Hakodate District, southern Hokkaido, were reviewed and analyzed. The results were as follows. 1) In this particular series a time trend study did not indicate a decrease in the relative incidence of calcium bilirubinate stones. 2) Cholesterol stones were commoner than calcium bilirubinate stones in Hakodate District as a whole. In urban Hakodate cholesterol stones were overwhelmingly common, but in rural areas both varieties were comparable to each other in incidence. 3) Age distribution analysis disclosed that in this series calcium bilirubinate stones were more closely associated with aged patients than cholesterol stones. 4) It was elucidated by comparison of this series with previous statistics that aged cases of cholelithiasis were increasing in number and that the age distribution of this disease was undergoing a considerable change partly because of a tendency for calcium bilirubinate stones to decrease in incidence.
Fundamental and practical problems in carrying out the radioimmunoassay of gastrin were studied by comparing the double antibody method using guinea pig anti-porcine gastrin serum (Wilson Lab.) with the gastrin kit method (G-K, CIS). The former method was found to have the range of measurable gastrin concentration between 60 and 1, 000pg/ml, wheras the range of the latter method was between 25 and 800pg/ml. Both methods were found to have satisfactory reproducibilities. The G-K method was, when compared with the double antibody method, found to be affected more readily by co-existing proteins, whereas the interferences by other biologically active factors, e.g., CCK/PZ, caerulein, etc., were negligible. While there was a highly significant correlation between the values obtained by the two methods (r=0.86, P<0.001), the values obtained by the G-K method were generally slightly lower than the values obtained by the double antibody method. The fractionation analysis employing the gel filtration of blood and tissue immunoreactive gastrin resulted in theobservation that the value of "big gastrin" as determined with the G-K method was lower thanthat obtained by the double antibody method, and that the difference was especially remarkable for gastrin in blood.