In 18 cases of tumor of the islets of Langerhans (insulinoma), controlled histomor-phological examinations were conducted to discuss the relationship of morphology of insulinoma to the secretory function of the islets. The results obtained are summarized as follows: 1) Dissimilarity was evident in the mode of secretion of insulinoma. The related tests all indicated that, as opposed to the normal cases, the insulinoma cases had no parallel changes between I.R.I. and blood sugar. 2) There was no correlation between the tumor cell arrangements and the secretory function. 3) No definite trend of affinity could be observed for specific staining. 4) The islets of Langerhans in the extra-tumor tissue were observed increasing islets smaller in size than those of controls, demonstrating evidence of the influence of insulinoma on the extra-tumor tissue of the pancreas.
The functional and organic narrowing of the papillary region which may complicate chronic inflammatory disease taking place in the biliary tract and pancreas, or after removal of a diseased gallbladder has long been known. Clinically we have often experienced cases of reversible narrowing resulting from edema or functional disorder in the papillary region. We presume not only that the functional disorder in the papillary region is a secondary outcome, but also that it may produce primary effects upon such surrounding organs as the liver and the pancreas. The functional disorder in the papillary region may lead to various symptoms such as, jaundice and nausea. It is essential for the diagnosis of a functional disturbance in the papillary region to make minute observations on pictures of the bile duct obtained by endoscopic retrograde cholangio-pancreatography (ERCP). Keenly feeling the necessity for more objective estimation of pathological conditions in the papillary region, we have developed a pressure sensor based on a semi-conductor. When the function of the terminal part of the choledochus was examined by the use of the pressure sensor, the wave type in the patients free from biliary disease showed a regular pattern, whereas the wave type in the patients with choledocholithiasis showed an irregular pattern. An irregular-wave pattern was seen in 50% of the 20 patients with duodenal ulcer. These findings suggest that there is a close correlation between the functional disorder in the papillary region and pathologic manifestation of the surrounding organs. In the diagnosis of the functional disorder in the papillary region, the pressure sensor method will be worthy of trial along with other clinical and laboratory examinations.
In the planning of clinical investigations on ulcer etiology, it is important to determine to what extent peptic ulcer patients can contribute to every day emotional stress. In this report, as a model to establishing an emotional stress condition, we took attention to the emotional conflict of the patients just before surgery. Changes of plasma concentration of corticosteroids (11-OHCS) were measured in resting, emotional-stressed preoperative condition and after surgery. Therewithal, gastric secretion was measured. In resting condition, determination of plasma 11-OHCS levels in patients with peptic ulcer failed to detect differences from control subjects. Slight increase in plasma 11-OHCS levels was observed both in the patients with or without peptic ulcers. During emotional stress condition, a significant increase in gastric acid and pepsin secretion was observed in duodenal and gastro-duodenal ulcer patients. Stress-induced gastric acid and pepsin secretion were reduced by atropin sulfate injection to 50% and 30%. The inhibitory rate of gastric secretion by the drug was less striking as compared with those levels in non-stressed resting condition. Laparotomy (physical stress) enhanced the gastric pepsin release in spite of vagotomy. The role of the emotions in altering gastric secretion was recognized in individuals with duodenal or gastro-duodenal ulcers. Emotional stress may plays an important role in the ulcer etiology. Although, the precise mechanism by which emotional stress affects the ulcerogenesis remains to be clarified, the role of extra-vagal humoral pathway (via the hypothalamo-pituitary-adrenal axis) is not a negligible matter.
Eleven patients with presumed cholesterol gallstones were given 0.45 to 2.0g per day of ursodeoxycholic acid during 4 months to one and half year. In case 1, multiple stones have disappeared after 7 months of the treatment. In case 2, multiple stones progressively diminished. In case 3, a small one of two gallstones has disappeared after 4 months of the treatment. In case 4, a single stone progressively grew smaller. The decision concerning to dissolution of multiple stones in case 5 is under discussion. While, in 6 patients with gallstone, there was no change in gallstone size. During the treatment, liver function test and serum cholesterol remained normal, and none of patients had anorexia, diarrhea and attack of pain. In three patients, bile lipid composition was measured before and after bile acid therapy. Ursodeoxycholic acid treatment significantly improved cholesterol solubility in bile by a reduction in molar ratio of cholesterol in bile. After the treatment, the major bile acid in bile was ursodeoxycholic acid, which occupied abcve 40% of total bile acid, and dihydroxy-cholanoic acid consisting of chenodeoxycholic and ursodeoxycholic acid made up 80% of total biliary bile acid.
Roentgenological opacification of the biliary system and adverse reactions by a new intravenous contrast medium, iodoxamic acid was investigated in comparison with adipiodone, used in our country at present. The comparison of both the contrast media was tried in 307 patients by a controlled study in the multiclinical system. Iodoxamic acid was superior to adipiodone in the maximum level and the continuation of the opacification at the bile ducts. At the gallbladder, iodoxamic acid tended to show superiority over adipiodone in the maximum level but was inferior in the continuation of the opacification. The side effects noted with iodoxamic acid tended to be less frequent and less severe than those with adipiodone.
Among 437 resected gastric cancer patients, there are 52 cases with similar gross findings to early gastric cancer; IIc similar type 21, IIc+III similar type 6, III similar type 5, IIc+IIa similar type 18, and ha or I similar type 3. 1) There are 4 cases whose tumor-size is less than 4cm and cancer invasion has extended into serosal layer of the gastric wall. 2) The incidence of lymphnode metastasis of 52 cases is 32.7% (17 cases), showing higher rate than that of early gastric cancer (5.8%) and lower than that of advanced cases (71.5%). 3) The relation of pattern of carcinomatous invasion to the survival-rate was correlative in our cases. Three cases of nine who died within five years after operation had small tumors less than 4cm in diameter with penetrating growth pattern. 4) Macroscopic appraisal of depth of carcinomatous invasion is such as nodular swelling and fusion of the folds and circular mucosal elevation at the edge of IIc lesion: rugged surface and stiffen and thicken wall of the lesion in IIc similar type. In IIa or I similar type, various extent of erosion and ulceration of the mucosa suggests the deep invasion of cancer. However, macroscopic differenciation of depth of cancer invasion in III similar cases was occasionally difficult.
Serum gastrin levels in patients with upper gastrointestinal diseases were measured with CIS-gastrin radioimmunoassay kit. All subjects roled out diabetic mellitus, liver cirrhosis and renal disorder, had the upper GI series and endoscopic examination beforehand. In the basal condition there were 27±15pg/ml in normal subjects, 57±41pg/ml in patients with single gastric ulcer, 71±44pg/ml in duodenal ulcer, 81±76pg/ml in early gastric cancer and 125±95pg/ml in advanced gastric cancer. Basal serum gastrin level increased in proportion to atrophy of gastric mucosa but reversely decreased in severe atrophy. There was no definite tendency between age and the basal serum gastrin level in subjects younger than 60 years old, but descending tendency in ones older than 61 years old. After sodium bicarbonate and propantheline bromide were given, serum gastrin level increased and the rate of serum gastrin level to the basal showed a peak 60 minutes after the drug administration in duodenal ulcer. The peak in normal controls or gastric ulce appeared earlier than that in duodenal ulcer. By secretin injection, serum gastrin level decreased and the rate of serum gastrin level to the basal took the lowest value 120 minutes after secretin injection in duodenal ulcer, in which the peak came slower than in normal subjects or gastric ulcer.
The effects of glucagon on the exocrine pancreatic secretion were studied in five pancreatoduodenectomized subjects, using the pancreatic juice obtained from pancreatic duct drainage. Under the background infusion of secretin, glucagon did not show an inhibitory effect on water and electrolyte secretion of pancreas but showed marked depression in enzyme secretion. Maximal percent decrease in enzyme output was 70-80% of the control level after the single injection of 2mg glucagon and 15-45% after the 3mg glucagon injection. The inhibitory effect appeared immediately after the administration of glucagon and its duration continued for an hour approximately. Elevation of blood sugar in the cases studied was remained below 200mg/dl. The effects of hypertonic glucose infusion were also studied additionally for the comparison with glucagon injection. The moderate depression in enzyme output, marked increase in blood sugar and slight elevation of plasma osmotic pressure were observed. From the results obtained, it was suggested that the effect of glucagon on the exocrine pancreatic secretion was direct action to the pancreas and this was not the inhibition to the synthesis of enzyme but to the enzyme release from the gland. And the possible application of glucagon to the acute pancreatitis, together with its therapeutic dose, was discussed.