There are two types of isoenzymes of GOT, one in the cytoplasmic fraction of cells (supernatant GOT, s-GOT) and the other in the mitochondria (mitochondrial GOT, -GOT). Wada et al. devised a new method for the direct determination of serum m-GOT. The principle is as follows: s-GOT in the serum is absorbed with sheep red cells sensitized with antibody corresponding to s-GOT and the remaining m-GOT activity in the serum is determined. The authors determined the serum m-GOT from 10 cases of normal subjects and 83 cases of patients with liver diseases by this method. In some cases of acute hepatitis, though the total GOT in serum elevated to 1500 I.U., m-GOT activity showed less than 30 I.U.. However, in one case of fulminant hepatitis, serum total GOT and m-GOT elevated markedly to 3690 I.U. and 295 I.U., respectively. It was recognized that the occurrence of the extensive degeneration and necrosis of liver tissue resulted in the marked increase of serum m-GOT. From these results, it was elucidated that values of m-GOT in the serum of patients with liver diseases were useful to judge the prognosis and had an important significance on the diagnosis of fulminant hepatitis.
The mode of carcinogenesis and rate of intramucosal extension of gastric cancer were approached biometrically by measuring surface areas of early cancer lesions by means of reconstruction of multisectional histologic specimens. A total of 236 early gastric cancers which were resected at the author's department was used. So-called patches (Stout) within the mucosal cancer boundaries were also measured if present. The surface areas thus measured exhibited a logarithmic normal distribution, which allowed for a geometric mean of areas to represent an "average" area. For a gross estimate of the growth rate the "enlargement index" for a certain group of cancers was defined as the ratio of the average area of submucosal cancers, with malignant tissues invading the submucosal layer, to that of mucosal cancers of this group. The enlargement index as well as the incidence and dimensions of patches were compared among groups of cancer specimens classified from various view points, and the results led to following suggestions: the mode of development of gastric cancer is divided into two patterns. In one case carcinogenesis occurs multicentrically in a relatively wide area, and the resulting cancer lesion shows a lesser tendency to spread horizontally in the mucosal layer. This pattern is common in cancers of the depressed type, in poorly differentiated ones, in those showing ulceration, in those not associated with intestinal metaplasia of surrounding mucosa, in those occupying a middle portion of the stomach and in those of younger patients. The other is the pattern in which carcinogenesis is restricted to a small area but cancer then extends relatively rapidly in the mucosal layer. Cancers of the elevated type, well differentiated cancers, non-ulcerating cancers, those associated with intestinal metaplasia, those occupying the pyloric antrum and those of older patients may commonly follow this pattern.
The ribonuclease in the pancreas and its substrate specificity have been widely studied. Neverthless, the correlation between its activity in the body fluid and pancreatic disease has not yet been evaluated. Conditions for the assay of its activity were studied to elucidate the correlation between the activity in the pancreas juice, serum and urine, and gastrointestinal disease. The activity in them can be determined in the following condition: 1.0ml assay solution contained 3mg of RNA, 0.1ml of sample and 0.05M Tris-HCl pH 8.0 was incubated at 37°C for 30 minutes. After the incubation, uranyl reagent was added to the solution to precipitate undigested RNA. The optical density at 260nm in supernate was read after centrifugation.
In order to establish the criteria for diagnosis of chronic pancreatitis, it is important to know structure and function, i.e., pathological anatomy and function in chronic pancreatitis There may be many causes of dispersion on evaluation of correlation between endoscopic retrograde cholangiopancreatography (ERCP) and pancreozymin-secretin test, that is, the multiformity in each of pathological anatomy and function, moreover in test itself, its procedure, manipulation, estimation of data in both of ERCP and pancreozymin-secretin test. Accordingly, it should draw stochastically statistical inference from data to know the correlation. The criteria for grading of ERCP was proposed for the diagnosis of chronic pancreatitis in 1972 by the authors, i.e., minimal, moderate and advanced stage. It is necessary to obtain visualization of the branches in ERCP for the above diagnosis, so manometric injection monitoring, prophylactic antiboitic use, sterilization of the manometer and cannula, and use of the following contrast material mixture, 1.0g of thiamphenicol aminoacetate HCl (Neomyson G) dissolved in about 6ml of saline and mixed 19ml of 65% meglumine diatrizoate (Angiografin) has been carried out for accomplishing ERCP with safety and effectiveness. Regression of total volume, total amylase output and maximum bicarbonate concentration of pancreozymin-secretin test on the grade of ERCP was calculated, and consequently, predominantly significant on the probability less than 0.1% in all of these three factors. Regression of frequency of abnormality below m-s and m-2s in three factors of pancreozymin-secretin test was predominantly significant on the probability less than 0.1% in both of m-s and m-2s. Evaluation of ERCP of cases in which ERCP and pancreozymin-secretin test did not coincide, i.e., which were beyond one standard deviation from regression line, revealed more remarkable difference in grading among the parts of the pancreas. This finding suggests the pathological multiformity in chronic pancreatitis, if the examination of ERCP and pancreozymin-secretin test were performed properly by the skilled hands and interpreted by the authorized investigators. Moreover this finding could explain the reason of this discrepancy with the assumption that pancreozymin-secretin test is functional mean value whereas ERCP is structural maximum value on the estimation. By means of sufficiently visualized ERCP, "structural mean value", i.e., "mean grade" G=∑fiGi/∑fi could be calculated.
The three dimensional appearances of the regenerative epithelium of the gastric mucosa described in the various healing stages of the gastric ulcer were examined by the scanning electron microscopy (JSM-U3) in contrast to the histopathological findings by light microscopy. In a case of Ul-II gastric ulcer the epithelium topping of the scar is made up of multilayered cuboidal cells. The three dimensional appearance reveals that the mucosal epithelium of the ulcer margin has become abruptly low and thin forming bundles of cell lines covering the excavation. These bundles are directed toward the center of the ulcer. In a case of Ul-III gastric ulcer, the histopathological section show that a single layer of flat epithelial cells has extended from the invaginated regenerated cells. Observation of the gastric surface reveals that the marginal regenerated mucosa of a palisade like appearance has become thin and pointed. A sheet of cell layer extends from the foot of the edge over the defect. These cells are arranged like rosary beads parallel to each other and are occasionally bifurcated. The microvilli of these cells are short and rough and irregularly arranged. In a case of Ul-IV gastric ulcer with protracted healing, the ulcer margin consists of mature regenerated mucosa and only a few epithelial cells are creeping out to cover the denuded area. The scanning electron microscopic findings show that the palisade like regenerated mucosae are occasionally separated by the crossing ditches to form squares at the margin of the ulcer. The cobble stone like regenerated mucosae which are in more mature stage are also present in the other part of the specimen.
The closed circuit cytoglomeration and plasma exchange (3C-PE) is a new method of plasma exchange, which was first developed in our hospital for the treatment of hepatic coma. In brief, cytoglomeration indicates the reversible aggregation of red blood cells in isotonic sugar solution. The patient's red blood cells were separated from plasma by cytoglomeration instead of by the conventional centrifugation method. The packed red cells separated from plasma were reinfused into the patient together with healthy fresh frozen plasma. All 8 patients of hepatic coma were treated by the 3C-PE therapy. One patient with fulminant hepatitis in coma recovered completely by the therapy. One patient with subacute hepatitis in coma emerged from the coma after therapy. Temporary improvement of consciousness was observed in 3 of 6 patients with liver cirrhosis in coma by the treatment.
Drug-induced hepatic injury is one of the most important problems in medical practice in recent years in Japan. We collected 3330 cases of drug-induced hepatic injury reported in Japanese articles published over a period of 50 years from 1925 to 1974. The numbers of cases in each decade were as follows: the first decade (1925-1934): 85 cases, the second decade (1935-1944): 177 cases the third decade (1945-1954): 88 cases, the fourth decade (1955-1964): 361 cases, the fifth decade (1965-1974): 2619 cases. Seventy-eight point sixty-five percent of total cases were reported in last ten years. The greatest number of cases of drug-induced hepatic injury was due to chemotherapeutic drugs 840; drugs acting on the central nervous system 667; antibiotics 508, cardiovascular drugs 421; hormone and hormone antagonists 301; diagnostic aids 267; and other drugs; 326. Ten of the most common drugs which caused hepatic injury were arsphenamine sodium, thorium dioxide, 4, 4'-diethylaminoethoxy hexestrol, ethionamide, chlorpromazine, erythromycin estolate, sulfonamide, PAS, rifampicin, ajmaline in descending order of frequency. Most of the cases were diagnosed on the basis of clinical history, however, in some cases, readministration test, skin test, macrophage migration inhibitory test and lymphocyte transformation test of suspected drug was also performed as diagnostic aid. The most common drugs reported to have high mortality due to severe hepatic impairment were thorium dioxide, combination chemotherapeutics for tuberculosis pyrazinamide, oxyphenisatin, halothane in descending order. Eight-hundred and seventy-seven cases of drugs or poison ingestion for suicidal purposes, accidental inhalation of industrial or agricultural chemicals and food poisoning were also collected.
For last 2 years, 47 operative choledochoscopies in 47 patients and 245 post-operative choledochoscopies in 89 patients were carried out in 90 patients including 23 cases of retained stones in the biliary trees and 10 cases of intrahepatic stones. Retained stones in the biliary trees were all successfully removed through the T-tube fistula by using improved choledochofiberscope developed in our department. Non-surgical removal under endoscopic guidance were successfully carried out in 2 out of 10 cases with intrahepatic stones. In remained cases, all intrahepatic stones were completely removed with surgical and endoscopic approach. In comparative studies between endoscopy and roentgenologic diagnosis, unexpected stones have been demonstrated by post-operative choledochoscopy in some cases of which cholangiogram interpreted no retained stone nor intrahepatic stones. This fact suggests that standard cholangiography is certainly of value though, 2 procedures of choledochoscopy and cholangiography complement one another to obtain correct diagnosis. In this paper, furthermore, the management of biliary stones were discussed on the basis of our experiences on retained biliary and intrahepatic stones, and staged operation was emphasized to prevent poly-surgery especially in the cases with intrahepatic stones. In conclusion, post-operative choledochoscopy may be safe and simple procedure and can be used repeatedly if T-tube fistula is maintained. Moreover reliability of this endoscopic examination and usefulness for treatment of intrahepatic or retained biliary stones were emphasized.
Thirty-nine patients having gallstones in a functioning gallbladder were treated with chenodeoxycholic acid (CDCA) for more 3 to 18 months. The dose of CDCA used was 500 or 300mg per day. Twenty-one patients with radiolucent gallstones showed a definite response in gallstone size by this treatment. Complete dissolution of stones occurred in 13 patients and reduction in size in 8. The effect of CDCA on gallstones varied with stone size and the dose of CDCA. Gallstones of small and medium size (less than 10mm in diameter) were dissolved completely or partially in 16 out of 17 cases within one year with 500mg of CDCA per day, whereas this treatment had no effect in 4 patients with radiopaque gallstones and in 5 out of 6 patients with large radiolucent gallstones. Diarrhoea occurred in 7 patients taking 500mg CDCA per day. A slight and transient elevation in SGOT, SGPT and alkaline phosphatase was seen in 8 patients. There was no histological evidence of hepatic injury induced by CDCA as studies on the liver biopsies of 12 patients. No significant changes were noted in the fasting serum cholesterol and triglyceride levels.