Investigation was made on the relationship between the survival rate at a given number of years and a series of clinical and pathohistological indices as the factors affecting the prognosis after resection of gastric cancer and these depend upon the"General Rules for Gastric Cancer Study in Surgery and Pathology". Moreover, there are clinical problems such as the localization, infiltration, size and extention as well as the Stage of progression of the major cancerous region. In regard to age, those patients of gastric cancer in their fourties showed the most favorable results. Pathohistologically, it was confirmed that histological pictures exert the most remarkable influences on the prognosis. Thus, not only the extent but also structural atypism and infiltrative growth were considered as the important indices for determining the prognosis of gastric cancer.
A group of five mongrel dogs underwent a four-stage operative procedure: (1) Heidenhain pouch; (2) selective proximal vagotomy; (3) selective gastric vagotomy; and (4) total truncal vagotomy. The more the extent of denervation was, the more increased the food-stimulated secretion of the Heidenhain pouch which was highest after total truncal vagotomy. Gastric acid responses to tetragastrin of Heidenhain pouch increased after selective proximal vagotomy but was no difference in between those after selective proximal vagotomy and selective gastric vagotomy. Following an insulin infusion after various types of vagotomy, there was no difference in gastric acid responses of Heidenhain pouch and in serum gastrin responses.
Cell-mediated immune responses to purified HBsAg (cellular HBsAb) and to insoluble hepatocyte-surface membranes (IHSM) prepared from rat livers were assayed in 40 patients with chronic hepatitis using the leucocyte-migration test. HBsAg, HBsAb and HBcAb in sera were also detected simultaneously in the same patient. Cell-mediated immunity to IHSM was found in 37% of patients with chronic persistent hepatitis and in 43% of those with chronic active hepatitis. Cellular immune responses to purified HBsAg were observed in 35% of patients with chronic hepatitis. Patients with at least one or more of HBsAg, HBsAb, HBcAb and cellular HBsAb were classified as HBV-associated chronic hepatitis group and patients without any of them as HBV-non-associated chronic hepatitis group. The former group was consisted of 28 out of 40 patients with chronic hepatitis (70%), partly due to a presence of cellular immunity to HBsAg in many HBsAg-negative patients. Out of 16 patients with chronic hepatitis who had cellular response to IHSM, 14 patients (88%) were belonged to HBV-associated chronic hepatitis group. The positive response to IHSM was found in 64% of patients with the positive cellular response to purified HBsAg but in 27% of patients with the negative response to purified HBsAg (P<0.05). Conversely, the positive cellular response to purified HBsAg was observed in 56% of patients with the positive cellular response to IHSM but in 21% of those with the negative response to IHSM (P<0.05). Furtheremore, there was a significant correlation in degree of the cellular response between to purified HBsAg and to IHSM in a group of HBV-associated chronic hepatitis (r=0.456, n=28, t=2.613, P<0.02). In a group of HBV-nonassociated chronic hepatitis, however, no correlation was found at all. Thus it seems likely that the development of a cellular response to IHSM in patients with HBV-associated chronic hepatitis was closely related with the development of a cellular response to purified HBsAg. These significances were discussed.
Bile acid deconjugation was measured by expired --CO- after oral administration of glycine-l---C-cholic acid to seventeen cases of intestinal obstruction. They were fifteen mechanical and two paralytic ileus. Among fifteen mechanical ileus, nine cases were operated and six cases were improved by the conservative treatment. Cumulative specific activity of --CO- for 6 hours before the treatment was 40.20±11.03 (SEM) (control 2.96±1.16) and was decreased to 6.86±3.64 after the treatment. Enteric bacteria, splitting amino radicles of the bile acid, were identified in the obstructed bowel more than 10-/ml. Cumulative specific activity of --CO- for 6 hours in two paralytic ileus was lower than the control value. Deconjugated bile acid was reported to inhibit water and electrolytes absorption in the small intestine and would play important role in fluid retention in intestinal obstruction.
Endotoxin was studied by Limulus lysate test about ascites and plasma of the 20 cirrhotics with both ascites and esophageal varices, and about plasma of the 16 control cirrhotics with esophageal varices only. Endotoxin was positive in 16 (80.0%) of the ascitic fluid and 13 (65.0%) of the plasma in the cirrhotics with ascites. In contrast, endotoxemia was found in only 18.8% (3 of 16) of the control patients The incidence of endotoxemia in the ascitic group (65.0%) was significantly larger than that of the ascitic free control group (P<0.025). Eleven of the 20 (55.0%) ascitic fluid showed high concentiations of endotoxin above 10-3μg/ml. Considering ascites is continuously circulating, it is natural to conclude that endotoxin mainly comes into the systemic circulation from the ascitic fluid in the cirrhotics, although the factors of the loss of capacity to detoxify intestinal endotoxins and the internal and external shunt must be taken into consideration. As to the biologic actions of endotoxin, no cases with endotoxemia showed hypotension, and only one case showed fever above 37.5°C, and the occurrence of endotoxin tolerance was suspected.
Effect of increased intravascular coagulation on the digestive mucosa was investigated in an experimental model of DIC (disseminated intravascular coagulation) produced in dogs and rats. Intravenous administration of bacterial endotoxin caused marked hemorrhagic necrosis of the intestinal mucosa of dogs within 3 to 8 hours and the lesion was coated with whitishpseudomembrane. Histologically, the villi showed marked deformity, fall of epithelial cells, cellular infiltrations, and sludging of red cells or thrombic formation in the microcirculations. There was no evidence of the increased tissue fibrinolytic activity in the affected mucosa. These data led us to conclude that the intravascular coagulation in the microcirculation of the intestinal mucosa affords to produce hemorrhagic necrosis of the mucosa, and to which fibrinolytic activity does not participate. Pretreatment of the intestinal mucosa of a dog by trans-AMCHA, a potent antiplasmin compound, or by Trasylol prior to the endotoxin shock, prevented the intestinal mucosa from hemorrhagic necrosis, and it was indicated that proteolytic enzymes present along the intestinal wall played a role in the production of mucosal damage when the microcirculation of the mucosa was disturbed by endotoxin. Further, it was found that rats treated with trans-AMCHA showed enhancement of the production of intestinal lesions following to the administration of endotoxin, indicating the antiplasmin agent inhibited secondary fibrinolysis, and accelerated the clot formation in the rat.
Peroral cholangiopancreatoscopy (PCPS) under duodenoscopic guidance was attempted on 18 patients with biliary tract and pancreatic diseases. A side-viewing duodenoscope (masterscope) and three types of cholangiopancreatoscopes (subscope) passed through an an instrument channel of the masterscope which were all specially made by Olympus Optical Co. were used in this study. The procedure was successfully accomplished on 15 of 18 patients without any complications; cholangioscopy in four, pancreatoscopy in three and cholangiopancreatoscopy in eight. In the remaining three, the tip of the subscopes could not be introduced into the duct systems because of technical or anatomical difficulty for cannulation of the ampulla of Vater. 1) Peroral cholangioscopy (PCS) Cholangioscopy was successful overall in 12 of 18 patients. Of these 12 patients, inspection of the hepatic biliary tree as well as the extrahepatic duct was possible in 8 patients. In the remaining four, the examination was limited within the extrahepatic biliary tract. The mucosa of the duct was shown to be yellow through bile. The bifurcation of the common hepatic duct was readily recognized as a carina similar to the bronchial bifurcation, and the hepatic duct shortly divided into two segmental divisions. In patients with choledocholithiasis, calculi were clearly visualized. 2) Peroral pancreatoscopy (PPS) PPS was successfully accomplished on 11 of 18 patients; two with visualization of the entire main duct and nine with that of the head and body. The lumen of the pancreatic duct had a pale-pinkish appearance with a delicate submucosal vascular reticulum. The orifices of the branch ducts sometimes could be recognized as pinholes.
Ultrasonotomography was conducted on a total of 100 patients with marked jaundice, consisting of 55 with surgical jaundice (extrahepatic obstructive jaundice) and 45 with medical jaundice (intrahepatic cholestasis and hepatocellular jaundice). As a result, it was demonstrated that such findings as remarkable enlargement of the gall bladder, dilatation of the choledochus and dilatation of the intrahepatic bile duct were specific to extrahepatic obstructive juandice. A fairly accurate differentiation between extrahepatic obstructive jaundice and intrahepatic cholestasis, which is of utmost importance in the clinical practice, could be attained by this method. In the of extrahepatic obstructive jaundice due to cancer of pancreas head, in particular, a more accurate differential diagnosis could be made. The author had an impression that in future ultrasonotomography without physical troubles of the patients and side effects could be expected as a method of first choice in the diagnosis of jaundice.