Experimental gastric ulcers were made in rats, and the regeneration of the mucosa was observed by acid phosphatase and beta-glucuronidase staining and mitotic figures were measured by administering colchicine. In the acute gastric ulcer model, the epithelial ingrowth was formed at the marginal zone of the ulcer, from which the healing mechanisms seemed to be started. While in the chronic ulcer model, regeneration of the mucosa was retarded by that insufficiency. The epithelial ingrowth is considered to be constituted of dedifferentiated cells from the mature cells and undifferentiated cells rolling down from the neck cells layer in the mucosa to heal the gastric wounds. It is a cell population, having a high potential energy to divide and differentiate, supported by the connective tissues of both the mucosa and base of the ulcer. It is suggested that lysosomal enzyme acid phosphatase and beta-glucuronidase are concerned with the metabolism just after the cells devided to develop and differentiate normally.
The etiology of peptic ulcer was studied separately from the view point of acid, pepsin and mucus. On the series of experimental studies the peptic ulcer was made by the perfusion method originally devised by the author in rats and the effect of acid, pepsin and mucus on the ulcerogenesis was separately examined with the factor of the pel fusion time. Meanwhile, on the clinical series the transition of gastric secretion as the ulcer stage was observed. On experiments, the author knew that the gastric mucous membrane was more resistent to the acid than the duodenum and the reduction of mucus secretion by the intravenous administration of prednisolone induced more rapid formation of gastric ulcer. On clinical observation the gastric mucous secretion was markedly less in the active stage of gastric ulcer than the scarring one. On the contrary the acid was thought to be more potent factor in the pathogenesis of duodenal ulcer. From these facts the author concluded that the major factor in the pathogenesis of gastric ulcer was different from that of duodenal ulcer.
In human gastric juice stimulated by tetragastrin, histamine output and acid output were parallel each other with time. Histamine content in glandular mucosa of the rat stomach decreased, while increased in gastric juice after stimulation by tetragastrin. Therefore, the relationship in content of histamine between gastric mucosa and juice formed a contrast. L-histidine-C14 (u) was altered to histamine-C14 in gastric mucosa, and then histamine-C14 was found in gastric juice. As above, it was confirmed that histamine was released from gastric mucosa to gastric juice. It was considered that histidine decarboxylase activity (HDC activity) in glandular mucosa of rat stmach was accelated by stimulation of tetragastrin, and then increased to replenish histamine released from mucosa to juice. On the basis of these studies, it was confirmed that histamine in gastric juice relates to gastric secretion closely.
This report was on the bais of experience with 22 cases of total pancreatectomy during the last 27 years. The postoperative care for them was reviewed. The postoperative period is divided into two periods: the surgical period and the medical period. The surgical period means 30 to 50 days after surgery when intravenous infusion of the nutrition and water is required. The medical period is the duration following to the surgical period when the patient is cared for at the medical ward or as an outpatient. The surgical period comprises an immediate period when oral water intake is immposible or not sufficiently feasible, and an intermediate period during which additional intravenous energy supply might be required. During the immediate period, the continous intravenous infusion of the solution of 200gm of glucose and 40 units of regular insulin for 24 hours was the most successful care. At the intermediate period, without restriction of food intake and with intravenous energy supply, if required, at least 20 units of regular insulin per day should be administered subcutanously. About 20gm of pancreatin given before, during and after each meal successfully improved the disturbed digestive function.
Absorption of glucose from the stomach with intestinal mataplasia was studied by double sampling method instilling 300ml of 5% or 10% glucose solution for 20 minutes. Forty eight subjects were examined in this study. Rate of glucose absorption from the stomach was neither related closely to extent of intestinal metaplasia, nor to gastric emptying. As the brush border of intestinal metaplasia contains many kinds of disaccharidase reported by Sugimura, it is possible to think that glucose may be absorbed from the gastric mucosa with intestinal metaplasia. In our study of 48 cases with intestinal metaplasia of the gastric mucosa, 21 cases showed the results suggesting gastric absorption of glucose much or less. Rate of glucose absorption from the stomach ranged a few % to 48% of instilled glucose in those 21 cases.
A new method of radioimmunoassay using duoble antibody method for human intestinal alkaline phosphatase (ALP) was first elabolated. The following results were obtained: 1) In this system, optimal antibody concentration is 10, 000 times dilution of original anti-serum and optimal assay range is 0.5 to 25ng. Enzymatic activity of 1ng intestinal ALP is 4.1 King-Armstrong units. 2) In this system, the sera including intestinal ALP are divided to two groups. One group shows dose response curve similar to those of purified intestinal ALP and the other shows lesser. This reason is not clear. Hepatic ALP, osseous ALP and placental ALP in the sera show no response in this system. 3) In this system, B/T value of 50μg of purified human placental ALP is almost equal to 1ng of purified human intestinal ALP. B/T value of 50μg of purified human intestinal ALP is almost equal to 5ng of purified human placental ALP similarly. This shows cross-reaction exists between intestinal and placental ALPs at high concentration.
We have already reported a peculiar alkaline phoaphatase (ALP) isoenzyme (ALP6) appeared in the sera of ulcerative colitis patients. Enzymological and immunological characteristics of this ALP6 were studied. The following results were obtained: 1) ALP6 was detected in the sera from 4 out of 20 cases (20%) with ulcerative colitis. 2) In active stage of the disease, ALP6 appeared along with decrease of hepatic ALP. ALP6 disappeared in remission. 3) The characteristics of ALP6 was similar to hepatic ALP with respect to the inhibition by L-phenylalanine, imidazole and L-homoarginine. As to the heat-stability at 56°C and inhibition by urea, ALP6 resemble more closely to bone ALP. 4) Active band of ALP6 on polyacrylamide-gel disc electrophoresis disappeared after treatment with anti-human hepatic ALP antibody, but was not affected with anti-human intestinal or placental ALP antibody. Therefore, ALP6, found in ulcerative colitis, seems to be a modified enzyme of hepatic ALP.
The gastric gland is classified histologically into the fundic and pyloric gland area. When we study about the localization of gastric ulcer, it is related to the glandular border between the fundic and pyloric glands, however, it could be also regulated by the vascular architecture of gastric wall. We would like to present the paper about the difference of vascular architecture between fundic and pyloric gland area of human stomach. The specimens were observed under light microscope after injecting black ink into main gastric artery of resected stomach. On the other hand, the corrosion casts of vessel were investigated by scanning electron microscope. In fundic area, capillary of mucosa runs vertically upwards to the gastric cavity. Diameter of vessels is enlarged again in generative cell zone, and the vessels running towards surface epitherial cells. Under the surface epitherial cells, there was capillary mesh, and they formed capillary loops, encircling each glandular openings and continuing venules. In pyloric area, numerous capillaries penetrated muscularis mucosa and immediately ascended radially towards the gastric cavity. Capillary meshwork is shorter and more coarse than fundic one. Also, we measured the diameter of each vessel injecting black ink and counted the number of vessels surrounding each glands, by horizontal cut section of glandular portion and generative cell zone under light microscope. The diameter of vessels of fundic area was slightly wider than the pyloric ones, and vascular distribution in fundic gland area was about two times as dense as in pyloric area.