The paper described morphological alterations of the papilla of Vater, the minor papilla, the peri-Vaterian diverticulum and the promontory in relation to ages and pancreatico-biliary diseases on materials from 202 autopsy cases whose chronological ages varied from 2 to 97 years. In Part-I, the problems relating to the papilla of Vater and the pancreas are discussed and those relating to the minor papilla, the peri-Vaterian diverticulum and the promontory will be descrived in Part-II. 1. Grossly the papilla of Vater consists of the major papilla (a protrusion at the orifice (s) of the common bile and Wirsung's duct), the longitudinal plica (the bulging oral to the major papilla), the frenulum (the thin fold(s) anal to the major papilla) and the hood fold (a transverse fold protecting the major papilla). Appearance and incidences of these structures, their contribution in formation of the papilla of Vater and relations of these alterations to aging were analyzed. The shape of the major papilla and the formation of the frenulum related closely to muscular arrangement of the Oddi's sphincter. Many longitudinal, thin bundles of smooth muscles, distinguishable from the muscle layers of the duodenum, blood vessels and glands, were noted in the frenulum. 2. Histologically the papilla of Vater and pancreatic structure were effected significantly by senescence and by existing cholelithiasis. Alterations of the papilla of Vater may be classified into three types; normal, inflammatory and adenomyomatous types. Both inflammatory and adenomyomatous changes to the pancreatic structure was proved statistically as equally significant. 3. A positive relation between the type of gallstones and the anatomical shape of the terminal of both choledochus and Wirsung's duct was noted. Cholecystolithiasis, especially of cholesterin stone, is more often in the types with common channel (Type III, IV), and choledocholithiasis, especially of bilirubin stone, is more often in the types without common channel (Type I, II).
In this part, the minor papilla, the peri-Vaterian diverticulum and the promontory (Eaton, 1969) were studied. One hundred twenty eight specimens from 202 autopsy cases used in the previous study were injected a radio-opaque material from amputated orifices of choledochus, pancreatic duct and duodenal canal and analyzed radiographically. Macroscopic and histological analyses were made on treated materials before and after subsequent formalin fixation. 1. The minor papilla was noted in 96.2% of the materials examined. Three types may be classified by its front view; round (59.4%), oval (29.8%), and unclassified (7.0%) types. Histologically the minor papilla showed a similar structure to that of the papilla of Vater. Since the minor papilla showed a significant relation to the pancreatic diseases, its alterations in clinical diagnosis of the pancreatic diseases is as effective as the alterations of the papilla of Vater. 2. The peri-Vaterian diverticulum may be classified into two types morphologically and histogenetically; Group-I, a diverticulum larger than 5mm in diameter, appeared near the major papilla and represents a classic term of the peri-Vaterian diverticulum. Group-II, a diverticulum smaller than 5mm in diameter, appeared multiply at the lowest part of the frenulum or bilateral to the frenulum at regular distance. Group-I appeared adjacent to the choledochus. Its incidence increased parallel to advancing age up to 30% in the group over 60 years. Group-II located at the site where vasculatures penetrated the duodenal wall and observed in 15% of the group over 60 years. The peri-Vaterian diverticulum gives little influence to the pancreatico-biliary system except for dilatation of the choledocho-pancreatic duct. 3. The promontory was absent in 30% of the materials regardless the age. The promontory may be classified into two types; complete and incomplete types. Ratio of the complete to incomplete type increased with advancing ages. Histologically no apparent relationship between the promontory and pancreatico-biliary system was observed.
Influence of salicylazosulphapyridine, a medicine for inflammatory bowel disease, on peripheral blood lymphocytes in healthy subjects was examined by chromium release assay. The following results were obtained. 1. Inhibition by salicylazosulphapyridine on the PHA-induced cytotoxic action of human lymphocytes was obserbed by using mouse L cells as target cell. 2. The degree of inhibition for cytotoxicity was inversely proportionate to the viability of the lymphocytes. 3. Lymphocytes pretreated with salicylazosulphapyridine synthesized about similar amounts of DNA by PHA stimulation in comparison with DNA synthesis by untreated lymphocytes. 4. The toxic action of salicylazosulphapyridine was examined by using human lymphocytes, human erythrocytes, human Chang liver cells and mouse L cells as targets. As a result, lymphocytes were more sensitive than other cells to the toxic action of salicylazosulphapyridine, indicating that salicylazosulphapyridine has selectively the toxic action for the lymphocytes. The above results suggest that salicylazosulphapyridine has some inhibitory action for immune system in vivo.
Four methods of Drip Infusion Cholangiography (DIC) method A, B, C, D were performed in patients with hepatobiliary diseases. Method A was basically a screening method, and the gallbladder was visualized in 68.8% and the common bile duct in 85.0% of 460 cases. Through method BD the gallbladder was visualized in 54.7% of 80 cases with suspected gallstone and the common bile duct in 78.8%. Through method C the visualization of the gallbladder was in 72.2% of 54 cases with parenchymal liver disorders and the common bile duct was in 50.0%. The visualization rate of the gallbladder elevated from 32.3% to 58.1% and of the common bile duct 69.4% to 85.5% through method BD in addition to method A in 62 cases. Through method C in addition to method A the visualization rate of the gallbladder and the common bile duct elevated from 11.1% to 66.7% and 22.2% to 55.6% in 9 cases, respectively. Through method A the visualization rate of the gallbladder significantly decreased in patients indicated over 20 KA unit of ALP, over 300 unit of LAP, over 300 unit of γ-GTP and over 3.0mg/100ml of serum total bilirubin, and the visualization rate of the common bile duct decreased in patients indicated under 0.100 of KICG, under 0.1000 of aICG and over 20.0% of R15ICG Through method BD the visualization rate of the gallbladder and the common bile duct was paralleled by changes in the degree of liver function tests. Through method C the visualization rate of the gallbladder decreased in patients indicated over 3.0mg/100ml of serum total bilirubin, under 0.050 of KICG, and over 40.0% of R15ICG. The optimum time to visualize the gallbladder in the patients with normal ICG test was 90 minutes after the drip infusion, whereas that of the common bile duct was 30 minutes. In the patients indicated under 0.100 of KICG or above 20.0% of R15ICG the gallbladder was favourably visualized at 120 minutes and the common bile duct was at 60 minutes. From these results it was concluded that the visualization of gallbladder was influenced by the excretory factors of iodipamide from liver to bile and that of the common bile duct was influenced by the uptake factors from plasma to liver, and that the specific method to be used should be determined by analysis of the liver function tests.
In order to study the effect of the pancreatic blood flow on the exocrine secretion of canine pancreas, simultaneous measurements of the blood flow of the inlet artery of the pancreas, the amount of the pancreatic juice and the amylase concentration in pancreatic juice were performed, following the intravenous injection of pancreozymin or secretin. Blood flow of the superior pancreatico-duodenal artery was measured by means of the non-cannulating type of the electromagnetic flowmeter after the ligations of the inferior pancreatico-duodenal artery and some branches of the splenic artery which gave blood supply to the pancreas. In addition, correlation between the pancreatic blood flow and the exocrine secretion was investigated by increasing the pancreatic blood flow by means of the artificial heart lung apparatus. Following results were obtained. 1) Pancreatic blood flow and exocrine secretion increased significantly in all dogs after the intravenous administration of pancreozymin or secretin. 2) Amount of exocrine secretion of pancreas was correlated well with the pancreatic blood flow when the pancreatic blood flow was increased by means of the artificial heart lung apparatus under the intravenous injection of secretin as background. 3) Amount of the exocrine secretion of pancreas increased significantly by increasing the pancreatic blood flow by means of the artificial heart lung apparatus without the use of any other stimulation. 4) It was considered from the above finding that the change of the pancreatic blood flow had close relation with the exocrine secretion of the pancreas.
Male Wistar rats were fed with 0.1% iodoactamide (IAM) and/or 0.005% (50mg/l) N-methyl-N'-nitro-N-nitrosoguanidine (NG) dissolved in drinking water. IAM induced chronic ulcers in the fundic region along the limiting ridge of the stomach. NG produced carcinomas in the pyloric region but none in the fundic region. The treatment with both of them led to development of cancerous lesions not only in the pyloric region but also in the fundic region which had been ulcerated. The fundic lesions were lower in their incidence and milder in atypia than the pyloric lesions. The findings suggest that gastric ulcer may be transformed into malignancy but the malignant transformation may occur less frequently than expected in the non-ulcerative and susceptible region.
An ovarian cancer with hyperamylasemia is reported. Amylase activity in the patients serum, cyst and urine was elevated. The amylase in these body fluids showed characteristic isozyme patterns. A homogenate obtained from tumor which displayed a feature of serous papillary cystadenocarcinoma showed 2 bands of salivary type, whereas the other homogenate from the tissue which showed cacinoma solidum simplex had only one band of the type. The amylase activity in the serum and urine markedly decreased after resection of the tumor. Kidney clearance of amylase was determined to be normal. Existence of macroamylasemia was excluded by Sephadex G-200 gel filtration.