The incidence and clinical features of acute gastroduodenal lesions were studied in 63 patients with head injury and 22 with burn. The acute gastroduodenal lesions were found in high frequency of 62 out of 85 cases (72.9%) by early endoscopy. Hemorrhagic erosion was thought to be the common lesion following severe injuries. It developed within two days after injury and usually located in the corpus of the stomach. Acute gastric ulcer, on the contrary, was occurred after one week and it was usually multiple. It was suggested that sepsis had a strong correlation with the development of acute gastric ulcer. Gastrointestinal bleeding was most frequent as the initial symptom and seen in 51 of 85 cases (65.9%). Only 2 cases complained abdominal pain. The other 17 cases were asymptomatic. Medical treatment including blood transfusion was ineffective in 16 of 51 cases with gastrointestinal bleeding and its mortality was 10%. These features were thought to be quite different from those of chronic peptic ulcer and acute gastric mucosal lesions following drug ingestion or emotional stress.
The surface pH of the gastric mucosa which were measured at 12 points in each subject by the microglass pH-electrode attached on the gastric fiberscope, were compared with the histologic findings and the gastric secretory functions in 11 cases with normal subjects and 19 cases with atrophic gastritis. The surface pH of the normal mucosa was mainly above 4.0 in the pyloric gland area, and was less than 4.0 in the fundic gland area. The surface pH of the gastric mucosa was, however, elevated in the fundic gland area in atrophic gastritis corresponding to the degree of the atrophic changes, showing the value of around 7.0 in severe cases. The mucosal pH of each part of the stomach, particulary those of the angle and the body, had significant positive correlation with the atrophic scores, and had significant negative correlations with the gastric secretory functions such as peak acid concentration, maximal acid output and basal acid output. The patterns of the distribution of the surface pH of the gastric mucosa in atrophic gastritis were classified into the following four types. This classification corresponded well with the histologic findings, and the atrophic border of the gastric mucosa was correctly estimated in almost all cases of atrophic gastritis based on this classification. Type 1: pH were below 4.0 in antrum, angle and body. Type 2: pH were below 4.0 in angle and body, and was above 4.0 in antrum. Type 3: pH was below 4.0 in body, and were above 4.0 in antrum and angle. Type 4: pH were above 4.0 in antrum, angle and body. The gastric secretory function was similar in Types 1 and 2, and it diminished in Types 3 and 4, more pronounced in the latter. The cases whose mucosal pH did not fall below pH4.0 at 20 minutes after the stimulation with tetragastrin (4μg/Kg, subcutaneously) showed hypo- or anacidity. It was considered that the measurements of the mucosal pH of the stomach under the direct vision was clinically useful as one of the endoscopical gastric function tests.
Some studies have been reported for intestinal bacteria in patients with immunoinsufficiency, but further examination would be required. In this study, the variations of intestinal bacteria in feces during administration of immunosuppressive drugs or anticancer drugs were examined for experimental animals and some clinical cases with malignant tumor. Intestinal bacteria in feces were isolated in aerobic or anaerobic conditions. As aerobic bacteria, Lactobacillus, E.coli, and Str.faecalis, as anaerobic, L.bifidus, Bacteroides, Peptostreptococcus, and Veillonella were chiefly isolated. By administration of steroid hormone, number of E.coli, Bacteroides and some enterobacteria in feces increased remarkably, and then after suspension of drug administration, original population of intestinal microflora was observed again 2 or 3 weeks later. Anticancer drugs such as 6 Mercaptopurine, 5 Fluorouracil, Azathiopurine were also resulted in fair increase of enterobacteria. The effect by Cyclophosphamide, Busulfan and Mitomycin C was not so remarkable compared with other drugs. By administration of these drugs, variations of constant intestinal microflora were observed. Therefore, it was demonstrated that the secondary disturbances in intestinal tract (for instance, increases of some amines produced by enterobacteria) would be appeared during therapy by various immunosuppressive drugs.
Intravenous infusion of 5% glucose, 10% maltose or saline to CCl4-injured rabbits was performed 24 hours after administration of the hepatotoxin. Liver function tests were examined on sera obtained at 24 and 48 hours and activities of several enzymes and contents of triglycerides, protein and glycogen were determined on livers obtained at 48 hours together with histological examination of hepatic tissues. The results indicated no essential differences among the above three experimental groups of animals with different treatments in the extent of hepatic injury found at 48 hours. Intravenously infused maltose was partially converted into glucose by intestinal tissues before entering into the liver through the portal vein. Small proportions of maltose was metabolized by the liver via glucose as an intermediate. Utilization of maltose by injured liver slices was reduced as compared with intact liver slices, although the relative rate of glucose utilization to the formation of glucose from maltose was greater in the injured liver than in the control. In conclusion, the intravascularly administered maltose is less likely to aggravate the preexisting hepatic injury, although the curative effect is not expected either once the process of liver damage has started.
Immune mechanism may play a main role in perpetuating injury of hepatocytes in chronic active hepatitis. Lymphocyte cytotoxicity was studied by microcytotoxicity assay in patients with chronic active hepatitis, using Coon liver cells as target cells. 1) Lymphocyte cytotoxicity was observed in 7 of 7 patient with chronic active hepatitis, using non E-RFC as effector cell. 2) Cytotoxicity was significantly reduced either by preincubation of 100μf/ml aggregated IgG into the medium or by addition of 10-3/ml anti IgG-Fc, using non E-RFC as effector cell (p<0.001). 3) Cytotoxic activity was found significantly in EA-RFC from patient with chronic active hepatitis comparison with controls (p<0.01) but in significantly in EAC-RFC. These result suggest that effector cell (K-cell) in the present experimental system may be Fc receptor-bearing cells.
Biopsied. liver tissues from 3 patients with drug-induced allergic cholestatic hepatitis were examined electron-microscopically with special reference to the microfilaments surrounding the bile canaliculi. Stretched microfilaments in the pericanalicular area increased in amount at about 60th day after jaundice, while they were not conspicuous at about 30th day. Microfilaments returned to the normal amount at about 100th day, though microfilaments in swollen microvilli were irregularly arranged. From these observations it is concluded that the increase of microfilaments around the bile canaliculi depends upon the stages of intrahepatic cholestasis.
The binding of Indocyanine Green (ICG) with serum proteins and rat liver supernatant was investigated by Gel-filtration using Sephadex G-200. By investigating the binding of various amounts of ICG, it was found that, in low concentration, it bound with high molecular proteins, but, in high concentration, with low molecular proteins. By examining the chromatographic patterns, the amount (mg; mg/g of protein) of ICG binding to each peak was calculated from samples of various liver diseases and from normal subjects. It was revealed that ICG significantly increased (p<0.05) in peak III in cases of acute hepatitis, chronic hepatitis and liver cirrhosis, while in peak II ICG was significantly decreased (p<0.025) in cases of chronic hepatitis. In the investigation of ICG binding to rat liver supernatant, ICG bound more to the Y protein than the X protein under low concentration (3.7mg/dl of supernatant), which was close to the initial concentration of the clinical ICG test. From these results it was presumed that the role of the Y protein was clinically more important than either the X or Z protein. Chromatographically, when a patient's serum (ICG-highly abnormal; BSP-normal) containing ICG was added to the rat liver supernatant, the transport of ICG was similar to the normal control. It is suggested that the abnormality of ICG binding to serum protein is not the cause of ICG abnormal retention phenomenon.
The prognosis of the hepato-biliary diseases was investigated to 2105 cases in whom indocyanine green (ICG) clearance test was performed during from Jan. 1, 1969 to Dec. 31, 1975. The questionnaire was answered by 743 cases (35.3%) The results were as follows. 1) In liver cirrhosis ICG test revealed a significant low value in patients who died within one year after the test than in alive patients. ICG test showed a significant low value in patients who died by gastrointestinal bleeding compared with patients died by hepatic coma. From these results it was suggested that a patient who showed a value of ICG plasma disappearance rate(K) under 0.05 or a value of ICG retention rate at 15 minutes(R15) upper 50% might possible die within one year caused by gastrointestinal bleeding. 2) There was a significant difference in cumulative proportion surviving rate between patients who showed K under 0.05 and patients showed K upper 0.05. 3) In alive cases with chronic hepatitis, liver cirrhosis and cholelithiasis there was a significant relationship between values of ICG test and the following condition of patients.
Solution of tetrasodium salt of ethylenediaminetetraacetic acid (EDTA 4Na), potent chelating agent, when incubated with slice of calcium bilirubinate stone, exhibited a yellow brown tint, which was spectroscopically characteristic of bilirubin. Microscopic examination of the slice revealed dissolution of granules of calcium bilirubinate, leaving behind a reticular matrix of PAS-positive substance. The efiect of EDTA 4Na was influenced by pH, being fully effective only at pH 10 or more, and by temperature and concentration as well. Simultaneous application of bile salt enhanced the activity of EDTA 4Na, hydrophilizing the gallstone surface to facilitate chelating reaction and also dissolving minor fatty components of the stone. Heparin at proper concentration also promoted disintegration of the stone, changing surface potential of its constituent particles to the dispersionprone charge. The effect of composite EDTA 4Na-bile salt-heparin was thus significantly greater than that of single EDTA 4Na. This mixture is promising for clinical application as a means of direct dissolution of residual gallstones.
The mechanism of pancreatic excretion of 5, 5-dimethyl-2, 4-oxazolidinedione (DMO) was studied by continuous intravenous infusion of secretin (4CHRu/Kg-hr) and DMO (50mg/Kg-hr) in 16 dogs. The pancreatic flow rate, pH, and electrolytes and amylase secretions showed no significant changes throughout the experiments. The avarage pH of pancreatic juice and whole arterial blood was 8.35 and 7.39, respectively. The DMO concentration in plasma and pancreatic juice continued to increase from 9.6 to 46.2mg/100ml and from 20.9 to 93.0mg/100ml, respectively. The pancreatic DMO concentration and output were closely related to their corresponding plasma DMO concentration. The concentration ratios of pancreatic juice/plasma for DMO (J/P ratio) were nearly constant throughout the experiments, avaraging 2.2. This value was only about a quarter of the theoretical value calculated from the pH partition hypothesis. The DMO transport from plasma to pancreatic juice can be accounted for without the assumption of any active transport system, but with a simple diffusion mechanism. There are many morphological barriers to rapid DMO diffusion into the pancreatic ducts, such as basement membranes surrounding endothelial, ductal, and acinar cells, and interstitial fluids. Furthermore, DMO trapped in the juice may be partly reabsorbed by a process of passive diffusion in the ducts. The observed values of J/P ratio are accordingly lower than the theoretical values.
A case of 78-year old man, who was diagnosed of gastric cancer metastatic to the liver and whose serum revealed the presence of 3 different carcinofetal antigens such as alpha-fetoprotein, variant alkaline phosphatase and carcino-embryonic antigen(CEA), was reported. In this case, alphafetoprotein producing cells seemed to be degenerating hepatocytes which were compressed by metastasis. Although synthesizing cells of variant alkaline phosphatase and CEA were studied biochemically using the extracts from the liver free from the cancer and gastric cancer, it was failed to make clear these synthesizing cells because of much contamination of the blood. However, alkaline phosphatase zymogram of the both extracts after treatment with neuroaminidase showed copresence of variant and fetal intestinal alkaline phosphatase which was firstly reported by Higashino et al. As the conclusion, we want to point out now a time for making clear the synthesizing cells of carcino-fetal proteins, although of course these proteins play an important role in clinical fields.