Authors carried out the endoscopic staining method using Congo red to patients with peptic ulcer of Japanese, Korean in Japan and German. From the functional fundo-pyloric border determined endoscopically, it was confirmed that there was a racial difference in the location of ulcer and chronic changes of the gastric mucosa underlying peptic ulcer, that is, the extent of atrophic gastritis. Furthermore, it was proved that the development of chronic atrophic gastritis howed a discrepancy of age between three races. Age when chronic atrophic gastritis was detected in over 50% of subjects, was thirties in Japanese, forties in korean in Japan and sixties in German. From the epidemiological investigation of the development of chronic atrophic gastritis, only high salt containing food was considered to show a significant difference between Japanese and Korean in Japan, . that is, the latter ate salty food much more than the former.
Serum globulin subfractions were examined on 110 patients with gastric cancer without complications. Alpha 1 AGP, α1AT, HP, α2M, α2HS, IgG, IgA and IgM were measured by single radial immunodiffusion method and the relationship between the variation of these proteins and the type or the stage of gastric cancer were examined in various aspects. IgG increased, and IgM decreased in the patients with early gastric cancer, while in advanced cases α1AGP, α1AT and HP increased, and α2M and IgM decreased. Furthermore, in patients with or without metastasis, these subfractions were respectively examined. Alpha 1 AGP, α1AT and HP increased, but α2M and α2HS tended to be decreased in patients with metastasis. Especially, HP remarkably decreased, and IgG increased in the patients with liver metastasis. In inoperable patients, α1AGP, α1AT and HP increased and α2HS markedly decreased. It was suggested that the determination of serum globulin subfractions was available to examine the pathophysiological findings in the gastric cancer.
Enzymological properties of tissue alkaline phosphatase (ALP) were examined in carcinoma, intestinal metaplasia, adenomatous polyp, atypical epithelium and normal mucosa of the stomach. ALP was extracted from biopsy and surgical materials with n-butanol by Morton's method. ALP isoenzymes were examined by polyacrylamide gel disc electrophoresis and heatstability at 65°C for 15min. Heatstable ALP was seen in the tumor tissues from 6 out of 20 gastric cancers (30%) and 1 out of 28 intestinal metaplasia, while not found in the tissue from adenomatous polyp, atypical epitherium and normal gastric mucosa. There were no relationships between the incidence of heatstable ALP and differentiation of gastric carcinoma. Heatstable ALP was in partial intestinal metaplasia tissue and histological findings of which showed low grade regenerative atypism but no malignant changes. The occurence of heatstable ALP in the tissue of intestinal metaplasia is very important, because this isoenzyme has never been seen in benign tissue. Therefore, the possibility exists in the intestinal metaplasia to be of premalignant lesion, although our only experience do not make a conclusion.
Disorders of bile acid and oxalate metabolism in four patients with Crohn's disease were investigated. They were all male patients and their affected lesions were ileum and colon. Two of them were operated and the remaining were treated with alicylazosulfapyridine. Increased ratio of glycine and taurine conjugated bile acid was seen in only one case, on the other hand, decreased ratio of rihydroxycholanic acid and dihydroxycholanic acid was seen in all cases. Enteric bacteria was positive in three out of four duodenal aspirates. Mean urinary oxalate excretionwas more than 200mg/day in two cases. In the remaining two cases, it was slightly increased compared to the control. Fecal fat excretion using I131-triolein were less than 5% in all cases.
Advanced hepatic diseases are associated with considerable distortion in serum amino acid patterns and severe mulnutrition. Two amino acid solutions, a mixture with essential and nonessential amino acids high in branched chain amino acids and low in aromatic amino acids (Fischer solution) and a synthetic mixture of branched chain amino acids containing 3 amino acids associated with the urea cycle (Hep-OU), were infused to control subjects and patients with severe liver diseases. Alterations of serum aminograms, blood ammonia levels and electroencephalograms were studied and compared with those obtained by a commercially available amino acid mixture. 1) Infusion of a commercially available amino acid mixture to cirrhotics induced an amino acid pattern documenting in hepatic encephalopathy. 2) Fischer solution resulted in further elevation of methionine and phenylalanine levels in serum in a cirrhotic patient. 3) Reduction of methionine, phenylalanine and tyrosine levels and clinical improvement in patients with liver cirrhosis and subacute hepatitis were obtained by infusion of Hep-OU.
The movement of the papillary region was measured by means of a pressure sensor, and the changes of the movement by gastrointestinal hormones were studied in rabbit. After the intravenous administration of CCK-PZ (4-8u/kg/3min) the movement of the papillary region was accelerated immediately. On the other hand, during the administration of CCK-PZ (0.5, 1 and 2u/kg/hr) in comparison with those of control pattern, the movement was depressed gradually. After the administration of caerulein (300ng/kg/3min) the movement was accelerated immediately as well as CCK-PZ. During the intravenous administration of caerulein with dose 100, 500ng/kg/hr the movement was accelerated gradually. The action of cholecystokinin on the papillary region was inhibited by secretin, but was not inhibited by atropin-administration and surgical vagotomy. About 15-60 minutes later, after duodenal amino-acids or olive oil perfusion, the elongation of wave length was observed in the dog. The effect of these hormones on the movement of the papillary region was mesured by the pressure sensor using a duodenofiberscope in man. After the administration of CCK-PZ (1-2u/kg/3min), the deterioration of the movement of papillary region was observed, then 6-7 minutes later, the movement was accelerated. At the same time, bile excretion was revealed under the direct vision by duodenofiberscope.
Effect of various doses of Ursodeoxycholic acid [UDCA] (300, 600, 900mg per day) on biliary lipid and bile acids composition was investigated in 15 gallstone patients with functioning gallbladder, using a constant format with ascending dose order. During treatment the effect of UDCA on gallstone dissolution was studied too. At every dose, UDCA therapy improved the lithogenicity of bile significantly (p<0.05). It seemed that this improvement in lithogenicity was associated with a selective reduction in proportion of cholesterol in biliary bile. Optimal dose of UDCA for gallstone dissolution was discussed on the basis of the relationship between percent CDCA+UDCA i.e."chenoid"and lithogenicity. The present study indicates that a dose of 8-12mg/kg or 600mg per day may be necessary to obtain desaturation in patients with gallstones. Nomarked side effect was observed during this study.
Since dissolution of cholesterol gallstones by chenodeoxycholic acid (CDCA) was reported in 1972, it has been suggested that ursodeoxycholic acid (UDCA), 7β-hydroxy group epimer of CDCA, may also have a similar effect. A series of reports have confirmed this hypothesis of late. In the present study, 100-450mg per day of UDCA was given to 66 patients with cholesterol gallstones in the gallbladder for 4-24 months and its safety and effectiveness to dissolve allstones were examined. AS a result, UDCA proved effective in 34.9% of the 66 patients treated (dissolution: 8/66, decrease in size and/or number: 15/66) and 43.5% of the 46 patients with noncalcified stones (20/46). Analysis of bile composition confirmed improvement of cholesterol solubility. The present study indicates that if suitable patients are selected, UDCA which has almost no side effects may be an effective gallstone dissolving agent.
In order to examine the prognosis of the carcinoma of the gallbladder, 44 cases were divided into 3 groups from the extension of the cancer at the time of operation. The prognosis is bad enough and it is not necessarily due to the operative method, but rather may well be due to the stage of carcinoma extension itself. Two cases out of 7 cases in Stage 1 survived 5 years or longer. Cases in Stage II survived only 8 months average after operation in spite of extensive surgical procedure. Histological examination of the operative and autopsy's specimens told that the operative procedure should involve not only cholecystectomy, resection of the bile duct, of all of the liver tissue which comprises the gallbladder bed and nodal dissection, but also that of the peritoneum and lymphatic tissue with nervous tissue. In cases of biliary tract obstruction due to the carcinoma of gallbladder should be done percutaneous transhepatic hepatic duct drainage or percutaneous gallbladder drainage. Cases in Stage III may get good result with palliative therapy like above, if it is found preoperatively.
In an attempt to clarify the transport mechanism of water and electrolytes, intercellular junctions of the canine exocrine pancreas by lanthanum tracer technique were studied ultrastructurally to evaluate the permeability characteristics. By perfusion of the pancreas with solution containing ionic lanthanum as a racer, lanthanum particles were perfectly stopped at the tight junction near the apex of the exocrine cells. However, they permeated into the lumen across the tight junction by stimulation with secretin. The flux of lanthanum particles into the lumen did not occur across the tight junction between the acinar cells, but occured across the tight junction between the acinar cell and the centroacinar cell.
This study was carried out to clarify the incidence and clinical features of the patients with pancreatolithiasis experienced in Hokuriku district, Toyama, Ishikawa and Fukui prefectures, during the past seven years. Twenty-five out of 31 patients with pancreatolithiasis were males and six were females. The average age was 45.9 years old for men and 49.5 for women. The period from the appearance of initial symptoms to the time of the diagnosis were less than 3 years in 64.5per cent of the patients. This suggests that the calcification in the pancreas appeared relatively in shorter period than generally considered. Ninety-four per cent of 31 patients complained of an abdominal pain but seven per cent had no pain. Etiologically, 48.4per cent were regarded as being related to alcohol intake, 9.4per cent to biliary diseases, 3.2per cent to acute pancreatitis, but 38.7per cent could not be etiologically distinguished, (idiopathic form). Eighty-four per cent of the patients showed a functional insufficiency in the pancreatic exocrine and 71.4per cent showed also a disturbed endocrine function. Furthermore, the patients with a diffuse calcification in the pancreas showed a remarkable reduction in both of exocrine and endocrine functions, while four patients with a localized calcification had normal exocrine functions. From these results, it is presumed that the pancreatolithiasis does not always imply a final stage of chronic pancreatitis.
The amylase-creatinine clearance ratio (ACCR) is useful diagnostic clue to acute pancreatitis in the patient with hyperamylasemia. In the present study, changes of ACCR were investigated after upper abdominal surgery. 1) The elevation of ACCR over 6% was observed in 32.3% of the postoperative patients with hyperamylasemia, in whom operative intervention had influenced on the pancreas and duodenum. 2) The acute pancreatitis should be considered when ACCR was elevated over 6% with high output of urinary amylase, but notwhen ACCR was below 6%. 3) The elevation of ACCR is generally considered the result of decreased tubular reabsorption, but renal disturbance, occuring in acute pancreatitis, may affect an elevation of ACCR due to low creatinine clearance.
We have recently seen a case of hepatocellular carcinoma, in which the initial symptoms were paraplegy and sensory disturbance of the lower extremities without obvious hepatic signs. The radiological interpretation, at that time, revealed massive tumor formations in the thoracic vertebral column and the paravertebral space. During admission, signs of the complete spinal transection were noted, later followed by hepatic failure, and respiratory insufficiency due to metastatic lung cancer. At autopsy hepatocellular carcinoma with Miyake B' cirrhosis of the liver was noted, associated with metastases to the thoracic vertebrae and paravertebral connective tissue. The spinal cord in the affected vertebra revealed transverse compression necrosis due to such bone metastases. The present case is very rare and literatures concerning bone metastasis of hepatocellular carcinoma with its clinical manifestation are reviewed.