An obliteration of the gastric coronary and short gastric veins by percutaneous transhepatic portography was performed in 5 esophageal varices patients without any critical complication. The portography carried out 3 or 4 days later revealed a recanalization in 2 cases. Rontogenographic and endoscopic examinations showed a marked decrease of esophageal varices especially in the lower esophagus and cardia. Two to 12 months follow up showed no progress in varices and clinically no further episodes of variceal fleeding. This procedure is thought to be of particular value in the esophageal varices with critical hepatic dysfunction and/or with active bleeding.
The present study was done to investigate the influence of pancreatic duct ligation on gastric secretion in dogs with Heidenhain pouches. The following tests in response to a test meal (Dog food 300g) with or without oral administration of pancreatic enzymes (Berizym: 3g/kg) were studied at the control period and every one week for a period of one to six weeks after pancreatic duct ligation (PDL); gastric acid secretion, serum gastrin levels, plasma pancreatic glucagon levels (IRG) and insulin levels (IRI). The results obtained are summarized as follows: Acid outputs in response to a test meal with administration of pancreatic enzymes were significantly inhibited, compared with those without administration of pancreatic enzymes. Serum gastrin levels began to increase from the second week and continued to increase until the sixth week after PDL, showing no effect of pancreatic enzymes on the serum gastrin levels. Also, plasma pancreatic glucagon levels began to increase from the first week after PDL, with a significant increase in case of administration of pancreatic enzymes, compared with those without administration of pancreatic enzymes. Plasma insulin levels were higher than those before PDL at the first week after PDL, but decreased after the second week following ligation of the pancreatic ducts. From these results, it is presumed that gastric hypersecretion after PDL would have complicated relations with pancreatic glucagon, GIP as well as antral gastrin.
To see if pancreatic glucagon is effective in reducing the motility and tonicity of the duodenum in hypotonic duodenography, twenty five patients with various gastrointestinal diseases were given 1mg of glucagon i.m. followed by, 5 minutes later, intravenous administration of glucagon after intubation of duodenal tube. The effect of glucagon was compared with that of scopolamine butylbromide administration. It was shown that the hypotonic effect of glucagon was significantly better than that of scopolamine butylbromide. Moreover the side effects induced by glucagon were encountered much less frequently when compared with those of scopolamine butylbromide. In summary, glucagon appears to be a choice of drugs in performing hypotonic duodenography.
Parapapillary choledochoduodenal fistula has been found more frequently than before since the introduction of duodenoscopy and ERCP. This paper presents the value and effect of endoscopic fistulotomy (EFT) in these cases. Parapapillary choleddochoduodenal fistula is usually observed on the longitudinal fold of the duodenal papilla or on its orla side. The papillotome is inserted into the common bile duct through the orifice of the duodenal papilla, then the wall between the orifice of the papilla and the fistula is cut to open the distal portion of the choledochus widely. Endoscopic fistulotomy was attempted on 7 cases and the procedure was successfully performed in all cases leading to wide open stoma of the distal common bile duct with unrestrained outflow of the bile. Residual stones, a common additional findings in cases with parapapillary choledochoduodenal fistula, may deliver spontaneously after endoscopic fistulotomy or can be removed by a basket catheter. Endoscopic fistulotomy in cases with parapapillary choledochoduodenal fistula is a reliable method especially in high risk patients and a real alternative to surgical treatment.
Abnormalities of intestinal absorption have been observed in chronic alcoholic subjects. We investigated the effect of the acute and chronic administration of ethanol on the energy metabolism of the rat small intestinal mucosa with respect of a possible, direct enterotoxic effect of ethanol. Acute ethanol ingestion did not change the rate of oxygen consumption of the intestinal mucosal homogenate. By contrast, chronic ethanol administration reduced the rate of oxygen consumption with added substrates, although it did not change the concentration of the respiratory enzymes of the intestinal mucosa. From these observations, it is suggested that the mitochondrial impairment of the intestinal mucosa is one of the underlying causes of malabsorption in chronic alcoholics.
The localization of HBsAg in the liver tissues obtained from patients with several liver diseases was studied for incidence, degree, intracytoplasmic distribution and intralobular distribution. The liver tissues were obtained from 50 patients with HBsAg negative liver diseases, 18 cases of acute viral hepatitis with transient HBs antigenemia, 92 of various liver diseases with persistent HBs antigenemia and 22 asymptomatic HBsAg carriers. Among several histochemical methods, aldehyde fuchsin staining method was chiefly used for the detection of HBsAg in the paraffin sections from fixed liver tissues. Conclusions are as follows. 1) HBsAg was not detected in the liver tissues from 50 patients with HBsAg negative liver diseases and 18 cases of acute viral hepatitis with transient HBs antigenemia. In the tissues obtained from 114 patients with persistent HBs antigenemia, incidence of cases containing HBsAg positive hepatocytes in individual disease was high in those with slight parenchymal lesions; 77% in asymptomatic HBsAg carrier, 70% in hepatic cirrhosis and 79% in hepatic cirrhosis with hepatoma. By contrast, the low incidence was encountered in cases associating with moderate or severe parenchymal lesions; 35% in acute viral hepatitis and 17% in subacute hepatitis (Tisdale). In chronic hepatitis the incidence (47%) was in the middle of the previous two groups. 2) With respects to the amount of HBsAg positive hepatocytes in the liver tissues many hepatocytes with HBsAg were found in most cases of asymptomatic HBsAg carrier and liver cirrhosis, but a small amount of hepatocytes containing HBsAg was detected in most cases of acute viral hepatitis, chronic hepatitis, and subacute hepatitis (Tisdale). 3) There were five types of intracytoplasmic distribution of HBsAg. They were perinuclear, diffuse cytoplasmic, pericytoplasmic and membranous distribution, and cytoplasmic inclusion. Occasionally, various types were mixed in the same hepatic lobules, but mainly found types were diffuse cytoplasmic, pericytoplasmic distribution and cytoplasmic inclusion. The membranous type was found in four cases of asymptomatic HBsAg carriers and one of hepatic cirrhosis. 4) The distribution pattern of HBsAg positive liver cells in the hepatic lobules was divided into three zones; periportal, middle and central one. In cases with many HBsAg positive hepatocytes they were distributed in all lobular zones, but in those with a small amount of HBsAg positive hepatocytes they were found in the periportal and/or middle zone. No HBsAg positive hepatocytes were detected limited in the central zone.
Cell-mediated immunity to hepatocyte membrane antigen (h.m.ag.) isolated by Meyer's method was evaluated by leukocyte migration tests (LMTs) with the antigen in 50 patients with chronic active liver diseases (CALD), including 8 lupoid hepatitis, in 31 patients with non-CALD and in 5 asymptomatic HBsAg carriers. Positive LMTs were obtained in 59.5% of the patients with CALD and 81.2% of these patients with positive LMTs had the evidence of hepatitis B virus infection. The patients with non-CALD demonstrated positive LMTs in 29.0% and 75.0% of the latter patients had also the evidence of hepatitis B virus infection. These findings suggest that cell-mediated immunity to h.m.ag. and hepatitis B virus infection would be closely related each other. By contrast, positive LMTs were encountered in 7 out of 8 patients with lupoid hepatitis, and no evidence of hepatitis B virus infection was demonstrated in 4 out of these 7 patients.
Leukocyte migration tests (LMTs) with bile duct antigen prepared from pooled human bile, and hepatocyte membrane antigen (h.m.ag.) were performed in the patients, including 9 with PBC, 22 with intrahepatic cholestasis, 12 with extrahepatic obstructive jaundice and 23 with active chronic hepatitis. Positive LMTs with bile duct antigen were obtained in all patients with PBC, in 36.0%, 25.0% and 43.5% of the patients with intrahepatic cholestasis, extrahepatic obstructive jaundice and active chronic hepatitis, respectively. The positive LMTs became negative with disappearance of jaundice in these patients with cholestasis except for PBC. Fifty per cent of the patients with PBC showed positive LMTs with h.m.ag.. In conclusion, cell-mediated immunity to bile duct antigen would be involved significantly in the pathogenesis of PBC, and cell-mediated immune responses showed some overlap between primary biliary cirrhosis and active chronic hepatitis.
Recently, much attention has been focused on the role of an altered immunologic state in the pathogenesis of alcoholic hepatitis. Dr. Leevy stated an increase in lymphocyte transformation follows addition of autologus liver or ethanol to lymphocyte cultured from patients with alcoholic hepatitis. Our studies were carried out in 11 healthy individuals and 53 individuals with abnormal liver function test who take alcohol above 80g per a day for longer than 10 years. Lymphocyte transformation was assayed by incorporation of H3T into DNA following addition of PHA-P, Ethanol, Acetaldehyde, Microsome, Mitochondrial fraction and liver specific antigen using a modification of the method of Hirschhnorn and the whole blood micro-culture technique. These three fractions were prepared by the method of Meyer zum Büschenfelde from 20% alcohol treated Ratte liver. The patient with alcoholic liver injury did not exhibit remarkable depression in PHA-induced lymphocyte response compared of the patient without taking alcohol. The mean stimulation index increased in 19 cases with the addition of ethanol or acetaldehyde to lymphocyte cultures from patients with alcoholic liver injury. A combination of microsome and ethanol tend to increase the S.I. from 4 cases with alcoholic liver injury. These observation confirmed the alternative immunologic reactivity in alcoholic liver injury and suggested abnormalities in lymphocyte reactivity may be important in a few cases of alcoholic liver injury.
We have been using endoscopic pancreatic parenchymography for diagnosing pancreatic diseases. On this occasion two water soluble contrast media, i.e. Sodium & Meglumine Diatrizoate and Sodium Iothalamate, were utilized in this method and a comparative study was made of the pancreatic parenchymographic result obtained with each contrast medium. With Sodium Iothalamate, a natrium salt preparation, good opacification of the pancreas was obtained in about 92% of the cases, but with Sodium & Meglumine Diatrizoate, only in 33%. Natrium salt preparation seems to be an apropriate contrast medium for this method on the assumption that it may have higher pancreatic permeability than Methylglucamine salt preparation. No particular complications were experienced in the 93 cases submitted to this method. On injecting the contrast media, few cases complained of abdominal pain which was, however, only transient. Although the serum amylase level rose in about 60% of the cases, no cases were presumed to have caught acute pancreatitis clinically.
The serum in the five patients with persistent hyperamylasemia was analysed immunochemically and following results were obtained. 1) Amylase activity appeared as a broad band located from β- to γ-globulin in the electrophoretic mobility. 2) The molecular size of these macroamylase was suspected 7s to 19s in sephadex G 200 column chromatography. 3) The protein binding with amylase was identified as the Ig-A immunoglobulin by the precipitation method using specific anti-IgA serum. 4) Four cases were found by the routine usage of the thin layer gel chromatography, which was useful in the fact that only small amount of serum were required and many samples were managed simultaneously. 5) Immunoglobulin free from amylase of the patient bound again normal human amylase. As the results mentioned, it was assumed that abnormality of immunoglobulin might be induced to macroamylasemia.
Since last year, we have experienced 29 cases with hyperamylasemia and studied on amylaseisoenzyme pattern in their sera. According to this study, 26 out of 29 cases showed something different pattern from the normal controls, in the meaning of"P"dominant or"S"dominant. We found out 2 cases with macroamylasemia in these 29 cases and concluded biochemically one was IgA complex and the other was sialic acid complex. Particullary, the case of macroamylasemia due to amylase-sialic acid complex seems to be rare. Anyway, the analysis of the case with hyper and macroamylasemia must be very significant in the relationship between pancreatic diseases and hyperamylasemia.
The effect of the exocrine pancreas upon the endocrine pancreas, especially on insulin release, was studied in vivo and in vitro using mongrel dogs. The elevation of the portal insulin levels after stimulation with secretin, was more evident in the dogs whose pancreatic ducts were ligated 2 hours before, than those of the unligated controls. To investigate the effect of the pancreatic juice on insulin release, 0.5ml/kg of pancreatic juice obtained sterilely from other dogs, was injected into the main pancreatic duct. The portal insulin levels of the dogs injected with the pancreatic juice, were more significantly elevated than those of the controls injected with 0.5ml/kg of saline in the same way. Finally, in order to investigate the direct effect of pancreatic juice on pancreatic islet B-cells, a monolayer culture system of the dog pancreatic islet cells was employed. 5 and 10 volume per cent of the dog pancreatic juice was added to 2 types of the incubation medium, the glucose concentration being 50mg/dl and 300mg/dl. After 2 hours incubation, the insulin concentration was increased more significantly in the medium containing pancreatic juice, compared to that without pancreatic juice. It was suggested that pancreatic juice, which passes through the pancreatic duct system into the pancreatic interstitium, may have a stimulatory effect on pancreatic islet B cells, to release insulin in physiological and/or pathological conditions. The route through which pancreatic juice passes, however, is not yet definitely proved.
This study covers a period of 13 years (1963-1975) and is based on the records of 80 cases of primary malignant tumor of the pancreas. Various aspects such as histological items, sex and age dependence, family history and past history have been analysed. Seventy-eight out of 80 cases were carcinoma of the exocrine pancreas and other two cases were malignant islet cell tumor and histiocytic tumor. The head of the pancreas was involved in 50% of the cases, the body and tail, 41.3%, and entire pancreas, 5.0%. The average diameter of carcinoma of the head of the pancreas was 4.6cm, of the body and tail 7.7cm and of entire pancreas 12.3cm. The liver, the lungs, and the peritoneum were the commonest organs of metastasis. Fifty one cases belonged to males and 29 to females, giving a ratio of about 1.8:1. In both sexes peak incidence lies between the ages of 60 and 69.21.3% of the cases had one or more patients with malignant tumor in any relatives to the second degree. Past history revealed pancreatitis in 0%, cholelithiasis in 3.8%, and diabetes mellitus in 12.5%. Alcohol intake was seen in 48.7% and cigarett smoking in 62%.