Ulcerative lesions in the early gastric cancer IIc were studied from a view point of scar zone. In this paper, a difference between ulcer in IIc lesion and benign ulcer, a pattern of recurrence of ulcer in IIc lesion and correlation between ulcer and cancer were discussed. The scars in IIc lesions were mostly shallow (UI-II type) when compared with benign ulcer scars. There was also difference in location of the lesions between IIc and benign ulcer scars especially in UI-II type. Thes edifferences seemed to be due to conditions of the mucus membrane in which ulcer was produced. The ulcerative lesions in IIc were usually multiple and erosion of IIc was respnosible for frequent production of ulcer of UT-II type. Therefore, it was considered that ulcerative lesion could be produced from the lesion of cancer but that cancerous lesion could not be produced frm the lesion of ulcer. The ulcer in IIc lesions was considered to recur in the same pattern as in begin ulcer and to occur usually at different places from the previous ulcer scars.
We observed duodenal bulb by endoscopy, and measured disaccharibdase (maltase, lactase) activity of biopsya specimens by gaschromtography. (1) Disaccharidase activity was influenced by the weight of biopsy specimens and larger weight showed olwer activity and smaller showed higher. (2) There were no sifference of activity by sex and age. (3) Both maltase and lactase activit showed high value in intact duodenal bulb, and maltase was clearly lower in surrounding duodenal ulcer and duodenal ulcer scar (focus) than in intact duodenal bulb. Lactase was lower in surrounding focuses than in intact duodenal bulb, but was same in the part of 1.5cm-2.0cm from focuses (unfocus) as in intact duodenal blb. (4) Regarding to fluctuation of activity in each stage of duodenal ulcer, maltase was high in both stage H2 of surrounding focuses and unforcuses, and lactase had no difference by stage and part. (5) Observing the distribution of villi form of uodenal bulb by stereoscopic microscopy, finger type villi occupied many part of it in intact duodenal bulb, surrounding facuses and ulfocuses. It was highest in intact duodenal bulb andhigher in duodenal ulcer scar than in duodenal ulcer. (6) In each type of villi, maltase and lactase were high in finger type of intact duodenal bulb an low in big leaf type and ridge type. (7) Regarding to fluctuation of disaccharidase activity in each stage of duodenal ulcer, maltase was high in stage H2 and Sl finger type villi and low in big leaf type and ridge type of each stage.
Histological examinations were made on the 27 "borderline atypical epithelial lesions" found at the 22 surgical specimens of the human stomach. Following conclusions were drawn regarding their histogenesis. (1) Although atypical epithelia showed some tendency of differentiation toward metaplastic intestinal epithelia, they were considered to be a manifestation of abnormal differentiation at relatively early stage of intestinal metaplasia from porper gastric glands rather than the development from fully matured metaplastic intestinal epithelia. (2) Atypical epithelia were considered to be arisen mainly from the superficial layer of the mucosa. (3) Serial sections of one atypical epithelial lesion revealed proliferations of atypical glands with frequent budding and anastomosis of adjacent glandular lumen, which might suggest neoplastic nature of this atypical epithelial lesion.
Tumour size, invasive and metastatic potential were closely related to the presence or absence of carcinoembryonic atigen (CEA) in gastric cancer as detected by an immunofluorescent technique. Patients with CEA positive gastric cancer had a better prognosis. Extensive connective tissue proliferation and macrophage infiltration were observed, especially around tumours of patients with CEA positive gastric cancer. Thers are interpreted as immune reactions against tumor. CEA positive gastric cancers were usually non-invasive; restricted to the antrum; microscopically well-differentiated; and surrounded by inestinal metaplasia. The result suggest that CEA positive gastric cancers bear great similarity to the intestinal carcinomas defined by Dr. Nakamura.
PNNG, the propyl derivative of MNNG, was administered to Wistar rats at a concentration of 59.5 μg/ml in the drinking water for 4, 8 and 12 months and the rats were killed in the 15th months. Intestinal metaplasia was induced in the glandular stomachs of 25%, 75% and 83% of the rats treated with PNNG for 4, 8 and 12 months, respectively. Metaplastic glands were found in the pyloric region, especially near the pyloric ring. These glands contained goblet cells and columnar cells with striated borders. Paneth's cell was found in the stomach of rat treated with PNNG for 12 months. No tumors were found in the stomach of rats after 4-months treatment, but adenomas were found after 8-months treatment, and both adenomas and adenocarcinomas after 12-months treatment.
The retrospective analysis was performed in order to evaluate computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) with following results. Materials were 44 lesions out of 39 cases with hpato-biliary and pancreatic disease confirmed operatively. Diagnostic accuracy of hepato-biliary lesions was 54% and 88%, that of pancreatic lesions being 65% and 83% in CT and ERCP, respectively. From the results mentioned above, it seems that diagnostic accuracy of the ERCP examination is superior than that of CT scan to diagnose either hepato-biliary or pancreatic lesions. However it must be emphasized that superiority of CT scan in capable to give information about size, configuraiton and character of the lesion or relationship between the surrounding organ in CT scan. Therefore, CT scan is quite useful to diagnose abscess, cyst or tumors. On the contrary, lesions which invade the hpato-biliary tract or pancreatic duct was easily diagnosed by ERCP examination. But ERCP has disadvantage for the diagnosis of parenchymatous lesions or infiltraiton of lesons into the surrounding organs. Therefore it might be concluded that combined use of both CT and ERCP is very important to enhance the diagnostic value for the diagnosis of hepato-biliary or pancreatic disease.
The diagnostic usefulness and significance of serum carcinoembryonic antigen (CEA) were studied in 439 patients with cancerous and noncancerous liver disases. The determination of CEA was made by radioimmunoassay. A positive assay (over 2.5ng/ml) was obtained in 82.2% of 62 patients with meatstatic liver cancer, 34.2% of 73 with hepatoma, 51.7% of 112 with liver cirrhosis, 29.3% of 92 with chronic hepatitis and 7.8% of 64 with acute hepatitis, respectively. A very high level (over 10ng/ml) was found in the 60% of CEA-positive patients with metastatic liver cnacer. The marked elevation seen in patients with metastatic disease affecting the liver might result from the increased production of both primary and metastatic lesions. There was a mild elevation of CEA levels in hepatoma, and higher CEA levels tended to be observed in patients with a largersized hepatoma. The serum CEA levels in patients with chronic diffusing liver diseases were frequently elevated: however, they were less than 5 ng/ml in the majority. It might be suggested that the impaired degradation of CEA in the liver and its excretion from the liver due to a deteriorated liver-function are one of the possible interpretations of the reason why CEA rises in chronic liver diseases.
Ninety seven percent of 30 alcohol consumed cirrhotics showed abnormal oral glucose tolerance (OGTT). Of these, 14 out of 22 patients, when examined by endoscopicretrograde pancreatography (ERP), showed abnormal pancreatograms. Mean IRI, but no c-peptide, response to OGTT, were higher in these patients when compared with diabetic groups. However, the more severe the pancreatic abnormality, the lower were both serum insulin and c-peptide responses. Insulinogenic index (1.1.) also inversely correlated with the grade of ERP abnormality. It was higher in the patient who had normal pancreatogram than the patient with diabetes mellitus. 1.1. had no correlation to the grade of liver injury estimated with ICG test or A/G ratio. The molar ratio CPR/IRI in patients who had more than grade II liver damage estimated with Au liver scan, was lower than controls. It seemed likely that pancreatic damage induced by chronic alcohol addiction was one of the important factors for the impaired glucose tolerance in alcohol consumed patients with liver cirrhosis, and one of the reasons for IRI hyperreactivity in these patients was impaired insulin metabolism in the liver.
Five cases of the Budd-Chiari syndrome diagnosed by venography of the inferior vena cava, were studied on their obliterations, clinical course, laboratory data and angiographical findings. Obstructions of the inferior vena cava where the hpatic veins branched off were revealed in all cases. Membranes were present in the inferior vena cava in the hepatic portion in 4 of 5 cases, in 3 of which thromboses attached to their membranes. Another case showed a large thrombosis between hepatic veins and renal veins. Bilateral hepatic veins were not noted in 2 cases, nor singel hepatic vein in other 2 cases accompanied with the occulusion of the inferior vena cava. The rest case showed normal hepatic venography. Besides the common physical findings such as hepatomegaly, venous dilatation of abdominal wall and esophageal varices, venous dilatation of backs and both legs, and ulcers and/or pigmentations of both legs were observed in these cases and lead us to consider the Budd-Chiari syndrome. The remarkable abnomral retention of Bromosulfophthalein or Indocyanine-green, compared with slight dysfunction of the liver tests, supported the presence of this vascular disases. Three cases with large thromboses at the inferior vena cava showed typical clinical signs and symptoms as well as abnormal data of liver function tests, hematological examination, and renal function tests.
Chemical and morphological analysis of gallbladder mucosa, gallbladder bile andgallstones, obtained by surgical resection from 27 patients with cholesterolosis of the gallbladder, were performed in order to clarify the mechanism of cholesterol gallstone formation. The chemical analysis indicated that the foamy cells, which were present in the gallbladder mucosa with cholesterolosis, consisted chiefly of cholesterol oleate and palmitate.Both cholesterol gallstones and radial cholesterol crystals were found together with the foamy cells in the mucosa of cholesterolosis. The analysis of the granules which were present on the surface of the mucosa revealed that the cholesterol composition was the same as that of the foamy cells, which were also present in the gallbladder bile and on the stones. It is therefore suggested that gallstone formation in cases of cholesterolosis progresses in the following order: first of all, intramucosal foamy cells (polypous cholesterolosis) appear; granules are discharged onto the mucosal surface and then into the gallbladder bile; following that, cholesterol cyrstals, irregularly shaped soft solids and finally the gallstone itself are formed.
Ultrasonically guided percutaneous fine needle aspiration biopsy for cytological diagnosis was performed on twenty-two patients with pancreatic lesions of ultrasonically scanned solid mass. Final diagnosis of these patients was pancreatic cancer in eighteen patients and chronic pancreatitis in four patients. In the three patients with pancreaetic cancer, radiation therapy had been performed before aspiration biopsy by this procedure because these three patints were diagnosed by other clinical methods. In thirteen of the fifteen patients with pancreatic cancer, except for three patients with pancreatic cancer for which radiation therapy had been performed, malignant cells were aspirated. In the remaining two patients with pancreatic cancer, however, the aspiration specimens were inadequate, being not enough for establishing cytological diagnosis. In four patients of chronic pancreatitis, normal pancreatic cells were aspirated, successfully ruling out the pancreatic cancer. Those results demonstrated that the high diagnostic accuracy (89%, 17/19) was obtained in the pancreatic tumor by this procedure. Of the fifteen pancreatic cancers, the accuracy was 87% (13/15); there was no false positive in the four chronic pancreatitis (100%, 4/4). This method, the combination of ultrasonic scanning and percutaneous fine needle aspiration biopsy, may be considered as very useful for diagnosis of the pancreatic tumor, especially for differential diagnosis of chronic pancreatitis and pancreatic cancer.