Recent progress in the diagnosis of gastric cancer has made it possible to detect early gastric cancer in many instances. Nevertheless, approximately 25% of gastric cancers have been discovered in an unresectable state and curative gastrectomy is feasible in only about 50%. Investigations of the current status in this particular field of medical practice led to the re-recognition that a major cause of such a deplorable status of the diagnosis and management of gastric cancer lies in the existing system of medical care, which relies for the discovery of gastric cancer upon a patient's subjective symptomatology, not in the diagnostic failures on the part of a physician. In order to improve therapeutic results in gastric cancer it is absolutedly necessary to have persons of cancer-bearing ages undergo pertinent examination at regular intervals irrespective of whether they have subjective symptoms or not. The paramount importance of re-recognition of this by both physicians and patients must be stressed.
Among 2, 336 cases of primary gastric carcinoma and 518 cases of large intestinal carcinoma, resected between 1955 and 1972 at Tokyo University Hospital, there were 115 cases (4.9%) of mucinous carcinoma of the stomach and 41 cases (7.9%) of mucinous carcinoma of the large intestine. Clinical and pathohistological studies of these mucinous carcinoma were made and the following results were obtained. 1. Age and sex incidence of mucinous carcinoma of the stomach was much the same as overall gastric carcinoma. Female cases of mucinous carcinoma of the large intestine were more common than male while male cases were more common than female in the overall large intestinal carcinoma. 2. Mucinous carcinoma was classified into three groups according to histological structural differentiation i.e. well differentiated, moderately differentiated and poorly dif-ferentiated group. The poorer the differentiation of mucinous carcinoma, the younger the mean age in both stomach and large intestine. Mean age of poorly differentiated group of large intestinal mucinous carcinoma was very young: 33.2 years of age. 3. It was confirmed that presence of metastasis to regional lymph node, depth of infiltration to the wall and grade of structural differentiation had influence on the prognosis of mucinous carcinoma of the stomach. Prognosis of mucinous carcinoma of the colon was much better than that of the rectum.
An attempt was undertaken to study possible role of cytomegalovirus, EB virus and herpes simplex virus for the development of HBsAg negative hepatitis. The subjects com-posed of 36 cases with HBsAg negative liver disease (group A), 35 cases with HBsAg positive liver disease (group B), with six control cases. Serum antibodies of cytomegalovirus, herpes simplex virus were measured by complement fixation test, these of EB virus was observed 8 cases in Group A(23%), and 1 case in Group B(3%). An elevated titer of cytomegalovirus antibody was found in 5 cases in Group A(14%), and 1 cases in Group B(3%). There was an increased titer of herpes simplex virus in one each of Group A(3%) and Group B(3%). In HBsAg negative liver disease, the tier of EB virus and cytomegalovirus anti-body tended to be higher than in cases of HBsAg positive chronic liver disease. Of 8 cases with a high titer of EB virus, 4 had cryptogenic liver cirrhosis and 4 of them also revealed an elevated value of cytomegalovirus antibody later. From the result, it is suggested that in some patients cytomegalovirus and EB virus may participate in the development of HBsAg negative hepatitis.
The present paper reports a sensitive and specific radioimmunoassay for Substance P (S-P) by using synthetic S-P as standard and Nα-Tyrosyl-S-P as tracer. The double antibody phase reparation technique was employed to separate the labelled Nα-Tyrosyl-S-P from damaged component and unreacted iodine. No cross-reaction were observed in this system by various hormones, i.e., VIP, ACTH, Glucagon, Gastrin, Secretin, Motillin, Calcitonin and CCK-PZ. The minimum detection limit was 120 pg/ml. Using this system, human plasma samples from healthy volunteers and various patients were detected to present the S-P like immunoreactivity. In normal subjects plasma S-P levels ranged from 300 pg/ml to 650 pg/ml and the average was 445 pg/ml. High plasma S-P levels were found in the patients with hepatic diseases, hyperthyroidism, chronic renal failure and shizophrenia, but not in the patients with peptic ulcer and medullary carcinoma of the thyroid. Hyperthyroid patients showed high S-P levels with high T3 and T4 levels. In hepatic diseases S-P levels were significantly elevated by ductal enzyms, i.e., LAP, Al-P and γ-GTP, but not by hepatocellular enzyms, i.e., GOT and GPT. After ligation of common bile duct of the dogs plasma S-P levels elevated and remaind high. In addition experimental obstruction of bile duct changed plasma S-P levels. The mechanism of which remains to be studied.
A total of 84 cases of primary carcinoma of the bile duct admitted the 13-year period, 1965-1978 to Kyoto University Hospital, are reviewed. A comparison of these cases was made and emphasized with regard to prognostic factors, which were the Infiltrative Factors (I.N.F.) and invasions into Lymphatic Vessels (Ly.), Veins (V.), Pancreas (P.) and Liver (H.). There were 60 men and 24 women, and the mean age was 59.0 years (35-75 years). Forty-One of the 84 patients (48.8%) were resectable and 19 patients (22.6%) died within one month after operation. We concentrated on 6 different areas;1) intrahepatic region, so-called cholangioma, 2) region of hepatic ducts and common hepatic ducts, 3) confluence of cystic duct, common bile duct and common hepatic ducts, 4) suprapancreatic portion, 5) intrapancreatic portion, 6) papilla of Vater. The tumor arising near the confluence of the hepatic duct and cholangioma were resected poorly, but other location tumors were resected well, particullarly on the in-trapancreatic portion and the papilla of Vater. The tumor differed in histopathology. The resectability of the tumors did not always correlate with differentiation grading. High resectability of the tumors on the intrapancreatic portion and the papilla of Vater is due to anatomical location surrounding the pancreas and duodenum. Many of the tumors were often scirrhous, so-called I.N.F., γ. Sometimes microscopic invasion into Ly., V., P, and H. may reflect prognostic factors. On carcinoma of the papilla of Vater, there was no correlation between macroscopic findings and histology. That is, early papillary adenocarcinoma produced a type of tumor formation and advanced papillary adenocarcinoma produced a type of ulcer formation. Five year survival on carcinoma of the intrapancreatic portion and the papilla of Vater were only present and were 27.3% and 10.5%, respectively. The longest survival was 10.4 years on carcinoma of the papilla of Vater. To obtain the best prognosis, attention must focus on means of earlier diagnosis and radical en bloc resection with adjuvant therapy.
Elemental analysis of unfixed and unstained fresh frozen thin sections of rat pancreatic acinar cells was carried out by using an energy dispersive X-ray microanalyser. The freeze substitution method adequately preserved cellular ultrastructure for X-ray microanalysis. The nucleus, rough endoplasmic reticulum, mitochondria with granules, secretory granules and acinar lumen were clearly observed. As a result of X-ray microanalysis of these organelles, the nucleus contained P, K and Cl. The rough endoplasmic reticulum demon-strated P and K. In mitochondrial granules the detection of S, K, P and Cl was seen. And then, the mature secretory granules showed peaks of S, K, P and Cl, however, in immature secretory granules the peak of S was markedly lower. Secretory substances in the acinar lumen demonstrated S, K, P, Si and Cl. As a result of analysis of variable secretory granules, clear differences of the peak of S were concerned between mature secretory granules and immature secretory granules.
The ultrasonographs from 8 cases of pancreatolithiasis were evaluated in comparison with the radiographs and clinical course of the disease. In 7 cases clear delineation of the pancreas was possible. In the cases of chronic relapsing pancreatitis the head and body of the pancreas was enlarged, while in chronic pancreatitis the size of the pancreas was variable; either enlarged, atrophied or not changed. Pancreatic calcification was delineated as strong echoes accompanied by acoustic shadows within the pancreas. In 3 cases the acoustic shadows were easily seen but in the other cases they were not so clear. Differential diagnosis between pancreatitis and pancreatic carcinoma was straightforward in most of the cases but in one case localized enlargement and irregular internal echoes made such dif-ferentiation difficult. Also, complicated pseudocysts were clearly delineated.
Innumerable juvenile polyps of the stomach were recognized in a 18-year-old girl. She had no extragastric polyps on roentgenographic and endoscopic studies. Her elder brother received a subtotal gastrectomy because of gastric polyposis 14 years ago at age of 14 years. Their mother died of gastric cancer at age of 37 years.Only these three subjects among this kindred appeared to be of low normal intelligence and have brown hair. Polyps produced chronic and severe loss of blood and protein, these symptoms being disappeared upon the operation. No change in number and size of the polyps in their residual stomach was noticed, and roentgenographic studies of the small and large intestines in addition to sigmoidscopy disclosed no abnormal findings for 2 and 14 years after the operation, respectively. They are now in good health. A classification of this hereditary syndrome may be proposed to be a newly designated entity, juvenile polyposis of the stomach.
A case of the gastrojejunal fistula caused by benign gastric ulcer in a 35 year old male is reported. He was admitted to our hospital with chief complaint of epigastric discomfort during the last 10 years. Laboratoy findings were within normal limits and physical examination did not contributory. Upper GI series disclosed a fistula between the stomach and jejunum. Endoscopic examination revealed a fistula and gastric ulcer on the lesser curvature at the distal gastric body. Biopsy specimens under direct vision from the margin of fistula showed no malignancy. A subtotal gastrectomy was performed. A gastric ulcer was penetrated through the transverse mesocolon into the jejunum approximately 10cm. from the ligament of Treitz. Macroscopic finding of the resected stomach showed a fistula in diameter of 3.0×1.5cm and ulcer scars, on the posterior wall at the distal gastric body. Histological finding showed no Malignancy. A gastrocolic fistula and a gastrojejunocolic fistula from benign gastric ulcer are relatively common but a gastrojejunal fistula is rare. Of the 8 previously reported cases of the gastrojejunal fistula from benign gastric ulcer in literatures. This is the first case reported in Japanese literatures according to our survey.
The septum formation of the bile duct is an extremely rare anomaly. The septum formation of the common hepatic duct was found in a 80 year-old female with choledocholithiasis. The patient was admitted to Kawasaki Medical School Hospital because of recurrent pain in right hypochondrial region. After admission, she had high fever, jaundice, leucocytosis and swelling of the gallbladder. PTC revealed a stone in the common bile duct, in addition a longitudinal shadow of 3cm in length was noted in the common hepatic duct. Choledochostomy confirmed the existence of a septum of 3cm×1mm in the common hepatic duct. These kinds of bile duct anomalies have never been reported in the literature.