Fifty-four patients with gastric cancer of Borrmann-4 type (defined the flat and diffusely infiltrative carcinoma with neither rand wall nor deep ulcer) resected at our depertment and other affiliated hospitals were investigated from the clinical and pathological viewpoints, together with the patterns of their developments. The results were as followed. 1) In terms of the patterns in aggravation of gastric cancer of this type (Borrmann 4 type), two forms were found out, one is Type (A) in which carcinomatous cells infiltrate through the space of tissues with no reactivity and with association of lymphangitis carcinomatosa, preceded mainly by lymphatic spreading, and the other type (B) in which carcinomatous cells infiltrate through the space of tissues in association with fibrosis, preceded mainly by peritoneal disseminated development. 2) In gross identification, Group A was often detected in the negative giant fold form of the irregular type, while Group B was often detected in the belt type, and positive giant fold form of irregular type. 3) In terms of prognosis, those of developments of Group A had extremely poor prognosis in comparison with Group B.
Studies were made on depth of invasion in gastric carcinoma of excavated type using comparative survey of gross morphology with histological features. The characteristic macroscopic changes of excavated lesion were divided into five types and of marginal elevation into four types. There was a good correlation between the characteristic changes of excavated area and the depth of infiltrative invasion in the group of undifferentiated gastric carcinoma, and also between the characteristic alterations of marginal elevation and that in group of differentiated gastric carcinoma. In both differentiated and undifferentiated groups the ratio of lesion area in the submucosa to the one in the mucosa (sm/m ratio) was less than 15% in cases in which the invasion was limited to the mucosa and/or upper half of the submucosal layer, and the sm/m ratio was more than 15% in cases in which the invasion reached to the lower half of the submucosal layer and/or muscularis propria layer. From the data mentioned above, possible processes of cancer growth in differentiated and undifferentiated types were also discussed.
We measured disaccharidase activity (maltase, sucrase and lactase) of intestinal metaplasia by endoscopic dyeing method with gascromatography and had enzymological study on it. We measured those activity of gastric cancer (focus) and intestinal metaplasia in surrounding focus and 1.5cm-2.0cm from focus. 1) Comparing disaccharidase activity of stained region and unstained region, that of stained region was higher. It was that there were many factors in endoscopic dyeing method to recognize disaccharidase activity in also unstained region. So we need further study about this fact. 2) Disaccharidase activity in each of the stain types showed almost same value. 3) As stainning degree was stronger, activity was higher. 4) Disaccharidase activity was not recognized in fundic area. Concerning to maltase and sucrase, there was no difference between the two value in intestinal metaplasia and duodenal bulb. Lactase showed 0.07/g min. in intestinal metaplasia and 0.12/g min. in duodenal bulb. 5) Maltase and lactase activity had no difference in each parts of early gastric cancer and advanced gastric cancer. Maltase and lactase activity were higher in each parts of well differentiated type than that of poorly differentiated type. 6) As the distance from focus was longer, maltase and lactase were higher, and those of intestinal metaplasia in intact stomach without gastric cancer were highest.
Mucin histochemical studies of 114 cases of mucinous carcinoma of the stomach and 41 cases of mucinous carcinoma of the large intestine, together with the normal epithelium of the gastrointestinal tract, were performed. The following results were obtained. 1) Proper gastric mucous epithelium contains neutral mucin with little non-sulfated acid mucin and sulfated acid mucin was rarely observed. 2) Both intestinal goblet cells and metaplastic goblet cells of the stomach contain acid mucin. While large intestinal goblet cells contain sulfated acid mucin, small intestinal goblet cells contain no sulfated acid mucin but only nonsulfated acid mucin. Some metaplastic goblet cells of the stomach contain sulfated acid mucin. 3) Non-sulfated acid mucin was detected in almost all cases and sulfated acid mucin was demonstrated in about half cases of mucinous carcinoma of the stomach. 4) Non-sulfated acid mucin was detected in all cases and sulfated acid mucin was demonstrated in most cases of mucinous carcinoma of the large intestine.
The present experiments were carried out to compare the metabolic differences between saturated and unsaturated long chain fatty acids in small intestinal mucosa and to determine the effect of fatty acid absorption and transportation on the activity of intestinal alkaline phosphatase. The absorption and transportation of fats were studied in male Wistar rats provided with intestinal lymph fistula. Mixed micellar solutions of fatty acids were administered into the duodenum of rats and absorbed fat and alkaline phosphatase activity were studied in intestinal lymph. The absorption and transportation of linoleic acid into intestinal lymph exceeded that of palmitic acid. Puromycin, an inhibitor of protein synthesis, decreased the absorption and transportation of linoleic acid, but did not change that of palmitic acid. Intestinal alkaline phosphatase activity was enhanced in proportion to the degree of fat absorption and puromycin prevented the rise in lymph alkaline phosphatase activity after the infusion of micellar solution of linoleic acid. However, palmitic acid-induced increase in lymph alkaline phosphatase activity was not affected by puromycin. L-phenylalanine, a specific inhibitor of intestinal alkaline phosphatase, decreased the activity of brush border alkaline phosphatase of rat jejunum and prevented the rise in lymph alkaline phosphatase during fat absorption. The absorption and transportation of linoleic acid was also decreased by L-phenylalanine. Therefore, different metabolic pathways were suggested between unsaturated and saturated long chain fatty acid in intestinal mucosa. Furthermore intestinal alkaline phosphatase may play an important role in the transport of long chain fatty acid into intestinal lymph.
A rapid method for determining the concentrations of 6 neutral amino acids, which are clinically essential for urgently treating patients with severe liver diseases, has been developed to use as one of routine laboratory tests. The liquid chromatographic technique for serum neutral amino acids takes only about 2 hours after obtaining blood samples. This simple and rapid method gave many valuable informations on selection of the therapeutic ways, prediction of impending coma and evaluation of the patients' responses to the treatments as well as analyses their pathophysiology and prognosis.
Correlation with cellular immunity and serum proteins was investigated in patients with chronic active hepatitis and liver cirrhosis. E-rosette forming cells were directly proportional to active rosette forming cells in patients with liver diseases. In those patients, active rosette forming cells were directly proportional with prealbumin. In patients with chronic active hepatitis, active rosette forming cells were directly proportional with al-AT. But, E-rosette forming cells have not correlation with serum proteins in liver diseases. It seems that active rosette forming cells have some correlation with serum proteins, compared with E-rosette forming cells.
Simultaneous measurement of membrane potential (PD) and intracellular K+ concentration (CK) was performed on rat liver slices with double barreled potassium ion-selective microelectrodes, and the data were used for the judgement of cellular injury of antineoplastic agents. Further, an action of coenzyme Q10 minimizing the cellular injury was examined. Both the membrane PD and intracellular K+ concentration were significantly decreased by administration of antineoplastic agents (Mitomycin C "MMC" or 5-Fluorouracil Dry Syrup "5-FUDS"). It is suggested, therefore, that both MMC and 5-FUDS would bring about a hypofunction of hepatic cells as a result of their side effects, being characterized by a decrease of cellular energy metabolilm, such as inabilities of cellular K+ accumulation and Na+ extrusion out of the cell. Administration of coenzyme Q10 was recognized to partially restore these abilities. Thus, it is considered that a certain side effects of antineoplastic agents on rat liver cells can be prevented, at least in part, by a combination therapy with the administration of coenzyme Q10.
Lecithin-cholesterol acyltransferase (LCAT) which is produced in the liver is the esterifying enzyme of free cholesterol in the blood stream. This enzyme activity is known to be frequently disturbed in patients with liver diseases. We have examined serum LCAT activity in conbination with various liver functional tests and serum lipoprotein-X (LP-X) in patients with obstructive jaundice by colorimetric method. Results are as follows. 1) Both high LCAT activity and serum total bilirubin level almost paralleled (Parallel phase), when liver function was not deeply disturbed. LP-X was usually positive and serum total cholesterol level was excessibly high in this phase. 2) LCAT activity was gettig low, but serum total bilirubin level remained high (Separate phase), when liver function was greatly damaged. LP-X usually turned to negative and serum total cholesterol level markedly decreased in this phase, in which the patients prognosis was definitely poor. This classification might be accepted not only in obstructive jaundice but in liver cirrhosis or congestive liver.
We performed 100 g oral glucose tolerance test (GTT) in 194 patients with acute hepatitis, and examined serum immunoreactive insulin (IRI)in 100 subjects. We investigated the relationship between prognosis of acute hepatitis and family history of diabetes mellitus, GTT patterns and insulinogenic index (30'ΔIRI/ΔBS) The results are as follows: The acute hepatitic patients with family history of diabetes mellitus transfere more frequently into chronic hepatitis than those without family history. The prognosis of acute hepatitis is significantly better in subjects with normal GTT than those with abnormal GTT during the acute stage. In the cases whose courses were followed from acute stage to recovery stage, the prognosis are better in the patients who showed improvement in GTT than those who showed no improvement. In respect to insulinogenic index (30'ΔIRI/ΔBS), the prognosis is obviously better in the cases with 30'ΔIRI/ΔBS>=d0.8 than those dBS dBS with 30'ΔIRI/ΔBS>0.8 either in acute or recovery stage. Accordingly, we conclude that GTT in acute stage and 30'ΔIRI/ΔBS or recovery stage may be useful as indicators of prognosis of acute hepatitis.
Hepatobiliary scintigraphy using 99mTc-pyridoxylideneisoleucine (99mTc-PI) was performed in 34 patients with various disorders and assessed its clinical usefulness. The images of liver, hepatic ducts, gallbladder and common bile duct were clearly visualized in patients without hepatobiliary diseases. The liver image was obtained at 5 min and biliary tract image was obtained at about 10 min. In patients with severe jaundice, the image of hepatobiliary system could not be obtained. However, in patients with moderate jaundice, the image of biliary tract could be obtained. Therefore, hepatobiliary scintigraphy using 99mTc-PI was considered to be clinically useful in the differential diagnosis of hepatocellular and obstructive jaundice, detection of site of biliary obstruction, preoperative diagnosis of congenital choledothal cyst and accurate diagnosis on radiocolloid liver scintigraphy. On the other hand, in almost all patients with gallbladder stones, the gallbladder image was not demonstrated, and so hepatobiliary scintigraphy was considered to be of little use in the detection of gallbladder stones. In a patient with Dubin Johnson syndrome, 99mTc-PI did not show such hepatic excretary disturbance as shown in 131I-BSP.
Pancreatic endocrine function, especially glucagon responses to arginine were studied in 2 groups of dogs with complete ligation and main pancreatic duct ligation only, over a period of 6 months. Fasting serum insulin levels and plasma glucagon levels were found to be low in dogs with a complete pancreatic duct ligation and a decreased plasma glucagon secretion was observed by the administration of arginine solution at the 6th months. However, dogs with a main pancreatic duct ligation had almost normal glucagon and insulin responses. These results suggested that pancreatic endocrine function was also damaged as well as pancreatic exocrine function at the 6th month after a complete ligation of the pancreatic duct.