We studied the pathological findings of 12 cases of stomal ulcer which were diagnosed by the fiberscope. They showed an increased output of acid and pepsin on gastric analysis, compared with cases without ulcers (p<0.01). There were found to be no differences for the fasting serum gastrin levels and the volumes of the residual stomach. The total mucosal thickness and the fundic gland length, however, showed some statistical differences (p<0.01), when measured by microscope. Our study of the relationship between the maximum acid output and the total mucosal thickness and fundic gland length showed a direct correlation between acid output and the degree of mucosal atrophy. In conclusion, we wish to confirm the relationship between the stomal ulcer and atrophic gastritis in the mucosa of the residual stomach.
Detection of intestinal metaplasia was performed by T es-tape method. Two types of intestinal metaplasia were recognized. Type I, so called complete type, in which sucrase and trehalase activities were present, was frequently observed in older persons but a few in younger ones. Type II, so called incomplete type, in which sucrase was present but trehalase was absent, was frequently observed in younger persons. Complete type metaplasia, which was observed in the intermediate zone of the stomach, contained well-developed brush border, many Paneth cells and goblet cells, histologically. While, in incomplete type metaplasia, poorly-developed brush border, a few Paneth and goblet cells, intracellular mucous in epithelial cells and double structure which means coexsistence of metaplastic glands and pyloric glands, were present. Results suggested that intestinal metaplasia developed from incomplete type to complete one, and complete metaplasia may have occurred from intermediate zone.
Intestinal metaplasia of resected stomach was studied histochemically with regards to the relationship between the morphology and the function in absorptive cells. Alkaline phosphatase (ALP) and adenosine triphosphatase were used as the marker emzymes. Light microscopic histochemistry showed that intestinal metaplasia was classified into "Complete type" with ALP activity and "Incomplete type" without ALP activity, and that marked difference in ALP activity was also found in the neighboring glands of "Complete type" metaplastic mucosa. By electron histochemical investigations, ALP activity was positive in dense and tall microvilli, while it was negative in sparse and short microvilli of absorptive cells in the surface portion of the mucosa. However, enzymatic activity of microvilli was different in the neighboring absorptive cells of the same gland of "Complete type" metaplastic mucosa. From the above results, intestinal metaplasia has various morphological types and various phenotypic expression of intestinal marker enzymes, and abnormal cellular differentiation may occur in intestinal metaplasia.
The purpose of this study was a comparison of X-ray findings with pathohistological findings of 114 cases of gastric linear scar and linear scar with ulcer (tadpole-shaped ulcer was included) in order to increase the ability of X-ray diagnosis for gastric linear scar. It was found that 57% of gastric linear scars had linear depression found macroscopically and narrow scar zone with a width of 3 mm or less examined histologically. The X-ray findings of gastric linear scar were as follows: all of gastric linear scar studied showed a localized rigidity of gastric wall and it was stable. The gastric linear scar with linear depression showed a spicular projection and 70% of which showed linear shadow. The gastric linear scar without linear depression did not show the spicular projection nor linear shadow but a half of which showed a picture of the belt-like arrangement of marked gastric area. In combining effectively each X-ray findings of gastric linear scar, the diagnostic rates was 100% for picking up and 82.5% for qualifying the lesion.
Pepsinogen synthesis and its secretion were investigated in human gastric corpus mucosa using an organ culture method. For the first, it was observed that the cultured tissue specimen maintained its viability functionally and histologically up to at least six hours under this condition. Within the culture period of time of six hours, it was proven the incorporations of 14C-leucine into the proteins extracted from the tissue and from the culture medium. Gelfiltration fractionation of these proteins was carried out by use of Sephadex G-100, and was separated into two fractions with pepsinogen activity in the second peak of the fraction. These findings were conjectured that the pepsinogen was newly synthesized during a period of the culture, and the activity was markedly detected in the normal mucosa while very few in the atrophic mucosa of the gastric corpus. It was further clarified that gastrin (tetrapeptide) and acetylcholine definitely play an enhancing roles during the synthesis and secretion of the pepsinogen.
Electron microscopic study was made on protruded lesions in canine stomachs induced by oral administration of ENNG. Histology of the lesions consisted of hyperplastic foveolar epithelium, atypical glands of various degrees and well differentiated adenocarcinoma at the top of the lesions and poorly and/or moderately differentiated adenocarcinomas at the base of the lesions. Ultrastructure of non-cancer-bearing gastric mucosa from the dogs fed by ENNG appeared to be identical to that of normal canine gastric mucosa. The fine structure of foveolar hyperplasia was almost identical to normal gastric mucosa expect for being tall in height and dense in granular population with stippling. Almost 90% area in tip of the protruded lesions was occupied by atypical glands. Ultrastructure of atypical glands suggested of an intermediate between foveolar hyperplasia and adenocarcinoma. While at the base of the protruded lesions, there could be noticed moderately differentiated and poorly differentiated lesions interlaced. In well and moderately differentiated adenocarcinomas, there were distinct tight junctions, and the secretory granules were sparse in population, devoid of stippling, and low in electron density, while in poorly differentiated adenocarcinoma, intercellular connections were loose and the granules were dense in population, lack in stippling, and with various electron density.
We have recently experienced 20 cases of acute colitis associated with characteristic transient rectal bleeding. These cases were divided into three groups: 5 cases with rectal bleeding after flu-like syndrome, 7 cases with rectal bleeding after antibiotics administration, and 8 cases with sudden onset of rectal bleeding. The laboratory data revealed some common findings in these cases that stool cultures were negative and serum antibody titers for various viruses were not elevated. Moreover, the serum IgA levels were increased in most of the cases. Although it is conceivable that these cases could be caused by viral infection, induced by antibiotics, considered as an early stage of ulcerative colitis or other immunological disorders, the definite cause of these cases is not clear. Therefore, at present it would be reasonable to deal with them "Transient hemorrhagic colitis" clinically.
In the pathogenesis of malabsorption of lipids, the impairment of the intramucosal reesterification to triglyceride has been yet unknown. Since 1968, the effect of aging on digestion and absorption of fats has been studied clinically by our group. We found no abnormal results in the fat digestion-absorption tests but a little elevation of fecal fat excretion ratios in the aged around seventies and eighties. In the rat everted sac studies, the mucosal uptake of 14C-palmitate is low in the aged compared with the juvenile, and a slow down of reesterification to triglyceride is demon-strated by the analysis of thin layer chromatography. Furthermore, the activity of acyl-CoA: monoglyceride acyltransferase, one of the lipid-reesterifying enzymes in the small intestine, is significantly reduced in the aged rats. The activity of this enzyme is also reduced in the elderly people. Thus, it is suggested that the impairment of intramucosal reesterification significantly contributed to the malabsorption of fat produced by aging.
An automated method is proposed for the assay of glycylproline dipeptidyl amino-peptidase (GPDA) activity in the serum by Rotochem ha centrifugal fast analyzer. The method has reduced technical involvement and offered considerable advantages in reproducibility and linearity. Good correlation was also obtained between the manual and automated methods. We also examined the activities of GPDA in sera from 256 patients with hepatobilliary diseases including 69 cases of hepatic cancer and from 100 healthy controls to investigate the diagnostic value of this enzyme. A highly significant elevation of the enzyme activity, more than 200 I.U./L, was found in 36% of sera from patients with hepatic cancer, but all other hepatobiliary diseases showed the enzyme activities less than 200 I.U./L in the sera with few exceptions. These results indicate that the assay of serum GPDA activity is useful for the differential diagnosis of hepatic cancer from other hepatobiliary diseases. The fact that no correlation was observed between the serum GPDA activities and α-fetoprotein levels may increase the clinical value of this enzyme for the early diagnosis of hepatic cancer.
A second mass examination of both stomach and gall bladder was carried out on a single occupational group three years after initial examination. When cholelithiais had been suspected, an intensive secondary examination was performed. The following results were obtained by studying both the incidence rates for cholelithiasis among healthy population and the state of the disease itself: 1) Incidence of observed cholelithiasis within population was 3%;2.9% male, and 3.6% in female. 2) The rate of cholelithiasis which went unobserved at the initial X-ray examination was 0.15%, while the rate of obviously new cases was found to be 0.20%. 3) Revealed a tendency for of cholelithiasis the incidence increasing with age. 4) The rate of cholelithiasis was low in patients with diseases of the upper digestive tract, and high in patients who had been operated on for diseases of the upper digestive tract. 5) 23% of population diagnosed as having cholelithiasis revealed abnormalities in tests of hepatic functions. 6) "Non-symptomatic cholelithiasis" was observed in 45.8% of population diagnosed as having cholelithiasis. Of these, a high percentage was found, as a result of X-ray examination, to have abnormal risualization and contractility.
The method for determination of serum ribonuclease (RNase) activity was established using Poly(C) as synthetic substrate. In healthy subjects the RNase activity was 118±2.7 units/ml/min. The value over 2 SD of the mean, i.e. 185 units/ml/min. being taken as abnormal, 95% of pancreatic cancer and 38.5% of other cancerous diseases revealed to be abnormal. Hepatic cancer and lung cancer showed relatively high value, while cancer of gastrointestinal tracts rather low value. In renal insufficiency the RNase activity was high and showed a good correlation with BUN. Besides, hepatic diseases as liver cirrhosis and hepatic cancer were of rather high value, which was reversely correlated with serum albumin and cholinesterase. It was, thus, suggested that serum RNase might derive from pancreas, and that the liver and the kidney might be involved in the increase of its activity. In this connection, the determination of serum RNase activity may be useful for the serological diagnostic tool of pancreatic cancer.
The effect of exogenous and endogenous secretin on plasma glucagon reacting to 30K antibody was investigated in totally pancreatectomized dogs. One clinical unit per kilogram of intravenously administered secretin (Eisai) caused no significant change in the plasma glucagon levels of normal dogs, but in the totally pancreatectomized dogs, slight suppression of glucagon secretion was observed. The administration of 7 clinical units of secretin caused a significant suppression of plasma glucagon in normal as well as the totally pancreatectomized dogs. Intraduodenally infused 0.1 N HCL gave rise to a rapid increase in the plasma secretin level, which showed no significant effect on the plasma glucagon of normal dogs. After total pancreatectomy, basal secretin levels increased gradually, and endogenous secretin released by duodenal acidification brought about a significant suppression of plasma glucagon levels. Thus, in the totally pancreatectomized dogs, both plasma secretin levels and the sup-pressive effect of endogenous and exogenous secretin on plasma glucagon were significantly enhanced.