Portal pressures were measured by the method of percutaneous transhepatic portal catheterization (PTPC) in 50 cases of liver cirrhosis, and a comparative study was carried out between levels of portal pressure and endoscopic findings of esophageal varices. The mean value of portal pressures of 39 cirrhotic patients with esophageal varices was significantly higher than that of 11 cirrhotics without esophageal varices (P<0.005). Esophageal varices trended to extend their localization and intensify their features such as engorgement and tortuosity in accordance with increase of portal pressure. Any definite correlation, however, was hardly observed between color tone of the varices and portal pressures. Out of 39 cirrhotic patients with esophageal verices, portal pressure of 5 patients with confirmed history of pervious rupture of esophageal varices were obviously higher than that of 34 remaining patients without any history of rupture (P<0.1). Esophageal varices in 5 patients with history of rupture were all classified in Stage III, according to the endoscopical criteria proposed by surgical society for the study of the portal venous system. In other expression, bleeding from esophageal varices was observed in 5 cases (71.4%) out of 7 cirrhotic patients both with esophageal varices of Stage III and portal pressures of over 325 mm H2O. Those results suggest that measurement of portal pressure by percutaneous transhepatic portal catheterization (PTPC) would give some contributory informations, besides endoscopic findings, for anticipation of possible rupture and indication for prophylactic surgery for cirrhotic patients with esophageal varices.
For the past 4-1/2 years, gastric ulcers were diagnosed in 168 patients at emergency endoscopy performed on total 418 patients with upper GI bleeding. Among them, 128 patients rescued by medical treatment alone were followed up. Healing rate at 3 months was 76.6%, which is compatible with other reports. Among 86 patients followed up for 1 to 4 years, 23 recurrences were observed in 19 patients, of whom 10 had rebleeding. Bleeding incidence in recurrent ulcer was as high as 43.5%. In 10 patients followed up for 4 years, ulcer recurred in 6, of whom 5 had rebleeding. Patients with bleeding gastric ulcer, therefore, should be observed carefully as long as possible.
We have performed various surgical procedures on 121 duodenal ulcer patients including 20 cases with co-existing gastric ulcer in the last six years. The methods of operation were as follows; 2/3 gastrectomy were performed on 29 cases, selective vagotomy with drainage in 57 cases, selective proximal vagotomy with or without drainage in 27 cases, selective vagotomy and antrectomy in 6 cases and simple closure of perforated ulcer in 2 cases. Vagotomy was the main surgical procedures on patients with duodenal ulcer. The types of vagotomy adopted were determined by our criteria settled in 1974 by the preoperative assessment of acid and gastrin secretory responses to tetragastrin and meat extract stimulation. The 2/3 gastrectomy was preferred in patients with gastro-duodenal ulcer. Operative death was seen in two emergency cases, one with preoperative renal failure and the other with adrenal insufficiency. Three cases were reoperated, one for gastric ulceration which occurred at three years after SPV to duodenal ulcer, one for postoperative bleeding from residual duodenal ulcer after SV+P.P. and one for many gastric symptom after SV+P.P. following no abnormal finding at operation. The postoperative complaints were less frequent and the recovery to work was sooner in vagotomized group than gastrectomized group. SPV with or without drainage obtained the best clinical scores. Acid reduction rate in SPV was the lowest and the gastrin response was the highest compared with the other procedures, though in the postoperative output there was no Dbvious difference among all procedures. Basal acid output was 0.6-2.3 mEg/hr, maximal acid output was 6.0-7.5 mEg/hr. In general, our surgical results were considered to be satisfactory and our criteria for the selection of a surgical procedure to be reasonable.
Histocompatibility (HLA) Antigen phenotypes were studied in 23 patients with ulcerative colitis and 121 normal controls lived mainly in Tochigi province in Japan, with special references to sex difference and onset age of the disease. Compared with normal controls, higher frequencies both of Al0 and B5, and lower frequency of BW15 were observed at corrected P less than 0.55, 0.11, and 0.11 respectively. Especially, the high frequency of CW3 was statistically significant, suggesting some possible linkage with immune response genes, which is considered to be related with biological immunity. Additionally, a high frequency of B5 was present in the younger patients of ulcerative colitis with onset age of less than 30 years old. This result might suggest that genetic factors would be involved in its early onset of the disease.
The distribution of lysozyme in colonic mucosa in ulcerative colitis was identified for the purpose of the investigation of lysozyme function in the pathological colon. The localization of lysozyme in colonic mucosa was determined with the use of the immunohistochemical techniques. This method, using ethanol fixation, is very useful because of maintaining stability of the antigenicity and comparison with the histological findings in colonic mucosa in ulcerative colitis. In contrast with findings in normal colon, in active ulcerative colitis lysozyme was detected in some mucosal crypt cells as well as in granulocytes, monocytes, and macrophages of the intestinal lamina propria. Serum lysozyme activities were also elevated in active ulcerative colitis. As the mechanism of the raised concentration of serum lysozyme in active ulcerative colitis, it is thought that leucocyte turnover is accelerated and that lysozyme containing mucosal crypt cells appear. The major histological finding associated with lysozyme containing mucosal crypt cells was goblet cell depletion. The present observations permit one explanation that the appearance of lysozyme containing mucosal crypt cells is a functional change of mucosal crypt cells in ulcerative colitis.
Hepatic lesions were studied in patients with porphyria cutanea tarda. The patients were men aged 33 to 77 years, all having a hestory of exessive alcohol consumption. Serum transaminase level was elevated slightly in 6 cases and bromosulfophthalein or indocyanine green retention was increased in 5 cases. Serum total bilirubin was normal in all cases. Histological examination revealed varying degrees of the following changes: liver cell necrosis (6 cases), portal inflammation (6 cases), destruction of limiting plate (6 cases), fatty change (2 cases) and fibrosis (5 cases). Cirrhosis was noted in 1 case. Hemosiderin and lipofuscin deposits in hepatocytes were observed in all cases. Brown needle-shaped cytoplasmic inclusions were found in all cases. They occured both singly and in clusters and did not show any particular distribution within the lobules. Electron microscopical examination showed needle-shaped electrolucent areas associated with surrounding lysosomal material. These inclusions are considered to be characteristic and highly diagnostic of this disease.
Serum GOT and GPT values, serum lipid levels and oral glucose tolerance were evaluated in 50 male obese subjects before and after weight reduction by caloric restriction. 1) The high incidence of abnormal S-GOT or S-GPT values before weight reduction markedly decreased after weight reduction of 5% as % ideal bw (pre-weight reduction GOT 52.9%, GPT 64.7%; post-weight reduction GOT or GPT: 11.8%). After weight reduction over 5% as % ideal bw all subjects had normal values of both transaminase activities. 2) The frequency of hypertriglyceridemia decreased after weight reduction over 5% as % ideal bw (pre-weight reduction 54.6%; post-weight reduction 9.0%), and that of hypercholesterolemia decreased from 64.7 to 5.9% after weight reduction over 10% as ideal bw. 3) The improvement of abnormal glucose tolerance before weight reduction was found in about 40% after weight reduction up to 20% as % ideal bw.
Part II. Clinical Study: Fluorescence Histochemical Studies in Various Gallbladder Disease in Human —Especially on relationship between autonomic nerves, digestive tract hormones, EC-cells and mast cells—
Takashi MIYAZAKI, Masakuni ONDA
1980 Volume 77 Issue 6 Pages
Published: June 05, 1980
Released: December 26, 2007
Fresh autopsy specimens of 50 cases, 80 cases of cholelithiasis, 5 cases of biliary dyskinesia, 11 cases of cholelithiasis after gastrectomy and 5 cases of cancer of the gallbladder for a total 151 cases were studied in order to clarify the role of the autonomic nerve and content of catecholamine in the bile duct. Section were collected from fresh autopsy specimens and various parts of the gallbladder were removed surgically. The fluorescence histochemical method of Falck and Hillarp and acetylcholine esterase staining of Karnovsky were performed on the specimens to obtain results as follows. 1) The human gallbladder consisted sufficient sympathetic nerves and parasympathetic nerves and was composed of three plexuses. 2) The human common hepatic duct and common bile duct also consisted adrenergic fibres. The more abundantly they were distributed to the terminal part of the common bile duct. 3) Yellow cells considered as CCK-PZ like cells were observed in the mucous layer and smooth muscle layer of the gallbladder. This is the first time that they were observed by the use of the fluorescence technique. 4) Nerve cells in the ganglion of the human biliary duct system were accounted for in the main by the Dogiel II type. 5) The NA content in the tissue of the human bile duct was found to be greatest in the cystic duct and least in the common bile duct. A difference in the mean value was observed with respect to the noradrenaline content in various diseases of the gallbladder. 6) The development of cholecystitis appears to involve mast cells for the acute phase and EC cells for the chronic phase. Further studies on this subject are under way. 7) In the biliary dyskinesia groups and the cholelithiasis groups following gastrectomy a pattern of hyperplasia was observed in each layer of the gallbladder for adrenergic fibres and a decrease in both true ChE and pseudo ChE was observed for cholinergic fibres. Thus, it is suggested that the autonomic imbalance is responsible for the etiology of these diseases. 8) A difference was observed between the cholelithiasis groups and cholelithiasis groups following gastrectomy. 9) In the gallbladder cancer groups, adrenergic fibres were not observed in cancer lesions but hyperplasia was noted a little away from the lesions. As for cholinergic fibres, abnormally thickened fibres were observed in the cancer lesions and likewise thickened fibres in the surrounding tissue. However, we would rather refrain from drawing any conclusion on this subject owing to the small number of cases studied.
The CEA levels in duodenal juice obtained after administration of Pancreozymin and Secretin were assayed by two step method of DINABOT RIA KIT. The CEA concentrations in duodenal juice were significantly high (P<0.001) in patients with pancreatic cancer than chronic pancreatitis and control subjects, especially in S3 fraction (40 minutes after Secretin injection). Average CEA values of pancreatic cancer, chronic pancreatitis and control subjects were 36.3±12.5, 23.0±8.6, and 16.3±6.4 ng/ml (M±SE), respectively. These results imply that CEA concentration in duodenal juice of S3 fraction may be a good indicator of the diagnosis of pancreatic cancer. When we compared the CEA levels of tumor extract with pancreatic cancer and normal pancreas, strikingly high levels of CEA in tumor were evident. The increased CEA levels in the tumor extract of pancreatic cancer may represent an increased CEA production by the proliferating tumor cells.
Histological changes of operation specimen taken from 59 cases of chronic pancreatitis were investigated morphometrically in relation to their clinical manifestations. Histological changes of the chronic pancreatitis were remarkable in the alcoholic pancreatitis and the idiopathic pancreatitis, in contrast to the biliary pancreatitis. The volume ratio of the remaining pancreatic parenchyma was highly correlative to the results of P-S tests, especially to Max HCO3- concentration, total output of HCO3- and amylase output amount/kg. With regards to the islets of Langerhans, the number and their total volume rate in the pancreas reduced corresponding to progressive pancreatic fibrosis. However, the decrease of the volume rate of the islets was not necessarily in parallel with the result of O-GTT, suggesting that functional changes of the islets were undergoing.