Gastric mucosal blood flow rate and transmucosal electrical potential difference (PD) which is a good indicator of the mucosal integrity were measured endoscopically in experimental animals and clinical cases with liver damage. Liver damage was induced experimentally by the oral administration of dimethylnitrosamine (DMNA) to beagles. In these dogs, gastric mucosal blood flow rate and PD were decreased with the progression of the liver damage. Until the 8th week after the beginning of the administration of DMNA, gastric mucosal pH value was elevated, but after the 12th week, it was decreased. In clinical cases with liver cirrhosis, a significant decrease of gastric mucosal blood flow rate at the body was observed, especially in cases with esophageal varices. PD was significantly decreased both at the antrum and body. Thus the gastric mucosa with liver damage was speculated to be exposed to circulatory disturbance and tend to be easily injured.
The growth pattern in the gastric wall of the thirty-five patients with the depressed type of gastric cancer including Borrmann type of advanced cancer was analysed by endoscopic ultrasonography. It was demonstrated that the gastric wall infiltrated by the tumor was significantly thickened by the accompaning with ulceration or the progression of the disease as compared with that of IIc type of gastric cancer without ulceration. The growth pattern in the gastric wall was clearly distinguished each other by the difference of macroscopical appearance of the gastric cancer; IIc type of gastric cancer with ulceration and Borrmann 2 type of gastric cancer showed the inward growth only, while IIc-like advanced gastric cancer and Borrmann 3 type of gastric cancer showed both inward and outward growth. By these observation of the growth pattern, it may be possible that the more accurate diagnosis of the depth of cancerous invasion by endoscopic ultrasonography can be made in the patients with depressed type of gastric cancer.
Capsules of Tc-99m pertechnetate that contained a releasing mechanism were prepared and given orally to volunteers to evaluate the portal circulation. A preliminary study of Macaca fascicularis showed that Tc-99m pertechnetate injected in the rectum circulated through the inferior mesenteric vein to the portal vein and liver, whereas the compound injected into the small intestine circulated through the superior mesenteric vein to the portal vein and liver. The results suggested that portal scintigraphy through the small intestine could be analyzed in the same way as per-rectal portal scintigraphy. The study of the volunteers was successfully completed in 3 of the 4 subjects. The Tc-99m pertechnetate was released when the capsule reached the small intestine. From there, the compound circulated through the superior mesenteric vein to the portal vein and liver. The results showed that this use of a capsule enclosing a radioisotope is possible and probably safe.
Faecal microflora in patients with ulcerative colitis were studied with respect to stool condition, stage and severity of the disease, Moreover, faecal microflora were compared between first relapsing cases under maintenance treatments and untreated cases. Counts of obligate anaerobes were significantly decreased irrespectively of stool condition, stage and severity of the disease. The frequenices of detection of obligate anaerobes were much lower particularly in severe cases and cases with bloody diarrhoea. Specifically the counts and frequencies of detection of bifidobacteria reflected the severity of the disease. Further, in the genera of the Enterobacteriaceae Eschrichia coli was not isolated and Proteus, which was not isolated from faeces of the healthy controls, was often isolated and became dominant in severe cases. These findings suggest the presence of abnormal microflora in the gut of patients with ulcerative colitis. Faculative anaerobes, especially streptococci were increased more markedly in first relapsing cases compared with untreated cases.
Peptide YY (PYY) is a 36 amino acid peptide which is mainly localized to endocrine cells of the lower gastrointestinal mucosa. In this study, we measured plasma PYY concentrations in patients with colorectal diseases by specific radioimmunoassay. The mean fasting plasma PYY concentrations in ulcerative colitis (remission) (84.5±10.6 fmol/ml) and colectomy and-or proctectomy (93.3±6.1fmol/ml) were significantly lower than those in healthy controls (145.6±13.4fmol/ml), ulcerative colitis (active stage) (162.3±33.8fmol/ml), and colorectal cancer (130.5±15.4fmol/ml). These results suggest that plasma PYY concentrations reflect a reduction in numbers of PYY cells in the lower gastrointestinal tract. Plasma PYY may therefore be a factor indicately the pathological changes of lower gastrointestinal tract.
Portal blood flow was measured using an ultrasonic Doppler duplex system in patients with liver cirrhosis or idiopathic portal hypertension who had undergone splenectomy as part of non-shunt operation to prevent the formation of esophageal varices. The effects of splenectomy on portal hemodynamics were studied. Tweny-two post-splenectomy patients (12 with liver cirrhosis, 4 with idiopathic portal hypertension and 6 others), 110 normal subjects, 65 non-surgically-treated patients with liver cirrhosis, and 13 non-surgically-treated patients with idiopathic portal hypertension were studied. Portal blood flow in liver cirrhosis patients was 11.5±4.8ml/min/kg after splenectomy (non-surgically-treated LC patients, 15.0±7.4ml/min/kg). In patients with idiopathic portal hypertension, the value was 5.4±1.7ml/min/kg after splenectomy (non-surgically-treated IPH patients, 22.8±9.3ml/min/kg). Portal blood flow decreased in both liver cirrhosis and idiopathic portal hypertension patients after splenectomy. The decrease was marked in patients with idiopathic portal hypertension.
To study the effect of chronic ethanol administration by the histochemical and biochemical analysis was performed using male-Donryu rats which fed on the 36% ethanol-containing liquid diet for 9 months. The histochemical study of the hepatic γ-GTP showed strongly positive stain on proliferated bile ductules in the portal area, while negative stain in hepatic parenchyma. With biochemical analysis, hepatic microsomal γ-GTP activity showed mild elevation by 2.75 times higher than control, however serum γ-GTP activity was scarecely elevated. These results suggest that the increase in serum γ-GTP commonly observed in alcoholics can partially be attributed to an induction of in the proliferated bile ductules.
Relationship between serum HBeAg/anti-HBe and liver histological finding or intrahepatic HBcAg was evaluated in 51 cases of chronic type B hepatitis. Including 19 cases in whom liver biopsies were performed more than 2 times, the following results were obtained. 1) Liver histological finding was improved in 66.6% of 12 cases which turned to HBeAg negative, 83.3% of 6 cases which seroconveted to anti-HBe positive from HBeAg positive, while only 14.3% of 7 cases which remained to be HBeAg positive. 2) HBcAg in the nuclei and cytoplasm in liver cells was significantly decreased in cases which turned to HBeAg negative or seroconverted to anti-HBe positive. 3) Cytoplasmic HBcAg was demonstrated in the high incidence in cases with marked intralobular degeneration or necrosis in the liver. From these results, it was strongly suggested that decrease of intrahepatic HBV and also improvement of liver histological finding have occurred in cases which turned to HBeAg-negative, especially in cases which seroconverted to anti-HBe positive from HBeAg positive after treatments.
It is well known that steroid withdrawal therapy is effective on seroconversion from HBe Ag to anti-HBe to the patients with HBe Ag-positive chronic type B hepatitis. But this therapy should be done carefully because it almost always causes transient elevation of serum transaminase levels. So we consider that steroid withdrawal therapy should apply to the patients who are assumed to be effective to it. In this reason, we have studied six back-ground factors (age, sex, mode of HBV transmission and as serum markers, S-GPT, HBs Ag titer and HBe Ag titer at initiation of therapy) concerning the effect of steroid withdrawal therapy on seroconversion from HBe Ag to anti-HBe. Thirty-eight patients were followed up, and 23 patients were HBe Ag negative in their sera, 15 patients remained HBe Ag positive in their sera at 1 year after the discontinuation of prednisolone. Specially, the mode of HBV transmission (vertical transmission or horizontal infection) was a very important previous factor concerning the outcome of the steroid withdrawal therapy even if after the statistical correction of the influence of other five factors. It has been concluded that steroid withdrawal therapy has a good indication to the patients with chronic type B hepatitis who were infected infected horizontally horizontally.
In order to evaluate the efficacy of EBD for the alleviation of obstructive jaundice, 311 patients (66 with benign diseases and 245 with malignant diseases) were entered into this study. 19 patients with malignant biliary obstruction were not indicated for EBD due to extensive cancerous invasion to the duodenum or the papilla Vater. Among the remaining 292 patients, EBD was successfully done in 266 patients (91.1%) and was effective in 246 patients (84.2%). Complications occurring within 1 month after EBD were found in 45 patients. The most frequent one, observed in 39 patients, was biliary infection in malignant biliary obstruction. Cholangitis developed frequently in the patients with malignant hilar strictures treated by endoscopic biliary endoprostheses. There was no death directly attributable to complication within 1 month. EBD is a safe and effective noninvasive biliary drainage method and can be indicated for all the patients with obstructive jaundice.
The present study was undertaken to determine the degree of pancreatic injury in 18 patients with SLE 27 autopsy cases. Of the 18 patients there were 7 cases (33%) with clinical symptoms of pancreatitis such as abdominal pain or hyperamylasemia including one case (6%) with obvious complications of acute pancreatitis, and two cases (11%) showing a definite decline in the pancreatic exocaline function test. Microscopic examinations of the pancreas in the 27 autopsy cases revealed 20 lesions; 2 arteritis (7.4%), 10 thrombosis (37.0%) 6 focal pancreatitis (22.2%), 8 periductal fibrosis (29.0%), 11 interlobular fibrosis (40.7%), 6 ductule dilatation (22.2%), and 7 fat diposition (25.9%). The rate of residual volume of the pancreas parenchyma, estimated by the point counting method was 79.2% in SLE, and 82.9% in control subjects. Although the difference was insignificant, six cases of SLE decreaed. The lowest value was 63% which was higher than the highest value of the moderate disturbance group of chronic pancreatitis. The cause for the decrease in the residual volume was considered to be independent of any specific lesion, but associated with the numbers of the lesions. These findings suggest that pancreatic demage in SLE are generally mild and occure more frequently than commonly accepted, but such severe pancreas damage as chronic pancreatitis might be rare.