Usefulness of a new method named"SALINE INJECTION METHOD"for endoscopic ultrasonography (EUS) of gastrointestinal tract was investigated. At first, the saline solution was injected from mucosal surface into the stomachs wall resected from normal canines and a patient with gastric cancer. Ultrasonography suggested that the saline solution was localized in the submucosal layer and spreaded surrounding the mass lesion. Histological study of the same materials showed localization of the injected saline solusion corresponding to the appearance of ultrasonography. The result of this study was applied to EUS for cancer and elevated changes of esophagogastric wall in clinical cases. Injection of the saline solution into the esophagogastric wall just before conventional EUS was carried out in 34 patients whose image of conventional EUS gave insufficient informations of the esophagogastric lesions. Such"saline injection method"was performed in order to make sure of being a marker near the lesion in trying EUS, and in consequence the probe of ultrasonic endoscope was correctly guided to the lesion in 1 cases out of 12, in which the lesion could not be found by conventional EUS. Moreover, EUS with such"saline injection method"demonstrated the clearer depth and margin of the lesion in 20 cases of 22 in which conventional EUS revealed no exact localization of the lesion in the esophagogastric wall. But this new method failed to discriminate cancer invasion in the submucosal layer from fibrosis in the same layer and to diagnose minute or scattered cancer invasion into the submucosal layer. It was concluded that EUS combined with"saline injection method"is very usefull when the conventional EUS failed to give detailed information of the gastrointestinal tract lesions.
The origin and renewal of EC, G and D cells in the duodenum were investigated using the peroxidaseanti peroxidase technique and radioautography in rats killed at various times after single or multiple injections of [3H] thymidine. After a single injeciton of [3H] thymidine, there were labeled EC, G and D cells, indicating self-replicating activity of some cells. After 2 days repeated injections of the isotope, labeled EC, G and D cells increased in number. They first occurred at the crypt and later at the villus. All these cells were found to be labeled after continuous labeling for about 5-6 days, which is considered to be renewal time for these cell population.
We investigated 67 liver tumors in 56 patients from the body surface and 27 liver tumors in 21 patients from the liver surface (during operation) using a B-mode combined duplex Doppler ultrasonography, and compared the Doppler flow signals with the histologic and angiographic findings. 1) We obtained three types of Doppler signals from the central and marginal areas of the tumor as follows: pulsatile-arterial (originating from arterial flow), pulsatile-nonarterial (mainly originating from hepatic venous flow), and non-pulsatile (mainly originating from portal venous flow). 2) The more hypervascular the tumor was, the higher the velocity of the signal obtained. 3) We obtained the arterial Doppler signals with a velocity greater than 70cm/sec (high-velocity arterial signals) from 6 out of 6 hepatocellular carcinomas where angiography demonstrated the existence of arterio-portal shunts. These findings indicate that ultrasonic Doppler signals are helpful in diagnosing the type of hepatic tumor, especially hepatocellular carcinoma.
Etiologic factors and clinical features were studied in four hundred and fifty three patients with hepatocellular carcinoma (HCC) of which 156 had small HCC less than 3cm in diameter. Patients with small HCC showed low incidence of HB positive (serum HBs-antigen is positive or HBc-antibody is positive in 1:200 dilution serum), high incidence of alcohol abuse and severe damage of liver function. Ultrasonography could discover small HCCs in high rate of success, whereas serum α-fetoprotein (AFP) was normal in 37.8%, and over 200ng/ml only in 17% of them. Patients with small HCC below 2cm showed good prognosis which was 58% in rate of 3-year survival. HCC patients with the HB positive were significantly related to mild liver damage, whereas those with alcohol abuse were to severe liver damage, low incidence of AFP elevation and good prognosis. It was strongly suggested that those with alcohol abuse had a close relationship with infection of non-B hepatitis virus through the injection of stimulant drugs or the tatoo. In patients with liver cirrhosis, the HB positive was not stastically significant in inducing HCC in comparison with the other etiologic factors
A continuous human cell line designated HCC-T was established from the hepatocelluar carcinoma (HCC) of a 69-year-old Japanese male patient. Serum hepatitis A antibody, hepatitis B surface, e and core antigens and antibodies to those viral antigens were all negative in this patient. He had no histories of a large alcoholic consumption and blood transfusion. It is thought that the HCC had developed from liver cirrhosis which was a sequela of nonA nonB type chronic hepatitis. HCC-T cells were cultured in tissue culture flasks attaching to the bottom, in RPMI-1640 medium supplemented with 10% fetal calf serum. The population doubling time of HCC-T cell was estimated as 24h in this culture medium. Morphological study based on the light and electron microscopies revealed that HCC-T cells were HCC cells of epithelial-like shape. Intracellular production of alphafetoprotein was demonstrated by direct immumofluorescence technique. The chromosome analysis revealed that HCC- T had a male sex chromosome and a chromosome mode of 64. It was demonstrated that HCC-T cells were able to grow without anchoring dependence in a soft agar medium. When HCC-T cells were subcutaneously transplanted to athymic BALB/c nude mice, tumors developed at sites and minimum transplantable cell number was 2×106. Light microscopic observation showed that the transplanted tumor tissue was similar in morphology to the original HCC tissue.
This study was undertaken to investigate the relationship between morphological characteristics and hepatic function in cirrhotic patient. Five parameters consist of Mean Area (M.A.) and Shape Facter (S.F.) of lobule or pseudolobule, ratio of fibrotic component to total area (F-Ratio) and Standard Deviation (S.D.) of M.A. and S.F. These parameters were quantitatively analyzed with 90 consecutive liver specimens (77 cirrhotic and 13 normal livers), using Automatic Image Analizer (IBAS-2). Sinfificant difference were observed with these five parameters between cirrhotic and normal livers. However, there were no statistical differences among four categories of liver cirrhosis; A, A', B and B' (Miyake's classification). Among liver function tests, HPT, Alb, ZTT, ICGK and Rmax value showed relatively high correlation ranging from 0.30 to 0.57 with these morphological parameters. On the other hand, both F-RATIO and S.D. of S.F. were relatively in good correlation with liver function tests as compared to other morphological parameters. According to multiple regression analysis to determine the correlation between morphological and functional indices, functional status of cirrhotic liver can be partly assumed by these morphological parameters with multiple correlation coefficient 0.67. It is concluded from these data that computerized morphometric analysis seems to offer an important aspect to evaluate liver cirrhosis.