Acute gastric mucosal lesion (AGML) was induced six hours after the administration of endotoxin. The decrease of gastric mucosal blood flow, used to be supposed as an important factor of the formation of AGML, was not found, but thiobarbituric acid (TBA) reactants in the gastric mucosa were increased three hours after endotoxin injection, 198±18.2 (vs control 130±18.2). The administration of platelet activating factor (PAF) inhibitor, CV3988, reduced the formation of AGML and increase of the TBA reactants. These results suggested that the chemical mediator like PAF and free radicals may play an important role in the pathogenesis of gastric mucosal injury induced by endotoxemia, without the decrease of mucosal blood flow.
We carried out measurement of gastric lesions in the inner surface of the stomach with a measuring system, which is composed of a stereo endoscope and a personal computer. Basically, the length on a flat board from 10mm to 50mm was measured by varying the distance betwen the lens and the board and the angles of the endoscope at first. The error of the measurement was less than 8.5%. Secondly, ten physicians of our clinic attempted the measurement of the pasted discs on the inner wall of a stomach model with the endoscope. The average measurement error and the average time required for endoscopy became more better using the newly developed system than a measuring rod. Clinically, we measured the length of stomach lesion and of normal mucosa in six patients and compared the values obtained with those of resected fresh specimens. The length of stomach lesions could be measured more accurately than that of normal mucosa of stomach. From our observations, it can be said that this system is as available as the basic examination procedures in use at present and worth using in clinical procedure for it's high reliability.
Characteristics of the vascular course of ruptured vessels in the submucosal layer of Dieulafoy ulcer were studied, and endoscopic hemostatic treatment was performed using Aethoxysklerol and ethanol. 1) Observations of vessel courses in serial sections revealed that ruptured vessels in Dieulafoy ulcer exhibit rhexis in the lateral portions of the vessel and long courses over the ulcer margin in the submucous layer. 2) More dependable hemostasis seemed to be provided by thrombosis not only at the source of bleeding, i.e., at the site of vessel rupture, but also in the region of the whole ruptured vessel in the submucous layer. 3) Hemostatic treatment by local injection of Aethoxysklerol and ethanol was performed in 4 patients with Dieulafoy ulcer, and complete hemostasis was achieved in all 4 patients.
In order to identify the most useful marker to diagnose hepatic fibrosis, type III procollagen peptide (P-III-P), lamininP1, and prolyl-hydroxylase (PH) in sera obtained from patients with liver diseases were simultaneously measured and compared with histological features of chronic hepatitis and with tumor size estimated on abdomical CT scan. Furthere more, the diagnostic accuracy of these markers was evaluated by using discriminant analysis. P-III-P and lamininP1 were closely correlated with the activity of chronic hepatitis. These two markers most accurately discriminated between the compensated stage of liver cirrhosis and the decompensated stage, and between liver cirrhosis and hepatocellular carcinoma. LamininP1 was found to most clearly distinguish chronic hepatitis from liver cirrhosis. P-III-P was significantly correlated with the size of hepatocellular carcinoma. However, PH failed to discriminate among liver diseases, and showed no significant correlation with a liver tumor size. And none of the markers examined were correlated with a degree of hepatic fibrosis. From these results, the analysis of both serum P-III-P and lamininP1 is a useful approach to evaluate hepatic collagen metabolism.
In order to clarify the histologic characteristics of well-differentiated hepatocellular carcinoma (HCC), a comparative morphometric study on cell density was performed in 15 HCCs smaller than 2cm in diameter, 6 HCCs with marked fatty and/or clear cell change, 7 hyperplastic nodules, 5 hyperplastic nodules containing foci of HCC, and non-cancerous areas of the livers bearing small HCC. In well-differentiated HCC, marked increase of cell density accompanying by decrease of cell size and increase of nuclear cytoplasm ratio were prominent, and the cell density was approximately two times larger than that of the non-cancerous area in most cases. In HCCs with marked fatty and/or clear cell change, as an increase of cell density was not evident because of swelling of the cytoplasm due to fat and/or glycogen accumulation, it should be careful to differentiate them from non-cancerous nodular lesions including hyperplastic nodule with marked fatty change. Hyperplastic nodules could be divided into two groups; those with marked increase of cell density, and those without increase of cell density. In the former group, 5 of the 7 nodules contained cancerous foci.
Intrahepatic distribution of the inferior mesenteric blood flow was evaluated with scintigraphy with transrectally administered 123I-iodoamphetamine (IMP). Twelve patients without liver diseases were studied. The IMP image was divided into 3 types; bilateral, left lobar predominant and right lobar predominant. Bilateral, left lobar predominant and right lobar predominant types were observed in 5, 5 and 2 patients respectively. Furthermore, uneven distribution pattern in the left or right lobe was observed in 2 of 5 patients with bilateral lobar type, 4 of 5 patients with left lobar predominant type and 1 of 2 patients with right lobar predominant type. In one patient with left lobar predominant type, repeat examination demonstrated bilateral lobar type. These results suggest that intrahepatic distribution of the inferior mesenteric blood flow is not uniform and consistent.
Data were obtained in 10 patients with amebic dysentery at Osaka Socio-Medical Center hospital during the period from April 1985, to April 1989. All of the patients were male, and their average age was 41 years old. In the past history, all of them had never gone to foregin countory, and 7 patients had the habit of homosexual love. In the serological test, positive rate of antiamebic antibody was 100% (6/6) by agar gel diffusion, that of antibody of Toreponema pallidum was 60% (6/10) by TPHA, but anti AIDS antibody was not detected (0/3) by HIV. Detectability of Entoamoeba hystolitica was 70% (7/10) in stool, 50% (2/4) in liver abscess, 25% (1/4) in biopsied specimens of rectal mucosa. Then, we fund that the serological test for antiamebic antigen was useful for diagnosis of this disease, and suspected that homosexual contact contributed to the infection of E. hystolitica.
A clinical trial was carried out for a lypophilized inactivated hepatitis A vaccine in order to confirm its safety and antibody responce. The vaccine used for the study has been developed by Denka Institute of Biological Science (Lot. D-01), Chiba Serum Institute (Lot. C-01) and The Chemo-Sero-Therapeutic Research Institute (Lot. K-02). Thirty-six volunteers were selected and employed for the present study from healthy male adults carrying no antibody against hepatitis A virus (HAV). They were divided into three dose groups; 1.0μg, 0.5μg and 0.25μg viral protein respectively. Each groups were injected intramuscularly 3 times with 0, 1 and 6 months interval. As the results, though, slight side effects such as local pain were found in 16 cases out of 99 total injected, but no abnormal value was observed in the blood and urine examinations. On the otherhand, the mean values of serum anti-HAV at 2 months after the first injection in 1.0μg, 0.5μg and 0.25μg dose-groups were 562mIU/ml, 323mIU/ml and 134mIU/ml, respectively, and at the 7 months, 3630 mIU/ml, 1288mIU/ml and 1000mIU/ml, respectively. Namely, the high immunogenicity and safety of the vaccine were confirmed in this trail.
Serial changes of intrahepatic portal blood flow were studied before and after percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC). In all eight patients examined, wedge-shaped perfusion defects distal to the tumor were clearly demonstrated by dynamic sequential computed tomography during arterial portography (CT-AP). However, no abnormalities of arterial blood flow were detected in the areas of reduced portal blood flow by enhanced computed tomography (CT), indicating that portal blood flow of the liver was selectively decreased by PEIT. Moreover, histopathological finding of two resected liver tissues after PEIT revealed organized thrombi in the portal veins in the non-cancerous liver tissues distal to the tumors. These findings suggest that decreased segmental portal flow is frequent after PEIT and obstructive vasculitis is caused by the drainage of ethanol injected in the tumor.
We investigated immunohistochemical expressions of the epidermal growth factor (EGF) and the epidermal growth factor receptor (EGFR) in 25 cases of pancreatic carcinoma, including 13 cases of metastatic lymph nodes. EGF and EGFR were stained mainly in the cytoplasm and on the surface of some pancreatic carcinoma cells, with positive rates of 18/25 (72%) and 9/25 (36%) respectively. In all cases EGFR was noted only when EGF was also detected. EGF and EGFR were stained frequently in differentiated types. In metastatic lymph nodes, EGF and EGFR were found in 54% and 15% respectively, and they were detected only when they were also noted in the same patient's primary lesions. EGF and EGFR were found more frequently in Stages III and IV than in Stage II. These results emphasize that EGF and EGFR may promote both the proliferation and the differentiation of human pancreatic carcinoma cells, as in other sites.