To characterize gastric acid response and its age distribution in the patients with duodenal ulcer (DU), we conducted pentagastrin (PG) dose-response study and culculated maximal response (Vmax-c), half maximal dose of PG (Km-c), and the mean response to 0.22μg/kg/hr of PG as percent of highest observed response (SI). The mean values of basal secretion (BAO), Vmax-c, and SI in DU were significantly greater than those of normal subjects (N). The mean values of Km-c were significantly less than those of N. The greater BAO, Vmax-c, and SI, and less Km-c were observed in all age groups of DU. The results indicate that DU patients not only secrete more acid but also are more sensitive to stimulation by pentagastrin than N, and that the characteristics are common in all age groups of DU.
To investigate roles of the sympathetic nervous system in the local release of VIP, pharmacological α (phenoxybenzamine), β (propranolol) adrenergic blockade or surgical sympathectomy by the ganglionectomy of splanchnic plexus was performed in anesthetized dogs. Portal and venous plasma VIP levels during intrajejunal infusion of 0.1N HCl solution at a rate 1.5ml/min for 20 minutes were observed before and after these procedures. The plasma VIP levels during the intrajejunal HCl infusion were significantly increased after blocking of α-adrenoceptors and surgical sympathectomy but showed no change after blocking of β-adrenoceptors. These results suggest the inhibitory mechanism of the sympathetic nervous system on the local release of VIP from the canine small intestine. In addition, the increase of portal blood flow and bile secretion, and the elevation of bicarbonate concentration in the secreted bile during the intrajejunal HCl infusion were significantly higher after surgical sympathectomy than before, and plasma VIP levels were also significantly higher.
The biological significance of silver binding nucleolar organizer regions (Ag-NORs) had been evaluated in tissue sections from 21 colonic adenomas (11 mild atypia, 10 moderate atypia), 23 primary adenocarcinomas of the colon (12 intramucosal carcinomas, 11 advanced carcinomas) and 5 control cases, by automatic image analysis. A significant difference in the mean number of Ag-NORs per nucleus was found when adenomas with moderate atypia and carcinomas were compared with adenomas of mild atypia and control cases. The mean Ag-NORs area per 1 Ag-NOR of carcinomas tended to be larger than that of the adenomas and control group. The mean value of form factor in carcinomas showed greater pleomorphism in shape than that of adenomas and control group. The mean quotient of number and area of Ag-NOR (Ag-NOR score) of the carcinomas was highest among the cases examined. These results indicate that evaluation of the mean Ag-NOR numbers is of great value, with regard to the cell proliferation, and that of Ag-NOR score may give the most accurate estimation of biological character in different groups of colonic neoplasia.
In 180 patients with hepatocellular carcinoma (HCC) who underwent radical hepatectomy, 52 patients were received preoperative arterial chemoembolization (TAE) for the whole liver (whole-liver TAE group: group A), 39 for the limited area of the liver (lobar or segmental TAE group: group B) and the remaining 89 had no treatments before surgery (control group: group C). In order to evaluate the significance of preoperative TAE, long-term prognoses were compared among the three groups. Although there were no significant differences in survivals between A and C, the 2- and 6-year survivals in group B were significantly better than those in group C (P<0.05). With regard to reduction rates of tumors and necrotizing effect for daughter nodules after TAE, the lobar or segmental TAE was significantly superior to the whole-liver TAE. Moreover, the lobar or segmental TAE deteriorated the liver function significantly less than the whole-liver TAE. These findings suggest that the lobar or segmental TAE is more advantageous than the whole-liver TAE as a preoperative adjuvant therapy.
The percentage of splenic blood in portal venous flow (SV%) was measured in 96 patients by using scintiphotosplenoportography and angiography. The patients were divided into two groups: Group 1, without collateral pathways from the splenic vein; Group 2, with collateral pathways from the splenic vein. SV% was significantly lower in patients without liver diseases or in patients of Group 1 with liver cirrhosis (LC). SV% was significantly higher in patients with idiopathic portal hypertension (IPH). A significant correlation was observed between SV% and splenic volume or ICGR15. No significant correlation of SV% was found with etiology of LC in patients of Group 1, esophagogastric varices, Child's criteria, portal venous pressure, cholinesterase, hepaplastin test or prothrombin time. Hence, the local hyperdynamic state of the splenic region was detected in patients with CH, LC and IPH.
We have evaluated the problem of autoantibodies such as antinuclear antibodies (ANA), smooth muscle antibody (SMA) and antibodies to thyroid microsomal (TMA) and to thyroglobulin (TGA) related to interferon therapy in 27 patients with chronic hepatitis B. Anti-interferon antibody was also studied by Western blot method. Eight patients had ANA and 2 had SMA during interferon therapy. However, 6 of the 8 patients were ANA positive and one of the 2 was SMA positive prior to interferon treatment. No patients developed TMA, TGA or anti-interferon antibody. Eight (29.6%) of the 27 patients had clearance of both DNA polymerase and HBeAg and persistent normalization in alanine aminotransferase levels with interferon therapy. Seven of the 8 responders developed none of the autoantibodies related to interferon therapy. These results suggest that the presence of ANA or SMA during treatment may affect the therapeutic response to interferon.
Endoscopic manometry using microtransducer was applied to evaluate the motor activity of the sphincter of Oddi (SO) and common bile duct (CBD) in patients with biliary tract stones and in controls. CBD pressure, SO pressure and the incidence of irregular phasic wave pattern (IRPWP) were relatively higher in patients with biliary tract stones than those in controls. There was no significant difference in CBD and SO pressure between patients with dilated CBD and patients with non-dilated CBD, however the incidence of IRPWP was significant higher in patients with dilated CBD than that in patients with non-dilated CBD. SO pressure and the incidence of IRPWP were significant higher in patients with papillitis than those in patients without it. Patients with valvular orifice of the papilla of Vater showed high incidence of IRPWP, and in such cases it was suggested that SO had different motor functions for CBD and pancreatic duct because these ducts were seen opening onto the papilla separately according to the findings of pancreatocholangiogram. We concluded that endoscopic manometry of CBD and the SO was useful to evaluate the motor activity of SO and provided a basis for the assessment of the motor function mechanism of SO. Our results indicated the motor activity of SO had close relationship with biliary tract stones, CBD dilatation and endoscopic findings of the papilla of Vater.
We studied the clinicopathological characteristics of the proximal border of bile duct cancer among 46 cases. In both the superficial and the superficially spreading type, cancer was located within the mucosa and the mucous membrane at its verge was more hypertrophic than the proximal noncancerous mucosa, but they didn't differ from each other in thickness at the fibromuscular and Glisson's fibrous layer. In bile duct cancer without superficial spread, on the other hand, the tumor involve the fibromuscular or Glisson's fibrous layer and fibromuscular or Glisson's fibrous layer at their verge was more hypertrophic than the proximal noncancerous bile duct, which resulted in the narrowing bile duct at the lesion. Percutaneous transhepatic cholangioscopy (PTCS) facilitates the preoperative diagnosis of the extent of the bile duct cancer, which shows a granular change of the mucosa and tumor vessels. The wall irregularity and narrowing of the bile duct demonstrated by the selective cholangiography are also referred to its extent.
The point mutation of c-K-ras oncogene at codon 12 was investigated in 15 cases of mucin-producing cystic tumor of the pancreas by a modified polymerase chain reaction (PCR) method. Three percent formalin-fixed and paraffin embedded materials were employed for the present investigation. These fifteen cases were histopathologically classified into five categories (from group I to V) according to Kozuka's classification which was based on cell atypia of the tumor cells; 5 cases were judged as group V, 4 cases as group IV, and 6 cases as group III. The frequency of point mutation was 5/5 in group V, 3/4 in group IV, and 2/6 in group III. The frequency of point mutation was correlated with morphologically determined cell atypia. Among group III, the point mutation was noticed in the cases with larger tumor size. From genetical point of view, the results indicated more malignant biological feature of mucin-producing cystic tumor of the pancreas than has generally been accepted.
To investigate the development of pancreatic exocrine function and intestinal negative feedback regulation with aging in rats, we measured pancreas weight, content of amylase and trypsinogen in the rat pancreas and plasma CCK concentrations, activity of amylase and trypsin in the small intestine at an hour after oral administration of trypsin inhibitor (TI), and also examined amylase secretory response to CCK-8 in the rat pancreaticacini at various ages in vitro. As a result, amylase content per pancreas weight increased with the age and amylase activity in the small intestine at al ages showed a significant increase in TI group compared to controls. Plasma CCK concentrations were elevated after administration of TI at all ages. Amylase release from pancreatic acini stimulated by CCK-8 responded poorly on days 7, then gradually increased with age, showing a biphasic dose response curve with maximal response of 10-10M of CCK-8 from 14-day-old to 66-day-old. The results indicated that the mechanism of pancreatic secretory response to TI already might exist at the stage of sucking rat and secretory response to CCK-8 in vitro showed a low response, and developed with age.