The purposes of this paper are to evaluate degree of dyspnagia at the pharryngeal stage of swallowing in patients with polymyosistis. A catheter with three diode transducers 5cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was commanded to drink water of 2ml at about five second intervals, and the swallowing pressures were recorded on condition that the speed of paper recording and catheter pull-through is the same 1mm/sec. Secondly the swallowing pressures were recorded on condition that the middle transducer is fixed at the level of the upper esophageal sphincter and the speed of paper recording is 5mm/sec. Thirdly the resting pressure of upper esophageal sphincter was recorded on the same condition of the first recording. The results were as follows: (1) All eight patients showed extremely low swallowing pressure at the all level of the pharynx compared with healthy men. (2) Four patients showed poor relaxation of the upper esophageal sphincter. (3) The resting pressure of the upper esophageal sphincter was low in seven. In polymyosistis manomerical study of the pharynx and the pharyngoesophageal sphincter is a useful method for evaluating swallowing function.
In an experimental stress ulcer models, we examined a pathophysiological role of EC-SOD in an extracellular fluid in guinea pig. Heparin has a releasing potency of EC-SOD into extracellular fluid from endothelial cell. In this study, we devided animals into four groupes; 1) control animals, 2) animals injected with heparin (1, 000 IU/kg), 3) animals injected with heparin and DDC (1g/kg), 4) animals injected with DDC treatment. In these four groupes, we measured ulcer index (UI) and lipid peroxides (LPO) of the gastric mucosa, before and serially after stress. Water-immersion, ethanol and burn were used as experimental stress. Animals injected with heparin inhibited the increase of UI and LPO of gastric mucosa induced by stress. This cytoprotective effect was abolished by DDC treatment. These results suggest that EC-SOD may be a cytoprotective factor in an extracellular fluid.
In order to investigate the healing process of gastric ulcer, cell proliferation kinetics of the regenerative mucosa over gastric ulcers was studied by an in vitro bromodeoxyuridine (BrdU)-anti BrdU method. In addition, the effect of histamine H2 receptor antagonists on gastric cell kinetics was also studied. The BrdU labeling indeces (L.I.) at the site ulcer margin, which were determined by the ratio of labeled cells to epithelial cells of gastric mucosa, were significantly higher in cases of endoscopic A to S1 stage ulcer than in cases of the atrophic gastritis served as control. While the mean L.I. of surrounding mucosa, approximately 1cm apart from the ulcer margin, in the stage A to S1 were also significantly higher than that of control, the value in the stage S2 was almost comparable to the value of control. There were no differences of L.I. between the cases treated with and without H2 receptor antagonists. These results suggest that in the healing process of ulcer not only reserved epithelial cells at the ulcer margin but also the cells apart from the margin participate in mucosal regeneration. And it seems advisable to consider the stage S2 rather than the stage S1 as the most precise healing stage of ulcer. H2 receptor antagonist may not give an influence on proliferative properties of regenerating mucosal epithelium.
Proton pump inhibitors, as agents for use against peptic ulcers, potently suppress gastric acid secretion, as is the case with H2 receptor antagonists. To evaluate this antisecretory action as objectively as possible, intragastric pH was continuously monitored during 24 hours. Eight subjects were enrolled and divided into 2 treatment groups: a group receiving a daily dose of 30mg of AG-1749 (lansoprazole) and the other group receiving 60mg. Intragastric pH recording was made in each subject before and after the consecutive administration of the drug, and the corresponding pH holding time was calculated to evaluate the effect obtained in each group. The result indicated that the proportion of time in 24 hours after medication during which the pH was maintained above each level was significantly larger than that after placebo administration, and the duration of action was superior to that of H2-receptor antagosists. From the above, it was concluded that the consecutive administration of ag-1749, at doses of 60mg as well as 30mg, exhibits excellent antisecretory action in terms of intragastric pH control.
Postoperative course including serial changes in values of liver function tests and occurrence of hepatic failure was investigated in 59 patients with hepatocellular carcinoma. Eleven cases out of 59 patients were associated with chronic hepatitis (CH group), while remained 48 cases were with liver cirrhosis (25 cases of group A and 23 of group B in Child's classification). There was no significant difference in survival rate or recurrence rate after operation among these three groups. Hepatic failure within one year after hepatectomy was observed in 9%, 28% and 91% of patients in groups CH, Child's A and Child's B, respectively, and the frequency of occurrence of hepatic failure in Child's B group was significantly higher than those of groups CH and Child's A. Hepaplastin test and serum albumin levels recovered from the decline after hepatectomy in groups CH and Child's A. On the other hand, norecovery was found in Child's B group as well as lower levels before operation and that was thought to be the major reason for the frequent occurrence of hepatic failure in Child's B group.
Hepatic functional mass was evaluated in patients with obstructive jaundice using the galactose tolerance test (GaTT), which reflected cytosolic function of hepatocyte. The T-1/2 values as an index on the GaTT were significantly prolonged in patients with obstructive jaundice in comparison with control subjects whether before or after percutaneous transhepatic biliary drainage (PTBD). But in each cases, some showed nearly normal GaTT-T/2 value and others showed severely prolonged value. Patients with obstructive jaundice could be devided into two groups according to the GaTT-T/2 value before PTBD. The decreasing rate of serum bilirubin level "b" after PTBD was significantly fair in the group A patients (good GaTT-T/2 value before PTBD) than the group B (poor GaTT-T/2 value before PTBD) (P<0.05). It was that GaTT-T/2 before PTBD which represented hepatic cytosolicfunctional mass could predict the effect of PTBD in patients with obstructive jaundice.
An effect on normothermic ischemia on the rat liver metabolism was examined using in vivo 31P-NMR spectroscopy. Energy metabolism was monitored by measuring the ratio of β-ATP/Pi and changes were compared between two groups, untreated rats (Group A) and rats of which spleens were subcutaneously transposed to perform portosystemic collaterals (Group B). In group A, β-ATP/Pi reduced to 0.18 after occlusion of both portal vein and hepatic artery for 10min, and recovered to 0.97 at 120min after reperfusion was initiated. In the case of 30 minischemia, however, it recovered only to 0.53 even at 120min after reperfusion. In contrast to group A, it recovered to 0.81 at 120min after reperfusion following 30min-ischemia in group B. Furthermore, when 10min-ischemia was repeated 3 times with intervals of 10min-perfusion in group B, it recovered to 0.87 as early as 20min after initiation of reperfusion. These results clearly indicate that the prevention of the portal congestion improves recovery from energy metabolic disorder and, in addition, division of total ischemic time with moderate intermission is effective to diminish the metabolic disorder due to occlusion of both hepatic artery and portal vein. However without the prevention of the portal congestion the effect of division of total ischemic time was significantly reduced.
We treated 41 chronic hepatitis C patients with recombinant interferon α2a, 6×106IU/day, for three weeks daily followed by intermittent therapy, 3×106IU/day, three times weekly for 6 months and more. After 6 months of intermittent therapy, serum aminotransferases (AST, ALT) decreased to normal or nearly normal levels in 29 of 41 patients (70.7%) with histological improvement. The HCV (C100-3) antibody disappeared during and after IFN therapy in 7 of 34 HCV antibody positive patients (20.6%). Serum aminotransferases levels of all such patients were normalized or nearly normalized. The IFN antibody was detected in 8 of 41 patients (19.5%) including one whose IFN antibody was already present before starting IFN therapy. IFN treatment was discontinued in 22 of 41 patients (53.7%) because they responded completely or nearly completely to IFN therapy. All of the 22 patients have been maintaining normal aminotransferase levels for 1 to 24 months (mean, 12 months) after the treatment period. We conclude that long-term IFN therapy is greatly beneficial in controlling hepatic inflammatory changes in chronic hepatitis C.
We designed a prospective trial of the mass survey for pancreatic disease, especially pancreatic cancer in consecutive 2576 subjects undergoing periodical health examination during 1989. In order to detect abnormality of the pancreas we measured serum amylase, elastase-1 and SPan-1 as serum markers and used ultrasonography(US). When abnormal elevation of serum markers or abnormal findings of US were obtained at the first screening, re-examination or further examination using ERCP, CT and endscopic US were performed. Frequencies of elevated amylase, elastase-1 or SPan-1 were 0.9%, 3.4% or 1.7%, respectively. However, no pancreatic diseases were detected among the cases of elevated serum markers after subsequent further examination. Frequency of abnormal US findings of pancreas were 2.3%(59/2576), including dilatation of main pancreatid duct, cystic lesion, space occupying lesion and calcification. Subsequent further examinations on subjects with abnormal US revealed 8 cases of pancreatic diseases including one small pancreatic cancer. US may be an efficient tool of mass survey for pancreatic cancer in the health examination at present.