We confirmed a new reliable and safe technique for endoscopic mucosal resection of the stomach using a ligating device (EMRL), which was used for endoscopic ligation of esophageal varices. We resected the gastric mucosa by this procedure in 6 mongrel dogs, and examined resected specimens histopathologically. It is concluded that EMRL can take a mucosal specimen 15 × 12mm in size on the average, be performed almost all the site which was previously difficult to resect endoscopically, and the submucosal local injection of physiological saline solution is necessary to perform EMRL. Based on these conclusion, we experimented to establish the safe and reliable technique of the divided mucosal resection, too. EMRL procedure is an easy and valuable treatment modality.
An assessment has been made regarding the gastric mucosal lesion associated with portal hypertension clinically and histopathologically. Endoscopically, characteristic findings were those accompanied mainly by mucosal atrophy, red spots and hemorrhagic spots (portal hypertensive gastropathy : PHG). It was considered that rupture of the gastric mucosal defense factor is involved in portal hypertension as gastric acid secretion shows hypoacidity in the patients. The true form of portal hypertension is considered to be congestive gastropathy from the points that PHG is observed in high frequencies in the high portal pressure group, the severe esophageal varices group and group without gastrorenal or splenorenal shunt, that the mucosal blood flow rate in the lesion increased and that venectasia is present in the submucosal layer. Exacerbation of PHG was observed in the fundic area after EIS (endoscopic injection sclerotherapy), but no particularly large change was observed in the region after direct operation on esophageal varices. Administration of propranolol was effective for PHG.
Ulcer index (UI), gastric submucosal blood flow (SMBF), gastric fundic mucosal content of 5 prostaglandins (PGE2, TXB2, PGF2α, PGD2, 6-keto-PGF1α) were measured in water immersion restrain rats under medical vagotomy (MV) or medical sympathectomy (MSp). UI decreased under MV and MSp with 6 hours stress. SMBF decreased less under MV and MSp than control rats. PGE2 of control rats decreased under stress, but increased under MV and MSp. It is resulted that MV and MSp effect PGE2 to increase, inhibition of SMBF decreasing because of increasing PGE2 were recognised and there for stress ulcer were inhibited.
The blood coagulation and fibrinolysis of 33 patients with compensated liver cirrhosis and 31 patients with hepatocellular carcinoma were examined using several markers, namely thrombin-antithrombin III complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), antithrombin-III (AT-III) and prothrombin time, and the relationship between these markers, endotoxemia, and TNF- was examined. These patients had no complications due to hepatic failure, such as infections, encephalopathy, ascites, G-I bleeding and clinical DIC. PIC was not elevated, but TAT tended to be elevated in LC and significantly elevated in HCC. AT-III was decreased in LC and HCC, and the blood endotoxin was partly positive in LC and HCC, but was not correlated with AT-III or PT. The TAT level in the blood-endotoxin-positive patients measured by endospecy methods was higher than that in the negative patients, and was significantly correlated with the blood endotoxin level in the LC and HCC patients (r=0.57, r=0.88, p<0.01). No relationship was observed between TNF- and blood endotoxin. In conclusion, (1)blood coagulability was activated already in compensated LC and HCC, but was not connected with fibrinolysis, (2)the activation of coagulability was closely related with endotoxemia, and (3)TNF- was not correlated with blood endotoxin or TAT.
I analyzed morphological pathology of elevated lesions of gallbladder (ELGB) 136 cases, 177 lesions. According to the characteristic morphological feature, I can reach to differential diagnosis of ELGB. Most of I s and II a type carcinoma is papillary adenocarcinoma, which have irregular papillary surface. A few of II a type carcinoma is tubular adenocarcinoma, which is macroscopically granular and nodular, but, have stereoscopically small, uneven pits. Adenoma, most of which is tubular adenoma, is pedunculated, and have macroscopically multinodular, stereoscopically smooth surface. Whereas, hyperplastic polyp can be classified to “papillary type” and “nodular type”, according to surface structure. “Papillary type” is pedunculated or sessile, but, “nodular type” is only sessile. This morphological feature is different from adenoma's. Pedunculated carcinoma ( I p type) is frequently localized in mucosa. Whereas, if we can exclude adenomyomatosis, sessile lesion, more than 13mm is frequently advanced carcinoma, which invade to subserosa or more deeply. But, sessile carcinoma, smaller than 11mm, is frequently early carcinoma, which is localized in mucosa or muscle layer.
To clarify the role of nitric oxide (NO) in the pancreas, we investigate the localization of NADPH-diaphorase activity and neuronal nitric oxide synthase (nNOS) immunoreactivity in the pancreas of the rat and dog. NADPH-diaphorase activity and nNOS immunoreactivity were identical in the neuronal element of both species. NADPH-diaphorase activity and nNOS immunoreactivity were localized in neurons and endothelial cells of vascular system. Numerous NADPH-diaphorase positive and nNOS immunoreactive fibers were observed around pancreatic ducts and arteries. A moderate number of NADPH-diaphorase positive and nNOS immunoreactive fibers were observed surrounding the acini of dog pancreas, but there were few of these structures in rat pancreas. The islets of the rat pancreas contained a moderate number of NADPH-diaphorase positive and nNOS immunoreactive fibers. However in the dog, these positive fibers were not detected inside the islets. In the rat pancreas, 85% of the ganglion cells showed NADPH-diaphorase staining. In the dog, however, 30-50% of the ganglion cells demonstrated NADPH-diaphorase activity. Although NADPH-diaphorase histochemistry did not show any positive staining in the islet cells of pancreas in either species, NOS immunocytochemical method demonstrated weak positive staining in the rat islet cells. These results indicate that NO may play an important role for the neuronal regulation of pancreatic exocrine and endocrine activities in both species, but in the species-specific manner.
To clarify the mechanism of the fat maldigestion in 9 patients with exocrine pancreatic insufficiency, lipase activities, pH, and micellar lipids in the upper small intestinal contents were studied. The upper small intestinal pH was slightly less in patients with exocrine pancreatic insufficiency than in healthy controls. Lipase activities and micellar lipids were significantly reduced in patients with exocrine pancreatic insufficiency compared with in healthy controls. There was a significant correlation between serum cholesterol and micellar cholesterol concentrations. The results suggest that there is maldigestive state in the digestion-absorption process in patients with exocrine pancreatic insufficiency due to insufficiency of lipase secretion and that insufficiency of lipase secretion disturbs hydrolysis of triglyceride and prevends micelle formation and leads to reduced uptake of cholesterol into micellar phase and it is reflected in serum cholesterol.