was performed. The acid colloid precipitated by glycol chitosan (GCh) was presumed to be sulfated glycoprotein-like substances, which were examined with ultrafiltration technique (fraction molecular weight 200,000) and infra-red spectroscopy.
The degree of the decrease in OD 440 nm with addition of GCh, that is, as content of acid colloid in bile, was studied in gallstone biles of 58 cases and in control biles of 5 cases.
In gallstone biles the acid colloid content was the highest in calcium bilirubinate stone cases and was not almost detected in black stone cases. And the acid colloid in infected biles was significantly higher than that in aseptic biles.
The acid colloid in bile, which is supposed to be responsible for gallstone formation, was indirectly identified by simple applicaion of colloid chemistry.

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To estimate the utility of CT-cholangiography in the diagnosis of choledocholithiasis, these studies were conducted in 415 cases.
In the studies concernd with visualization of common bile duct, the CT number in the liver disease group was not significantly higher than that in the normal group, nor was found an age-related trend such as CT number. Furthermore, when we compared IVC and CT with CTcholangiography, CT visualization was achieved even in many cases in poor- and non-IVC visualization groups, and the undilated bile duct in CT yielded a low visualization rate.
The diagnostic rates in 57 cases of choledocholithiasis were US 32%, IVC 44%, ERG 100%, CT 37% and CT-cholangiography 96%. Thus, except ERG which is a direct imaging method, CT-cholangiography was outstandingly superior. Comparison of diagnostic rates among the non -invasive methods by size of stone showed that CT-cholangiography was particulary useful for small stones not larger than 5mm.

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This study was designed to clarify the efficacy of Mitomycin C adsorbed to charcoal (MMCCH)for the treatment of upper bile duct cancer using the cancer model of rabbits. Administration of MMC-CH is focused to the lymphatic infiltration of cancer cells around the intrahepatic bile duct. Results were as follows.
1) Activated charcoal suspension (CH-40) was injected to the wall of the bile duct of rabbits. Microscopic examination revealed that CH-40 was absorbed into the lymphatic vessels in Glisson's sheath. Furthermore, in rabbits to which CH-40 was injected, the number of Glisson's sheath containing CH-40 was remarkably increased after ligation of lymphatics in the hepatoduodenal ligament.
2) MMC-CH was administered into the bile duct wall near the tumor in 10 rabbits. Cancer cells in the lymphatics showed degeneration or necrosis in various degrees 48 hours after administration. In the section 0.5cm apart from the tumor,22% of the lymphatics with cancer infiltration were evaluated as effective.
Our findings support that MMC-CH is useful for the treatment of upper bile duct cancer.

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Prognostic factors of resected hepatic hilar bile duct cancer are cancer rest at the hepatic bile duct stump, periductal lymphatic invasion and invasion to caudate lobe. To overcome these points, postoperative intracavitary irradiation was proposed.
This study was designed to clarify the radiation injury after intracavitary irradiation using Remote Afterloading Sytem (RALS).
27 dogs underwent intracavitary irradiation via hepatic bile duct and inferior vena cava with the total dose of 8 to 300 Gy.
It was revealed from dose distribution curve that hepatic hilum and caudate lobe can be selectively irradiated through hepatic duct and inferior vena cava. Peripheral blood analysis, liver function tests and histological examination showed minimal adverse effects if the total radiation dose was less than 20Gy.
Based upon these results, clinical application has been started.

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This study was done to elucidate the role of local immune system of the bile duct ongallstone formation. Secretory IgA and secretory component (SC) in the resected hepatic tissuesfrom 18 patients with hepatolithiasis were studied by immunohistochemical stains. At the sametime, IgA and IgG concentrations in the intrahepatic or common bile duct bile samples obtainedduring the operations or FTC drainage were measured by single radial immunodiffusion assay.Biological activity of S-IgA was also examined. Immunohistologically, S-IgA and SC were apparentlyobserved in the epithelium of the intrahepatic bile duct and its periductal glands, evenmore in immature concrement around the stones. Levels of IgA in the bile specimens in casesof intrahepatic or common bile duct stones were higher than those of cases without biliary tractdisease. These findings indicate that local immunological response which was accelerated inpatients with intrahepatic and common bile duct stones plays an important role in the growthof calciumbilirubinate stones.

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Four cases of so-called porcelain gallbladder are reported in this paper. For each case, we analized about inorganic calcium salts of the calcified wall and contents from their infrared (IR)spectra.
Clinically, acute biliary symptoms were not common and cystic ducts of all cases were obstructed by gallstones. Calcification of whole wall was seen in only one case, and other three cases had partial calcification of wall. So-called limy bile was observed in three cases.
From the IR spectral analysis of calcified walls, calcium phosphate (hydroxyapatite) was mainly detected in all cases as usual calcification of tissue, which is called dystrophic calcification, and furthermore large amount of calcium carbonate was also detected in two cases. From these findings, it is suggested that the mechanism of calcification of gallbladder may be somewhat different from that of usual tissue calcification and that limy bile may participate in its calcification in some cases.

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Gianturco expandable metallic stents were used to treat obstructive jaundice in 5 paients,4with extrahepatic bile duct cancer and one with postoperative biliary stricture. In 3 of 5 cases, high-dose-rate intracavitary irradiation with remote afterloading systm (RALS) was performed previously. Insertion of stents was succeeded in all cases, and in 4 of 5, all stents expanded sufficiently enough to remove the external drainage catheter. No obstructive jaundice was noted at follow-up of 4-37 weeks. These stents and intracavitary irradiation may offer effective treatment of malignant biliary obstructions.

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Initial endoscopical biopsy could not comfirm carcinoma in 6 out of 29 surgically resected ampullary carcinomas. The histological diagnoses of these 6 cases were Group IV (one case), Group III (two cases) and Group II (three cases). In Group IV and one of the Group III cases, carcinomatous tissue was so scanty as to confirm the malignancy. In the other Group III case, biopsy diagnosis was suspicious of adenoma. Macroscopical classifications of these six cases were intramural protruding type in three and early carcinoma of exposed protruding type in three. Mean maximal diameter of the tumor and the exposed dimension into the duodenum of the carcinoma were 1.8 and 4.7mm; smaller than those in 23 comfirmed cases,2.7 and 17.7mm respectively. In such biopsy negative cases, further precise examinations including rebiopsy; cytological study, EST and image analysis using ERCP or PTC should be done.

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A 52-year-old female admitted to our hospital because of fever and weight loss on 12th May 1983. Ultrasonography and computed tomography respectively showed hypoechoic mass and low density area in the head of the pancreas. Hypotonic duodenography showed irregular tumor at the papilla of Vater.
The specimens biopsied by duodenal fiberscopy from the papilla of Vater realized well differenciated tubular adenocarcinoma, but those biopsied by percutaneous transhepatic cholangioscopy from the lower bile duct showed tubular adenoma.
Pancreatic duodenectomy was performed to her on 14th July. Resected speciemens showed the papillary tumor of the papilla of Vater, and its histological findings were well differenciated tubular adenocarcinoma in the duodenal side of the tumor associated with tubular adenoma in the side of the bile duct of the tumor, and the infiltration of the adenocarcinoma was located only in the mucosa of the papilla of Vater.
We reviewed the patients with the early adenocarcinoma of the papilla of Vater associated with adenoma in Japanese literature.

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We experienced a case of carcinoma of the papilla of Vater showing polypoid growth in the bile duct. A 71-year-old male was referred to our department with a chief complaint of right hypochondralgia. Laboratory data was normal except highγ-GTP leve1. US showed dilatation of the bile duct and CT indicated the presence of a tumor in the lower common bile duct. Subsequent ERCP revealed a large polypoid tumor in the lower common bile duct. The tumor was about 65mm in maximum length and easily changed shape with compression. Cancer of the lower common bile duct was suspected and the patient underwent surgery. The tumor was found to be a papillary adenocarcinoma of the papilla of Vater arising from the epithelium of the bile duct mucosa within the ampullary portion. It had a stalk, and invasion was confined to the mucosa. This case does not fit the criteria established by general rules for surgical and pathological studies on cancer of biliary tract. To understand the nature of this type of cancer, it is important to realize the presence of cases such as this one.

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Three cases of cholangiocarcinoma associated with intrahepatic cholelithiasis were reported. One case did not undergo resection, two cases had curative resections. These cases were diffcult to make a differential diagnosis from chronic cholangitis, liver abscess. US-guided liver biopsy was the most useful procedure to make a preoperative diagnosis of chlangiocarcinoma associated with intrahepatic cholelithiasis.

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Ectopic pancretic tissue is often found in the gastrointestinal tract but rarely in the gallbladder. In a 31-year-old female complaining of right upper quadrant pain, ultrasonography demonstrated gallbladder stone. Cholecystectomy was performed and microscopic examination of the resected specimen revealed pancreatic acini and duct measuring 1mm in the cystic duct. Islet of Langerhans was not present. Thirty-two reported cases have been reviewed. Incidence of ectopic pancreas in the gallbladder is only 1.5%.

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