A. Miyoshi

Immunological aspect in experimental pancreatitis

In order to invest igate immune mechanism in pancreat i t is , following exper iments were tried. 1. Eleven ra ts were injected int raper i toneal ly 40 mg of dl-Ethionine every other day for 2 weeks. Serum amylase was elevated markedly and acinus of pancreas was fulled of zymogen granules. Latex agglutination tes t and double gel diffusion tes t were used to prove isoantibody of pancreas . Antibody appeared one month af te r the 1st injection and persis ted to about 5 months , and showed organ specificity. It d iminished on 295 days af te r the 1st injection, and the pancreas of this r a t was histologically normal . 2. Four ra ts of group A were injected in t ramuscu la ry wi th the homogenate of normal pancreas wi th Freund s complete ad juvant once a week for 5 weeks. Four ra ts of group B were injected wi th the homogenate of dl-Ethionine injured pancreas wi th the adjuvant . Four ra ts of group C were injected only wi th the adjuvant . All ra t s of group B showed highly destroyed acinus in pancreas with marked fibrosis. But these changes were observed sl ightly in only 2 ra t s of Group A and 1 ra t of group C. In summary , the dl-Ethionine t reated pancreas resulted in severe changes in the pancreas of the recipient rats. I t was speculated tha t t r ea tment wi th dl-Ethionine caused a change in ant igenici ty of the pancreas and then severe pancreas damage occured.

Gastrone and gastric secretion

Anti-gastrone and anti-urogastrone sera were obtained from rabbits which were immunized with gastrone extracted from human gastric juice and with urogastrone extracted from urine of pregnant women. Using these anti-sera, the origins and locations of Salivogastrone (SG. in the saliva), Gastrone (GO. in gastric juice) and Urogastrone (UG. in urine) were investigated by serial application of gel diffusion method and fluorescent antibody method, and the mutual relationship between these was studied. As a result, it was suggested that SG is almost identical to GO and that SG, GO and UG have partially the same characteristics. It was also suggested that GO existed in the salivary gland, in the neck of the gastric glandular cell, in the duodenum, in the brushborder and Goblet cells of the upper part of the jujunum, and also in the pancreas. Now, using the 3 types of gastrone, the inhibitory mechanism of gastric secretion was studied, the results of which are as follows: 1. When ~81SG and UG labelled with I TM were injected to rats, it was found that, unlike PSi-labelled human serum albumin and PSL-labelled sodium iodide, these two gastrone were accumulated preferentially to the stomach, and, besides, the accumulation reached maximum 180 minutes after SG infection and 60 minutes after UG infection, indicating the difference in the organ distribution pattern between SG and UG. 2. Gastrone inhibited carbonic anhydrase activity of rat stomach mucosa. 3. Gastrone exerted its effect on histamine release in the inverse way gastrine or cortisone. 4. When injected to feeding rats, gastrone depressed histidine decarboxylase activity to the half of the preinjection activity of rat stomach mucosa. When injected to fasting rats, a large dose of gastrone depressed histidine decarboxylase activity, whereas a small dose of gastrone did not influence on the activity. 5. Electron microscopic findings of gastric parietal cells of the rat injected with gastrone was found similar to those injected with atropine. 6. Phase contrast microscopic study after adding gastrone to rat parietal ceils revealed atrophy of the nucleus and the cytoplasma, and destruction, and degeneration of the mitochondria. The above described results suggest that gastrone exert its inhibitory effect on the gastric secretion at cellular as well as enzyme level. Further studies such as the elucidation of the chemical structure and the assay of gastrone are required at least for the thorough clarification of gastrones mode of action.

Two unusual cases of gastric cancer as observed by endoscopy

From January, 1965 to June, 1968 513 cases with gastric lesions were operated including 241 cases with gastric and/or duodenal ulcers and 218 cases with gastr ic cancers (42.5%). For three years (from January, 1965 to December, 1967) 10 cases of gastr ic cancers were found among 9723 subjects by the gastric-mass-survey, out of them there were 5 cases (50%) proved early gastric cancers (superficial carcinomas of the stomach), while by means other than the gastric-mass-survey the superficial carcinoma of the stomach was observed in only 8.2% of the gastric cancers. The rate of resectabili ty of gastric cancer was 65.6% (143 cases) including total gastrectomy. Thirty lesions (27 cases) of early gastric cancer were presented: IIc and I Ic+II I types were the most (60.0%), I and IIa types were 36.7%. Besides, 4 cases with gastr ic double cancers, 3 cases of gastric cancer with gastric ulcer, one case of gastric cancer with polyps and 10 cases of gastric polyps (18 polyps) were reported. (Authors abstract)

The studies on shunt bilirubin (III)

We have already reported the exsistence of b i l i rubin phosphate in serum and urine paperchromatographical ly using molibdic-acid color reaction. In this report we confirmed the exsistence of bi l i rubin phosphate us ing p32 as a tracer. We made the fistula on bile ducts of normal rats, injected 0.5 ml of Na2P320~ into the duodenum, gathered bile for 24 hours and est imated radioactivi ty wi th G.M. counter. At first, b i l i rubin extracted from this bile was f ract ionated by paperchromatography, then radioautography or radiochromatography was carr ied out. The 3rd spot of b i l i rubin on paperchromatogram was agreed with the radioact ive spot on radioautogram or radiochromatogram. On the o ther hand, we separated the bile b i l i rubin ex t rac t into indirect, saIt-form and esterform bi l i rubin using Kosaka-Hara s method and es t imated bi l i rubin concentra t ion and radioact ivi ty of each fract ion Ester-form bi l i rubin exhibited 98.9% radioactivity.

Limits of cytologic diagnosis in early gastric cancer

Clinical significance of endoscopical features of ear ly gast r ic cancer, especially of IIc type, were discussed in the previous repor t in 1963. In th is report, gross findings of resected specimen were studied comparat ively with endoscopical findings, in 38 lesions of 37 cases of IIc type early gast r ic cancer, macroscopically and histologically. GROSS FINDINGS AND EXISTENCE OF CANCER CELLS Cancer cells were found in the site of rugal in te r rupt ion in 26 lesions of 31 lesions, in gradual s lenderness of rugae in 34 of 35 lesions, in discolorated surrounding mucosa in 2 of 5 lesions, in 12 cases cancer cells overspead beyond the demarca t ing line. SIZE AND SPEC1FIC FEATURES OF THE LESIONS In the large lesions almost all features of early gast r ic cancer could be found, in small lesions the margin of the depress ion and the depress ion itself lost thei r specific fea tures of ear ly cancer, but the features of surrouding mucosal pa t t e rn such as in ter rupt ion of rugae, rugal slenderness, lowering of folds and convergement of folds became more impor tan t to find out smaller early cancer with endoscopy. GROSS FINDINGS AND ENDOSCOPIC FINDINGS In ter rupt ion of rugae was fonnd in 32 lesions in resected specimen and in 33 lesions endoscopically, of 38 lesions. Gradual s lenderness of folds was found in 30 lesions and in 20 lesions, macroscopically and endoscopically. Rough velvetin-like surface of the depress ion was found both in resected specimen and endoscopically well. In the comparat ive study of the IIc type early gast r ic cancer, with resected specimen and endoscopic examination, comsider ing optical factors and blood circulation, the following resul ts were obtained; even in small lesions the findings around the depression can be well observed and detected with endoscopy r a the r easily, and in the diagnosis of the small depressed type cancer, the findings of sur rounding mucosa is very important . The changes in color must not be overest imated.

Immunological aspects of chronic gastritis

A relationship between chronic atrophic gastri t is and degeneration of enteric plexus of the stomach was suggested by investigation of the clinical materials. We investigated this relationship experimental ly by degenerating the enteric plexus of the stomach. Through left gastric artery, body portion of the dog stomach was perfused first with saline, and then with Tyrode solution containing 0.002% mercury dichloride, and kept in a temporary state of anemia for one hour, blood circulation of the stomach being resumed thereafter. Even after 270 days, the stomach of the perfused area showed marked atrophic gastri t is , and enteric plexus showed marked degeneration. In the plexus, about 80 to 90% of ganglion cells were degenerated, and number of the cells decreased to one fourth of the control. Although in this study, some circulatory disturbance might take place, we feel, that the enteric plexus may some role in regeneration of the mucosa, and its degeneration leads to the atrophic change of the mucosa.

A study concerning the mast cell of the gastric mucosa (I)

occurred already in 10 to 21 days in most cases and aggravation thereaf ter appeared to be extremely slow. On the other hand, no changes were seen in about one fourth of the cases. The reason for the rapid appearance of atrophy may be attributable to the circulatory disturbance of the mucosa due to surgery. No relationship was found between postoperative gastr i t is and age, types of anastomosis, original diseases or symptoms.

Immunologic approach to the mechanism of the development of chronic gastritis

We reprot here histologic and endoscopic findings of gastric mucosa of various gastric disoders with help of biopsy, gastrocamera and gastrofiberscope. Patients clinicaly diagnosed as primary gastritis were classified into superficial gastritis (57.3%), atrophic gastritis (30.5%)and normal gastric mucosa (12.2%) by means of suction biopsy. As to so calld associated gastritis of peptic ulcer and gastric cancer, the tendency was no correlation between incidence of chronic gastrit is and sex and also the type of gastritis and the severity of pain or pain associated with meals. It was observed that the incidence of atrophic gastitis incereased as the time interval between the onset of symptoms and gastric biopsy performed expaneded, but this could not be applied to gastric cancer accompanied with gastritis. Patients with atrophic gastritis secreted no acid or less than normal on Katsch-Kalk method mostly, while associated gastritis of gastic cancer also showed a n or hypo-acidity even in the presence of normal gastic mucosa or superficial gastritis. There was the parallel relationship between the age and the incidence of chronic gastritis especially atrophic gastritis. The fiberscopic gastrit is amounted to 83% while the accuracy of atrophic gastritis remained 73% being characterized with the high incidence of the wrong diagnosis in the prepyloric area. The greyish or greyish-blueish appearance of gastric mucosa and the increased visuality of blood vessels on fiberscopy corresponded well to the existence of glandular atrophy and intestinal metaplasia in the histological examination.