A. Seki

Cysteamine-induced duodenal ulcer and the hepatoduodenal branch of the vagus nerve

SummaryWe investigated the role of the autonomic nervous system in gastric acid secretion, somatostatin concentration and PAS-positive mucus production in Brunner’s glands in cysteamine-induced duodenal ulcer. Vagotomized rats were used. No ulcers occurred in the groups with vagotomies of the hepatoduodenal, truncal or gastric branches after cysteamine administration. However, in the hepatoduodenal branch vagotomized group, there was an increases in gastric acid secretion after cysteamine administration. A similar increase was observed in the control group, but the decreases in somatostatin concentration and PAS-positive mucus seen in the control group were not found in the hepatoduodenal vagotomized group. These results suggest that the hepatoduodenal branch of the vagus nerve might play an important role in the ulcerogenic process of cysteamine-induced duodenal ulcer.

Long-term prognosis of patients with achalasia treated by cardial dilatation therapy

SummaryThe long-term prognosis of expanding bag dilatation therapy using a Matsuo pneumatic bag dilator was evaluated in 163 cases of esophageal achalasia treated by this method over the 26-year period from 1964 to 1989. In all these cases, one year or more had passed since therapy. Practically no correlation was found between the efficacy of the therapy and the grade of esophageal dilation prior to therapy, the previous history of symptomatic distress or the number of dilatations performed. The efficacy of expanding bag cardial dilatation was most obvious in the increase of body weight, 59 cases (36.2%) showing an increase of 1–5 kg and 48 cases (29.4%) showing an increase of 6–10 kg. The therapy was rated “highly effective” in 61 cases (37.4%) and “effective” in 60 cases (36.8%), i.e. it was effective in a total of 121 cases (74.2%). It was rated as being “ineffective” in 16 cases (9.8%) including 4.3% of cases in which an operation had been performed. This indicated that surgical operation of esophageal achalasia should be performed in those cases in which good long-term results were not obtained even after expanding bag dilatation therapy had been carried out several times.

Studies on gastrointestinal tract hormones (XII) studies on plasma gastrin levels

Plasma gastrin levels were measured by radioimmunoassay on dogs with Heidenhain pouches after oral administration of 50 ml of 1 M glycine solution. Effects of splanchnectomy and secretion inhibitory hormones (secretin & gastrone) on plasma gastrin levels were observed. Resulting data are followed: 1) After oral administration of 50 ml of 1 M glyeine solution, plasma gastrin levels showed polyphasic elevation, on the other hand, acid secretion was seen only under the 1st peak of plasma gastrin levels and was not seen after 2nd peak of gastrin. 2) After oral administration of glycine solution on splanchnectomized dogs with Heidenhain pouches, however, small amount of acid secretion was seen even after under 2nd peak of gastrin. 3) Previous treatment of four times, ten minutes interval, intravenous injections of 1 unit/Kg ofsecretin, inhibited both elevation of plasma gastrin levels and acid secretion after oral administration of glycine solution. 4) After intravenous injection of 500 pg/Kg of of gastrone purified from the antrum of whale stomach, plasma gastrin levels revealed polyphasic elevation, while acid secretion was not stimulated.

Studies on gastrin and it’s antagonistic hormon (XI) “measurement of gastrin by radioimmunoassay”

As Grcgory and Tracy have succeeded in the determination and the synthesis of peptide of gastrin in 1964, gastrin level in blood has been measured by radioimmunoassay as well as other peptide hormones. (McGuigan and Trudeau 1970, Yalow and Berson 1970) We also have succeeded in the measurement of gastrin in blood by the method of Yalow and Berson using antigastrin serum prepared by Wilson Co., USA. The resulting data are following below: 1) Using our method, a very small amount of gastrin in blood even under 100 pg/ml was able to be measured. Cholecystokinin-pancreozymin which has similar C-terminals showed no immunological cross reaction under 1000 pg/ml concentration of gastrin. Our method also showed an excellent reproducibility and recovery. There was no dilution effect of samples. 2) Fasting serum gastrin of those who were under 30 year old or were recognized as normal with endoscopic and biopsy examination was 40-140 pg/ml. 3) Concerning to fasting serum gastrin levels in patients with peptic ulcer, higher levels of gastrin than normal were observed in the most cases of active peptic ulcer. The patients who were in convalescent revealed almost within normal limit. 4) The values of fasting serum gastrin of 3 cases of pernicious anemia were 3650, 2980 and 2750 pg/ml. 5) Thir ty minutes after the oral administration of 240 ml of 0.5 M glycin to human being, the gastrin level in blood reached to the peak and then decreased gradually, but raised again after 2 hours and then decreased. 6) The amount of gastrin in the biopsy material of gastric antral mucosa (4-7 mg of wet weight) has been able to be measured by our method of radioimmunoassay after being homogenized in saline solution.

Therapy of peptic ulcer by parasympatholytic agents and gastro-intestinal hormone

On the evaluation of drug therapy of peptic ulcer, spontaneous healing tendency of the ulcer and placebo effect of the drug should be considered sufficiently. We performed the controlled trial on the therapeutic effect of the combined preparation of dycycloomine bromide with some antacids. The subjects are hospitalized patients with active gastric ulcer conformed by the both X-Ray and endoscopy. They were divided into 4 groups according to the location of the ulcer (the angle and the body) and the size of the niche (more or less than 1 cm in diameter). Two cases in each group were made a pair, and the true drug or placebo were administered at random for 4 weeks. The subjects were kept in the same condition of the rest and diet during this trial and followed up to study the healing process of the ulcer by X-Ray and fibergastroscopic examination every 2 weeks. After 4 weeks medicamentation, it was evaluated from radiologic and endoscopic findings which had better effect on ulcer healing, the true drug or placebo of each pair. Among 62 cases (31 pairs) of gastric ulcers, the true drug was superior to placebo in 16 pairs, inferior in 9 pairs, and the both was equal on a pair in 6 pairs. These results was examined sequentially by Brosses design, but, at the present point, there is no significant difference statistically between the true drug and placebo. The fur ther study should be continued to given a conclusion in this trial. In our study, as the subjects was limited to hospitalized patients, the beneficial effects of the psychosomatic rest and diet therapy were greater, and the pharmacological effect might have been covered. In spite of these possibility, our study shows that, as peptic ulcer is apt to heal easily, especially under the hospitalization, a serious consideration must be paid on the evaluation of medical t reatment of peptic ulcer.

On atrophic gastritis-its relationship to enteric plexus: An experimental study

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.

Studies on the pathological changes of gastric mucosa in aged people

vessels of the eye ground and kidney as believed previously. Specific small vessel lesion were also observed in the skin or the mucous membran of the gastrointestinal tract of diabetics. From the point of view that the atrophic change of gastric mucous membrane in diabetic patients would be caused by the diabetic change of the small vessel, we have made a comparative study of the vascular complication and gastroscopical findings. RESULT All 59 cases of diabetics showed gastric mucosal changes. 19 cases (32.2%) of them showed severe atrophic change. Three cases had continuous albuminuria, and 2 of them suffered from severe atrophic gastri t is . Four out of 7 diabetics who were supposed to have coronary vascular disease by the ST.T changes of electrocardiogram, showed strong atrophic gastri t is . Seven out of 14 cases of diabetic retinopathy had inclination to gastric mucos atrophy; On tho other hand, among 24 diabetics without retinopathy, only 4 showed strong atrophic changes. No correlation were recognized between gastroscopic findings and serum cholesterol level. Concluding from the foregoing were assume that diabetic vascular change is one of causative factors of atrophic gastr i t is observed in diabetic patients.