F. Matsunaga

Comparative study of methods of administering mitomycin C.

Patients with inoperable cancer were divided into three groups and treated with mitomycin C (MMC) as follows: Group 1—MMC 0.2 to 0.3 mg/kg every 14 to 20 days with glycyrrhizin iv daily. Group 2—MMC 0.12 mg/kg iv two times a week with dexamethasone 1 mg per os daily. Group 3—MMC 0.04 mg/kg iv daily. The clinical effects were evaluated in each group by the score expression of the clinical symptoms and signs on the basis of our strict criteria. The best results were obtained in group I, then in group 3 then in group 2. The results of enzymological studies in the three groups also were compared. In group 1 RNase and G6Pase activities increased for 20 days following MMC administration to the normal level. In group 2, however, the same increase lasted for only ten days. The activities in group 3 remained below the normal. A similar tendency was observed in the activities of ATPase and Beta‐GLPase.

Studies of ultramicrostructure in relation to disaccharidase activity in the jejunal mucosa

SummaryUltramicrostructural changes of the mucosa of the small intestine were studied in relation to the alterations of the lactase activity, measuring the height of microvilli by electron microscopy and the enzyme activity by the method of Dahlqvist.Studies with clinical cases revealed that the height of microvilli correlated with the lactase activity significantly (p<0.01), and that patients with relatively higher microvilli had a correspondingly higher activity of lactase. In animal experiments an increase of lactase activity by lactose load feeding and low calorie feeding resulted in a raise in the height of microvilli.It was concluded that lactase deficiency in adults and in various gastrointestinal diseases, where no histological abnormality was observed by light microscopy is perhaps due to shortening of the microvilli of the mucosa. It was speculated that the microvillous change and the sequential hypolactasia may be the initial ultramicrostructural and enzymatic alteration in the diffuse disease of the small intestine.

Roentgenological and colonofiberscopic studies of the early ulcerative colitis

32 cases of chronic ulcerative colitis were examined from June , 1968 to July, 1971. The total number of examinat ion was 111, and 362 biopsied specimens were obtained. The roentgenological and endoscopic findings of the early chronic ulcerative colitis were studied. In 4 cases, findings indicative of ulcerative colitis were totally absent at the first roentgenological and colonofiberseopic examinations, and the diagnosis was made after a long period of observation. The 4 cases were retrospectively studied. Spiculation projecting perpendicular ly f rom the colon was often seen on the X r a y film of the early ulcerative colitis, but it was also seen in normal cases or in other diseases of the colon. Thus, it was very difficult to make a diagnosis of ulcerative colitis by findings such as the spiculation alone. In the endoscopic examinat ion, we were not able to make an accurate diagnosis of ulcerative colitis on the basis o f turbidi ty or loss of vascularity of the colon mucosa, before the appearance of small yellow spots or erosions.

Colonofiberscopic examination of the chronic ulcerative colitis

Crohnkheit and Canada reported two cases of generalized gastrointest inal polyposis associated with pigmentation, nail alopecia and onychotrophia in 1955. Gastrointest inal polyposis associated with ectodermal changes is very rare and only 12 cases were reported since first report by Crohnkheit and Canada. Case report: A fifty-eight year old female was admit ted to our hospital with complaints of diarrhea and loss of body weight. She has no familial history of gastrointest inal polyposis. Several examinat ion revealed low proteinemia and diffuse gastrointest inal polyposis with skin pigmentation, alopetia and nail atrophy. Gastrointestinal fluoroscopy revealed polyposis of s tomach which were resembled with giant rougae and numerous polyps in large intestine. The one of polyp in sigma was egg sized and was diagnosed adenocarcinoma papillotuburale by histrogical examination of biopsied specimen. She was under taken s igma resection for cancer. But she died at sixth days after operation for heart infarct. Autopsy revealed multiple polyposis of s tomach, duodenum, terminal ileum and colon.

Treatment of gastric and duodenal ulcers—from my own experience as a patient

lase were observed in about one-third of the cases. Thus, there is not always a parallel relationship between the disease type or severity of acute pancreatitis and the amylase levels. Especially, in the necrotic type or severe cases of poor prognosis, the amylase levels frequently are low. Further, in the acute diseases of the biliary system requiring the most careful differential diagnosis from acute pancreatitis, in the cases of perforation due to gastric or duodenal ulcer, and in the cases of ileus, the amylase levels are often elevated. Under these circumstances, relying for diagnosis only upon the amylase level would possibly result in misdiagnosis. From the above points of view, we consider early laparotomy and early diagnosis to be imperative for the treatment of acute pancreatitis. The recent widespread use of Trasylol, a trypsin inhibitor, has significantly improved the therapeutic records of the recent cases of acute pancreatitis. Whenever acute pancreatitis is suspected, we now are accustomed preoperatively to give Trasylol along with various symptomatic treatments, while carrying out an early laparotomy together with the Trasylol administration. With the establishment of the diagnosis of acute pancreatitis, we make it a rule to begin administering Trasylol in higher doses. The type of operation in the 79 cases of acute pancreatitis subjected to surgical management was simple laparotomy alone in 30 cases, the use of drainage in 13 cases, cholecystectomy in 22 cases, external or internal biliary fistulization in 9 cases, and gastric or intestinal surgery in 5 cases. Based on our own experiences with clinical cases of acute pancreatitis, we have reported in this paper the therapeutic principles to be adopted. We have also reported the need for early diagnosis and the limits of indications for surgical managemunt of the disease. Imperative in the treatment of acute pancreatitis is an early institution of adequate managements by early diagnosis. Today when no definitely efficient diagnostic technique has yet been established, we should emphasis the need for an early laparotomy that will help arriving at a firm diagnosis. Let us now repeated the role of an early laparotomy in acute pancreatitis. They are : (1) An early laparotomy enables a firm diagnosis. (2) An accurate estimate of severity of inflammatory process. (3) An adequate treatment with Trasylol in higher doses in early stage. (4) A prevention of misdiagnosis. (5) A surgical management of complication.