H. Hattori

Hyperbaric treatment for acute intestinal obstruction and peritonitis

From the results on the clinical and experimental studies on the relation between the cause of acute intestinal obstruction and peritonitis and the growth of intestinal microorganisms, the authors have the following conclusion; In the cases of acute intestinal obstruction and peritonitis, the intestinal microorganisms especially the number of E. coli group of bacilli remarkably increase and the endotoxin (lipopolysaccharide of the cellular component) might be liberated and increased in blood. These pathological process induce the liber, kidney and circulatory disturbance and the high grade of dropping or insufficience of the function in the various kinds of organs. By such bad circulation as the cause induce the result and the result induce the cause, the high grade of oxygen deficiency and at last the death may be induced. From the point of view on the cause of the acute intestinal obstruction and peritonitis, the active surgical t rea tment were carried out on 8 cases of severe acute intestinal obstruction and pertionitis who are in the high grade of poor risk and are unable to stand the operation by the hitherto method. The hyperbaric t reatment was carried out to the patients before and after the operation and 5 cases were rescued. In order to clarify the reason why the hyperbaric t reatment was effective to the shock by intestinal obstruction and peritonitis, the clinical and experimental results on the effect of the hyperbaric t rea tment to the pathophysiology of intestinal obstruction were carried out and the following results were obtained. 1. It was clearly observed that the decrease of oxygen pressure in arterial blood, increase of carbonic acid gas pressure and the remarkable drop of blood pH were clearly inhibited by the hyperbaric t rea tment and moreover it was clarified by the histological feature by the microscope and the cellular fine structure by electron microscope that the severe oxygen deficiency of the organs such as liber, kidney and adrenal gland became to better by the hyperbaric treatment. 2. The appearance and the increase of E. coli endotoxin (lipopolysaccharide of the components) in intestinal obstruction was clearly inhibited by the hyperbaric t rea tment and the survival time of the animal remarkably prolonged. 3. The inhibitory effect of the hyperbaric t rea tment against the lethal disturbing action of E. coli endotoxin (lipopolysaccharide of the component) was clearly observed. These results on the effect of hyperbaric t rea tment upon the pathophysiology of intestinal obstruction may clarify one of the reason why the patients suffering f rom severe acut intestinal obstruction and peritonitis who are unable to rescue by the hitherto concept were rescued by the active surgical and hyperbaric t rea tment and the survival time of the experimental ileus animal prolonged remarkably by the hyperbaric treatment.

Studies on the dynamic movement of the circulating blood in the acute intestinal obstruction (III)

From the clinical and exper imenta l resul ts on the cause of the acute intes t inal obstruct ion and the microorganisms in the intest ine, the authors reported that E. coil group of bacilli remarkabely increased and the bacter ial components , l ipo-polysaccharide endotoxin l iberated into the blood and at las t caused death because of the high grade of c i rcula t ing disturbance. Th i s t ime the authors have studied on the biological activi t ies of endotoxin especially on the hemodynamic effect of l iver circulat ion using the dog and compared to the hemodynamic effect of the l iver in the acute intest inal obstruction. Fur the rmore , f rom the immunological points of the t r igger mechanisms considered as one of the most influencial theory or the necrosing mechanisms of endotoxin, the hemodynamic effect to the l iver by 2 ~ 3 chemical mediators were studied and the following resul ts were obtained. 1. Immediately af ter the adminis t ra t ion of endotoxin the ar ter ial blood pressure dropped and the volume of the hepatic ar tery and portal vein decreased remarkabely, but portal vein pressure rose up remarkably. These results are accord with the resul ts of the hepatic hemodynamic effect in the case of the acute intest inal obst ruct ion the authors have been reporting. 2. After the adminis t ra t ion of acetylcholine and his tamine, the acute dropping of the ar ter ial blood pressure, the remakable decrease of the hepatic ar ter ia l volume and the remarkable r ise of the portal vein pressure were observed. However the portal vein vloume was observed to be increased by the adminis t ra t ion of acetylcholine and the biphasic change was observed in the case of his tamine. These findings are not necessari ly accord with tha t of the hepatohemodynamic effect in the case of endotoxin shock. 3. In the dog adminis tered endotoxin af ter the t r ea tmen t of a t ropine (antiacetylcholine drug) and diphenylpyral ine (ant ih is tamine drug), the above mentioned remarkable change of the hepatohemodynamic effect was inhibited. These resul ts and the author s previous repor ts tha t a t ropin has the most effective action among the antial lergy drugs against the lethol necrosing action of endotoxin suggest tha t acetylcholine might be one of the influential chemical mediators and the resul t s may be one of the infuluential exper imenta l basis to the acetylcholine theory in the acute intest inal obs t ruct ion which the au thors have been advocating.

Studies on gallstones by means of the x-ray diffractometer

Powder X-ray diffractometer char t s of 7 crit ical gal ls tones are shown in F igure 1, where some differences between cholesterol stone and calcium bi l i rubinate stone are confirmed at 20 in 14.9 ~ 15.5 ~ 17 ~ and 23.1 ~ Hydrous cholesterol stone associated by cholesterol shows a spli t t ing peak a t 20 in 14.6 ~ and 14.9, where the fo rmer peak is s t ronger than the la t te r of normal cholesterol stone. A calcium carbonate stone shows an indicant peak at 20 in 29.3 ~ and a fa t ty acid stone gives a dis t inct peak a t 20 in 13.8 ~ 419 206 diffraction charts of gallstone are shown in Table 1, where variations of peak in intensity ~re found. Figure 1. X-Ray Diffractometer Charts of Gallstones

Pathophysiological role of bile in the acute intestinal obstruction

In this paper, the resul t s of clinical and exper imenta l observat ions concerning the steroid induced ulcer, are presented. The incidence of the s teroid induced ulcer in the pat ients wi th var ious disease t rea ted in our clinic wi th cort icosteroids, was 2.4%. The incidence of ulcer in all was 2.8%. No difference was found in the incidence of ulcer between the s teroid t reated pa t ien ts and the control ones. Exper imental observat ions of s teroid ulcer were per formed on the guinea pigs. The an imals were feeded normally. 1 or 2 mg of be tamethasone was injected subcutaneously everyday in the periods ranging f rom 14 to 120 days. The s tomachs were fixed in Bouins fluid, embedded in paraffin and s tained with hematoxylin-eosin. Erosions of the mucous membrane occurred only in 3 of 20 guinea pigs.