Haruya Okabe

Long-term follow-up of 2529 patients with gastric and duodenal ulcer: Survival rate and causes of death

We investigated 2529 patients with peptic ulcer diagnosed from 1963 to 1975 to determine the prognosis relative to life span and causes of death. During the follow-up period of 9-23 yr, 486 patients (19.2%) died, 2025 (80.1%) were alive, and the fate of 18 (0.7%) was unknown. No significant differences were found between these numbers and the numbers expected from the sex- and age-matched general population at 1-20 yr after the initial diagnosis for patients with gastric ulcer, duodenal ulcer, or both gastric and duodenal ulcer, or for all ulcer groups combined. The survival rate for the surgically treated patients did not differ from the expected survival rate. The number of deaths from peptic ulcer (observed/expected = 18/5.47) was statistically high and the number from cerebrovascular disease was significantly low. Our results show that for patients with a peptic ulcer, the prognosis relative to life span is as good as that of the general population and surgery has little influence on the prognosis.

Long-term follow-up of 2529 patients reveals gastric ulcers rarely become malignant

To examine the relationship between peptic ulcer and gastric cancer, we investigated 2529 patients with peptic ulcer diagnosed from 1963 to 1975. During the follow-up period of 9–23 years, we found 38 in whom gastric cancer developed or who died of gastric cancer. Included were nine in whom gastric cancer was detected at the same site as the gastric ulcer initially diagnosed, and 22 in whom the gastric cancer was detected at another site. In the remaining seven, gastric cancer was given on the death certificate, but the details were unknown. When the data on gastric ulcer initially diagnosed were reevaluated, gastric cancer was suspected or could not be completely ruled out in seven of the nine in whom gastric cancer was detected at the same site. In the remaining two, a diagnosis of benign ulcer was made even when the initial data were reviewed. In these two, however, there was the possibility that the initially diagnosed gastric ulcer represents a phase of the “malignant cycle.” The number of deaths from gastric cancer in patients with gastric ulcer was significantly low, compared with that expected and computed by the age- and sex-matched general population. These results suggest that gastric ulcers rarely become malignant.

Microcirculatory responses to estradiol benzoate in chronic liver damage induced by carbon tetrachloride in the rat

SummaryMicrocirculatory responses to estradiol benzoate (ES) under condition of chronic liver damage induced by long-term administration of carbon tetrachloride (CC14) was investigated in the rat. One hundred and five male rats were divided into the following groups receiving 0.1 mg/100 g body weight ES injected intraperitoneally 5 times per week: (1) controls, exposed to CC14 alone; (2) rats treated with ES from the fourth week of CCl4 exposure; (3) animals treated with ES from the 11th week of CC14 exposure. In rats receiving CC14 alone, liver cirrhosis was induced by 10 consecutive weeks of exposure. Microangiograms of the liver demonstrated conspicuous rarefaction of the vascular tree. On the other hand, animals treated with ES had neither atrophic liver nor rarefaction of the intrahepatic vascular tree. ES produced also intrahepatic neovascular proliferation in the cirrhotic liver. After long-term CCl4 administration, ES treated rats had extremely enlarged nodules with tumor-stain like findings, giving rise to a structure differing from hepatocellular carcinoma which latter generally displays a broom-swept appearance. It is concluded that in providing potent angiogenesis in the liver, ES protects the liver against microcirculatory derangement and parenchymal damage induced by CC14.

Symposium (III): Intestinal Ulcers

In order to make the more exact diagnosis of the organic lesions of small intestine, a double contrast method was applied as the following procedure. The tube was inserted into the duodenojejunal region using guide wire under the X ray observation (intubation was made about five minutes) and 300-600 ml of 40-50% bar ium was poured, thus the filling picture of the small intestine was observed, then 500-800 ml of air was infused and a venous injection of 1-2 ml of Hyoscin-N-butylbromide was applied. According to the above method, the t ime required for the contrast media to pass through the small intestine was much more shortened than that of routine method. The mean durat ion of contrast media to reach cecum was 25 minutes in 62 cases without organic disease, while in 80% of them, the durat ion ended within 30 minutes. On the other hand, the mean durat ion was 51 minutes in 23 cases at tended with organic disease, namely 7 cases of small intestinal tuberculosis, 8 cases of Crohns disease, 2 cases of mult iple small intestinal ulcer, 3 cases of ileoceca tumor and 3 cases of acute local enteritis, while in 70% of them, the durat ion ended within 30 minutes. I t was also demonstrated that the double contrast method was obviously better than routine method in ability to elucidate the picture of the organic lesions in all parts of the intestinal canal without any topical differences. O n the organic lesions in the small intestinal ulcer, the results obtained from the X ray observations before operation and the macroscopic observations of the excised intestinal canal were compared. I n 9 cases of small intestinal tuberculosis, 38 out of 40 organic lesions were able to be diagnosed by the X ray observations, and since the ability to elucidate the niche was only 27.5% most cases were diagnosed by the marginal variations such as stenosis. In 6 cases of multiple small intestinal ulcer which showed many small and shallow ulcers, 27 out of 82 organic lesions (33%) were able to be diagnosed, however, niche was elucidated only in 3 lesions and the others were diagnosed as a light stenosis, marginal rigidity and mucous convergence. In 4 cases, the diagnosis of Crohns disease was easily made, since longitudinal ulcer, cobblestone appearance, string sign and eccentric stenosis were well observed.

Difference between gastric ulcer and duodenal ulcer

ConclusionFrom the results above described, I feel inclined to separate the gastric ulcer from the duodenal ulcer as different entity. Also, I think that the gastric ulcer combined to the duodenal ulcer will be not quite same with the gastric ulcer alone in their etiology, if any at allFrom the results above described, I feel inclined to separate the gastric ulcer from the duodenal ulcer as different entity. Also, I think that the gastric ulcer combined to the duodenal ulcer will be not quite same with the gastric ulcer alone in their etiology, if any at all