Hidehiko Shimura

Ursodeoxycholate - in vitro cholesterol solubility and changes of composition of human gallbladder-bile after oral treatment.

Abstract In vitro solubilization of cholesterol by sodium ursodeoxycholate was low in bile salt alone system. In the bile salt-lecithin system, the cholesterol solubilization was increased to a considerable extent but remained much lower than that induced by chenodeoxycholic acid. Oral treatment with ursodeoxycholic acid in patients without evidence of hepatobiliary diseases caused a marked increase of ursodeoxycholate in gallbladder-bile, but a little change in the content of other bile salts. These results suggest that oral treatment with ursodeoxycholic acid should be much inferior to treatment with chenodeoxycholic acid.

Medical dissolution of gallstones : clinical experience of d-limonene as a simple, safe, and effective solvent

Retained gallstones in the bile ducts account for 60–70% of all the cases of postchole-cystectomy syndromes. A solventd-limonene preparation was injected directly to the biliary system of 200 patients to dissolve or disintegrate the retained gallstones. The outcomes were: retained stones completely disappeared in 96 cases (48%); partial dissolution in 29 (14.5%); chelating agent was also used with partial dissolution in 16 (8%); ineffective in 59 (24.5%). To make this method more effective, several guidelines should be observed including anin vitro trial dissolution test. Cautious observation for possible side effects and frequent hepatic and pancreatic function tests during the treatment with this preparation also should be performed.

Liquid crystal formation in ursodeoxycholate-rich human gallbladder bile

SummaryWe studied liquid crystal formation in bile samples obtained from the patients with radiolucent gallstones who had been administered either ursodeoxycholic acid (UDCA) at a dose of 600 mg/day or chenodeoxycholic acid (CDCA) at 400 mg/day for one week preoperatively. The UDCA/total bile acids ratio was found to range from 50 to 60% and the CDCA/total bile acids ratio ranged from 70 to 80%. Cholesterol molar percent was 5 in UDCA-rich bile and 6 in CDCA-rich bile. Phospholipid molar percentage was about the same in both groups. Liquid crystal formation was confirmed only in the UDCA-rich bile samples but not in the CDCA-rich bile samples. This result suggests that cholesterol in the UDCA-rich bile samples is not solubilized by the bile salt and phospholipid mixed micells but also consumed to form liquid crystals.

Clinicopathological study on 100 early gastric cancer cases.

SummaryClinicopathological study was given to 100 early gastric cancer cases. The cases included 50 intramucosal lesions (m-group) and 62 submucosal lesions (sm-group), and the share is 17% of whole cases treated surgically. The sex ratio is about 2:1 (male: female). According to the classification by location, the occurrence rate of lesion on anterior wall is 18.8%. This fact suggests the impotance of roentgenscopy by compression technique and double contrast in a prone position focussed on anterior wall. In addition, endoscopy is essential in order to detect minute cancers.The rates of metastasis of early gastric cancers is 2.4% of m-group and 16.1% of sm-group.No metastasis occurs in protruded or elevated type as far as cancer cells remain within the mucosa. Once cancer cells infiltrate into the submucosa, metastasis is oberserved in 36%.In the present cases, 9 (9%) out of 100 cases of early gastric cancers are the multiple cases. In order to avoid oversight of cancer foci, the portion of stomach to be remained after surgery should be throughly examined prior to operation and again under direct vision after gastric incision.

A useful cholesterol solvent for medical dissolution of gallstones

SummaryDissolution of cholesterol gallstones by direct instillation of an agent into the biliary tract has been considered an alternate to surgical procedures. We developed an excellent direct solubilizer by combiningd-limonene and medium-chain monoglyceride. This mixture enhances the advantages of each individual solvent and minimizes the disadvantages. In vitro experiments were done to determine the viscosities and the cholesterol dissolving rates of various combinations, and in vivo experiments were conducted to study their irritation effects on tissues. The optimal combination was a 3:2 mixture ofd-limonene and medium-chain monoglyceride. It could quickly dissolve cholesterol gallstones with minimal or no observable side effect.

The uptake of anticancer drugs by tumor tissues and lymph node and the effectiveness of postoperative adjuvant chemotherapy on survival time

Forty-one patients with advanced gastric cancer underwent gastrectomy and the correlation between tissue uptake of the adjuvant drug and the prognosis were studied. The patients were preoperatively administered Tegafur (Futraful, Taiho Pharmaceutical Co. Ltd, Japan) and samples of tissue were obtained intraoperatively. 5-FU levels in the tumor and lymph nodes were measured by gas chromato-massfragmentography (GCMF). The patients in whom the 5-FU uptake by the tissues was measured and who were given over 60 g of Tegafur as postoperative adjuvant chemotherapy, were divided into two groups; namely, one group in whom the 5-FU uptake by the tumor tissue and lymph nodes was over 0.05 μg/g and the other in whom the uptake was lower than 0.05 μg/g. There were no significant differences in the background factors of either group. Each survival rate was calculated by the Kaplan-Meier method, and the generalized Wilcoxon method was used for statistical analysis. There was no statistically significant correlation between the 5-FU uptake by the tumor and the prognosis, however the 5-year survival rate in the group whose 5-FU uptake of the lymph nodes was over 0.05 μg/g was statistically significant (p=0.018).

In vitro studies on mechanism for concentrating function of gallbladder

SummaryThe mechanism for concentrating function of gallbladder was studied in vitro, turning and attention to changes in the gallbladder bile composition, especially a marked increase of Na+ and a marked decrease of Cl- in the the concentrating process of hepatic bile to gallbladder one. The following results were obtained by the present investigations: 1) bile acids present in bile regulate the rate of Na+ and Cl- transport: 2) the epithelial membrane of the gallbladder can be regarded as being a simple semi-permeable membrane.

Combined Non-Surgical Treatment with Transileocolic Obliteration and Endoscopic Injection Sclerotherapy for Esophageal and Gastric Varices

Abstract: Clinical results associated with the combined treatment of endoscopic injection sclerotherapy (EIS) followed by transileocolic obliteration (TIO) for esophageal of gastric varices were evaluated in 31 patients. Twenty patients underwent emergency treatment, and 11 underwent non‐ememgency treatment. No fatal complications developed after this combined treatment.

A new approach to absorptive function of gallbladder

SummaryTo investigate the mechanism of concentration of bile, the normal canine gallbladders were cannulated through the cystic duct into the gallbladder neck with polyethylene tube, and hypotonie, isotonic and hypertonic salines as well as hepatic and gallbladder biles were placed in the gallbladder.Low molecular electrolytes such as Na + and Cl were transported across the epithelial membrane against water flux. The hepatic bile was decreased markedly in volume and each level of electrolytes including bile acids approached that in the gallbladder bile. The different results were obtained by concentration of the hepatic bile in the gallbladder with chemically induced cholecystitis.

Clinico-pathological evaluation of recurrence in the residual lever following hepatectomy of hepatocellular carcinoma.

最近5年9か月間に根治手術が可能であった肝細胞癌55例を対象に再発様式, 再発因子について検討を加え, 以下の成績を得た. 1) 23例 (41.8%) の高率に再発を認めた. 2) 再発までの平均期間は術後10.9±6.0か月で, 再発発見時に主腫瘍径が5cm以下の21例は, すべて術後2年未満に再発した. 術後2年間無再発症例は再発の危険性が低いと考えられた. 3) 再発様式は主腫瘍径2cm以下の多発小結節が切除断端以外の他区域にも存在するものが最も多かった. 4) 肝切除時の娘結節の有無や顕微鏡的門脈内腫瘍塞栓の有無などが再発と強く相関し, 進行度判定に重要と考えられたが, 単発病変の腫瘍径や術前Transcatheter arterial embolizationの有無などは再発と相関しなかった.