Hisaaki Shimazu

Vitamin D status after total gastrectomy

Serum levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, 1,25-dihydroxyvitamin D, immunoreactive parathyroid hormone, and urinary excretion of nephrogenous cyclic AMP were measured in 25 patients after total gastrectomy. Two types of reconstruction after total gastrectomy were also compared. Serum 25-hydroxyvitamin D levels were significantly decreased and serum 24,25-dihydroxyvitamin D levels were markedly reduced, whereas serum 1,25-dihydroxyvitamin D levels were significantly increased in the patients. Although serum levels of immunoreactive parathyroid hormone did not show a significant difference, serum alkaline phosphatase levels and urinary excretion of nephrogenous cyclic AMP were significantly increased in the patients. The results suggest that defective vitamin D storage and enhanced vitamin D action coexist in patients after total gastrectomy and that the enhanced vitamin D action, possibly derived from slightly increased parathyroid function, would be a compensatory mechanism to sustained calcium deficiency. No substantial difference of vitamin D status was observed between the two types of reconstruction which differed in passage through the duodenum.

G-cell population in antral mucosa of the dog

The gastrin-cell (G-cell) population in the pyloric antrum of 8 dogs was studied quantitatively by immunofluorescence. The G-cell population was dense in the pyloric antrum and very few cells were seen in the antrocorporal junction. The estimated total number of G cells was (1.66±0.12)×107 in the pyloric antrum and the greatest number of G cells per unit mucosal surface area was along the greater curvature of the pyloric antrum. Except along the greater curvature, G cells per unit mucosal volume were significantly greater in number (P<0.05) in the proximal antrum adjacent to the antrocorporal junction than in any other regions distal to it. Differences in mucosal thickness were considered as a causative factor for these differences.

A new in vivo staining method, cresyl violet staining, for fiberoptic magnified observation of carcinoma of the gastric mucosa

SummaryA polypoid gastric mucosal lesion with a flat portion was observed by a fiberoptic magnifying endoscope with a new in vivo staining method, cresyl violet staining. The fine surface structure of this lesion showed a characteristic “ruined sulciform pattern” suggesting papillary carcinoma histologically. Successful application of the findings of dissecting microscopy to clinical magnifying endoscopy by means of this new staining material indicates the possibility of diagnosing gastric mucosal carcinomas with much more accuracy.

Superficial carcinoma of the esophagus

SummaryNine cases of superficial carcinoma of the esophagus were described. Although 3 patients complained of abnormal sensation on swallowing or dysphasia, 6 patients did not present with any symptoms related to the esophageal lesion. The radiologic diagnosis is particularly difficult in cases with superficial type esophageal cancer, and no definitive findings were obtained in three such cases. However, esophagoscopy using Lugol spray was far more effective for the recognition of these superficial lesions. Although surgical resection of the esophagus is technically easier in these cases, the indications of surgery should be carefully evaluated. One operative death occurred in our series. In cases that are good indications, however, wide lymph node dissection should be carried out, since metastases occur even to distant lymph nodes, particularly in cases with cancer invasion of the submucosal layer. The histopathologic diagnosis was squamous cell carcinoma in 8 cases, but in one case it was adenocarcinoma of mucus-secreting gland origin in the mid-thoracic esophagus.

A histopathological study on pyloric ulcer.

SummaryAfter the pyloric ulcer was defined as a peptic ulcer occurring at the pylorus or having its centre in the prepyloric region within 2 cm from the pylorus, its histopathological features were studied on 94 pyloric ulcers in 88 surgically resected stomachs. 72.3 per cent of these ulcers were less than 1.0 cm in diameter. The incidences of Ul-II, III and IV ulcers were almost equal, and the majority of Ul-II and Ul-III ulcers were found in scarring stage in the specimens. These pyloric ulcers were classified into three types according to whether the centre of ulcer is situated above (Type-1), on (Type-2) or below (Type-3) the pylorus. Type-1 ulcers were the most frequent, their incidence being 70.2 per cent. On histologic examination, it was observed that duodenal gland area extended over the pyloric antrum in 90 per cent of the specimens. Contrary to the mucosal rule of Oi for the genesis of peptic ulcer, pyloric ulcers were located in pyloric gland area in 30.9 per cent and on the glandular boundary in 57.4 per cent. Only in 11.7 per cent, the ulcer developed in duodenal gland area. In 68.2 per cent, pyloric ulcer was associated with other gastric or duodenal ulcers. The majority of these coexisting gastric ulcers occurred in the pyloric gland area adjacent to the antrofundic border, and all the duodenal ulcers in the proximal duodenum. Moderate or severe atrophic changes in gastric antral mucosa were found in a large number of the specimens with coexisting gastric ulcer, whereas the changes were less pronounced in those with pyloric ulcer alone.

Evaluation of gastric freezing

As methods of the medical management of peptic ulcer, we have studied the process of brief trial of rigid medical management, following the previous report. The total under examination was 78 cases of which males were 70, and the rest was 8 cases of femeles. Their average age were 44. 1. This management was not so effective in the cases of duodenal ulcer. 2. Ulcer scar did not show any effects in this management. 3. Those cases which were effected in this management showed the best look in the process. 4. Many of those which were not effected in the manegement showed UI-IV ulcer or malignant one. From above, we can say that this management efficient as the s tar t ing point of the medical management of gastric ulcer.

Effects of truncal vagotomy on tissue gastrin content and G cell density in rats

SummaryTissue and serum immunoreactive gastrin (IRG) concentrations were measured by radioimmunoassay, and antral G cell density was studied by immunofluorescence in seven non-operative and ten vagotomized (one month postoperatively) rats.In the non-operative rats, tissue IRG concentration was overshelmingly high in the antrum, especially in the distal antrum, and much less in the small intestine, in which it tended to be lower toward the distal part.There were no significant differences between the vagotomized and non-operative rats in antral G cell density, antral tissue IRG concentration, total IRG content of the anterior antrum and serum IRG level, although significantly increased wet weight of the specimen, which was considered a result of the operation, was observed in vagotomized rats.The presence of G cell hyperplasia after vagotomy cannot be confirmed from our one-month postoperative observations in rats.

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.

Gastric response to meat extract stimulation in patients with gastroduodenal ulcer and patients after vagotomy or antrectomy.

Gastric acid secretion basally and in response to intragastric meat extract instillation or to tetragastrin, and circulating gastrin concentration basally and after meat extract stimulation were studied in 67 patients with gastroduodenal ulcer, 30 patients after highly selective vagotomy or selective vagotomy for duodenal ulcer, 12 patients after antrectomy for or gastric ulcer and 10 control subjects. Circulating gastrin concentration increased significantly after meat extract stimulation in control subjects, patients with ulceration and patients after highly selective vagotomy, and acid secretion in each group was increased significantly above basal level. In patients after selective vagotomy, significant increase of circulating gastrin concentration was observed, but it was not associated with significant increase of acid secretion. After antrectomy, neither gastrin nor acid secretion increased significantly after meat extract stimulation. In conclusion, present study suggested that (1) gastric acid secretion in response to intragastric meat extract is chiefly affected by the responsiveness of oxyntic cells and release of antral gastric and that (2) the presence of the antrum is almost essential for acid secretion after a test meal, and release of duodenal gastrin after antrectomy would not be so potent biologically as to result in an acid secretion.

Inhibition of gastric secretion by intraduodenal hypertonic glucose in patients with duodenal ulcer.

SummaryIntraduodenal instillation of hypertonic glucose significantly inhibited tetragastrin-induced gastric acid and pepsin outputs in man. The secretory volume of gastric juice was markedly decreased, whereas, acid concentration remained unchanged. Pepsin concentration, on the contrary, was reduced significantly. The degree of inhibition of pepsin output, therefore, was greater than that of acid output. No significant difference in the extent of inhibition of acid or pepsin output was observed between control subjects and patients with duodenal ulcer.