Junichi Wakisaka

Comparative studies on pulmonary hypertension in lung and heart disease.

Correlation between the histological changes occurring in the pulmonary blood vessels and in the alveolar wall and the cardiopulmonary hemodynamics was investigated in pulmonary hypertension due to chronic lung disease as well as to heart disease in special reference to its reversibility. The ratio of pulmonary to systemic resistance, cardiac index, the histological changes in pulmonary blood vessels and secondary changes in alveolar wall seem to be important factor of veversibility of the lesion, and should be carefully evaluated before the indication for heart and lung surgery in severe cases is made.

LACTOSE ABSORPTION AFTER GASTRECTOMY AND EFFECTS OF LACTASE PREPARATION

成人における乳糖不耐症あるいは牛乳不耐症に注目し, 私どもは今日まで最大血糖上昇度Clinitestによつて, 胃切除前後の乳糖吸収状態を吟味してきたが, 今度は胃切除後の乳糖吸収を14C-lactoseにより呼気中のCO2を測定するとともに, 小腸におけるLactase活性値を十二指腸ならびに空腸で測定した.胃切除後には術前に比較して乳糖不耐症例の頻度が増加し, また, 臨床的にも下痢・腹痛を訴えるものが多いが, 日本人における小腸のLactase活性値は欧米人に比べて非常に低値であり, また, 胃切除後の再建方法によつても乳糖吸収に差異を生じた, しかし不耐症状の有無にかかわらず, Lactase剤投与は乳糖吸収に充分なる効果があることを報告するとともに, 小腸におけるLactase活性値が低くとも, 下痢などの不耐症状のない人もあることを述べた.

Surgical considerations of early gastric cancer

SummaryMetastasis to lymph nodes was seen more higher rate in protruding lesion, especially in Type Ha and IIa + IIc than in concaving lesion.In view of the metastasis to the secondary regional lymph nodes or the third regional lymph nodes, care should be taken in the eradication of lymph node in early gastric cancer of Type IIc.Five-year survival rate was 88.9% of the resected cases of early gastric cancer.

Observation on early gastric cancer

Of the 1,758 cases of gastrecromy performed during the three-year period of September, 1964 to August, 1967, there were 231 cases of gastric cancer, of which 38 cases proved to be the cancers of early stage, occupying 17% of the total cases of gastrectomy. By the macroscopic classification, 8 cases of protruding cancer of early stage (Types I and IIa) showed 10 pathologic foci, 30 cases of indented early stage cancer (Types IIc, I Ic§ 31 pathologic foci. The number of early stage gastric cancer is increasing each year, but these cases began to appear only since 1965. Looking at the age distribution, Types I and IIa are found in the age range of 65 years in average; Type IIc 55 years; Type I Ic§ 53 years; and Type III 45 years. This increase in the percentage of protruding type of early-stage gastric cancer often found in old age and of protruding pathologic foci owes much to the advance in the endoscopic techniques. Histologically, in the protruding type of early cancer, adenocarcinoma papilliferum was found in 8 out of the 10 foci, proving to be markedly frequent. Indented cancer of early stage was found only 4 in the 31 foci, whereas tubular adenoma and mucocellular cancer numbered 15 and 11 foci, respectively. As for the size of the tumors, 20 loci (46%) were under 2.0 cm in diameter; 15 foci (35%) ranged between 2.0cm and 4.0cm; 8 foci (19%) were over 4.1cm; and those measuring less than 2.0cm in diameter occupied almost half the total cases. Especially with Type IIc, 11 loci out of the 16 proved to be less than 2.0cm in diameter. As for the depth of invasion into the stomach wall, only tow foci out of the ten reached as deep as the snbmucous layer in the protruding tumors, while in the case of indented type, 15 foci (48%) out of the 31 tumors reached the submucous layer, showing a high incidence. The presence of ulcers in the entire early-stage gastr ic cancer group was observed in 19 cases (44%) out of the 43, but there was no ulcer in the protruding tumor group. In the indented early-stage cancer group the percentage of ulcer present was as high as 61% of the 31 pathologic loci, but ulcer was absent in the group whose tumors measured less than 1.0 cm in diameter. In contrast , the groups whose tumors measured 1.1 to 2.0cm the incidence of ulcer was 50% and in those measuring over 2.1cm it was as high as 83%. IIa-like atypical epithelium which poses a problem in ident ifying it from Type IIa: In comparing macroscopic features of 8 cases of IIa-like atypical epithelium with those of 8 cases of IIa type tumor, those tumors measuring less than 1.0 cm in diameter were practically all spherical in shape with smooth fringe, while with those measuring over 1.1cm, both atypical epithelium and IIa type had smooth surface (1) of goblet or rosette shape with the periphery of chrysanthemum-like shape (2). As regards those atypical epitheliums measuring over 1.0cm