K. Asano

Studies on etiology and treatment of peptic ulcer

The etiology of peptic ulcer and the mechanisms of action of anti-ulcer agents were investigated by measurement of gastric blood flow. I t has been found that there are differences of blood flow between the regional border of the corpus ana antrum, and between the anterior wall and the posterior wall of corpus. The gastric blood flow was max imum in the anterior wail of corpus and min imum in the antrum. These results suggest that there are the warps of Mood flow between each gastric regions. A change in blood flow occured by some vasoactive agents and anti-ulcer agents. The remarkable increase of blood flow by histamine occured in the corpus with the exception of the lesser curvature. On the other hand, atropine caused a reduction of mucosal blood flow in the corpus. In the group of animals in which acetylcholine was administered, a remarkable increase in blood flow occured at the corpus, especially at the muscular layer of the lesser curvature, I t is known that acetylcholine is closely related to gastric motility, while the effect of histamine closely influences on gastric secretion. These results mean that there are relationship between the gastric Mood flow and gastric functions. Regarding the mechanisms of action of some anti-ulcer agents, a study was made from the standpoint of the relationship between the gastric functions and the variations of blood flow. The effects of anti-ulcer agents on the variations of blood flow between each gastric regions were investigated in the groups of animals which were administered acetylcholine and histamine. It has been found that atropine, scopolamine butylbromide, gefarnate and prostaglandin E x showed the normalizing effects of the variations of blood flow induced by acetylcholine and histamine, whereas the normalizing effect of sulpiride was not significant. On the other hand, proxazole citrate corrected the change of blood flow due to the effect of acetylcholine, while it did not prevent the effect of histamine.

The relationship between the etiology of peptic ulcer and the blood flow and metabolism in the gastric mucosa

The incidence of human peptic ulcer differs greatly by the site of the stomach. Therefore, we have conducted a series of studies on the etiology of peptic ulcer by measurements of blood flow and enzymes in the gastric mucosa. The distribution of gastric blood flow are max imum in the anterior corpus and min imum in the an t rum. Histamine, acetylcholine, epirenamine, norepinephrine and prostaglandine E affect the distribution of blood flow in the s tomach, and the blood volume shifts from an t rum to corpus. Fur thermore , the characteristic changes of blood flow are the increase in corpus except lesser curvature and the decrease in muscle layer of lesser curvature by the injection of histamine, and was the increase in the muscle layer of lesser curvature by acetylcholine. These results suggest tha t there are warps of blood flow between an t rum and corpus, and between anterior corpus and posterior. The activities of aldolase, isocitric dehydrogenase and lactic dehydrogenase are higher in the mucosa of corpus than ant rum. The ratio of HfM of lactic dehydrogenase isozyme are larger in the mucosa of greater curvature of corpus than an t rum. It is suggested that these differences in the blood flow and the specificity of metabolism account for more frequent development of peptic ulcer in the area covering lesser curvature between an t rum and corpus.

Studies on gastric diseases in diabetes mellitus

Case 2. 61 yearold male. Six months af ter Billroth II gastrectomy due to gastric ulcer. Pustulous granulation t issues surrounding black dacron sutures. Case 3. 65 yearold male. Seven months af ter Billroth II gastrectomy due to gastric ulcer. A part of black dacron continuous sature was seen to hang across the stomal orifice. Case 4. 45 yearold male. One year after Billroth II gastrectomy due to gastr ic ulcer. White silk thread across the anastomotic lumen. Case 5. 41 yearold male. Three years af ter Billroth II gastrectomy due to duodenal ulcer. A medium-sized gastric ulcer near the stoma. Case 6. 33 yearold male. Three months af ter Billroth I gastrectomy due to gastric ulcer. A deep gastric ulcer near the stoma. Case 7. 54 yearold female. One year and seven months after Billroth II gastrectomy due to gastr ic polyp. Three polypous granulation t issues at the site of anastomosis. Case 8. 63 yearold female. Six months after Billroth I gastrectomy due to gastric polyp. A fairly large tumor near the stoma on the lesser curvature. Preoperative invagination of the gastric mucosa, granulation tissue or missed tumor during operation might be its nature. Case 9. 32 yearold female. Six months after Billroth If gastrectomy due to gastric carcinoma. Scirrhous change around the stoma cancer relapse. Case 10. 56 yearold male. One month after Billroth II gastrectomy due to gastric ulcer. Two polyps in the cardia which had been probably missed preoperatively and found postoperatively by fiberscope turnover technique. These findings which used to escape the conventional examination may meri t fur ther study concerning their clinical significance and t rea tment .