K. Seta

Review of five cases of limy bile--particularly on radiological, chemical and crystallographic studies--.

SummaryIncidence of “limy bile” is relatively rare and only 120 cases have been recorded in Japan so far. The present report is to add five more cases operated on at our clinic. On chemical analysis by atomic absorption spectrophotometry calcium carbonate was the major constituent of solid portion and ranged from 73.5 to 88.5%. On crystallographic analyses, the infrared spectra by means of KBr-disk method gave patterns of calcium carbonate in all the cases, and the X-ray powder diffraction studies disclosed those of aragonite only in cases 2 and 4, and aragonite-calcite mixture in cases 1 and 3. The exact etiology of formation of limy bile in the gallbladder has not yet been understood completely.

Histological appearance of small thyroid carcinoma

Histopathological characteristics of the tumor growth were studied in 59 small carcinomas detected in thyroids at autopsy and in 33 from surgically removed thyroids. Tumor size was less than 5 mm in 56 of the 59 carcinomas (95 per cent) detected in autopsy materials. Histologic findings of the small carcinomas were papillary adenocarcinoma in 45 of 59 (76 per cent), and sclerosing carcinoma in 32 (54 per cent). Among these 59 small carcinomas, intrathyroid metastases were found in six (10.2 per cent). In small carcinomas measuring less than 5 mm, carcinomas in females had an average diameter of 2.19 mm and were significantly larger than those found in male, having an average diameter of 1.14 mm (p<0.05). In small carcinomas from the surgical specimen, incidence of regional lymph node metastasis was high when associated with numerous intrathyroid metastases and when the distance was great between the edge of the primary tumor and the farthest satellite metastatic focus.

EFFECTS OF SELECTIVE PROXIMAL AND TRUNCAL VAGOTOMY ON CANINE GASTRIC MOTILITY

With the use of electromyography and intraluminal pressure recording of the pylorus, the effect of selective proximal and truncal vagotomy on the gastric motility was investigated in 10 dogs. The results are summarized as follows: 1. Control dogs showed regular discharge intervals with elevation of intrapyloric pressure coinciding with the action potentials. There was seen no occurrence of antiperistalsis. 2. Selective proximal vagotomy resulted in the prolongation of discharge intervals along with slight decrease in the incidence of action potentials. The rate of antiperistalsis was 4.4%. Besides, the rate of pyloric contraction also showed a tendency of slight decrease. 3. Truncal vagotomy lead to the prolongation of discharge intervals and decrease in the incidence of action potentials, though these changes were milder than those after selective proximal vagotomy. The incidence of antiperistalsis was 6.8% which was higher than the one after selective proximal vagotomy. Eelvation of intrapyloric pressure did not necessarily took place coinciding with the action potentials. Intrapyloric pressure as well as the incidence of pyloric contraction showed a marked decrease when compared with those of the control and selective proximal vagotomy dogs. Out of these results, it is concluded that the selective proximal vagotomy is superior to the truncal vagotomy when viewed from the preservation of the gastric motility.

EXPERIMENTAL AND CLINICAL STUDIES ON ANTI-REFLUX EFFECT OF MODIFIED END-TO-SIDE ESOPHAGOGASTROSTOMY IN PROXIMAL GASTRECTOMY

A modified end-to-side esophagogastrostomy devised at our department to prevent postoperative reflux was evaluated both experimentally in 15 dogs and clinically in 4 cases. The seromuscular coat of the anterior wall of the remnant stomach was excised longitudinally, the distal esophagus was burried and anastomosed at its distal end so as to provide an effective thin flap valve. The presence of gastroesophageal reflux was attested by the use of withdrawal pH, intraluminal pressure and fluoroscopy studies as well as by autopsy in dogs. Furthermore, 7 out of 15 dogs were subjected to the analytical study of reflux prevention mechanism employing an intraoperative pressure measurement.The results are summarized as follows:Gastroesophageal reflux was absent in 11 out of 15 dogs and in all the 4 clinical cases. A specific finding after this procedure was that even after resection of the cardia, there was seen creation of an artificial high pressure zone at the site of the anastomosis serving as a barrier to reflux.Reflux prevention mechanism of the present method lies in an effective flap valve mechanism which seals the distal esophagus receiving the side pressure from the artifi cial fundus. The procedure is technically easy and seems to serve overcoming the problem of postoperative reflux highly seen after conventional end-to-end or end-to-side esophagogastrostomy.

Clinical studies on abdominal surgery in the aged patients

In our clinical laboratory, 3228 cases of abdominal surgery have been experienced for the past 11 years and cases of the aged (over 70 years old) have accounted for 128 cases (4%) of them. The number of male aged cases was 2.5 times as many as the female ones. 51 cases in the aged, the greater number in the various abdominal diseases were suffered from gastric cancer. In such aged cases, the increase of mortality rate was the most significant finding. In cases with ileus, mortality rate was 55.6%. One of such cases died in intestine paralysis and three in cardiac failure. The causes of death in their series were dehydration, unbalance of electrolyte and hypoproteinemia due to repeated vomitting. On the diseases of biliary tract and pancreas, mortality rate was 53.3%, the rate of which was 75% in malignant diseases and 25% in benign ones. Jaundice index was over 100 unit, except for one case, and primary radical operation, therefore, was impossible on them. On gastric cancer, the rate of Stage 3 and 4 types were 93.5% of all the aged cases. The patients of this disease complained mainly of anorexia epigastralgia and epigastric distress. 5 year survival rate was 14.3%. On the other hand, the operative death rate was 6.5%. It seems to be natural that surgical t reatment in the aged patients should be performed under the suitable management.

Ten cases of non-specific ulceration of the intestine

value of the controls. On the third day, more than a half of the patients also showed lower values than the minimal value of the controls. As concerns 17-KS, the male patients showed higher values than those of the female patients and was the similar pattern to that of the controls after administration. The excretion of 17-KGS in the patients was generally lower than that of the controls. Speaking of the mean value, the excretion of 17-OHCS after administration of ACTH-Z shows a less increase in the patients, namely the adreno-cortical reaction upon ACTH in patients with irritable colon syndrome is thought to be lowered. The excretion of 17-KS in urine generally decreased in the female patients and that of 17-KGS is also lower in both male and female patients, and the reaction upon ACTH is week. It is concluded that the secretion of adreno-cortical hormones is decreased and the reaction upon ACTH is also lowered in patients of irritable colon syndrome, and then the disease, called irritable colon syndrome, seems to be related with some hormonal dysfunction.

The clinicopathological studies on the early gastric cancer

The relationship between the characterist ics of histological pat tern of developmental origin and the macroscopical type was examind clinicopathologically on 31 cases of early gastr ic cancer. As it was generally shown that early gastr ic cancer was relatively slow in its development. In the present study, the process ranged from 3 months to about 20 years. The lymphatic metastasis were found in 60% of protruding type and 9.5% of depressive type. As regards the relation between the lymphatic metastasis and the depth of its invasion, a high rate in metastasis was observed in submucosa than in mucosa. In the histological findings on the marginal mucosa of cancer lesion, a high rate in metaplasia or in disappearance of the glands was found in protruding type, and inflammation or atrophy of the glands in depressive type were observed frequently.

A study on the reticuloendothelial reaction in superficial gastric cancer

A recent progress in the field of gastroscopy and roentgen examinations has made it possible to diagnose an early gastric cancer much more in detail. However there remain some difficulties in the diagnosis of a gastric cancer of a protruded type as well as in the technical procedure. One proninent of these difficulties is the differentiation of this type from erosive gastri t is , menetrier disease and lymphreticular hyperplasia. We reported a case of localized hypertrophic gastrit is. This was revealed an irregular protrusion in the antral glands region which was quite resembling findings such as in an early gastric cancer of the protruded type, so far as it was examined by X-ray and gastrocamera.

Experimental studies on the fatty acid metabolism in the host bearing tumor

Plasma fatty acid fraction and lipoprotein fraction of patients with stomach cancer were determined respectively by means of gaschromatography and paperelectrophoresis as compared with non cancer patient in order to investigatethe changes of fatty acid coposition in the host bearing tumor. The results obtained were as follows: Decreasing of the linoleic acid and increasing of the oleic acid were mostly observed as characteristic changes of fatty acid in the patient of stomach cancer group. These tendencies were not observed in the case of gastroduodenal ulcer patients. Low levels α-lipoprotein based on hypoproteinamia accompanied with decreasing of albumin were mostly observed in stomach cancer patients. No relations were found between variations of plasma fatty acid fraction and those of the removed specimens which were classified according to Borrmanns and histological classification.