Kazuo Harima

Histopathological Study on Aging of the Pancreas from 423 Autopsy Cases

山口大学第1病理学教室の過去8年間の剖検例423例を年代別にわけて組織学的検索を加え, 加齢によるいわゆる老性変化の有無について検討した. さらに, 慢性膵炎の頻度および成因別頻度についても若干の検討を加えた結果, 次のような結論を得た.1) 加齢による膵のいわゆる老性変化として明らかなのは, 膵内動脈硬化のみであるが, 脂肪細胞浸潤, 膵管上皮の杯細胞化生および扁平上皮化生においても, 加齢とともに頻度の増加がみられた.2) しかし, 結合織の増生および外分泌腺にみられる形態学的変化の多くは, 加齢よりも基礎疾患による2次的修飾像の可能性が強い.3) 慢性膵炎は39例 (9.2%) にみられ, その約半数は60歳以上の高齢者であった. また39例のうち, 臨床的に慢性膵炎の診断がついていたのは, わずかに1例であった.4) 3)が示すように, 剖検例において組織学的に慢性膵炎と診断される症例の頻度は, 臨床的に診断される頻度よりはるかに多く, 潜在性の慢性膵炎はかなり多い.5) 慢性膵炎の成因別頻度をみると, アルコール, 腹部手術, 消化性潰瘍, 胆砂～胆石の順にみられ, 原因不明のものも38.4%みられた.

THERAPEUTIC EFFECT OF SECRETIN IN PATIENTS WITH JAUNDICE ; DOUBLE-BLIND PLACEBO-CONTROLLED MULTICENTRIC TRIAL

Secretin, a gastrointestinal hormone, has been shown to have a potent choleretic effect. Having already obtained some beneficial effects with secretin in patients with intrahepatic cholestasis, we sought to confirm its effects in a double-blind placebo-controlled study in patients with mild jaundice after acute or during chronic hepatitis, where total bilirubin level was in excess of 4.0 mg/dl for 3 days or more. Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and familiar hyperbilirubinemia were excluded from the study. Ninety-three patients were included in this analysis, but the final evaluation covered 69 of them. No statisticaly significant differences were found in the reduction of serum bilirubin levels between secretin and placebo groups. As a number of patients with liver cirrhosis had been included, the subjects were subdivided into one group with cholestasis in hepatitis and one with liver cirrhosis. In the subgroup of cirrhotic patients who received secretin, serum levels of AST were significantly increased compared with the placebo group. However, since the choleretic effect of secretin is unique, further studies seem to be warranted.