Kenji Tsuneoka

Clinical course of peptic ulcer and the effect of pharmacotherapy

SummaryComparative clinical trials were conducted by the double-blind technique in a series of 302 cases of gastric ulcer at fifteen medical institutions in order to investigate the clinical course of peptic ulceration and the effect of pharmacotherapy on it, using N-acetyl-L-glutamine aluminum complex (KW) as test drug and basic aluminum sucrose sulfate (UL) as reference drug as well as an inactive placebo of lactose (PL) with the results as follows:In 12 weeks of treatment with inactive placebo, a higher cure rates were noted in inpatients than in outpatients, and in patients with ulceration in the corpus ventriculi than in those with ulceration at the angulus. The overall evaluation of therapeutic responses indicated that, both KW and UL were significantly superior in efficacy to placebo in 12 weeks of therapy. These two medicaments displayed different modes of efficacy, possibly reflecting their different mechanisms of pharmacologic action. The efficacy of the medicaments was particularly superior in outpatients and patients with peptic ulceration at the gastric angle both of which showed lower rates of response to placebo.

Symposium (II): Submucosal tumors of the stomach

Benign nonepithelial tumor which grows covered by gastric mucosa have generally been called the gastric submucosal tumor, but aberrant pancreas and eosinophilie granuloma have been included in this category because the correct diagnosis could not be made preoperatively. The submueosal tumor are infrequent but recently reported seri;cs of this lesions have been increased in Japan . 58~3 cases were reported until 1966 but the number reached to 2,360 until 1973. While the submucosal mass was found in 0.04% in the mass survey in Akita Prefecture during the past three years, le iomyoma of the stomach were reported in 0.12% in autopsy series in Japan . Therefore, the gastric submucosal tumor was not so rare. In our cases, the following ones such as pyloric muscle hyper t rophy in adult type, duplication of the stomach, pseudotumor forming gastric varix, and metastatic lesion of cancer of the stomach were diagnosed as gastric submucosal mass preoperatively. Accordingly, the gastric submucosal mass should include aberrant pancreas, eosinophilic granuloma, pyloric muscle hypertrophy, duplication of the stomach, reactive lymphoret ieular hyperplasia in localized type and carcinoid added to nonepithelial tumor, because these histological findings were not established preoperatively and preoperative diagnosis necessarily depends on radiological and gastroscopic impressions.

Cytological diagnosis of gastric cancer by gastroendoscopical method with fibergastroscope

SummaryAs described above, the methods of collecting cells from the stomach under direct observation by fibergastroscope of various types, paticularly the structure of each instrument and the result of cytological diagnosis of early gastric cancer have been reported in detail. Studies in this field will have more and more importance in future with improvement of the instrument to obtain better results of the diagnosis of early gastric cancer together with the roentogenologic and endoscopic examinations.

Treatment of upper gastrointestinal hemorrhage: Significance of early fiberscopic examination

1,003 cases of gas t r ic ulcers were t rea ted in the last five and a hal t years at our hospital. 404 cases were t rea ted medically and were observed more than 6 months . 22.2% in those were healed within I month, 51.3% within 1.5 mos., 85.1% within 4 mos. and 89.6% within 6 mos.. All of 28 cases, whose ulcers were less than 5 m m in diameter, healed wi th in 6 mos., 91% out of 56 cases wi th ulcers of 610ram in d iameter were healed within 6 mos., 84% of 49 cases wi th ulcers of 1 1 ~ 1 5 m m in diamether were healed, 86% of 21 cases wi th ulcers of 16~20mm in diameter healed, and 91% out of 36 cases wi th over 20mm in d iameter ulcers were healed within 9 mos.. Nextly, relationship between heal ing rate and depth of ulcers was studied. 96% in 83 cases of ulcers, whose ulcers were less than 5mm in depth, healed within 6 mos., 87% out of 98 cases wi th ulcers of 6 ~ 1 0 m m in depth healed within 6 mos.. In 22 cases with ulcers of over 15mm in depth healed in 78%, 22 cases have been followed up in the past 4~4.5 yrs., in which 9 developed relapses (44%), in the group of 3 .5~4 years follow up study 7/21 (33%) relapsed, 3~3.5 yrs. 7/36 (19%), 2.5~3 yrs 9/35 (26%), 2N2.5 yrs 12/49 (25%), 1.5~2 yrs 8/43 (19%), 1~1.5 yrs 8/43 (19%) and 0.5~1.0 yrs 4/48 (8%) were relapsed. Relapses occured in 55/66 (83%) wi th in 1.5 yrs a f te r the i r complete pr imary healing. There was no relat ionship between sex and frequency of relapses, but relapses were seen more often in the 3rd and 4th decade of age and a l i t t le more often seen relapses in the lower par t of the body. Relapses were occured in the same places in 55 out of 67 relapses cases, but in 12 cases it occured in apparently different places.