Kimindo Kumagai

An Approach to the Mechanism of Acute Ulceration in Obstructive Jaundice

Changes of noradrenaline (NA) and prostaglandin (PG) E2 in gastric mucosa and gastric wall blood flow (GWBF) were investigated after stress load in rats with obstructive jaundice. We found that water immersion and restraint stress more easily increased the ulcer index and decreased GWBF, corresponding to a decrease of the NA and PGE2 contents in the gastric mucosa, as the duration of jaundice increased. Administration of PGE2 reduced the increase of the ulcer index and the decrease of the GWBF and NA contents in the gastric mucosa. It is suspected that the rapid decrease of NA and PGE2 is connected with the rapid decrease of GWBF after stress load in obstructive jaundice, and we reached the hypothesis that both PGE2 and NA mutually regulate local GWBF.

SURGICAL TREATMENT OF BLEEDING GASTRODUODENAL ULCER IN THE VIEW OF RISK FACTORS

出血性胃十二指腸潰瘍75例の治療成績から予後に影響を及ぼす背景因子について検討を加えた. 潰瘍入院総数に対する出血率は22.4%で, 手術の内訳は緊急32例, 待期27例で, 死亡率は緊急21.9%, 待期3.7%と緊急の予後が著しく悪かった. また加齢につれて死亡率は上昇し70歳以上の高齢者では19例中6例 (31.6%) であった. 予後に影響を及ぼす重要な背景因子は年齢と併存症で, シメチジン出現以後, 年度別の出血例は減少したが, 入院数に占める出血率には変化なく, 緊急手術率は前期に比べて増加した.従って, 併存症を有する高齢者に対しては保存治療に固執することなく手術適応を考慮して手術時期を失しないよう迅速に対処することが必要である.