Kotaro Uchida

Cumulative Results in 57 Institutions in Japan

In this study the experiences with carcinomas of the pancreas, ampulla of Vater, terminal comma bile duct, and duodenum found in a series of 3,610 patients collected from 57 major Japanese institutions was compiled over a 26 year period. The results were analyzed as to the success of resectional and palliative surgery for the various lesions. The most common lesion was carcinoma of the head of the pancreas. Unifortunately, only 18.3% of these patients were resectable with a 25.3% mortality. Carcinoma of the body and the tail was the second most frequent lesion, and it also exhibited a low resection rate. Carcinomas of the ampulla and the terminal common bile duct and duodenal regions were the most favorable for resection; usually pancreatoduodenectomy with an overall mortality of 20.8%. As a result of the large number of pancreatectomies performed, there was also a large number of postoperative complications, the most frequent being leakage at an anastomotic line. Hemorrhage also occurred frequently. Distal pancreatectomies were reserved for carcinoma of the body and the tail of the pancreas, and the most common postoperative complication of this procedure was hemorrhage. There were only 45 total pancreatectomies among the 973 resections being performed most frequently in patients with carcinoma of the head of the pancreas. Again, the most frequent postoperative complication was hemorrhage, followed by anastomotic leakage. The long term survivals following resection for these lesions were each poor. The best mean survival time was 22.7 months for carcinoma of the ampulla of Vater. Patients having resections for carcinoma of the head of the pancreas had a mean survival time of 12.3 months. At 5 years there were few survivors and most of them were patients who had undergone resections for carcinoma of the ampulla of Vater.

Congenital cystic dilatation of the common bile duct as a cause of primary bile duct stone

Of the 101 patients with congenital cystic dilatation of the common bile duct, eighty-eight with adult-type cysts are reported on. The association of primary bile duct stone and adult-type cyst of this anomaly is discussed and found to be higher than previously recognized. In the cases without calculi, abnormal arrangement of the pancreaticobiliary ductal system is indicated to play an important role in the manifestation of the symptom. The anatomic and clinical features and the results of treatment for this type of cyst are reviewed.

Carcinoma of the pancreas arising in the region of the uncinate process.

Of 54 patients with carcinoma of the head of the pancreas, six were confirmed to have lesions arising in region of the uncinate process. The present study was initiated in an attempt to clarify the particular clinical features exhibited by these lesions. As compared with patients with periampullary carcinoma, those with uncinate carcinoma revealed the following characteristics: jaundice, abdominal mass, and severe pain were rare; the preoperative identification of the lesion was very difficult, even with cholangiography, scintigraphy, and the pancreozymin secretin test in addition to routine laboratory studies; the most helpful information could be obtained from selective arteriography and hypotonic duodenography; because of its topographic relationship with the portal vein system and mesentery, the lesion became unresectable even in a comparatively early stage; and long survival after surgery could not be expected, even when the lesion was resectable.

Effect of human epidermal growth factor (hEGF) on splanchnic circulation in dogs

The effect of intravenous administration of human epidermal growth factor on the splanchnic blood flows was examined in anesthetized dogs, using an ultrasonic transit-time volume flow meter. Human epidermal growth factor (0.1, 0.5 and 1 microgram/kg) significantly increased blood flows in the portal vein (36.9 +/- 7.4% at 1 microgram/kg) and the superior mesenteric artery (49.0 +/- 16.8% at 1 microgram/kg). Systemic blood pressure monitored simultaneously was significantly decreased (8.4 +/- 1.2% at 1 microgram/kg). This study is the first to demonstrate that intravenous administration of epidermal growth factor increases the portal venous blood flow.

Percutaneous Transhepatic Portal Catheterization as a Useful Diagnostic Method for Localization of Insulinoma

We have performed percutaneous transhepatic portal catheterization (PTPC) with measurement of insulin concentration in 9 patients for 11 years, and could localize tumors in 8 of the 9 patients by the

Effect of synthetic porcine neuropeptide Y (NPY) on splanchnic blood flows and exocrine pancreatic secretion in dogs.

This study examined the effect of synthetic porcine neuropeptide Y on the splanchnic blood flows and the exocrine pancreatic secretion in dogs. Graded doses of neuropeptide Y (0.1–5 μg/kg, intravenous) caused dose-dependent reduction of the secretin-stimulated exocrine pancreatic secretion and of the blood flows in the superior mesenteric artery, the portal vein, and the pancreatic tissue. Neuropeptide Y at 5 μg/kg reduced the blood flows to 45.9±13.3% (superior mesenteric artery), 63.0±10.5% (portal vein), and 77.9±4.8% (pancreatic tissue), respectively. This dose also reduced secretin-stimulated pancreatic juice volume and CCK-8 plus secretin-stimulated protein output to 65.2±9.3 and 63.3±14.0%, respectively. This study shows a potent vasoconstrictor effect of neuropeptide Y on splanchnic vessels. Neuropeptide Y also inhibited exocrine pancreatic secretion in a significant correlation with the reduction in pancreatic tissue blood flow, which suggests that reduction in the blood flow may be one of the possible mechanisms of the inhibitory action of neuropeptide Y on exocrine secretion.

Qualitative and quantitative changes in islet cells of autotransplanted pancreas in dogs in relation to glucose metabolism.

This study was conducted to clarify the quantitative and qualitative changes in the cells of the islets of Langerhans in the autotransplanted pancreas in dogs and to correlate these changes with alterations of glucose tolerance. The left lobe of a canine pancreas was transplanted into the left iliac fossa. The splenic vessels were anastomosed to the left iliac vessels. The pancreatic duct was left open to the peritoneal cavity. Open biopsies of the autotransplanted pancreas were performed 3, 7, 11, and 14 weeks after transplantation. The islets in the transplanted pancreas were examined ultrastruc-turally; B-cells, A-cells, and D-cells were identified immunohistochemically and their percentages were determined. Intravenous glucose tolerance tests were performed 3, 5, 7, 11, and 14 weeks after operation, and several indexes (K values and integrated response and increased values for baseline serum and immunoreactive insulin) were calculated. Fibrosis of the transplanted pancreas progressed after transplantation. The percentage of B-cells fell significantly (p <0.01), whereas that of A-and D-cells did not have significant changes. The ultrastructural study revealed an increase in collagen bundles, degranulation of B-cells, and marked preservation of A-cell granules 3 weeks after transplantation. B-Cells with dark cytoplasm were found 7 weeks after operation. In contrast, clusters of immature B-cells were seen in some sections of the pancreas 14 weeks after autotransplantation. The integrated response in baseline serum was increased significantly (p <0.01), and the K value was decreased significantly (p <0.01) 11 weeks after autotransplantation when compared with the initial posttransplant period. On the other hand, 14 weeks after autotransplantation, neither the integrated response in baseline serum nor the K value showed significant difference from the initial posttransplant period. It may be that the trend toward slight recovery of glucose metabolism 14 weeks after autotransplantation was associated with the clusters of immature B-cells observed ultrastructurally, although the number of B-cells was relatively decreased. Further studies must be done to clarify this phenomenon.

Abstracts of selected papers presented at the 73rd general meeting of The Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.

1) Diagnosis of benign papillary lesions by cholangiography and biliary pressure study

Diagnosis of benign papillary lesions including organic and functional changes is significant clinically because of a close relationship of the lesions and the diseases of the liver, biliary tract and pancreas 1). The X-ray study was made by PTC and to analyse videotaped images. The pressure study was done by using Microt ip Catheter Transducer that was inserted through T tube into the common duct. From the pressure curve, the value of the closing and opening pressure were found. The histological study was made to investigate the specimens obtained by papilloplasty and by autopsy as the control materials~L The results are as follows : 1) The pathologic findings of the papilla of Vater were divided into 3 types; inflammation type (I), glandular and/or fibrous proliferation type (II) and adenosis (adenomyosis) type (III) . 2) The pathologic findings of cholangiograms are rigidity and stenosis. The former was histopathologically based on the type I and the latter was chiefly based on the type I I or I I I . The cholangiograms of the lower end of the common bile duct were divided into 4 types; normal type, fingertip type, funnel type and sclerosed-tapering type. The fingertip type was seemed to be chracteristic of primary papillary stenosis. 3) The findings of the biliary pressure were divided into 3 types based on the level of the opening pressure; hypertensive, hypotensive and normotensive types. In cases with the hypertensive type with high level of the closing pressure, functional disturbance ot the papilla may be considered, whereas organic changes may be present in cases with low level of the closing pressure. References 1) Hess, W.: Surgery of the biliary passages and tile pancreas. D. Van fflostrand Company, Inc. 1965. 2) Tanabe, T.: Pathological study of papilla of Vater including the relationship between the biliary tract and the pancreas. Japanese Journal of Gastroenterology 71: 973-988.