Masanori Mita

Crohn's Disease Consisting Solely of Aphthoid Ulcers at the Time of First Visit

Abstract: It is generally considered that early lesions detected macroscopically in Crohns disease are aphthoid ulcers. The lesions are usually found close to more advanced lesions and sometimes observed in the distal colon. However, there are a few patients who have almost only aphthoid ulcers without any typical major lesions through the alimentary tract. We studied 5 such cases (4 men and 1 woman, 15–31 years old) out of 107 patients who had not undergone any surgery at the time of their first visit. Four patients had aphthoid ulcers in both the small and large intestine as well as some lesions (ulcer, erosion and redness) in the gastroduodenal region. The remaining case had some lesions only in the large intestine. Non‐caseating epitheloid cell granulomas were detected in the biopsy specimens obtained from the aphthoid ulcers of the colon in 4 cases. These cases with granulomas were considered to suffer from Crohns disease and were treated with an elemental diet. Aphthoid ulcers showed a remarkable improvement but relapse followed the beginning of an oral diet. In 3 cases, the lesions in the small intestine developed into longitudinal ulcers 18, 27 and 37 months after the first visit, respectively. Although a female patient in whom granulomas could not be proven was not diagnosed as having Crohns disease, she had bloody stool again 17 months later, and a barium enema revealed a cobblestone appearance in the colon so that she was diagnosed as having Crohns disease.

Secretin-like activity in duodenal mucosa and peptic ulcer

SummaryThe secretin-like activity contained in bioptic specimens of duodenal mucosa was measured by means of bioassay in healthy controls and patients of peptic ulcer. It was found that the activity tended to be increased in duodenal ulcer in comparison with gastric ulcer which did not differ from healthy controls, Possibilities of impaired release and/or increased production of secretin-like substance in duodenal ulcer were discussed.

Study of the inhibitory action of prostaglandin on gastric secretion in rat and man

Synthesized prostaglandin Et (PGEt) was investigated regarding its inhibitory effect on gastric juice secretion and experimental gastric ulcer formation. Continuous increase of gastric juice secretion was produced by cont inuous injection of histalog to the dogs with pylorus ligation. The gastric juice secretion was remarkably inhibited by int ravenous injection of PGE1, 2/*g/kg/min, for 20 minutes. The secretion star ted again 20 minutes after discontinuation of the injection. Gastric ulcer was produced experimental ly on ra ts to observe the inhibitory effect of PGE1. PGE1 remarkably inhibited gastric juice secretion to produce Shay s ulcer and Reserpin ulcer, but only mildly to produce steroid ulcer.

Endoscopic diagnosis of duodenal disease

Benign and probably benign tumors, including one case of aberrant pancreas of the descending limb of the duodenum operated, the others of eleven cases following up by endoscopy and direct vision biopsy, are localized in the bulb in half and the rest in the post-bulbar region. It is difficult to differentiate benign or malignant on duodenal tumor only by endoscopic observation and biopsy by which not enough specimens are obtained, sn follow-up study will be desired. I t is very easy to diagnose papillary and duodenal carcinoma, two cases of duodenal carcinoma located in papillary region was resectable by Whipple and Child method each other. These show malignant ulceration endoscopically, with erosion and hemorrhage. The diagnosis of pancereatic carcinoma is available by endoscopic pancreatocholangiography (EPCG) and endoscopic abnormali ty in the case of involvement of the duodenum. It is the same in the biliary tract carcinoma. However, ten cases of pancreatic and biliary tract carcinoma experienced were unable to resect for too late stage. It will be neccessary to detect malignancy in early stage that application of EPCG, cytology and echogram etc. should be usually used.

The roentgenological studies on the clinical course of the gastric ulcer

To invest igate the possibli ty of express ing mathemat ica l ly the prognosis of the gastr ic ulcer on the basis of the measurement on the X-ray film, H(~) and H(~),, as designated in the at tached diagram, were calculated in 91 pat ients wi th the gastr ic ulcer on 113 ulcers. All these pat ients were hospitalized pat ients and followed by the periodic X-ray examinat ion which included both of filling and double cont ras t method at the interval of two to three weeks. The resul ts demonstrated tha t the actual number of the days required for the healing correlated significantly with the H(a),. On the basis of roentgenological profile niche of the initial X ray examination, the gastr ic ulcers were classified into 5 types namely special type, and type I to IV. The X-ray findings of the healed gast r ic ulcers were classified into 5 types, namely type UNO, UNI (UNIt), UN II (UNIIr), UN III and UN IV. The relat ionship between these two classifications is studied by comparing them in each pat ients and the resul ts are reported.

Gastric mass survey in Miyagi prefecture

(1) Since Sept. 1964 to June 1967, the gastric mass survery in field on 12,212 cases have been performed. Across examination was necessary for 3,472 cases and the rate of cross examination was 28.8%. (2) The indirect roentgenographic apparatus was taken by Hitachi 113 type (Odelca-mirror camera) which was set up on the car. We employed the roentgenographic procedure as a s tandard which 4 films were taken in upright position and 2 in supine position. (3) Pat ients who underwent examination (from April 1966 to June 1967; 6711 cases) readed to 40% in forty decade; 22% in fifty decade and 19% in thir ty decade. (4) The results of the cross examination on 2835 cases is as follows; 33 cases of gastric cancer (5 cases were early stage cancer), 42 cases of gastric polyp, 565 cases of gastr ic ulcer, 155 cases of duodenal ulcer, and 39 cases of gastroduodenal ulcer. Out of 33 cases, 5 cases of early stage cancer (1 case of I Ia§ type; 1 case of IIc type, 2 cases of Hc+II I type and one case of I I I+IIc type) were found and others were far advanced cases. (5) For fur ther improvement of gastric mass survey we would like to emphasize nexts: ( i ) Number of examined cases in one day has to be limited certain 50~60 cases, for fur ther deviced procedure for radiological exposure of the auterior wall of the stomach. ( i i) It is desirable to carry a indirect roentogenographic T.V. and in mass survey car ride skillful radiologist for first screening. (iii) Improvement of roentgenologic T.V. and endoscopy instrument. (iv) Registration and strict follow up study of cancer patients.

On the function of autonomic nervous system in patients with peptic ulcer

In order to know the function of autonomic nervous system of pat ients with peptic ulcer, both i t s tonus in res t s tate and it s a t t i tude to chemical s t imula t ion were examined. The fo rmer is judged synthetical ly on the basis of findings of 9 examinat ions i. e. max. blood pressure, hear t period, sublingual tempera tur , electric palmar skin resistence, electric fo rea rm resistence, basal metabolic ratio, adrenal in and noradrenal in in ur ine and its sum, which were selected out of 30 examinat ions th rough principal component solution in factor analysis. The la t ter is done by means of mecholyl test . Using the fo rmer method, it can be said sefely tha t autonomic dis turbance dominates in peptic ulcer as a rule and sympathet icotonic state is seen of tner in duodenal ulcer tha t in gastr ic ulcer. Us ing mecholyl test, it was found tha t p-type dominates in gast r ic ulcer and stype is seen of tener in duodenal ulcer than in gastr ic ulcer. Only electrical palmal skin resistence represent ing psychogenic persp i ra t ion in above wr i t ten 9 examinat ions showed more sympathet icotonic s tate in duodenal ulcer than in gastr ic ulcer, and personal i ty tes t such as Y.G., C . M . I . and M.A.S . showed abnormal in duodenal ulcer and sympathet icotonic state. As a result , i t seems tha t the funct ional difference of autonomic nervous system between gastr ic and duodenal ulcer is related to psychogenic factor and remains to be determined in the future.