Masayuki Muramoto

A bacteriological study of perforated duodenal ulcers

Peritoneal fluid sampling and bacteriological examination were performed in 63 patients with perforated duodenal ulcers, and the results compared with those in 175 patients with other perforations. Bacterial culture was positive in 100 per cent of the patients whose perforations occurred in the colon, whereas it was positive in only 44.4 per cent of those with duodenal perforations, being negative in many cases when the interval from perforation to surgery was short. A mixed contamination with both aerobes and anaerobes was usually found in the cases of lower digestive tract perforation, and the isolates from duodenal perforations were uniquely aerobes in most cases. It is suggested that bacteria play a minor role in the pathogenesis of early stage duodenal perforation, which supports the technique of primary closure without indwelling drainage tubes during early stage operations following sufficient peritoneal lavage. Moreover, if the stomach is empty at the time of perforation and the peritonitis is localized, even conservative therapy seems possible, provided it is begun shortly after the perforation.

A study on multiple primary gastric carcinoma.

過去18年間に教室で経験した多発胃癌症例について検討した. 多発胃癌の定義はMoertelらの基準によった.胃癌症例692例中同時性多発胃癌は24例 (3.4%) に認められ, 2多発癌22例, 3多発癌2例であった. 主・副病巣とも胃中部領域に存在するものが7例と最も多かった. 副病巣には早期癌が比較的多かった. 多発早期胃癌では陥凹型と隆起型の組み合わせは1例のみであった.組織型の組み合わせでは, 主・副病巣とも分化型を呈するものが14例 (58.3%) に認められた. 副病巣が胃上部領域に存在する6例は, 組織学的に副病巣の方がより低分化であった.中下部領域胃癌に対して幽門側胃亜全摘出術を施行する際には, 術前および術中に胃上部領域の検索を行い, 併存する癌病巣を見逃さないよう十分な注意が必要である.

Bacteriological study of peritonitis due to perforated duodenal ulcer.

十二指腸潰瘍穿孔例 (63例) について, 手術時採取腹水の細菌学的検討を行い, その他の部位の穿孔例 (175例) と比較した. 腹水中細菌の陽性率は, 結腸穿孔 (陽性率100%) などの下部消化管穿孔と比較し, 十二指腸潰瘍穿孔では44.4%と低く, さらに穿孔より手術までの時間の短いものでは菌陰性例が多かった. 腹水から好気性菌と嫌気性菌が混合で分離される症例は下部消化管穿孔に多く, 十二指腸潰瘍穿孔では好気性菌の単独分離が多かった. 十二指腸潰瘍穿孔の早期手術例では, その病態に細菌が関与することは少ないと考えられた.