Minoru Fukuda

Suppressive Effect of Antiulcer Agents on Granulocytes—A Role for Granulocytes in Gastric Ulcer Formation

Many clinicians have believed that H2-blockers and proton pump inhibitors ameliorate gastric ulcers via their antacid function. We examined the effects of these antacids on granulocytes. Gastric ulcer patients were administered an H2-blocker or proton pump inhibitor for a week and the number of granulocytes and the superoxide production were examined. To determine the trafficking of granulocytes, mice were exposed to restraint stress for 24 hr. The H2-blocker decreased the number of granulocytes, while the proton pump inhibitor suppressed their superoxide production in humans and mice. The major function of H2-blockers and proton pump inhibitors in curing gastric ulcers seems to be their suppressive effects on granulocytes. In this case, stress accelerates the trafficking of granulocytes from the bone marrow to the gastric mucosa. If we demonstrate a role for granulocytes in gastric ulcer formation, an gap in the acid–pepsin theory and the Helicobacter pylori theory is filled in.

ADENOCARCINOMA IN THE ANAL CANAL ASSOCIATED WITH A FISTULA : REPORT OF A CASE

Adenocarcinoma in the anal canal associated with an anal fistula is extremely rare, and in most cases its origin is difficult to ascertain because the primary sites have already been destroyed before any diagnosis of malignancy is able to be made. We report herein the case of a 62-year-old man found to have papillary adenocarcinoma with partial mucinous carcinoma associated with an anal fistula. The tumor was not exposed to the mucosal surface of the anal canal or rectum and an abdominoperineal resection was carried out. Macroscopic findings suggested that the tumor had developed from the anal fistula; however, the tumor showed a positive result when tested for O-acetylated sialic acids. This test also proved positive in the mucus of normal rectal mucosa, but not in the mucus of the anal glands. We speculated that the results of these tests may indicate that this tumor could have originated from the rectal mucosa, from where it migrated into the anal fistula.

Difference in calcium metabolism following Billroth-I and Billroth-II procedures for gastric and duodenal ulcers.

There have been 7 patients with postoperative osteomalacia in our series of 500 patients who had a gastrectomy for gastric or duodenal ulcers. All seven of these patients had a Billroth-II type gastrojejunostomy or esophagojejunostomy which caused food to bypass the duodenum and the upper part of the jejunum, and six of these patients showed milk intolerance and had diarrhea on food other than cows milk. From this finding, it may be surmised that patients are predisposed to osteopenia after gastrectomy due to disorder in the process of calcium absorption and they develop osteomalacia when treated with the Billroth-II procedure, showing milk intolerance and diarrhea on food other than cows milk.

A case of bilateral obturator hernias: Image diagnosis and description of a retropublic operative approach

A case of bilateral obturator hernias which was diagnosed by ultrasonography (US) and computed tomography (CT), and repaired by a retropublic extraperitoneal operative approach under spinal anesthesia is reported herein. A 91-year-old woman presented with lower abdominal and left groin pain consistent with a Howship-Romberg sign. US demonstrated an image of the bowel projecting from the small pelvic space to the left thigh with a to-and-fro movement of the bowel contents. The definitive diagnosis of an incarcerated left obturator hernia was made by CT which also revealed a mass in the right obturator foramen. Surgery was performed through a retropublic extraperitoneal approach under spinal anesthesia. No necrosis was observed in the incarcerated bowel and resection was not necessary. A simple hernial sac was found in the right obturator canal. The operation using the retropublic extraperitoneal approach was successful and we believe it to be the most effective procedure for obturator hernias which have been diagnosed early.

Hepatic portal venous gas associated with cholangitis following pancreaticoduodenectomy : report of a case

A 63-year-old man developmented fever and shock 2 weeks after undergoing a pancreaticoduodenectomy for carcinoma of the gallbladder with duodenal involvement. Computed tomography (CT) of the abdomen showed transient hepatic portal venous gas in the right lobe of the liver, which had probably been induced by obstruction of the bilioenteric anastomosis by the biliary drain. The gas and bacteria, both of which are commonly observed in cases of bilioenteric anastomosis, may have been diffused through the sinusoid into the portal venous system. Thus, hepatic portal venous gas could be a serious sign when it develops in patients with cholangitis following bilioenteric anastomosis.

Bone lesions and dental caries after gastrectomy--evaluation of milk intolerance and operative procedure.

We investigated the development of bone lesions and dental caries in 350 patients who had undergone gastrectomy during the 11 year period from 1968 to 1978, on the basis of bone mineral content (BMC), decayed missing and filled (DMF) teeth and urinary c-AMP. We found that patients with low BMC and incidence of DMF teeth increased in number during the postoperative years; These abnormalities were, in comparison to the Billroth-I (B-I) and milk intake groups, significant in the Billroth-II (B-II) and non-milk intake groups. Among the gastrectomized patients, those with increased DMF teeth had significantly higher contents of urinary c-AMP. The possibility that secondary hyperparathyroidism resulting from gastrectomy contributes to the development and incidence of dental caries has to be given consideration.