Noburu Sakakibara

The preventive and therapeutic effects of vagotomy for stress ulcer —Experimental studies on the aspects of gastric submucosal blood flow and ulcer index—

The purpose of this study was to examine the preventive and therapeutic effects of vagotomy on the stress-induced ulcer in terms of gastric submucosal blood flow and ulcer index. Stress was induced in male Wistar rats by forced immersion in water, and the gastric submucosal blood flow (hydrogen clearance method) and ulcer index were determined in animals that underwent truncal vagotomy alone or truncal vagotomy+pyloroplasty as well as in untreated controls. Both truncal vagotomy alone and truncal vagotomy+pyloroplasty were effective in maintaining the blood flow during stress and preventing the development of ulcers, however, these effects were more notable in the truncal vagotomy+pyloroplasty animals. Truncal vagotomy alone or truncal vagotomy+pyloroplasty performed after the development of stress-induced ulcers had no therapeutic effects.

Three Cases of Esophageal Granular Cell Tumor

Abstract: Although it has long been thought that granular cell tumor (GCT) is relatively uncommon in the esophagus, in recent years, reports of this disease have increased due to advances in endoscopic examination and endoscopic therapy. The authors recently experienced three cases of esophageal GCT, all of whom underwent endoscopic polypectomy. Endoscopic findings were consistent with Yamadas type I or II, the surface of the lesions being smooth and the color white or whitish‐yellow. These three cases were treated by endoscopic polypectomy. In case 1, the resection was made possible by raising the tumor with forceps under a 2‐channel‐scope. In case 2, the tumor was resectable following submucosal injection of physiological saline. In case 3, the tumor was resected via strangulation with a snare. The lesions described herein were diagnosed as benign and completely resected by polypectomy, though some showed differences in nuclear size or dyskaryosis. As numerous points remain to be clarified regarding the clinical characteristics of this tumor, and some tumors have been diagnosed as malignant despite being small, it appears that endoscopic polypectomy should be performed for the purpose of diagnosis as well as complete resection.

Search for immunobiological parameters predictive of clinical effects of OK-432 in patients with malignant ascites

Although OK-432, a potent BRM, has been known to induce the remarkable improvement of clinical conditions in cancer patients through its strong effects on their immune capabilities, no specific immune parameters have been identified to best predict the clinical outcome after the OK-432 treatment. In an attempt to identify early parameters indicative of the clinical effects, we have administered 0.1 mg of OK-432 intraperitoneally to a total of 12 patients with malignant ascites and examined peritoneal fluid and peripheral blood obtained on 4 days before, 1, 3, and 7 days after the OK-432 injection using various immunobiological assays. Four weeks later, clinical improvements were evaluated by the disappearance of malignant cells from and/or substantial decrease in ascites. Four patients (responders) showed the improvements while 8 patients (nonresponders) showed no clinical evidence for improvement. In a few parameters among the many examined, significantly different patterns of changes were noted between responders and nonresponders. Thus, in nonresponder patients MØ and T cell population returned to an initial low level after early increases (on days 1 and/or 3), while they remained increased day 1 through 7 in responders. In responder patients, the cytotoxicity of peritoneal mononuclear cells against K562 and Daudi cells were augmented on day 7, but not in nonresponder patients. Thein vitro stimulation of the mononuclear cells with OK-432 enhanced the cytotoxic activity and induced the interferon (IFN) production in the responders but not in nonresponders. These parameters will be useful for the early prediction of the expected clinical effects of OK-432.

A Clinical Study of Acute Pancreatitis following Endoscopic Retrograde Cholangiopancreatography

Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) has been established as a safe and effective examination for patients with pancreatobiliary diseases. Pancreatitis following ERCP is an extremely rare complication. However, once pancreatitis occurs, patients may deteriorate developing a severe condition. This study was designed to investigate the cause of this pancreatitis with the aim of minimizing complications.

A Case of Duodenal Duplication

Abstract: Duplication of the duodenum is extremely rare. Including the present case, duodenal duplication in adults has been reported in only 20 cases in Japan. All previously reported cases underwent open surgery, and endoscopic resection has not previously been reported. In this report, we describe a patient in whom a duodenal duplication was endoscopically resectable, demonstrating the usefulness of endoscopic resection for the treatment of this malformation.

Study of Distribution of Minute Gastric Cancerous Foci in Multiple Early Gastric Cancer Cases — In Order to Decide the Extent of Gastric Resection

In this study, we analyzed the relationship between the distribution of cancerous foci and the condition of the surrounding mucosa on the 28 cases of multiple early gastric cancer having the co-existence of minute cancerous focus. The macroscopic types of the minute foci were the IIb or IIe type, and only one focus was diagnosed by the preoperative examination. The main foci and the minute foci were mainly in the same surrounding gastric mucosa, and mainly showed the same histologic type. In cases that had cancerous focus located in the intermediate zone, the foci showed the tendency of multiplicity and the minute foci distributed widely in the intermediate zone.

Significance of Fecal Bile Acid Ratio in Colorectal Cancer Patients

Fecal bile acid values in 10 colorectal cancer patients have been demonstrated to have diagnostic significance. Deoxycholic acid (DCA) and cholic acid (CA) were measured by Emzyme Linked Immunosorbent Assay (ELISA) method and their composition ratio (DCA/CA) was used for the pre and post operative comparison. The post operative ratio was found to be lower than the pre operative ratio in every patient. The result can be anticipated the clinical utility in the diagnosis of colorectal cancer patients.

Pathogen Oriented Prevention of Hepatocellular Carcinoma in Japan

Annual mortality of HCC in Japan was 21.1/105 in 1990. Less than 25% of them were due to persistent HBV infection and 77% to HCV infection including 10% double infection. Main route of persistent HBV infection was perinatal and that of HCV was blood transfusion. Immunization with HBIG and HB vaccine of newborn babies made 98% protection and HCV blood screening 99% protection. Improvement of general hygienic and nutritional states significantly prevented both virus infections. Together with interferon therapy and early stage diagnosis, more than 92% of HCC in Japan can be prevented.

Experimental Studies on Relationship Between Donor Starvation and Graft Viability after Liver Transplantation.

肝移植後のgraft viabilityをdonorの絶食期間とdonor肝の単純浸漬冷却保存時間cold ischemic time (CIT) の面より検討した. 肝移植後3時間の胆汁排泄量は, 絶食期間が48時間以上になると, CITの延長するほど低値を示した. また30日生存率は絶食期間48時間, CIT6時間, 絶食期間72時間, CIT1, 6時間で0%と, Euro-Collins solutionの安全域とされるCIT6時間でも極めて不良であった. 肝ATPは絶食期間72時間で有意に低値を, 肝ADPとenergy chargeは絶食期間48, 72時間で有意に低値を示し, これらはCITの延長とともにより低下した. 電顕による観察では, 絶食期間48時間以上で細胞質の空胞化, 類洞内にblebが認められ, CITが6時間では類洞内皮細胞の変性, 脱落が認められた. 以上よりdonorの48時間絶食ではCITが延長すると, また72時間絶食ではCITが短時間でも, 肝移植後のgraft viabilityを低下させ, 移植成績を不良とする原因となりうることが示唆された.

Clinical Study on Perforated Peptic Ulcers in the Elderly.

本論文の目的は, 70歳以上の消化性潰瘍穿孔例を詳細に分析し, その臨床的特徴を明らかにすることにある.対象は1966年から1990年までに, 順天堂大学で手術が施行された消化性潰瘍穿孔192例で, うち70歳以上の高齢者は20例であった.方法は全例を年代別, 年齢別に検討し70歳以上の症例については, 患者背景, 術前併存疾患, 臨床所見, 治療, 病理学的所見および死亡例について検討した.最近の10年間で70歳以上の症例は有意に増加し, 穿孔症例の年代別平均年齢は年々高くなっている.70歳以上の穿孔例20例のうち十二指腸潰瘍は16例と多くを占めていた.潰瘍の既往歴の無い例は14例で, 術前併存疾患合併率は85%であった.病理学的には急性潰瘍型が11例であった. 手術は単純閉鎖術が2例のみで他は根治手術が行われ, 手術死亡は4例であった.高齢老の穿孔例は, 既往歴の無い例が多く, 病状が刻々変化するので, 画像診断を駆使して早期に診断すべきである.