S. Matsukura

Studies on gallstones by means of the x-ray diffractometer

Powder X-ray diffractometer char t s of 7 crit ical gal ls tones are shown in F igure 1, where some differences between cholesterol stone and calcium bi l i rubinate stone are confirmed at 20 in 14.9 ~ 15.5 ~ 17 ~ and 23.1 ~ Hydrous cholesterol stone associated by cholesterol shows a spli t t ing peak a t 20 in 14.6 ~ and 14.9, where the fo rmer peak is s t ronger than the la t te r of normal cholesterol stone. A calcium carbonate stone shows an indicant peak at 20 in 29.3 ~ and a fa t ty acid stone gives a dis t inct peak a t 20 in 13.8 ~ 419 206 diffraction charts of gallstone are shown in Table 1, where variations of peak in intensity ~re found. Figure 1. X-Ray Diffractometer Charts of Gallstones

Post cholecystectomic syndrome

Now in conclusion, the author has referred to the problems of postcholecystomic syndromes. In any case, it is essential to make correct diagnosis prior to any treatment in any disease. In my clinic, in 202 cases in period I from 1936 to 1956, the diagnosis was made correctly in 93.6% clinically on admission, and in 645 cases in period II from 1957 to June 1966, in 98.5%. Misdiagnosis was made in 13 cases in period I and in 9 cases in period II, i. e. in total in 22 cases. By the way, for the treatment of cholelithiasis, we surgeons should try to make the correct diagnosis in reference to various clinical symptoms as well as to clinical examinations and for the operation, not to deviate from the correct criteria of the indications and for the operative performance, not to damage the bile ducts or not to leave any gall stone and postoperatively, to pay enough attention to the rehabilitation, thus to endeavour to improve the therapeutic results.ConclusionNow in conclusion, the author has referred to the problems of postcholecystomic syndromes. In any case, it is essential to make correct diagnosis prior to any treatment in any disease. In my clinic, in 202 cases in period I from 1936 to 1956, the diagnosis was made correctly in 93.6% clinically on admission, and in 645 cases in period II from 1957 to June 1966, in 98.5%. Misdiagnosis was made in 13 cases in period I and in 9 cases in period II, i. e. in total in 22 cases.By the way, for the treatment of cholelithiasis, we surgeons should try to make the correct diagnosis in reference to various clinical symptoms as well as to clinical examinations and for the operation, not to deviate from the correct criteria of the indications and for the operative performance, not to damage the bile ducts or not to leave any gall stone and postoperatively, to pay enough attention to the rehabilitation, thus to endeavour to improve the therapeutic results.

Diagnosis and treatment of acute abdominal conditions with special reference to roentgenographic findings

Abstract The diagnosis and treatment of acute abdominal conditions, with the principal emphasis on abdominal x-ray findings, are discussed. There are various diseases which are classified under the category of acute abdominal conditions, and it is therefore very difficult to make a diagnosis of each of them without making any error. Early diagnosis and adequate treatment are possible if one thoroughly examines the abdominal roentgenographic findings with reference to the various clinical symptoms which accompany the abdominal pain. Needless to say early diagnosis is as important in acute abdominal conditions as it is in any other disease. However, early treatment is postulated even more urgently and the utmost care must be taken not to lose much time in a search for diagnosis, which would thus risk the life of the patient. It is therefore considered necessary to resort to laparotomy without hesitation when a diagnosis of acute abdominal condition is roughly made, even if a more exact and detailed diagnosis is difficult.

Studies on cholelithiasis

Summary1)The results of the cholecystography in 227 cases with cholelithiasis, using Biloptin and Biligrafin in combination were as follows; in 96 cases of total cases (42.3%) stones were radiologically imaged, in 59 cases (26.0%) no stone was imaged but some abnormal findings in the morphology of the gall bladder or bile ducts were observed and 72 cases (31.7%) were radiologically so called “negative cases.”2)In the radiologically “negative cases”, the differential diagnosis is needed in consideration of other diseases in epigastrium, in which the image of gas formation of the intestinal canals in the right epigastrium plays an important role. In our study, the gas formation was observed in 66 of 72 radiologically negative cases (91.7%) and 34 cases of them were acute gangrenous cholecystitis.3)Cholecystographic studies were also made in dogs which were made artificially allergic cholecystitis in application of the antigen-antibody reaction using the cell substance of coli bacilli; the radiological image of the gall bladder became less and less distinguishable on the time passing until in 72 hours from the beginning it turned to the negative case. la these cases, also the gas formation of the intestinal canals was apparently observed and in these experiments the correlations among cholecystitis, radiologically negative cases and the appearance of the gas formation of the intestinal canals in the right epigastrium were clarified.4)The “Supersonogram”—an ultrasonic wave method in diagnosis—, exploited in our department, made it possible to obtain the recording of the tomogram of the living body and in this method the authors could also confirm the existence of gall stones, the localization, and the depth from the body surface. The stone-echo was obtained in 63 of 68 cases with cholelithiasis (92.6%) and it was a noticeable good result that in 27 of 31 radiologically negative cases (87.1%) the existence of stones was confirmed by “Supersonogram”. In our study it was apparent that the diagnostic result of cholelithiasis could be markedly improved by paying attention to the appearance of the abnormal gas formation of the intestinal canals in the right epigastrium radiologically on the one hand, and applying the “Supersonogram” on the other. The authors could obtain correct diagnosis of cholelithiasis, in 99.1% preoperatively by combining the previously mentioned methods and also in consideration of the clinical symptoms.1) The results of the cholecystography in 227 cases with cholelithiasis, using Biloptin and Biligrafin in combination were as follows; in 96 cases of total cases (42.3%) stones were radiologically imaged, in 59 cases (26.0%) no stone was imaged but some abnormal findings in the morphology of the gall bladder or bile ducts were observed and 72 cases (31.7%) were radiologically so called “negative cases.” 2) In the radiologically “negative cases”, the differential diagnosis is needed in consideration of other diseases in epigastrium, in which the image of gas formation of the intestinal canals in the right epigastrium plays an important role. In our study, the gas formation was observed in 66 of 72 radiologically negative cases (91.7%) and 34 cases of them were acute gangrenous cholecystitis. 3) Cholecystographic studies were also made in dogs which were made artificially allergic cholecystitis in application of the antigen-antibody reaction using the cell substance of coli bacilli; the radiological image of the gall bladder became less and less distinguishable on the time passing until in 72 hours from the beginning it turned to the negative case. la these cases, also the gas formation of the intestinal canals was apparently observed and in these experiments the correlations among cholecystitis, radiologically negative cases and the appearance of the gas formation of the intestinal canals in the right epigastrium were clarified. 4) The “Supersonogram”—an ultrasonic wave method in diagnosis—, exploited in our department, made it possible to obtain the recording of the tomogram of the living body and in this method the authors could also confirm the existence of gall stones, the localization, and the depth from the body surface. The stone-echo was obtained in 63 of 68 cases with cholelithiasis (92.6%) and it was a noticeable good result that in 27 of 31 radiologically negative cases (87.1%) the existence of stones was confirmed by “Supersonogram”. In our study it was apparent that the diagnostic result of cholelithiasis could be markedly improved by paying attention to the appearance of the abnormal gas formation of the intestinal canals in the right epigastrium radiologically on the one hand, and applying the “Supersonogram” on the other. The authors could obtain correct diagnosis of cholelithiasis, in 99.1% preoperatively by combining the previously mentioned methods and also in consideration of the clinical symptoms. The results of the cholecystography in 227 cases with cholelithiasis, using Biloptin and Biligrafin in combination were as follows; in 96 cases of total cases (42.3%) stones were radiologically imaged, in 59 cases (26.0%) no stone was imaged but some abnormal findings in the morphology of the gall bladder or bile ducts were observed and 72 cases (31.7%) were radiologically so called “negative cases.” In the radiologically “negative cases”, the differential diagnosis is needed in consideration of other diseases in epigastrium, in which the image of gas formation of the intestinal canals in the right epigastrium plays an important role. In our study, the gas formation was observed in 66 of 72 radiologically negative cases (91.7%) and 34 cases of them were acute gangrenous cholecystitis. Cholecystographic studies were also made in dogs which were made artificially allergic cholecystitis in application of the antigen-antibody reaction using the cell substance of coli bacilli; the radiological image of the gall bladder became less and less distinguishable on the time passing until in 72 hours from the beginning it turned to the negative case. la these cases, also the gas formation of the intestinal canals was apparently observed and in these experiments the correlations among cholecystitis, radiologically negative cases and the appearance of the gas formation of the intestinal canals in the right epigastrium were clarified. The “Supersonogram”—an ultrasonic wave method in diagnosis—, exploited in our department, made it possible to obtain the recording of the tomogram of the living body and in this method the authors could also confirm the existence of gall stones, the localization, and the depth from the body surface. The stone-echo was obtained in 63 of 68 cases with cholelithiasis (92.6%) and it was a noticeable good result that in 27 of 31 radiologically negative cases (87.1%) the existence of stones was confirmed by “Supersonogram”. In our study it was apparent that the diagnostic result of cholelithiasis could be markedly improved by paying attention to the appearance of the abnormal gas formation of the intestinal canals in the right epigastrium radiologically on the one hand, and applying the “Supersonogram” on the other. The authors could obtain correct diagnosis of cholelithiasis, in 99.1% preoperatively by combining the previously mentioned methods and also in consideration of the clinical symptoms.

Pathophysiological role of bile in the acute intestinal obstruction

In this paper, the resul t s of clinical and exper imenta l observat ions concerning the steroid induced ulcer, are presented. The incidence of the s teroid induced ulcer in the pat ients wi th var ious disease t rea ted in our clinic wi th cort icosteroids, was 2.4%. The incidence of ulcer in all was 2.8%. No difference was found in the incidence of ulcer between the s teroid t reated pa t ien ts and the control ones. Exper imental observat ions of s teroid ulcer were per formed on the guinea pigs. The an imals were feeded normally. 1 or 2 mg of be tamethasone was injected subcutaneously everyday in the periods ranging f rom 14 to 120 days. The s tomachs were fixed in Bouins fluid, embedded in paraffin and s tained with hematoxylin-eosin. Erosions of the mucous membrane occurred only in 3 of 20 guinea pigs.

Immunoserogical studies on the production of cholecystitis

Follow up resu l t s of 45 pat ients in th i s series have been presented. All 5 pa t ien ts wi th heredi tary spherocytosis and acquired hemolytic anemia were cured and gained in good heal th . Two cases wi th idiopathic thrombocytpenic purpura obtained only remission. Results of splenectomy in 4 cases of congestive splenomegaly due to cirrhosis oi the l iver and 2 cases of unknown causes were un i formly poor, The chief cause of death was hematemesis . In early and moderately advanced 32 cases of Banff s syndrom obtained in very good results, and gained in goog heal th of long durat ion. The cause of deaths were not hematemesis bu t mainly c i r rhosis of the liver.