S. Miwa

Studies on leucine aminopeptidase

It is well known tha t the liver protein content remarkably decreases in CC14 damaged ra t and that high prote in diet is profitable in recovering the damaged liver. We examine the a l ternat ion of activi t ies of following four teen liver enzymes-amino acid act ivat ing enzyme, t ransaminases , peptidases, glutamic dehydrogenase, glutamine synthetase , arginine synthetase etc. 1) CC14 damaged ra t liver, a) arginine synthetase: From beginning the activity gradual ly decreases in the course of damaging, b) amino acid act ivat ing enzyme: In early stage the activity sl ightly increases and in late stage when liver protein content diminishes ex t remely it decreases markedly. 2) Damaged l iver and high protein diet . We adminis ter high prote in diet and s tandard diet to damaged ra ts and observe a l thernat ion of activit ies, a) arginine synthetase: The act ivi ty gradually increases but there is no difference in activity between the group of high prote in diet and tha t of s tandard diet. b) amino acid act ivat ing enzyme: The activity of high prote in diet increases more rapidly than that of s tandard diet.

Course of gastric ulcer after niche disappeared Based on x-ray figure of ulcer

considerat ion was laid on the X-ray diagnosis of depressed type of early carcinoma in the grea ter curvature , based on 9 cases experienced, including 2 cases of microcarc inoma wi th the largest d iameter less than 5 ram. 1) Barium-filled Stomach: In 2 cases wi th relatively large ulcerat ion (Type I Ic+I I I ) , barium-filled stomach showed obviously the existence of the lesion, due to marked degree of marg ina l depression. In the remain ing 5 cases except for 2 cases of microcarcinoma, barium-filled s tomach could not lead to confirmation of the lesions, because some findings such as marg ina l depression, marg ina l i r regular i ty and depressed niche were fa r minute, compared with the gross findings of the lesions, and they appeared reluctant ly in the serialy taken films. 2) Double Contrast Radiograph: Barium fleck and convergence of the folds character is t ic of Type IIc (or Type III) were noticed in 7 cases. Marginal changes such as depression, depressed niche and i r regular i ty were obtained in 6 cases, and 3 of 6 cases they appeared and disappeared, according to the gastr ic per is ta ls is , the degree of extension, and posi t ioning of the patients . 3) Compression Study: In 3 cases compress ion was applied correct ly to the lesion, and the findings demonst ra ted were charac te r i s t ic of Type IIc (or Type III), but in only one case the lesion was detected at fluoroscopy. It deserves mention, however, tha t in 2 cases marg ina l depression or t iny filling defect was relat ively clearly demonst ra ted in the films, despite tha t compression applied was a little out of focus. This may be an aid to the diagnosis of the depressed type of ear ly carcinoma in the grea te r curvature . 4) Mucosal Study: In 2 cases charac ter i s t ic findings of Type IIc (or Type III) was obtained. 5) In 2 cases of microcarcinoma, only very sl ight changes of the marg in were pointed out by the re t rospect ive in terpre ta ion of radiographs.

Differential diagnosis between early cancer and advanced cancer of the stomach (On the basis of x-ray diagnosis)

We studied on the relation of the chief complaint to the size, gross appearance and the location of the tumor, and also to the stage of carcinoma progress, and especially to the accompanying gastr i t is of the resective stomach in the gastric carcinoma cases. The result obtained are summarized as follows. 1) Some abdonimal pain (i.e. nausea, epigastric discomfort, bloody vomiting, epigastric inflation) was complained in 425 (82.5%) out of 513 cases and some general complaint (i.e. anorexia, anemia, lassitude, emaciation) in 101 cases (19.7%), and also no pain in 52 cases (10.1%). The rate of appearance of the complaints was slightly increasing with the progress of lesion. 2) The chief complaint was independent of the size of the tumor. The rate of appearance of complaints was higher in the cases in which the tumor was located in the antrum than the others, and also the gastric pain was more marked in the case of Borrmann type II and III. 3) The metaplastic severe atrophic gastr i t is was observed in 31 (45%) out of 68 cases and no gastri t ic finding in 10 cases (14.5%). There was no significant correlation between the chief complaint and the accompanying gastr i t is of the resective stomach. 4) Among 35 cases of the early gastric carcinoma, 22 cases (63%) felt a abdominal pain, but all cases complained no general symptom.

A new safer method of percutaneous transhepatic cholangiography in the differential diagnosis of jaundice

Though the pathologic changes, which seem to intercept extrahepatic bile flow, involve in the common bile duct and the surrounding organs, jaundice manifests not always clinically. So, we have been investigating the morphological factors contributing to the clinical manifestation of jaundice in the pathologic changes of the common bile duct and its surrounding organs. To realize our intention, we have been observing the clinical course of patients with pathologic changes of them, who were eventually treated either surgically or autoptically. Two years after the first pointing out the dilated common bile duct on the X-ray examination, cholecystectomy and choledochoplastic operation were performed and disclosed impaction of a stone 1 cm in diameter in the prepapil lary portion, a contracted gallbladder and the obstruction of the cystic duct. The common bile duct measured 25ram in diameter. This case has never had icteric manifestation. In order to clarify the interrelationship between the extent of the common bile duct and the icteric manifestation, we have studied some cases with idiopathic dilatation of the common bile duct, which we have before treated in our clinic and we have hitherto found in literature. Standing upon the investigation, we can say that there is a limit to the clinical manifestation of jaundice between hens and gooses egg in size. In a case, in which the common bile duct was packed full with 24 gallstones 5~10mm in diameter, laparotomy disclosed also 13 stones and carcinoma of the bladder. In another case, the carcinoma of the gallbladder infiltrated to the wall of the choledochus and then caused thickening of it. The common bile duct measured 15mm in width and the canal was very restricted. Histological examination revealed intense fibrosis including metas tas is of carcinoma into the wall of the choledochus and impacted desquamated epithelial cells in the canal of it. In these cases, adhesion surrounding the choledochus, thickening of the common bile duct, narrowing of the canal and impaction of desquamated epithelial cells into the canal of the common bile duct are morphological factors for the icteric manifestation. When carcinoma obstructed thoroughly the canal, jaundice became lasting. Based on our own experience and hitherto reported cases, it can be said that the most important morphological difference between carcinoma of panreatic head with jaundice and that without jaundice lies whether carcinoma infiltrates into the major papilla of Vater. From what we have above described, it might be said that simultaneous existence of both decreased elasticity of the common bile duct and intracanal materials, such as gallstone and desquamated cells, causes icteric manifestation.

Studies on bile secretion (III) the uptake, conjugation and excretion of bile pigments by the liver under the obstructive jaundice

on the host ra t s was found to have higher electrophoret ic mobili ty and increased surface concent ra t ion of sialic acid residues, comparing wi th low mal ignant s t ra in of the asci tes hepatoma, AH 62F. Based on the above findings, the electrokinetic propert ies of human stomach cancers, surgically removed, were examined. All e lectrophoret ic mobil i t ies of 12 stomach cancer cells were found to be higher than the one of the gast r ic epithelial cells of the surrounding mucosal layer in each corresponding case, though each difference was var iable with the histopathological features of each cancer case. In general , the electrophoretic mobil i t ies of anaplast ic cancers have higher than the one of the differenciated type of cancers. And there are considerable var ia t ions of individual cancer cells in the electrophoretic mobi l i t ies of anaplast ic cancers. The findings were thought to correspond to the morphological pleomorphismus of anaplas t ic cancers .

Bile secretion (2): Bile secretion and obstructive jaundice

We have reported experimental studies on the pathophysiology of bile outflow in this society. Recently, we performed experiments on the effect of phosphorylcholine on bile outflow, demonstrating a marked effect of augmenting the bile outflow and the movement of the biliary system. Adult dogs more than 10 kg were used in the experimental method III of our own device. Experiments of intravenous injection of phosphorylcholine in dogs revealed a marked effect of elevating the internal pressure of the gallbladder, augmenting the flow of hepatic bile, and relaxing of the sphincter of oddi. Based on such experimental results, cases with poor contraction of the gallbladder were selected clinicaly treatment with phosphorylcholine which was given 200 mg intramuscularly for 2 weeks. Subsequent cholecystography revealed an excellent contracting ability of the gallbladder. From these experimental and clinical studies, it might be concluded that phosphorylcholine increases outflow of bile, being effective in the treatment of diseases of gallbladder and biliary tract.

Studies on the tissue mast cells in the liver of viral hepatitis

In our institute, endoscopic examination of the s tomach were done in 2027 cases; 980 cases of Fiberscope, 581 cases of Gastrocamera (V type), 466 cases Retrovision Gastrocamera (Vb type) f rom May, 1965 to February, 1967. In this study, the relationship between X-ray findings and pictures from Vb type Gastrocamera was studied. The cases showing irregularity of the margin in lesser curvature of the cardia and barium floccuration or fleck on the cardia were selected and observed in detail by Vb type. I. Of 466 cases, 60 showed the irregularity of the margin. Examination by the Vb type revealed only gastri t is in 56 cases (93%), ulcer in 2 cases (3%), xanthoma in one case. Another one failed in this examination. These gastr i t is were always severe and showed reddish and uneven cardiac mucosa with many folds. 2. In X-ray, 22 cases showed the barium floccuration or fleck and all cases had manifest gastr i t is as shown before, and had no other finding in the pictures from Vb. It is considered that the irregulari ty and the barium floccuration or fleck in X-ray films were correlated to the unevenness, a large quantity of mucas and many folds due to severe gastrit is. But of these cases showing the irregulari ty in X-ray, 2 cases revealed ulcer. Therefore, in these cases repeated examination by the Vb gastrocamera is nessesary.

Fine structure of the liver in dubin-johnson syndrome

Some investigations have been reported on the fine s t ructure of human hepatoma, whi le little on metastat ic carcinome of human liver. Two cases of metas ta t ic carcinomas in the liver, one of which was adenocarcinoma of sixty-four-year-old man obtained by the needle biopsy and another carcinoma simplex of seventy-three-year-old woman obtained by the exploratory laparotomy were examined with electron microscope. Mitochondria were small and scanty in the cell of adenocarcinoma. Cristae mitochondriales were i rregular and partly disappeared to become vacuole. Cisternae of rough of rough ER were dilated to form vesicle or vacuole-like structure. Extremely bizzare and irregular nucleus and its envelope deeply dipping into the nuclear matr ix to form inclusion body or vacuole were observed. In the lumen formed by several tumor cells long microvilli resembling those of intestine were most prominent. The cell of carcinoma simplex had a gigantic nucleus and a greatly decreased cytoplasmic volume. Few organelles were seen except for abundant free ribosomes. Bile ductulus-like formaions were present frequently between the adjacent cells, Neither microvilli nor bile pigment, however were observed.

Electron microscopic observations on metastatic carcinoma of human liver

Some investigations have been reported on the fine s t ructure of human hepatoma, whi le little on metastat ic carcinome of human liver. Two cases of metas ta t ic carcinomas in the liver, one of which was adenocarcinoma of sixty-four-year-old man obtained by the needle biopsy and another carcinoma simplex of seventy-three-year-old woman obtained by the exploratory laparotomy were examined with electron microscope. Mitochondria were small and scanty in the cell of adenocarcinoma. Cristae mitochondriales were i rregular and partly disappeared to become vacuole. Cisternae of rough of rough ER were dilated to form vesicle or vacuole-like structure. Extremely bizzare and irregular nucleus and its envelope deeply dipping into the nuclear matr ix to form inclusion body or vacuole were observed. In the lumen formed by several tumor cells long microvilli resembling those of intestine were most prominent. The cell of carcinoma simplex had a gigantic nucleus and a greatly decreased cytoplasmic volume. Few organelles were seen except for abundant free ribosomes. Bile ductulus-like formaions were present frequently between the adjacent cells, Neither microvilli nor bile pigment, however were observed.

Influence of experimental hepatic disorder on plasma cholesterol esters (I)

Serum Triglycerides level in hepatic disease showed high in serum hepatit is and obstructive jaundice, relatively high level in viral hepatitis, and relatively low level in liver cirrhosis. In the course of hepatic disease, Triglycerides showed markedly relat ionship wi th liver functions, and especially S-GOT, S-GPT, bilirubin became normal or marked reduction in many cases of triglycerides reduced patients. But we noticed that, in the triglycerides increased cases though GOT, GPT became normal level, the other liver functions especially bilirubin, T. T. T. and A.P. was not improved or conversedly worsed in many patients.