S. Yamagata

Secretin-like activity in duodenal mucosa and peptic ulcer

SummaryThe secretin-like activity contained in bioptic specimens of duodenal mucosa was measured by means of bioassay in healthy controls and patients of peptic ulcer. It was found that the activity tended to be increased in duodenal ulcer in comparison with gastric ulcer which did not differ from healthy controls, Possibilities of impaired release and/or increased production of secretin-like substance in duodenal ulcer were discussed.

Comparison of dose-response curves between acid and pepsin to betazole hydrochloride in the dog with gastric fistula

SummarySecretory responses to subcutaneously or intravenously administered betazole hydrochloride of graded doses were compared between acid and pepsin in the dog with gastric fistula. Although the dose related increments in acid and pepsin outputs were parallel in the range of lower doses than 2.0 to 3.0 mg/kg body weight of betazole hydrochloride, higher doses caused in decrease in pepsin output, but did not in acid output. It was pointed out that the dose of betazole hydrochloride that stimulates acid secretion maximally dose not correspond to the maximal stimulation for pepsin secretion in the dog.

Difference in secretory response of the stomach to various gastric secretory depressants between gastric and duodenal ulcer

SummaryIn order to know the mechanisms responsible for producing the difference in basal secretion between gastric and duodenal ulcer, secretory response of the stomach to gastric secretory depressants of differenent acting mechanisms was compared. The intravenous administration of an anticholinergic agent “glycopyrrolate” reduced both basal acid and pepsin output more profoundly in duodenal ulcer than gastric ulcer, while intravenous administration of secretin yielded the opposite results in acid secretion in contrast to the indifinite tendency observed in pepsin secretion. In this connection secretin was shown to depress the gastrin-mediated acid secretion of the stomach. It was concluded that the elevated basal secretion in duodenal ulcer is caused under the more intensive vagal influence than gastric ulcer, and basal acid secretion in gastric ulcer is relatively under the intensive influence of gastrin-mediated humoral secretory mechanism in comparison with duodenal ulcer. Key words : peptic ulcer, gastric ulcer, duodenal ulcer, gsatric secretion, acid, pepsin, gastrin, gastric secretory depressant, anticholinergic agent, glycopyrrolate, secretory cell mass, neural secretory mechanism, humoral secretory mechanism, secretin.

Study of the inhibitory action of prostaglandin on gastric secretion in rat and man

Synthesized prostaglandin Et (PGEt) was investigated regarding its inhibitory effect on gastric juice secretion and experimental gastric ulcer formation. Continuous increase of gastric juice secretion was produced by cont inuous injection of histalog to the dogs with pylorus ligation. The gastric juice secretion was remarkably inhibited by int ravenous injection of PGE1, 2/*g/kg/min, for 20 minutes. The secretion star ted again 20 minutes after discontinuation of the injection. Gastric ulcer was produced experimental ly on ra ts to observe the inhibitory effect of PGE1. PGE1 remarkably inhibited gastric juice secretion to produce Shay s ulcer and Reserpin ulcer, but only mildly to produce steroid ulcer.

Measurement of plasma gastrin level by radioimmunoassay in various clinical entities

The plasma gastrin concentration was measured by radioimmunoassay of two antibody method in various clinical entities. Although the increase in age tended to elevate the fasting plasma gastrin level in general in cases without any localized organic diseases of the stomach, no difference was found among each decades in selected cases of endoseopically normal gastric mucosa and each remained as high as 163.70• Accordingly the age-effect of the fasting plasma gastrin level was regarded to reflect the difference of the incidence and the degree of atrophic gastritis in each decade. High degree of atrophic mncosal changes in advanced gastric cancer was also found to effect the fasting plasma gastrin level significantly. No essential difference was found concerning both the fasting and postprandial plasma gastrin level among eases of endoscopically normal gastric mucosa, gastric ulcer and duodenal ulcer. Besides the stomach, diseases of the kidney and liver especially the former were found to elevate the fasting plasma gastrin level.

Multiplicity of gastric proteases and its clinical significance

Bioptic specimens of gastric mucosa and 24 hours urine specimens collected from cases of histologically normal gastric mucosa or various gastric diseases were studied for multiple existence of acid proteases by means of agar gel electrophoresis. In cases of histologically normal gastric mucosa, mucosa obtained from fundie gland area, was proved to contain eight proteases, PI to PVII and slow mo,Ang protease (SMP), while in pyloric gland area three proteases, PVI, PVII and SMP, were found. In urine, however, four to three proteases, PII to PV, were demonstrated. These findings indicate that two groups of gastric proteases are elaborated in gastric mucosa characterized by the different distribution on gastric mucosa and the different attitude to renal excretion. Namely PI to PV were produced in fundic glandular area probably in chief ceils and excreted into urine, while PVI, PVII and SMP are elaborated in whole gastric mucosa probably in mucous neck cells and do not appear in urine. In a case of pernicious anemia only SMP was demonstrated in all mucosal specimens without any connection to the site of biopsy. In cases of early cancer of ulcerative type, mucosal specimen obtained at the edge of lesion does not show any proteolytic activity, while the full spectrum of proteases was found at the distant site from the lesion. The same findings were found in mucosal specimens around peptic ulcer.

The study on the metabolism of gastrin and its related substance

Using Lais method modified by adoption of Brom Cresol Green as the indicator to detect the terminal point of acid secretory response of rat s stomach to A0C tetrapeptide which was given via femoral vein or superior mesenteric vein, acid output in each method of administration was compared with following conclusions. 1) The decrease in acid output was observed in the administration of AOC tetrapeptide via sup. mesent, vein as compared with via femoral vein. The data was interpreted to support the livers role in inactivation of AOC tetrapeptide. 2) The pattern of this decrease is not simple irrespective of method of experiment used namely various dosis of stimulus given in the certain time and the certain dosis of stimulus given in the different time, suggesting that the mechanism of inactivation of AOC tetrapeptide in the liver is complicated. 3) The possibility that such complicated mechanism of inactivation may be working against endogenous gastrin physiologically in the liver is pointed out. This may necessitate to consider the possible secondary hypergastrinemia due to decreased inactivating ability in the liver as the aetiological factor of peptic ulcer which is known to occur frequently in various liver diseases in addition to the primary hypergastrinemia due to increased release of gastrin into blood stream.

The roentgenological studies on the clinical course of the gastric ulcer

To invest igate the possibli ty of express ing mathemat ica l ly the prognosis of the gastr ic ulcer on the basis of the measurement on the X-ray film, H(~) and H(~),, as designated in the at tached diagram, were calculated in 91 pat ients wi th the gastr ic ulcer on 113 ulcers. All these pat ients were hospitalized pat ients and followed by the periodic X-ray examinat ion which included both of filling and double cont ras t method at the interval of two to three weeks. The resul ts demonstrated tha t the actual number of the days required for the healing correlated significantly with the H(a),. On the basis of roentgenological profile niche of the initial X ray examination, the gastr ic ulcers were classified into 5 types namely special type, and type I to IV. The X-ray findings of the healed gast r ic ulcers were classified into 5 types, namely type UNO, UNI (UNIt), UN II (UNIIr), UN III and UN IV. The relat ionship between these two classifications is studied by comparing them in each pat ients and the resul ts are reported.

Gastric mass survey in Miyagi prefecture

(1) Since Sept. 1964 to June 1967, the gastric mass survery in field on 12,212 cases have been performed. Across examination was necessary for 3,472 cases and the rate of cross examination was 28.8%. (2) The indirect roentgenographic apparatus was taken by Hitachi 113 type (Odelca-mirror camera) which was set up on the car. We employed the roentgenographic procedure as a s tandard which 4 films were taken in upright position and 2 in supine position. (3) Pat ients who underwent examination (from April 1966 to June 1967; 6711 cases) readed to 40% in forty decade; 22% in fifty decade and 19% in thir ty decade. (4) The results of the cross examination on 2835 cases is as follows; 33 cases of gastric cancer (5 cases were early stage cancer), 42 cases of gastric polyp, 565 cases of gastr ic ulcer, 155 cases of duodenal ulcer, and 39 cases of gastroduodenal ulcer. Out of 33 cases, 5 cases of early stage cancer (1 case of I Ia§ type; 1 case of IIc type, 2 cases of Hc+II I type and one case of I I I+IIc type) were found and others were far advanced cases. (5) For fur ther improvement of gastric mass survey we would like to emphasize nexts: ( i ) Number of examined cases in one day has to be limited certain 50~60 cases, for fur ther deviced procedure for radiological exposure of the auterior wall of the stomach. ( i i) It is desirable to carry a indirect roentogenographic T.V. and in mass survey car ride skillful radiologist for first screening. (iii) Improvement of roentgenologic T.V. and endoscopy instrument. (iv) Registration and strict follow up study of cancer patients.

A Case of intrahepatic aneurysm diagnosed by selective celiacography

In t rahepat ic aneurysm is an uncommon lesion which is very ra re ly diagnosed preoperatively and only a smal l number of cases have been succesfully treated. A 34-years-old male admitted in our hospital because of bleeding gas t r ic ulcer, and gas t ro je junos tomy was performed on 15. March, 1966. The bleeding was pointed out rup tured a r te ry on the bot tom of the ulcer by histologic examinat ion. After this operat ion serum hepati t is was developed and SGT elevated to 260 u., SGPT was 420 unit . For the purpose of making accurate diagnosis needle biopsy of liver was done under control ing by laparoscopy, and no serious bleeding was noted on liver surface. However following this procedure severe r igh t upper quodrant pain occured and vigorous t a r ry stool wi th hematoemesis came out continiously dur ing several weeks. Then selective cel iacography was performed by Seldinger s method and the X-ray film revealed two round aneurysm in the area of lobus quadora tus of the liver, which had small flngr top size and belong to the 3rd b ranch of hepatic ar tery. On the next day, par t ia l hepatectomy was performed and no more aneurysm was found by direct hepatic a r te r iography dur ing surgery. Now, pa t ien t has no hematoemesis or t a r ry stool af ter hepateetomy and has been very well. Numerous factor have been implicated in the etiology of this disease, bu t in our case needle biopsy tha t has been performed on severe stageof serum hepat i t i s was chief role of making this aneurysm.