Satoshi Nakano

Vanishing tumor of the abdomen in patient with Sjögren's syndrome

SummaryA patient with Sjögrens syndrome is reported. A 52-year-old man admitted to our hospital because of a mass in the upper abdomen with disseminated tumors on the face. The diagnosis for this syndrome was established by biopsy of the salivary gland which revealed cell infiltration composed of lymphocytes and plasma cells, abnormal sialogram, diminished lacrimation, and hyperglobulinemia.Because of the location, size, and shape of the mass and its disappearance with concomitant improvement of the stenotic lesions of the common bile duct and the main pancreatic duct following steroid therapy, we concluded that this was a pancreatic mass and attributed the underlying abnormality as an inflammatory swelling of the pancreas without surgical or histological proof to document this.

Etiology and Pathogenesis of Marked Elevation of Serum Transaminase in Patients With Acute Gallstone Disease

From 1980 through 1988, biliary surgery was performed in 197 patients with acute gallstone disease and concomitant elevation of serum glutamic oxalacetic transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT) of over 300 Karmen units. In 137 patients, anatomic inspection and liver biopsy were performed during the acute stage of the disease. Impacted and floating bile duct stones were found in 69 (50%) and in 43 (32%) of the 137 patients, respectively. The main liver histology was necrosis of liver cells. After surgery, high serum transaminase fell rapidly with immediate recovery in 99% of the patients. In the remaining 60 patients, their signs and symptoms settled soon after initial conservative treatment and surgery was performed after an average time of 21 days. At laparotomy, impacted bile duct stones were found in 2 (3%) and liver histology revealed regeneration of liver cells. These findings suggest that marked elevation of serum transaminase in patients with acute gallstone disease might be due to an acute inflammatory liver cell injury caused by impacted bile duct stones or migrating stones, which would be transient and reversible after early resolution of the bile duct obstruction.

Effectiveness of multivariate analysis of tumor markers in diagnosis of pancreatic carcinoma: a prospective study in multiinstitutions.

In 403 patients suspected of having pancreatic cancer, we prospectively studied a combination assay of various serum tumor markers: CA19-9, DUPAN2, tissue polypeptide antigen, elastase 1, γ-glutamyltranspepti-dase, lactate dehydrogenase, lipase, amylase, and alkaline phosphatase. The diagnostic value of each marker was compared with a multivariate analysis (computer-aided multivariate and pattern analysis system for pancreatic cancer examine-1: CAMPAS-PX1). Pancreatic cancer was subsequently identified in 47 patients. CAM-PAS-PX1 had higher negative in health and positive predictability than those of each marker used alone in the diagnosis of pancreatic cancer. CAMPAS-PX1 proved the most effective marker for diagnosing pancreatic cancer, but in terms of its codbenefit ration CAMPAS-PX1 was not superior to CA19-9 used alone. In this prospective trial, we experienced poor generalizability in the statistical models (CAMPAS-PX1). We believe that selection bias was present in samples used for model building. Based on this study a new model has been designed.

A bleeding Meckel’s diverticulum diagnosed by arteriography

SummaryA case of Meckel’s bleeding diverticulum diagnosed by emergent arteriography is presented. Arteriography revealed an extravasation of contrast medium into the distal ileum and an abnormal ileal artery which passed to the antimesenteric border of the ileum. The diverticulum was demonstrated by double contrast study of the small intestine. The merits of emergent arteriography and other examinations for diagnosing Meckel’s diverticulum are discussed.

Clinical Diversity in Biliary Pancreatitis — Classification of Two Types

One hundred and seven patients with biliary pancreatitis undergoing operation from 1976 to 1989 were reviewed. To clarify the reason for failure to respond to conventional supportive therapy, 73 patients (68%) who underwent emergency surgery were retrospectively divided into two groups according to the severity of the pancreatitis evaluated at laparotomy and compared. Sixty-two had minimal or mild pancreatitis (Group I), among whom 44 (71%) had life-threatening acute biliary tract disease. All underwent biliary surgery and 4 (6%) subsequently died, 2 due to acute obstructive suppurative cholangitis. Eleven had hemorrhagic necrotizing pancreatitis (Group II), among whom 7 had complications of acute pancreatitis such as pancreatic ascites or abscess. These underwent pancreatic and/or biliary surgery and 3 (27%) died of multi-organ failure. There appears to be two types of biliary pancreatitis refractory to conventional supportive therapy, which differ in the extent of surgery required and in mortality: (1) minimal or mild pancreatitis with persistent life-threatening acute biliary tract disease (biliary type), and (2) more severe pancreatitis (pancreas type) early in the course of the disease.

Recovery of portal blood flow after percutaneous transhepatic biliary drainage in patients with obstructive jaundice

Using an ultrasonic Doppler system, we prospectively studied the changes in portal venous flow (PVF) following percutaneous transhepatic biliary drainage (PTBD) and evaluated the correlation between PVF and liver function in 10 patients with obstructive jaundice. The patients were divided into two groups according to their rate of decrease in serum bilirubin (“b”). Group A comprised 5 patients with a “b” of less than −0.1, while group B consisted of 5 patients who did not meet this criterion. The mean PVF increased following PTBD (P<0.01). The increase in PVF was due to an increase in the maximum velocity of the portal vein (Vmax). The rate of increase in the Vmax in group A was significantly higher than that in group B on both the 7th and 14th postdrainage days (P<0.05). The rate of increase in the Vmax correlated significantly with the rate of decrease in the serum bilirubin concentration (P<0.01). Based on the above findings, we conclude that measuring the Vmax by Doppler ultrasonography is useful in evaluating the liver function in patients with obstructive jaundice.

Diagnosis of pancreatic cancer by endoscopic retrograde cholangiopancreatography and pancreozymin secretin test.

SummaryEighty cases with carcinoma of the pancreas were divided into 10 groups according to the location and size of the tumor. Drip infusion cholangiography, percutaneous transhepatic cholangiography, hypotonie duodenography and endoscopie retrograde cholangiopancreatography were employed for this classification. Comparison of cholangiopancreatograms (ERCP) with results of the biliary and pancreatic secretory function assessed by pancreozymin secretin test (PS test) gave us clear-cut information, enabling to identify each 10 group. The pancreatogram by ERCP delineates only macroscopic changes of the pancreatic ducts and PS test clarifies secretory capacity of the exocrine pancreas. But combination of ERCP and PS test with cytology is necessary for the correct diagnosis of the pancreatic cancer and it is hoped that the combination may excavate the disease in the early stage.

Proceedings of the 23rd Autumn Meeting from October 14–16, 1981-Yonago City, Tottori, Japan

The methodology currently used in the field of physiology of intestinal absorption was reviewed and important progresses in our knowledge of mechanisms of intestinal absorption brought about by introduction of new methods were also summarized. The physiological methods currently employed can cover a broad range of investigations from those at an organ level, e.g. perfusion of intestinal segments, to those at a molecular level, e.g. transport studies in reconstituted systems with purified membrane proteins. By these methods, Na +-dependent mechanism of uphill uptake of various organic solutes and electrolytes across the brush border membrane have been largely clarified and active transport of various solutes is now explained on the basis of the concept of the secondary active transport. The mechanism of exit of solutes from the enterocytes have also been investigated in isolated cell suspensions and purified basolateral membrane vesicles, and some carriers responsible for the exit have been characterized. The charge transfer associated with organic solute transport has been studied by electrophysiological techniques. These studies indicate that organic solutes induce a Na + pathway and resultant Na + flow across the membrane causes a coupled flow of the cosubstrate. A relatively new problem is the transport of small peptides in intact form. Its physiological significance, comparative and developmental aspects are now under investigation in several laboratories. Vira l hepatitismRecent advances of its fundamental research

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.