Shuichi Okumura

Papillary hyperplasia of the pancreas.

We report the first case of surgically resected pure papillary hyperplasia of the pancreas. Interestingly, it was not associated with chronic pancreatitis or pancreatic cancer. Histologic and immunohistochemical features are described, with a review of the literature on papillary hyperplasia of the pancreas.

A Monoclonal Antibody, KM10 Reactive with Human Gastrointestinal Cancer and Its Application for Immunotherapy

A monoclonal antibody, KM10 (IgG1) was produced by fusing spleen cells from a human gastric cancer cell (MKN45)‐primed BALB/c mouse with the murine myeloma cell line X63‐Ag8‐653. The antibody reacted strongly with the plasma membrane of human gastrointestinal carcinoma. Sections of the malignant and benign tissues were tested with immunoperoxidase. All of 10 (100%) large intestinal cancers, 26 of 31 (84%) gastric cancers, 5 of 7 (71%) pancreatic cancers and all of 3 (100%) ampullary cancers reacted positively. Moderate or weak reactivity was observed with normal human tissues, hepatoma and carcinomas of mammary, thyroid and adrenal glands. According to a study of the distribution of 125I‐labeled KM10 in nude mice bearing human gastric cancer, KM10 selectively localized in tumor tissue rather than normal tissue. Whole body autoradiography also supported such a selective distribution. Destruction of antigenic properties by pronase digestion demonstrated its protein nature and by Western blot analysis, it was identified as a protein with an Mr of 180–200 kd. KM10‐adriamycin (ADM) conjugate was prepared via an oxidized dextran bridge and this immunoconjugate retained the binding activity against human gastric cancer. MKN45 cells were inoculated subcutaneously into athymic mice and intravenous treatment was begun when the tumor became measurable. A dose‐dependent antitnmor activity was observed in vivo with KM10‐ADM conjugate, while this conjugate was less toxic than free ADM.

Fish bone penetration of the duodenum extending into the pancreas: Report of a case

We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas.

Experimental Studies on Fluosol Da Administration in Acute Pancreatitis

Therapeutic use of the perfluorochemical emulsion, Fluosol DA, in acute pancreatitis was experimentally discussed in view of maintaining the local blood flow and oxygen supply in the pancreas to avoid further aggravation of pancreatitis. Acute pancreatitis was induced by deoxycholate injection into the pancreatic duct in adult mongrel dogs. Fluosol DA or 6% hydroxyethylstarch (HES) solution as control was transfused at 20 ml/kg/hour for the first 3 hours. Fluosol DA and HES solution improved the depressed cardiac output and pancreatic blood flow to normal levels. Compared with HES solution, Fluosol DA administration revealed a prominent increase in oxygen tension in the pancreatic tissue, which had decreased severely from onset of pancreatitis. Fluosol DA administration brought about better preservation of pancreatic mitochondrial functions. Despite no significant differences in blood levels of other pancreatic enzymes between Fluosol DA and HES solution, the sharp decrease in plasma postheparin phospholipase A2 suggested the protection of involved systemic organs including pancreas. Thus, maintaining pancreatic blood flow and increasing the oxygen transport by Fluosol DA administration seemed to play a positive role in inhibiting the progress of pancreatitis, though improvement of survival rate in acute pancreatitis was incomplete by Fluosol DA administration alone.

METABOLIC CHANGES AND THEIR CARE OF THE SURGICAL PATIENTS WITH DISEASES OF ALIMENTARY TRACT

消化管切除後の代謝的変化とその対策を術後急性期と慢性期に分け, 臨床例と動物実験の成績より検討し, 以下の成績を得た.消化管手術は侵襲の大きいものが多いこと, 他の疾患にくらべて経口摂取の長い制限のあることを反映して, 代謝抑制が強くかつ長いと思われたが, 積極的な外科栄養管理は術後のcatabolismを相対的に減少させえた.慢性期の代謝的変化はすでに手術時の再建術式によってかなりの部分が決まってしまうので, 可及的術後変化の生じにくい再建術式が必要であるが, 同時に不可避の変化を管理する代謝的対策が必要と思われた.