Sotaro Fujimoto

The diagnosis of pancreatic cancer by endoscopic ultrasonography.

Endoscopic ultrasonography was evaluated for detection of tumors of the pancreas. The technique was performed in 42 patients with cancer of the pancreas and 8 patients with nodular fibrosis of chronic pancreatitis. The lesions were clearly identified in all 50 patients, even when the size of the tumor was less than 20 mm in diameter. A tumor of the pancreas was usually visualized as a hypoechoic mass that had a characteristic image depending on the size. Ultrasonographic differentiation of malignant from benign tumors of the pancreas was possible in tumors larger than 30 mm in size but difficult in tumors less than 20 mm in size. Compared with conventional ultrasonography, endoscopic retrograde pancreatography, computed tomography, and angiography, endoscopic ultrasonography had the highest detection rate of tumors of the pancreas, especially in cases of small tumors under 20 mm in size. In cancer of the pancreas, endoscopic ultrasonography also proved to be valuable for the detection of vascular invasion.

Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS)

Peroral cholangiopancreatoscopy (PCPS), a new concept in gastrointestinal endoscopy, has been developed for direct examination of the bile and pancreatic duct systems. The procedure was successfully accomplished in 42 of 50 patients with no complications. Stones and tumors of the ducts were directly inspected by this new technique. There are still certain technical limitations in the use of our prototype instruments. When the improved instruments are available in the near future, PCPS promises to be one of the most reliable tools in the diagnosis and management of biliary and pancreatic diseases.

Tritiated thymidine radioautographic study on the origin and renewal of secretin cells in the rat duodenum

The origin and renewal of secretin cells in the duodenum were investigated using the unlabeled antibody peroxidase-antiperoxidase technique and radioautography in rats killed at various times after single or multiple injections of [3H]thymidine. Secretin cells were spatially distributed from the upper crypt to the villus tip, being particularly numerous in the upper two-thirds of the duodenal villi. After a single injection of [3H]thymidine, there were no labeled secretin cells, indicating a lack of self-replicating activity. After repeated injections of the isotope, labeled secretin cells appeared and increased in number. They first occurred at the upper part of the crypt and the lower part of the villus, and later at the villus tip. All these cells were found to be labeled after continuous labeling for 120 h, which is considered to be the renewal time for this cell population.

G-Cell population and serum gastrin response to cimetidine-oxo test meal in relation to histopathological alterations in resected stomachs from patients with peptic ulcer disease

SummaryThe relationship between histopathological alterations and G-cell population in the stomach was studied in 14 resected stomachs from patients with chronic peptic ulcer disease (6 with duodenal ulcer and 8 with gastric ulcer). G-cells were identified by indirect immunoperoxidase method. When atrophy was graded three steps (0, 1, 2), the average grade of DU and GU was 0.23 and 0.89, respectively. There was a significant correlation (r=-0.871, p<0.005) between atrophic grade and G-cell population in each stomach. The mean occupation rate with intestinal metaplasia was 0.9% in DU and 35.8% in GU. There was no correlation between total pyloric area and G-cell population, however residual pyloric area excluding intestinal metaplasia correlated significantly with G-cell population (r=0.557, p<0.05). There was a significant difference in the mean G-cell population which were 26.5 millions in DU and 8.9 millions in GU. The mean integrated gastrin response to Cimetidine-OXO test meal were 559±236 pg/ml in DU and 216±124 pg/ml in GU, and there was significant correlation (r=0.889, p<0.005) between G-cell population and integrated gastrin response. The average age of both groups, however, was 27.7 in DU and 52.8 in GU, so that these differences of G-cell population and functional G-cell mass in both groups might originate in the histopathological alterations accompanying with the aging.

Serum alkaline phosphatase (Al-pase) isozyme in gastric and colonic cancer

SummaryUsing the simple thin layer polyacrylamide gel electrophoresis, serum alkaline phosphatase could be separated 5 isozyme bands in various digestive diseases, consisting of 54 cases of gastric cancer, 11 of colonie cancer, 12 of hepatoma, 4 of cholangioma, 14 of pancreatic cancer, 81 of benign hepatobilliary diseases, 13 of cancers of other organs and 61 of control. The obtained results were as follows:1)The electrophoretic analysis of serum alkaline phosphatase showed the specific band remaining at the origin, already reported as “alkaline phosphatase O“, in primary and metastatic cancer of the liver and cholelithiasis. On the contrary, alkaline phosphatase O was never found in gastric and colonie cancer without cancerous metastasis to the liver, and it was also inclined to be positive with the progress of liver metastasis among them.2)Intestinal alkaline phosphatase was usually found in higher frequency in blood group B and O than in the others, and it was apt to disappear in gastric or colonie cancer with an exacerbation of its cancerous lesions.3)Heat-stable alkaline phosphatase was found in 10% of gastric or colonie cancer, all of which were histologically proved to be well differentiated adenocarcinoma.