Takashi Matsushiro

EFFECTS OF DIET ON GLUCARIC ACID CONCENTRATION IN BILE AND THE FORMATION OF CALCIUM BILIRUBINATE GALLSTONES

The authors reported previously that beta-glucuronidase in bile, especially during biliary infection with Escherichia coli, plays a substantial role in producing cium bilirubinate gallstones. In the present study, bile levels of glucaro-1:4-lactone (measured as glucaric acid) the leading inhibitor of beta-glucuronidase, were measured in both man and in rats fed high, medium, and low protein-fat diets. Glucaric acid and total bilirubin in bile correlated well in human controls but not in gallstone patients. In animal experiments, the levels of these substances in bile were high in rats on high protein-high fat and low in those on low protein-low diets. These data suggest that when bile is infected with E. coli, calcium bilirubinate gallstones seemed to form more easily in patients on low protein-low fat diet than in those consuming food rich in protein and fat. On the other hand, the ratio of lecithin to cholesterol was higher in low protein-low fat rats than in high protein-high fat rats, suggesting that cholesterol gallstones were more likely to form on the latter diet. The animal, clinical, epidemiological, and dietary data are consistent with the known trend to a decreased incidence of calcium bilirubinate and an increased incidence of cholesterol gallstones in Japan.

Lymphoepithelial cyst in the pancreas: A case report

SummaryA case of lymphoepithelial cyst in the pancreas was reported. A 64-year-old man without any specific compalints was found to have a cystic lesion in the anterior portion of the pancreas, as revealed by ultrasonography of the abdomen at an annual medical examination in 1988. This was dissected easily from the pancreas. Histologically, it was diagnosed to be a benign lymphoepithelial cyst in the pancreas. Cysts of this type are rare, and their histogenesis is also not well understood.

Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy

To prevent regurgitation esophagitis in esophagogastrostomy after proximal gastrectomy, valvuloplasty plus fundoplasty was carried out in 17 patients with stomach cancer or cancer of the abdominal esophagus. For this purpose, an equilateral triangular flap of 2.5 cm per side was formed at the upper margin of the remaining stomach along the greater curvature. The flap was inverted into the stomach only to serve as a valve. After the esophagogastrostomy was properly performed, fundoplasty was carried out, lifting and suturing the uppermost edge of the stomach to the esophagus along the greater curvature. To prevent pylorospasm as a result of reduced gastric volume, pyloromyotomy was also performed. The results were excellent in those followed for more than 1 year. The technique is simple and effective and, we believe, deserves further clinical evaluation.

Clarification of the nomenclature of pigment gallstones

Abstract Gallstones of the pigment line should be classified into two types. One is a black gallstone or a conventional pure pigment stone formed in the gallbladder without infection, and the other is a gallstone formed by apposition or aggregation of calcium bilirubinate particles induced by biliary infection. The latter should be called calcium bilirubinate gallstone .

Undifferentiated carcinoma of the duodenal ampulla

This report demonstrates a case of undifferentiated carcinoma of the duodenal ampulla. A 74-year male experienced jaundice lasting for 3 weeks. An upper gastrointestinal series demonstrated a polypoid, ovoid filling defect in the second portion of the duodenum, and duodenoscopy disclosed a protruding mass involving the orifice of the papilla of Vater. Cholangiography demonstrated obstruction due to compression in the terminal common bile duct. Pylorus-preserving pancreatoduodenectomy was performed on the diagnosis of ampullary carcinoma. The gross specimen showed a polypoid mass, measuring 3.5 cm in diameter, in the ampulla, located mainly in the duodenal submucosal layer and invading the terminal common bile duct. Histologically, the tumor was small cell type, undifferentiated carcinoma, arising from the duodenal epithelium adjacent to the ampulla.

Surgical indications in patients with silent gallstones

Abstract The characteristics of silent gallstones were investigated clinically and histopathologically to study the indications for operation in patients with this entity. The results are summarized as follows: 1. 1. In cases of silent gallstones, which are essentially cholecystolithiasis, the gallstones consisted entirely of cholesterol or pure pigment. 2. 2. Clinically, the incidence of silent gallstones was high among aged patients, but these patients showed no other inherent characteristics that could distinguish them from the patients with symptomatic cholecystolithiasis. 3. 3. Histopathologically, inflammatory changes in the wall of the gallbladder in patients with cholecystolithiasis were most prominent with cholesterol stones, followed by pure pigment stones, contrasting with comparatively slight changes in patients with calcium bilirubinate stones. This trend of changes in the wall of the gallbladder according to the types of gallstone was identical with the trend in patients with silent gallstones. 4. 4. The development of symptoms in patients with silent gallstones was more sudden in the older age groups and frequently accompanied acute cholecystitis. Prognosis in such cases was generally unfavorable. 5. 5. The incidence of cancer of the gallbladder associated with gallstones progressively increased with age, occurring in 3.8 per cent of men and 9.3 per cent of women older than sixty years of age. On the basis of these findings, the indications for cholecystectomy in patients with cholecystolithiasis with slight symptoms, including those of silent gallstones, are discussed.

Pathogenesis and the role of bacteria in acute cholecystitis

The objective of this study was to clarify the etiology of acute cholecystitis and the role of bacteria in the bile in this condition. We evaluated 52 patients with acute cholecystitis; 46 had cholesterol stones and 6 had no claculi. In the presence of cystic duct obstruction, circulatory disturbance occurs gradually, but circulatory disturbance alone cannot cause severe inflammation unless a bacterial infection is present. If there is no obstruction, rapid circulatory disturbance produces necrotic changes of the gallbladder wall, which are implicated in a fulminant course. In both instances, bacterial infection may play an important role in fulminant cholecystitis. Bacteria implicated in acute cholecystitis are usually present in the bile before the onset of this disease.

A Case Report of Laparoscopic Right Hemicolectomy with Intracorporeal Anastomosis for Crohn's Diesase.

症例は18歳の男性. 大腸クローン病で上行結腸に高度の狭窄を来したため, 腹腔鏡下右半結腸切除術を施行した. 手術はすべて体内操作で行い, 回腸横行結腸吻合は自動吻合器を用い, 側側吻合いわゆるfunctional end to end ananstomosisを施行した. 摘出標本では, 上行結腸に広範に敷石状外観と縦走潰瘍がみられたが, 両側断端には病変の遺残はなかった. 術後経過は良好で, 早期に排ガス, 排便や完全な歩行が得られ, 開腹例に比べ回復が早いと思われた. 術後透視で吻合口は大きく保たれ, 9か月続過した現在, 再発の徴なく健常である. 以上から, 早期回復や腹腔内癒着の軽減が期待される腹腔鏡下腸手術は, その手技に熟練すれば, クローン病などの炎症性腸疾患にも, 積極的に施行されるべきと考えられた. しかし, 腹腔鏡下右半結腸切除術は手技が煩雑で簡単でなく, トロッカーの位置を含め手技の定型化や簡便化が今後の問題と思われた.

Operative results and prognostic factors of the upper bile duct cancer.

肝 管癌 お よ び上 部胆 管癌 を主 体 とす る いわ ゆ る肝 門 部胆 管癌 の治 療成 績 はい まだ きわめ て不 良 であ る.今 回 は著者 らの施設 にお い て これ まで に経験 した本 症 の 32切 除例 を検討 し,予 後 を規 定す る諸因 子 と手 術成 績 との関連 につ いて のべ た い. I.自 験 例 の概要 自験32切 除 例 を,胆 道 癌取 扱 い規 約1)に も とづ い て 分 類す る とstage I8例,II8例,III10例,IV6例 で あ る.こ れ らに対 して,胆 管切 除兼胆 道 再建 術 を25例 , 胆管 お よび肝 葉切 除兼 胆道 再建7例(右 葉切 除2例, 左葉 切除5例)行 った が,以 後 前者 を胆 管切 除術,後 者 を肝切 除術 と略称 す る.本 症 の切 除率 は44%で,直 接 死 亡 は胆管切 除 に2例,肝 切 除に2例 計4例 で あ っ た. II.成 績 1.stage別 術後 生存期 間 本症 のstage別 生 存期 間 は表1の ごと くで,stage I は8例 中7例 が1年 以上生 存 し,ま た5例 は2年 以上 生存 し,う ち3例 は 目下生 存 中で あ る.stage IIの8例 で は1年 以上 生存 は1例 の みで あ った.stage IIIの10 例 の うち3例 が1年 以上 生存 し,そ の2例 が 目下生 存 中で あ る.さ らにstage IVで は6例 中2例 が1年 以 上 表1 stage別 生 存期 間

On radiopaque gallstones

Selenomethionine pancreatic scint iphotography on 59 pat ients suspected of having pancreatic disease were reviewed. It was possible to confirm the presence or absence of pancreatic disease by laparotomy or autopsy in 18 of these patients. Serial pancreatic scint iphotography were taken 3 min. to 3 hrs. after in t ravenous adminis t ration of 250 ~ci of T~Se-selenomethionine in the PHO-Gamma III scintillation camera manufac tu red by Nuclear Chicago. Prospectively, there were eleven errors of interpretat ion in 59 patients, 8 being false positive and 3 false negative. Among 8 patients, diagnosed as pancreaticoduodenal cancer by scintiphotography, 6 were correct and 2 were false positive. There were 3 correct and 1 false positive diagnosis with carcinoma of the body or tail of the pancreas. In 24 pat ients with pancreati t is correct diagnosis was 79 per cent. There were three false negative cases. Accordingly, it may be concluded tha t scint iphotography is valuable as a screening technique for suspected lesions in any part of the pancreas as well as for pancreatit is.