Toshiaki Ebata

Studies on the etiologic mechanism of anisakiasis

SummaryIn an attempt to determine the etiological mechanism of anisakiasis, immunological studies were performed using guinea pigs and rabbits. In order to carry out these examinations, we used a specific antigen, hemoglobin ofAnisakis larva. We demonstrate that the etiological mechanism of anisakiasis involves anaphylactic reaction as well as Arthus reaction in the digestive tract. Cell-mediated immune reaction also have to consider the relation of establishment of allergic condition in experimental anisakiasis. These results suggest that the three types allergic reaction may play the main role in clinical symptomes of human anisakiasis.

Effects of aldosterone and dexamethasone on blood chemical mediators in endotoxin shock.

Although the pathogenesis of endotoxin shock is still a matter of speculation, we attach importance to chemical mediators in endotoxin shock. We measured chemical mediators such as histamine, serotonin, bradykinin and catecholamines and investigated the anti-toxic effects of aldosterone and dexamethasone on rabbits in endotoxin shock. Histamine, serotonin and catecholamines were measured by fluorometric assay. Bradykinin was measured by bioassay using rat uteri. The blood concentration of chemical mediators after endotoxin administration was elevated. Aldosterone and dexamethasone inhibited the release of chemical mediators, thereby preventing endotoxin shock.

Gastric Outlet Syndrome Caused by a Gallstone : Report of a Case

An extremely unusual case of gastric outlet syndrome, otherwise known as Bouveret’s syndrome, caused by a large gallstone impacted in the duodenum due to a cholecystoduodenal fistula (CDF), is described herein. Another large gallstone impacted in the CDF itself was also detected. As endoscopic extraction of the gallstone from the duodenum proved unsuccessful, and a laparotomy was required. Our patient, being 88 years old, is probably the oldest patient recorded in the literature of this syndrome. The methods of establishing a correct diagnosis by endoscopy and recent therapeutic strategies are discussed following the case report.

Endogenous endotoxin absorption and the role of intestinal lymphatics

We investigated the absorption routes of endotoxin derived from the intestine of rabbits with or without thoracic duct lymph drainage (TDLD). The intestinal circulatory disorders induced were superior mesenteric artery occlusion (SMAO) and superior mesenteric vein occlusion (SMVO). Detection and quantitation of endotoxin in plasma and lymph were carried out using a synthetic chromogenic substrate (peptide-4-methyl-coumarin amide, MCA). In the SMAO group, endotoxin levels in portal plasma exceeded levels in lymph from the thoracic duct throughout the experiment, and in the SMVO group, the relationship was reversed. In peripheral arterial blood, endotoxin levels were significantly lower in rabbits with TDLD than in those with intact lymphatic system. Intestinal lymphatics probably play an important role in appearance of systemic endotoxemia in non-septic shock.

Primary malignant lymphoma of the rectum with distant metastasis to the stomach: Report of a case

Primary extranodal malignant lymphoma frequently occurs in the gastrointestinal tract; however, it is rarely encountered in the rectum. We report herein the case of an 85-year-old man who underwent abdominoperineal resection for primary malignant lymphoma of the rectum, and 1 year later, developed hematemesis caused by gastric metastasis. To our knowledge this is the first case report of such distant metastasis developing from malignant lymphoma of the rectum.

Abstracts of selected papers presented at the 74th general meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 74TH GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY March 24-26, 1988 Sendai, Japan Chairman: Toshio SATO, M.D.

HETEROTOPIC CARCINOMA OF THE STOMACH, REPORT OF A CASE

A 55-year-old woman underwent a medical check-up. X-ray examination revealed an elevated lesion on the an-terior wall of the antrum (Figs., 1, 2). Endoscopic examination of the stomach showed an elevated lesion with bridging folds (Fig. 3). Gastric biopsy proved the lesion to be nonmalignant. Subtotal gastrectomy was performed because it seemed probable that the lesion might contain a submucosal tumor or carcinoma. We diagnosed adenocarcinoma of the stomach in the frozen section. Gross findings of the resected specimen showed an elevated lesion, 2.3×1.5cm in size (Fig. 5). The lesion was located in the muscular region of the stomach, well-defined and separated from the surrounding normal tissue. The tip of the lesion was slightly depressed and erosive. The histological diagnosis was well-differentiated tubular adenocarcinoma of the stomach-tub, , INFβ, ly1 v0, awθowθn1θ0/28, n2θ0/8. Histologically, it was proved that the adenocarcinoma was produced in heterotopic growth in the subumucosal layer of the stomach (Fig. 8a). This is a rarely seen lesion although a few reports concerning similar lesions have been made.