Tsutomu Sekoguchi

Carbohydrate metabolism and endocrine function in the pancreas remnant after major pancreatic resection

Changes in glucose tolerance, in secretion of pancreatic hormones and in the islets of the pancreas were investigated after major resection of the pancreas in dogs to elucidate the pathophysiologic features of carbohydrate metabolism and the difference in the amount of insulin required in diabetes after total and partial pancreatectomy. In diabetes after 90 percent or more pancreatectomy, both insulin secretion and the function of the anti-insulin system decreased, associated with degeneration of the islet B, A, and D cells. The required insulin amount was similar to that needed after total pancreatectomy. Diabetes developed more than 6 weeks after 70 to 90 percent pancreatectomy, and insulin secretion decreased but the function of the anti-insulin system was accentuated with an increase in plasma glucagon levels, associated with degeneration in B cells but not in A and D cells. The amount of insulin required was 3 to 4 times greater than that needed after total pancreatectomy.

Heterotopic pancreas in surgically resected stomach.

SummaryThe heterotopic pancreas collected from the surgically resected stomachs were studied clinico-pathologically. The number of the cases of heterotopic pancreas were 64; 43 in the stomach and 21 in the duodenal bulbus. They were corresponded to 1.2% in the 5446 resected stomachs. The operated cases with this lesion were frequently found in the age of thirty to fifty with male predominance. Thirty eight cases of them were combined with other gastro-duodenal diseases, especially gastric or duodenal ulcers. About 90% of these lesions were found in the pylorus and antrum. They were situated frequently in the greater curvature, posterior and anterior wall, and rarely in the lesser curvature. Their size was ranged about 0.3 to 4.7 cm in diameter, and about 80% of them within 3 cm in diameter. Macroscopically, 49 polypoid, 8 nipple-like, 7 flat and 1 thickening folded lesions were found, respectively. The bridging folds were found in 9 cases, 13.8%. Microscopically, 30, 29 and 6 lesions of type I, II andIII types according to Heinrich’s classification were found, respectively. The ulcer formation of the mucosal surface of the heterotopic pancreas was found at rate of 10%, and cystic transformation in about 6%.

Resectability of the pancreas without producing diabetes, with special reference to pancreatic regeneration

SummaryThe exact resectability of the pancreas without producing diabetes was investigated in dogs, with consideration of pancreatic regeneration.Within the first week after major pancreatectomy, acinar cell division occurred, followed by hypertrophy; these changes resulted in an increase in weight of the remnant pancreas. The regeneration rate correlated well with the resection rate, glucose tolerance, and the insulin secretion of the remnant pancreas.Immediately after resection of more than 92% of the pancreas, severe diabetes developed, and the regeneration rate was 29.9 ± 6.03% three to six weeks after surgery.Twelve weeks after resection of 74–92% of the pancreas, so-called Sandmeyers diabetes had developed. The regeneration rate was 45.3±4.22% in the non-diabetic group, but in the diabetic group it proved to be only 15.4±2.39%.When less than 74% of the pancreas was resected, diabetes did not occur throughout the postoperative observation periods of 3–18 weeks, and the regeneration rate was 5.5±6.62%. These results suggested that 74% of the pancreas may be removed without producing diabetes.

Giant cholesterol polyp mimicking gallbladder carcinoma: A case report

Cholesterol polyps are the most common polypoid lesion of the gallbladder and are usually less than 10 mm in diameter. In this report, we present a case of giant cholesterol polyp 32 mm in diameter treated by cholecystectomy, in which it was difficult to differentiate preoperatively between a cholesterol and a neoplastic polyp. The tumor was histologically diagnosed as a cholesterol polyp with fibrosis. We also discuss the diagnosis and treatment of large polyps of the gallbladder.

A CASE OF PRIMARY ADENOCARCINOMA OF THE PROXIMAL JEJUNUM, WITH REVIEW ON PRIMARY CARCINOMA OF THE SMALL INTESTINE IN JAPAN

症 例 症例:42歳,男 性. 主訴:悪 心,嘔 吐. 既往 歴 ・家族歴:特 記 すべ きこ とな し. 現病 歴:入 院1ヵ 月前 よ り食 後 に悪心,咽 吐 を きた し近 医 受診.上 部 消化 管及 び注 腸透 視 を受 け る も異常 所 見 を指摘 で きず,ま た腹 痛 な どの他 の異常 所見 を認 め な いため 内服治 療 のみ で経過観 察 を受 け ていた が, 次第 に悪 心,嘔 吐 が頻 回 とな り,さ らに1ヵ 月間 に約 10kgの 体 重減少 を きた した ため 当科 を受診 した. 入 院時 現症:体 格中 等度,栄 養 状態 は不 良 で るいそ う著 し く,上 腹 部 は膨満 す るも下 腹部 は陥 凹 し軟 で, 肝,脾 な らびに腫瘤 は触 知 しな か ったが,便 潜 血反 応 は強 陽性 であ った. 検 査 成 績:一 般 血 液 検 査 で は 赤 血 球 数594×104/ mm3,ヘ マ トク リッ ト53.5%,白 血 球 数16,200/mm3と 血 液濃 縮状 態 にあ り,血 清生 化学 的検 査 ではGOT 237 U/L,GPT 548U/L,LDH 367U/L,総 ビ リル ビン2.3 mg/dlと 肝機 能異 常 を 示 し,さ らにBUN 44mg/dl , Creatinine 2.3mg/dl,Na 128mEq/l,K 2.1mEq/l,Cl 46mEq/l,動 脈血 ガス分 析で はpH7.621,PaO49.1 mmHg,PaCO 50.0mmHg,BE24.4と 著 しい脱水,電

Gastric carcinoma combined with distant gastric ulcer.

SummaryThe cases of the gastric carcinoma combined with distant benign gastric ulcer were 90 of 1257, 7.1%, and the carcinomas were frequently found in the lesser curvature of the antrum and the combined gastric ulcers frequently in the lesser curvature and posterior wall of the corpus. Average age in the combined cases was 58.8 which was older about 7 years than that in the cases of the gastric ulcer. The cases, in which the ulceration in the gastric ulcer was same or deeper than that in the gastric carcinoma, occupied about 70% of these combined cases. It should be considered that the malignant transformation does not always occur in the preceding ulcerative lesion. However, the intestinal metaplasia was usually severe, and so the welldifferentiated carcinomas were twice frequent to the low-differentiated ones. The repeated regeneration of the epithelial cells associated with the erosive or ulcerative change may be of some relation to the carcinogenesis, because the intestinal metaplasia appears usually associated with the repeated defect and repair of the propria mucosae.