A young gastric carcinoma patient with umbilical and scrotal metastasis

A 21-year-old gastric carcinoma patients who showed umbilical and scrotal metastasis is reported. Cutaneous metastases are seen in 3-4% of malignant tumors. The most frequent primary sites are the breast, lung, stomach, ovary, colon, uterus and kidney. Intraabdominal malignancies may produce umbilical metastasis. The primary cancer is usually in the stomach, colon, pancreas or ovary. Umbilical metastasis from the stomach seen in our case is known as Sister Joseph's nodule which is a sign of a poor prognosis. Metastatic scrotal carcinoma is a relatively rare condition which occurs by the hematogeneous pathway. However, in our case, direct invasion of tumor cells though the peritoneal cavity and along the lymphatic system of the spermatic cord was the most likely cause of scrotal metastasis.

The PFD test for pancreatic disease patients

The PFD test was performed on various pancreatic disease patients. The urinary PABA excretion rate was significantly lower in chronic pancreatitis patients and in pancreatic carcinoma patients than in the controls, but no difference was observed between PABA excretion in the two diseases. After surgery, PABA excretion values of pancreatic carcinoma patients were significantly lower than those of non-pancreatitis non-pancreatic carcinoma patients. This was thought to be caused by the difference in residual anastomosed pancreatic tissues. Mild to severe pancreatitis, fibrosis and/or fat necrosis were seen in the pancreatic tissues of carcinoma patients, but these changes were minimal in non-pancreatitis non-pancreatic carcinoma patients. The PFD test is useful in detecting decreases in pancreatic exocrine functions or measuring the grade of pancreatic disorders in various pancreatic diseases, although it can not be used to differentiate pancreatic diseases.

magnified endoscopic observations on the healing process of experimental ulcers

Experimental gastric ulcers in the canine stomach were observed and followed up using a magnifying endoscope. There were differences in the healing processes between antral ulcers and ulcers on the corpus. Antral ulcers were healed linearly by epithelization with a glandular structure, and ulcers on the body were healed by covering with a singly layer of epithelium without pit-formation and the scar resembled a shallow depression. These differences were thought to be caused by differences in blood flow, mucosal regenerability and glandular structure.

Magnified observations of the intestinal mucosa

Before and after dispersal of glucose, aminoacid and fat solutions, the intestinal mucosa was observed by a magnifying endoscope, dissecting microscope and scanning electron microscope (SEM). Minimal changes were observed after dispersal of 5% glucose, 20% sucrose and 10% artificial fat solutions, while, moderate to severe changes in shape, color and surface epithelium were recognized after dispersal of 12% aminoacid and 20% glucose solutions. These differences in the changes were thought to be caused not only by the characteristic differences in the solutions but also by the differences in osmotic pressure of the solutions. In intestinal examinations, dissecting microscopes and SeM can be used concomitantly with observations by the magnifying endoscope.

[A case of craniopharyngioma with hyperprolactinemia in postoperative course (author's transl)]

Authors report a case of craniopharyngioma with hyperprolactinemia, which was never noticed before surgical operation and showed the amenorrhea-galactorrhea syndrome from 7 months after surgical procedure. The patient is a 44 years old housewife. By the medication of CB-154 (Bromocriptin), the high value of plasma prolactin came to normal range and the galactorrhea disappeared, but the amenorrhea persisted. Because author was able to except the possibility of combine of PRL releasing pituitary adenoma or ectopic malignant tumors from the various examination and laboratory findings, the mechanism of secretory disturbance of PRI inhibiting factor in hypothalamus was investigated. These are 1) compression or invasion to hypothalamus through the recurrence of residual tumor, 2) mechanical focal damage of hypothalamus due to surgical manipulation, 3) side effects in hypothalamus depended on postoperative radiation and 4) others. As first element is denied in findings of postoperative CT scan, author is considering that second and third element may be possible factor.

The coexistence of gastric cancer and duodenal ulcers

The records of 356 gastric carcinoma patients who were treated surgically were reviewed. Among them, six patients (1.7%) had duodenal ulcers. Five cancers of the six patients were "early" gastric cancers classified as type "IIc" or "IIc + III" according to "The general rules for the gastric cancer study in surgery and pathology". The cancers of the six patients were located in the lower half of the stomach. Gastric secretion activity was normal in four and above normal in two cases. Three had signet ring cell carcinomas, two had poorly differentiated adenocarcinomas and one had a well differentiated adinocarcinoma. Our results were similar to other results reported in many papers. In Japan gastric carcinomas coexisting with duodenal ulcers were more often confirmed in the "early" gastric cancer stage. This is probably because endoscopic examinations of the stomach were more often performed in Japan than in other countries because of te large number of gastric disease patients. In addition, it is assumed that the growth of gastric cancer in the stomach is slow because of the very active gastric secretion.

Hematemesis and Melena: gastritis

The records of a total of 60 gastritis patients who showed hematemesis and/or melena are reviewed. The mean age was 40. The ratio of males to females was two to one. During the examination, 19 upper G-I lesions were confirmed in addition to gastritis. Sixteen patients had severe underlying diseases which were thought to be the cause of the bleeding tendency. Thirteen patients took alcohol or drugs which induced bleeding. Prognoses of the patients were relatively good when they were treated medically.

The effect of test meals on the PED test

The effects of test meals on the PFD (pancreatic function diagnostant) test, which was introduced as "the B.T.PABA test" in the previous reports, were studied. The higher the protein in the test meal, the lower the urinary excretion value of p-aminobenzoic acid (PABA) and the first 3-h of PABA excretion. By using a test meal containing protein, the differences in digestion-absorption disorders between gastrectomy procedures (Billroth I and Billroth II) were clarified. Therefore, a test meal which contains a suitable amount of protein should be used in the PFD test to improve diagnostic accuracy.

Lesions of the upper gastrointestinal tract in patients with chronic renal failure

Endoscopy of the upper gastrointestinal tract was performed on 84 patients with end-stage chronic renal failure undergoing hemodialysis. Gastric acid secretion and fasting plasma gastrin levels were also examined in these patients. Hemorrhagic gastritis was most frequently observed (23 cases) followed by erosive gastritis (18 cases). No patients had gastric ulcers. Duodenal ulcers were observed in only two patients. Gastrointestinal bleeding was observed in 15 cases (17.9%). Thirteen of these 15 cases had hemorrhagic gastritis, one of which had a duodenal ulcer as a complication. Fasting plasma gastrin levels (359.6 +/- 336.5 pg/ml) were significantly higher than those of normal subjects (35.2 +/- 37.1 pg/ml), but no acceleration in gastric acid secretion was observed either in the basal condition (BAO 0.8 +/- 0.7 mEq/h) or following tetragastrin stimulation (MAO 9.0 +/- 6.9 mEq/h). Our results were inconsistent with the previous reports that high frequencies of peptic ulcers and increased gastric acid secretion were observed in patients with chronic renal failure. Our data suggest that the defensive factors rather than the aggressive factors of the gastroduodenal mucosa may be involved in chronic renal failure.

Hematemesis and melena: gastric ulcer

Differences in distribution of age, hemoglobin values, location and number of ulcers, activities of gastric secretion, associated conditions, treatment and prognoses between bleeding and non-bleeding gastric ulcer patients were studied. The ages of bleeding patients were distributed more widely than those of non-bleeding patients and the number of patients over 70 years of age was greater in bleeding patients than in non-bleeding patients. Associated conditions of bleeding patients were more serious than those of non-bleeding patients and some bleeding patients showed coagulation disorders. Fifteen out of 17 bleeding patients were treated and well controlled surgically, and seven out of 62 bleeding patients who were treated medically died. In this study, the exact cause which made the difference between bleeding ulcers and non-bleeding ulcers could not be found. Bleeding ulcer patients with associated conditions did not always die directly from bleeding, but the bleeding decreased their general condition and, as a result, they died. Therefore, surgical treatment is the first choice in these patients if their conditions will tolerate such treatment.

Hematemesis and melena: Endoscopic examination

Today, gastrointestinal endoscopy has become a routine examination. In our "Endoscopy center", about five hundred gastroscopies are performed every month. It has been said in many reports that endoscopy, especially emergency endoscopy, is an effective method of discovering sources of bleeding. In this report, we also emphasize that emergency endoscopy is effective in diagnosing upper gastrointestinal bleeding on the basis of reviewing 318 endoscopic examinations.

Hematemesis and melena: Mallory-Weiss syndrome

The records of 29 patients with Mallory-Weiss tears diagnosed by endoscopy are reviewed. Ingestion of alcohol was a chief cause of bleeding. Single tears were the largest in number and 68% of the lacerations were seen just distal to the esophago-cardial junction. Lacerations occurred more frequently on the right lateral wall of cardia than on the left lateral wall. Most of these lesions were mild and could be treated medically except for two cases which were surgically treated.

Serum CEA levels in gastrointestinal diseases

Preoperative carcinoembryonic antigen (CEA) levels in 36 colorectal carcinoma patients were corrected in accordance with pathological stage and tumor location. Increasing levels of CEA were found in advanced stages of the disease. There were no significant differences among the CEA levels of right-sided colon tumors, left-sided tumors and rectal tumors.

B.T.PABA test: a new absorption test

B.T.PABA has been evaluated as a new pancreatic exocrine function diagnostant. In this study, it was used as a new absorption test. After ingestion of 1 gm of B.T.PABA and the test meal, PABA in 6-h collected urine was determined. The urinary PABA excretion rate in Billroth I type postgastrectomy patients, 8-14 days after surgery, was lower than that of controls and that in Billroth II patients, 10-14 days after surgery, was the lowest of the three. However, the PABA excretion values of postgastrectomy patients 10 months to 20 years after surgery recovered nearly to the normal level of PABA excretion. These decreases in PABA excretion were considered to be caused by postgastrectomy digestion-absorption impairment. In addition, there was a significantly high correlation between the conventional 131I-labeled albumin absorption test and the B.T.PABA test. Therefore, it was concluded that the B.T.PABA test can be used as a simple absorption test.

The therapeutics of peptic ulcers: clinical evaluation of C-Fe therapy

Ascorbic acid and ferrous sulfate were given to peptic ulcer patients (C-Fe therapy). In gastric ulcer patients, the healing index of the C-Fe therapy group was significantly higher than that of controls, but in duodenal ulcer patients, no significant difference was observed between the healing index of the C-Fe therapy group and that of controls. According to these results, it was concluded that C-Fe therapy was effective in healing gastric ulcers and that the cause of duodenal ulcers might depend more on aggressive factors than that of gastric ulcers.

Electron microscopic visualization of restriction sites on DNA molecules

DNA molecules were adsorbed to a polylysine-treated carbon film and digested directly on the film by restriction enzymes. After washing the film with 1 M NaCl, 0.4% Kodak Photo-Flo and 9% formamide, each cleavage site introduced was visualized as a gap under the electron microscope. By measuring the gapped positions on linear DNA molecules induced by other enzymes, a single EcoRI site on a lambda dv1 molecule and three HinHI sites on an fd1RF molecule were mapped at the positions expected from the cleavage maps, respectively. This electron-microscopic procedure may be useful for the construction of a cleavage map.

[A case of choroid plexus angioma with subarachnoid hemorrhage--case report (author's transl)]

Authors report a case of choroid plexus angioma of lateral ventricle, in a 42 years old woman, initiated with an episode of subarachnoid hemorrhage. The localization of lesion, in the anterior horn and body of right lateral ventricle, producing primary intraventricular bleeding was revealed by pneumoencephalography, especially polytome pneumotomography. However, it was difficult to find by angiography. Patient was successfully removed angioma and showed good recovery. In review of the literatures, the choroid plexus angioma is found more frequently in children than adults, caused by primary intraventricular or subarachnoid hemorrhage and is ocasionally associated with other congenital anomalies. Otherwise, it is found incidentally at autopsy and show hydrocephalus or normal pressure hydrocephalus. Prognosis is excellent in operated case, but heavy mortality in non-operated case and combined with intraventricular hematoma.

Gastric emptying in normal subjects and patients with peptic ulcer: a study using the acetaminophen method

Gastric emptying in patients with peptic ulcer and normal subjects was studied using the acetaminophen method. The subjects consisted of 15 normal subjects, 52 gastric ulcer patients and 65 duodenal ulcer patients, who were studied in active stage of the ulcer. As an indicator of gastric emptying, the plasma acetaminophen concentration was measured by dye method (diphenylhydrazyl), as mcg/ml, at 45 minutes after ingestion of a high calory pasty test meal (200 ml) with 1.5 gr of acetaminophen. In normal subjects, the plasma acetaminophen concentration was 9.4 +/- 3.6 mcg/ml. In gastric ulcer patients, the concentration was 7.4 +/- 3.2 mcg/ml, which showed significantly delayed gastric emptying (P less than 0.05). In duodenal ulcer patients, the concentration was 11.6+/-3.3 mcg/ml, which suggested significantly rapid gastric emptying (P less than 0.05). In consideration of gastric secretion, gastric ulcer cases with lower acid secretion have more delayed gastric emptying. In duodenal ulcer cases with hypersecretion, gastric emptying is more rapid than normo-and/or hyposecretory cases (P less than 0.005). The delayed gastric emptying may play a role in etiology of gastric ulcer. On the other hand, the rapid gastric emptying with gastric acid hypersecretion may be important in the pathogenesis of duodenal ulcer.

Mucoepidermoid carcinoma of the esophagus. Report of an unoperated autopsy case and review of literature

The esophageal tumor which occurred in a 53-year old female and was histologically similar to the salivary mucoepidermoid carcinoma, showed local invasion at autopsy. No distant metastasis was noted. Our literature review showed invasive and metastatic nature of the tumor. Submucosal location of the tumor in our case supported the proposed origin of the neoplasm from the esophageal gland.

Criteria of complete remission from trophoblastic neoplasia with the use of human chorionic gonadotropin (HCG) excretion pattern as a parameter

The excretion pattern of human chorionic gonadotropin (hCG) or luteinizing hormone (LH) was observed in the urine of 77 patients with trophoblastic neoplasia, 109 with complete remission from trophoblastic neoplasia, and 94 with no trophoblastic neoplasia, when the anti-beta-subunit hCG system radioimmunoassay (anti-beta-subunit RIA), which specifically measured hCG was used. The sensitivity of anti-beta-subunit RIA was limited to urinary hCG 16 mIL/ml from the specificity of the anti-beta-subunit serum. Luteinizing hormone in the urine of patients with complete remission and in normal menstrual, postmenopausal, and castrated women was less than 16 mIU/ml in most cases. The excretion pattern of urinary hCG in the patients undergoing treatment for trophoblastic neoplasia was more clearly comprehended with the anti-beta-subunit RIA as compared with the anti-hCH RIA. The criteria for judgment of complete remission were that the hCG value dropped to less than 16 mIU/ml and that cellular response was not observed at least in the last two courses.

O-alkylhomoserine synthesis catalyzed by O-acetylhomoserine sulfhydrylase in microorganisms

An enzyme that can synthesize O-alkylhomoserine from alcohols and O-acetylhomoserine was purified from Corynebacterium acetophilum. The enzyme was found to be identical to O-acetylhomoserine sulfhydrylase; a preparation that appeared homogeneous on polyacrylamide gel electrophoresis showed both O-alkylhomoserine-synthesizing and O-acetylhomoserine sulfhydrylase activities. Its molecular weight was determined to be about 220,000, and it consisted of two subunits. Its pH and temperature optima for the two reactions were the same. Besides catalyzing the formation of homocysteine from O-acetylhomoserine and sulfide, it also catalyzed the syntheses of O-alkylhomoserines corresponding to the alcohols added form O-acetylhomoserine and ethyl alcohol, n-propylalcohol, n-butyl alcohol, methyl alcohol, and n-pentyl alcohol, its activities with these alcohols decreasing in that order. L-Homoserine, O-succinylhomoserine, and O-acetylserine reacted with sulfide. O-ethylhomoserine, O-acetylthreonine, O-succinylhomoserine, and O-acetylserine inhibited both enzyme activities. O-acetylhomoserine sulfhydrylase purified from Saccharomyces cerevisiae also showed O-alkylhomoserine-synthesizing activity. Thus, O-acetylhomoserine sulfhydrylase seems to catalyze O-alkylhomoserine synthesis in the presence of appropriate concentrations of alcohol and O-acetylhomoserine in microorganisms.

[Two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma (author's transl)]

As a causative factor in spontaneous subarachnoid hemorrhage, vascular anomalies, especially aneurysm or arteriovenous malformation, have been generally recognized. On the other hand, subarachnoid hemorrhage from brain tumor and cryptic vascular malformation are rare. We experienced two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma as an initial symptom. Case 1: A 48-year-old woman, who complained of severe headache and vomiting on Feb. 10th, 1972, gradually became lethargic. Lumbar puncture revealed moderately hemorrhagic C.S.F.. On the fifth day after the onset, she was admitted to our hospital. On admission she showed disorientation and disturbance of resent memory. Aphasia and agnosia were slightly observed. On ophthalmologic examination right homonymous lower quadrant hemianopsia was observed. The carotid angiogram showed slight square shift of the anterior cerebral artery to the right side, elevation of the middle serebral artery and a homogeneous tumor stain in the occipital region in capillary phase. A walnut sized tumor invading the middle portion of the left lateral sinus and showing firm adhesion to the tentrium was found. There was an intracerebral hematoma behined the tumor. The tumor, the tentrium and the lateral sinus were extirpated en bloc and the intracerebral hematoma was aspirated. Histologically, the tumor was angioblastic meningioma. Case 2: A 7-year-old boy, who complained of severe abrupt headache, nuchal pain and vomiting on Sept. 17th, 1972, became gradually lethargic. Lumbar puncture revealed hemorrhagic C.S.F., On the tenth day after the onset, he was admitted to our hospital. He showed confusion and agitation. The carotid angiogram showed an unrolling of the pericallosal artery, but no findings of space taking lesions. An air study indicated a globular filling defect protruding into the anterior horn of the right lateral ventricle. The tumor located in the laterobasal wall of the anterior horn was removed picemiel by transventricular approach. Histologically, the tumor was vascular hamartoma. Furthermore, we discussed various brain tumors showing subarachnoid hemorrhage as an initial symptom, its frequency and bleeding mechanism on the literature.

Cell-mediated immunity in pregnant women

Phytohemagglutinin-induced lymphocyte transformation (PHA-T) was depressed in pregnant women, as compared with that in nonpregnant women. Pregnancy serum had a suppressive action on PHA-T which was enhanced with the advance in pregnancy. Hydrocortisone, progesterone, alpha-fetoprotein and trophoblast-specific antigen, were demonstrated as immune suppressive factors. From these results, it was concluded that cell-mediated immunity might be reduced in pregnant women and that this reduction might be one of the causes for the maintenance of pregnancy.

Clostridia in soil of the Antarctica

From the soil in the area around the Syowa Station, the East Ongul Island, the Antarctica, a total of 193 strains of clostridia were isolated and identified. It was surprising that the soil samples taken from the places which were considered to be scarcely contaminated by human beings and animals contained many clostridia. One hundred and fifty-five strains were assigned to 11 species, including C. perfringens, C. bifermentans, C. sordellii, C. sporogenes, C. plagarum, C. paraperfringens, C. septicum, C. tertium, C. cadaveris, C. butyricum and C. felsineum, but 38 strains remained unidentified. C. perfringens, C. bifermentans and C. sordellii were isolated very frequently and C. sporogenes less frequently. All the strains of C. sordellii were nonpathogenic and had almost the same characteristics as those of C. bifermentans except for the attitude in the urease test. The peculiar distribution and characteristics of the clostridia in the Antarctic soil were discussed in comparison with those found in the soil in Japan.