Plasma secretin levels in total pancreatectomy and pancreaticoduodenectomy

The secretory response of plasma secretin to intrajejunal acid was measured in 11 patients who underwent total pancreatectomy and eight with pancreaticoduodenectomy. In cases of pancreaticoduodenectomy, the secretory response of plasma secretin was well maintained, but in those with total pancreatectomy there was a significantly impaired secretory response of plasma secretin. Among patients with total pancreatectomy, those with Billroth II type anastomosis showed a significantly impaired response compared with those with Billroth I type anastomosis. Thus biliary secretion is more impaired in patients with total pancreatectomy than in those with pancreaticoduodenectomy. To improve the impaired biliary secretion after total pancreatectomy, Billroth I type anastomosis for reconstruction procedure of the alimentary tract appears to be more feasible. In the case of the major pancreatectomy, much attention should be given biliary secretion and such may decrease the possibility of occurrence of ulcer at the anastomosis and improve the digestion-absorption of fat.

Effects of hypothermia on energy metabolism of metabolically loaded liver

The effects of hypothermia on adenine nucleotide level, mitochondrial metabolism and redox state of the remnant liver were studied in 25, 50, 70 and 93% hepatectomized rabbits. In 25% of the hepatectomized rabbits, energy charge levels and mitochondrial phosphorylative activities remained unchanged, while in 50 and 70% hepatectomized rabbits, the energy charge levels decreased maximally at 24 hours after hepatectomy with a concomitant rise of mitochondrial phosphorylative activity. In 93% hepatectomized rabbits, the energy charge levels decreased rapidly without enhancement in mitochondrial phosphorylative activity and these rabbits died within 12 hours after hepatectomy. Body cooling significantly increased the energy charge of the remnant liver with further enhancement in mitochondrial phosphorylative activity in 25, 50 and 70% hepatectomized rabbits, but did not increase the energy charge in 93% hepatectomized rabbits. On the other hand, during body rewarming, the energy charge levels of the remnant liver decreased. More than 60% of 70% hepatectomized rabbits died during body rewarming, while all of 50% or less hepatectomized rabbits remained alive. Thus, body cooling may provide remarkable protection for the remnant liver from an energy crisis under the condition that compensatory mitochondrial enhancements are present.

Relationship between development of fibrosis and hemodynamic changes of the pancreas in dogs

Studies were conducted to investigate the relationship between development of fibrosis and hemodynamic changes in the pancreas in dogs. The basal blood flow rate in the atrophied, fibrotic pancreas was preserved at almost the same level as in the normal pancreas. Fibrotic pancreas responded to VIP with increased blood flow, but not to administration of secretin. On the other hand, normal pancreas showed a brisk increase of blood flow in response to both of these agents. Our findings suggest that direct arterial acinar blood flow per gram of acini decreases prominently, whereas direct arterial flow to the islets per gram of islet is well maintained after the development of pancreatic fibrosis. It is also suggested that secretin acts indirectly by stimulating metabolic activity of the acinar cells with a secondary increase in blood flow, whereas VIP has a direct effect on the pancreatic vasculature.

Changes in blood ketone body ratio: their significance after major hepatic resection

Changes in the ratio of acetoacetate to 3-hydroxybutyrate (the ketone body ratio) in arterial blood were investigated after massive liver resection in patients and rabbits. In a patient who had had a successful hepatectomy, the blood ketone body ratio decreased rapidly after the operation and then returned to the preoperative level; whereas in a patient who had had an unsuccessful hepatectomy, the blood ketone body ratio did not decrease rapidly after the operation. In 70% hepatectomized rabbits, the blood ketone body ratio decreased maximally nine hours after hepatectomy and then returned gradually to a normal level. The blood ketone body ratio paralleled the hepatic energy charge after 70% hepatectomy in rabbits. The measurement of the blood ketone body ratio is very useful for evaluation of the energy status of the remnant liver.

Differences in predominant energy substrate in relation to the resected hepatic mass in the phase immediately after hepatectomy

Changes in the energy substrate utilized by the remnant liver after hepatectomy were studied in relation to the hepatic energy status in 25%, 70%, and 93% hepatectomized rabbits. In 25% hepatectomized rabbits, the energy charge ((ATP + 1/2ADP)/(ATP + ADP + AMP)) level of the remnant liver remained unchanged after hepatectomy and was not affected by portal infusion of (+)-octanoylcarnitine, an inhibitor of fatty acid oxidation. In contrast, the energy charge level of the remnant liver decreased rapidly after 70% hepatectomy and reached the lowest level of 0.77 at 12 to 24 hr after hepatectomy (p less than 0.01). At this time, the energy charge level was further decreased to 0.45 by (+)-octanoylcarnitine (p less than 0.001). It returned to near normal 4 days later. At this time, the effect of (+)-octanoylcarnitine was less evident, with the restoration of the energy change. In 93% hepatectomized rabbits, the energy charge level of the remnant liver decreased rapidly and steeply in the phase immediately after hepatectomy. It is suggested that the remnant liver metabolism switches to predominant utilization of fatty acid as an energy source when the energy charge decreases; it then becomes able to utilize glucose with the restoration of energy charge level. In addition, it is emphasized that hyperosmolar glucose solution or insulin administration during the early period after major hepatectomy should be reconsidered because of their inhibition of the mobilization of free fatty acid from adipose tissue.

Parametric survival analysis of gastric cancer patients

A total of 1026 patients with gastric cancer was followed up for five years after surgery and classified into different groups according to surgeons' assessment of nodal involvement, serosal invasion, peritoneal spread, and hepatic metastasis. The survival of each group was studied by parametric analysis, using the log normal model and three parameters estimated: proportion of patients cured (c), mean (m), and SD of log survival times of patients not cured. With these parameters, compared with the conventional five-year survival or the median time, the survival pattern of each group was delineated in detail, and prognostic inferences beyond the follow-up period were made feasible. Groups with more localized lesions were characterized by higher values of c and m. This implied that although patients in these groups have a better chance of cure, they are exposed to a relatively higher risk of late death due to recurrence. This method proved also useful to compare the prognostic values of different classification and to develop better staging systems.

Manifestations of carcinoma of the uncinate process by means of superior mesenteric arteriography

Identification of carcinoma arising in the uncinate region of the pancreas is difficult because of the peculiar topographic relationship of this lesion with adjacent structures. Among the various diagnostic procedures performed upon ten patients with this malignant lesion, superior mesenteric arteriography provided the most helpful information, including signs of invasion in the main trunk of the superior mesenteric artery and vein and in the proximal portion of the jejunal arteries. A clearer visualization of these vascular involvements was attained in the right posterior oblique projection rather than in the anteroposterior projection. On the contrary, the arterial and portal vessels belonging to the celiac territory, such as superior pancreaticoduodenal arteries, dorsal pancreatic artery, gastroduodenal artery, splenic vein and portal vein, were almost free of involvement. At laparotomy, almost all of the patients had direct extension of the tumor to the superior mesenteric vessels, forming a cancerous core in the root of mesentery. All died of cachexia within six months after a palliative surgical procedure. Serial roentgenograms of superior mesenteric artery, especially taken in the oblique projection, are the best means of confirming carcinoma of the uncinate process, for which only a few available methods have been established to evaluate the clinical aspects.

Four stages of mitochondrial deterioration in hemorrhagic shock

It is of great importance to define the manner in which cells are damaged and how intracellular derangement becomes irreversible during shock. When supply of both oxygen and substrates to cells is limited during shock, cellular energy metabolism of vital organs is severely depressed. In this experiment, the relationship was clarified between the reversibility of shock and the cellular energy status, from the viewpoint of hepatic energy change, mitochondrial redox state, ATP synthesis of isolated mitochondria, and fragility of mitochondrial membrane in rat livers. The derangement of energy metabolism passed through a series of four stages during hemorrhagic shock. At Stage I (initial stage), the cellular energy level decreased greatly due to marked energy consumption, without any organic damages in the mitochondria. Stage II (cell distress stage) showed that cellular energy imbalance occurred due to the depressed mitochondrial activity in vivo, although it was reversible when the blood supply was restored. Stage III (transitional stage) was the phase at which mitochondrial fragility increased severely. At Stage IV (terminal stage), mitochondria were markedly damaged organically and cellular energy metabolism was not remedied by any intensive therapies, which inevitably meant the death of vital organs.

The effects of cross-circulation and charcoal hemoperfusion on adenylate energy charge of the remnant liver after major hepatic resection

The effect of liver support on the adenylate energy charge (ATP + 1/2 ADP) / (ATP + ADP + AMP) of the remnant liver after major hepatic resection was studied in rabbits. The present study emphasizes the principle of the use of homologous or heterologous liver for preventing the decrease in the energy charge of the remnant liver after major hepatic resection. The energy charge level provides the cell with a very sensitive intracellular control mechanism. Regulatory enzymes from biosynthetic sequences exhibit very little activity at low levels of energy charge, and their activities increase sharply at high charge values. The energy charge level of the remnant liver maximally decreased from the normal level of 0.843 to 0.767 at 24 hours after 70% hepatectomy. The energy charge level increased from 0.767 to 0.828 after one hour of cross-circulation of systemic blood between the 24-hour, 70% hepatectomized rabbit and a normal rabbit. An increase from 0.767 to 0.801 also occurred after one hour of charcoal hemoperfusion. Although either means of liver support serves to restore energy charge levels, the above results suggest that cross-circulation may be more effective than charcoal hemoperfusion for biosynthesis in the regenerative processes of the remnant liver.

Circulating hepatodepressant factors decreasing the energy charge levels of the remnant liver after hepatectomy

In 25% hepatectomized rabbits, the mitochondrial phosphorylative activity and the energy charge [(ATP + 1/2 ADP)/(ATP + ADP + AMP)] levels of the remnant liver remained unchanged after hepatectomy. In 70% hepatectomized rabbits, the energy charge levels of the remnant liver decreased maximally 24 h after hepatectomy (p less than 0.001), simultaneously with a marked enhancement of mitochondrial phosphorylative activity (P less than 0.001). Afterward, both returned to normal levels within 4 days. In 93% hepatectomized rabbits, the energy charge levels fell rapidly, with an inhibition of mitochondrial phosphorylative activity, within 6 h after hepatectomy. When a 24-hour 70% hepatectomized rabbit was cross-circulated with a normal rabbit, the energy charge in the liver of the normal partner decreased to 0.732 at 30 min after the blood exchange and then returned to 0.855 while that in the remnant liver of the hepatectomized partner increased from 0.767 to 0.820 (p less than 0.001). Also, the energy charge values of a 24-hour 70% hepatectomized rabbit were increased by the extracorporeal normal liver perfusion. It is suggested that a decrease in the energy charge of the remnant liver is due, at least partly, to the accumulation of the substances consuming hepatic energy (hepatodepressant factors) in the systemic blood of hepatectomized rabbits.

Parametric survival analysis of gastric cancer patients

A total of 1026 patients with gastric cancer was followed up for five years after surgery and classified into different groups according to surgeons' assessment of nodal involvement, serosal invasion, peritoneal spread, and hepatic metastasis. The survival of each group was studied by parametric analysis, using the log normal model and three parameters estimated: proportion of patients cured (c), mean (m), and SD of log survival times of patients not cured. With these parameters, compared with the conventional five-year survival or the median time, the survival pattern of each group was delineated in detail, and prognostic inferences beyond the follow-up period were made feasible. Groups with more localized lesions were characterized by higher values of c and m. This implied that although patients in these groups have a better chance of cure, they are exposed to a relatively higher risk of late death due to recurrence. This method proved also useful to compare the prognostic values of different classification and to develop better staging systems.

Hemodynamic response of the pancreas to synthetic chicken VIP in dogs

The effects of synthetic chicken VIP (an octacosapeptide corresponding to the entire sequence of chicken VIP) on pancreatic blood flow and on systemic arterial pressure was examined in dogs. The relationship between pancreatic blood flow and systemic arterial pressure in response to synthetic chicken VIP was also investigated. Pancreatic blood flow increased promptly and significantly with exogenous synthetic chicken VIP. Synthetic chicken VIP administered in graded doses resulted in dose-dependent increases in both the peak rate of the pancreatic blood flow and the duration of the response of the pancreatic blood flow. Graded doses of synthetic chicken VIP also elicited both a graded increase in the systemic systolic pressure and a decrease in the systemic diastolic pressure. Therefore, synthetic chicken VIP given in graded doses resulted in a dose-dependent augmentation of the maximum pulse pressure. Pancreatic blood flow increased despite a fall in the systemic arterial pressure in response to synthetic chicken VIP. This increase in blood flow lasted significantly longer than the changes in the systemic arterial pressure. It was clarified in this study that synthetic chicken VIP has a biological effect on both the pancreatic blood flow and the systemic arterial pressure. The results of our experiments also suggest that synthetic chicken VIP itself may directly induced vasodilatation of the local vessels in the pancreas.

Studies on rat liver catalase. XI. Site of synthesis and segregation by stripped ER membranes

We reinvestigated the site of synthesis of rat liver catalase, and it has been reconfirmed that catalase is synthesized not only by free polysomes but also by membrane-bound polysomes. Considerable amounts of nascent catalase on rough microsomes were released from the membrane into the medium upon incubation with puromycin, not transported directly into the intracisternal cavity of microsomes. On the other hand, catalase newly synthesized in vitro was shown to be segregated by stripped rat liver microsomal membranes in a state resistant to proteolysis. Since this segregation occurred without coupled protein synthesis, catalase appears to be transported by a mechanism different from co-translational transfer. A hypothesis is presented regarding the mechanism of intracellular transport of liver catalase.

Changes in plasma glucagon after total pancreatectomy in man

Changes in the blood glucagon reactive to 30K antibody were followed in two patients before, during, and after total pancreatectomy. The blood glucagon level was decreased six hours after the operation, and then increased gradually unless insulin was administered. The increased non-pancreas glucagon was immediately suppressed by insulin administration. The glucagon secretion response to an arginine load was already low one week after the operation, and was absent even three weeks after the operation.

Angiography and pancreatoductography in resectable carcinoma of the pancreas

Angiography and pancreatoductography were performed in 18 patients with resectable carcinoma of the pancreas. The presence or absence of vascular and ductal tumor involvement was evaluated. Accurate diagnosis was obtained in 83 per cent at pancreatoductography alone, in 66 per cent at angiography alone, while combination of the methods resulted in 94 per cent accuracy. Tumor involvement of the capsule and secretion stagnation in the distal part of the pancreas are of importance for the surgical management and the survival after resection. An improved result after surgery may be obtained by combined evaluation of the vascular and ductal morphology as demonstrated at preoperative radiography.

Studies on peptides. LXXXVII. Synthesis of an octacosapeptide amide corresponding to the entire amino acid sequence of chicken vasoactive intestinal polypeptide (VIP)

The octacosapeptide amide corresponding to the entire amino acid sequence of chicken VIP was synthesized in a conventional manner, using a new arginine derivative, NG-mesitylene-2-sulfonylarginine, Arg(Mts). Treatment of a fragment, Z(OMe)-Thr-Asp-Asn-Tyr-NHNH2 with methanesulfonic acid or HBr was found to give a product with a low recovery of Asp, after aminopeptidase digestion. Ring closure of the Asp-Asn unit seemed to be responsible for this phenomenon. Deprotection with HF or TFA exhibited definitely less such a tendency. In the final step of the synthesis, all protecting groups, including the Mts group, were removed by HF in the presence of m-cresol and the deprotected peptide was purified by ion-exchange chromatography on CM-cellulose followed by isoelectric focusing in Ampholine pH 9--1. Synthetic peptide exhibited the identical Rf value with that of natural chicken VIP and was active as the natural peptide.

Time-course of mitochondrial and cytoplasmic oxidoreduction state of rat liver following an intravenous glucose load

Changes in mitochondrial and cytoplasmic oxidoreduction states after an intravenous glucose infusion were studied in the freeze-clamped liver of normal and alloxan-induced diabetic rats. In normal rats the mitochondrial oxidoreduction state (NAD+/NADH) increased maximally at 5 min after glucose infusion (p less than 0.001) and then returned to about normal fasting level at 30 min later. The cytoplasmic oxidoreduction state reached its peak level at 30 min after glucose infusion (p less than 0.001). A clear temporal correlation was observed between the mitochondrial oxidoreduction state and insulin and glucose levels in plasm. On the other hand, in alloxan-induced diabetic rats no changes were detected in the oxidoreduction state os either mitochondria or cytoplasm in response to glucose infusion. Therefore the increase in portal insulin level as it occurs in response to the rise of blood glucose may play a role in the shift of the mitochondrial oxidoreduction state to its more oxidized state. This shift seems likely to be due to an accelerated removal of the reducing equivalents through electron transfer by the respiratory chain.