Ecological structure and incidence rates of schizophrenia in Nagasaki City

The purpose of this study was to investigate the relationship between incidence rates of schizophrenia and residential features in Nagasaki City, Japan. Social features of residents in 259 areas in the Nagasaki City ecological structure were determined using the results of the 1980 national census. Six residential factors--employment status, occupational and academic career, household status, length of residence, housing tenure and young male predominance--were selected as factors that clearly reflect residential differentiation of residents. Contrary to the findings of many other studies conducted in Western cities, no statistically significant differences were observed, although it seemed that incidence rates were comparatively higher in the lower social classes. These results possibly reflect differences in cultural and social values and structures.

[Endoscopic treatment of early colorectal cancer]

Early cancer of the colon and rectum is currently treated by endoscopic or surgical resection. We studied the indications for endoscopic treatment of early colorectal cancers (80 lesions) in relation to the size and macroscopic findings. The endoscopic treatment consists of polypectomy for a pedunculated or a sessile polyp and strip biopsy for a plaque-like or a depressive lesion. Microscopic or most small cancers were completely treated endoscopically. From macroscopic findings of the early cancers, type Ip (less than 2cm and 2cm in diameter) was completely treated by polypectomy, type I s and type II a (less than 1cm and 1cm in diameter) by polypectomy or strip biopsy, and type II c (less than 0.5cm and 0.5cm in diameter) by strip biopsy.

Application of ultrasonic probes prior to endoscopic resection of early gastric cancer

The development of a new strip biopsy technique for endoscopic mucosectomy utilizing endoscopic saline injection and a double-channel endoscope permits the safe and simple resection of superficial type early gastric cancer which has been difficult to perform with conventional polypectomy techniques. Preresection assessment of the depth of invasion and postresection assessment of efficacy are important with regard to treatment of early gastric cancer, but conventional endoscopic ultrasonography employed for this purpose requires special equipment and involves intricate procedures. An ultrasonic probe which can be used endoscopically has recently been developed and is currently in the trial stage. The authors have conducted studies with respect to a 7.5 MHz radial scanning type Miniature Ultrasonic Probe as well as a 20 MHz manual linear scanning type Sonoprobe System. Experimental studies indicated that the former type is capable of delineating postresection ulcers, while the latter permitted delineation of tumors as hypoechoic images in 9 of 11 cases of early gastric cancer.

Evaluation of peptic ulcer healing with a highly magnifying endoscope: potential prognostic and therapeutic implications

Gastric and duodenal ulcer healing and scarring were evaluated with a highly magnifying endoscope. The appearance of scar was classified into three types: Sa, with a depression at the center; Sb, with a pattern of regenerated mucosa reaching the center; and Sc, with a uniform pattern throughout. The relationship between regenerative mucosal patterns and histologic findings of biopsy specimens was investigated in 58 patients with gastric ulcer. Mucosal regeneration was sufficient in 26.7% of patients with Sa pattern, 79.2% of patients with Sb pattern, and 100% with Sc pattern. From prospective endoscopic follow-up observations, the relationship between endoscopic findings of ulcer scars and ulcer relapses was investigated in 80 patients with gastric ulcer and 56 patients with duodenal ulcer. As a result, patients who completed the cycle of ulcer healing from Sa pattern through Sb to Sc patterns had rarely relapse. In contrast, patients with a Sa pattern of mucosal scar showed a high rate of recurrence: 88.8% for gastric ulcer, and 88.0% for duodenal ulcer. Our method of evaluation of gastric and duodenal ulcer healing with a highly magnifying endoscope may have important prognostic and therapeutic implications. It may indicate a population of patients (with Sa scarring pattern) with a high risk of ulcer recurrence and therefore requiring prolonged prophylactic treatment.

Role of epidermal growth factor in protection and repair of gastric mucosal injury

A role of epidermal growth factor (EGF) in protection and repair of gastric mucosal injury caused by p.o. administration of 0.6 N HCl was investigated in male Wistar rats. Previous to the study on the role of EGF in gastric mucosal protection and repair, changes of gastric mucosal EGF level was determined sequentially by RIA for 180 min after treatment with 0.6 N HCl and intraperitoneal injection of recombinant hEGF. Concentration of incorporated hEGF into the gastric mucosa reached the peak level at 30 min after injection of hEGF. On the other hand, the gastric endogenous EGF level fell remarkably immediately after treatment with 0.6 N HCl. Successively, an association with the mucosal levels of incorporated hEGF and gastric ulcer indices was investigated in the rats in which hEGF was injected intraperitoneally 30 min prior to or at the same time as oral administration of 0.6 N HCl. In conclusion, pretreatment with hEGF protected significantly against gastric mucosal injury with 0.6 N HCl, whereas simultaneous administration of hEGF could not protect against mucosal injury but indicated possible stimulation of the repair process from acute gastric mucosal damage.

Physical growth of Aymara children in a herding community of the Bolivian Altiplano

In a small agropastoral Aymara community called Wariscata in the Andean Altiplano of Bolivia, anthropometric measurements were made in 1988. In comparison with those of published data for the other rural and urban Andean populations (Aymara, Quechua and Mestizo at high and low altitudes), the Aymara children of Wariscata were taller and heavier than other rural high altitude native children, but similar in height to urban high altitude children. This is possibly due to secular change of growth accompanied with nutritional improvement that has taken place in recent years. Chest width and depth had similar values to those in other Aymara children. But, Aymara children in Wariscata of both sexes had smaller chest dimensions (depth and width) than those of Quechua children. However, these ethnic differences in chest dimensions were not reflected in the adult Aymara and Quechua, suggesting different process of chest growth in Aymara and Quechua populations.

Caroli's disease: scintigraphic and radiographic findings

Caroli's disease is a rare congenital anomaly of the liver. Since new diagnostic techniques for the evaluation of hepatic disease have been introduced, the number of reported cases of Caroli's disease has been gradually increasing. This report describes the case of a 13 year old girl with nausea, vomiting, fever and hepatomegaly. The diagnosis of Caroli's disease was established by ultrasonography and CT scan. The complications and management are discussed. The important points in management are to relieve symptoms and to conduct regular examinations by ultrasonography for the early detection of hepatobiliary carcinoma.

Effects of various mucosal protective drugs on diethyldithiocarbamate-induced antral ulcer in rats

This study was designed to determine the effects of exogenous Cu,Zn-superoxide dismutase (SOD) and various mucosal protective agents against antral ulcer induced by diethyldithiocarbamate (DDC), inhibitor of Cu,Zn-SOD. Exogenous Cu,Zn-SOD reduced ulcer formation and prevented a decrease in SOD activity in gastric mucosa. This result indicates that maintenance of mucosal SOD activity is essential to prevent the ulcerogenicity of DDC. Many mucosal protective drugs that increase blood flow, mucus secretion, and endogenous prostaglandin failed to prevent ulcer formation and decrease of mucosal SOD activity. Rebamipide, however, significantly reduced ulcerogenesis and maintained mucosal SOD activity. This suggests that rebamipide has new protective effects on gastric mucosa.

Urban growth and health in Nagasaki after the atomic air raid

According to development of the city, it has been revealed that demographic characteristics and living condition, as well as health status, have been differentiated among areas within it. On the causal relationships between urban growth and health, the present study shows no evidence, but a significant correlation between population density and demographic characteristics, and health, especially in maternal child health, have been observed in the same city (Takemoto et al., 1988). Considering the regionalization of characteristics in man and his environment within a city, public health activities based on the assessment of health needs in each community should be developed in urbanized society.

An immunohistochemical study of copper, zinc-containing superoxide dismutase detected by a monoclonal antibody gastric mucosa and gastric cancer

The immunohistochemical localization of copper, zinc-superoxide dismutase (Cu,Zn-SOD) in human gastric mucosa and gastric cancer was studied using a monoclonal antibody. In gastric mucosa, parietal cells, pyloric glandular cells and foci of intestinal metaplasia showed positive staining in the cytoplasm and/or nucleus. The wide distribution of Cu, Zn-SOD in the gastric mucosa suggests cell function may be vulnerable to active oxygen species. In gastric cancer, 34 of 70 cases showed a positive reaction for Cu, Zn-SOD. There was a relationship between the grade of Cu,Zn-SOD immunoreactivity and the histological type of gastric cancer, well-differentiated types of gastric cancer being more frequently positive. The positive cases of poorly-differentiated adenocarcinoma were characterized by a pattern of diffusely infiltrative invasion. These results suggest that some types of gastric cancer are resistant to active oxygen species.

In vivo cell kinetics studies of the duodenum during and after healing of cysteamine-induced duodenal ulcer in rats using bromodeoxyuridine incorporation

The present study investigated the defect of duodenal defence responsible for the tendency of recurrence of duodenal ulcer. Male Wistar rats were treated with cysteamine-HCl subcutaneously to induce duodenal ulcer, and bromodeoxyuridine (BrdU) was given intraperitoneally 1 h before laparotomy. Serial tissue sections and immunocytochemical staining of BrdU were done to study the cell kinetics during and after healing. Deep ulcers developed in the proximal part of the duodenum 24 h after cysteamine injection, and the ulcer was replaced by scar tissue 1 week later. BrdU-labelling index of normal duodenal mucosa in control rats was 30-34%. On the peripheral part of the regenerative mucosa, BrdU-labelling index increased from 1.5% to 26-27%, 1-4 weeks after injection and remained at this level thereafter. On the central part, except the most central area, the labelling index remained at 0% until 3 weeks, and was 15% 6 weeks after cysteamine treatment. It never achieved the level seen in control normal mucosa. The labelling rate of fibrous cells in scar tissue decreased from 28% to nearly 0% 1-4 weeks after the injection. It is concluded that both the ulcer scar and the regenerative mucosa do not achieve a mature state in the initial scarred stage; they need more time to reach a relatively mature condition. Moreover, the regenerative mucosa will be the weak, easily damaged part of the duodenum.

Binding specificity of Fusobacterium nucleatum to human erythrocytes, polymorphonuclear leukocytes, fibroblasts, and HeLa cells

Eighteen strains of Fusobacterium nucleatum were studied with respect to their adherence to human erythrocytes, polymorphonuclear leukocytes, fibroblasts, and HeLa cells. Four types of adherence were found: 1) sugar-sensitive adherence 2) amino acid-sensitive adherence 3) unknown adherence 4) weak adherence. There was no obvious correlation between the patterns of hemagglutination and adherence to other cells. The results indicate not only a complex network of bacterial receptors on human cells, but also a variety of types of bacterial adherence as expressed by the selectivity of the bacterial binding to specific cell surfaces.

Role of active oxygen species in diethyldithiocarbamate-induced gastric ulcer in the rat

Diethyldithiocarbamate, an inhibitor of Cu,Zn-superoxide dismutase, was recently found to be ulcerogenic in the rat stomach, and active oxygen species were found to be responsible for its ulcerogenicity. To clarify which active oxygen species play a role in ulcerogenesis, the effects of various scavengers and iron-chelators were studied. As superoxide dismutase and catalase reduced the ulcerogenesis induced by diethyldithiocarbamate, the superoxide radical and hydrogen peroxide were considered to play a pathogenic role in this ulcer model.

Lack of tumorigenicity of aminopyrine orally administered to B6C3F1 mice

To test the tumorigenic potential of aminopyrine, an antipyretic analgesic, it was administered in drinking water at levels of 0 (control), 0.04 and 0.08% to 50 male and 50 female B6C3F1 mice for 100 weeks, and the mice were subsequently maintained without aminopyrine for a further 4 weeks. The most frequent types of tumor, in both treated and control groups, were hepatocellular tumor in male mice and malignant lymphoma/lymphoid leukemia in female mice. No statistically significant differences were observed in the incidences of these tumors between treated and control groups. The incidences of several other tumors in male and female mice also showed no statistically significant differences between treated and control groups. Therefore, no tumorigenic effect of orally administered aminopyrine in B6C3F1 mice was apparent in the present study.

Ranitidine and sucralfate as maintenance therapy for gastric ulcer disease: endoscopic control and assessment of scarring

The efficacy of ranitidine (150 mg nocte), and sucralfate (1 g tds) as maintenance therapy to prevent gastric ulcer relapse was evaluated in a 12 month trial in 363 patients. The relapse rates were 8.8% at three months, 14.7% at six months, 18.1% at nine months, and 21.0% at 12 months for the ranitidine group and 14.7%, 21.3%, 29.9%, and 30.2% respectively for the sucralfate group. At nine and 12 months the cumulative relapse rates for the ranitidine group were significantly lower than those for the sucralfate group (p less than 0.05). In both groups ulcers recurred mainly from red scars observed at the endoscopic scarring stage. This indicated the necessity of drug treatment up to the white scar stage. The results suggest that ranitidine is effective in preventing gastric ulcer relapse.

Molecular cloning and characterization of MACIF, an inhibitor of membrane channel formation of complement

Human erythrocytes contain a membrane protein, MACIF, which inhibits the formation of a membrane attack complex (MAC) of complement. We have cloned and sequenced the complementary DNA of MACIF messenger RNA. The amino acid sequence predicted from its nucleotide sequence consists of 128 amino acids. The amino-terminal 25 residues may correspond to a signal peptide. The carboxy-terminal sequence confirmed that MACIF is a glycosylphosphatidylinositol (GPI)-anchored protein. The amino acid sequence of MACIF was partially determined by established techniques for protein chemistry and the resultant sequence was consistent with that predicted from the nucleotide sequence. The results of sequence analyses also suggested that asparagine at the 18th position was N-glycosylated. When mRNA obtained from the MACIF cDNA clone with SP6 RNA polymerase was microinjected into Xenopus oocytes, the oocytes synthesized a product which exhibited MACIF activity and reacted with anti-MACIF antibody. Comparison of the predicted sequence revealed significant homology with mouse Ly-6 antigens.

[Definition of the adaptation of endoscopic surgery for early gastric cancer. Special examination on the relationship between the histological differentiation of the intramucosal gastric cancer and the lymph node metastasis]

Out of five hundred and nineteen surgically resected lesions which were histologically shown to be intramucosal gastric cancer, 247 were well differentiated, 98 were moderately differentiated, and 176 were poorly differentiated lesions. The incidence of lymph node metastasis in the 247 well differentiated, 98 moderately differentiated, and 176 poorly differentiated intramucosal adenocarcinomas were 0.8% (= 2/247), 2.1% (= 2/98), and 8% (14/176), respectively. The cumulative survival rate of 5 years after gastrectomy was 94.2% for the 247 well, 93.3% for the 98 moderately, and 93.7% for the 176 poorly differentiated adenocarcinomas. A pathological study on the atypism of the gland of the cancer and the condition of the proprial space under the cancer cells was conducted on 100 lesions of well differentiated adenocarcinomas in order to define the criteria of non-surgical endoscopic removal resection for early gastric cancer. Out of the 100 lesions mentioned above, there were only two well differentiated adenocarcinomas with lymph node metastasis in which the boundary between the epithelium of the cancer and the proprial space under the cancer was very unclear and the interstitial space in the propria under the cancer was very small. On the other hand, we have resected 73 intramucosal gastric cancers using the endoscopic surgical method called strip biopsy since 1984, and have followed up these cases. The cancers resected by strip biopsy, and were histologically intramucosal well differentiated adenocarcinomas shown to have a moderately maintained interstitial space under the cancer cells. And, up to the present, there has been no incidence of recurrence after strip biopsy for the 73 lesions mentioned above. According to these results, we have defined the criterion for early gastric cancer endoscopic surgery, as follows. Intramucosal cancer which is shown to be well differentiated adenocarcinoma with a moderately maintained interstitial space under the cancer cells is considered to be sufficient for non-surgical endoscopic resection.

Human serum immuno-reactive copper, zinc-superoxide dismutase assayed with an enzyme monoclonal immunosorbent in patients with digestive cancer

Two types of monoclonal antibodies, N4 and N6, were raised against human copper, zinc-superoxide dismutase (Cu,Zn-SOD). An enzyme-linked immunosorbent assay for Cu,Zn-SOD was developed in sandwich method using these monoclonal antibodies. The measurable assay range was 1.0-100 micrograms/l and the coefficient of variation within and between series were 7.5% and 8.1%. Sera of 154 healthy control subjects displayed a low level (14 micrograms/l) of immunoreactive Cu,Zn-SOD with a logarithmic normal distribution. On the other hand, serum Cu,Zn-SOD levels were significantly elevated in patients with various digestive cancers.

A new therapeutic trial of secretin in the treatment of intrahepatic cholestasis

Many animal experiments have been studied on the choleretic effects of secretin. We intended to estimate secretin choleresis in human (15 patients) who had received PTCD or T-tube insertion into the common bile duct. Based upon these data of secretin and choleresis, secretin was administered to 11 patients with prolonged jaundice due to intrahepatic cholestasis in order to evaluate this as a new therapy for intrahepatic jaundice. As controls, eleven patients with intrahepatic cholestasis treated with steroid hormones and/or phenobarbital were used. In all cases with biliary drainage, secretin produced a remarkable choleretic effect with a high concentration of bicarbonate. In 9 out of 11 patients with intrahepatic cholestasis who were treated with secretin, levels of serum bilirubin decreased linearly and other liver function tests returned to the normal range. The mean values of T1/2 (number of days required for reduction by half) of serum bilirubin in 9 effective cases to secretin was 10.8 days. On the other hand, that in 11 effective cases treated with steroid hormones and/or phenobarbital was 23.2 days. These results suggest that secretin therapy may be an effective treatment for intrahepatic cholestasis.

Hemagglutination activity of Campylobacter pylori

Forty-five strains of Campylobacter pylori isolated from gastric biopsy specimens showed distinct hemagglutination activity. The activity was partially decreased by treatment with heat, trypsin, or an alkylating agent and was inhibited by porcine gastric mucin but not by various compounds, including D-mannose.

Endoscopic pancreatic sphincterotomy--technique and evaluation

Endoscopic pancreatic sphincterotomy has been developed as a new method of treatment of chronic pancreatitis in our institution since 1982. We introduced pancreatic sphincterotomy as a safe technique, after performing it successfully in 21 cases of chronic pancreatitis without any complications, and relieving both abdominal and back pain in 19 of the cases. Recently, we have added endoscopic elimination of viscid pancreatic juice including protein plugs. This report describes our procedure of pancreatic sphincterotomy in detail, and evaluates it in the endoscopic treatment of chronic pancreatitis.

Gastric mucosal protection and superoxide dismutase

Diethyldithiocarbamate (DDC), an inhibitor of Cu,Zn-superoxide dismutase (SOD), at a dose of 500 mg/kg or aminotriazole (AT), an inhibitor of catalase, at a dose of 2,000 mg/kg reduced slightly gastric mucosal SOD activity, did not change gastric mucosal blood flow (GMBF), and did not cause gastric ulcers. However, when both DDC and AT were administered together, gastric mucosal SOD activity and GMBF remarkably decreased, and gastric ulcers appeared. Moreover, the administration of SOD attenuated gastric ulcer induced by DDC plus AT. These results suggested that SOD may play an important role in the gastric mucosal defense mechanisms against active oxygen species.

Changes in cortical thickness of the clavicle and serum bone gamma-carboxyglutamic acid-containing protein in the elderly in an island community in western Japan

The cortical thickness of the clavicle (CTC), concentrations of bone gamma-carboxyglutamic acid-containing (Gla) protein (s-BGP, osteocalcin), alkaline phosphatase (s-ALP), calcium (s-Ca) and inorganic phosphorus (s-P) in serum, and calcium/creatinine (u-Ca/Cr) and inorganic phosphorus/creatinine (u-P/Cr) ratios in urine were examined in 211 subjects aged over 40 years in Oshima Island in Nagasaki prefecture. CTC decreased and s-BGP increased with age in both sexes, especially in women. Serum BGP was significantly higher in women than in men at the ages of 50's and over. Serum ALP in women increased until the ages of 60's. Serum Ca at the ages of 50's and s-P at the ages of 60's and over were higher in women than in men. As the increase in s-BGP is reported to be coincident with active bone formation, our findings do not support the view that age-related bone loss, especially in women, primarily results from decrease in bone formation.

Three-dimensional determination of gastric ulcer size with laser endoscopy

We have developed a new endoscopic system for measuring the three-dimensional structure of the gastric ulcer. The system consists of an argon ion laser generator, a side-viewing endoscope with diffraction grating made of glass fibers, and a graphic processing unit. Via a fiber grating fitted in the tip of the endoscope, about 1600 light spots produced by the diffracted laser beam were projected on to the gastric mucosa. By graphic processing involving the detection of the deviation of the laser spot array on the gastric lesion, the diameter, area, and height or depth of the lesion could be determined. To evaluate the accuracy of the system, the diameter and area of a rubber disc were determined in vitro and in the stomach. A cubic model 10 mm in height was used to evaluate the accuracy of the system in measuring height. Accuracy proved to be satisfactory for clinical use. The course of healing of 6 gastric ulcers treated by histamine receptor antagonist was followed with the system. A linear decrease in diameter and depth of the ulcer was observed.

[Endoscopic therapy of early gastric cancer by strip biopsy]

Strip biopsy is carried out in accordance with the principle of endoscopic injection and polypectomy. By using strip biopsy, the full thickness of the mucosa is removed, including the submucosal layer, largely without risk, even in cases of depressed or flat lesions. We have applied this procedure to the therapy of early gastric cancer. Its most valuable aspect is that the resected tissue is collected and the efficacy of the therapy can be evaluated from both macroscopic findings and histological sections. We have applied strip biopsy in 133 cases involving 137 lesions of 8 early gastric cancer, of which 65.0% were totally resected using only the strip biopsy technique. Other cases were treated surgically or subjected to additional endoscopic therapy. sixteen cases were confirmed to have been perfected resected by stomach surgery. Another 71 patients who were not candidates for surgery because of their physical condition have been followed endoscopically for 2 to 48 months, but there has not been any recurrence. On the basis of this study, we believe that the strip biopsy therapy of early gastric cancer should be evaluated in addition to surgical therapy, especially in cases of small lesions localized only in the mucosa.

An antigen specific to hyperplastic liver nodules defined with monoclonal antibody: a new marker for preneoplastic cells in rat chemical hepatocarcinogenesis

Two monoclonal antibodies (MoAbs) were prepared against the hepatocytes of hyperplastic liver nodules from rats killed in the 13th week during hepatocarcinogenesis with 2-acetylaminofluorene. The specificity of these MoAbs was confirmed by cellular radioimmunoassay. By means of immunoperoxidase staining with 2 MoAbs (HAM 6 and HAM 7), HAM 6-defined antigen was detected on the plasma membrane and/or cytoplasm of the hepatocytes in hyperplastic nodules, while HAM 7 reacted to the hepatocytes surrounding hyperplastic nodules. Therefore, HAM 6 seemed to be specific to hyperplastic nodules, but HAM 7 to be a MoAb developed accidentally to the surrounding hepatocytes by contamination of the cell suspension of hyperplastic nodules.

Hepatocellular tumorigenicity of butylated hydroxytoluene administered orally to B6C3F1 mice

Butylated hydroxytoluene (BHT), a preservative widely found in food as a food additive, was orally administered at concentrations of 1% and 2% of the diet to B6C3F1 mice for 104 consecutive weeks. Treated animals underwent a 16-week recovery period prior to pathological examination. In male mice administered BHT, the incidence of mice with either a hepatocellular adenoma or a focus of cellular alteration in the liver was increased in a clear dose-response relationship. The incidences of male mice with other tumors and the incidences of female mice with any tumor were not significantly increased as a consequence of BHT administration. The results of this study indicate BHT to be tumorigenic to the liver of the B6C3F1 male mouse.

Effects of ranitidine on plasma clearance of indocyanine green in patients with liver cirrhosis

The effects of ranitidine on plasma clearance of ICG were investigated in 68 cirrhotic patients (9 were positive for HBsAg, 33 were alcoholics and 26 had cryptogenic cirrhosis). The ICG clearance test was performed before and after ranitidine administration. In 31 patients treated with ranitidine (150 mg perorally), the plasma ICG clearance were 233.6 +/- 20.4 ml/min (mean +/- S.E.) and 239.2 +/- 20.5 ml/min before and after ranitidine, respectively. In the 37 treated with intravenous ranitidine 50 mg, the corresponding values were 205.4 +/- 17.7 ml/min and 206.4 +/- 17.9 ml/min. There was no significant change in the plasma clearance of ICG or the elimination rate constant after ranitidine administration. Even in patients with decompensated liver cirrhosis, no significant change was demonstrated in the plasma ICG clearance after ranitidine. These results led to the conclusions that ranitidine does not reduce the hepatic blood flow and that it is a safe and useful drug for the treatment of gastrointestinal tract bleeding in patients with liver cirrhosis.

Palliative laser therapy

Endoscopic laser treatment has been tried for hemostasis, relief of stenosis and reduction of tumor volume in advanced upper gastrointestinal cancer. This form of treatment was found to be effective for each purpose, but success was usually only temporary. Thus, it was considered that endoscopic laser therapy for problems of advanced upper GI cancer could perhaps be improved by modifying the technique and/or developing new methods, such as the combination of the laser with other therapies.

Clinical evaluation of glucagon and insulin in therapy of fulminant hepatitis

Forty five patients were examined in order to evaluate the usefulness of glucagon and insulin as a therapy of fulminant hepatitis. Thirty patients were treated with simultaneous infusion of glucagon and insulin, whereas prednisolone was given at a daily dose of 60 to 90 mg in 15 cases. In the former group, 1 mg of glucagon and 10 units of regular insulin were infused over a period of 2 to 6 hours. Two such treatments were given per day in the early critical period of fulminant hepatitis. The therapeutic effect of glucagon and insulin was evaluated in comparison with that of prednisolone, and additionally, with a combination therapy of either blood exchange or plasmapheresis in both groups. The survival rate was superior in the group treated with glucagon and insulin (46%) and in the one with combined infusion of these hormones plus plasmapheresis (33%).