Crohn's disease, non-specific ulcers of the small intestine, and idiopathic proctocolitis in a Japanese university hospital from 1954 to 1974

Most of the cases of Crohn's disease reported in Japan were originally treated surgically as acute appendicitis and, after appendectomy, they were diagnosed as acute terminal ileitis or acute Crohn's disease, which should belong to a category different from typical Crohn's disease, according to the international nomenclature by the Council for International Organization of Medical Sciences in 1973. Reviewing our university hospital records from 1954 to 1974, the incidence of typical Crohn's disease and idiopathic proctocolitis has been increasing, while the patients with intestinal tuberculosis have been decreasing. Clinical and histopathological features of operated three groups of our patients with Crohn's disease of the small intestine, non-specific ulcers of the small intestine and prestomal ileitis were comparatively studied. Furthermore, 9 cases of operated Crohn's disease of the colon and 23 cases of operated idiopathic proctocolitis were similarly evaluated. The importance of diagnosing Crohn's disease as a whole from both clinical and histopathological stand points of view was emphasized, and main differential diagnostic criteria between Crohn's disease and idiopathic proctocolitis were discussed.

Relationship between disturbances of micellar formation and steatorrhea

In order to clarify the correlation between decrease in micellar formation and degree of steatorrhea, upper intestinal content was analyzed after administering a test meal of Borgström et al. Fecal fat was also measured. It was demonstrated that micellar phase was composed chiefly of fatty acid and monoglyceride, with low concentrations of diglyceride and triglyceride. The fat composition of micellar phase was nearly constant in normal subjects and in cases of malabsorption syndrome. The correlation between the ratio of micellar fat to the whole ingested fat in the intestinal content and daily excretion of fecal fat was very marked.

Abnormal micelle formation in various malabsorption syndromes

In order to clarify the abnormal micelle formation in various malabsorption syndromes, the analysis of upper intestinal contents after administering a test meal of Borgström et al. was performed. It was demonstrated that the percentage of micellar fat to total fat and lipase concentrations decreased markedly from the normal controls despite of normal concentrations of bile salts and pH in cases of pancreatitis and pancreatectomy. In contrast, it was shown that the percentage of micellar fat was markedly low and the concentrations of conjugated bile salts were reduced in cases of ileal diseases. Unconjugated bile salts were detected although the concentrations of total bile salts were normal in blind-loop syndrome. The correlation between the percentage of micellar fat and lipase concentrations or bile salts concentrations in normal controls and various malabsorption syndromes was also reported.

Prenatal diagnosis of I-cell disease

A pregnancy from a family in risk of I-cell disease was monitored. The fetus was diagnosed as having I-cell disease based on the findings that (1) lysosomal enzyme activities except for acid phosphatase and alpha glucosidase were clearly elevated in amniotic fluid and were reduced in cultivated amniotic fluid cells, and (2) cytoplasmic inclusions were seen in cultivated amniotic cells by phase contrast microscopy. The accuracy of prediction was confirmed by cultured skin fibroblast of the aborted fetus.

[The difference in cholesterol metabolism by tocopheryl linolate and a mixture of tocopherol and linoleic acid with special reference to biosynthesis, absorption and excretion (author's transl)]

Animal experiments using mice were conducted to determine the difference of cholesterol metabolism, if any, between a group of mice administered with dl-alpha-tocopheryl linolate (EL) and another group administered with a mixture of dl-alpha-tocopheryl acetate (E), and ethyllinolate (L) (E+L) that were combined in such a way as to have the same composition as EL. The following results were obtained. 1. While no difference in cholesterol biosynthesis was seen in, in vitro liver homogenate to which agent were added, in liver from animals orally administered with agents in vivo, a decrease in biosynthesis of liver cholesterol in the EL group compared against the E+L group was seen, where-as opposite results were obtained when the agents were injected. 2. Absorption of cholesterol was studied. Cholesterol-4-14C was intubated into the stomach of mice fed with the agents. From the cholesterol radioactivity appearing in blood, it was seen that the inhibition of cholesterol absorption in the small intestine was higher in the EL group than in the E+L group. At the same time the excretion of the sterol-14C coming from the intubated cholesterol-14C into the feces was considerably higher in the EL group as compared with the E+L group. However, when a mixture of the agents and cholesterol-4-14C was intubated into the stomach of normally fed mice, no differences in absorption was seen and results opposite to the above were seen in the excretion of sterol-14C into the feces. 3. Following cholesterol-4-14C injection, when the mice were fed on agent added feed, the EL group showed an increased excretion of sterol-14C and sterol into feces as compared with the E+L group. 4. Regarding the disappearance of injected cholesterol-4-14C from the tissue, no difference was seen between the EL group and the E+L group, when the agents were injected or fed. 5. With regard to in vivo biosynthesis of fatty acid in the group administered orally with the agents, liver fatty acid biosynthesis showed to decrease in the EL group compared with the E+L group, while opposite results were seen in the injected groups. Based on the above, when viewed from cholesterol metabolism, oral administration of agents in the EL group showed a superior effect as a cholesterol-lowering agents compared against the E+L group and the writer is of the opinion that this may well be used for clinical purposes.

[Effect of vitamin B6 group on cholesterol and fatty acid biosynthesis (author's transl)]

The effect of vitamin B6 groups, pyridoxine, pyridoxamine, pyridoxal (pyridoxal phosphate and pyridoxal phosphate Ca) on hepatic cholesterol and fatty acid biosynthesis in mice were studied. 1. Acetate-14C incorporation rate into cholesterol and fatty acid in pyridoxal phosphate supplement in vitro increased remarkably, relative to pyridoxine or pyridoxamine. 2. When daily subcutaneous injection of pyridoxal phosphate or pyridoxal phosphate Ca were given to normal mice, pyridoxal phosphate produced the decrease of liver cholesterol biosynthesis and cholesterol levell and the increase of fatty acid biosynthesis and fatty acid level, while pyridoxal phosphate Ca did not produce any significant changes, relative to the normal groups. 3. The dietary cholesterol supplement given pyridoxine fed mice did not produce any changes in liver cholesterol and fatty acid synthesis, and liver cholesterol level, while the increase of liver fatty acid and blood cholesterol biosynthesis were seen. Pyridoxal phosphate Ca plus cholesterol feeding did not produce any changes in liver cholesterol and fatty acid biosynthesis, and liver fatty acid levels and blood cholesterol biosynthesis, while the increase of liver cholesterol leve was seen, relative to the cholesterol fed group.

Histochemical mapping of catecholamine neurons and fiber pathways in the pontine tegmentum of the dog

The distribution of catecholamine-containing neurons and fiber pathways were studied in the dog's pontine tegmentum by the Falck-Hillarp method. There are fundamental similarities between the dog and other mammals. Most catecholamine fluorescent cell bodies in the dog are located within the nucleus locus coeruleus and subcoeruleus in the pontine tegmentum. They are more diffuse and extensive than in the rat, monkey and human, and rather similar to those of the cat. In this study, catecholamine fiber pathways were clearly traced without using the lesion-degeneration technique. The dorsal pathway from the locus coeruleus consists of more compact bundles of non-varicose fibers than the rat, cat and monkey. It runs parallel to the mesencephalic tract of the trigeminal nerve in pons and midbrain. The ventral pathway courses as loosely arranged varicose fibers in the midreticular formation of the pons and sends axon collaterals to the caudal midbrain to form a dense network of varicose fibers. There are fluorescent plexi of fine varicose fibers at the ventromedial and dorsolateral aspect of the superior cerebellar peduncle. Cells of the medial and lateral parabrachial nucleus, in addition to those of locus coeruleus, send fluorescent fibers to this peduncle. No fluorescent fibers are found in other peduncles.

Curative effects of 1alpha-hydroxycholecalciferol on calcium metabolism and bone disease in patients with chronic renal failure

Synthetic 1alpha-hydroxycholecalciferol (1alpha-OH-D3) was given intravenously in a dose of 2.5-10 mug per day to three patients with chronic renal failure. As little as 10 mug of 1alpha-OH-D3 daily for a week improved intestinal calcium absorption to a normal level, raised serum calcium, and reduced serum alkaline phosphatase. Severe rickets which had not responded to large amounts (greater than 200 mg in total) of vitamin D2 was markedly cured with 2.5 mug of 1alpha-OH-D3 given daily for 3 weeks. These clinical data hold promise that is certainly useful in the improvement of intestinal malabsorption of calcium and bone diseases in renal failure.

Halothane hepatitis with renal failure treated with hemodialysis and exchange transfusion

A 38-year-old white female, hepatitis B antigen negative, developed fluminating hepatic failure associated with oliguria and severe azotemia after two halothane anesthesia and without exposure to other hepatotoxic drugs or blood transfusions. She was treated with multiple hemodialysis and exchange blood transfusion. The combined treatment corrected the uremic abnormalities and improved her level of consciousness. the liver and kidney function gradually improved, and she made a complete recovery, the first recorded with hepatic and renal failure under these postanesthetic conditions. Further evaluation of this combined treatment used for this patient is warranted.

Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction

Before I begin, I want to add my own personal reminiscence. I knew Dave Hume for almost 14 years, slightly for the first 4 and well for the last 10. I first talked to him at an elevator entrance at the Greenbrier Hotel in West Virginia, in April, 1959, and for the last time in April, 1973, in the lower lobby of the Century Plaza Hotel in Los Angeles. In May, 1973, I was in the railroad station in Albuquerque, New Mexico, when I learned from my grief-stricken youngest son that Dave was dead. It is strange how the exact details of these and some other memories in between, of the time I spent with Dave Hume, stand out with the same clarity as what I was doing when I learned of the bombing of Pearl Harbor, the assassination of John Kennedy, but very few other things. The most eloquent tribute to Dave Hume I have heard was the briefest, coming from a non-medical friend who told me sadly, “He really was a dynamite guy!”