Unresponsiveness of insulinoma cells to secretin: significance of the secretin test in patients with insulinoma.

It is well known that B cells in the pancreas release insulin when stimulated by secretin, but there have been few reports on the response of insulinoma cells to secretin. In five patients with insulinoma, changes in serum immunoreactive insulin (IRI) concentration were measured after the intravenous injection of secretin into the peripheral vein before and after extirpation of the insulinoma. The extirpated insulinomas were cultured and tested for their response to secretin. The rise in serum IRI in response to secretin in patients with insulinoma was significantly slower and smaller than in normal volunteers. After removal of the insulinoma, the response to secretin became prompt and increased with time. Cultured insulinoma cells did not release insulin when stimulated by secretin. Therefore, it is concluded that the response of insulinoma cells to secretin is quite different from that of normal beta cells, and that the function of beta cells in the insulinoma-bearing pancreas is suppressed by the autonomous hypersecretion of insulin by the insulinoma. The extent of the decrease in function of the beta cells in patients with insulinoma can be estimated by the intravenous secretin test. Thus, the secretin test is sometimes useful in the differentiation of hypoglycemia due to insulinoma from that due to beta cell hyperplasia or alimentary hyperinsulinemia.

The effect of hepatic artery ligation for irresectable cavernous hemangioma of the liver.

During the past 19 years, 52 cases of hepatic cavernous hemangioma have been treated at our institution. Thirty patients underwent hepatic resection. In six patients, the extensive tumor mass invaded multiple segments or both lobes of the liver and complete resection was deemed hazardous. Therefore, hepatic artery ligation was carried out. In all six cases the hemangioma occupied more than two segments. Right hepatic artery ligation was done in five patients and left hepatic artery ligation in one. All are doing well without complication. The longest follow-up is 19 years and the shortest 2 years and 2 months following operation. Four patients have been followed for more than 4 years and in all patients there are no residual complaints. Computerized tomography (CT) revealed the reduction of the tumor size after arterial ligation. One patient suffered from cholecystolithiasis 9 years after hepatic artery ligation, and at the time of cholecystectomy, a biopsy and microscopic examination of the lesion revealed evidence of fibrotic degeneration of the hemangioma. These findings indicate the effectiveness of hepatic artery ligation for treatment of hepatic cavernous hemangioma that are judged hazardous to resect.

[The efficacy and limitations of laser surgery in malignant tumors].

Using rats with tumor transplanted into the subcutaneous tissue, tumor resections done with either an ordinary scalpel or a laser scalpel were compared from the viewpoints of tumor recurrence and survival time. It was found that tumor resection using the laser scalpel and laser irradiation of the field after tumor resection were effective in preventing recurrence. With this concept in mind, 286 operations involving laser surgery were performed, including 179 for malignant tumor, most of which were cancers of the liver, esophagus, stomach and colon. Laser surgery for hepatoma and other malignant tumors yielded better results than ordinary surgery. Another experimental study of PDT (photodynamic therapy) for malignant tumor of the parenchymal organs was carried out. The uptake of HpD (hematoporphyrin derivatives) by the liver was as much as 1.5 times that by the digestive tract. The concentration of HpD in the tumor tissue of WKA rats with DAB hepatic tumor was twice that in liver tissue. However, the difference in HpD concentration between the tumor tissue and liver tissue is not large enough for PDT and this point requires further study.

[Cooperative Study of Surgical Adjuvant Chemotherapy for Colorectal Cancer (third report): five-year results after surgery].

Beginning in January 1984, in collaboration with 357 institutions nationwide, comparative studies on curative resection cases of colorectal cancer and a control group were conducted for 2 years. The following method of administration was employed; Group A received 12 mg/m2 of MMC on the day of operation, followed by 6 mg/m2 every 2 months 6 times. From the 2nd week after the operation, 800 mg/body/day of Futraful was administered for one year. Group B received no treatment. Altogether 2786 cases were collected and, excluding ineligible cases, 2477 evaluable cases were analyzed. There was no difference in either survival rate or disease free rate, but after the bias of background factors was corrected by the hazard model, the disease free rate was better with Group A, and there was a significant difference with the rectum. According to the Dukes classification, in the Dukes C cases with the rectum Group A had higher rate of survival, disease free rate and lower rate of metastasis to the liver and local recurrence of cancer.

[A case of chemotherapy by the transarterial catheter with reservoir against malignant lymphoma of the colon].

We had a case of malignant lymphoma of the colon with two lesions, one in the transverse colon and the other in the ascending colon. The tumor of the transverse colon was resected, but that of the ascending colon was unresectable. Chemotherapy was performed through the catheter with reservoir via the iliac artery into the right colic artery. Three months later, the tumor disappeared completely, and the ascending colon was resected. On histopathological examination, there was no lymphoma cell in the ascending colon. Chemotherapy by a transarterial catheter with reservoir is a new method of treatment against malignant lymphoma.

[Three elderly cases of renal cell carcinoma with pancreatic metastasis].

Three elderly patients, (an 80-year-old female, 78-year-old female and 78-year-old male) suffering from renal cell carcinoma with pancreatic metastasis were reported. In all cases, renal cell carcinoma had been diagnosed previously. Pancreatic tumors were revealed by computed tomography and ultrasonic study during subsequent admission in all cases. In the first case, laparotomy and histological examination proved that pancreatic tumor was metastatic from renal cell carcinoma. In the other cases, according to their clinical course and other laboratory data, we considered the pancreatic tumors to be metastatics from renal cell carcinoma though histological diagnosis was not obtained.

[A clinical study on the cases of ischemic colitis: comparison of clinical images based on time from onset of the disease to detection of bloody stool].

A study was performed on 28 cases of ischemic colitis. The patients were divided into three groups: Group A (9 cases with bloody stool detected within 2 hours after the onset of abdominal pain), Group B (7 cases with bloody stool detected in 2 to 6 hours), and Group C (12 cases with bloody stool detected after more than 6 hours). These cases were comparatively studied. Variables used were as follows: (1) age, (2) sex, (3) constipation, (4) vomiting, (5) peak value of WBC count (/microliter) after admission, (6) peak value of log CRP (microgram/dl), (7) presence of ulcerative lesion in endoscopic findings in acute stage. Using Group A B and C as classification variables, canonical discriminant analysis was performed. As a result, clear linearity was recognized in Group A-->B-->C, and the values (5), (6) and (7) were extracted as the corresponding variables. For these variables, significant difference was also noted in multivariate analysis of covariance. These results suggest that it is possible to predict the severity of the disease to some extent as represented by objective markers of inflammation by finding the time from onset of abdominal pain to detection of bloody stool.

[Evaluation of the relationship between esophageal varices and azygos vein using percutaneous transhepatic cine-portography].

To evaluate the relationship between esophageal varices and the azygos vein--which is generally considered to drain the major part of the esophageal variceal blood--we examined 36 patients with portal hypertension using percutaneous transhepatic cine-portography. The patients were classified into three groups (azygos, cervical and combined) according to the amount of blood to be considered drained by the azygos vein. Eighteen patients (50%) fell into the azygos type group, five (14%) into the cervical, and 13 (36%) into the combined. Highly developed esophageal varices were recognized endoscopically in all patients in the combined and cervical type groups while some of the patients in the azygos type group had less well developed varices. In the azygos type group, there was a tendency for the varices to be increasingly severe the higher the part of the azygos vein they drained into. Because it helps us to fully comprehend the significance of the azygos venous blood flow and the occasionally uncertain effect of endoscopic injection sclerotherapy for esophageal varices, it is important to evaluate the drainage route of esophageal varices in vivo and in detail. Percutaneous transhepatic cine-portography is the useful method for this purpose as it enables us to visualize even the most minute blood stream.

[The statistical evaluation of the female breast cancer detected by mass screening in Hokkaido].

In Hokkaido, 113, 612 women were subjected to mass screening of breast cancer from 1973 to 1983. Out of them, 74, 285 (56.3%) were examined once and the remainder twice or more: 4,798 (4.2%) were advised to receive further precise examinations and 99.8% of them underwent the second examination. Breast cancer was detected in 377, in which 291 (77.2%) were detected by the first examination and 33 (3.8%) were so-called "interval cancer" with the mean interval of 19.3 months. The detection rate was 0.3%. Histologically non-invasive cancer was seen in 26 (6.9% of 377). Despite a recent significant increase in detection rate of the earlier stage of breast cancer, the present study showed no evidence of a decrease in advanced cancer. The prognosis of the patients who had curable operation revealed 86.9% in 5 year survival rate and 40% in 10 year survival rate.

[Xenon enhanced dynamic computed tomography of the lung; regional ventilation measurement].

CT-functional images (CT-FI's) were created from Xe-dynamic CT data of 10 patients with chronic pulmonary emphysema and 6 volunteers with normal lung. In CT-FI's of normal lungs, the values of washin and washout parameter of outer zone were larger than those of inner zone. In CT-FI's of chronic pulmonary emphysema, the values of washin parameter of inner zone were larger than those of outer zone and the value of washout parameter of outer zone were larger than those of inner zone. CT-FI's proved to helpful in evaluating the axial distribution of ventilation dynamics in chronic pulmonary emphysema.