Perfusion cholangiomanometry with papillary stimulation by dilute hydrochloric acid.

A modification of cholangiomanometry in which the papilla of Vater was stimulated by hydrochloric acid was devised as a means to evaluate the papillary function. Manometric tracings could be classified into four patterns according to the mode of response to hydrochloric acid of the papilla. Pattern I was the type in which a group of regular, high-amplitude spikes appeared within 60 seconds after the onset of perfusion. This represented a normally functioning papilla. Pattern II was characterized by rhythmic occurrence of low-amplitude waves. This represented a reversible papillitis as evidenced by the fact that postoperatively such cases exhibited pattern I results as examined through T tube. In pattern III the perfusion pressure remained flat, showing no reaction waves. This represented an incompetent papilla. The pattern III patients with conditions which were reversible responded to intravenous pentazocine. In pattern IV the perfusion pressure continued to increase without reaction waves, representing cicatricial stenosis of the papilla or incarcerated stone in the papilla. This method of cholangiomanometry was thus found to be useful for selecting candidates for sphincteroplasty.

Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy.

To prevent regurgitation esophagitis in esophagogastrostomy after proximal gastrectomy, valvuloplasty plus fundoplasty was carried out in 17 patients with stomach cancer or cancer of the abdominal esophagus. For this purpose, an equilateral triangular flap of 2.5 cm per side was formed at the upper margin of the remaining stomach along the greater curvature. The flap was inverted into the stomach only to serve as a valve. After the esophagogastrostomy was properly performed, fundoplasty was carried out, lifting and suturing the uppermost edge of the stomach to the esophagus along the greater curvature. To prevent pylorospasm as a result of reduced gastric volume, pyloromyotomy was also performed. The results were excellent in those followed for more than 1 year. The technique is simple and effective and, we believe, deserves further clinical evaluation.

Availability of omental flap on prevention against muscular atrophy of a latissimus dorsi cardiomyoplasty.

Dynamic cardiomyoplasty (DCMP) has been performed in more than seven hundreds cases world wide. However, despite symptomatic improvement in the majority of patients surviving the procedure, objective hemodynamic effects have not been consistently demonstrated. Previous studies reported that left ventricular function deteriorated and returned to preoperative level in the chronic phase. We previously reported that atrophy of the latissimus dorsi muscular flap (LDMF) was responsible for the effect of DCMP on improvement of cardiac function in the chronic phase. Ischemia of the muscle flap was proved to induce peripheral muscular atrophy of the flap, and thus preservation of the blood flow is important in preventing muscular atrophy. In the present study, we applied omental flap to LDMF, and postulated that the omentum would improve vascularity and perfusion of latissimus dorsi and prevent peripheral muscle atrophy. In dogs, the right and left latissimus dorsi muscles were dissected free from all attachment except for its thoracodorsal pedicles, and omental flap was wrapped around peripheral part of the left LDMF. Tissue blood flow, maximal muscle isotonic strength, morphologic features, and tissue vascular endothelial growth factor (VEGF) were examined in left LDMF with omental flap (OM group) and in the right LDMF served as the control (Control group). In the distal part of the LDMF, tissue blood flow of OM was significantly preserved than Control (86.4 +/- 6.5% in OM and 33.6 +/- 3.4% in Control, p < 0.05). Maximal isotonic tension was significantly higher in OM as compared to Control. Microscopic findings of H and E stained specimen from distal part of LDMF showed that muscle fibers were preserved in OM. And in the distal part, VEGF expression of OM was 49.6 +/- 7.9 pg/100 micrograms protein and significantly higher than that of Control. Our results indicated that induced endogenous VEGF expression in the LDMF by the omental flap preserved blood perfusion and muscular strength of the LDMF, and suggested that dynamic cardiomyoplasty might not lose its long-term direct cardiac assistance when an omental flap applied for the latissimus dorsi muscle flap.

Changes of eye-blink activities during hypnotic state.

Three experiments were conducted to examine eye-blink activity during the hypnotic state. The results were as follows: (1) eye-blink rate was dramatically reduced during the hypnotic as compared to the nonhypnotic state, (2) blink-rate variability between events (for example, the task and rest period) was smaller under the hypnotic than under the nonhypnotic state, (3) decrements, after induction of hypnosis, were observed in all aspects of blink-wave attributes (amplitude, duration, slope, and area). These findings can be interpreted in terms of the facilitation of motor inhibition by hypnosis.

[Pathophysiology of duodenal papillitis in cholelithiasis].

Pathological features of duodenal papillitis relative to cholelithiasis were analyzed in terms of dilatation of the bile duct, intracholedochal pressure, and histopathological pictures of papillitis, and the following conclusions were drawn: The principal causes of bile duct dilatation appeared to be pathological changes in the papilla per se; Papillitis accompanying choledocholithiasis with cholesterol stone were secondary to those gallstones evacuated from the gallbladder; Calcium bilirubinate stones seemed to be formed primarily as the result of papillitis. In some cases, ascariasis in their past history was thought responsible for the papillitis; and 4. It is suggested that as the papillitis advances, papillary incompetence will emerge.

[Trial of early detection of breast cancer by mass screening in Miyagi Prefecture].

Mass screening for breast cancer which was commenced by Miyagi Cancer Society in 1977 has been carried out on 94953 examinees. The main activities comprise itinerant screening in the communities and group screening at the workplaces. In addition to two types of mass screening, examination was also performed at the detection center. The overall breast cancer detection rate was 0.12% in mass screening. In contrast it was 3.1% at the center. Early breast cancer, however, was more frequently found in mass screening than at the center examination. The cytologic studies of nipple discharge were performed on 14314 subjects as first screening. Positive finding was seen in 5 (0.005%). In high risk group, which also underwent mammography at first screening, the detection rate was higher than that among general examinees. Method for effective procedures for detecting early breast cancer are now under study.

Mobile unit for use in mass screening for breast cancer.

Since 1977, mass screening for breast cancer has been carried out in Miyagi prefecture, Japan. The main activities involve itinerant screening in the communities and group screening at the workplaces. The first step in this screening is the physical examination; the second step, for women with suspicious findings, is examination by mammography and ultrasonography, in a specially equipped mobile unit. The number of subjects screened over a seven-year period ending in March, 1984, was 94,953. Mammography was performed on 4,485 subjects (4.7 per cent) Breast cancer was detected in 116 subjects (0.12 per cent). Since 1980, 2,292 high risk subjects have undergone mammography as the first step screening. The detection rate (0.35 per cent) for this group was higher than for the general subjects examined. Therefore, mammography performed in a mobile unit is a suitable approach for the detecting and diagnosing of breast cancer.

Factors affecting the cholesterol dissolution ability of human bile.

Bile samples were obtained from 13 patients with cholesterol gallstones at laparotomy. Control bile samples were obtained from 15 patients with gastric cancer or gastric ulcer. One mixed stone was cut in half and serial thin sections, 10 micrometers in thickness, were prepared from the cut surface. The solubility of cholesterol in these gallstone sections after immersion in the bile samples was observed microscopically after 1, 3, 5 and 24 hr. Of 15 control bile samples, 9 showed a marked cholesterol dissolution after 1 hr, and 6 showed it after 3 and 5 hr. Three out of 13 bile samples from the patients with cholesterol stones dissolved the gallstone section after 1 hr, and 7 after 3 and 5 hr. The dissolution was not observed in the remaining 3 bile samples. Cholesterol and total bile acid concentrations of the control bile were significantly higher than those of the bile from the cholesterol gallstone patients (p less than 0.05 and p less than 0.02, respectively). Correlative studies of the composition of bile and its ability to dissolve cholesterol revealed that bile samples with a high total bile acid concentration possessed a higher dissolution ability, even when the ratios of total bile acid to cholesterol were almost the same in control and cholesterol gallstone bile. On the basis of these findings, it may be concluded that the solubility of cholesterol in bile cannot simply be explained in terms of relative concentrations of cholesterol, phospholipids and total bile acid, because the absolute concentration of total bile acid also plays a significant role for the dissolution ability.

Exfoliation as a mode of cancer elimination in rectal carcinoma.

A histopathological survey of surgical materials from 143 patients with rectal carcinoma subjected to chemotherapy and low-dose radiotherapy with tegafur and bleomycin was carried out. The chemotherapy combined with radiotherapy brought about better results than chemotherapy alone. In 4 of the 58 patients treated with radiochemotherapy, no cancer cells could be found in surgical specimens. Exfoliation into the rectal lumen of cohorts of cancer cells may occur in some cases of rectal carcinoma thus treated, resulting in cancer cell elimination.

Trial of early detection of breast cancer by mass screening.

Since 1977, mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan. The main activities consist of itinerant screening in the communities and group screening at the workplace. In addition, examinations were also carried out at a detection center. The total number of subjects examined was 90,076 in mass screening, with 4172 (4.6%) of them requiring a second examination. The overall breast cancer detection rate was 0.12% in the mass screening. In contrast, it was 3.1% at the center examination. Cytologic studies of nipple discharge were performed on 31,833 subjects. Positive findings were seen in 4 (0.004%). The incidence of smaller tumors was higher and that of nodal metastasis was lower in subsequent examinations than in the initial screening. In the high-risk group, who also underwent mammography at first screening, the detection rate was higher than that among general subjects examined.

Mass screening for breast cancer.

The mass screening for detection of breast cancer has been conducted in Miyagi Prefecture since 1977. The main activities comprise the itinerant screening in the residential districts and the group screening of female workers at the vocational sites. The routine examination at the Cancer Detection Center is also an integral part of the activities. In the present paper, the data from the above three procedures were compared. The examinees were 49,114 in the residential districts, 6,725 at the vocational sites and 3,055 at the Center. The breast cancer was detected in 51 cases (0.1%) by the itinerant residential screening, 14 (0.2%) at the vocational sites and 73 (2.4%) at the Center. The problems of the first-stage mass screening to detect breast cancer at the early stage were discussed.