Treatment of gastric cancer with combined surgery and intraoperative radiotherapy.
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Biomedical subjects
Publications and source records attributed to T Tobe.
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Changes of an exocrine function after major resection of the canine pancreas were observed by pancreozymin-secretin test and the results were compared with an endocrine function examined by glucose tolerance test. The exocrine function of the remnant pancreas revealed characteristic changes according to the resection rate of the pancreas: 1) After removal of 50 to 70 per cent of the entire pancreas, diabetes did not develop and the exocrine function of the remnant pancreas was well maintained. 2) After 70 to 90 per cent pancreatectomy, diabetes developed six weeks or more later and the exocrine function of the remnant pancreas per body weight decreased slightly. The degree of disturbance of the exocrine function in the diabetic dogs was greater than that in the non-diabetic group, but the exocrine function per the remnant pancreas weight increased and it was greater than normal level even in the diabetic dogs. The hypersecretory state of the exocrine pancreas after surgery was verified. 3) After 90 per cent or greater resection of the pancreas, diabetes occurred immediately and disturbance of the exocrine function was remarkable. Hypersecretory state did not appear. 4) Both the endocrine and exocrine functions after major pancreatic resection were found to be related to the resection rate, but there were significant differences in the reserve capacity of the endocrine and exocrine pancreas.
Pancreatic endocrine function was studied in 13 patients who had undergone massive bowel resection. The patients were divided into two groups: one month after operation (short-term group), and three or more months after operation (long-term group). Oral administration of glucose caused a persistent low insulin secretion in almost all the patients and the glucose tolerance curve showed a diabetic pattern in four. In contrast, the insulin response to intravenously infused arginine was impaired in the short-term group, but was at an approximately normal level in the long-term group. Pancreatic glucagon response to intravenous arginine, however, remained unchanged in both groups. Interruption of the enteroinsular axis as the result of massive bowel resection probably plays a major part in this discrepancy of the behaviour of insulin in the long-term group.
The early metabolic disturbances in the liver following ligation of the left hepatic or the common duct were studied in the rabbit. In the rabbits subjected to ligation of the left hepatic bile duct, the phosphorylative activity of the liver mitochondria in the ligated lobe decreased to about 50% of controls 48 h after the ligation, while that in the nonligated lobe increased 2-fold. These rabbits continued to live. On the other hand, in the rabbits subjected to ligation of the common bile duct, the mitochondrial phosphorylative activity increased slightly at 3 h after the ligation but fell rapidly thereafter. The mitochondrial free NAD+ to NADH ratios and hepatic energy charge (ATP+1/2ADP/ATP+ADP+AMP) markedly decreased after the ligation. Most of these rabbits did not survive over 2 days. These results indicate that the metabolic disturbances in the jaundiced liver are due to an impairment of the oxidative phosphorylation. In addition, it is suggested that the maintenance of the energy balance by enhanced mitochondrial phosphorylative activity is readily impaired in the jaundiced liver.
Oblique projections in celiac and superior mesenteric angiography have been of value in patients with carcinoma arising in various parts of the pancreas. Oblique views allow better perception of the slight and uncertain changes in the pancreatic vessels, which are not discernible on anteroposterior projections because of overlapping with the extrapancreatic vessels and the spine. Anteroposterior and oblique views of both celiac and superior mesenteric arteries are the first, and, therefore, the most essential, step in angiography of lesions of the pancreas.
Changes in the free NAD+/NADH ratio and the energy charge (ATP + 1/2 ADP/ATP + ADP + AMP) of the liver were compared with the ratio of acetoacetate to beta-hydroxybutyrate of arterial blood in rabbits subjected to ligation of the common bile duct. Both the acetoacetate/beta-hydroxybutyrate ratio of the liver, which reflects mitochondrial free NAD+/NADH ratio, and the heptic energy charge decreased in accordance with the decrease of mitochondrial phosphorylative activity after the ligation. The decrease in the acetoacetate/beta-hydroxybutyrate ratio of the liver was attributed to a restricted mitochondrial reoxidation of NADH due to an inhibition of oxidative phosphorylation. Moreover, changes in the ratio of acetoacetate to beta-hydroxybutyrate in arterial blood were positively correlated with those of the liver (r = 0.695, P less than 0.01) and the hepatic energy charge (r = 0.844, P less than 0.01). It is suggested that the ratio of acetoacetate to beta-hydroxybutyrate in blood can reflect the energy charge of the liver in jaundiced rabbits.
Spontaneous tumors in urodele amphibians have been considered uncommon, and this resistance has sometimes been associated with the natural regenerative capacity of tissues in such species. This report describes spontaneous, nonpigmented, benign epitheliomas which were found in 44 of 1586 (2.8%) adult newts, Cynops pyrrhogaster, captured in central Japan. Both sexes were affected equally, usually with single tumors occurring at any epidermal site. Under laboratory conditions, these large tumors rapidly regressed or disappeared. Lesions were histologically noninvasive, hyperplastic epidermal reactions accompanied by loss of basal, subdermal melanocytes. Ultrastructurally, enlargement of intercellular spaces between tumor cells, increased pigment granules and membrane-bound cytoplasmic aggregates within the spaces, swollen rough endoplasmic reticula, degenerating pigment granules, and altered corneal cells were noted. Virus-like particles were observed in one tumor cell. Prelminary attempts failed to demonstrate transmissibility of the tumor, and no new cases arose under laboratory conditions. The cause of these tumors in the Japanese newt remains unknown, and it is suggested that if a viral agent is involved then other environmental cofactors (diet, temperature, or water constituents) are required for its expression.
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The results of preoperative angiograms and pancreatoductograms in 37 patients with cancer of the pancreas were correlated with each other, with the findings at laparotomy, and with survival times. Tumors which could not be detected by arteriography and/or pancreatography were resectable, except for those located in the uncinate process. Among the resectable tumors, those which were identified only by pancreatography were confined mostly to the parenchyma of the pancreas and were nearly 2 cm in size. Those patients were expected to have a long survival after total pancreatectomy. In contrast, those tumors which were diagnosed only by arteriography arose from the subcapsular portion of the gland or the uncinate process and showed macroscopic invasion to the capsule of the pancreas. These tumors, recurred within 1 year, despite total pancreatectomy. The resectable tumors showing both vascular and ductal invasion were more than 3 cm in size and extended far beyond the capsule of the gland, and patients with these tumors died within 1 year after operation. In this group no difference in survival time was seen among those treated by the Whipple procedure, those by total pancreatectomy, or those by resection of the total pancreas and the portal vein.
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Total pancreatectomy was performed in dogs; and arginine test was conducted at the first, second and third weeks after surgery, and measurement was made of blood glucose, glucagon and insulin on a time-course basis for a comparative study with normal dogs. 1) After total pancreatectomy, glucagon reacting to 30 K antibody decreased once but increased with the lapse of time when no insulin was administered. 2) In the arginine test, glucagon showed a biphasic reaction in normal dogs, but a monophasic reaction in totally depancreatized dogs. This reaction declined three weeks after surgery. 3) When blood samples were taken from the pancreaticoduodenal vein, the left-gastroepiploic and mesenteric veins, during and after arginine was infused for 30 minutes. Glucagon in the pancreaticoduodenal vein increased markedly, but there were no such prominent changes in the left-gastroepiploic or mesenteric veins, Meanwhile, the level of glucagon in the left-gastroepiploic vein increased remarkably in dogs one week after total pancreatectomy.
Glucagon was administered exogenously via a subcutaneous route to totally depancreatized adult mongrel dogs and studies were made with major emphasis on glucagon effect on the plasma glucose levels. 1. In the totally depancreatized dogs, the plasma glucose levels determined 90 minutes after glucagon injection (40 micrograms/kg s.c.). were compared with the pretreatment fasting plasma glucose levels. The rate of increase in the plasma glucose levels was 5.13 +/- 0.48 times (M +/- SEM) in dogs with low pretreatment level (lower than 100 mg/dl). In dogs with higher pretreatment levels (100-400 mg/dl), the increase was 1.62 +/- 0.40 times. And in dogs with the pretreatment levels higher than 400 mg/dl, the value was 0.90 +/- .07 times. 2. Ninety minutes after regular insulin injection (0.25 U/kg i.v.), glucagon was administered (40 micrograms/kg s.c.), and the changes in the plasma glucose levels were determined. 3. In totally depancreatized dogs, a transient increase in the plasma insulin level was noted when glucagon was administered (40 micrograms/kg s.c.) under infusion of a mixture of glucose and insulin. 4. There was no significant difference in the rate of disappearance of glucagon from the blood between normal and totally depancreatized dogs. 5. It is considered that glucagon would be useful for the treatment of hypoglycemia encountered after total pancreatectomy.
Functional alteration of the islet cells was investigated in dogs after the resection of different parts of the small intestine. Three weeks after jejunal or ileal resection, when the dogs might still have been in a catabolic state, insulin and pancreatic glucagon release in response to intravenously infused glucose and arginine was reduced. Three months after jejunal resection, both intravenous glucose tolerance and insulinogenic index in the intravenous glucose tolerance test were significantly below the preoperative values (P less than 0.001, P less than 0.05), while pancreatic glucagon release in response to arginine infusion release. This functional alteration three months after jejunal resection was similar to that seen in diabetes mellitus. On the other hand, three months after ileal resection, insulin and pancreatic glucagon release was almost normal. We conclude that the jejunum plays a more important role in the enteroinsular system than the ileum and that prolonged interruption of this enteroinsular axis can cause insular disorder and what could hypothetically be called enterogenic chemical diabetes, in view of the altered glucose tolerance test and the alteration in insulin secretory response.
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