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In a double-blind clinical trial, 24 patients with advanced chronic liver disease received 1.2 g of nicotinohydroxamic acid daily and 23 patients received 1.5 g of neomycin. Patients receiving nicotin

The histopathological examination of the submucosal tumor without surgical intervention has been difficult. The ordinary gastroscopic forceps were thought to be ineffective to obtain the material from the lesion. To cope with these difficulties, the thorny needle biopsy method was invented using adental cleanser needle. Through the built-in channel of the biopsy gastrofiberscope, the needle was inserted into the lesion. The material attached to the needle was removed and either direct smearing or the preparation after membrane filtration was carried out. The Papanicolaou staining was used for cytological examination. The method was applied to 113 cases of submucosal tumor of the stomach. In 19 cases, surgically removed specimen or specimen removed by high frequency current endoscopic polypectomy were available for comparison. In 9 of 12 myogenic tumors (75%) tumor cells were obtained by the method. Three of these 9 cases were leiomyosarcoma and two of them were so diagnosed before surgery. In one case the re-examination after surgery of the previously obtained biopsy material by the thorny needle method revealed presence of the tumor cells. In one case of the aberrant pancreas, the correct pre-surgical diagnosis was made by the method. The method can be applied without significant hazards to the patients with submucosal tumors especially myogenic tumors or aberrant pancreas even in out-patient clinic, and can be used as the new method for the screening of malignant tumor and highly atypical tumor of the submucosal nature.

Hepatitis associated antigen (HB Ag) was measured using a single radial immunodiffusion (SRID) method or an immunoadherent hemag-glutination (IAHA) method in patients under various clinical conditions including acute hepatitis, chronic hepatitis, liver cirrhosis, hepatoma, various malignant tumors and other diseases as well as in normal subjects. HB Ag was found to be frequently positive in patients with hepatoma and with malignant tumor with liver metastasis by the immunoadherent hemagglutination method. The significance of this finding is discussed.

The roles played by peritoneoscopic examination, direct cholangiography and cytological examination of aspirated bile at the time of direct cholangiography were studied in 140 patients with various biliary and pancreatic diseases. Both peritoneoscopic and cholangiographic examinations were important in detecting the lesion, and cytological examination was effective in deciding the nature of the lesion. The detection rate of the cancer cells in aspirated bile depended upon the location of aspiration in relation to that of the lesion. The closer the distance the better was the detection rate. The combined use of these three diagnostic methods contributed to correct diagnosis.

Incidence of abnormality in liver functions was significantly higher in patients with peptic ulcer than in the control group. It was also significantly different from that in patients with gastric cancer or gastritis. The disturbance of liver functions in peptic ulcer was usually mild to slight in degree. No definite correlation was found between liver functions and histological findings on biopsy specimens obtained from 19 randomly selected patients with peptic ulcer.

Particular method and program of mass survey examination of gastric cancer were introduced into Miyagi Prefecture and the results accumulated during the past 14 years are presented. During this period, 1,427 cases of gastric cancer (0.18%), as well as many cases of other diseases of the stomach and duodenum, were found by the mass survey. 450 cases were those of early cancer in which invasion of carcinoma was limited to the mucosa and submucosa. The ratio of surgically confirmed early cancer cases to all the stomach cancer cases was 36.4%. Almost in all cases of early stomach cancer there were neither complaints nor clinical symptoms; that is, they were the cases of so-called preclinical cancer of the stomach. The prognosis after surgery of early stomach cancer was remarkably favorable with a five-year survival rate over 90% and the death rate due to stomach cancer was actually decreased in the surveyed population.

The significance of the cytological examination in the diagnosis of gastric cancer, especially in the detection of the early cancer of the stomach, was examined in 1200 cases subjected to the cytological examination in the mass survey, including 181 cases with early cancer of the stomach, 148 cases with advanced cancer of the stomach. Comparison of the detection rates of cancer in cases of surgically confirmed stomach cancer revealed that cytological examination is more reliable than endoscopic and X-ray examinations of the stomach. In only a few instances, the false negative and false positive diagnoses were made, and therefore it is important for correct diagnoses to correlate the cytological finding with the other findings. The importance of cytological examination was clearly indicated by examination of the annual detection rate of early cancer, which showed a sudden increase after the period of the introduction of the cytological method in mass survey.

Glutathione reductase activity of both serum and liver tissue homogenates was measured in normal controls and in cases of hepatic parenchymatous diseases, and the results were compared with those from animal experiments in which hepatic damage was produced by CCl4 injection. Glutathione reductase showed a different attitude from those of transaminases and alkaline phosphatases under these clinical and experimental conditions. Glutathione reductase activity increased in both serum and liver in patients with hepatic damage, and this increase occurred earlier than the changes in alkaline phosphatase activity.

51 cases of chronic hepatitis were followed up by serial liver biopsies. 6 cases, all of which were of the active type, showed transition to liver cirrhosis within 5 to 10 months after the initial biopsy which had indicated chronic hepatitis. In 109 cases of liver cirrhosis, the antecedent acute hepatitis had been found within a relatively short period, usually 2 to 3 years before the establishment of the diagnosis of liver cirrhosis. Whether these cases which showed rapid transition to liver cirrhosis after acute hepatitis should be included in the group of chronic hepatitis or in another group remains to be settled.

Serum alkaline phosphatase activity was found to increase more markedly in patients with liver cirrhosis than in patients with peptic ulcer and this increase was found to be influenced by blood types. After testing several amino acids and bile acids, phenylalanine and cholic acid were chosen and their inhibitory effects upon serum alkaline phosphatase activity were studied in 66 patients with various liver diseases. It was found that the combination of both agents demonstrates different patterns of inhibition between the patients with liver cirrhosis and obstructive jaundice. This inhibitory effects were also variable among cases of different blood types. Basing upon the present observation, the possible source of the elevated alkaline phosphatase activity in liver cirrhosis was discussed.

The sulfokinase, that transfers activated sulfate from PAPS (3′-phosphoadenosine-5′phosphosulfate) to 4nitrocatechol sulfate was studied. 1. It is thought that the enzyme plays an important role in detoxication by the sulfation of polyhydric phenols in liver. 2. The enzyme had an optimum at pH 8.0 in Tris-acetate buffer. Km was 0.105 x 10-3M. The rate of conjugation was linear within 1 min. 3. The main distribution of the sulfokinase was found in the liver, lungs, spleen and various other organs in the rat. The activity of the enzyme in rat liver was the highest in soluble fraction. In chronic hepatic injury caused by carbon tetrachloride injection, the activity of the enzyme gradually decreased to below about onehalf of the control value.

The micromethod technique for the determination of enzyme activities in liver is out lined. It is demonstrated that the micromethod technique is reliable. Glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline and acid phosphatases, glucose-6-phosphataso, catalase, aldolase and arginase activities in liver and serum were measured in various liver and malignant diseases. Routine hepatic function tests were done simultaneously and the results were compared with the results of hepatic enzyme studies. This study showed significant correlation existing only between alkaline phosphatase activity in liver and A/G ratio. Simultaneously done histological studies demonstrated significant correlation existing only between the alkaline phosphatase activity in liver and the grade of fibrosis in the liver. The duration of the hepatic disease correlated significantly with glutamic oxaloacetic transaminase and glutamic pyruvic transaminase activities in the liver. Although the changes in enzyme activities of the serum and the liver in majority of the cases showed concomitant and symmetrical pattern of the changes, enougn number of cases deviated from this general rule, suggesting the necessity of further study in regard to the mechanism of the increase of these enzyme activities in the serum, mode of activation of the liver enzymes, its turnover, in short, the dynamic mechanism of the liver enzymes.