Diagnosis of Gastric Cancer in Early Stage — The Clinical Ob­servation of Operated Cases

1. An attempt has been made to find the diagnostic criteria for early gastric cancer. It is most important to detect the evidences or suspected features of the malignant growth in incipient stage in order to attain the radical cure by surgical operation. 2. Twelve patients with early gastric cancer (groups A and B) were selected out of 476 patients who had undergone gastrectomy during the past three years in the Okayama Saiseikai General Hospital. The other 6 patients in the &#34;precancerous group&#34; (group C) were also studied, who had abnormal epithelial proliferation in the resected stomach membrane during the same period. 3. The processes of discovery of early cancer have been described. Fairly precise diagnosis can be made in the mucosal carcinoma, but it is not in the ulcer-carcinoma. It was generally difficult to estimate the degree of the malignancy and the extension of the growth preoperatively. 4. The details of the diagnostic aids are as follows. i. Negative occult blood of stool does not always mean the definite diagnostic aid. ii. The malignant gastric change may occur even in non-anacidity. Further investigations should be followed up on gastric ulcer patients if malignant alteration is under the consideration. iii. Minor roentgenological findings, such as the absence or irregularity of mucosal folds, rigid and/or overlapped contour, localized absence or decrease of the peristaltic waves and absence or bow-shaped deformity of the angulus, are of important significance. Such changes should be minutely sought for by X-ray film examination. iv. On gastroscopy and gastrocamera photography, such changes as erosion or irregular granular thickening of the membrane with abnormal reddening and edematous appearance, irregularity of ulcer edge, uneven swelling on ulcer margin with reddening and unsharpness of the edge of adherent coat on ulcer floor, must be noted in the early gastric cancer. v. It is not safe to leave a patient having stomach ulceration under a mere conservative management because it is often quite difficult to dissolve the question of malignancy of the lesion with all sorts of examinations. vi. So far as clinical examinations have indicated malignancy, histological examination must be carried out immediately at the time of operation, even when malignant lesion is absent in inspection and palpation on the exposure of the stomach. vii. On the gross observation of the resected stomach, a particular attention must be paid to erosion, depression or atrophy, irregular granular thickening and abnormal reddening on the restricted areas of the mucosal surface.</p

Patho-Histologic Studies on the Disses Space of the Liver in Epidemic Hepatitis Part Ⅲ A Study on the Disses Space of Experimental Dog With Liver Damage

Eppinger, H. tried to endorse the inflammatory theory with the experimental of allyl formate, but there are not a few scholar expressed their opinions against the theory and also same differencies on Disses space are foung between autopsy and biopsy. Under the above sence, I studied histologically on the influence of DOCA using for epidemic hepatitis. 1. Searching mainly for the variation of Disses space on the dog's liver leaving at the room temperature, is not clearly shown in a short time, but it is clearly shown after 3 hours and it is remarkably observed after 24 hours. As for its living wall, it is mostly void but a light flocculatise substance is sometimes observed in it. Therefore, the general theory that Disses space being clear by the changeness after death night be agreeable. We, therefore, must accept the general theory, which the Disses space become clear by the changeness after death, put forward by many scholars. 2. Leaving the dog's liver toxicated by allylformate at the room temperature, the dilatation of Disses spaces is observed as same as the healthy one. On the other hand, observing closely for the fresh tissues, it is possible to observe the Disses space, and the serous exsudation and the imperturbability of homozeneaus substance or brownish blue granular material are found at the same place. But the dgree of it is not as clear as the one found in the liver of epidemic hepatitis. 3. Making the allylformate toxication on dogs, the expansion intermediate and the atrophy of the liver cells with the vacuolar dgeneration in a part or zones and peripheral zones vacuolar are observed, and the capillary vessels are remarkably limited, interrupted and partly obliterated and staynative hyperemia is fouud. 4. If DOCA is given to the dogs, at that time, the above changes are improved according to the dosis. The degeneration of the liver parenchym is light with a small amount of DOCA, and the capillary vessels is normal or becomes a little narrow, and it is not observed even a little with the big dosis and the capillary vessels is rather dilated and the blood circulation is increased. 5. It is, therefore, clear that the influences of DOCA on the dogs toxicated with allyl-formate is remarkable and DOCA acts upon the vascular system and improves the changes of the liver parenchyms

Patho-Histologic studies on the Disses Space of the Liver in Epidemic Hepatitis part Ⅰ Comparison Between the Biopsy-Findings and the Autopsy-Findings of the Liver

Since Iversen, P. and Rohom, K. attempted the liver-biopsy and reported that it was a valuable method to make the diagnosis of liver-diseases in 1939, the liver-biopsy has been used for making the diagnosis of liverdiseases. But one scholar described that the patho-histologic findings of the liver on liver-biopsy are not just same with those on autopsy. For the purpose to find the degree of the above differences, I made the acute and subacute liver damages in dogs with the subcutaneous infection of Allyl formate, and studied the biopsy-findings and autopsy-findings of the liver. And I found the following resultes: 1. The biopsy-findings of the acute and subacute diffuse changes in the whole liver agree with the histological findings of the autopsymaterials at the early stage of death. It is thought, especially, Disses space is not the artificial product from the liver-biopsy and the pathologic studies on it are necessary. 2. The tissues from the liver-biopsy are so small that the observation of the Disses apace and the determination of the blood volume in it are occasionally difficult. But it can be supplied the deficiency of the biopsy to use the methodes for silver impregnation and other stains and the completion of the continual pieces

Patho-Histolosic Studies on the Disses Space of the Liver in Epidemic Hepatitis Part Ⅱ A Study on the Disses Space of the Liver in Epidemic Hepatitis

It is not entirely agreeable with the serous inflammatory put forward by Eppinger, H. as the Onchopathology of epidemic hepatitis. Making clear the point described the above, the author examined both the material from the autopsy and from the liver biopsy on epiemic hepatitis especially about the Disses space of the liver, the foundation of serous inflammatory, and made clear its pathological significance. The results are as follows: 1. By the autopsy, the Disses spaces dilatation was observed in the whole parts of liver acinus, and we also observed the serous exsudation dying equally to Eosin. variously to Anilinblan, deeply and irregularly or nodularly to Anilnblan and in which deposited the substance dying gray white, frown or black to Bielschowsky-Pap, and the extra vasation of red cell, also the existance of aksquamated cell. A certain relation was observed between the size of Disses space and the degree of parenchyma damage. 2. The dilatation of the Disses space was not so distinguishable on the material of liver biopsy, but its dilatation was more or less observed in the whole parts of acinus by carful observation, especially, the same substances as depositedin the liver from autopsy were observed at the same place on the cases with the unclear dilatation of Dissea space. And the finding is inclined exactly to follow step and tide of disease, and the material become fibrosing and the wall of vessels become thickining with the chronic process of diseases. 3. The above findings show the meaning of the pathological significance of Disses space, and it proved the introduction of Prof. Yamaoka that the remarkable findings are seen in the vascular system of epidemic hepatitis with the dilatation of central vein in the liver-lobules and in lymphatic space