Tropical calcific pancreatitis.........An overview

Tropical calcific pancreatitis is a nonalcoholic type of chronic pancreatitis affecting the childrens and young adults characterized clinically by recurrent abdominal pain in childhood, diabetes in adolescent and death in early childhood. Although the exact etiology is not known, malnutrition and chronic cassava toxicity either singly or in combination are presumed to be the prime factor in pancreatic injury unopposed by detoxification of free radical. Moreover micronutrients deficiency, oxidant stress and antioxidant deficiency might play substantial role. Diabetes secondary to tropical calcific pancreatitis is a distinctive and frequent problem, being named by W.H.O. study group as 'fibrocalculous pancreatic diabetes (FCPD) and classified as one of the variant of the so-called malnutrition related diabetes mellitus (MRDM).熱帯地方の貧困層の小児や若干成人にみられる非アルコール性の慢性膵炎で,小児期に反復する腹痛で発症し,10～20歳で膵性糖尿病になり,20～ 30歳で死亡する類似の病像を示す症例をTropical calcific pancreatitis(熱帯性石灰化慢性膵炎)という｡高率に膵石を伴う｡成因は乳幼児期からの熱量,蛋白貰,micronutrients(亜鉛,銅,セレニウム)の摂取不足に加えて食事中シアン産生物質や環境中oxidantsなど複合因子によると推測されている｡病理像は世界各国にみられる慢性膵炎典型例に類似する｡最近は,生活環境や医療事情の改善により,全身栄養障害の減少や生存期間 の延長など病像が変貌しっつある｡糖尿病を重視する立場からはFibrocalculous pancreatic diabetesと呼ばれ,同一地域にみられるProtein-deficient pancreatic diabetesと合わせてMalnutrition-related diabetes mellitus(MRDM)と総称し,糖尿病の一亜型に分類されている

Effect of long-term daily intake of thermal water on gastric mucosal blood flow

内視鏡（オリンパス製XQ－10胃ファイバースコープ）と臓器反射スペクトル法を応用して，2週間連日の飲泉が胃粘膜血流におよぼす効果を検討した。健常者3名および胃疾患患者9名（治癒期にある胃潰瘍の患者6名と慢性胃炎の患者3名）を対象とした。当院飲泉場の温泉水による2週間連日の飲泉を行ない，2週間の飲泉の前後において，胃の3箇所（胃幽門部小弯，前庭部小弯，胃角部小弯）で胃粘膜血流を測定した。その結果，胃前庭部小弯では胃粘膜血流の有意の増加を認めた。しかし胃全体としては有意差を検出出来なかった。個々の症例について検討すると、飲泉後で胃の3箇所すべてにおいて血流が増加したケースが頻度多く認められ，飲泉の有効性が示唆された。従来から認められてきた慢性胃腸疾患に対する飲泉の効果には，胃粘膜血流の改善による要因も加わっている可能性が考えられる。Effect of long-term oral intake of thermal water on gastric mucosal blood flow was evaluated, using an endoscopic organ reflex spectrophotometry together along with an Olympus XQ-10 forward viewing gastro-fiberscope． Three healthy volunteers and nine patients with gastric diseases in remission (six with healed gastric ulcer and three with chronic gastritis) were put on a 2-week treatment with daily oral intake of Misasa thermal water (38 to 42 ℃, 200mℓ, two times a day between meals). Gastric mucosal blood flow was measured just before and after the treatment period at three spots of the stomach (lesser curvature of the pylorus, antrum and angle) : Life style and drugs were unchanged during the period. Following results were obtained : (1) Pre-and post-treatment gastric mucosal blood flow (IHb) was 95.0±18.0, and 98.2±15.3 at the pylorus, respectively ; 104.8±16.9 and 110.8±12.8 at the antrum, respectively ; 116.1±20.4 and 118.7±18.5 at the angle, respectively. (2) However, Evaluation of each individual case showed that the post-treatment values were　higher than the pretreatment ones in 75 % of patients at the pylorus and in 67 % of patients at the antrum and angle, respectively. (3) Student's paired t-test showed that the post-treatment increase in blood flow was statistically significant (p<0.05) only at the antrum． These results suggest that an improvement in gastric mucosal blood flow, along with an improvement in gastric secretion and motility, is also contributory to the favorable therapeutic results of spa-drink in chronic gastric diseases. Further studies are in progress to reveal (1) the clinical significance of the improvement in gastric mucosial blood flow, such asacceleration of healing and maintenance of remission, and (2) the characteristics of patients who are likely to show favorable response to the treatment

Etiology and pathogenesis of chronic pancreatitis

慢性膵炎の成因の主たるものは，アルコール性，特発性，胆石性である。病態面では，社会的・家庭的にもっとも責任が重い壮年期に頑固な疼痛，消化吸収障害，二次性糖尿病のために生活の質が低下することが問題になる。経過中に併発してくる膵およびそのほかの臓器の癌，および糖尿病の合併症による死亡も少なくない。アルコール性慢性膵炎の初期病変の発生機序としては，①膵過分泌の結果として細膵管内に形成される蛋白栓による膵液流出障害と，②蛋白栓あるいはアルコールの直接障害作用による細膵管上皮の損傷，およびその結果生じる膵管狭窄による膵液流出障害が注目されている。膵液流出障害はその上流域に実質細胞の破壊と間質の線維化をおこす。膵液には多くの生化学的異常が認められ，いったん発生した膵管の構造異常とあいまって慢性膵炎進展の原因となる。素因および栄養のアンバランスは発症，進展の促進因子となる。発症を予防し，進展を阻止する手段を開発するためには素因および飲酒・食事を含む環境因子の解析が今後の重要な課題である。Main etiologies of chronic pancreatitis (CP)include "alcoholic" (60%), "idiopathic" (27%)and "biliary" (8%). Clinico-pathological features comprise intractable abdominal pain, maldigestion secodary to exocrine pancreatic insufficiency and diabetes secondary to endocrine pancreatic insufficiency. Death is not infrequent during follow-up. Pathogenesis and evolution of alcoholic CP were discussed in connection with "Big Duct Theory", "Toxic-Metabolic Theory", and "Protein Plug Theory". Diet and congenital predisposition as well as alcoholic comsumption play important roles in various combinations in the pathogenesis and evolution of CP. Important initial lesins of alcoholic CP are probably : (1) pancreatic ductular Obstruction due to proetin plug formation resulting from increased protein and mucoprotein concentration in pancreatic juice ; (2) damage and sloughing of ductular epithelia caused by protein plugs or by a direct toxic effect of ethanol secreted into pancreatic juice, and subsequent ductular stenosis and peri-ductular fibrosis. Parenchymal destruction with interstitial fibrosis is induced upstream to the ductular lesions. These, structural abnormalities and multiple biochemical abnormalities of pancreatic juice further lead to self-perpetuating evolution. Anti-acinar-cell antibody, anti-duet-cell antibody and immune complex in serum are most probably mere epiphenomena and not the causes of CP

Short term effect of spa-water on gastric mucosal blood flow

臓器反射スペクトル法と内視鏡を併用して胃粘膜血流を測定し，当院温泉水飲用の消化機能に対する基礎的検討を胃粘膜血流を指標に行なった。温泉水の対照として空気と白湯を選び3群に分け検討した。その結果，温泉水は空気に比し胃粘膜血流を増加させる作用を有していることが示唆された。また温泉水は部分的ではあるが白湯にくらべても胃粘膜血流を増加させる作用があることが示唆された。よって飲泉療法の消化器疾患に対する臨床的有用性が胃粘膜血流の面からもうかがわれた。Short-term effects of spa-drink therapy on gastric mucosal blood flow were evaluated by an endoscopic organ reflex spectrophotometry, using Olympus XQ-10. Thirty-four subjects were randomly divided into three groups : 10 subjects for warm spa-water (40±C) infusion group, 10 subjects for warm tap-water infusion group, and 14 subjects for warm air infusion group. Intragastric infusion of water or air was performed through the fiberscopic infusion channel. Gastric mucosal blood flow was determined just before and 10 min after the infusion on the three points of gastric mucosa : lesser curvature of the angle, the antrum and the pylorus. Following results were obtained : 1) Spa-water exerted a beneficial effect on gastric mucosal blood flow as compared to air. The difference was statistically significant on all of the three points. 2) Spa-water tended to exert a beneficial effect on gastric mucosal blood flow as compared to tap-water. The difference, however, was significant only on the mucosa of the gastric antrum. In conclusion, it was suggested that spa-drink therapy was useful for the treatment of chronic gastritis and gastric ulcer in which impairment of gastric mucosal blood flow plays an important pathogenetic role. Studies on the long-term effects of spa-drink therapy on the gastric mucosal blood flow are now in progress

Effect of spa-drink therapy on exocrine pancreatic function

膵外分泌機能におよぼす飲泉（三朝温泉水）の効果を飲泉群および非飲泉群を対象として検討した。膵外分泌機能検査法としては，糞便中キモトリプシン活性比色測定法（モノテストカイモトリプシン）を用いた。その結果，糞便中キモトリプシン活性は，飲泉開始2週後に40　％　の患者で上昇し，4週後は2週後と変わらなかった。以上より，2週間の飲泉は膵外分泌機能を改善させる効果があることがわかった。The effect of spa-drink therapy (Misasa hot spring) on exocrine pancreatic function was studied on 18 patients after their physical and psychological conditions were stabilized about two weeks following hospitalization. Patients were randomly divided into two groups : eight patients into a control group (continuance of spa-bathing) and 10 patients into a spa-drink therapy group (continuance of spa-bathing plus commencement of spa-drink therapy). Spa-drink therapy refers to drinking 200mℓ of warm spa-water (42℃) two times a day : between meals in the morning and in the afternoon. Exocrine pancreatic function was evaluated by fecal chymotrypsin activity, using a colorimetric method (Boehringer-Mannheim). Following results were obtained : 1) With 2-week's spa-drink therapy, fecal chymotrypsin activity was significantly enhanced in 40 % of the patients, while none of the controls showed an increase in fecal chymotrypsin activity. 2) Fecal chymotrypsin activity at the time of 4 weeks was similar to that obtained at the time of 2 weeks in both groups. In conclusion, spa-drink therapy for 2 weeks was effective for the enhancement of exocrine pancreatic function

Tropical calcific pancreatitis ........ .An overVIew

Abstract: Tropical calcific pancreatitis is a nonalcoholic type of chronic pancreatitis affecting the childrens and young adults characterized clinically by recurrent abdominal pain in childhood, diabetes in adolescent and death in early childhood. Although the exact etiology is not known, malnutrition and chronic cassava toxicity either singly or in combination are presumed to be the prime factor in pancreatic injury unopposed by detoxification of free radical. Moreover micronutrients deficiency, oxidant stress and antioxidant deficiency might play substantial role. Diabetes secondary to tropical calcific pancreatitis is a distinctive and frequent problem, being named by W.H.O. study group as &apos;fibrocalculous pancreatic diabetes (FCPD) and classified as one of the variant of the so-called malnutrition related diabetes mellitus (MRDM)