ROCK PROPERTIES OF AN ANDESITE AFTER FREEZING AND THAWING IN WATER

Freezing and thawing damages of rock materials in many rock slopes have been well known to be severe under climatic cold region of Fukui Prefecture. Here, several weathering tests for hard rock material of andesite have been executed by freezing and thawing in water from -30℃ to +50℃ temperature. As the result, it is cleared that many rock properties tend to fall into decay gradually in linear relationship to the number of repeating cycles within 600 cycles

トランスフェリンを介する鉄の細胞内取り込み機序 ―特に肝細胞への取り込みにおける内皮細胞の関与について―

Transferrin (Tf) is thought to play a pivotal role in iron metabolism of various kinds of cells. Tf has specific receptors on the surface of the cells that require iron. Tf-receptor binding is followed by internalization through a system of coated pits and vesicles. The rapid decline of pH of these vesicles leads to the release and sequestration of iron by the cell. Apotransferrin-receptor complex returns to the cell surface, where under neutral pH conditions, apotransferrin is dissociated from the receptor. Recent advances in cellular and molecular biology, gene cloning and monoclonal antibody technique have elucidated many features of these processes at a molecular level. These advances are briefly reviewed, and particularly, our own observations concerning endothelial mediation of uptake of Tf by hepatocytes are discussed.トランスフェリン（Tf）は鉄代謝において重要な役割を担っている。鉄を必要とする細胞の表面には，Tfの特異的受容体が存在し，Ffは受容体との結合に引き続いて，coated　pitsとcoated　vesiclesを介して細胞内に取り込まれる（internalization）。Vesicle内での急速なpHの低下にともない，鉄はTfから分離し，細胞内で分画される。一方，鉄を失ったTf（アポTf）は受容体と結合したまま細胞表面にもどり，中性のpHのもとで受容体から解離する。最近の細胞・分子生物学の進歩，遺伝子クローニング，ならびにモノクローナル抗体の開発により，分子レベルで鉄代謝経路が解明されつつある。今回，これまでの主要な知見をまとめ，特に，最近筆者らの研究により明らかとなった，肝の鉄代謝における内皮細胞の役割について考察した

A case report of a family with Peutz-Jeghers syndrome

A 58-year-old female was admitted because of colicky abdominal pain. Physical examination revealed firm abdominal wall, increased bowel sounds and multiple pigmented macules on the lips, oral mucosa, soles and volar aspects of the fingers and toes. Hyperventilation and tetanic rigidity of the extremities were also noted. The symptoms were successfully treated by intravenous injection of butropium bromide and diazepam. Roentgenological and fiberscopic examination revealed multiple polyps in the stomach, small intestine and colon ; the small intestine was most heavily loaded with polyps. Biopsy specimen revealed only inflammatory changes. The patient had undergone a resectien of the terminal ileum with polyps 15 years previously because of ileo-ileal intussusception. Histological re-evaluation of the polyp showed an actively proliferating papillary adenoma. The characteristic history and gastrointestinal findings lead us to the examination of the family, which revealed that her father, son and grandson had similar pigmentation of the skin and polyps in the gastrointestinal tract. These characteristic findings and family history permitted us to make a diagnosis of Peutz-Jeghers syndrome. The diagnosis had been missed supposedly because of unawareness of the skin lesions and the lack of hamartoma-like findings in the polyp. The tetanic rigidity of the extremities was probably hyperventilation syndrome induced by severe abdominal pain. The patient has been followed up for possible recurrence of symptoms and a potential malignant change

An evaluation of pancreatographic findings in the differential diagnosis of chronic pancreatitis and pancreatic cancer

In an attempt to evaluate the pancreatographic findings, particularly of the pancreatic duct branches, in the differrential diagnosis of chronic pancreatitis and Pancreatic cancer, twenty seven post mortem pancreases were subjected to retrograde pancreatography and histological examination. The materials consist of 15 cases with chronic pancreatitis and 12 cases with pancreatic cancer. The results obtained are as follows. 1) In cases with chronic pancreatitis, abnormal findindings such as irregular dilatation, straightening-hardening, narrowing-stenosis of the pancreatic duct branches were more common. 2) Incases with pancreatic cancer, abnormal findings such as diminishing, irregular dilatation, narrowing-stenosis of the pancreatic duct branches were more common. 3) Abnormal findings in cases with chronic pancreatitis reveled the dendency of diffuse expansion, on the other hand, in case with pancreatic cancer revealed the tendency of localized expansion. 4) When the fine and clear pancreatography was obtained, it was possible to predict the presence of chronic inflammation or tumor cell infiltration from above findings and tendencies. On the contrary, in cases with localized, severe chronic pancreatitis and in cases with complicated, it was difficult to differentiate the pancreatic cancer from chronic pancreatitis

Clinical evaluation of endoscopic ultrasonography (EUS) in the diagnosis of gastric disease.

ラジアルセクタ式超音波内視鏡（EUS）を，15例の胃疾患患者に用い，その有用性を検討した。胃癌の深達度診断は併存潰瘍を有するm癌の1例をsm癌とした以外は，いずれも正診であり，胃癌の深達度診断にEUSが有用であることが示唆された。その他，胃粘膜下腫瘍の占拠部位や発育様式の診断や壁外性圧排との鑑別など胃疾患の診断にEUSの有用性が示唆され，文献的考察を加えて報告した。We performed EUS in seven cases with gastric cancer, one with gastric malignant lymphoma, two with submucosal tumor of the stomach (SMT), two with tumourous compression by extra-gastric organs and three with others. Except one case with early gastric cancer, the depth of cancerous lnvasion was correct1y diagnosed by EUS. It was posible to detect which layer had SMT in the 5 layer strcture of the gastric wall by EUS and it was helpful in determination of histological origin of SMT. Furthermore EUS was able to make the differential diagnosis between SMT and tumourous compression by extra gastric organ. Our result showed that EUS was a useful procedure in the diagnosis of gastric diseases

Early diagnosis of pancreatic cancertrial of a mass screening test for detecting early pancreatic cancer

膵癌を治癒に導くためには早期診断，早期切除以外に方法はない。そこで，無症状者のなかから早期膵癌を発見するためのスクリーニング法を検討するためProspective studyを実施した。人間ドック目的の来院患者を主とする三朝分院外来患者776名を対象とし，一次スクリーニング検査として，血清アミラーゼ，エラスターゼⅠ，CA19－9，アルカリフォスファターゼ，γ-GTP，血糖値の測定および腹部超音波検査を施行し，異常者に対して二次スクリーニングとして腹部超音波検査の再精査およびERCPを施行した。その結果，早期膵癌1例および進行膵癌2例を検出し，膵癌発見率は0.39％　と満足のいく結果が得られた。しかし一次スクリーニング検査の要精検率は46％　と高値を示したこと，一次スクリーニング検査の費用は胃集検の約3.3倍，二次スクリーニング検査の費用は胃精査の約2.6倍かかることからcost-benifitの面で問題となった。また見逃し症例の有無をモニターするためfollow upも今後の問題として残った。There is no other way of curing pancreatic cancer than early diagnosis and resection. However, an effective protocol has not been established for detecting early pancreatic cancer among asymptomatic populations by means　of a mass screening test. Therefore, a prospective study was attempted on 776 patients who came to Medical Clinic of Misasa Branch Hospital, Okayama University Medical School mostly for a routine annual check-up. The following tentative protocol was proposed, based on the retrospective analyses of our 13 patients with early pancreatic cancer: (1) a first step test includes serum amylase, elastase Ⅰ, alkaline phosphatase, r-GTP, carcinoembryonic antigen, fasting blood sugar and routine abdominal ultrasonography (US); (2) a second step test includes thorough abdominal US with various kinds of probes and patients' positioning which was performed on individuals with abnormal findings on the first step test, (3) a third step test includes ERCP which was performed on individuals with abnormal or questionable findings on the second step test. Further detail examinations were performed when ERCP was abnormal or questionable. Consequently 357 patients (46% of the total 776 patients) underwent thorough US and 45 patients (5.8%) underwent ERCP. ERCP findings included pancreatic cancer in two patients, suspect of pancreatic cancer in three, advanced chronic pancreatitis in two, equivocal as for chronic pancreatitis (according to the Cambridge classification) in nine, and normal in 29. Final diagnosis was early pancreatic cancer in one patient, advanced pancreatic cancer in two, and calcified chronic pancreatitis in two; detection rate of pancreatic cancer (0.39%) in this series was slightly higher than that usually reported with a mass screening test for stomach cancer. From a cost-benefit point of view, however, examinations for the pancreas cost 2.6 times as much as those for the stomach. Further studies are needed (1) to refine the protocol, (2) to improve cost-benefit efficiency, (3) and also to confirm by follow-up that no cases of pancreatic cancer have passed through the test undetected

Characteristic pancreatographic findings in chronic pancreatitis and their diagnostic value. …Studies on post mortem pancreas…

慢性膵炎25例および対照として正常例125例計150例の新鮮剖検膵を用いて膵管造影を行い，X線所見と同部位の組織所見とを厳密に対比させ，慢性膵炎における各X線所見の診断学的価値を検討した。その結果，主膵管像では不整拡張像，硬化＋辺縁不整像，狭窄＋辺縁不整像が，分枝像では不整拡張像および不整配列像が，positive predictive value（PPV），specificity（Sf），negative predictive value（NVP）ともに77.1～100％　の高率を示した。しかしsensitivity（St）は，2.1～18.1％　と低率であった。したがって，これらの所見は慢性膵炎を診断する上で組織予見性および特異性に優れた診断的価値のあるX線所見と言える。しかし一方では軽症の慢性膵炎の検出能はあまりよくないという限界が膵管造影法にはある。Postmortem pancreas tissue was prepared within 6 hours of death for the comparative study of pancreatographic findings and histological findings to define characteristic pancreatographic findings of chronic pancreatitis and determine their diagnostic value. Pancreas tissue was obtained from 25 patients with chronic pancreatitis and 125 with a normal pancreas. Among various pancreatographic findings, irregular dilatation and irregular arrangement of the branches of the pancreatic duct, and also irregular dilatation, rigidity with irregular margin and stenosis with irregular margin of the main pancreatic duct showed the highest sensitivity. specificity, positive predictive value and negative predictive value and conseqently had the highest diagnostic valus. However, the sensitivity was not high enough, indicating that the above pancreatographic findings could be absent at the site of positive histological findings in mild chronic pancreatitis