6種類の血中膵酵素値に及ぼす加齢および性の影響

The serum levels of some pancreatic enzymes have been reported to be affected by age and gender. Currently, serum total amylase, pancreatic isoamylase (P-amylase) , lipase , trypsin (ogen) , pancreatic phospholipase A(2) (PLA(2)) , and elastase I are utilized in diagnosing pancreatic diseases. We here compared age and gender-related alterations of these six pancreatic enzymes in healthy subjects to delineate different properties among the enzymes. Subjects were 155 males and 172 females between ages 20 and 79 years who were apparently healthy, and were stratified by age and sex. PLA(2) and elastase I were assayed by RIA, trypsin (ogen) by EIA and others by activity. The pancreatic enzymes, except PLA(2), were significantly elevated with age, although they declined in males in the 260 age group. There were significant sex differences in total amylase and P-amylase. Total amylase was significantly higher in females than in males in the 260 age group, P-amylase in the 40-49 age group. Age should be considered in the valuation of serum enzymes except PLA(2), sex difference should be considered in the valuation of amylase (total and P-amylase).ある種の血中膵酵素値は加齢や性により影響を受けることが知られている。現在膵疾患の診断に利用されている6種類の膵酵素，アミラーゼ，P－アミラーゼ，リパーゼ，トリプシン，フォスフォリパーゼA(2)（PIA(2)），そしてエラスターゼⅠの血中値に及ぼす加齢および性の影響を比較検討した。健常者327名（男性：155名，女性：172名，年齢：20－79歳）を対象として，年齢および性により層別化して検討した。PLA(2)とエラスターゼⅠはRIA，トリプシンはEIA，そして他の酵素は活性を測定した。PLA(2)以外の血中月率酵素値は加齢とともに有意に上昇した。しかし男性では60代以降低下した。性差はアミラーゼとP－アミラーゼとに有意差が認められた。すなわち，アミラーゼは60代以降に，P－アミラーゼは40－49歳群でそれぞれ男性より女性において有意の高値を示した。PLA(2)以外の血中膵酵素値を評価する際には加齢による影響を考慮すべきであり，アミラーゼおよびP－アミラーゼの血中値を評価する際には性を考慮すべきである

マトリックスメタロプロテアーゼと膵疾患

Matrix metalloproteinases (MMPs) is a family of collagenolytic enzymesand are associated with many pathological conditions. Especially, MMPs have a strong relation with tumor progression and invasion. In this review, we focused on association of MMPs and pancreatic diseases, and a potential treatment of MMPs inhibitors for pancreatic cancer.マトリックスメタロブロテアーゼ（MMP）は，コラーゲン分解能を有し，種々の疾患との関連性が示唆されている。とりわけ,癌の浸潤，転移には密接な関係があるとされている。また，MMP阻害剤を癌の治療に用いる試みもなされている。本稿ではMMPと膵疾患の関連性，MMP阻害剤の膵癌への応用の可能性について総説する

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

臨床的および実験的側面からみた慢性膵炎とフリーラジカル

Free radicals have been suspected to play an important role in the pathogenicity of chronic pancreatitis. We reviewed studies on free radicals in chronic pancreatitis in both c1inical and experimental aspects. Many clinical studies have provided circumstantial evidence for the close relation between free radicals and chronic pancreatitis. However, few experimental studies in animals on relation between free radicals and chronic pancreatitis have been reported, because adequate experimental models for elucidating a pathological role of free radicals in chronic pancreatitis have not been established. The research concerning the role of free radicals in chronic pancreatitis is expected to improve our understanding the pathological mechanisms of the disease.慢性肺炎の発症機序は不明な点が多いが､フリーラジカルがそれに関与することが示唆する報告も多い｡しかし,その直接的な証明はなされていない｡慢性膵炎の病態にフリーラジカルがどのように関与するかを理解することは慢性膵炎の発症機序の解明の一助になると考え,臨床的および実験的側面から慢性膵炎とフリーラジカルの関係を概説した

New Large Bowel Segmentation on Plain Abdominal Radiography in Comparison with the Conventional Method

Plain abdominal radiography is a very basic examination and plays an important role in primary care. The objectives of this study were to clarify colon distributions on plain abdominal radiographs. Forty-three healthy volunteers underwent gastric fluoroscopy, and 2 hours later, plain abdominal radiography in the supine position. A region of interest (ROI) was defined uniformly on each X-ray image to divide the image into 600 zones. The area corresponding to the large bowel within the ROI was divided into 4 segments (ascending colon, transverse colon, descending colon, and sigmoid colon＋rectum). The percentage of barium in each segment relative to the total volume of barium used was calculated to evaluate the percent ROI occupancy. The large bowel covered 76.7% of the entire ROI, with the percent duplication being 55%. The duplicated area corresponded to the transverse colon region. When the method proposed by Arhan et al. was used, the percentage of the colon actually present in each segment relative to that determined theoretically was 99.6% for the right colon segment, 92.2% for the left colon segment, and 92.2% for the sigmoid/rectal segment. However, in cases in which the transverse colon descended partially from the fifth lumbar vertebra, the percentage occupied by the sigmoid colon＋rectum decreased to 57.2%. We applied a new large bowel segmentation method especially for patients with ptosis, by devising a line joining the lateral side of the right lesser pelvis and the lower ends of both sacroiliac joints

Effect of Taurine on Acinar Cell Apoptosis and Pancreatic Fibrosis in Dibutyltin Dichloride-induced Chronic Pancreatitis

The relationship between pancreatic fibrosis and apoptosis of pancreatic acinar cells has not been fully elucidated. We reported that taurine had an anti-fibrotic effect in a dibutyltin dichloride (DBTC)-chronic pancreatitis model. However, the effect of taurine on apoptosis of pancreatic acinar cells is still unclear. Therefore, we examined apoptosis in DBTC-chronic pancreatitis and in the AR42J pancreatic acinar cell line with/without taurine. Pancreatic fibrosis was induced by a single administration of DBTC. Rats were fed a taurine-containing diet or a normal diet and were sacrificed at day 5. The AR42J pancreatic acinar cell line was incubated with/without DBTC with taurine chloramines. Apoptosis was determined by using terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. The expression of Bad and Bcl-2 proteins in the AR42J cells lysates was detected by Western blot analysis. The apoptotic index of pancreatic acinar cells in DBTC-administered rats was significantly increased. Taurine treatment inhibited pancreatic fibrosis and apoptosis of acinar cells induced by DBTC. The number of TUNEL-positive cells in the AR42J pancreatic acinar cell lines was significantly increased by the addition of DBTC. Incubation with taurine chloramines ameliorated these changes. In conclusion, taurine inhibits apoptosis of pancreatic acinar cells and pancreatitis in experimental chronic pancreatitis

慢性膵炎患者の全消化管通過に関する研究

Abnormalities of whole gut transit could contribute to the maldigestion and　digestive symptoms of chronic pancreatitis patients. Whole gut transit was measured by radiopaque markers method. Fifteen chronic pancreatitis patients (2 females, 13 males; age range 40-78 years) and 17 controls (4 females, 13 males, 32-73 years) were studied. Additionally, we also looked for evidence of autonomic neuropathy in the chronic pancreatitis patients by using cardiovascular tests. In chronic pancreatitis, whole gut transit was shorter than controls. These abnormalities were not influenced by the degree of autonomic neuropathy. We conclude that whole gut transit is shorter in chronic pancreatitis patients.慢性膵炎の患者の自覚症状や消化不良には消化管の通過異常が関与している可能性がある｡慢性膵炎患者15例と対象群17例で全消化管通過を測定した｡さらに慢性膵炎患者は自律神経機能について評価した｡全消化管通過は慢性膵炎患者は対象群より早いことが示された｡しかしその機序として推定された自律神経機能異常の有無では全消化管通過に差は認められず,慢性膵炎の消化管機能異常の原因は自律神経異常ではないと推定された

食道痛細胞におけるWntのベータカテ二ンTCF経路の活性化の検討

Although, accumulation of nuclear and cytoplasmic beta-catenin has been observed in ESCCs, mutation of APC and beta-catenin are not found in ESCCs. Therefore, another mechanism for cytoplasmic beta- catenin accumulation might exist in ESCCs. Materials and Methods: Human ESCCs cell lines and the 293 stable transfectants expressing Wnt-1, Wnt-5A, and Wnt-7A were cultured under standard conditions. The TOPFlash or FOPFlash reporter plasmids were transfected. Results: Transfected mutant beta-catenin as well as an axin fragment harbing the GSK3 beta interaction domain, the latter a potent GSK3 beta inhibitor. both robustly activated pTOPFlash in ESCCs cells. When pTOPFlash/pFOPFlash reporters were transfected in ESCCs cell lines followed by cocultivation with 293 cells that stably express Wnt -1, all cell lines except one demonstrated TCF mediated transcriptional. But, cells were co- cultured, Wnt - 7A or Wnt - 5A did not activate TCF mediated transcription in a cell number dependent fashion. Discussion; We report the activation of TCF promoter gene by extemal Wnt stimuli in ESCCs cells.背景:食道癌細胞にベータカテニンの蓄積があることは報告されているが,大腸癌とことなり,ベータカテニン,Axin,APC変異の報告がなく,そのメカニズムは不明である｡ 方法:8種類の食道癌細胞株において,3種類のWntの刺激によるベータカテニンTCF系の活性化への影響をTCFプロモーターを持つルシュフフェラーゼプラスミドを癌細胞にトランスフェクションして検討した｡ 結果:代表的な食道癌細胞は変異ベータカテニン,変異APC,変異Axinのいずれも,TCFの活性化をおこした｡8種類中7種類の癌細胞はWnt1により量依存性のTCFの活性化が認められたが,Wnt5A,Wnt7Aでは活性化が認められなかった｡ 結語:食道癌の進展にWnt1の関与が示唆された

Gastrobiliary Dysmotility in Patients with Chronic Pancreatitis as Assessed by a Single Noninvasive Test

We simultaneously assessed gastric emptying and gallbladder contraction after oral administration of a liquid meal by noninvasive ultrasonography in 17 patients with chronic pancreatitis (CP) and in 17 healthy controls. Gastrointestinal (GI) transit was also assessed by a noninvasive radioopaque marker method. Exocrine pancreatic function was evaluated by analyzing pure pancreatic juice and by analyzing the autonomic nervous system by cardiovascular reflex tests. Patients with CP showed impaired gallbladder contraction at 15 min and hastened gastric emptying. The cause of the former is unclear, whereas the latter was closely related with decreased pancreatic lipase output, but not with autonomic dysfunction. GI transit time did not differ between controls and patients with CP. In conclusion, we succeeded in clearly demonstrating impaired gallbladder contraction and hastened gastric emptying in patients with CP by a single noninvasive test, ultrasonography. We also revealed for the first time that hastened gastric emptying is associated with insufficient pancreatic lipase output

A case of eosinophilic gastroenteritis with stenosis in the colon

大腸に全周性狭窄をきたした好酸球性胃腸炎の1例を報告した｡症例は54才の女性で,腹痛と下痢を主訴に来院した｡上部消化管検査では異常を認めなかったが,下部消化管造影検査と大腸内視鏡検査で横行結腸の全周性狭窄を認め,生検にて大腸粘膜の好酸球浸潤を認めた｡貝料理の摂取にて腹痛発作が出現したが,原因抗原は同定できなかった｡貝類の摂取を避けることにより,症状は消失し,末梢血液中の好酸球増多は消失した｡本邦ではこれまでに124例 の報告があるが,大腸に全周性の狭窄をきたす症例は稀であり,文献的考察を加え報告する｡We report a case of eosinophilic gastroenteritis with a stenosis in the transverse colon. A patient, 54 year-old-woman, presented to our clinic with abdominal pain and diarrhea. Esophagogastric endoscopy and biopsy were normal. Contrast barium enema examination and colonic endoscopy showed a stenotic segment in the transverce colon. Biopsy specimens obteind from the stenotic segment revealed moderate eosinophilic infiltration in the colonic mucosa. Oral intake of sea shells exacerbated her symptoms. Avoiding sea shells has resulted in the disappearance of symptoms and peripheral blood eosinophilia. The present case was discussed in comparison with the 124 cases heretofore reported in Japan