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Gas was injected from the apex of the coccygeal bone. A 1000~1300cc mixture of equal volume of CO~ and air was used. Fur thermore compound effervescent powders (4% citric acid water 25 cc and 8% sodium bicarbonate water 25 cc) was placed in the stomach through peroral ingestion and 1000 cc of air was injected into the large intestine. Frontal and lateral circus tomographies of the pancreas were then carried out. This method represents the best method of X-ray studies of the pancreas available at present.

Cases; Cancer of the pancreas, chronic pancreatit is, cancer of the bile duct, actinomycosis of the stomach and polyp of the small intestine.

5. E F F E C T O F A L C O H O L ON T H E P A N C R E A S

Masayuki Oda and Yozo Ogiwara

Department of Internal Medicine, Faculty of Medicine, Shinshu University, Japan

The following results were obtained after analysation into the questionnaires on the frequency and the actual condition of the alcohol-induced pancreatitis, af ter investigation into the pancreatic dysfunction by the intake of the excess volume of alcohol, and finally examination of the effect of the diet on the pancreas both clinically and experimentally.

1) The diseases of the pancreas which were diagnosed as chronic pancreatitis, have been increased recently in our country. Nearly 10 percent of them were due to the intake of excess alcohol. On the hail of pancreatic calcification were caused of alcoholic suspectively. Interest- ingly, the patients of these assimilated the less diet in their drinking habbit.

2) About 30 percent of the long term drinker of alcohol were shown abnormalit ies on their pancreatic function tests (Pancreozymin-secretin test, I131-triolein absorption test, Glucose torelance test etc.).

3) Though the slightly increasing of the oxygen-consumption and the levels of catalase in the pancreatic t issue on the group of the short term administrat ion of alcohol experimentally. as the cause of the pancreatic damage by these results were not calculated. Contraversingly, there were some pathological findings thought to be dysfunction being shown the decrease of oxygen-consumption of pancreatic tissue and of exocrine secretion of pancreatic juice in the group of long-term feeding of alcohol.

4) The pancreatic changes were observed in the group of low-protein diet rats, especially of low-protein high fat, af ter 4 to 15 weeks of the feeding.

They include (1) acinal atrophy (2) fatty degeneration (3) desfiguration of mitochondria with shartened and distar ted cristal (4) vesiculation or vacuolization in endoplasmic reticulum (5) increase in free ribosomes.

The fibrosis of the pancreas were noticed in some rats of this group after 12 to 15 weeks of the feeding.

The low-protein diet only was also found to cause the direct damage on the pancreas. The less histological changes of the pancreas were seen in the rats of single alcohol feeding group, moreover no duodenitis, edema and no dilatation of the pancreatic duct were observed. When alcohol were administered simultaneously to the group of low-protein feeding rats, a little more marked findings in the pancreatic tissue were noticed than those of low-protein diet rats. It was concluded that pancreatic damages were more severe by low-protein diet than that by alcohol administration.

6. S U R G I C A L T R E A T M E N T O F C H R O N I C P A N C R E A T I T I S

Toshio Sato, M.D.

Department of Surgery, Tohoku University School of Medicine, Sendai (Director: Prof. T. Maki)

Recently, chronic pancreatit is has been drawing wide attentions in our country with increas- ing frequency. Apart f rom whether majori ty of the cases are mild in symptoms or not, it

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seems to be a matter of fact that there are few cases of severe chronic pancreati t is for which surgical intervention is mandatory. Number of operations performed for chronic pancreatit is at our department counts only 24 during the past 25 years.

Modes of operations performed are; cholecystectomy in two cases, cholecystectomy with T- tube choledochostomy in two cases, cholecysto-duodenostomy and Billroth II operation in one case respectively as the indirect operations. Direct operations employed toward chronic pancreati t is are; transduodenal pancreaticolithotomy in one case, resection of the head of the pancreas in four cases, caudal pancreatectomy in six cases and caudal pancreatectomy with side-to-side pancreatico-jejunostomy in seven cases. Our recent experiences with pancreatic calculi have assured us that side-to-side pancreatico-jejunostomy after Puestow and others is the procedure of choice for those with severe chronic pancreatits. All the cases in which side- to-side pancreatico-jejunostomy were employed had pancreatic calculi. We modified the method and resect the tail of the pancreas, incise through the pancreatic duct of the head and body of the pancreas and anastomose side-to-side with the jejunum.

Follow-up results of these cases underwent side-to-side pancreatico-jejunostomy are sum- marized as follows: Length of follow-up ranges from two months up [to two years and eight months. Results of operation are satisfactory with disappearance of upper abdominal pain except in one case, remarkable gain in body weight and most of the cases returning to their preoperative occupation. One of the cases expired eight months af ter the operation. Provocative test of blood amylase by pancreozymin and secretin was within normal limits in majori ty of the follow-up cases suggesting that the site of anastomosis had been patent. Two cases, however, developed glycosuria postoperatively. A case has been under observation without any specific t rea tment but the other has been treated as diabetes mellitus. Postoperative diabetes may be rendered to the large resection of the pancreas.

7. N E W P R O B L E M S I N P A N C R E A T I C D I S E A S E

Ichio Honjo

First Department of Surgery, Kyoto University Medical School

Pancreas which has dural functions, endocrine and exocrine secretion, is one of the most important organs. Pathophysiology of the pancreas is so complex that it is hard to clarify the character is t ic and elaborate mechanisms in this organ. A few of the most interest ing subjects recently developed in this field will be discussed.

1) Acute pancreatitis There have been many studies on a role of trypsin in acute pancreatitis and importance of

t rypsin contributing to pathophysiology of acute pancreati t is has been emphasized. It has been pointed out that it is not enough to explain the pathological condition of pancreati t is merely by action of trypsin, and an important role of phospholipase has been stressed recently by Creutzfeld and Zieve.

Based on our experimental study on a development of liver necrosis af ter hepatic arterial occlusion, a significant role of phospholipase in pancreati t is has been assumed from our own viewpoints. A few problems which have been studied in our laboratory will be reported.

2) Carcinoma of the pancreas It is a wellknown fact that a prognosis of cancer of the pancreas is worst. Comparing

carcinoma of the head of the pancreas with carcinoma of the ampullary region which shows similar clinical pictures as the former, the latter prognosis is far better than the former. It was clearly shown that from our recent precise case analysis this different prognosis should have been attributed to a character of tumor itself.

It is a truly difficult problem to improve a prognosis of carcinoma of the head of the pancreas, even if an operative technic will be ameliorated. The only hope is an early diagnosis. Although various diagnostic methods have been devised recently, evaluation of initial and early symptoms of our patients with carcinoma of the pancreas has been carried out. The results will be reported.