JaLCDOI 10.18926/19752
タイトル(別表記) Early diagnosis of pancreatic cancertrial of a mass screening test for detecting early pancreatic cancer
フルテキストURL 059_024_030.pdf
著者 松本 秀次| 越知 浩二| 入江 誠治| 武田 正彦| 田中 淳太郎| 原田 英雄|
抄録 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。
抄録(別表記) 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.
キーワード 膵集検 (Mass screening) 早期膵癌 (Early pancreatic cancer) 膵癌の早期診断 (Early diagnosis of pancreatic cancer)
出版物タイトル 環境病態研報告
発行日 1988-08
59巻
開始ページ 24
終了ページ 30
ISSN 09133771
言語 Japanese
論文のバージョン publisher
NAID 120002309153
JaLCDOI 10.18926/19662
タイトル(別表記) Effect of aging on pancreatic exocrine function -Aging and fecal chymotrypsin activity-
フルテキストURL 057_024_028.pdf
著者 松本 秀次| 原田 英雄| 越智 浩二| 武田 正彦| 田中 淳太郎| 森永 寛| 吉田 光雄| 木村 郁郎|
抄録 膵外分泌機能に及ぼす加齢の影響を検討する目的で,健常人43名,非膵疾患患者41名,老人ホーム入居者39名を対象として比色法により糞便中キモトリプシン活性(FCA)を測定し,以下の結論を得た。1)FCAは逐齢的に低下し,60歳以上は60歳未満より有意の低値を示した。しかし,分布図のretrospectiveな検討からは,膵外分泌機能の低下は,実際には65~70歳あたりから明らかになることが示唆された。2)FCAの正常下限値を14.5U/gに定めたが,高齢者の診療にあたってはこの正常値のみを根拠にして疾病の有無を判定すべきではない。3)老人ホーム入居者のFCAは特に低値を取ったがその主要因は高齢者が多いためと考えられた。
抄録(別表記) To examine the effect of aging on the pancreatic exocrine function, fecal chymotrypsin activity (FCA) was measured by the photometric method in 43 healthy controls, 39 controls in an old-age home and 41 patients with non-pancreatic diseases. Following conclusions were obtained. 1) Pancreatic exocrine function showed a significant decrease with aging as indicated by the present prospective study : ① a significantly lower FCA in the B group of 22 healthy controls (≧ 60 years of age) than the A group of 21 healthy controls (< 60 years of ago) ; ② significant correlationship between aging and FCA in the 43 healthy controls and also in the 41 patients with non-pancreatic diseases. 2) FCA in controls in an old-age home was especially low. Presumably it was due to their far-advanced aging. 3) The calculated lower limit of normal in FCA was 14.5U/g. However, the diagnosis of pancreatic diseases should not be coined solely on the basis of decreased FCA value.
キーワード 糞便中キモトリプシン活性 (Fecal chymotrypsin activity) 加齢 (Aging) 膵外分泌機能 (Pancreatic exocrine function) 膵 (Pancreas) 酵素 (Enzyme)
出版物タイトル 環境病態研報告
発行日 1986-07
57巻
開始ページ 24
終了ページ 28
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002309096
JaLCDOI 10.18926/19715
タイトル(別表記) Effect of spa-drink therapy on exocrine pancreatic function
フルテキストURL 058_012_016.pdf
著者 松本 秀次| 原田 英雄| 越智 浩二| 武田 正彦| 田中 淳太郎| 妹尾 敏伸| 入江 誠治| 石橋 忠明| 木村 郁郎|
抄録 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。
抄録(別表記) 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.
キーワード 糞便中キモトリプシン活性 (Fecal chymotrypsin activity) 飲泉療法 (Spa-drink therapy) 膵外分泌機能 (Pancreatic exocrine function) 膵 (Pancreas) 酵素 (Enzyme)
出版物タイトル 環境病態研報告
発行日 1987-08
58巻
開始ページ 12
終了ページ 16
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002309038
JaLCDOI 10.18926/19706
タイトル(別表記) Short term effect of spa-water on gastric mucosal blood flow
フルテキストURL 058_001_004.pdf
著者 田中 淳太郎| 松本 秀次| 妹尾 敏伸| 入江 誠治| 越智 浩二| 武田 正彦| 原田 英雄|
抄録 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。
抄録(別表記) 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.
キーワード 飲泉療法 (Spa-drink therapy) 消化器機能 (Digestive function) 胃粘膜血流 (Gastric mucosal blood flow) 臓器反射スペクトル法 (Organ reflex spectrophotometry)
出版物タイトル 環境病態研報告
発行日 1987-08
58巻
開始ページ 1
終了ページ 4
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002309081
JaLCDOI 10.18926/19750
タイトル(別表記) Clinical evaluation of endoscopic ultrasonography (EUS) in the diagnosis of gastric disease.
フルテキストURL 059_017_023.pdf
著者 越知 浩二| 原田 英雄| 松本 秀次| 入江 誠治| 武田 正彦| 田中 淳太郎|
抄録 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。
抄録(別表記) 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.
キーワード 超音波内視鏡 (Endoscopic ultrasonography) 胃癌 (Gastric cancer) 胃粘膜下腫瘍 (Submucosal tumor of the stomach) 癌深達度診断 (Diagnosis of the depth of cancerous invasion)
出版物タイトル 環境病態研報告
発行日 1988-08
59巻
開始ページ 17
終了ページ 23
ISSN 09133771
言語 Japanese
論文のバージョン publisher
NAID 120002309109
JaLCDOI 10.18926/21087
タイトル(別表記) Endoscopic diagosis of gastric malignant lymphoma
フルテキストURL pitsr_056_045_052.pdf
著者 三宅 啓文| 原田 英雄| 安岡 正敏| 岡 浩郎| 松本 秀次| 越智 浩二| 武田 正彦| 田中 淳太郎| 大熨 泰亮| 木村 郁郎|
抄録 To delineate the pitfalls and counter-measures in the endoscopic diagnosis of gastric malignant lymphoma (GML), reviewed were 32 cases of primary GML and 16 cases of systemic ML with gastric involvement (secondary GML). 1) Accurate diagnosis of GML had been made in only 13 cases of primary GML ; 18 cases had been diagnosed of gastric cancer (GC); the remaining one of benign ulcer (BU). Review of the endoscopic films, however, revealed more than two of the three findings characteristic, but not pathognomomic, of GML in 84 percent. This result indicates that possibility of GML must be kept in mind in the differential diagnosis of malignant lesions despite its rarity, because endoscopists tend to be predisposed with an impression of GC. 2) Follow-up examinations made in nine cases of primary GML revealed marked changes in endoscopic findings in three cases : healing of an ulcer lesion in one case, healing of an ulcer lesion on an unchanged tumor in another and enlargement of a tumor in the remaining one. The first case had been followed up for two years with an impression of BU. This result indicates that improvement of ulcer does not necessarily rule out GML because it can show "malignant cycle" just as GC. 3) Endoscopic biopsy performed in 30 cases of primary GML had led to accurate diagnosis in only 16 cases and erroneous diagnosis of GC in five and no malignancy in nine. Review of the cases revealed the importance of having suspicion of GML at first from endoscopic findings, because it can lead to an increase of the number of biopsy specimens, careful selection of biopsy sites, careful use of biopsy instruments to obtain good specimens and closer contact with pathologists. 4) Prospective studies on systemic ML revealed gastric involvement in 17 percent. Examinations of the GI tract, especially of the stomach is one of the important steps for staging of systemic ML and deciding therapeutic modalities. 5) It is extremely difficult to diffierentate primary GML and secondary GML from endoscopic findings alone, although there are a few findings characteristic of the latter.
出版物タイトル 岡山大学温泉研究所報告
発行日 1985-03-30
56巻
開始ページ 45
終了ページ 52
ISSN 0369-7142
言語 Japanese
論文のバージョン publisher
NAID 120002310992
JaLCDOI 10.18926/19821
タイトル(別表記) Interstitial matrix components in relation to the pathogenesis of fibrosis
フルテキストURL 060_076_082.pdf
著者 妹尾 敏伸| 原田 英雄| 越智 浩二| 田中 淳太郎| 松本 秀次| 石橋 忠明| 武田 正彦| 三宅 啓文|
抄録 慢性膵炎の症例は近年増加の一途をたどっており,その発症機序と病態の解明および対策の確立が急がれている。慢性膵炎の重要な所見の一つである膵間質線維化の発生機序の解明および早期発見法の確立は重要な課題であるが,従来の知見は断片的にすぎない。そこで,筆者らは膵線維化の系統的な研究を始めるにあたって,細胞間マトリックスの構成成分と線維化に関する従来の知見および今後の課題を整理した。細胞間マトリックスのうちでも特にコラーゲン,グリコサミノグリカン,フィブロネクチンをとりあげ,その構造と機能および組織の線維化形成における役割について文献的考察を行った。今後,膵組織および膵液中のプロリンハイドロキシラーゼ,コラーゲンとその型別分布および各型コラーゲンの比,ヘキソサミン,デルマタン硫酸,フィブロネクチン,ラミニンを検討することが重要と思われた。
抄録(別表記) Increasing numbers of patients with chronic pancreatitis have been reported all over the world, including Japan. Pathogenesis of chronic pancreatitis has remained to be revealed and the early detection has remaind difficult despite extensive investigations. Interstitial fibrosis forms one of the most important histopathological features of chronic pancreatitis along with loss of parenchyma and irregular dilatation of the ducts and ductules. However, only a limited numbers of reports have been pubiished on the pathogenetic mechanisms of interstitial fibrosis of the pancres, because tissue materials are not easily accessible and blood samples can hardly reflect the fibrotic process of the pancreas unlike the case of the iiver. Our Preliminary studies revealed that biochemical and immunochemical analysis of pure pancreatic juice, such as determination of collagen, hexosamine, fibronectin and proline hydroxylase, might reflect the fibrotic process of the pancreas. The results led us to review the earlier reports on inter-cellular matrix in relation to the formation of fibrosis to find suitable markers to be evaluated in the future systematic investigations. The review revealed that pure pancreatic juice should be analyzed for collagen, types of collagen, hexosamine, dermatan sulfate, fibronectin, larninin, proline hydroxylase, collagenase and cathepsin B(1).
キーワード 慢性膵炎 (Chronic pancreatitis) 膵の線維化 (Interstitial fibrosis of the pancreas) 膵間質成分 (Interstitial matrix of the pancreas)
出版物タイトル 環境病態研報告
発行日 1989-07
60巻
開始ページ 76
終了ページ 82
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002309179
JaLCDOI 10.18926/19669
タイトル(別表記) Diagnosis of chronic pancreatitis
フルテキストURL 057_029_036.pdf
著者 武田 正彦| 原田 英雄| 松本 秀次| 越智 浩二| 田中 淳太郎| 吉田 光雄| 岡 浩郎| 三宅 啓文| 木村 郁郎|
抄録 近年,各種膵疾患に対する検査法の発達には目を見張るものがあるが,実際の運用にあたっては各検査法の適応,限界,組合わせおよび実施する順序等に迷うことが少なくない。本研究では,最近我々が経験した慢性膵炎Ⅰ群116例の診断過程を振り返ることにより,慢性膵炎の診断における理想的な検査法の組合わせとそれぞれの役割を検討し,同時に診断名のみならず病態と病期が容易に理解できる表現方法を提案した。画像診断法,膵外分泌機能検査法(EX),膵内分泌機能検査法(EN)を比較検討し,以下の結果を得た。①画像診断法は必須である。②内視鏡的逆行性膵胆管造影(ERCP)を軸とした腹部超音波検査(US)あるいは腹部CTスキャン(CT)の組合わせは欠くことができない。③EXもまた必須の検査法である。④ENは慢性膵炎の診断に必要不可欠ではないが,治療方針を決めるうえで重要である。⑤純粋膵液(PPJ)の生化学的検査と組織化学的検査は膵炎の診断と病態生理の解明に重要である。⑥PPJ中の細胞診は慢性膵炎に合併した膵癌の検索に有用である。⑦以下に示すような診断の記載方法を提案した。"Calcified chronic pancreatitis, alcoholic, diffuse, ERCP-3, US-2, CT-3, EX-2, EN-1, Lf(+)"。
抄録(別表記) Endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography (US), computed tomography (CT), exocrine pancreatic function test (EX), endocrine pancreatic function test (EN), and analysis of pure pancreatic juice (PPJ) are currently available for the investigation of pancreatic diseases. The purpose of the present study is to evaluate the roles and preferable combinations of these tests in the diagnosis of chronic pancreatitis and then to propose a way to describe the results of the tests along with diagnosis for a better understanding of the disease process. Comparative studies of imaging, EX and EN led to the following conclusions. 1) imaging procedures (ERCP, US and CT) are mandatory, partly because they were frequently the test that showed diagnostic changes and partly because they often gave key information for operative treatment. Among the imaging procedures, ERCP combined with US and/or CT is mandatory because these combinations alone can reveal detailes of structural changes attendant on chronic pancreatitis. 2) EX is also mandatory, because it was occasionally the only test that showed diagnostic changes and partly because it often gave important information for medical treatment. 3) EN is also important, not because it was indispensable for detecting chronic pancreatitis, but because it often gave important information for medical treatment. For btter understanding of the disease process as well as diagnosis, we propose, as suggested by Seligson, that the test used for the establishment of the diagnosis and the degree as well as extent of abnormalities. An example is "Calcified chronic pancreatitis, alcoholic, diffuse, ERCP-3, US-2, CT-3, EX-2, EN-1, Lf(+)". This attitude will lead to a more rational approach to both diagnosis and treatment.
キーワード 慢性膵炎 (chronic pancreatitis) 画像診断 (imaging diagnosis) PS試験 (pure pancreatic juice) 純粋膵液(PPJ) (Pancreozymin-Secretin test) 内視鏡的逆行性膵胆管造影(ERCP) (endoscopic retrograde cholangiopancreatography (ERCP))
出版物タイトル 環境病態研報告
発行日 1986-07
57巻
開始ページ 29
終了ページ 36
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002309023
JaLCDOI 10.18926/19770
タイトル(別表記) Etiology and pathogenesis of chronic pancreatitis
フルテキストURL 059_068_082.pdf
著者 原田 英雄| 松本 秀次| 越智 浩二| 武田 正彦| 妹尾 敏伸| 入江 誠治| 田中 淳太郎|
抄録 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。
抄録(別表記) 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.
キーワード 慢性膵炎 (Chronic pancreatitis) 成因 (Etiology) 発生機序 (Pathogenesis)
出版物タイトル 環境病態研報告
発行日 1988-08
59巻
開始ページ 68
終了ページ 82
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002308982
JaLCDOI 10.18926/19747
タイトル(別表記) Characteristic pancreatographic findings in chronic pancreatitis and their diagnostic value. …Studies on post mortem pancreas…
フルテキストURL 059_012_016.pdf
著者 田中 淳太郎| 松本 秀次| 越知 浩二| 入江 誠治| 武田 正彦| 原田 英雄|
抄録 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。
抄録(別表記) 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.
キーワード 慢性膵炎 (chronic pancreatitis) 膵管造影像 (pancreatogpaphy)
出版物タイトル 環境病態研報告
発行日 1988-08
59巻
開始ページ 12
終了ページ 16
ISSN 09133771
言語 Japanese
論文のバージョン publisher
NAID 120002309156
JaLCDOI 10.18926/21107
タイトル(別表記) An evaluation of pancreatographic findings in the differential diagnosis of chronic pancreatitis and pancreatic cancer
フルテキストURL pitsr_054_039_041.pdf
著者 田中 淳太郎| 越智 浩二| 入江 誠治| 武田 正彦| 原田 英雄|
抄録 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.
出版物タイトル 岡山大学温泉研究所報告
発行日 1984-03-25
54巻
開始ページ 39
終了ページ 41
ISSN 0369-7142
言語 Japanese
論文のバージョン publisher
NAID 120002310981
JaLCDOI 10.18926/21123
タイトル(別表記) Role of endoscopic elimination of protein plug in the treatment of chronic pancreatitis
フルテキストURL 053_057_060.pdf
著者 田中 淳太郎| 武田 正彦| 高杉 潔| 原田 英雄| 万治 忠福|
抄録 Endoscopic aspiration of pure pancreatic juice (ppj) was performed on 65 patients with chronic pancreatitis (cp) or suspected CP primarily for evaluating the validity of biochemical and physiochemical analysis of PPJ in the study of pathogenesis, pathophysiology and diagnosis of CP. PPJ was collected from within the main pancreatic duct by endoscopic retrograde catheterization of the papilla. With increasing experience, it has been revealed that various numbers of protein plugs are contained in PPJ obteined from patients with CP or suspected CP and that endoscopic elimination of protein plugs can provide them with dramatic relief from abdominal pain and back pain. The purpose of this report is to evaluate the role of endoscopic elimination of protein plugs in the treatment of CP. The following conclusions were obteined: (1) endoscopic elimination of protein plugs from within the pancreatic duct is useful. at least on a short-term basis, for relieving abdominal pain and back pain in one-forth of patients with CP or suspected CP; (2) this procedure can be an effective therapeutic tool in selected cases of CP or suspected CP where no prominent stenotic lesions are noted in the major pancreatic duct system and abstinence from alcohol bevarage is strictly observed.
出版物タイトル 岡山大学温泉研究所報告
発行日 1983-03-25
53巻
開始ページ 57
終了ページ 60
ISSN 0369-7142
言語 Japanese
論文のバージョン publisher
NAID 40000321176
JaLCDOI 10.18926/21124
タイトル(別表記) A case report of a patient with chronic pancreatitis successfully treated by endoscopic elimination of protein plugs
フルテキストURL pitsr_053_061_065.pdf
著者 武田 正彦| 田中 淳太郎| 高杉 潔| 原田 英雄| 万治 忠福| 森永 寛| 鶴見 哲也| 藤井 靖久|
抄録 Presented here is a case report of a 56 years old male patient with chronic pancreatitis in which a dramatic improvement in symptoms and objective findings were noted after endoscopic elimination of protein plugs. In September, 1979, he had an acute onset of pancreatitis followed by pseudocyst formation and the following combined operations were performed: resection of the pseudocyst, resection of the body and tail of the pancreas along with the spleen, partial resection of the stomach and the transverse colon, and gastroenterostomy according to Billroth I method. He had been followed up at out-patient clinic for chronic pancreatitis and diabetes until January 14,1979 when he was hospitalized for anorexia, loss of weight, pretibial edema, and upper-abdominal pain. The patient's condition was characterized by emaciation (height 152 cm, weight 37 kg), anemia (Hb 7.9g/dl), hypoproteinemia (serum protein 4.2 g/dl) , and hypolipidemia (total cholesterol 73 mg/dl). Abdominal ultrasound, abdominal CT and ERCP revealed stones in the pancreatic duct. Symptoms and objective findings were only partially improved by medical regimens. Subsequently we performed endoscopic cannulation of the pancreatic duct for elimination of pancreatic stones. Successful elimination of large numbers of protein plugs resulted in dramatic improvement of symptoms and objective findings. This procedure proved to add a new important tool in the treatment of chronic pancreatitis.
出版物タイトル 岡山大学温泉研究所報告
発行日 1983-03-25
53巻
開始ページ 61
終了ページ 65
ISSN 0369-7142
言語 Japanese
論文のバージョン publisher
NAID 120002311007
JaLCDOI 10.18926/19771
タイトル(別表記) 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―
フルテキストURL 059_083_092.pdf
著者 入江 誠治| 松本 秀次| 越智 浩二| 武田 正彦| 田中 淳太郎| 原田 英雄| Mehdi, Tavassoli|
抄録 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.
抄録(別表記) 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。
キーワード Iron uptake (鉄の細胞内取り込み) Transferrin (トランスフェリン) Receptor-Mediated Endocytosis Desialation (脱シアル化) Endothelium (内皮細胞)
出版物タイトル 環境病態研報告
発行日 1988-08
59巻
開始ページ 83
終了ページ 92
ISSN 0913-3771
言語 English
論文のバージョン publisher
NAID 120002309113