J.Jpn. Surg. Soc.. 55(7): 698-705, 1954
Others
Some Fundamental Problems of the Gastroduodenal Ulcer
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Surgical Clinic of Tokyo Jikei-Kai School of Medicine Minoru OI |
I. On the problem whether or not the chronic ulcer originates from the hemorrhagic erosion
The macroscopical, histological, cytological or chemical observations of the stomach, parietal cells, adrenal gland and gastric juice were performed on stress rats, dogs under electrical hypothalamic stimulation, Shay rats and dogs, dogs with consecutive injections of histamine in oil, and modified Mann-Williamson dogs by oral shift of the jejunal loop bearing the primary anastomotic ulcer. We could not confirm the theory that the chronic ulcer originates from the hemorrhagic erosion, because the hemorrhagic erosion occurs in the area of parietal cell distribution in contrast with the predilection of non-parietal cell area by the chronic ulcer. From the results it is assumed that the hemorrhagic erosion probably occurs under the similar mechanism as that of the stimulation of parietal cell function followed by increase of HCI in the gastric juice.
II. Doses the impulse of the central nervous stimulation of HCl secretion be conducted by the hypothalamo-pituitary-adrenal-gastric route?
The same items as I group were observed after the vagotomy on stress rats, electrically hypothalamo-stimulated dogs, dogs under ACTH injection, adrenectomized rats and dogs with total stomach pouch. The remarkable changes in type of hemorrhagic erosion are almost completely abolished after the vagotomy, but both increase of the parietal cell function and of the out-put of HCl in the gastric jnice can be evidenced even after the vagotomy. Then, it is presumed that the hypothalamo-pituitary-adrenal-gastric route is present.
III. On the difference of the secretion of pepsin between human and canine
The amount of pepsin secretion in human gastric juice is measured more than in canine, either at the hunger periode or under the stimulation by insulin and histamine. Such data can be probably attributed to the fact that the mitochondria in the body chief cells are rich in human, scarce in canine. The pepsin secretion is, furthermore, higher measured in patients of ulcer than of other gastric diseases, and it can be observed that the gradient of distribution of body chief cells is parallel with that of parietal cells. On the other hand,the chronic ulcer can be induced by histamine injections, though the supperession of its secretion is evidenced on dogs under such conditions. It is now at hand that the alternative,acid-peptic theory or acid theory should be determined.
IV. On the com pensatory eventual increase of HCl secretion in the gastric remnant
The gastric mucosa and parietal cells were examined on specimens removed from the gastrectomized dogs and secondarily operated patients. The examination was performed at various periods after the operation and under various types of the anastomosis.
It was evidenced that the secretory function of HCI of the gastric remnant never increase, even if decrease.
The results obtained from the above-discussed four groups support the rationale of my opinion that the more dense distribution area of parietal cells should be removed, of the most efficiency, at the conventional partial gastrectomy.
(author's abstract)
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