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With the implementation of a small-caliber panendoscope which was made according to our suggestion, we gradually replaced the conventional barium meal as the first line of the upper gastrointestinal tract examination by panendoscopy after 1976. The efficacy of panendoscopy for the early detection of gastric cancer in our 8-yr experience was investigated. In 910 matched pairs of patients subjected to "screening" fluoroscopy or panendoscopy two and six cases of early gastric cancer were detected respectively. Panendoscopy was superior to fluoroscopy in its sensitivity for detection of gastric cancer (86.4% vs. 80.0%), in its specificity (99.5% vs. 97.0%) and in its low false-positive rate (17.4% vs. 69.2%). After 1976, the detection of early gastric cancer increased year by year. The frequency of early gastric cancer detected by panendoscopy was about three times that of early gastric cancer detected by fluoroscopy (61.5% vs. 21.7% of all cancer). Early cancer located in the proximal third of the stomach and superficial esophageal cancer were detected only by panendoscopy. All gastric cancers that were overlooked by panendoscopy were in the gastric body. How to prevent such overlooking is discussed. In 24,000 panendoscopies we have encountered six complications (0.03%). The cost of panendoscopy and fluoroscopy is 6,500 yen and 11,000 yen respectively.

Nine patients with HBsAg-positive acute hepatitis were tested for antibody to hepatitis B core antigen (anti-HBc) by the immune adherence haemagglutination method. A high anti-HBc titre (2(15) or more) was found in three, while anti-HBc was not detectable in the remaining six. All of them recovered from hepatitis with the return of hepatic function tests to normal, but HBsAg persisted in the three patients whose acute-phase serum had revealed high anti-HBc titres. On the basis of these observations, the three patients were thought to be persistent HBsAg carriers who had contracted opportunistic acute hepatitis of non-B aetiology. Titration of anti-HBc may be indicated in patients with HBsAg-positive acute hepatitis, because it helps distinguish persistent HBsAg carriers with non-B hepatitis from patients with hepatitis B at the outset, during the episode of acute hepatitis.

Present condition and activities of Jeddah Endoscopy Center managed in cooperation with Saudian and Japanese doctors are reported. Total number of patients examined are 1,183 cases; 73% of which were subjected to endoscopy and 27% were to fluoroscopy. With respect to the stomach diseases, gastric cancer and ulcer were found in 16% and 14.7%, respectively. On the other hand, high incidences of severe atrophic gastritis and haemorrhagic or erosive gastritis accounted totally 64.7% of all stomach diseases were noted. Out of 264 cases of duodenal diseases, duodenal ulcer was diagnosed in number of 202 cases (76%). The ratio between gastric and duodenal ulcer was, therefore, approximately 1:6. It was further noted that most of patients with esophagus cancer were found in males having the local habit of taking green tobacco. From the results obtained, discussions were made on the statistical differences of gastrointestinal diseases between Saudi Arabia and Japan.

We describe a patient transfused with 200 ml of donor fresh whole blood three times at 2-week intervals. Three weeks after the last transfusion, transplantation and splenectomy were done at the same time. Splenic cells from this DST pretreated patient were fused with murine myeloma cells (X63-Ag8, 653). With DST pretreatment, various clones were developed in vivo, and finally 69 human immunoglobulin-secreting clones were obtained. Modulation of the alloantigen-specific MLR by supernatants from 69 clones showed various degrees of suppression or augmentation. The hybridoma clone 7 and clone 2, which had been secreting IgG antibody for more than 6 months, showed some degree of suppression in the alloantigen-specific MLR (mean suppression = 63%, 46% respectively). According to the result of MLR, clone 7 antibody was directed against recipient lymphocytes and clone 2 antibody was against donor lymphocytes. Immunoprecipitation was carried out by clone 7-IgG and clone 2-IgG. Clone 7-IgG specifically precipitated 1 molecule from the recipient lymphocyte with a molecular weight of 120 KD, similar to the molecular weight range reported for T cell receptors. Clone 2-IgG precipitated a 20 KD molecule from the donor lymphocyte. The data suggest that DST induces antibodies directed against the blood donor alloantigen-specific receptors on the recipient's T lymphocytes--and, at the same time, induces antibodies against donor lymphocyte antigens. These antibodies may be essential to prolongation of kidney allograft survival following DST.

Among 56 cases who presented to Kanto-Teishin Hospital complaining of bloody diarrhea or considerable hematochezia of acute onset, 8 cases (14.3%) were considered due to colitis associated with oral ampicillin therapy. The bloody diarrhea, often with abdominal cramps, began 2-7 days after starting the treatment. The dosage of ampicillin taken ranged from 2.0 to 4.5 g. Early total colonoscopy and biopsy revealed marked mucosal hemorrhage with minimal or no inflammatory changes mainly in the right colon. Rectum and sigmoid colon are completely normal except in one case. Symptoms rapidly resolved after the endoscopy. At follow-up colonoscopy, performed 4-12 days later, the mucosal changes had cleared completely. There was no evidence to support a hypersensitivity reaction of the colonic mucosa to ampicillin. We believe that right-sided hemorrhagic colitis is one of the common forms of colitis associated with ampicillin. Its differentiation from other kinds of acute colitis and the importance of early total colonoscopy are discussed.

The effect of FeCl3 on the uptake of 67Ga by inflammatory and normal tissues was studied to clarify the role of transferrin in 67Ga uptake by inflammatory tissue. The administration of FeCl3 5 min before the injection of 67Ga decreased the uptake of 67Ga by liver and spleen, but had little effect on the uptake of 67Ga by the inflammatory tissue. These results suggest that 67Ga is taken up by normal tissues in a transferrin-bound form but in an unbound form by inflammatory tissue. On the other hand, when FeCl3 was simultaneously injected with 67Ga, the uptake of 67Ga by liver and spleen was markedly increased but the uptake by inflammatory tissue was decreased.

A 54-year-old man, who had the history of a blood transfusion 29 years ago, was admitted to our hospital because of dyspnea and abdominal fullness. Physical examination revealed jaundice and massive ascites and laboratory data suggested liver cirrhosis. The high level of AFP and a CT scan indicated the association of hepatocellular carcinoma and its metastasis to the right adrenal gland. On the 21st hospital day, he suddenly complained of severe pain in the right upper quadrant and the right flank, and fell into hemorrhagic shock. Blood transfusion was given, but he died on the 24th hospital day. Autopsy revealed liver cirrhosis, accompanied by hepatocellular carcinoma with the metastasis to the right adrenal gland and multiple pulmonary tumor thrombi. Massive hemorrhaging due to rupture of the right adrenal metastasis was seen in the retroperitoneal space.

Changes of distribution of immunoreactive gastrin (IRG) and molecular forms of intra-tissue gastrin in the growth course of rats were examined. The results obtained were as follows; 1) IRG concentrations and G cell counts were extremely low in the fetal antral mucosa. However, a gradual increase of the above was observed during the neonatal suckling period, accompanied by a rapid increase at the commencement of feeding. 2) IRG concentrations in the duodenal mucosa of the fetal and neonatal period were markedly higher than that of adult rat. 3) Jejunal IRG concentration was negligible in the fetal period. The value obtained from the postnatal rats was equal to or higher than that of adult rat. 4) The major form of antral gastrin was G-17 throughout the fetal and adult age. No qualitative change of antral IRG in the growth course of rats was seen. 5) The major form of the duodeno-jejunal mucosa was G-17 in the fetal period and thereafter G-34 increased gradually in the growth course of rats. These results suggested that, (1) suckling and feeding appeared to be a trigger of the production and release of antral gastrin in the growth course of rats. (2) In the initial stage of the growth, G cells distributed in the duodeno-jejunal mucosa as well as in the antral mucosa may participated in the production and release mechanism of gastrin.

Serum gastrin concentration became became detectable in rats at one week after birth (56 pg/ml), and a rapid rise to 198 pg/ml was seen at two weeks after birth. Gradual decreases were seen again at three weeks and four weeks, and thereafter it attained the adult level of 132 +/- 17.6 pg/ml. In regards to the gastrin-like immunoreactivity (GLI) in the gastrointestinal mucosa during the fetal period, the values were extremely low even in the antral mucosa. However, the GLI showed an increase during the neonatal suckling period, and was accompanied by a remarkable increase at the commencement of feeding. This GLI coincided with so-called little gastrin, and while an increase accompanied by the development of growth was seen, no qualitative changes were evident. GLI values were high in the duodenal mucosa followed by the antrum, and positive evidence was also seen in the corpus of the stomach and jejunum. High values of GLI in the mucosae were gradually seen at two weeks after birth coinciding with the rise in serum gastrin levels, and the significance of the increases was discussed from the anlge of the trophic effect of gastrin.