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From September 1978 to October 1984, we carried out mass screening for thyroid disease in Tokushima prefecture. In this survey 13, 049 subjects were examined, and the following results were obtained. 1. Thyroid abnormalities necessitating further examination were found in 334 subjects, accounting for 2.6% of the total. 2. Diffuse goiter was prevalent in younger subjects and nodular goiter was prevalent in older ones. 3. Thyroid cancer was found in eight cases. The incidence of thyroid cancer in this survey was 0.06%. Five were in stage I and three in stage II. 4. Simple diffuse goiter and chronic thyroiditis showed higher incidences than other benign thyroid diseases. 5. Mass screening was useful in detecting early thyroid cancer and in surveying incidences of other benign thyroid diseases.

Yotsuyanagi's theory is often quoted in the discussion of the etiology of congenital dilatation of the biliary duct (CDBD), but there has been no established etiology as yet. With particular reference to the relationship between anomalous arrangement of the pancreaticobiliary ducts and CDBD, Babbit collected 19 cases of CDBD. The authors also observed the anomalous arrangement in 10 of 24 cases of CDBD (42 percent). Analysis of 570 CDBD cases collected in Japan disclosed that the anomalous arrangement was present in 183 of them (33 percent), dilation of the intraheptic bile ducts in 236 (42 percent), and narrowing and malformation of the bile duct in the hepatic hilum in 58 (10 percent). The authors have proposed a new classification, including these morphologic anomalies of the whole pancreaticobiliary ductal system. This classification provides useful indices in selecting the surgical procedures. The effect of the anomalous arrangement was pathophysiologically studied on dogs. The static internal pressure of the dog pancreatic duct was 14.6 + or - 5.5 cm H2O, and that of the dog bile duct, 8.9 + or - 3.4 cm H2O. Puppies were then operated on by shunting the pancreaticobiliary ducts. As the result, the biliary tract was devastated by pancreatic juice, giving rise to similar pathologic changes to those clinically observed.

In recent years, the incidence of carcinoma of the colon has been increasing. Patients with advanced carcinoma or obstructed colon carcinomas are numerous. There were 156 patients operatd on for colon carcinomas in our department over the past 10 years. Of this group, 19 patients (12.2%) who had large bowel obstruction were analyzed clinicopathologically. In the obstructed group, the lesion was most frequently located in the sigmoid colon and the resection rate of the carcinomas was 84.2%, the curative resection rate, 68.4%. This was little lower than that in the non-obstructed group. There were no significant differences in the pathological findings or in the five-year survival rate of the two groups. Radical surgery in primary or second staged resection is recommended for the management of obstructed colon carcinoma.

膵管胆道合流異常 (以下合流異常) を有する先天性胆道拡張症 (以下本症) での膵障害について臨床的および実験的に検討した. 本症56例中, 発熱, 腹痛, 高アミラーゼ血症の膵炎様症状を9例に認め, 成人例で肝外胆管拡張形態では嚢胞状, 合流異常形態では古味b型を示す頻度が高く, 結石合併率, 細菌検出率は低い傾向があった. 3例に術中肉眼的に膵炎を認め, 物理的要因の存在が認められた. 実験的に古味b型合流異常モデル犬を用い膵障害を検討したところ, 乳頭部の機能異常が認められたが, 明らかな膵障害は認められなかった. 以上より, 本症での膵障害発現の機序として, 合流異常による乳頭部の機能異常および物理的要因により活性化膵酵素の膵への逆流が示唆された.

Preoperative soft tissue rcentgenography was studied retrospectively in 193 patients histologically diagnosed postoperatively. Calcifications were found out 43 of the 193 cases. The positive rate was 43.4% in malignant diseases and 19.8% in benign conditions. Calcifications were divided into two groups, larger than 0.5mm in diameter as coarse and smaller than 0.5mm as psammomatous. By this definition, psammomatous calcifications were found only in cases of papillary carcinoma of the thyroid. And these calcifications were also classified into five types (type I-V) according to Noguchi's pattern classification, which was added our new definition mentioned above. Using this pattern classification, type II was found in 60% of the malignant conditions and type III in 95% of the benign diseases.

Forty patients with choledochal cysts, 17 children and 23 adults, were treated by cyst excision in this institution (1972 to 1982). Histochemical and immunohistochemical studies were performed on tissue from the walls of these 40 cysts. The type and degree of histologic changes observed were found to correlate with patient age at time of cyst excision. Specimens from four patients less than two years of age at time of excision revealed epithelial desquamation, fibrosis, and minimal evidence of inflammation. Among specimens from 13 patients, 4 to 15 years of age, only two had an intact epithelial lining. Marked inflammation and intramural glandular structures were observed. Specimens from 23 patients, more than 15 years of age at the time of cyst excision, showed marked acute or chronic inflammation and destruction of the epithelial lining. In this age group, intramural glandular structures with goblet and argyrophil cells were regularly observed within the cyst walls, and gastrin and somatostatin-like immunoreactivity was detected in cells of these metaplastic glands. In association with these changes, in five of the 23 patients in the oldest age group, adenocarcinomas were observed in the cyst walls. These studies establish the increasing rate of epithelial metaplasia in the walls of choledochal cysts with advancing age, and suggest that these changes are a continuing process with malignancy one of the end results.

Histochemical and immunohistochemical studies on 47 consecutive specimens excised for choledochal cyst were performed to clarify possible metaplastic changes of the biliary duct in relation to carcinogenesis. An anomalous arrangement of the pancreaticobiliary ductal system was observed in all 39 cases examined. Among the 47 patients, 5 (10.6 per cent) had biliary carcinoma. 27.3 per cent mucous gland, 13.0 per cent goblet cell and 9.5 per cent argyrophil cell in 23 children. On the other hand, 81.8 per cent exhibited mucous gland, 41.7 per cent goblet cell and 27.3 per cent argyrophil cell in 24 adults. These metaplastic changes seemed to be an intestinal metaplasia and increased with age. Immunoreactive-gastrin or -somatostatin were evident immunohistochemically in 4 adults. These findings confirmed that intestinal metaplasia may develop in the biliary duct in cases of choledochal cyst. Although direct evidence between intestinal metaplasia and the development of biliary carcinoma was not found, reflux and stasis of pancreatic enzymes in the biliary duct may relate to the development of intestinal metaplasia and be an important factor related to the carcinogenesis of choledochal cyst.

肝転移を伴うZollinger-Ellison症候群患者に胃全摘出術を施行することにより, 術後3年6ヵ月の現在経過良好である1例を報告する. 同時に, 本邦で報告されているZollinger-Ellison症候群51例について集計し, 胃全摘出術の効果について検討した. その結果, 転移のある症例においても胃全摘出術を施行する必要がある.また, 胃全摘出術後の腫瘍の消長ならびに血清ガストリン動態とセクレチン, Ca負荷との関係について文献的考察を加えた.

昭和50年1月から59年12月までの過去10年間に経験した大腸多発癌14例(同時性多発癌11例(7.1%),異時性多発癌3例(1.9%)),大腸重複癌7例(4.5%)を大腸単発癌132例と比較検討した.性比では多発癌は男:女=10:4であり,重複癌では2:5であり,重複癌では女性に多い傾向が見られた.同時性多発癌では第1癌と第2癌で組織型に差異を認めなかったが,進行癌と早期癌の組み合わせが6例(54.5%)に見られた.またポリープ癌も5例(45.4%)に見られた.一方癌家族歴では大腸多発癌および重複癌では単発癌に比較し,有意差を見なかった.ポリープの併存は単発癌2例(28.6%),多発癌10例(71.4%),重複癌2例(28.6%)と多発癌に著しく高率に見られ,大腸多発癌ではポリープの癌化率が高いと推察された.一方重複癌7例の他臓器癌の部位は胃2例,乳房2例,子宮2例,前立腺1例であった.