53 CLINICAL AND EXPERIMENTAL STUDY OF DISORDERS OF THE PANCREAS SHINGO AOYAMA 2nd Department of Internal .Medicine, Nagoya University School of Medicine (Director: Prof. Shingo Aoyama) For the past several years various experimental and clinical observations have been made on disorders of the pancreas in this department by the writer and his co-researchers (Motoaki Kishikawa et a!.). The items of content listed below are the selective results of those observations, which the writer presented as a special report before the joint meeting of the 51st General Assembly of the Japanese Society of Internal Medicine and the 41st Assembly of the Gastro-enterological Society of Japan, held in April, 1954. A summary of this report constitutes the body of this paper, arranged in the same order as the original. Due to the limited space most of the data on the indi­ vidual experiments have been omitted, and, as a whole, only their summarized results are recorded herein. CONTENTS I. Some fundamental items 1. Pancreatitis due to Candida albicans i. Method of the administration of Candida ii. Histopathological changes in the pancreas iii. Effects of killed Candida on the pancreas iv. Instilling of Candida into the gall bladder, the biliary tract, the portal vein and the liver parenchyma v. Emigrated enzymes in the blood vi. Blood sugar and its regulation vii. Changes in various body organs viii. Attitude of Candida on pancreatic juice, bile and emulsion of the pancreas ix. Effects of some drugs on the growth of Candida x. Therapeutic effects of some drugs on pancreatitis due to Candida 2. Viral pancreatitis i. Coxsackie-virus ( Connecticut-5 strain) a. Histopathological changes in the pancreas b. Emigrated enzymes in the blood c. Changes in the blood sugar ii. Influenza virus iii. Mumps virus 3. Allergic pancreatitis i. Antigen and the method for its administration ii. Histopathological changes in the pancreas iii. Emigrated enzymes in the blood iv. Blood sugar and its regulation v. Changes in various body organs Received for publication March 2, 1955. 54 S. AOYAMA vi. Clinical cases 4. Transplantation of chick sarcoma into the pancreas i. Histopathological changes in the pancreas ii. Emigrated enzymes in the blood iii. Changes in the blood sugar iv. Comparison of cases where transplants are made into various parts of the pancreas 5. Pancreatic impairment due to bacterial exotoxin 6. Pancreatic impairment due to ethionine 7. Oxygenase system in the normal and impaired pancreas i. Succinic acid dehydrogenase system in the pancreas, the liver and the kideys ii. Cytochrome oxygenase system in the pancreas, the liver and the kidneys iii. Malic acid dehydrogenase system in the pancreas, the liver and the kidneys 8. Acid soluble phosphorus, lipoid phosphorus and nucleic acid phosphorus in the tissues of the normal and impaired pancreas 9. Water soluble vitamines in the pancreas and pancreatic juice i. Thiamine and riboflavin in various viscera a. Normal dog, liver-impaired dog and pancreas-impaired dog b. Changes after loading ii. Ascorbic acid in viscera a. Normal dog, liver impaired dog and pancreas impaired dog b. Changes after loading iii. Thiamine and riboflavin in pancreatic juice a. Normal condition b. Effects of loading and drugs stimulating pancreatic secretion c. Action of transforming the thiochrome reaction negative of pancreatic juice iv. Ascorbic acid in pancreatic juice a. Under normal conditions b. Effects of loading and of agents stimulating pancreatic secretion II. Diagnosis of pancreatic disorders and its basis 1. Emigration of enzymes into the blood i. Blood diastase a. Fundamental items 1) Comparison of the method of estimation 2) Blood diastase, visceral diastase, and Vagostigmin test in various experimental pancreatic impairments, and histopathological changes 3) Pancreatic secretion stimulant and blood diastase 4) Blood diastase and visceral diastase after complete pancreatec· to my 5) Relation of internal pressure of pancreatic duct to blood diastase 6) Blood diastase and Vagostigmin test in relation to histopathologi­ cal changes 7) Effect of the intravenous injection of fresh pancreatic juice on blood diastase 8) Process of emergence of pancreatic diastase in the blood 9) Diastase of the blood passing in and out of various abdominal organs under normal and affected conditions 10) Kidney impairment and blood diastase DISORDERS OF THE PANCREAS 55 11) Liver impairment and blood diastase 12) Reticuloendothelial system and blood diastase 13) Salivary glands and blood diastase 14) Vagus nerve and blood diastase 15) Various drugs and blood diastase b. Clinical items 1) Blood diastase and Vagostigmin test in healthy human body 2) Blood diastase and Vagostigmin test in various pancreatic diseases 3) Relation of blood diastase after Vagostigmin injection to diastase in duodenal fluid in various pancreatic diseases 4) Blood diastase and V agostigmin test in diabetes 5) Blood diastase and Vagostigmin test in diseases of the alimentary tract 6) Blood diastase and Vagostigmin test in renal diseases c. Summary ii. Blood esterase a. Fundamental investigations 11 Consideration of the method of estimation 2) Esterase of the various organs of a normal dog, and its nature 3) Esterase in pancreatic juice and bile, and its nature 4) Blood esterase of a normal dog 5) Blood esterase after intravenous injection of pancreatic juice 6) Blood esterase during fatty necrosis in peritoneal cavity 7) Blood and visceral esterase during the pancreatic impairment 8) Blood and visceral esterase after complete pancreatectomy 9) Rlood and visceral esterase during the liver impairment 10) Salivary glands and blood esterase 11) Histochemical investigations of visceral esterase b. Clinical items 1) Esterase in human pancreatic juice 2) Visceral esterase in the human liver and pancreas 3) Blood esterase of healthy human body 4) Blood esterase of patients with pancreatitis. pancreatic tumour, after complete or partial pancreatectomy 5) Blood esterase in patients with diseases of the liver, the gall bladder and the biliary tract 6) Blood esterase in diseases of the stomach and the duodenum c. Summary iii. Blood protease a. Method of estimation b. Protease in blood during experimental pancreatitis c. Protease in blood during complete pancreatectomy d. Protease in blood during the liver impairment e. Significance and value of protease in the blood in the diagnosis of the pancreatic impairment 2. Blood catalase 3. Blood sugar and its regulation i. Fundamental items a. Consideration of the Staub effect b. Comparative studies of methods to test the sugar regulation c. Salivary glands and sugar metabolism 56 S. AOYAMA ii. Clinical items iii. Summary 4. Investigations on the duodenal contents i. Estimation of enzymes a. Experimental pancreatic impairment b. Pancreatic disease c. Comparison between natural secretion and secretion after stimulation d. Diagnostic value ii. Microscopic examination 5. Stool examinations i. Method of examination ii. The three enzymes in the stools of patients with chronic pancreatic disease iii. Digestion of animal nucleo-proteins in pancreatic disease iv. Digestion of animal proteins in tuberculous disease v. The three enzymes in the stools of anemic patients 6. X-ray diagnosis i. Method of examination ii. Findings on pancreatic tumour iii. Findings on acute pancreatic disease iv. Findings on subacute pancreatic disease v. Findings on chronic pancreatic disease 7. Summary III. Changes during pancreatic impairment 1. Pancreatic impairment and cardiac disorders i. ECG in experimentally induced pancreatic impairment ii. ECG in complete pancreatectomy iii. ECG in various pancreatic diseases iv. Secretin, insulin, Kallikrein and cardiac function 2. Pancreas and hypotensive substances i. On Kallikrein, insulin and secretin ii. On the pancreas, the salivary glands and the anterior pituitary iii. On hypotensive substances in urine 3. Pancreatic impairment and sweat 4. Pancreatic impairment and changes in the blood i. The blood in experimentally induced pancreatic impairment ii. Pancreatic impairment and antithrombin iii. Pancreatic impairment and electrolytes iv. Pancreatic impairment and pictures of the blood and the bone marrow a. Experimentally induced pancreatic impairment b. Pancreatic disease v. Bleeding time, coagulation time and resistance of erythrocytes in pan­ creatic disease 5. Pancreatic impairment and gastric function i. Gastric secretroy function in experimentally induced pancreatic impair- ment ii. Gastric motor function in experimentally induced pancreatic impairment iii. Gastric secretory function in pancreatic disease iv. Gastric motor function in pancreatic disease 6. Pancreatic impairment and sugar metabolism i. Sugar regulation in experimentally induced pancreatic impairment DISORDERS OF THE PANCREAS 57 ii. Insulin sensitivity in complete pancreatectomized dogs iii. Changes in blood sugar after intravenous injection of fresh pancreatic juice iv. Effects of pancreas stimulating agents on blood sugar v. Vagus nerve and sugar regulatory function vi. Blockage of the reticuloendothelial system and blood sugar vii. Functions and histopathological changes of the anterior pituitary and the adrenals in complete pancreatectomy viii. a cell impairment and sugar metabolism 7. Pancreatic impairment and blood proteins i. Plasma proteins in experimentally induced pancreatic impairment ii. Plasma proteins in pancreatic disease iii. Salivary glands and plasma proteins 8. Digestion and absorption of proteins during pancreatic impairment i.