Intussusception of the appendix with a calcified fecalith.

We treated a patient with a complete invagination of the appendix which contained one large laminated calcified fecalithy. Colonofiberscopy showed a dimpling submucosal tumor, which was palpated as a bony hard tumor at laparotomy. This finding suggested that the fecalith caused an intussusception of the appendix and that such an intussusception should be suspected when there is a bony hard dimpling submucosal tumor in the cecum.

Case of spontaneous gastrojejunal fistula due to gastric cancer.

A rare case of gastrointestinal fistula secondary to gastric cancer is presented. Fluoroscopic examination visualized the passage of contrast medium from the stomach to the small intestine. Gastric fiberscopy revealed cancer on the greater curvature of the corpus perforating into the jejunum. The scope could be inserted readily into jejunum through this perforation. Laparotomy showed that the cancer infiltrated and perforated from the stomach to the jejunum at about 10 cm. from the ligament of Treitz. Distal gastrectomy and resection of 10 cm. of the perforated jejunum were performed. The resected specimen revealed a Borrmann III gastric cancer of the greater curvature perforating the jejunum.

Parotid saliva tests in patients with pancreatic diseases before and after surgery.

Two patients with pancreatic cyst were treated by cystojejunostomy, two others with pancreaticolithiasis by pancreaticojejunostomy (side to side), and pancreato-duodenectomy was done in one patient with cancer of the duodenal papilla and in one patient with cancer of the intrapancreatic bile duct. All these patients made uneventful recovery. In all these cases, parotid gland function was found depressed. After the operation, four patients showed normal parotid gland function and in one patient it was abnormally elevated. Thus, as previously reported in animal experiments, the parotid gland function was presumed to return to normal or to be elevated in parallel with the improvement of the pancreatic function or lesions.

A new diagnostic test for pancreatic disorders by examination of parotid saliva.

The parotid saliva test was performed in 146 subjects, including 48 patients with pancreatic disorders, 82 with nonpancreatic disorders and 16 healthy persons. The following results were obtained: 1. The salivary output as well as the maximum bicarbonate concentration and amylase content in the parotid saliva of patients with pancreatic disorders were significantly less than those of patients with nonpancreatic disorders. 2. An abnormal saliva test was found in 83.3% of the patients with the pancreatic disorders. 3. Comparison was made of the parotid saliva test with the pancreozyminsecretin test in regard to diagnostic reliability in 44 subjects, including 22 with pancreatic disorders and 22 with nonpancreatic disorders. The data indicated that, in this series, an abnormal parotid saliva test was 88.6% accurate in diagnosing pancreatic disorders, whereas positive pancreozymin-secretin was only 65.9%.

Experimental studies on the pathophysiological changes in the pancreas of rat following bilateral ligation of the parotid gland duct.

The blood sugar level, blood insulin level, serum amylase level and organ amylase level in the pancreas were measured in a total of 110 rats examined at 12, 24, 48, 72, and 96 hr, and 1,2, 3, 4, and 5 weeks after bilateral ligation of the parotid gland ducts. In parallel with this functional study, light microscopic study of th=e pancreas and the parotid gland and electron microscopic observations of the pancreas obtained from the rats were performed at the respective periods. The following results were obtained: 1) The serum amylase level was most elevated in the group examined at 12 hr after ligation and it decreased gradually and returned to the normal level at 96 hr after ligation and thereafter. 2) As for the pancreatic exocrine function, the organ amylase level of the pancrease was significantly elevated in function, the organ amylase level of the pancrease was significantly elevated in the groups examined at 24 hr to 3 weeks after ligation. Electron-microscopically, hyperfunctional state in the pancreatic acinar cells was recognized as evidenced by the dilatiation of the granular endoplasmic reticulum. 3) With regard to the endocrine function of the pancreas, the blood sugar level and blood insulin level did not show and significant changes after ligation as compared with the control group. Morphologically, electron microscopy showed a decrease in electron density and swelling of the cored granules, disintegration and fusion of their limiting membranes in the beta cells. These changes are interpreted as indicating the discharge of secretory granules in the beta cells. It is concluded that an impairment of the parotid glands influences the function of the pancreas to a certain degree.