現時点でX線的あるいは内視鏡的診断上,いわゆるタコイボ型びらん性胃炎と称せられるものについて,胃内視鏡による長期経過観察とその胃生検,切除胃による組織学的検討,および酸分泌を指標とする胃液検査の形態と機能の両面よりの検索の結果,これを消失型であるGastritis erosivaと存続型であるGastritis verrucosaの二種類に分類した。そして更にGastritis erosivaは急性滲出性病変(acute exsudative lesion)であり,Gastritis verrucosaは増殖性病変(proliferative lesion)であると結論し,併せてその発育史のなかに占める胃液分泌の意義を述べた。

抄録全体を表示

We applicated dye scattering method of methylene blue solution in 31 cases, indigocarmine one in 19 cases and Lugol's one in 124 cases, to the esophagoscopy for the description of fine uneveness of the esophageal epithelium and the supplemental endoscopic diagnosis of esophageal diseases. The obtained results were as follows; 1) By means of scattering the blue dye solution to the esophageal epithelium, we could clearly observed fine granular changes of esophageal epithelium in 16 cases (84.2%) among 19 scattered ones, and we could easily diagnose granular lesions, leucoplakia and II c type lesion of minute cancer with the aid of biopsy examination. Furthermore, this method clarified transparent blood vessels of submucosal layer through the epithelium in almost cases, esophagogastric junction in 7 cases and linear redness of epithelium in 5 cases. 2) We confirmed that Lugol's solution dyes the esophageal epithelium to brown and silk crape formed epithelium, from the results of animal experiments and microscopic investigation of frozen biopsy materials taken from the stained esophageal epithelium. 3) Whitisch granula and leucoplakia were dyed in black brown by this method, by which we could observe more clearly whitisch granula of the esophagus in 68 cases (74.7%) among 91 scattered ones than routine endoscopy. 4) Lugol's solution could not dye the cancerous lesion and esophagitis, but they could be more clearly observed in 27 cases (79.4%) among 34 scattered ones. 5) We could clearly observed the esophagogastric junction in 61 cases (62.9%) among 97 scattered ones of Lugol's solution. 6) From these results, we concluded that the dye scattering method for esophagoscopy is useful for supplemental diagnosis of esophageal diseases by reason of the clarification of minute depressed or elevated findings of esophageal epithelium.

抄録全体を表示

As gastric sarcoma responds well to chemotherapy or radiotherapy and its postoperative prognosis is relatively fair, its correct preoperative diagnosis is imperative. Endoscopic diagnosis of gastric sarcoma, however, still remains extremely difficult. Solid foundation for endoscopic diagnosis is provided by a close study of gross appearance. Since the cases of gastric sarcoma an institute can experience are limited, it would be of importance to describe precisely the gross appearance of resected specimens of gastric sarcoma, to which we had an access.Materials and Methods Gastric sarcoma in the surgical materials resected at the University of Tokyo Hospital during the period from January 1960 to June 197 were studied with reference to the incidence, location within the stomach and gross findings of the mucosal aspect, particularly of ulcerative lesions in reticulum cell sarcoma, with the aid of their gross photographs and histological specimens.Results and Discussion Twenty-seven cases of gastric sarcoma including 20 cases of malignant lymphoma and 7 cases of leiomyo-sarcoma were found in 3327 stomachs resected during the above-mentioned period, comprising 0.8 % of all the gastrectomy cases. The incidence of sarcoma in all the gastric malignancies was 1.3% during the last six and a half years. The ratio of malignant lymphoma to leiomyosarcoma was 3; 1. Those results coincide with the hitherto published reports. Malignant lymphoma encountered was only reticulum cell sarcoma; lymphosarcoma and Hodgkin's disease were not included. The predominance of reticulum cell sarcoma consistent with the other Japanese reports is in contrast with that of lymphosarcoma among the Caucasians, which is said to represent a racial difference.1. Reticulum cell sarcoma The age and sex distribution showed the mean age of 45.5 years, with the range of the 3rd to 7th decade, without sex preference. Location of the lesions showed that 16 of 19 cases involved the pars angularis or distal to it, which is in accordance with many reports (Nakamura, Palmer, Thorbjornarson et al, Joseph & Lattes) . Size of 29 lesions in 19 cases ranged from 0.7cm to 15 cm in greater diametre with the mean ±S.D, being 5.9±4.8cm Gross classification was made according to the degree of protrusion or depression of the tumour from the mucosal surface of the uninvolved area into the following three : ulcerative, diffuse infiltration and tumour formation types. Of 19 cases, 14 were classified as ulcerative type, of which 5 had multiple ulcerations ;1 case was of diffuse infiltration type featured by diffuse mural thickening and the other 4 cases were of tumour formation type. It should be noted that the ulcerative lesions in the cases with multiple ulcerations were not necessarily of sarcomatous nature ; in a case with 5 ulcerations, status post gastric irradiation, 4 lesions were free of sarcomatous involvement. Three of 4 cases of tumour formation type had multilobated fungating tumours ; each lobe or nodule was rounded, partitioned by deep sulci ; the overlying mucosa was generally smooth with lustre, partially with haemorrhage and adherance of necrotic materials. Such a shape has never been encountered in the other diseases, except probably in some of Palmer's collected cases of other sarcomas. The other cases of tumour formation type had a single Borrmann 1 type mass with a wide, shallow ulceration at the top. No case with the shape of the so-called submucosal tumour was seen in this series, though rarely reported in the literature and included in our unresected, autopsy cases. The depth of involvement was intramucosal in 1 case, submucosal in 3, both of which gave rise to the apperance mimicking early gastric carcinoma the involvement down to the muscularis propria was seen in 5 cases, subserosal in 5, serosal in 4. The primary focus of malignant lymphoma has been believed to be the lymphoid tissue in the submucosa, but Snoddy also reported a case o

抄録全体を表示

Seventy-two benign ulcerative lesions of the resected stomach were studied under the dissecting microscope. The appearance of the regenerative mucosa was com-pared in normally healing and slow healing ulcers. Usual healing course of a gastric ulcer : Four stages can be recognized in a gastric ulcer which heals com-pletely by the end of 3-months of medical treatment. Stage I : Initial stage. One layer of the regenerative epithelium at the margins. Stage II : Regenerative mucosa with a palisade-like appearance at the margins.Stage III : Red scar with a palisade-like appearance, Stage IV ; Red and white scar with a cobblestone appearance. Gastric ulcer showing protracted healing was deviled into three groups under the dissecting microscope. Group I : Small, shallow and irregular ulcer surro-unded by the regenerative mucosa with pale red, regular cobblestone appearance. Group II : Small, deep and irregular ulcer surroun-ded by the regenerative mucosa with red, irregular and uneven cobblestone appearance. Group III : Large and irregular ulcer surrounded by small multiple erosions and by the regenerative mucosa similar to group II The above classification can be applied to gastros-copic studies in clinical practice. Benign gastric ulcer without exacerbation follows either a normal healing course or a course of Group I. When an ulceration exacerbates during the protra-cted healing course of Group I, it takes the appeara-nce of Group III which in turn changes into that of Group II when a healing process occurrs. These three groups are closely related and interchangeable, and a slow healing ulcer is supposed to shift from one to another in a cycle.

抄録全体を表示

Colonic tumour is a general designation of the colonic lesion featured by its protrusion into the bowel lumen, regardless of its benign or malignant nature ; most of the colonic tumours are the so-called benign polyp, which is said to have a close relation to carcinoma on one hand, and is sometimes most difficult to tell from carcinoma, on the other. The purpose of this paper is to find reliable criteria for differentiation between benign polyp and polypoid carcinoma of the colon.1. Analysis of endoscopic observations The materials are 73 cases with 106 lesions, in total, of endoscopically benign, colonic tumours without ulceration, adherence of blood clot or necrotic material detected by colonic fibrescopy (with CF-SB, CF-MB and CF-LB, Olympus) at the First Department of Internal Medicine, University of Tokyo and at the Department of Medicine, Tokyo Medical College, until May 1972 and at the Medical Department of Luisen Hospital, Aachen, at the Department of Gastroenterology, Leiden University, and at the Department of Medicine, Laennec Hospital Paris from May to August 1970; those casess of the latter 3 institutes are the personal experiences of Niwa, one of the authers. Of the above mentioned lesions, 75 lesions in 61 cases, in which sufficient histological specimens were taken by direct vision biopsy, were selected for the study of relation between size and shape of protrusion, on one hand, and histological diagnosis on the other. The shape of protrusion was classified as sessile, semi-pedunculated and pedunculated: The size was assessed by comparison with the opened biopsy forceps, measuring ca. 5 mm in length, and graded as about 0.5 cm, 1 cm and 2 cm in diametre. The incidence of carcinoma was significantly higher (p<0.01) in the semi-pedunculated tumours (4/31) than in the sessile ones (0/36) ; the differences between pedunculated (1/8) and sessile, and between pedunculated and semi-pedunculated, were insignificant. Comparison between size and incidence of carcinoma revealed a higher incidence in 2.0 cm group (2/8) than in 0.5 cm group (1/44) with some statistical significance (p=0.058), but the differences in the other combinations were insignificant. With the 46 lesions, which were well photographed, surface appearance and colour were studied by the photographs with reference to incidence of malignancy. The incidence of carcinoma was significantly higher (p<0.01), in uneven surface (4/10) than in even surface (1/36) ; the colour of the surface was divided into three categories, id., red, normal and pale, but the difference in carcinoma incidence was insignificant among them.2. Study of surgical materials Hundred and eighty-six colonic tumours seen in the colectomy specimens at the University of Tokyo Hospital from January 1967 to December 1971, and at the National Cancer Centre until November 1971 were studied for the relation of shape and size to histological malignancy. Concerning the shape, incidence of malignancy was significantly higher (p<0.01) in the semi-pedunculated tumours (9/23) than in sessile (11/81) or pedunculated (11/82). Size was closely related to malignancy (p<0.001) . The larger the tumours, the higher the incidence : carcinoma was seen in 1/97 tumours less than 1 cm in diametre, 10/56. 1 to 1.9 cm, and 20/33 larger than 2cm. Expected occurrance rate of carcinoma in each group (with the reliability coefficient of 0.90) was estimated as 0.05 to 4.8% in the tumours less 1 cm in diametre, 10 to 29% in the tumours 1 to 1.9 cm, and 44 to 75% in the tumours larger than 2cm. Summary and Conclusion Ulceration, bleeding, and adherence of necrotic materials over the tumour are generally accepted as suggestive evidences of malignancy. The present study revealed the presence of malignancy even without those findings. Other findings were also found by the present study to suggest malignancy : semi-pedunculated tumour, rough surface and large size were all associated with malignancy. Even with that

抄録全体を表示

The purpose of this paper is to report our experience of endoscopic papillotomy. This endoscopic papillotomy was first evaluated as to the technical feasibility and safety using 10 dogs. The safety of this new method has been established with the experiment using dogs. Tne first clinical trial in human being was performed in a 65 year-old male. The instnument used was a cutting snare specially designed by us in attempt to avoid postoperative stricture. The snare was introduced into the papilla. Papillotomy was performed with high-frequency way e. No recongnizable hemorrhage occured by this technique. Vital signs were observed after the papillotomy. Serial measurement of SGOT, SGPT, alkaline-phosphatase and serum-amylase was performed. There was no change in vital signs and biochemical data. The papilla was sufficiently wide open to extract biliary stones. Stones was successfully removed and follow-up study revealed no side effect and insufficiency of the sphincteric muscle. We have successed 3 cases of 4 we have done. We believe this will prove to be a very useful technique for removal of residual choledochal stone in certain poor risk patients.

抄録全体を表示

　1.胃体部に発生し縦の線状ないし長楕円形の対称性潰瘍は,組織学的にUlIIの急性潰瘍であり,ストレス潰瘍を含む急性潰瘍の一形態と考えられる。　2.本症例は高木らの胃幽門前庭部の急性対称性潰瘍に対し胃体部のそれに相当すると考えられ,高令で中間帯が高位であるために胃体部に発生したものと考えられる。前庭部に比べて重篤な出血をきたすものが多かった。　3.切除胃に見られた急性潰瘍につき,その形態的特徴を慢性潰瘍と対比しながら調べた。急性潰瘍は発生部位は主として体部で,多発,接吻のしめる率が高く,縦の線状ないし長楕円形は8個(38%)にみられ,大部分対称性潰瘍であった。これに対し慢性潰瘍ではわずかに1個(0.6%)にすぎなかった。　4.本症例とMallory-Weiss症候群との異同につき考察し,Mallory-Weiss症候群の本邦報告例を急性ストレス潰瘍の観点より検討を加えた。

抄録全体を表示

Two cases of pseudomyxoma peritonei diagnosed by laparoscopy were reported in this paper. The diagnostic usefulness of laparoscopy and the pathogenesis of pseudomyxoma peritonei are also discussed. Case 1 was a 66 year-old male with a large amount of ascites which was thought to be due to peritonitis carcinomatosa or liver cirrhosis. Laparoscopy showed a diffuse involvement of the peritoneal surface covered with many gelatinous nodules. The patient has been asymptomatic only with diuretics for 12 months since discharge from the hospital. Case 2 was a 68 year-old female with right hypochondrial tumor. Massive gelatinous materials in peritoneal cavity were observed by laparoscopy. On laparotomy, mucocele of appendix and metastatic tumor on the surface of omentum were seen, and total excision was perf omed. The patient has been symptom free for 7 years after the surgery. In these two cases, mucin-secreting epitheliums in the gelatinous materials without malignant change were histologically demonstrated. Pseudomyxoma peritonei should be defined to be accumulation of gelatinous materials and the appearance of mucin-secreting epitheruum which occur solely in the peritoneal cavity. It should be, therefore, differentiated from the mucinous adenocarcinoma which shows distant metastases as well as malignant cells in histology. On the other hand, if no epithelial cells are found in mucus, it should be called to be the rupture of a simple mucocele. The epithelial cells disseminated on the peritoneal surface show a marked mucus secretion without malignant alterations in morphology. Pseudomyxoma peritonei takes a progressive and fatal disease process developing the secondary adhesion of intestine or ileus, although it is non metastatic or invasive. For this reason the treatment should be the same as in malignant tumors.

抄録全体を表示

Carcinoma of the pancreas in young females are relatively rare. A case diagnosed by Endoscopic pancreatocholangiography (EPCG) is presented. Case Report: This 29-year-old woman was admitted to another hospital for an ovarian cyst operation. Histological examination revealed adenocarcinoma, probably from the stomach. She was then sent to our hospital. Upper gastrointestinal series with . barium and GTF study showed an extrinsic compression on the posterior wall of the upper gastric body. On EPCG study, the main pancreatic duct was completely obstructed at the body of the pancreas. At autopsy, a large ductal carcinoma at the body and the tail of the pancreas was found.

抄録全体を表示