The purpose of this study is to make the same size model of the lesions of the digestive organs. Using silicon RTV gumm (KE-12) as the material, mould of the lesions of the freshly dissected organ were made, and using ultra-hard plaster or acryl-lesin-base the cast is made. The method was applied to the fresh, semi-fixed and fixed resected specimens and showed very clear replica of the original lesion especially the fine mucosal features. X-ray examination using Softex of the mould made it possible to study the fine mucosal changes of the lesion on the plain X-ray film. An attempt was made to apply the technique to the gastric ulcer through endoscopy. The mould of the gastric ulcer was made through gastroscope. The cast made from the mould helped in delineating the depth, size and mucosal changes of the ulcer lesion. The comparison of the histological findings with the findings obtainable by this new method will help in the understanding of the nature of the lesion as well as deminishing the exposure dose of the X-ray in the diagnosis of the gastric lesion. Preparation of the lesion for moulding, for instance how to make it dry enough, and the search for the more suitable moulding material remains to be investigated as well as the development of new fiberscope for this purpose.

抄録全体を表示

1. The relation of fundal gastritis to the gross and histological type and location of early gastric cancer was examined by the endoscopic Congo red test. Results in-dicated a close correlation between the gross and histolo-gical type of cancer and the extent of fundal gastritis. In general, when there was little or no f undal gastritis, cancers were ulcerated and histologically undifferentiated, and they were chiefly located in nonacid-secreting areas adjacent to acid-secreting areas, or sometimes they were surrounded by acid-secreting areas. On the contrary, when fundal gastritis was extensive cancers were polypoid and histologically differentiated, they were located in nonacid-secreting areas far from acid-secreting areas. Therefore, it was possible to estimate exactly the extent of cancerous infiltration in 760 of the ulcerated and histologically undifferentiated cancers. However, it was difficult to determine the infiltration in differentiated ulcerated and polypoid cancers by this method. 2. The endoscopic Congo red test, combined with Methylene blue test, was developed in this clinic. This method makes it possible to determine the exact extent of the cancerous infiltration of the differentiated, ulcerated or polypoid, cancers.

抄録全体を表示

Intestinal meiaplasia of the stomach is studied gastroscopically by vital staining with orally administering the capsule which contains 0.05 gm methylene blue. Fine structure of intestinal metaplastic epithelium and atypical epithelium are studied by investigating dissecting-microscopic apperance of the biopsy specimen after vital staining by methylene blue. Distribution and degree of intestinal metaplasia are classified in this study, as seen Fig. 3. and Fig. 4. Intestinal metaplasia can be diagnosed accurately as many former studies about gastrectomy specimen or biopsy specimen. More accurately, intestinal metaplasia could be diagnosed by examining density and staining degree of papillae, as seen in Fig. 6. According to our classification of intestinal metaplasia, the differentiation early gastric cancer relates to that of intestinal metaplasia (Fig. 5). Atypical epithelium and elevated early gastric cancer exsist within moderately or more well differentiated in-testinal metaplasia. Furthermore, after examining density and staining degree of papillae, we find atypical epithelium in the process of the differentiation of intestinal metaplasia (Fig. 6).

抄録全体を表示

In order to detect early colon cancer in its nonsymptomatic stage, it is necessary to screen the colon regardless of complaints. About 70% of all cancers and polyps of the large intestine are located in its distal part (sigmoid colon and rectum). Therefore, proctoscopic examination is worthwhile to observe these area. However, some of Japanese have elongated sigmoid colon and a proctoscope is not long enough to observe the entire sigmoid colon of these persons. Therefore, during the last ten months, screening colonoscopy using a flexible sigmoidofiberscope, TCF-1s (O-lympus), was performed to 120 subjects. Age distribution of the patients was 32, under 39-year-old and 88, over 40-year-old. Seventy patients of 120 had some symptoms, whereas 50 had no complaints. Seventy patients who had some complaints were prescribed to take "Boncolon" for their diet and 250cc of magnesium citrate solution, and 50 patients without any complaints were forced to evacuate the bowels with aid of glycerin enema but no limitation of their diet. Almost all parts of sigmoid colon and rectum were visualized clearly without retained stool by both preparation methods. In six cases of advanced cancer and missprepared patients, TCF-1s could not pass through the leisons because of stenosis. Excepting these six cases, 114 cases were succeeded in introducing the scope to the proximal end of the sigmoid colon (sigmoid-descending colon junction) within 2.1 minutes. It took about 5.4-5.7 minutes to examine one case in this study. For the observation of the lower parts of the colon, handling of TCF-ls was easier than the conventional colonoscope. Various diseases could be detected not only in 29 cases (41%) among symptomatic patients but 6 cases (12%) among non-symptomatic patients. Especially, one early cancer was found out among non-symptomatic patients in this series. It is emphasized that the elder age groups must be screened as well as the gastric mass survey, and TCF-ls is very useful for the screening examination of the lower colon.

抄録全体を表示

Recently, the Mallory-Weiss syndrome has been noticed as one of the cause of the upper gastrointestinal bleeding. Reviewing the Japanese literatures until 1976, we collected 216 cases of the Mallory-Weiss syndrome. Now in Japan, the Mallory-Weiss syndrome is not so rare disease.1) We experienced ten cases of the Mallory-Weiss syn- drome during three years f som 1975 to 1977. The age distribution was from 31 to 69 years of age, and the average age was 45.9 years. All of them were male. As the causes of on set, 7 cases had episode of vomiting, 2 cases had retching and a case had episode of coughing All cases developed symptom after drinking. As for the interval between the on set and the establishment of endoscopical diagnosis, the shortest case was diagnosed 5 hours after hematemesis, and the longest case was diagnosed 96 hours after hematemesis. The average time interval was 29.5 hours. Emergency endoscopy was performed to all patients within 18 hours after first consultation. Only one case required surgical therapy repairing mucosal laceration, and partial gastrectomy was carried out for duodenal ulcer. None of the patient died. The endoscopic films of three cases which were followed up from the initial stage to the healed stage were demonstrated. Nine cases were notso severe and bleeding was small in amount. Only a case required the blood transfusion. All of the lacerations healed in a comparatively short term.2) We collected 216 cases of the Mallory-Weiss syndrome which were reported in Japan, and clinical pictures of these reported cases were compared to our 10 cases.3) Schematic diagram was made on the etiology of the Mallory-Weiss syndrome.

抄録全体を表示

The diagnosis of congenital diverticulum of the gallbladder has been reported to be one of the most rare cogenital anomalies of the gallbladder. In our hospital we have the opportunity to make this diagnosis by ERCP, and simultaneously the pancreatic cyst communicating with the main pancreatic duct was also found. The patient, a 48 years old woman, came to the hospital complaining of fever and pain in the right hypochondrium. The symptom was suspected to be related to the presence of the diverticulum and cholecystectomy was performed. The gallbladder showed no particular inflammation except for fibrous adhesion between the gallbladder neck and the duodenum. The diverticulum was lying on the upper surface of the body and was shown to be true one from the histological pattern. Embryologically, this congenital diverticulum was thought to have its origin from an incomplete resolution of the solid stage and some relation between the diverticulum and the pancreatic cyst in their embryologic development was suspected.

抄録全体を表示