GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 21, Issue 2
Displaying 1-14 of 14 articles from this issue
  • YOZO IIDA
    1979 Volume 21 Issue 2 Pages 155-169
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    By the application of endoscopic congo red method, the patterns are classified according to Kimura's classification. At this time, pathological condition of the gastric mucosa of congo red border was studied. Spraying the congo red solution onto the gastric mucosa, the black spotty mucosa was observed, (black colored island), mainly on lesser carvature. The distribution-grade of black spots was classified in 4 grades from grade-0 to 3. Grade-0 means no black spot and grade-3 means the presence of many black spots. The border of pattern C-i was almost clearly distinguished. But it became irregular in pattern C-2 or C-3, and many black spots were observed. Contrary, black spots disappeared in open type of congo red pattern. Histological studies were made on this black spotty mucosa, adjacent mucosa and Congo red border. Histological studies on the biopsy specimens taken from the black spotty mucosa showed that 50% of the black spots consisted of the mucosa in intermediate zone and 40.4% of these spots of the f undic gland mucosa. On the other hand, 44% of the adjacent mucosa consisted of the mucosa in intermediate zone. About a halt of the biopsy specimens taken from the congo red border showed the mucosa in intermediate zone. Inflammation in the black spotty mucosa was slight as compared with the adjacent mucosa. Magnifying observation of atrophic border was carried out by using magnifying endoscope (FGS-ML, Machida Co.) and dissecting microscope. Sakaki, one of our coleaques, already reported the presense of f oveolointermediate pattern (FIP) which was transitional pattern between FP and FSP, which were proposed by Yoshii. In many of the cases, FIP observed on the histological intermediate zone at this time. In the area of FIP, inflammation was remarkably seen in comparison to the othe sites. Studies were make how to detect the intermediate zone endoscopically. The term of endoscopic atrophic border had already reported by Takemoto et al. While there are few reports about the detection of intermediate zone by using endoscope. Therefore, our trials, which was mentioned above, can conclude that the black spotty area should be identified as the "endoscopic intermediate zone".
    Download PDF (4545K)
  • SHINJIRO YOSHIMOTO, MASATO SAKON, TUGUKIYO HIRAI, MAKOTO BEPPU, NOBUHI ...
    1979 Volume 21 Issue 2 Pages 170-177
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The anomalous pancreaticobiliary ductal union in which a common bile duct terminates not in the duodenum but in a high position of pancreatic duct has recently been attracting attention in the relation to the congenital ditation of the biliary tract. In this study, 10 cases of the anomalous union capable of being diagnosed by means of the endoscopic retrograde pancreaticocholangiography have been investigated. The clinical symptoms, laboratory findings and x-ray findings in these cases are reported. Major clinical symptoms, 9 cases out of 10 cases, included upper abdominal pain and epigastric pain. The rise of serum alkaline phosphatase level was also observed frequently. The length of common channels examined by the x-ray was in the range of 15-30mm, the average was 19.1mm, The dilatation of common bile duct was detected in 8 cases out of 10 cases (80%), whereas the narrowing was observed in 1 case, which was suffered from the carcinoma of the extrahepatic biliary duct. Advanced dilatation, namely the diameter of common bile duct being more than 20mm, was seen in 5 cases out of the 8 cases, and only mild dilatation was observed in remaining 3 cases. On the basis of these findings, it was considered to be premature to indicate some correlation between the congenital dilatation of the biliary tract and the anomalous union of common bile duct. Further studies with more clinical cases are required to derive the conclusion and to establish effective therapeutic means.
    Download PDF (5495K)
  • HIROHUMI NIWA
    1979 Volume 21 Issue 2 Pages 178-192
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Complications of colonoscopy were studied by analysing questionnaires sent to all the major institutes of Japan. The total number of colonoscopy was 54, 463 examinations, including 51, 196 diagnostic colonoscopies and 3, 267 polypectomies. Complications of colonoscopy occurred in 116 cases, 0.21%, in total, including perforation in 68 cases, 0.12%, bleeding in 30 cases, 0.06%, rupture of the tenia coli in 1, laceration of the serosa in 1 and others. Among those, the complications following diagnostic colonoscopy occurred in 81 cases, 0.16%, including perforation in 59 cases, 0.12%, bleeding in 7 cases, 0.014% and others. Polypectomy-induced complications were seen in 35 cases, 1.07%, including 9 cases, 0.28% of perforation, 23 cases, 0.70% of bleeding and others. Location of perforation follows: The majority, 53 of 68 cases of the perforations were in the sigmoid colon, followed by the sigmoid-descending junction and descending colon, in the order of frequency. Among 68 cases of perforation, 54 perforations occurred after colonoscopic observation alone, 5 took place after observation with biopsy, and 9 after polypectomy. Concerning the findings that led to the discovery of perforation, there were escape of the instrument tip noticed while under X-ray control, peritoneal visualisation and abdominal pain, each with the frequency of about 240. The interval between the examinations and confirmation of perforation follows : Perforation was detected during or immediately after colonoscopy in the majority of cases, but there were a considerable number of cases, in which more than 10 hours to even more than 24 hours elapsed until the detection of perforation. As the causes of perforation, there were the factors arising from the endoscopists, factors arising from the patients, and the faults with the instruments. Some were considered unavoidable. The sigmoid colon was found to be a bleeding site in almost half of the cases, followed by the rectum and descending colon in frequency. Colonoscopic procedures which caused haemorrhage were almost exclusively polypectomy. As for the interval between examination and detection of bleeding a considerable length of time elapsed in a significant number of cases. The direct causes of bleeding were insufficient cauterisation and inappropriate handling of the snare in the majority of cases. Besides, there were also bleeding tendency of the patients and the nature of the lesions. When the experience of endoscopists was compared with the accidents, the accidents occurred also by fairly experienced endoscopists, but with regard to polypectomy, accidents seemed to occur more frequently by the hands of endoscopists less experienced in polypectomy. The most important things for prevention of complications are strict decision for indi-cation, good preparation of the patients and careful manuoeuvre during the examination. There are, however, unavoidable accidents. The patients must be advised to contact the endoscopist who examined them as soon as they noticed any abnormality. This applies not only for the few hours but also for the few days after the examination.
    Download PDF (1927K)
  • MASAHITO NOKIHARA, YOSHIHITO URAKAMI, SEIICHIRO KISHI
    1979 Volume 21 Issue 2 Pages 193-197
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The electrosurgical removal of polypoid lesion from the upper gastrointestinal tract with using a small caliber forward-viewing f iberscope (GIF-P 2) has proven to be a safe and effective procedure. Sixty one polypectomies performed on 40 different patients are discussed. Polyps were removed from the distal esophagus, stomach and duodenal bulb. Since a safety circuit for diathermic current is built into the GIF-P2, the operator is freed from worry about elertrical accidents caused by current leakage and can concentrate on the operation. The bending portion of the GIF-P2, which is shorter than those of previous instruments, gives improved handling inside the organs, makes approaching the target easy and makes snaring the polyp very easy. Furthermore, the small diameter of the instrument makes it possible to examine the patients with minimal discomfort. In all 40 cases the resected polyps could be recovered using the polypectomy snare, the grasping forceps, or the basket catheter. The method could be carried out in all patients without any complication.
    Download PDF (2452K)
  • YOSHIMITSU HIGUCHI, TAKEMICHI INOUE, KYOICHIRO NISHINA, Hidenori GION
    1979 Volume 21 Issue 2 Pages 198-207
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    It is well known that a laughing gas (nitrous oxide) is most suitable for artificial pneumoperitoneum during peritoneoscopy. However, the utilization of artificial pneumoperitoneum employing laughing gas in Japan is 20% or less, since commercially available apparatus for pneumoperitoneum employing laughing gas is very expensive. Under these circumstances, we have developed an auxiliary equipment used by attaching to Nomura-type pneumoperitoneum device, to thereby accomplish pneumoperitoneum employing laughing gas. The equipment has produced good results as we expected, that is, it could be safely and easily applied to patients and caused scarcely any pain to patients after peritoneoscopy by means of the equipment as well as during the peritoneoscopy. So, to demonstrate an excellency of the equipment, we gave an outline of the equipment and reported the results of the study of 27 cases as to pneumoperitoneum employing laughing gas by means of the present equipment comparing with 21 cases as to that employing air. The following matters were indicated in the report. The both was substantially the same in the amount of gas initially used in the pneumoperitoneum operation, while, the former was somewhat more in the amount of additionally supplied gas than the latter. There was not a significant difference between the both concerning the variations of blood pressure and concerning pH, Pa02 PaCO3 and so forth determined in the blood gas analysis. The pain caused by the former during and after peritoneoscopy was less than that caused by the latter, and the former was higher in the extinguishing rate of pain than the latter. The average concentration of laughing gas in the blood measured as to 7 examples just before the end of the peritoneoscopic examination was 668 ppm, indicating twentieth or thirtieth of the laughing gas concentration detected during anesthesia.
    Download PDF (3871K)
  • MICHIKO SASAKI, YOSHIYUKI HAMADA, MITSURU ODAWARA, MASATOSHI WATANABE, ...
    1979 Volume 21 Issue 2 Pages 208-217_1
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Six cases of antibiotic-induced colitis have been described; Case 1, 28-year-old man was treated with Ampicillin 1500mg orally for five days as therapy of polysinuectomy. On the seventh day of this therapy, lower abdominal pain, diarrhea and bloody stool developed. Colonoscopy revealed non specific inflammatory changes of the colon. Case 2, 45-year-old man received Lincomycin (600mg, i.m., for a day), Clindamycim (900mg, orally, for two days), and Cephalexin (lg, orally, for nine days) because of cholecyslitis. Diarrhea and bloody stool developed after six days of administration of Cephalexin. Colonoscopy diagnosed of aphtoid colitis. Case 3, 30-year-old woman underwent curretage of placenta accreta and received oral administration of Ampicillin lg daily. Five days after the beginning of therapy, diarrhea and bloody stool were noted. Colonoscopy revealed aphtoid colitis. Case 4, 30-year-old man was diagnosed of malignant lymphoma. Oral administration of Ampicillin, 1500mg per day was recommended under diagnosis of acute bronchitis. Five days after the beginning of therapy, lower abdominal pain, bloody stool, and diarrhea were seen. Colonoscopy showed diffuse redness and localized erosion. Case 5, 55-year-old woman was diagnosed of alveolar abscess, receiving Dibekacin Sulfate (100mg, i.m., for 6 days), Ampicillin (lg, orally, for 6 days), One week after this treatment, lower abdominal pain, waterly diarrhea, and bloody stool happened. Colonoscopy revealed erythematous macule, scattering at the recto-sigmoid colon. Lymphocyte transformation to several antibiotics showed elevated stimulation indices with Ampcillin. Case 6, 71-year-old woman was stung by an insect and received Cephalexin lg orally. Severe diarrhea, low grade fever, and lower abdominal pain developed from the following day. Colonscopy revealed aphtoid colitis. Drug-induced colitis is well known as a type of pseudomembranous colitis. None of our cases led to pseudomembrane formation. With the discontinuation of etiologic agents, all the cases were convalescing satisfactorily. Although colonoscopy revealed various types of colitis, particularly three out of six showed a finding of "aphtoid colitis." Much attention should be paid to the complication at the time of antibiotic therapy, particularly upon colitis in the gastro-enterological field. Therefore, the antibiotic must be ceased immediately when the sign suspectively accompanied with colitis is noted during the administration of antibiotics. Colonoscopic examination is useful to learn both of the spread and the nature of this disease.
    Download PDF (6721K)
  • SACHIKO DOI, SHINJIRO YOSHIMOTO, KOICHI YASUI, YOSHITAKE SHINJI, MAKOT ...
    1979 Volume 21 Issue 2 Pages 218-227
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Benign extrinsic stricture of the rectosigmoid and sigmoid colon, caused by pelvic perito-nitis and pelvic abscess, is discussed in this paper. There are nine cases in the Prefectural Nishinomiya Hospital from Sep. 1976 to June 1978. Duration of clinical symptoms which are acute inflammatory features, fever and ab-dominal pain, is relatively short. The examinations discussed in the paper are Ba-enema, colonofiberscopy, angiography and colonofiberscopy infusing the dye, Indigocarmine, into the feeding artery_??_ On the Ba-enema, extrinsic stricture of the colon that margin is featherlike is visible But the stricture recures progressively. So follow-up study is im-portant. By the colonofiberscopy many hemorrhagic spots of the intestinal mucosa are visible. If infusing the Indigocarmine into the feeding artery, it can be observed that the colour of intestinal mucosa changes into blue uniformly. On the angiography hypervascularity of peripheral feeding vessels are visible. There are neither encasement nor obstruction. But these findings are not distinctive for pelvic abscess. There are many diseases have to be differ-entiated e.g., primary and metastated cancer, Crohn's disease, tuberculosis, ischemic colitis, radiation colitis, endometriosis and so on. Primary focus of pelvic abscess is caused by appendicitis, diverticulitis of the colon, cholangitis, pancreatic cyst and perforated peptic ulcer. In our nine cases four are caused by appendicitis but the primary focus was not confirmed in the rest of the cases. It is important to seek the primary focus, although it is not aways possible to discover the focus.
    Download PDF (6247K)
  • JOSE LUIZ PIMENTA MODENA, REGINALDO CENEVIVA, JOÃO BATISTA CARD ...
    1979 Volume 21 Issue 2 Pages 228-239
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Download PDF (12901K)
  • CHOW SHEN JUNG
    1979 Volume 21 Issue 2 Pages 240-242
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Download PDF (313K)
  • P, FRÜHMORGEN, F. BODEM, H. D. REIDENBACH, B. KADUK, L. DEMLING
    1979 Volume 21 Issue 2 Pages 243-246
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Download PDF (529K)
  • JIRO MIYAMOTO, YASUHIRO TAKASE, AKIRA NAKAHARA, ISAO KAWAKITA, SUSUMU ...
    1979 Volume 21 Issue 2 Pages 247-251_1
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Damage to the wall of the esophagus by foreign bodies or instrumental trauma may involve only the mucosa, leaving the muscle layer intact. And occasionally this damage may lead to an occurrence of esophageal submucosal dissection. X-ray examination has been the best way to find the presence of this condition hitherto, but recently a case of esophageal submucosal dissection communicating with the main esophageal lumen at both ends was found endoscopically. The patient was 59-year-old woman and was admitted to this hospital because of splenomegaly. She had a history of previous operation for esophageal varices. A mucosal bridge was noted by esophagoscopy and the lesion showed no remarkable signs of inflammation. It was difficult to decide whether this lesion was congenital or acquired one but from anamnesis and the form of this brigde this was thought to be acquired. This was 'the first case in Japan that was found endoscopically, and endoscopic examination will reveal itself a very useful method for observation of lesions making their ap-pearrace in the lumen, but it is noteworthy to say that endoscopic examination is always accompanied by the risk to damage the esophageal wall. Jiro Miyamoto Department of Gastroenterology, Institute of Clinical Medical Science, University of Tsukuba, Japan
    Download PDF (3747K)
  • TOSHIHIKO KOSAKA, KIYOHARU HAYASHI, HIROMI GOTOH
    1979 Volume 21 Issue 2 Pages 252-256_1
    Published: February 20, 1979
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    An unusual case of leiomyoblastoma of the stomach in a 70-year-old male is reported. He was admitted to hospital with a complaint of anemia. Gastric X-ray examinations revealed a large diverticulum on the anterior wall in the mid-body of the stomach. Gastroscopically, a deep ulceration like a diverticulum was found at the same site and it seemedto be a source of bleeding. Partial gastrectomy with gastroduodenostomy was performed. The resected specimen showed an extraluminal tumor, 7. 5x8 . 0x6. 5cm in size, on the anterior wall of the mid-body of the stomach. The tumor was cystic like a cavern and the inside of the tumor was necrotic, having no epithelium. Microscopically, the tumor consisted of round, oval or polygonal cells with hyperchromatic nuclei and perinuclear clear zone in the cytoplasm, intermingled with spindle-shaped cells in close-packed arrangement commonly seen in leiomyoma. Mitosis was scarcely seen. From these findings, this lesion was diagnosed as bizarre leiomyoblastoma. Sixty-two cases of leiomyoblastoma of the stomach in Japan were collected and reviewed. Leiomyoblastoma of the stomach with cystic degeneration like a complete cavern has not been reported previously.
    Download PDF (4545K)
  • HIDESHI KOMORI, SHUSUKE TOMITA, AKIO TODO, YASUTOMO KITAURA
    1979 Volume 21 Issue 2 Pages 259-265
    Published: February 20, 1979
    Released on J-STAGE: February 09, 2012
    JOURNAL FREE ACCESS
    A case of acute fulminating ulcerative colitis is reported, which show specific double contrast radiografic findings and colonoscopic picture. It was difficult to differ the case from drug induced colitis. In this case, serum immunoglobulin (IgG, IgA) level transiently increased and then return to normal level, following clinical remission. And in this case, steroid enema was more effective than steroid one shot infusion in mesenteric artery.
    Download PDF (1447K)
  • HIDESHI KOMORI
    1979 Volume 21 Issue 2 Pages 266-270
    Published: February 20, 1979
    Released on J-STAGE: February 09, 2012
    JOURNAL FREE ACCESS
feedback
Top