Patients with spinal cord injury frequently complicate serious gastrointestinal diseases such as perforation of a duodenal ulcer. On the other hand, there have been very few reports about radiological and endoscopic examinations of these patients. Therefore, we evaluated endoscopic appearance of gastric mucosa and gastric acid secretion of these patients with spinal cord injury, who were thought to be vagotonic. Ten patients with chronic cervical spinal cord injury were investigated on the severity of the disease, serum gastrin level, gastric acid excretion including endoscopic Congo red Study, and biopsy of gastric mucosa. The conclusion are as follows: 1) In these patients, endoscopy was more tolerable than radiological examination. 2) Gastric atrophic border of these patients located more distal than that of normal persons. 3) Mean basal acid output level of these patients was higher than that of normal persons. 4) It was thought that the ability of gastric acid secretion in these patients resembled that of patients with duodenal ulcer.

View full abstract

The clinical evaluation of glucagon for the premedication of upper gastrointestinal endoscopy was made to 172 patients. When the lowest dose of glucagon (0.5mg, intramusculary) was given, gastric motility was inhibited in 87.5% (27/32) of the cases at the start of endoscopical observation. The inhibition was continued for 15 minutes in 42.9% (3/7). The effect of glucagon in this dose on the gastric motility was equivalent to that of anticolinergic (butropium bromide, 4mg intramuscular injection). The inhibition of gastric motility was most prominent and prolonged in patients given 1.0mg of glucagon intravenously. Gastric motility was inhibited in 97.1% (34/35) of patients soon after the injection of glucagon and in 66.7%(8/12) at 15 minutes after the injection. No untoward effects of glucagon were noted. These results indicate glucagon an the drug of choice for premedication in upper gastrointestinal endoscopy.

View full abstract

A laparoscopic equipment which has an EE-automatic extracorporeal flash in the photographic system has recently been developed by the Olympus (Figure 1-5, Table 1). We have used this type in 60 patients for testing the performances (Table 2). From the experiences, we are confident that the Olympus new type has some advantages on observation capacity, photographic recordability and easiness of operation. The great advantage of the Olympus new type would be that, by including the 16mm film camera having the EE-automatic mechanism connected with the light supply (Figure 3, 4), a fine photograph is constantly obtained even by unskilled operators (Figure 8, 9). At present, however, unstability of color-tone rendering remains to be unfavorable. Accordingly, it would be necessary to make further improvement of the light guide system. Moreover, it is desirable that the EE-automatic system is also included in the 35mm film camera.

View full abstract

Association of benign hypertrophic gastritis with gastric cancer is a rare occurrence. Recently we encountered three cases of gastric cancer associated with benign hypertrophic gastritis. Case 1. A 48-year old man was admitted to our hospital complaining of the emaciation on August 22, 1977. X-ray examination revealed the enlarged and tortuous folds of the mucosa of the greater curvature. Cancer was only limited in a part of the hypertrophic mucosal fold of the greater curvature of the lower body and its depth invasion was m (II b type). Histological features of the thickened mucosal folds consisted of the simple hypertrophy of the gastric gland and epithelial hyperplasia of gastric pits. Case 2. A 28-year old man was admitted to our hospital complaining of the epigastralgia on July 15, 1978. X-ray examination revealed the meandering and enlarged folds of the mucosa of the greater curvature and niche surrounded by these tortuous folds. Biopsy specimens obtained from the margin of an active ulcer showed histologically poorly differenciated adenocarcinoma. Total gastrectomy was performed on August 11, 1978. Cancer was only limited in the geater curvature of the lower body and its depth invasion was ss. Histological features of hypertrophic mucosal folds consisted of remarkable glandular hypertrophy. Case 3. A 35-year old man was admitted to our hospital complaining of the discomfort in the upper abdominal region on January 8, 1979. X-ray examination revealed the enlarged and tortuous mucosal folds in the greater curvature of the body. Endoscopic examination showed slight depression in the posterior wall of the lower body. Biopsy specimens obtained from depressed lesion showed histologically signet-ring cell carcinoma. Subtotal gastrectomy was performed on February 8, 1979. Detailed histologic examination of the resected stomach disclosed that there was a 5×8 mm lesion of II c early cancer with an invasion of m in the posterior wall of the lower body. On the other hand, histological features of the thickened mucosal folds consisted of remarkable glandular hypertrophy.

View full abstract

A 70-year-old female was seen with a gastric cancer (Borrmann I), which was dislodged during chemotherapy. A tumor, measuring 45×35 mm in size, was found at the pyloric antrum (Figure 1, 2), and it was confirmed as gastric cancer, Borrmann I, papillary adenocarcinoma by the endoscopic examination (Figure 3, 4). Then, a combination chemotherapy (MFC+5-FU D.S.) was started because the family refused surgical treatment. The tumor became much smaller and transformed (Figure 5) when the general symptoms improved and she was discharged. During the follow-up observations she felt sever epigastralgia and was rehospitalized. The X-ray and endoscopic examinations could not find the tumor (Figure 6, 7, 8 ), and we thought that the tumor had dislodged. The biopsy from the previous location of the tumor revealed only necrotic tissue, however, one week after the second biopsy it revealed tumor cells. Despite of the liver metastasis she is now followed up as an outpatient. Case reports of dislodging of protruded gastric cancer are rare (Table 3). In our case, the necrotic change of the tumor's neck by chemotherapy and the location of the tumor, pyloric antrum where peristaltic movement is strong and frequent, seem to have caused the dislodging of the tumor.

View full abstract

A 27-year-old man was admitted to our hospital because of nausea, vomiting and weightloss of 10kg in 10 months. Roentgenographic examinations showed a circular narrowing in the jejunum 40cm distal to the ligament of Treitz, and showed dilatation of the intestine proximal to the lesion. Laboratory examinations showed dysgammaglobulinemia, and a low IgG level. Laparotomy revealed a white, circular narrowed lesion, 2cm in length in the jejunum 40 cm distal to Treitz ligament, with scattered metastases on the mesenterium from of the ligament Treitz to the ileum end. At the same time, operative endoscopy was done distally and proximaly to the narrowed lesion. A tumor with an irregular ulceration was seen in the stenotic area. Jejunal resection 10cm away from the narrowed lesion on bothsides, and an end-to-end anastomosis was performed. The operative specimen showed a napkin ring carcinoma, moderately differentiated adenocarcinoma with involvement to the serosa microscopically. After operation complaints of nausea and vomiting disappered, and the patient was discharged on the 29th day after surgery. In the meantime, a low j gG level recovered to a normal range 18 days after surgery. By our opinion, dysgammaglobulinemia of this patient was due to protein loss from carcinoma itself or the dilatated intestine, because it disappered after resection of the carcinoma and disappearance of dilatation of the interstine.

View full abstract

The treatment of sigmoid volvulus may be either non-operative or operative. Its nonoperative treatment consists of high-pressure enema, rectal tube insertion, sigmoidoscopy and flexible colonoscopy We recently succeeded in non-operative reduction of sigmoid volvulus by flexible colonoscopy in two cases : One was acute and the other reccurent. We conclud that colonofiberscopic reduction is superior to the other non-operative treatment in sureness and safety.

View full abstract

Although lymphoid hyperplasia in the terminal ileum has been frequently suggested as a possible cause of intussusception in infancy and early childhood, evidence for this condition is difficult to obtain. Therefore, very few cases have been reported in the leterature. This report illustrates a case occuring in a 13-month-old female infant treated by surgical resection. Before operation, colonoscopy was examined under general anesthesia and an irregularly knotty tumor was clearly inspected at the ileo-cecal valve. Recently, the advent of the flexible f iberoptic endoscope has facilitated the observation of the colonic mucosa of the infant and/or children with more ease and safety.

View full abstract

This report is a case of xanthoma of the colon under endoscopical, hematological, and histopathological examinations. This patient is 61 year-old female who visited our hospital with complaints of lower abdominal pain, diarrhea, general fatigue and weight loss. Multiple xanthomas were found in the entire colon and two adenomatous polyps in the flexura lienalis. Additionally, the examination of the stomach revealed multiple xanthomas. The shape of the xanthomas was various and three types (flat, plateau-like elevation, mushroom-like elevation) were differentiated. There was no hyperlipemia.

View full abstract

A laser endoscope for the Nd-YAG laser was developed. Nd-YAG laser was guided to the tip of the endoscope (MACHIDA PFS-L 1) by the quartz fiber through the biopsy channel covered with laser window. Our preliminary study with this laser endoscope was done by using canine stomach. Tentatively, the 70 W Nd-YAG laser was able to stop an artificial bleeding within 8-sec on an average and perforation was not observed. The power of laser in this experiment was measured at the laser head. But it is desirable to measure it at the tip of the endoscope, for transmission of laser in the quartz fiber is unstable. Clinical experiences with this laser endoscope pointed out some problems as follows. It was difficult to irradiate the angulus and posterior wall of the corpus, because the endoscope was thick and forward viewing. The laser power fluctuated when voltage of supplied electricity was unstable. Fragility of the quartz fiber and difficulty of observing the guide-spot by He-Ne laser were also to be improved.

View full abstract