Endoscopic toluidin blue-iodine double staining method is perfomed by applying 2% toulidin bule solution in water at first, then 3 % iodine solution on the surface of esophageal mucosa. 64 advanced esophageal carcinomas underwent endoscopic double staining method, then 59 erosive esophagitis were also studied and 9 erosive esophagitis cases were followed by endoscopic double staining method. Staining properties of each lesion and its histologic characteristics were discussed as follows. I: Esophageal mucosa is devided into three areas according to staining characteristics. A; Brown area. It is covered by normal esophageal epithelium. B; Blue area. It lacks normal covering epithelium, and C; Yellowishwhite area. It is covered by epithelium with pathologic changes. II: 64 advanced esophageal carcinomas presented 104 yellowish-white areas (unstained area). Those unstained areas were classified into four typed; broad type, small type, mixed type, and solitary type. Histologic studies of biopsy specimens of unstained areas showed interaepithelial carcinoma in 85% of broad type, 40% of small type, 17% of mixed type, and 30% of solitary type. 16 resected specimens were histologically studied and accuracy of endoscopic diagnosis of interaepithelial carcinomas by double staining method were discussed. Intraepithelial carcinoma could be detected with accuracy of 63%, and remaining 37% were carcinoma with partial invasion into the lamina proplia. III: 59 erosive esophagitis presented erosions of three types according to their staining properties; active type, regenerating type and healed type. This classification of esophageal erosions showed close relationship to histologic characteristice of esophagitis. Staining properties changed from active to regenerating then to healed type, among 9 erosive esophagitis cases which were followed by endoscopic double staining method.

View full abstract

Distribution of Gastrin cells (G-cells) of the gastric mucosa was determined in the gastrectomized specimens from various patients with duodenal ulcer, gastric ulcer, early gastric cancer and pernicious anemia associated with early gastric cancer. G-cells were counted in the multiple antral and fundal biopsies obtained by endoscopy from 50 subjects. They included various patients with duodenal ulcer, gastric ulcer, atrophic gastritis, pernicious anemia and chronic renal failure. The immunoperoxidase method was used for staining G-cells, and the mean concentration of nucleated G-cells per square centimerter of mucosal surface was determined by light microscopy. Fasting serum gastrin levels, integrated gastrin response to test meal stimulation and gastric acid secretion were also evaluated in these patients. The results obtained were as follows; (1) G-cells were found in the pyloric glands, mainly occupying the middle portion of the mucosa. None were found in the fundic and cardiac glands. (2) G-cells were distributed countinuously in the pyloric gland area and they were patchily distributed in the intermediated zone. However the presence of patchy intestinal metaplesia resulted in a absence of G-cells from the corresponding part of the mucosa even in the pyloric gland area. (3) A statistical correlation was found between the antral G-cell number and atrophic index which was estimated by histological examination of biopsy specimens. (4) The antral G-cell numbers were higher with statistical significance than the fundal G-cell numbers in the cases of closed and open type atrophic gastritis. In the cases of 0-4 type atrophic gastritis, there were no statistical differences between the antral and fundal G-cell numbers. (5) The antral and fundal G-cell mumers in the patients with pernicious anemia were higher than that in the patients without pernicious anemia with statistical significance. (6) The antral G-cell hyperplasia was observed in all patients with pernicious anemia and in 2 out of 10 cases with severe atrophic gastritis and in 2 out of 20 cases with gastric ulcer. (7) There were no relationship between the antral G-cell numbers and the fasting serum gastrin levels. There was a statistical corelation between the antral G-cell number and the integrated gastrin response to test meal stimulation. (8) There was a statistical corelation between the antral G-cell numbers and the muximum acid output.

View full abstract

We made an analysis of the X-ray findings on 51 cases of the congenital dilatation of biliary tract, including 43 cases of the abnormal pancreatico-cholangio-connection (abnormal P, C, C). The results were as the followings. 1) The abnormal P, C, C was defined radiologically as that the pancreatic duct and the choledochus are connected and make the common channel which is divided into two parts; the common channel above notch and the common channel below notch. 2) The abnormal P, C, Cs were classified into main four types and a few atypical types based on three characteristic X-ray findings: the location of the stenosis of choledochus, the dilatation of the common channel above notch and the number of the pancreatic duct. 3) The mode of the branches of pancreatic duct from the common channel and the degree of the dilatation of choledochus were varied depending on the types of the abnormal P, C, C. 4) Congenital dilatation of the upper half of choledochus, i. e. “THE CHOLEDOCHAL CYST”, was accompanied by the abnormal P, C, C in all cases, but the other types were not. 5) Five cases of the carcinoma of gallbladder had two common findings on the type of the abnormal P, C, C : one was that the common channel above notch was dilated and the other was that the degree of the dilatation of choledocus was less manifest comparing with the cases without the carcinoma.

View full abstract

In the routine endoscopic examinations of the upper GI-tract, we became aware of the presence of bluish elevated lesions in the esophagus. Their endoscopic appearances were suggestive of dilated veins, but are notably different from that of esophageal varices which are generally observed in the cases of portal hypertension. They are usually seated at the upper or middle thirds of the thoracic esophagus and never extended to the esophago-gastric junction. We reviewed the files and the endoscopic photographs of the upper GI endoscopy of Kanto Teishin Hospital during 3 years and 5 month (Nov. 1976-Mar. 1980), and collected 122 cases among 12, 405 examinations. The cases which are not documented in the endoscopic photographs are discarded. The examination was carried out with a forward-viewing panendoscope GIF-P2 (Olympus Co). The lesions can be classified into two categories. The typel lesions (55 cases) are dome-shaped small bluish elevations. It is observed in patients whose age ranged 37 to 87 years, 62 years on the average (Figure 2). In 17 cases the lesions are multiple (Figure 1). Microscopic examination on an autopsy case revealed that the typel lesion was not a dilated vein but a cyst in the mucosal layer, probably a retention cyst of the esophageal glands (Figure 8 and Figure 9). But in some cases, the type-1 lesions seemed to consist of dilated submucosal vein. (Figure 4 and Figure 12). The type2 lesions (67 cases) are “Quonset but”-shaped bluish elevations running longitudinally on the esophageal lining. This is observed in patients whose age ranged 23 to 78 years, 44.4 years on the average (Figure 2). The type2 lesions seem to be dilated submucosal esophageal veins, but we have not yet succeeded to prove it by angiography or microscopic examination. Why such venous dilatation is observed only in the upper and middle thoracic esophagus remains obscure. The complexity of blood supply and venous drainage of the esophagus around the level of the tracheal bifurcation may have some etiologic contributions. Studies on associated disorders (Table 1) and the results of biochemical tests (Table 2) suggest that the lesions are, in most cases, not related to portal hypertention, congestive heat failure or SVC obstruction which are the common causes of esophageal varices.

View full abstract

The healing process of gastric ulcer following cimetidine treatment was observed endoscopically and histologically comparing with that of conventional treatment (control group). Cimetidine treated group clearly showed shortening of the healing process of gastric ulcer compared with the control group. Endoscopically, diffuse or localized elevation and light reddness of marginal mucosa of the ulcer were frequently found in cimetidine treated group. These features which were very similar to those of early gastric cancer, were thought to be the specific endoscopical findings following the cimetidine treatment. Histologically, the ulcers covered with the linear or tufty regenerative epithelia were scarcely found and the ulcer floor were directly marginated with the heightened regenerative mucosa with many pseudopyloric glands and indifferent cells in the cimetidine group. While, the ulcer floor of the control group were covered with linear or tufty regenerative epithelia. These findings suggest that cimetidine treatment strongly stimulate regeneration of the marginal mucosa of gastric ulcer. However, the mechanism of the increase in regenerative activity of the marginal mucosa could not be clarify in this study.

View full abstract

In intractable gastric ulcers, the healing process appears to be hindered by extensive fibrinoid tissue around the edge and extending to the base. For the past fifteen years, we have done endoscopic topical injections of steroids and alantoine in order to facilitate gran-ulation formation with excellent results. We irradiated intractable gastric ulcers with a YAG laser which resulted in fresh ulcer. By this we expected to facilitate the healing process. By irradiation of the edge of a intractable gastric ulcer of 3 or 4 sites with 50 watts for a second in each site, all seven cases of intractable gastric ulcer which were resistant to treatment by injection healed well within 2 months without recurrence.

View full abstract

Endoscopic intratumoral frequent injection therapy with OK-432 has been carried out in 8 cases with gastrointestinal malignant tumors since November 1979. In 4 cases (Case 1, 2, 3 and 4) with gastric cancer, surgical therapy could not be applied because of complications or patient's refusal. Of 2 cases with malignant lymphoma of the stomach, Case 5 had chronic renal failure, and Case 6 took laparatomy, but the tumor was far advanced and resection was not done. Case 7 with gastric cancer only had an operation after 5 times of OK-432 intratumoral injection therapy. In Case 8 with rectal cancer, bone metastasis and Virchow's node were existed. OK-432 was diluted with saline to 5 ml and was injected intratumorally through optic fiberscope at a dose of 10 K. E. once a week. Fever within 24 hours was the only side effect. Systemic chemotherapy was combined with this local therapy according to each case. Regression or partial destruction of the tumor was found in all of the cases. Pathohistologic malignant findings were not found in the biopsy specimen of 4 cases with gastric cancer and in autopsy of one case with malignant lymphoma after the therapy. The injected tumors of Case 6 and Case 8 regressed, but metastases extended after this therapy. Mechanism of OK-432 intratumoral injection is not elucidated, but nonspecific activation of macrophage by lymphokine from T cell sinsitized with OK-432 is estimated as a major mechanism. Instead of macrophge appearance to the interstitial tissue, plasma cells infiltration was microscopically prominent. These findings are different from those of BCG intratumoral injection. Therefore it is suggedted that humoral immunity may play a role in OK-432 intratumoral injection therapy. From our experience, local effect of this therapy on relatively small tumor is macked, but it is not effective to metastased. It is concluded that the intratumoral injection therapy with OK-432 to cancer or malignant lymphoma of the gastrointestinal tract is valuable in combination with systemic chemotherapy, if surgical therapy is not applied by any reason.

View full abstract

Up to date 119 cases of juvenile polyp have been reported in Japan. We recently ex-perienced seven cases. We devided all of the 126 cases into two groups; a child group under 15 years of age, and an adult group of 15 years and older. The child group with average age of 3.7 years consisted of 107 cases (84.9%), and the adult group with average age of 23.8 years consisted of 19 cases (15.1%). The age distribution of patients had two peaks. A higher peak was observed about 3-4 years of age, and a lower peak was about 20 years of age. After that the incidence of juvenile polyp decreases with age. Among these two groups, there was no significant difference about the location of polyps, sex ratio and symptoms. Neither histologically nor in macroscopic appearances, any difference was observed between these two groups. But polyps in the adult group showed a tendency to be smaller in size and with shorter duration of symptoms than in the child group. We discussed the pathogenesis of juvenile polyp from the clinicopathological aspect, but were not able to make it clear.

View full abstract

Laparoscopic features of fatty liver were comparatively studied in between 16 cases of alcoholic of daily ethanol uptake over 150g and 21 cases of non-alcoholic. In alcoholic fatty liver, the margin of yellow spots is not sharply demarcated, the liver surface being slightly uneven. In non-alcoholic fatty liver, the margin is usually sharply demarcated with the smooth liver furface. The difference in these Laparoscopic features between alcoholic and non-alcoholic fatty liver seem to be closely related to the difference in histological findings. In alcoholic fatty liver, fat vacuoles are diffusely distributed throughout the lobules, after accompanied by fibrosis. In non-alcoholic fatty liver, fat vacuoles are located mainly in centrolobular areas, seldom accompanied by fibrosis. Turbidity of the liver capusle due to possible inflammatory process was considered to have some effects on the difference of endoscopic features. As to the past history as well as liver function tests, however, there was no definite difference observed between the two groups.

View full abstract

The scattering dye on the liver surface at laparoscopic examination is very useful for the detection of liver fibrosis. We have used the scattering dye method with Indigo carmin in 500 cases and studied relationship between the condition and severity with histology of biopsied specimen. Also, histologic studies were carried out in areas where the dye pooled by utilizing autopsied livers and dog livers. The scattering dye pooled on the liver surface just over the fibrosis of Glisson capsules. The breadth or depth of pooling dye accorded with the extent of the fibrosis. Generally. as collagen fibers of the liver increase, more scattering dyes are seen on the liver surface. And as lobular distortion becomes severer, more scattering dyes connect each other just like the networks of collagen fibers of the liver. These findings are exactly similar to fine collagen fibers stained in blue by AZAN staining. Dye scattering findings and histologic appearances coincided in 87.6% except for 62 cases which did not coincide due to overreading. We thought that these facts revealed the necessity of dye sattering method for detection of minute changes of liver fibrosis.

View full abstract

Forty-five jaundiced patients with confirmed pancreatico-biliary diseases were studied to determine the value of body imaging in the differential diagnosis of jaundice. In this study, body imaging included five tests, which were US, CT, FRCP, PTC and RI. The results indicate that each of these five tests is useful and highly accurate in differentiating between obstructive and nonobstructive jaundice (about 90%). The site of obstructon was delineated in 91.3%, 90.9%, 82.5%, 66.7% and 50% by PTC, FRCP, CT, US and RI, respectively. ERCP, PTC, CT, US and RI helped determine the etiology of jaundice in 79.5%, 65.2%, 57.5%, 50% and 0%, respectively. ERCP and US were highly accurate in establishing the diagnosis of resectable pancreatico-biliary cancer with obstructive jaundice. On the basis of these results, we propose a diagnostic approach to obstructive jaundice as in Table 5.

View full abstract

Up to date, small intestinal fiberscopes have developed along three main lines; (1)push type fiberscope, (2)rope-way type fiberscope and (3)sonde type fiberscope. However, none of them were complete in manipulation. With our recent device in manipulation, the sonde type small intestinal fiberscope was improved in order to have an angulation mechanism and a biopsy mechanism (SSIF-Type V, Olympus). In the same manner as in push type fiberscope, SSIF-Type V was inserted into the upper jejunum with ease, while in the conven tional manner of the sonde type fiberscope, it was inserted into the lower part of the small intestine in 20-100 minutes. Therefore, it is emphasized that SSIF -Type V is a more improved scope and has merits of both the push type and sonde type fiberscopes. Using SSIF-Type V, availability of enteroscopy will become much more widened.

View full abstract

During the course of the observation of peptic ulcer, we found the chronic myelogenous leukemia in four patients, and the blood histamine, serum gastrin and serum serotonin levels were determined. All four cases showed higher blood histamine level with increase of basophilic cells. Serum gastrin and serum serotonin levels were found to be within the normal range. Hyperhistaminemia with increase of basophilic cells found in all four cases had peptic ulcer formation with chronic myelogenous leukemia, which were throught to be one of the etiologic factors.

View full abstract

A 37-year-old man with liver cirrhosis wad admitted to our hospital because of high elevation of AFP (570 ng/ml). Hepatocellular carcinoma was suspected, but could not be detected by liver scintigram, echogram., computerized tomography and angiogram. But laparoscopy revealed a hepatoma nodule, on the top of the right lobe just under the diaphragm, and laparoscopic biopsy under direct vision prooved the existence of hepatocellular carcinoma (Edmondson II). This hepatocellular carcinoma was resected. The tumor was 2.5×3.5 cm in size and capsulated by fibrous tissues. AFP values decreased under 5 ng/ml at 4 weeks after operation. The important role of laparoscopy for diagnosis of early hepatocellular carcinoma was reported, and discussions were made on the similar 6 cases reported previously.

View full abstract

A 62-year-old man presented a complaint of abdominal mass (10×11 cm) in February, 1979. Barium meal examination showed a tumor shadow on the greater curvature of the pylolic antrum and a large mass in the head of the pancreas. On endoscopic examination, a protruding mass (Borrmann type I carcinoma) was found in the pylolic antrum and many polypoid tumor masses were observed in the second part of the duodenum. Laboratory data demonstrated obstructive jaundice and hyperamylasemia, and clinically an intrcnsic tumor of the pancreas was suspected Postmorten examination revealed an adenocarcinoma of the stomach with widespread hematogenous and transcoelomic metastases, involving the liver, gallbladder, bilateral adrenal glands, duodenum, colon and pancreas. Lymphatic spread to the retroperitoneal nodes and nodes of left venous angle was also noted. The pancreas is not rarely the site of metastatic lesions from other organs. In Japan, gastric cancer is the most frequent primary tumor. But such a case with clinical manifestations like ours is considered to be rare. On the contrary, carcinoma of the stomach scarcely involves the duodenum except for direct extension. There is no paper in the literature describing endoscopic findings of the lesions in the duodenum as a result of hematogeneous metastasis from gastric cancer.

View full abstract

The case reports of the congenital dilatation of the bile duct have increased in frequency according to the pervasion of endoscopic retrograde cholangio-pancreato-graphy (FRCP). But, almost all of the cases reveal the dilatation of the extra and intrahepatic bile ducts. So-called Caroli's disease, showing only the cystic dilatation of the intrahepatic blie ducts, is rare. In this paper two cases of Caroli's disease diagnosed by ERCP are reported. Case 1: 24 years old female, multiple cystic dilatation of the intrahepatic bile ducts and distended gallbladder are shown by FRCP. Case 2: 40 years old male, multiple cystic dilatation of the intrahepatic bile ducts are shown by FRCP.

View full abstract