Rat experimental ulcer is very often used to examine the biological effects of many anti-ulcer drugs. We attempted to obtain a detailed picture of gastric mucosa in rat. The gastroscope is mainly used in large animals such as dogs, and is not used in small animals such as rats. Recently a few reseachers use a bronchoscope in rats. Bronchoscope is small in diameter, and does not provide a detailed picture of rat gastric mucosa. In this study, using a human gastroscope, we could take detailed pictures of gastric mucosa in rats with gastric fistula. This method is very useful for studying the experimental ulcer in the rat.

View full abstract

To evaluate the efficacy and the limitation of emergency endoscopy for diagnosis and treatment of hemorrhagic gastric ulcers, the patients who underwent the operation due to the disease were studied. The patients were divided into three groups according to following periods : A period ; from Jan. 1970 to Dec. 1972, when the emergency endoscopy was not employed, B period ; from Jan. 1978 to Oct. 1980, when the emergency endoscopy was carried out only for the diagnosis, C period ; from Nov. 1980 to Dec. 1982, when the emergency endoscopy was carried out for the diagnosis and treatment using local injection of hypertonic saline epinephrine solution (HSE) into the lesions to arrest hemorrhage (Table 1). 1) Compared with A and B, there were not significant differences in clinical sym-ptoms between them but preoperative diagnosis was correct in more cases and operated small ulcers were fewer at B period than at A (Figure 1-7). 2) Operative rate was significantly lower at C period (13.7%) than at B (37.4%), which showed endoscopic local injection of HSE was effective in arresting hemorrhage permanently (Table 1). 3) The mean interval from admission to operation was longer at C period than at B, which showed endoscopic local injection of HSE was effective also in arresting hemorrhage temporarily (Figure 3). 4) The operated cases at C period showed following many features. They are a) past history of gastric ulcers, b) deep ulcers of U1-IV, c) ulcers at lesser curvature of the angulus and d) giant ulcers over 3 cm in diameter (Figure 4-10). Thus, here may be the limitation of the endoscopic local injection of HSE to arrest hemorrhage in those cases. Gastroenterological Endoscopy

View full abstract

In this report we introduced a new method to measure gastric blood flow using hydrogen gas generated by electrolysis. This method uses a small probe consisting of two platinum wires, one of which is used to generate and the other to measure hydrogen. In this method diffusion of H2 gas to the surrounding areas cannot be disregarded, and therefore the values are greater in general than those found in the H2 inhalation method, and also in order to calculate the absolute values of blood flow it is necessary to observe the changes due only to diffusion after cardiac arrest. The major advantages of the local H2 generation method are that the apparatus and procedure is extremely simple and this method requires less time than the inhalation method because measurements can be made without inhalation of H2 gas. And the repeatability of this method was found to be very good. Adding to this pulse method we also presented a continuously measuring method of local hydrogen pressure to yield qualitative data on local blood flow. Using these pulse and continuous methods we investigated the effect of gastrin on the dog's gastric blood flow. Gastrin increased blood flow in the pulse method but in the continuous method the curve showed a reverse response. And the basic experiment revealed that pH change have influence on the movement of the curve.

View full abstract

We carried out basic studies on the diagnostic accuracy and clinical evaluation of a system involving administration of HpD against malignant tumors and N₂ dye laser (Molectron Co. Model 8910) photoradiation, and obtained the following results. The laser beam emitted from N₂ dye laser is a discontinous wave, but it could be seen macroscopically as continuous one when pulse repetition was increased to 60 pps or more. Therefore, observation of fluorescence of HpD did not be disturbed. At the tip of the light guide fiber of N₂ dye laser, average power was as low as 23 mW, but peak power was as high as 38 KW, which was sufficient to excite HpD. The mininum HpD value detected using a diluted solution of HpD (5 mg/cc) was 5×10^-4pg. In human stomach cancer and mouse transplanted tumors (Sarcoma and carcinoma), fluorescence could be observed even to the thickness of 50 p, 48-72 hours after the administration of 3 mg/kg of HpD. In the observation of fluorescence of HpD, 0.3% indigocarmine solution in dye spraying method did not disturbed, but fresh blood, mucus and white coating on lesion disturbed. Since usefulness of N₂ dye laser was demonstrated by this basic study, we will attempt application of this system consisting of the laser and an image intensifier (30, 000 fold) in endoscopy.

View full abstract

Cresyl Violet Staining is proved to be useful for magnifying observation of mucosal carcinomas in fresh resected stomachs and furthermore for magnifying endoscopy. For the clinical use of Cresyl Violet Staining, maximal harmless dose of this solution should be clarified. For testing the toxicity of cresyl violet acetate and tnionine solution(0.14% cresyi violet acetate and 0.11% thionine 5% ethanol solution), acute toxic animal test was attempted using wistar strain rats (male ; 45, female ; 20) through two different routes, oral administration and intraperitoneal injection. Rats of these 2 groups were given 100, 25, and 5 times of a clinical dose (5 ml of this solution) by body weight. Blood chemistry (GPT, GOT, LDH, ALP and TB) and histological examinations of liver, kidney and stomach after 24 hours of administration showed no abnormal values or findings. From these results, we concluded that a clinical application of Cresyl Violet Staining was possible.

View full abstract

Radiographic and endoscopic diagnosis of synchronous multiple cancer of the large bowel was studied, based on 70 cases which had been operated on and histologically proven at the Cancer Institute Hospital in a period 34 years from 1946 to 1979, excluding cases of polyposis of the large bowel, and the following result was obtained. Seventy cases of the synchronous multiple cancer comprise 4.7% of all operated cases in the same period. Lesions of multiple cancer were most frequent in the rectum and sigmoid colon, comprising 59.5%. All multiple lesions had not been detected by the radiographic examination in many cases in a period of 28 years from 1946 to 1973 because the double contrast radiography has not been established in this period. Endoscopically, lesions located proximal to the mid-sigmoid colon had not been observed because a rigid rectoscope was used for the most cases. However, in a period of 6 years from 1974 to 1979 when the double contrast radio-graphy has been established and fiberscope has been routinely used, there had been few cases which were missed by radiology and/or endoscopy except for cases with obstruction and marked stenosis due to cancer. In this period both radiology and endoscopy revealed the lower detection rate of early cancer than advanced cancer. Endoscopy revealed a tendency to detect lesions proximal to primary cancer less effectively than the primary one, itself and those distal to it. It is considered that small lesions may be missed by radiology with no relation to a presence of stenosis and that there is the least possibility for the lesion distal to a primary cancer to be missed by endoscopy. In order to obtain the better diagnostic yield of multiple cancer, an attention should be focused on the rectum and sigmoid colon where it is most frequent, and when one cancer is detected the same segment and an adjoining segment should be scrutinized on the assumption that at least two more cancers may be present.

View full abstract

It is essential to know the depth of invasion and the presence or absence of metastases in the mediastinal lymphnodes before operation of esophageal cancer. Although several methods of examination have been proposed for this purpose, a reliable method of diagno-sis has not yet been established. We have used linear array ultrasonic fiberendoscopes manufactured by Machida Seisakusho Company and Toshiba Medical Company, to investigata its usefulness in the diagnosis of disases of upper digestive tract since June 1981. The present paper deals with the results of esophageal cancer. Ultrasonography was performed in an excised specimen fixed in air-free water, and then a needle was stuck in each layer of the same and a small amount of India ink was injected. The ultrasonic image obtained was compared with the histologic picture. The esophageal wall was delineated into 5 layers and through this comparison it became clear that the third hyperechoic layer correspond to the submucosa, the fourth hypoechoic layer tothe muscularis propria and the fifth hyperechoic one to the adventitia and adipose tissue. However, the relation of the first hyperechoic and the second hypoechoic layer with the mucous tunic and the muscularis mucosa respectively, needs further studies. A thin hyperechoic layer was present in the fourth layer in some cases. It was confirmed to be due to the connective tissue between the two layers of the muscularis propria. In clinical cases the lymphnodes were seen as hypoechoic lesions and their detection was possible if the diameter was equal or larger than 5 mm. Using the ultrasonic f iberendoscope, it was also possible to detect the depth of the cancerous invasion into the eophageal wall by referring to the normal portion of the same organ as landmark. According to theese results, the linear array ultrasonic fiberendoscope is a new and useful preoperative diagnostic technique of esophageal cancer.

View full abstract

Five cases of speudomyxoma peritonei, 2 originating from the appendix and 3 originating from the ovarium, were reported. All cases were diagnosed by peritoneoscopy. In 2 cases originating from the ovarium, follow-up evaluations by peritoneoscopy were carried out during the post-operative chemotherapy. The follow-up observations by peritorieoscopy yielded remarkable information for the determination of the effectiveness of chemotherapy. Therefore, peritoneoscopy was considered to be one of the most preferable procedures for the early diagnosis of pseudomyxoma peritonei, the detection of the primary lesions, and particularly for the determination of the effectiveness of chemotherapy.

View full abstract

A 71-year-old woman visited our hospital with a complaint of heartburn. Fluoroscopic examination of the stomach revealed a filling defect with a smooth margin on the lesser curvature of the cardia. Endoscopic examination of the stomach revealed a hemispheric mass with a bridging fold on the anterior wall of the cardia. From these findings it was difficult to differentiate a gastric submucosal tumor from an extrinsic compression. Under photofluorography the submucosal area was visualized with a water-soluble contrast medium. There was a gap between the contrast medium and the mass. The compression was found to be due to a tumor in the area outside the stomach, and the patient was admitted to our hospital for a detailed examination. She underwent ultrasonographic examination of the abdomen, CT, angiography, laparoscopy, etc. after admission. An operation was performed with the diagnosis of hepatic hemangioma. The tumor, 3.0×6.0 cm, was located in the left hepatic lobe and was reddish purple and multilobular. Histopathologically, the tumor was seen to have vascular cavities of various sizes, and its lumen consisted of a layer of endotheliocytes. A diagnosis of hepatic cavernous heman-gioma was made. It is often difficult to differentiate a gastric submucosal tumor from a compression outside of the stomach. It was considered that submucosography can be an effective means for differentiating them.

View full abstract

A 53-year-old female was admitted to Kyushu University Hospital because of poly-arthralgia. A diagnosis of systemic lupus erythematosus was made and treatment with 20 mg-45 mg daily of prednisolone was administered for 3 months, followed by development of gastric ulcer. One year after the episode, the patient had mild epigastralgia. Barium study of upper gastrointestinal tract revealed a fistulous tract that connected the pre-pyloric region with the duodenal bulb. A diagnosis of double pylorus was established on endoscopic examinations. There were two channels in the pyloric area. An ulcer was observed in the superior one. A plastic tube was placed through the inferior channel (the normal pylorus). The probe could be visible endoscopically through the superior one (the second acquired channel). The acquired double pylorus might be due to penetration of the prepyloric ulcer to the duodenal bulb as a result of long-term steroid therapy.

View full abstract

A case of severe hepatitis presenting potato liver on peritoneoscopy was reported. A 21-year-old male developed jaundice and hyperammonemia. Intensive parenteral administration of prednisolone and THE combined with oral lactulose brought about a recovery, and subsequently he was submitted to peritoneoscopy on the 105th hospital day. Both liver lobes showed typical potato liver according to the H. Kalk's classification. A typical potato liver is rare, and the pathogenesis of potato liver was discussed.

View full abstract

A 38-year-old man born in Formosa, was hospitalized for treatment of dysentery. In spite of antibiotic administration diarrhea persisted. At admission red blood cell count was 500×104/mm3, hemoglobin was 14.4 gr./dl, and white blood cell count was 47, 500/mm3, showing an increase in white blood cell count. Differential count showed 46% of abnormal T cells with a convoluted or a lobulated nuleus. X-ray findings suggested the presence of ulcer with edema in the small and the large intestinal mucosas. Colonof iberscopic findings showed mainly opaque edematous mucosa with multiple ulcers and reddenings, and scattered pseudopolypoid lesions or small ele-vations. Biopsied specimens showed the infiltration of the abnormal T cells with a convoluted or a lobulated nucleus which were the same as those found in peripheral blood, suggesting the infiltration of ATL cells into the colonic mucosa.

View full abstract

In December 1982, we started to apply an apparatus of endoscopic camera as a new recorder of endoscopic findings. This record-method with EC-3 has some merits which could not be obtained with the conventional film system of Model SC-16. As compared to the conventional film system which required some time for development, EC-3 has made it possible to obtain an image picture immediately after endoscopy as EC-3 is an instant camera system. The important characteristic of EC-3 lies in this. The fact that image can be obtained immediately after endoscopy is very convenient for communication of information. Immediately after urgent endoscopy, the clinician can have a discussion with a third person based on the uicture obtained. After endoscopy, he can make an explanation to patients and their families by showing the photographs. By attaching the report of endoscopic findings to the medical chart, the time required with conventional method for applying the film to the projector can be saved. Moreover, home doctors who referred patients to us appreciated very much, when we attached the Polaroid film to the replying letter. The size of the apparatus of EC-3 is 190 (width)×160 (height)×90 (length) mm, with a weight of abuot 900 g. The size does not give us much inconvenience in handling the apparatus. The image given by EC-3 is very sharp. However, the size of picture is too small and the film costs somewhat high. We believe that this instant camera system (Olympus EC-3, Polaroid camera) should be applied for endoscopy in various fields in the future. We described our experiences with the use of a new apparatus of endoscopic Polaroid camera EC-3 together with some advantages and disadvantages.

View full abstract