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Yasushi KUYAMA
1984 Volume 26 Issue 11 Pages
1887-1895
Published: November 20, 1984
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Progressive systemic sclerosis alters smooth muscle function throughout the gastrointestinal tract. In 7 consecutive patients with the disease were measured colonic electrical activity and contractive activity at the same time. We improved the biopolar silver-silver chloride electrodes at the top of the biopsy forcep. This was clipped on the colonic mucosa at 15cm from the anus with the pressure catheter, 2mm in diameter, through the rectal scope. The catheter was not perfused and the pressure was transmitted to transducer (statham p50). All patients and subjects fasted at least 12hr before the study. Basal recordings were performed for 30min and following the administration of neostigmin, recordings were continued for 60min. The slow wave activity was present all of the recording time and occured two frequency 2.9-4cycle/min and 6-7cycle/min by the frequency analysis of histogram. In normal subjects the predominant slow wave frequency was 6-7.5cycle/min. Three patients of PSS was revealed remarkably low colonic pressure and not responsed to neostigmin injection This was related to the esophageal pressure measured at the same time. In two patients, low colonic pressure, the slow wave frequency, 2.9-4cycle/min was increased. According to measurament of the colonic motility and slow wave. We can diagnose thecolonic dysfunction at the early stage not appeared in x-ray findings. It is concluded that this method is easy, painless and effective for studies of functional and organic disorders of the colon.
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Chikao SHIMAMOTO, Ichiro HIRATA, Masahiro SHIRAKI, Shuji ASADA, Kazuhi ...
1984 Volume 26 Issue 11 Pages
1896-1903
Published: November 20, 1984
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46 "pm" gastric cancers, the invasion of which was limited to the muscularis propriae, among 472 cases of gastric cancers operated during a 4 year period from 1978 to 1982 were studied endoscopically, macroscopically, and histologically. Macroscopically, pm cancers are divided into Borrmann type and early cancer-like type. 16 cases (34.8%) of pm cancers were Borrmann type, and Borrmann 2 type was most often seen. Histologically, well differentiated adenocarcinomas were most frequent in this group. 30 cases (65.2%) were early cancer-like type, and the IIc type was most often seen. The proportion of well differentiated adenocarcinomas and undifferentiated adenocarcinomas were almost the same in this group. A histological relationship between marginal findings such as nodular protrusions and degree of the infiltrating depth was studied in early cancer-like "pm" cancers. Well differentiated adenocarcinomas in this type showed some correlation between degree of the marginal protrusion and the infiltrating depth, but there was no correlation in undifferentiated adenocarcinomas because marked fibrosis and edema in the submucosa elevating the mucosal surface. Therf ore, the diagnosis of the infiltrating depth was much more difficult in the undif f erenrentiated adenocarcinomas than in the differentiated adenocarcinomas.
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Masaharu TATSUTA, Hiroyasu IISHI, Shigeru OKUDA
1984 Volume 26 Issue 11 Pages
1904-1910_1
Published: November 20, 1984
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The extent of fundal gastritis and the grade of antral gastritis in patients with duodenal ulcer and coexisting gastroduodenal ulcers were examined by the endoscopic Congored test. Forty-two patients with duodenal ulcer were followed up by the chromoendoscopy to investigate the location of gastric ulcers developing during a mean observation period of 3 years and 4 months in relation to the changes of fundal and antral gastritis. There was a significant difference between the extent of fundal gastritis and the grade of antral gastritis in patients with duodenal ulcer and coexisting gastroduodenal ulcers. Duodenal ulcers were associated with slight antral gastritis and without fundal gastritis. In the coexisting duodenal and antral ulcers, fundal gastritis was about the same in severity as that in duodenal ulcers, but antral gastritis was usually severe. In contrast, fundal and antral gastritis were both severe in the coexisting duodenal and high lying ulcer. Follow-up studies showed that there was a significant relationship between the development of gastric ulcers and the changes of antral and fundal gastritis. Gastric ulcers developed in the antrum or the angulus in patients with duodenal ulcer when antral gastritis became worse, but not fundal gastritis, and that when fundal gastritis extended, ulcers developed in the gastric body. In conclusion, the sites of gastric and duodenal ulcers were determined by the extent of fundal gastritis and the grade of antral gastritis.
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Kenjiro YASUDA, Keisuke KIYOTA, Hidekazu MUKAI, Kazuhiko NISHIMURA, Ei ...
1984 Volume 26 Issue 11 Pages
1911-1923
Published: November 20, 1984
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Recent progress in f iberoptic endoscopy and ultrasonographic tomography has enabled us to develop endoscopic ultrasonography (EUS) for a more precise diagnosis of pancreatobiliary tract diseases and for interpretation of G-I tract lesions. In this paper, clinical evaluation of EUS is described. From April, 1980 to December, 1983, we have used three types of ultrasonic endoscopy(Olympus and Aloka Co. Ltd.) with sector scan transducer (5.0MHz or 7.5MHz)and have examined 118 cases (32 pancreatic diseases, 23 biliary diseases, 52 G-I tract diseases). The G-I tract wall was visualized as 5 layer structure by EUS, the submucosal layer was demonstrated as a wide echogenic layer and the proper muscular layer was visualized as a hypoechoic layer. By means of those results, it was possible to determine the invasion of G-I tract cancer. Advanced cancer of the G-I tract was demonstrated as destruction ofthe layer structure with hypoechic tumor mass. Benign submucosal tumors of the G-I tract with intra-and extramural wall expantion were clearly shown by EUS with detection of the tumor origin. Laser ulcer was demonstrated as a destructed submucosal layer. In the diagnosis of the pancreato-biliary small cancer, the lesions were clearly demonstrated by EUS, compared with the other diagnostics e. g. FRCP, CT, angiography and conventional US.
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Yujiro TANAKA, Shuzo YOSHIDA, Masayoshi ITO, Akira KITAMURA, Haruhito ...
1984 Volume 26 Issue 11 Pages
1924-1931
Published: November 20, 1984
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In this report, we defined duodenitis as cases with erythematous swelling, erosions, or verrucous erosions constituting more than half of the duodenal cap, and without duodenal ulcer. (Figure 1 shows a typical endoscopic view of duodenitis.) In 15, 468 upper G. Lendoscopic examinations performed with a forward-viewing endoscope (GIF-P2 or -P3Olympus Co., Tokyo) between Jan. 1978 and Dec. 1982, 69 cases were diagnosed as duodenitis. 22 cases of them were associated with liver diseases. Any etiologic factors of duodenitis were suggested in 11 cases. The incidence of duodenitis among patients with liver disease was significantly higher than those without liver disease (2.09 % vs 0.42 %). The liver diseases associated in these 11 cases were acute viral hepatitis in 3, chronic viral hepatitis in 4, decompensated cirrhosis in one, drug-induced liver injuries in 2 and constitutional hyperbilirubinemia (Gilbert syndrome) in one. In 8 cases, endoscopy was carried out during acute exacerbation of hepatic dysfunction. In some cases of acute viralhepatitis, improvement of duodenitis with recovery of hepatic function was confirmed by follow-up endoscopy (Figure 2 and 3). These findings suggested that liver diseases, especially acute exacerbation of liver dysfunction might be a causative factor of duodenitis.
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Yasuo HAYASHIDA, Shin-han LIU, Motoki NAKATSU, Takanori HABA, Tetsuzo ...
1984 Volume 26 Issue 11 Pages
1932-1941
Published: November 20, 1984
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Recently, ERCP is used as one of the important examinations of biliary and pancreatic diseases. It is a fact, that even if the smaller carcinoms of the pancreas are found by ERCP, there are still a few patients to whom the pancreatectomy was performed under the diagnosis of suspicious cancer. Progress of the diagnosis of ERCP should be made to revise this point, and the new technical trial was made using the cytology brush and the biopsy forceps inserted into the biliary and the pancreatic duct after the papillotomy. We have inserted the cytology brush into the pancreatic duct since 1974. But the insertion of this cytology brush is not easy. Forthis reason, papillotomy was done to facilitate inserting the cytology brush and the biopsy forceps into the biliary and the pancreatic duct easier, and at the same time in order to take histological specimens to establish the diagnosis. Usually, the papillotomy is used as a method of therapy in choledocholithiasis, however, we use this papillotomy as a method of establishing the diagnosis of biliary and pancreatic diseases. We named this new thechnique "Diagnostic Papillotomy", and show this method and illustrative cases.
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Tokiaki TOYOHARA, Fukuji MOCHIZUKI, Naotaka FUJITA, Shigeki LEE, Shoic ...
1984 Volume 26 Issue 11 Pages
1942-1946_1
Published: November 20, 1984
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A case of superficial exfoliation of esophageal mucosa associated with pemphigoid was seen and endoscopic examinations were performed before and after immunosuppressive therapy. The case is a 45 year old woman who was admitted to the hospital because of nausea followed by hematemesis and an emesis of string formed whitish material. Endoscopic examination revealed well demarcated circular, reddish mucosal defect locating in esophagus about 33cm from the dental arch. The oral side of this lesion appeared to be normal but easily exfoliated by biopsy forceps leaving well demarcated reddish discoloration. Electron microscopic examination of the mucosa was made and findings were reported to be identical with the diagnosis of pemphigoid. Predonisolone 30mg and endoxan 50mg per day were given and after this treatment the above mentioned esophageal changes disappeared. The superficial exfoliation of esophageal mucosa, like in this case, can be a part of pemphigoid, and the immunosuppressive treatment was thought to be effective.
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Kozo MATSUMOTO, Ryoichi ASO, Katsuhiro TANABE, Ikuko TASAKI, Toru OKAJ ...
1984 Volume 26 Issue 11 Pages
1947-1950_1
Published: November 20, 1984
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A 59-year-old man who had been treated for gastric ulcer since 4 years before, visited our hospital complaining of epigastralgia Endoscopic examination using a forward viewing panendoscope revealed a gastric ulcer at the angnlus and a minute lesion of elevated type carcinoma (type ha) measuring 1.0×0.5cm in size at the esophagogastric junctional area. The depth of invasion was limited within the submucosal layer. The minute early cancer at the area of esophagogastric junction is rare and the authors emphasized the utility of endoscopic examination with a review of Japanese literatures.
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Shigetoshi KANAZAWA, Kunito IWABUCHI, Kouroku OTOKIDA, Seizo ORISO, Ma ...
1984 Volume 26 Issue 11 Pages
1951-1956
Published: November 20, 1984
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A 74-year-old man with hypertension and sequelae due to cerebral infarction was treated in our hospital. An endoscopic examination was performed on September 16, 1981 because he complained of gastric discomfort. There was no chest pain suggesting of angina pectoris or myocardial infarction at the time of effort or resting. The endoscopic examination was completed in ten minutes and no abnormality was found in the stomach and bulb. However, about fifteen minutes later, he developed cardiac and respiratory arrest. Cardiac resuscitation was successful. The patient was diagnosed as having acute myocardial infarction based on changes in the ECG and in serum enzymes, and was discharged from the hospital without further complications. It is suggested that endoscopic examination might cause the acute myocardial infarction in this patient.
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Kyohei MARUYAMA, Toru OHISHI, Tatsuyuki SATO, Hitoshi OKANO, Shozo YOR ...
1984 Volume 26 Issue 11 Pages
1957-1963
Published: November 20, 1984
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A 63-year-old man visited our hospital complaining of epigastric discomfort. Upper GI series revealed small elevated lesions involving the cardia, f ornix, and upper gastric body. Endoscopic study disclosed nodular clusters of polypoid lesions with erosion and redness, in wide area extending from the cardic region to the upper body. Endoscopic view of fine uneveness and granules of the elevated mucosal surface was emphasized by scattering indigocarmin. Total gastrectomy was performed and the resected specimen showed "grouped ha" with IIb lesion. Histologically, the lesion was well-differentiatedadenocarcinoma. Depth of invasion was mostly limited within the mucosal layer, and partially invaded into the submucosa. Repoted cases of "grouped ha" type early gastric cancer in Japan were all localized in the antrum and the body. It is rare that the lesion was located in the proximal stomach.
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Yutaka ORII, Kinichi YOKOTA, Hiromasa MINEMOTO, Ikuo KONISHI, Kiyoshi ...
1984 Volume 26 Issue 11 Pages
1964-1968_1
Published: November 20, 1984
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Gastric syphilis is relatively uncommon. An accurate diagnosis of gastric syphilis which may be confused with malignant lesion is difficult without surgery. The case reported here in is worth recording. A 73-year-old female was referred to our clinic for complete check-up of a IIc like lesion which was found on mass X-ray survey of the stomach. X-ray and endoscopic examinations showed an irregular depression with fold convergencies indistinguishable from a IIc lesion on the lesser curvature of the antrum. There was no healing tendency of the lesion after two months of treatment with cimetidine and repeated biopsy could not reveal malignant findings. Based on a positive result of serologic test for syphilis and characteristic X-ray and endoscopic findings, gastric syphilis was strongly suspected.Epigastric pain was relieved and the lesion was healed immediately after twenty days of treatment with benzyl penicilline procaine.
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Yasutaka KUMEI, Kazumichi HARADA, Noriyuki VEDA, Masayoshi NAMIKI, Yos ...
1984 Volume 26 Issue 11 Pages
1969-1973_1
Published: November 20, 1984
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A 66-year-old man had suffered from dizziness for 6 months before he was admitted to our hospital. In addition, he noticed tarry stools a month ago, for which he visited our hospital for a detailed examination. An UGI series revealed a giant, semispherical raised lesion with a broad base, locating from the body to the cardia. Endoscopic examination also showed a large raised lesion, white-yellow in color, associated with bleeding. Biopsy could not make a difinitive diagnosis. A total gastrectomy was performed because of persiteint bleeding. The resected specimen revealed a tumor of 14 x 10cm in size, with the cut surface showing segmentation of the inner side. Histologically, the diagnosis of fibrous xanthoma was established. Fibrous xanthoma of the stomach is an extremely rare disease. To our knowledge, only 6 cases have been reported since 1949 in the world. This was the second case in Japan.
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Toshio ASAI, Yoshiki YAMAMOTO, Manabu KAJIKAWA, Kenichi TAKANO
1984 Volume 26 Issue 11 Pages
1974-1981
Published: November 20, 1984
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In our hospital we experienced one case of primary duodenal cancer with gastric spread. A patient was 73-year-old woman, who was admitted to the hospital, since she was pointed out to have polypoid lesion in the duodenal cap by a routine gastrointestinal examination. Duodenofiberscopy showed multiple whitish polypoid lesion. Biopsy speci men showed adenocarcinoma. Gastrectomy, partial duodenectomy and lymph node dissection were performed. Gross examination revealed aggregated ha like polypoid lesion, measuring 50?70 mm in diameter, in the duodenal cap and adjacent stomach. Histologicalexamination of the resected specimen exhibited tubular adenocarcinoma with occasional villous structure. Most of the tumor cells were limited within the mucosal layer, however they invaded into the proper muscular layer in the area adjacent to the pyloric ring and involved gastric mucosa. This case suggested that the pyloric ring is a pyloro-duodenal barrier. An ultrastructual study demonstrated that this tumor was intestinal-type car cinoma. The present case is the first case of duodenal cancer in Japan examined submicroscopically by freshly fixed specimens fer electron microscopy.
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Kenji NAGAI, Tetsuo HAYAKAWA, Aiji NODA, Takaharu KONDO, Ribun MIZUNO, ...
1984 Volume 26 Issue 11 Pages
1982-1986_1
Published: November 20, 1984
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A 54 year-old man was admitted to our hospital for evaluation of high serum concen trations of amylase and elastase 1. Endoscopic and histologic examination revealed cancer of the ampulla of Vater. Five patients were found with the same clue from 1976 to 1982 in Japan. All of them showed good prognosis. Radical pancreatoduodenal resection for cancer of the ampulla of Vater was done on 17 patients at our hospital. Eight of them revealed high level of serum amylase and six of seven patients high level of serum elastase 1. Serum pancreatic enzymes, especially elastase 1 and amylase, are important for the diagnosis of cancer of the ampulla of Vater.
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Michio KANAI, Hideo YAMAMOTO, Shigehiko SHICHINO, Taichiro SATOH, Yuki ...
1984 Volume 26 Issue 11 Pages
1987-1995
Published: November 20, 1984
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We report a case of protruding type of gallbladder cancer 22×19×17mm in size, and insist on utilization of Percutaneus Transhepatic CholeCystoScopy (PTCCS) and Percutaneus Transhepatic CholangioScopy (PTCS). The patient was a 66-year-old female presenting with a chief complaint of epigastric discomfort and weight loss, there was no sign of jaundice, ultrasonography revealed a tumor locating on the dorsal side of the middle part of the bile duct, a stenosis of the bile duct due to compression by the tumor, a dilatation of the hepatic duct, and cholecystolithiasis. CT, HDG, PTC, PTCCS and PTCS were performed to make the diagnosis. Then the tumor was diagnosed to be a protruding type of gallbladder cancer with metastatic lymph nodes in hepatoduodenal ligament, inf iltlating the common bile duct. Biopsy from the protrusion in the fundus of gallbladder on PTCCT revealed a well differentiated adenocarcinoma. Biopsy from a stenosis area of the bile duct on PTCS revealed identical adenocarcinoma cells, infiltlating the submucosal layyer. As mentioned above, a definite histological diagnosis could be made preoperatively.
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Takashi AMATSU, Nobuyoshi TAKEDA, Kenji FUKUMOTO, Hideki TADA, Hirohum ...
1984 Volume 26 Issue 11 Pages
1996-2000_1
Published: November 20, 1984
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Benign recurrent intrahepatic cholestasis is a very rare form of jaundice. We report here a case of benign recurrent intrahepatic cholestasis occured after delivery. A 25 year old female who had four episodes of jaundice was admitted because of recurrence of jaundice two weeks after her first delivery. On laparoscopy, liver had smooth surface, sharp edge and greenish-brown color. Histological findings showed the accumulation of bile pigment in the bile canaliculi particulary in the centrilobular region.There was no evidence of inflammation or fibrosis. Electron microscopy revealed dilated bile canaliculi filled with electron-dense deposits and thickend pericanalicular zone. There was marked loss of canalicular microvilli. Although serum Al-P level was elevated, serum γ-GTP level stayed within normal range during period of jaundice. It is suggested that the attack of benign recurrent intrahepatic cholestasis of this case occured in response to delivery.
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Yozo NAKAMURA, Hiroshi SAKAUE, Yuji MIZUKAMI, Tatsuo SASAKI, Yasushi H ...
1984 Volume 26 Issue 11 Pages
2001-2007
Published: November 20, 1984
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Transcatheter arterial embolization (TAE) has been conducted for therapy of patients with hepatocellular carcinoma with favorable results. Some complications with this procedure have been reported, but few gastroduodenal complications were previously reported. In order to clarify the effects of TAE on the gastroduodenal tract, endoscopic examinations of the upper gastrointestinal tract were performed 13 times in 8 patients before and after TAE. Three of them were subsequently found to have multiple gastric erosions with redness and ulcers, and multiple duodenal erosions were observed in one. In a case with acute gastric ulcers, autopsy revealed severe fibromusculosis in the submucosal layer of the antrum histologically, which suggested that both mucosa and submucosa in the stomach might be damaged by TAE. These changes of gastroduodenal mucosa were supposed to bedue to gastroduodenal infarction after TAE. In all cases esophageal varices were observed, but no paticular changes were found in the endoscopic findings after TAE.
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[in Japanese]
1984 Volume 26 Issue 11 Pages
2009-2034
Published: November 20, 1984
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[in Japanese]
1984 Volume 26 Issue 11 Pages
2035-2056
Published: November 20, 1984
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[in Japanese]
1984 Volume 26 Issue 11 Pages
2056-2092
Published: November 20, 1984
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[in Japanese]
1984 Volume 26 Issue 11 Pages
2092-2133
Published: November 20, 1984
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[in Japanese]
1984 Volume 26 Issue 11 Pages
2134-2141
Published: November 20, 1984
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