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Tsuyoshi AIBE
1984 Volume 26 Issue 9 Pages
1447-1464
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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The author reported that 5 layers, 9 layers and 11 layers of the gastric wall could be visualized by means of the ultrasonic endoscope and clarified these layers of the gastric wall by comparing endoscopic ultrasonograms with corresponding histology. The results were as follows; 1) In 5 layers of the gastric wall, the 1st layer and the 2nd layer meant the mucosal layer, the 3rd layer was the submucosal layer and the 4th layer corresponded to the muscular layer. 2) The 1st layer was a border echo visualized inside the mucosal layer. The 5th layer consisted of the serosal layer and a border echo demonstrated outside the serosal layer. 3) The gastric wall was separated to 9 layers when a thin layer was visualized at the same time in the 2nd layer and the 4th layer. The gastric wall was demonstrated as 11 layers when a thin layer was visualized in the 2nd layer and two thin layers were seen in the 4th layer. 4) The muscular membrane was composed of a thin layer in the 2nd layer and a norrow layer between a thin layer in the 2nd layer and the 3rd layer. A thin layer in the 2nd layer was a border echo visualized inside the muscular membrane. 5) A thin layer in the 4th layer of the gastric wall consisted of a border echo and a connective tissue between the inner circular muscle and the outer longitudinal muscle. Two thin layers in the 4th layer of the gastric wall were thought to be composed of border echos and each connective tissues between the inner oblique muscle and the middle circular muscle and between the middle circular muscle and the outer longitudinal muscle. 6) The proper echo of the muscular membrane was thought to be hypoechoic. The proper echos of the lamina propria and the gastric glands were hypoechoic. 7) The gastric mucus was visualized as a high echo, but had no relation to the 1st layer of the gasric wall.
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Tsuyoshi AIBE
1984 Volume 26 Issue 9 Pages
1465-1473
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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The author had reported about the structure of layers of the gastric wall visualized by means of the ultrasonic endoscope and it's histological solution of these layers. Moreover, the author investigated the structure of layers of the esophageal wall and the colonic wall which could be demonstrated by the method of the ultrasonic endoscope and clarified the histological structure of these layers of the esophageal wall and the colonic wall by compairing endoscopic ultrasonograms with corresponding histology. As the result, the esophageal wall was separated to 5 layers or 7 layers on a endoscopic ultrasonogram both in the resected specimens and the clinical cases. The colonic wall was separated to 7 layers on a endoscopic ultrasonogram both in the resected specimens and the clinical cases. In the histological aspect, the main structure of layers demonstrated by means of the ultrasonoic endoscope was 5 layers both in the esophageal wall and the colonic wall. The histological structure of these 5 layers of the esophageal wall or the colonic wall was as same as that of the gastric wall, except that the 5th layer in the structure of 5 layers changed from the serosal layer to the adventitia in the esophageal wall and the rectal wall. The wall of the esophagus or the colon was recognized as 7 layers when a thin layers was visualized in the 4th layer of the esophageal wall or the colonic wall demonstrated by the method of the ultrasonic endoscope. A thin layer composed of a border echo and the connective tissue between the inner circular muscle and the outer longitudinal muscle. In a resected specimen of the esophageal wall, 9 layers could be observed on a endoscopic ultrasonogram. The histological structure of these 9 layers of the esophageal wall was as same as that of the gastric wall.
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Hirokazu KAWATA, Kazuya NAKATA, Shunsuke HAGA, Kenichi KUMAZAWA, Hiros ...
1984 Volume 26 Issue 9 Pages
1474-1480
Published: September 20, 1984
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During the period between December 1980 and September 1983, 53 patients with esophageal varices were treated by endoscopic injection sclerotherapy (EIS) in which 5% ethanolamine oleate was injected into the varices. The endoscopic findings on esophageal varices one year after EIS were compared with those before EIS in 25 of the patients, according to each category of the "General Rules for Recording Endoscopic Findings on Esophageal Varices" prepared by the Japanese Research Society for Portal Hypertension. The varices had disappeared in 5 patients. Improvements in endoscopic findings on esophageal varices were detected in form in 20 of 25 patients (80.0%), fundamental color in 7 of 15 patients (46.7%), location in 8 of 25 patients (32.0%), red color sign in 14 of 19 patients (73.6%), red wale markings in all of 7 patients, cherry-red spots is 12 of 16 patients (75.0%) and hematocystic spot in all of 4 patients. Analysis by Quantification Theory II revealed that 13 of 14 patients (92.9%) who had been predicted to be bleeders before EIS could be expected to be non-bleeders after the therapy. The effectiveness of EIS was demonstrated by determination of changes in the endoscopic findings of esophageal varices after the therapy.
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Kazumichi HARADA, Kinichi YOKOTA, Katsumi SHIROTA, Hideki HAYASHI, Iwa ...
1984 Volume 26 Issue 9 Pages
1481-1488_1
Published: September 20, 1984
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We have experienced 7 cases of giant ulcer showing the protruding change of the ulcer floor on its healing process. These gastric ulcers were treated with histamine H2 receptor antagonist, e. g. Cimeditine, Ranitidine and Famotidine. Location of the lesion was the angulus in one case and the body in 6 cases. Compared with the group treated with conventional anti-ulcerative drugs, the period from active stage to healing stage was short in this group. The protruded change of ulcer floor appeared 5-6 weeks after the treatment and healed as a red scar 4-10 weeks later. Biopsy specimen from the protruded lesion showed granulation tissue which consisted of cell infiltration and renewed capillary without regenerated epithelia. There has been only one resected case treated with histamine H2 receptor antagonist so far in Japan. Histopathological examination proved that this lesion consisted of the same fresh granulation tissue with slight regenerated epithelia and marked fibrosis beneath it. It was suggested that the lesion would develop due to unbalanced rapid repairment of ulcer floor and edge.
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Toru OHISHI, Yoshinobu FUSE, Hitoshi OKANO, Tatsuyuki SATOH, Kyohei MA ...
1984 Volume 26 Issue 9 Pages
1489-1494_1
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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Polypoid lesions in the duodenal bulb were observed in 106 cases during the past 10years at the rate of 3.3%. Endoscopically they were classified into 4 types ; diffuse finegranular lesion, small, medium and large polypoid lesion in size. Endoscopic studies werecarried out in 83 cases of small, medium and large polypoid lesions in size. Results obtainedwere as follows ; 1) Average age was 57.4 years of age and 76% of them were distributed over 50 years of age. Male to female ratio was 45 to 38. 2) Concerned with the number of polypoid lesions, 81% of cases had only a single lesion. 3) Most of these lesions (86%) were smaller than 10 mm in diameter. 4) According to the Yamada's classification, 81% of cases showed sessile, type I orII. 5) Ninety two percent of these lesions showed smooth appearance in surface, 74% of which had neither central reddness nor depression. Polypoid lesions with granular or nodular surface were only 8%. 6) Histological diagnosis was obtained by endoscopic biopsy, endoscopic polypectomy and surgical resection in 17 cases. 7cases showed Brunnerioma or hyperplasia of Brunner's glands. It was concluded that it was necessary to make the accurate histological diagnosis in order to study the details of duodenal polypoid lesions.
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Kazuo INUI, Yoshiyuki NAKAE, Junichi KANO, Yuji NIMURA
1984 Volume 26 Issue 9 Pages
1497-1502
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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Continuous electrocardiographic monitoring with a Holter electrocardiocorder was performed during ERCP on 33 unselected patients. ECG changes during ERCP were analyzed. Eight patients (24.2%) exhibited arrhythmia, 6 ventricular premature beats, one supraventricular premature beats and one paroxysmal atrial tachycardia. ST segment depression was observed in seventeen patients (51. 5%). The incidence of ST segment depression tended to be higher in the older patients, but there was no relationship between the occurrence of ST depression and the duration of ERCP. None of the patients developed severe cardiac diseases in this report, but ERCP should be performed with careful consideration of the risks and preparation for cardiopulmonary resuscitation, especially in older patients and/or in patients with severe cardiac diseases .
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Koichi NISHIMURA
1984 Volume 26 Issue 9 Pages
1503-1511
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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Ultrasonography has been proven to be useful in evaluating the liver diseases. Some of reports have commented on the parenchymal echogram of the liver, however only a few have been published in which analysis was made of the reliability of the liver surface echograms. Retrospective evaluations were performed of abdominal ultrasonographies in 135 patients who underwent peritoneoscopy to analyze the liver surface echogram in dignosis of liver disease. Peritoneoscopic findings were expressed using Shimada's code number system. Liver surface echograms were classified into five patterns : Pattern I (thin and straight line), pattern II (thin and dotted line), pattern III (thick and blurred line), pattern V (uneven parallel dotted line) and pattern IV (wavy line). The results were : (1) Most of cases with smooth liver surface (peritoneoscopically, diagnosed as Shimada's code No. 100 or 200) showed pattern I or II in liver surface echogram. (2) No fixed pattern was obtained in cases with block formed liver surface (code No. 300). (3) Most of cases with nodular liver surface (code No. 400 or 500) showed pattern III, although the cases with micronodular cirrhosis, of which nodules being 1-2mm in diameter showed pattern I or II. Three of four cases with pattern IV or V were accompanied with ascites. On the other hand, only one case with macronodular cirrhosis, of which nodules being over 5mm in diameter, was not accompanied with ascites. (4) Results of evaluation for ability of ultrasonography to distinguish smooth liver surface from nodular liver surface were : Sensitivity, specificity and overall accuracy in liver cirrhosis being 73%, 88% and 84%, respectively.
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Masaaki MIYAOKA, Takeshi KINOSHITA, Pei-Chin CHEN, Yoshiko KUBOTA, Shi ...
1984 Volume 26 Issue 9 Pages
1512-1520_2
Published: September 20, 1984
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In 10 patients with amebic colitis 23 colonoscopic examinations were performed during a period of 15 years (1968-1983), All patients were male. The age distribution ranged from 23 to 64 years old and the mean age was 44.4. The duration of subjective symptoms before admission ranged from 7 day to 7 years. Most of them complained of watery diarrhea or mucousbloody stool. Only 4 patients (40%) had a history of travel to foreign countries. In case of amebic colitis, the findings of colonoscopic examination were studied. There were localized, skip and diffuse type in the distribution of endoscopic changes. The commonest site of the lesion was the rectum and cecum. The characteristic endoscopic findings were varioliform elevated lesion, punctate hemorrhage, small round ulcer and edematous thickening of mucosal folds. The intervening mucosa among them showed intact or slightly edematous change. The other findings were erosion, varif orm ulceration, edema, reddness and stricture which were common to the other inflammatory bowel diseases. Detectability of E. histolytica was 3/7 (49.2%) in feces, 7/9 (77.8%) in biopsy specimens and 5/5 (100%) in colonic mucus. Serological test for amebiasis was performed in 4 patients and showed positive titers in all. Pathologically 24 of 104 biopsy specimens revealed a cluster of E. histolytica in the necrotic tissue. We concluded that biopsy specimens should be taken from the center of the ulcerative lesion. When the mentioned characteristic pictures are found, rectal mucus should be examined. Application of serological examination also plays an important role in the diagnostic procedures.
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Kazunori IDA, Naoki HOSHIYAMA, Haruo MIYAGAWA, Masayuki OZAKI, Junichi ...
1984 Volume 26 Issue 9 Pages
1523-1527_1
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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An 81-year-old man was referred to our hospital for laser therapy of gastric lesions under endoscopy. UGI series showed a 2c+2a type lesion, 38mm in diameter, on the posterior wall of the lower body and aIIc + II type lesion, 43mm in diameter, on the anterior wall of the middle body of the stomach. The same findings were recognized by gastroscopy but the lesion on the anterior wall had more irregular invasion. W repeatedly radiated these lesions by YAG laser with 70w, duration time of 1 sec. at distance of about 10mm. Total energy was about 10, 000 J regionally. The lesion on the posterior wall was completely treated, but cancer was not eradicated at the lesion on the anterior wall. Therefore, N2 dye laser was irradiated after injection of 4.5mg/kg HpD, with average power of about 50mw, duration time of 30 min. at distance of about 10mm. With this therapy the anterior lesion could also be completely eliminated. From this experience, we think that large or wide invasion of early gastric cancer should be treated firstly by Nd-YAG laser having high power, and if cancer still remains, it is desirable to treat it with photoradiation therapy. This "combination laser therapy" under endoscopy may be extremely useful for a large cancer lesion of the alimentary tract.
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Fumio KAWAMURA, Kimitoshi KATO, Kunio WAKABAYASHI, Shingo NAKABE, Akih ...
1984 Volume 26 Issue 9 Pages
1528-1533
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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This is a case report of a small granular cell tumor on the middle esophagus removed by biopsy forceps during upper gastrointestinal endoscopy. We performed upper gastrointestinal examination on a 42-year-old male who complained of epigastralgia and during the endoscopy we incidentally found an elevated lesion of Yamada's type 1 sized 3 mm in diameter at 30 cm from the incisors. The lesion was diagnosed as a granular cell tumor by biopsy. Repeated endoscopy showed no elevated lesion any more and rebiopsy confirmed nonexistence of the tumor. Therefore, we suspected the tumor had been removed by biopsy forceps on the first endoscopic examination. The granular cell tumor of the esophagus is uncommon and experiences of endoscopic diagnosis of the granular cell tumor as small as in our report has been rarely reported.
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Takeshi TANAKA, Mitsumasa KIMURA, Toshio AKIYAMA, Shiro SUZUKI
1984 Volume 26 Issue 9 Pages
1534-1537_1
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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It is very rare that gastric ulcer scar becomes elevated. We experienced a case of an elevated scar after healing of acute antral kissing ulcers and followed up the morphological changes for 3 years, especially a scar of the posterior wall. A 32-year-old man was admitted on November 22, 1979 because of sudden epigastric pain. Gastric juice showed hyperacidity. Endoscopic examination showed acute antral kissing ulcers which healed after 8 weeks. Five months later the scar of the anterior wall become a ha like lesion and the posterior one became a polypoid lesion with white coat. During observation for 3 years, the elevated lesion of the anterior wall unchaged but the posterior one became as the submucosal tumor after disappearance of the white coat. The histological finding of the polypoid lesion revealed remarkable edema, atrophic ducts and mild inflammatory cell infiltration but no hyperplastic change. When the polypoid lesion became as the submucosal tumor, the remarkable edema disappeared and the gastric mucosa was improved to almost normal appearance. From the above, we suggest that the elevated changes would be due to remarkable edema and inflammatory change.
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Junichi OKUDA, Haruo MIYAGAWA, Masayuki OZAKI, Keishi TAKECHI, Shuji K ...
1984 Volume 26 Issue 9 Pages
1538-1542_1
Published: September 20, 1984
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A 42-year-old man visited our hospital with a complaint of epigastric discomfort. Fluoroscopic examination of the stomach revealed multitudinous barium flecks of differentsizes spreading from the lower body to the antrum. Endoscopic methylene blue (MB)staining method of the stomach revealed zonal intestinal metaplasia of depressed type spreading along the fundic-pyloric mucosal border over the anterior and posterior walls with its depressed region found in the fundic gland area. An 8-year observation with the MB staining method showed that intestinal metaplasia of depressed type changed partly to that of flat type and spread proximally. During the period of observation, intestinal metaplasia newly developed in the antral and cardic regions, and the antral intestinal metaplasia also spread upwards and the cardiac intestinal metaplasia spread downwards. Follow-up observation in this case revealed developing directions of intestinal metaplasia of the stomach..
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Eiji TARUYA, Michio SOWA, Yasuyuki KATO, Teruyuki IKEHARA, Ryuichiro M ...
1984 Volume 26 Issue 9 Pages
1543-1548_1
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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As a whole, it is known that esophagogastric varices is associated to patients with portal hypertention. But it is sometimes difficult to diagnose the gastric varices without esophageal varices endoscopically. We reported two cases of pancreatic disease accompanied with gastric varices in absence of esophageal varices. Case 1. A 38-year-old man with a complaint of hematoemesis. The tortuous and nodular varices with blood clots, in cardia was seen by endoscopic examination. Splenoportographic findings revealed stenotic pictures of splenic vein and remarkable gastric varices. Spleen was enlarged in size but liver was normal. Pancreas was atrophic and elastic hard in consistency. He was diagnosed to the stenosis due to pancreatitis, and splenectomy with devasculation of short gastric vein was performed in order to prevent gastric bleeding. Case 2. A 63-year-old female with complaints of hematoemesis and melena. Endoscopic findings showed tortuous varices with red-colour-sign. Celiac angiographic picture revealed a hypervascular tumor stain at the hilus of spleen and remarkable gastric varices, but any obstruction and stenosis of splenic vein were not seen. Total gastrectomy combined with splenectomy and resection of pancreas tail was performed. Histological diagnosis of this tumor was malignant islet cell tumor of the pancreas from which infiltrated directly into splenic parenchyma
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Toshio FUJIOKA, Kenichi MATSUNAGA, Hideo TERAO, Jyunichi SUETSUNA, Min ...
1984 Volume 26 Issue 9 Pages
1551-1557_1
Published: September 20, 1984
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Two cases of mucin producing pancreatic carcinoma with characteristic findings excreting mucinous pancreatic juice from the orifice at the papilla of Vater were reported. Case 1: A 72-year-old male was admitted because of severe epigastralgia. Laboratory data revealed elevated serum amylase and lipase values. This case was characterized by endoscopic findings of papilla of Vater, excretion of mucinous pancreatic juice from a swollen orifice at the papilla of Vater, and diffusely dilated main pancreatic duct with a defect at the head of the pancreas on ERCP. Pancreatoduodenectomy was performed and histopathological findings was well differentiated mucinous cystoadenocarcinoma with the size of 4.0X4.0 cm. Case 2 : A 58-year-old male was admitted because of general fatigue and ascites. Upper GI series showed a Borrmann I type tumor in the antrum of stomach. Findings of papilla of Vater were similar to those of case 1. On ERCP, the main pancreatic duct was diffusely dilated and a defect in the main pancreatic duct was revealed at the head of the pancreas. Angiography revealed a hypervascular tumor in the right lobe of liver, and serum AFP value was elevated. He died because of disseminated intravascular coagulation (DIC). At autopsy, pancreatic carcinoma localizing in the intrapancreatic duct, 1.5X0.6 cm in size, gastric carcinoma and hepatocellular carcinoma were confirmed to coexist.
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Tadashi HACHISU, Teruo NAKAO, Naondo SUZUKI
1984 Volume 26 Issue 9 Pages
1558-1562_1
Published: September 20, 1984
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There are several types of papillotome, but they are not always satisfactory for use. Therefore we devised an improved pushing-type-papillotome in November 1979 and reported it's structure and characteristics. Some advantages of the improved papillotome were as follows, (1) durability is stronger than ordinary ones, (2) well suited for pushing incision under duodenoscopic stretching approach, (3) suited for fine incision i, e. in cases with an juxtapapillary diverticulum or in cases with reincision, (4) can prevent serious complications due to it's fine incision. In Sakura National Hospital, endoscopic papillotomy was carried out on 43 patients with choledochlithiasis or benign papillary stricture by using the improved pushing-typepapillotome, from November 1979 to December 1983 and was successful in 40 cases (93%) without serious complications.
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1984 Volume 26 Issue 9 Pages
1563-1579
Published: September 20, 1984
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1984 Volume 26 Issue 9 Pages
1580-1595
Published: September 20, 1984
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1984 Volume 26 Issue 9 Pages
1595-1599
Published: September 20, 1984
Released on J-STAGE: May 09, 2011
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