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-WITH SPECIAL REFERENCE TO ENDOSCOPIC COLOR AND VASCULAR BEDS IN CANCEROUS MUCOSA BY IMAGE ANALYSIS-
Wasaburo KOIZUMI, Masahito OHIDA, Katunori SAIGENJI, Haruya OKABE, Eio ...
1986 Volume 28 Issue 3 Pages
493-507
Published: March 20, 1986
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A clinical endoscopic observation was carried out to determine the extent of mucosal infiltration of flat or depressed early gastric cancers, by spraying epinephrine and prostagland in E
1 (PEP). In effective cases of cancer lesions, their enhanced areas appeared red and were surrounded by discolored normal mucosa. To clarify the mechanism of the PEP, the ratio of vascular beds in cancerous mucosa to normal mucosa of the oral side [C/N ratio-U (upper layer), C/N ratio-T (total layer)] was caluculated using an image analysis system. A study was also made on the relation on the C/N ratio-U to endoscopic color of gastric cancer lesions and histological types.The results obtained were as follows:1. Endoscopic color of early gastric cancer was found to be determined by the C/N ratio-U rather than the C/N ratio-T (0.05<p<0.001).2. The C/N ratio-U showed values that increased in the order of signet ring, tubular, and poorly differentiated types.3. C/N ratio was significantly higher for effective cases of PEP than non-effective ones (p<0.001).4. PEP was useful for diagnosing the extent of early gastric cancer with reddened or no differed color before spraying vasoactivators.Based on the results, PEP appears to act on cancer lesions in two possible ways: 1) PEP constricts the arterioles in the abundunt vascular bed of cancerous mucosa causing stasis, pooling and refluxing of the blood flow; 2) the arterioles may be only partially constricted by PEP, but the blood still continues to flow in canceruos mucosa.
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Masaharu TATSUTA, Hiroyasu IISHI, Hiroshi KASUGAI, Shigeru OKUDA
1986 Volume 28 Issue 3 Pages
508-515
Published: March 20, 1986
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Gastric emptying and gastric peristalsis in 31 patients with and without fundal gastritis were measured by the acetaminophen absorption method and endoscopic procedures, respectively. The relation of gastrointestinal and related complaints to the extent of fundal gastritis and gastric motility was investigated. The extent of fundal gastritis was estimated by the endoscopic Congo red test. In patients with severe fundal gastritis, gastric emptying was significantly delayed, and gastric peristalsis was also significantly slower than in patients without severe fundal gastritis. Gastrointestinal and related complaints, especially epigastric fullness and f atigability were more frequent in patients with delayed gastric emptying. The acute effect of oral administration of domperidone on gastric emptying and gastric peristalsis was assessed. A single administration of domperidone (20 mg) significantly increased the rate of gastric emptying and accelerated gastric peristalsis.
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Tohru MATSUDA, Hirotaka TODA, Hiroshi ITASAKA, Kotaro UENO, Makoto ISH ...
1986 Volume 28 Issue 3 Pages
516-522
Published: March 20, 1986
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The present study evaluated the effects of gastric acid levels on intragastric coagulation by thrombin, optimal levels of thrombin which produce the maximum coagulation, and effects of secretin and cimetidine on intragastric pH values. In addition, small amounts of thrombin were repeatedly administered after administration of secretin or cimetidine in patients with acute upper GI tract hemorrhage in order to evaluate its hemostatic effects. Although the coagulative activity of thrombin was almost completely inactivated at pH 1.0, it increased as pH values increased and peaked at pH 6.0 or above . Inactivated thrombin was re-activated when pH values were increased after storage at room temperature for 45 min but not after storage at 37°c for 45 min . A comparison of the coagulative activity of thrombin dissolved in physiological saline at different concentrations indicated that the maximum coagulation is achieved at 5, 000 U/20-40 ml. Intragastric pH values increased to 7.0 and over 45 to 50 min after iv injection of secretin (150 U) or cimetidine (200 mg). The increased pH values were maintained for about 45 and 90 min in the case of secretin and cimetidine, respectively. These results suggested that acute upper GI tract hemorrhage may be effectively treated by oral administration of thrombin in repeated small doses at 3 hr intervals at 5, 000 U/20-40 ml while maintaining high intragastric pH values by administering secretin or cimetidine. This thrombin therapy was then applied in 30 patients with acute upper GI tract hemorrhage. As a result, effective hemostatic effects were obtained in 18 of 19 patients (94.7%) and 9 of 11 patients (81.8%) treated and not treated with endoscopic injection therapy, respectively. These results indicate that this oral thrombin therapy is effective in the treatment of upper GI tract hemorrhage.
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-INDICATION OF ENDOSCOPIC SPHINCTEROTOMY (EST)
Kazuo HARIMA, Tadasu FUJI, Tetsuji AKIYAMA, Takayoshi NOGUCHI, Kimihir ...
1986 Volume 28 Issue 3 Pages
523-530
Published: March 20, 1986
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In recent several years, endoscopic sphincterotomy (EST) of the papilla of Vater has become a common method of treatment for biliary duct stone, instead of surgical operation. Moreover, the technique, instrument and indication for EST have been developed rapidly. We have attempted EST in three cases of the anomalous arrangement of a pancreaticobiliary duct system. It was concluded that EST was not always contraindication in this disease and EST was an useful treatment for the complication in follow up cases with non congenital choledocal cyst (non-CCC). Of course, cases of anomalous pancreaticobiliary duct system classified in non-CCC type should be followed up strictly because of high risk of association with biliary cancer. On the other hand, we concluded that EST was not suitable in cases of CCC, because of some demerits induced by EST.
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-THEIR CLINICAL PICTURE AND HEALING PROCESS
Masayuki KANEKO, Toshio NAKAJIMA, Hisato TADA, Yutaka SUZUKI, Toshihir ...
1986 Volume 28 Issue 3 Pages
531-541
Published: March 20, 1986
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To delineate the characteristic findings of the mucosal lesions of antibiotic-associated colitis, endoscopic observation has been done in 49 cases which have been admitted in our hospital during these 7 years. Antibiotic-associated colitis in these cases were classified into 4 types accoring to the endoscopic findings of the lesion: 18 cases with pseudomembranous colitis (PMC), 15 cases with acute hemorrhagic colitis (AHC), 13 cases with aphthoid colitis (APC), and 3 cases with unclassified lesion. In 28 case out of 49 cases, dye spraying method and endoscopic magnifying observation have been done. Main mucosal findings of AHC were mucosal hemorrhage and edema, which generally disappeared within about one week. Varioliformed protrusions in cases with APC decreased gradually in the size and height, and finally left only shallow depressions about one month later. Lymphfollicular proliferation was confirmed by biopsy in the submucosa of each variolif ormed protrusion. In 10 out of 11 cases with PMC followed-up endoscopically, pseudomembranous lesions were disappeared within 2 weeks, remaining varioliformed or punctif ormed erosions during 2 to 3 months. By magnifying observations of the regenerative mucosa of lesions in 28 cases, irregularity and disordered arrangement of the pits were observed on the mucosa only in the case with PMC, whereas no irregularity or disarrangement of the pits were seen on the mucosa in cases with AHC and APC. From these results., it can be said that each mucosal lesion of PMC, AHC and APC shows each characteristical healing process.
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Kang-yi WANG, Takashi MATSUNAGA, Masahiko SAKAI, Haruto UCHINO, Takeo ...
1986 Volume 28 Issue 3 Pages
542-549
Published: March 20, 1986
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Laser Doppler velocimetry was applied through a colonoscope to investigate the local microcirculation of the large intestine in normal subjects, ulcerative colitis patients and liver cirrhosis patients. In normal subjects (47 cases), laser Doppler flow (LDF) of the rectum was significantly (p <0.001) lower compared with LDF of the colon and cecum. In ulcerative colitis patients (13 cases, 23 times), LDF of the rectum was significantly higher in active stage compared with remission stage (p <0.01) and normal subjects (p <0.05). There was no difference in LDF of the rectum between ulcerative colitis patients in remission and normal subjects. These results coincided with the results obtained by hydrogen clearance method. In liver cirrhosis patients (9 cases), LDF of the sigmoid colon and rectum was significantly lower compared with normal subjects. It is suggested that measurement of local blood flow in the large intestine could be a good method for studying the pathophysiology of the large intestine under various disease conditions.
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-ENDOSCOPIC OBSERVATION VERSUS PHOTOGRAPH -REVIEWING-
Osamu KATO, Kazuhiko Hattori
1986 Volume 28 Issue 3 Pages
550-553_1
Published: March 20, 1986
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Since 1975, we have started to utilize a panendoscope exclusively in the routine and precise endoscopic approaches to the disease of the upper gastrointestinal tract. And we have reported the efficacy of panendoscopy as a diagnostic procedure of the upper gastrointestinal tract disorders. The purpose of the present paper is to document the diagnostic capabilities of panendoscopy, especially of direct observation and photographreviewing from the viewpoint of detecting early gastric carcinoma. During the period from January 1979 to December 1984, 207 gastric carcinomas, including 84 early carcinomas in 81 patients, were disclosed by panendoscopy and biopsy. Among them, ten carcinomas, including nine early carcinomas, appeared endoscopically to be benign gastric diseases and four of these nine early carcinomas looked still like benign disorders even by the photograph-reviewing. Two minute carcinomas overlooked endoscopically were disclosed by the photograph-reviewing. Although direct endoscopic observation coupled with biopsy is important, photographs of good quality by the current panendoscope provide occasional informations to find overlooked gastric lesions by direct observation. We considered that a panendoscope is a satisfying instrument even as a gastroscope.
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Hiroshi SATO, Shigeru ASAKI, Toshiaki NISHIMURA, Hiroshi SHISHIDO, Aki ...
1986 Volume 28 Issue 3 Pages
554-561
Published: March 20, 1986
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Gallard-Dieulafoy ulcer, relatively rare, often causes intractable massive bleeding with exposed vessel involvement in spite of small mucosal defect. Surgery has been the only therapeutic treatment of this type of ulcer. We tried local injection of pure ethanol for hemostasis in 6 patients with Dieulafoy ulcers, and all patients were treated successfully. 6 patients (47-66 y. o., 3males and 3 females), were diagnosed to be Dieulafoy ulcer endoscopically. All patients had a small and shallow ulcer ranged from 4 to 10 mm in diameter with large diameter vessel exposed. Most of them had projectile or pulsating bleeding. Bleeding foci were located in the cardia in two patients, and in the lower body in four. Three patients had hematemesis and tarry stools and the other three had tarry stools only. Five of the 6 patients showed a shock symptom. Three of the patients had a co-existent disease and the other three had a history of mental stress, alcohol abuse, or taking analgesics. All of them were treated successfully with local injection of pure ethanol. Our trial of local injection of pure ethanol in patients with Dieulafoy ulcers showed that endoscopic hemostasis is effective in these patients. Endoscopic diagnosis and treatment enables bleeding, blood transfusion to be less avoids an emrgency surgery. In conclusion, we believe that the endoscopic hemostasis with local injection of pure ethanol is an effective therapeutic method in Dieulafoy ulcer patients.
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Hisato HARA, Kaoru IKE, Makoto UTUMI, Etsuhiro TORIMOTO, Yukinori MIYO ...
1986 Volume 28 Issue 3 Pages
562-568
Published: March 20, 1986
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In the past 8 years, 1, 200 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) in our department. Pancreas divisum was diagnosed in 13 patients, an overall incidence of 1.1% of total pancreatogram. Although all patients had recurrent episodes of upper abdominal pain, definite evidence of pancreatitis was obtained in six patients who were alcoholic. Two patients among seven cases without pancreatitis was alcoholic. These results suggested that the exsistence of pancreas divisum itself did not cause pancreatitis but alcohol might play an important role as a cause of pancreatitis in addition to insufficient drainage through Santorini's duct.
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Ken FUJII, Yoshikazu NARASAKI, Eiji RATA, Yuichi SATO, Yoshihiro KONDO ...
1986 Volume 28 Issue 3 Pages
569-575
Published: March 20, 1986
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Clinical use of glucagon (G) as a pretreatment in endoscopical examination of the upper gastrointestinal (GI) tract in elderly patients with gastrointestinal complaints (GIC) and in patients with chronic renal failure (CRF) was conducted. Butylscopolamine (B) was used for control study to evaluate the clinical efficacy of G. The results were as follows;1) Inhibitory effect of G on gastric peristaltic movement and gastric secretions was almost similar to that of B administration during endoscopical examination in eldery patients with GIC. The duration of pharmacologic action by G seemed to be a equal to that by B.2) The pretreament of endoscopical examination with G or B in patients with CRF seemed to show a lower efficacy compared to that in eldery patients with GIC.3) Thirst and tachycardia were more often observed in the pretreatment with B than with G in eldery patients with GIC (p <0.01 and p <0.001, respectively). On the other hand, no side effects were found in patients with CRF pretreated with G except for a transient and slight abdominal pain in one case. From these results thus obtained, it appeared reasonable to conclude that G in highly useful for the pretreatment of endoscopical examination of upper GI tract in both eldery patients with GIC and patients with CRF.
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Kyutaro TOYAMA, Ken ADACHI, Makoto NOTO, Hiroyuki MITOMI, Tetsuaki SAK ...
1986 Volume 28 Issue 3 Pages
576-581_1
Published: March 20, 1986
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A case of gastrocolic fistula caused by benign gastric ulcer in a 40-year-old male patient is reported. He was admitted to our hospital because of epigastric pain and anorexia presenting for approximately 2 months. An upper gastrointestinal series taken on admission demonstrated a giant gastric angular ulcer, about 4.5 cm in size. He was treated with cimetidine and maalox, and pirenzepine, thereafter responding well. On the eighty-sixth hospital day, frequent diarrhea appeared but no other symptoms were accompanied. Endoscopy performed on the one hundred forty-fifth hospital day disclosed findings suggestive of a gastric fistula. A gastrocolic fistula was confirmed by endoscopic transgastric fistelography. A subtotal gastrectomy and a simple closure of colonic fistula were performed. A gastrocolic fistula related to benign gastric ulcer is very rare in Japan and this is the first reported in Japanese literature according to our survey. In addition, this is a very valuable case endoscopically observed the developing process of gastrocolic fistula.
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Katsushi OKAMOTO, Yuji NIMURA, Naokazu HAYAKAWA, Hiroshi HASEGAWA, Jun ...
1986 Volume 28 Issue 3 Pages
582-587
Published: March 20, 1986
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A 49-year-old man who had undergone Billroth II gastrectomy due to gastric ulcer 26 years ago, admitted to our hospital because of suspicion of stomal cancer. Endoscopic examination revealed a slightly depessed lesion with white coat along the gastrojejunostomy. The biopsy specimen revealed adenocarcinoma and total resection of the remnant stomach was done. Macroscopically, the resected specimen showed annular IIc lesion, 15×70mm in diameter, along the stoma. Histologically, stomal gastric mucosa showed hyperplasia and cystic dilatation of the pseudopyloric glands and their submucosal invasion ; these features were reported as gastritis cystica polyposa (GCP) by Littler et al., and moderately differenciated adenocarcinoma exsisted in the superficial mucosa and submucosal layer in GCP. It was considered that carcinoma developed from GCP, as IWASHITA et al. reported in 1982. There was no lymph node metastasis and the patient is living well 14 months after the operation.
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Yoshihiko NAKAZAWA, Sinichi IWAMURA, Satoru TAMURA, Yoshiya SAKAMOTO, ...
1986 Volume 28 Issue 3 Pages
589-594_1
Published: March 20, 1986
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Recently endoscopic coagulation with microwave system was devised for the treatment of gastrointestinal polypoid lesion, cancer and bleeding. We applied a new procedure of endoscopic duodeno-choledochal fistulization (EDCF) for a case with biliary obstruction due to choledocholithiasis. In this case, seventy-five years old female who had several episodes of abdominal discomfort, two choledochal stones (20×16 mm, 19×6 mm in diameter) were disclosed by ERCP examination. Serum total bilirubin level had been normal and biliary enzymes had increased remarkably. The coagulations with microwave system were done each time with 20 watt for 20 seconds, and were performed totaly 44 times. This therapeutics was safely achieved without any complication during and after the procedure. Successful discharge of two stones through the artifical fistula was demonstrated by ERCP 7 days after the procedure. The increased enzymes have returned to normal level within a week after discharge of the stones.
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Osamu SAITOH, Keiko MASAKI, Akihiro TATSUMI, Kou TAKADA, Hisashi MATSU ...
1986 Volume 28 Issue 3 Pages
595-605
Published: March 20, 1986
Released on J-STAGE: May 09, 2011
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We reported two cases of Cronkhite-Canada syndrome. The first case was a 48-year-old male and the second case was a 53-year-old female . In both cases, generalized gastrointestinal polyposis, hypoproteinemia, skin pigmentation, onychodystrophy and alopecia were found. In addition, anorexia and loss of taste were present in both cases. Gastrointestinal polyposis was prominent in the stomach and colon with histologic findings of cyctic dilatation of glands and edema of the lamina propria. In case 1, after two months of enteral nutrition with low residue diet, marked improvement of clinical manifestations and decrease of polyps in number were found. In case 2, enteral nutrition using low residue diet or elemental diet had no effect. The combination therapy of total parenteral nutrition (TPN) and oral glucocorticoid administration had a good effect on improvement of clinical manifestations and reduction of polyposis. Serum level of tumor markers was measured in both cases. In case 1, CA 19-9, tissue polypeptide antigen (TPA) and immunosuppressive acidic protein (IAP) were increased on admission. After that, they decreased gradually. In case 2, transient increase of CEA, CA 19-9, TPA and elastase 1 was found in the hospital course.
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Nobuyuki HIRAI, Yasuhiro KATO, Eiki MATSUSHITA, Manabu YONESHIMA, Nobu ...
1986 Volume 28 Issue 3 Pages
606-613
Published: March 20, 1986
Released on J-STAGE: May 09, 2011
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A long-term followed-up case of primay sclerosing cholangitis (PSC), 30 y. o. male, is reported. In 1979, he admitted to our hospital for 4-year lasted general malaise and itching. On admission, laboratory findings suggested a prominant cholestatic pattern without hyperbilirubinemia. The antimitochondrial antibody, HBsAg or HBsAb were negative. ERCP demonstrated typical "constricturing and beaded" appearances and diverticular outpouchings diffusely in the biliary tree without biliary stones. The liver histology showed portal fibrosis accompanied with atypical ductular proliferation and periductal concentric fibrosis of septal bile ducts. The diagnosis of PSC was made and he was followed-up for about 6 years, during which the levels of GOT and ALP gradually elevated, resulting to show occasional short-lasting jaundice. ERCP after the 6-year follow-up, essentially unchanged, indicated an advance in the stenotic changes of the bile ducts. Findings in the liver histology, including hydropic changes and orcein-positive copper-binding proteins in hepatocytes, also indicated an advance in the cholestatic changes. By the colonoscopic examination and mucosal biopsy, a focal non-specific colitis located in the entire colon but in the rectum was demonstrated. In the present case, the biliary lesions in PSC indeed advanced during the 6-year follow -up period, but this advance seems to be rather gradual when compared to ever reported cases in Japan.
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Yasutaka TAKEDA, Hironobu YANAGIE, Tsukasa TAKAHASHI, Yoju MIYAMOTO, G ...
1986 Volume 28 Issue 3 Pages
614-618_1
Published: March 20, 1986
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A 52-year-old man was hospitalized for the complaints of right hypochondralgia and back pain. He had an episode of right hypochondralgia 2 years ago, and a year later he developed jaundice. ERCP was performed and dilatation of the common bile duct was found. However, no other abnormal findings were found and jaundice was improved within 2 months. A year later on admission, ERCP showed a marked dilatation of the common bile duct again, and no stones and tumors. Endoscopic sphincterotomy was performed for the purpose of biopsy. Two weeks later, a small tumor was recognized between the orifice of the common bile duct and that of the pancreatic duct on ERCP. Biopsy diagnosis was well differentiated adenocarcinoma. Pancreaticoduodenectomy was carried out (1984. 7. 30) and the surgical specimen revealed the tumor locating within Oddi's muscle sheath, and infiltrating along with the bile duct and pancreas tissue to a small extent. It is considered that endoscopic sphincterotomy is very useful for dignosis of non-exposed type carcinoma at the papillary portion of the duodenum.
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Katsuhide SHIMAKURA, Keiichi NOZAWA, Kotaro YAMAGUCHI, Shuichi WADA, Y ...
1986 Volume 28 Issue 3 Pages
621-627_1
Published: March 20, 1986
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In patients with Billroth II partial gastrectomy, it is often difficult to pass a fiberscope along the afferent loop. Once the papilla Vater can be seen by an endoscope passing through the afferent loop, ERCP is feasible. However, it is difficult to perform EPT because of reverse approach. We succeeded to perform EPT and ERBD in a patient undergone Billroth II partial gastrectomy, who had an extrahepatic bile duct stenosis due to metastasis of epipharygeal cancer. The method is as follows ; firstly, selective ERC and EN BD with a 7 Fr. pig tail catheter was performed using a forward-viewing fiberscope (Olympus GIF-HM). Secondly, a sideviewing fiberscope (J. F-3.7) was introduced into the papilla Vater over the ENBD catheter, and the ENBD catheter was withdrawn leaving the guide wire placed in the intrahepatic bile duct. Thirdly, after a 6 Fr. guide catheter was introduced into the right intrahepatic bile duct over the guide wire, 10 Fr. large bore tube could be placed correctly in the aimed position over the guide catheter through an intact papilla. And then EPT could be performed using a snare for endoscopic polypectomy as a needle knife to prevent the development of satillite pancreatitis and also to facilitate exchanging the endoprosthesis. Our experience in this case indicates that EPT and ERBD can be performed easily and safely by the above-described methods in patients with bile duct diseases after Billroth II partial gastrectomy, if a fiberscope can be entered into the region of the papilla Vater along the afferent loop.
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Yoshito OSHITA, Yukinori OKAZAKI, Tadayoshi TAKEMOTO, Katsue NAKAMURA
1986 Volume 28 Issue 3 Pages
628-631_1
Published: March 20, 1986
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The patient was a 50-year-old male with a chief complaint of epigastric pain. Cystic tumor like lesion of wallnut size was observed in the antrum since 1979 to 1982. The tumor like lesion had been disappered after renal transplantion suceeded in 1983.
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Kiyoshi IGARASHI, Hitoshi SHIMA, Mitsuro CHIBA, Michiro OHTAKA, Hiroma ...
1986 Volume 28 Issue 3 Pages
632-641
Published: March 20, 1986
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A family of the cancer family syndrome containing six cases of colorectal cancer and a case of endometrial cancer was reported. The proband, 44 years old female with cancers in the ascending colon and multiple colon polyps, received right hemicolectomy for the former and endoscopic polypectomy for the latter. These were confirmed to be five synchronous multiple colon cancers. Multiple polyps developed in the residual bowel in a rather short period after the operation. Her grandfather had a large bowel cancer and her father had a metachronous multiple cancers of the large bowel and a ureteral cancer. Her two aunts had a colorectal cancer and the other aunt had an endometrial cancer. Her young brother also had a colorectal cancer. Six out of eleven colorectal cancers among these cases were in the right colon and the remainder was in the left colon. Colorectal cancer developed evidently at earlier ages in these cases compared to those seen in conventional colorectal cancer and the later the generation became, the earlier the age of the onset became. Therefore, a careful designed screening program for off springs of the cancer family syndrome is mandatory.
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Kazunori HOSHIKA, Eizo KAYASHIMA, Kazushi KOZUKA, Sadaomi NAGASAKI, Yo ...
1986 Volume 28 Issue 3 Pages
642-647_1
Published: March 20, 1986
Released on J-STAGE: May 09, 2011
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We experienced two cases of primary carcinoma of the jejunum diagnosed by endoscopic biopsy. Case 1: A 50-year-old man, complaining of upper-abdominal fullness was admitted to our hospital. Small intestinal radiography revealed a localized irregular stricture in the jejunum about 25 cm distant from the duodenojejunal flexure (Figure 1). Endoscopic examination using PCF revealed a tumor with an irregular surface (Figure 2). Endoscopical findings strongly impressed cancer of the jejunum and the biopsy revealed adenocarcinoma (Figure 3). The gross appearance of resected material showed an irregular ulceration (Figure 4) and this lesion was histologically diagnosed as adenocarcinoma consistent with the preoperative diagnosis (Figure 5). Case 2 : A 72-year-old man, complaining of abdominal fullness was admitted to our hospital. Samll intestinal radiography revealed a localized irregular stricture in the jejunum about 25 cm distant from duodenojejunal flexure (Figure 6). Endoscopic examination using SIF-B revealed a tumor with an irregular surface (Figure 7). Endoscopical findings strongly impressed cancer of the jejunum and the biopsy revealed adenocarcinoma (Figure 8). The gross appearance of the resected material showed an irregular ulceration (Figure 9) and this lesion was histologically diagnosed as adenocarcinoma consistent with the preoperative diagnosis (Figure 10).
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Hiroyuki MAGUCHI, Norio HAYASHI, Hideki HAYASHI, Yasutaka KUMEI, Kazum ...
1986 Volume 28 Issue 3 Pages
648-656_1
Published: March 20, 1986
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A case of rectal leiomyosarcoma was reported with special references. It is a relatively rare disease and to our knowledge, 80 cases have been reported so far in Japan. A 65-year-old woman was admitted to our hospital because of check up of disturbances in defecation and occasional dyschezia. In the rectal examination, tumorous mass was palpated 4 cm above the anal ring. Based on the findings of barium enema, fiberoptic endoscopy, ultrasonography, CT, endoscopic ultrasonography and angiography, myogenic tumor was suspected. For confirmation, a needle biopsy was performed through the anus. Histological examination of the biopsy specimen revealed loiomyoma. Surgical excision of the tumor was carried out through the anus. Malignancy was confirmed by histopathological examination of the resected specimen. Therefore, radical reopration was performed.
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Seiji SHIMIZU, Hiroko OKADA, Atsuo IWASAKU, Masato YOSHINAKA, Isoo INA ...
1986 Volume 28 Issue 3 Pages
659-663_1
Published: March 20, 1986
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Ten years have passed since the development of a push type enteroscope (SIF-B), and its usefulness has been sufficiently established. However, its specifications have become out of date. A newly devised enteroscope (SIF-10) has stronger angle mechanism, wider view field, and higher resolution compared with SIF-B. We had an opportunity to use SIF-10 in 20 patients. The results showed slight improvement in depth of insertion and time required for examination, proving the superiority of SIF-10 to SIF-B. However, the improvement in insertion was not marked, despite the remarkable mechanincal improvement in SIF-10. These facts suggested the limitation of push method itself and further modification was considered necessary.
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[in Japanese]
1986 Volume 28 Issue 3 Pages
664-667
Published: March 20, 1986
Released on J-STAGE: May 09, 2011
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