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Volume 29, Issue 4
Displaying 1-21 of 21 articles from this issue
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A CORRELATIVE STUDYShiann Pan1987 Volume 29 Issue 4 Pages 619-625
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA total of 448 patients with endoscopically healed duodenal ulcer received regular follow-up for 3 to 8 years. Eighty-seven (19.4%) of them never experienced recurrence (group 1), 39 (8.7%) had only once recurrence during the follow-up course (group 2), 269 (60.1%) recurred periodically or irregularly (groups 3 and 4), and 53 (11.8%) needed surgical operation finally (group 5). Group 1 patients consisted of 69% of patients with normal-shaped bulb (type I) and 31% with mild degree of bulbar deformity (type II). Group 5 included 54.7% of patients with marked deformity of the bulb (type III). In average, the type Iulcer patients were the youngest and the type III ulcer patients the eldest (with statistical significance). The mean age of groups 1 and 2 was significantly younger than that of groups 4 and 5 (P<0.01 in each). Male was more prominent in group 5 than group 1(P<0.05). Twenty-two (4.9%) of these 448 patients changed from type I to type 11 (17 cases) or from type II to type III (5 cases), 1 to 5 years later. In general, patients with type I ulcer seemed to have a larger chance to be cured but does not necessary approve a better prognosis in individual cases. Markedly deformed bulb (type III) probably is one of the important factors leading the duodenal ulcer to recur or even to going to the condition needs surgical intervention.View full abstractDownload PDF (5950K) -
Makoto ISOBE, Yutaka NISHIMURA, Jinryo TAKEDA, Teruo KAKEGAWA1987 Volume 29 Issue 4 Pages 627-635_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSNonoperative dilatation was performed to a total of 30 stenotic lesions at the esophagus and esophageal anastomoses, by means of endoscopic incision using electrocautery, mercury bougie and Celestin dilator. Treated cases were 25 postoperative anastomotic stenoses (19 esophagogastrostomies, 2 esophagojejunostomies, 4 esophageal transections), 3 reflux esophagitis, one stenosis following sclerotherapy for esophageal varices and one esophageal cancer. Endoscopic incision was utilized in 16, mercury bougie in 10 and Celestin dilator in 4 instances. Satisfactory results were obtained in most occasions. However, nonoperative management was unsuccesful in one patient with esophageal stenosis of 20 mm in length which resulted from anastomotic leakage after esophageal transection. In our early experience, re-incision was at times required soon after endoscopic incision. In instances in which the esophagus was markedly deviated, mercury bougie could not always be inserted for a sufficient distance. Various nonoperative dilatation have been devised, and these techniques have their advantages and disadvantages. Therefore, in order to achieve maximum effectiveness, each method should be utilized depending upon the type, extent and cause of stenotic lesions. At present, our principal approach to esophageal stricture is as follows : 1) Endoscopic incision and prophylatic mercury bougienage for so-called membranous stenosis less than 10 mm in length. 2) Mercury bougienage for smooth stenosis more than 10 mm in length. 3) Celestin dilator with or without endoscopic incision for longer stenosis or severe and deviated stricture. It was convinced that individualized selection of dilatation procedure will provide the satisfactory result.View full abstractDownload PDF (12387K) -
Yuji HAYAKAWA, Taizou HIJIOKA, Tomoyuki MUKUDA, Eiji MASUDA, Hiroyuki ...1987 Volume 29 Issue 4 Pages 636-642_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe have experienced 8 cases with peptic ulcer showing protruding changes in their healing processes. Seven cases are gastric ulcer and the other is duodenal ulcer. On consecutive endoscopic examinations, in the early phase of these lesions, ulcer floors were observed to become elevated and finally to make protruding lesions (Figure 3). In their healing stage, these protrusion had diminished in height and red scars were observed at the regions. Biopsied specimens showed these lesions were consisted of granulation tissues and were different from 'elevated type gastric ulcer scar'. These lesions were observed in stomach body, angle, antrum and duodenal bulb, suggesting that there are no specific regions for these lesions to occur. These protruded lesions were appeared in 2 to 5 weeks after the active stage of the ulcer and disappeared within 5 weeks to 12 months (Figure 6, 7). Incidence of this lesion is 1.2 % in gastric ulcer and 0.8% in duodenal ulcer in our hospital. All cases reported here had been treated with histamine H2 receptor antagonists, cimetidine or famotidine. Because of the powerful antacid effect of these drugs, we speculate that the healing process of the ulcer could be accelated, and that these putative rapid healing might account for the transient appearance of 'over-healing' granulation lesions. We think that this lesion is considered as a special type of healing in peptic ulcer.View full abstractDownload PDF (6895K) -
Kiyoshi ASHIDA, Katuyoshi HAYASI, Shinya ORINO, Shuuji ASADA, Masahiro ...1987 Volume 29 Issue 4 Pages 645-653
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA clinical characteristics of 107 cases with acute gastric lesion (AGL) were studied which was endoscopically diagnosed. Of 107 cases, 55 cases were acute ulcers, 33 cases were hemorrhagic erosions except for punctiform hemorrhagic erosion and 19 cases were ulceroerosions except for erosion without white coating. Concerning age and sex of these cases, the ratio of man to female was 3 : 1 only in the age group under thirty nine years of age, however, there were no significant difference of sex in other age groups. Most of patients complained of sudden symptom such as abdominal pain, hematemesis and melena. Therefore, it was able to presume the time of onset in these patients. However, it was unable to presume the time of onset in a few patients because they had no symptom or complained of equivacal symptom. There was some difference of clinical picture depending on the location of AGL. Most of patients with AGL in the antrum complained of abdominal pain. On the other hand, Most of patients with AGL in the corpus complained of hematemesis and melena. Furthermore, hemorrhagic erosion of the antrum changed to acute ulcer or ulceroerosion, but the lesions in corpus did not change to acute ulcer. Duodenitis accompanied in AGL was mostly found in the cases with antral lesion, therefore, it would be necessary to observe endoscopically the duodenum in these cases.View full abstractDownload PDF (4449K) -
-INVESTIGATION OF EXPERIENCED CASES IN OUR INSTITUTION-Tadayoshi TAKEMOTO, Takashi HARIMA1987 Volume 29 Issue 4 Pages 654-658
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSRe-examination was made on the hazards caused by endoscopic examinations experienced in our institution. Recently hazards in occasion of usual observation has been decreasing, however, hazards in the "endoscopic surgery" became conspicuous. Retrospective study clarified causes of hazards as follows : 1) examiner's carelessness and overconfidence, 2) patient's overstrain and lack in good relationship between a examiner and a patient, 3) insufficient pre-examination and inadequate judgement of indication for endoscopic surgery. Especially, hazards in the "endoscopic surgery" are sometimes miserable and distressed, compared to those of the usual observation. We must go back to "fundamentals in endoscopy". "Fundamentals in endoscopy" is a sympathy for helpless patients. A considerate endoscopist may proceed examinations for "truly ill patients", prudently and carefully. There may be some new developments of relationships between a patient and a doctor on an accident, if the doctor makes every effort sincerely.View full abstractDownload PDF (542K) -
Yoshinori IGARASHI, Masayuki NIWA, Yukifumi SAITOH, Toshiyuki KATOH, H ...1987 Volume 29 Issue 4 Pages 659-667
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSOut of 5, 000 examinations of endoscopic retrograde cholangiopancreatography (ERCP) in the past 16 years, 3851 ERCP were taken with the purpose of diagnosis in pancreatic and biliary duct system, and were analysed in this series. In results, pancreas divisum were found in 25 cases (5 cases confirmed, 20 cases unconfirmed). No cases with pancreas divisum combined with chronic pancreatitis or cancer. Cases with pancreas divisum over 50 years of age had high incidence of diabetes mellitus. Cases with bigger Santorini duct in comparison to Wirsung duct were observed in 8 cases. In these cases symptom of upper abdominal pain was observed frequently without hyper amylasemia. In 9 cases, localized stricture was observed at the junction of Santorini duct and Wirsung duct without any another abnormality in the rest of pancreatic duct system. In these localized stricture cases complaint of epigastric pain was frequently.View full abstractDownload PDF (5782K) -
-WITH REFERENCE TO DEPTH OF INFILTRATION AND INTERNAL ECHO PATTERNS-Sachiko KAWAMURA, Tsuyoshi AIBE, Taeko MIYAHARA, Shunji YOSIMURA, Sinj ...1987 Volume 29 Issue 4 Pages 668-674
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe studied on depth of invasion of the colonic cancer with endoscopic ultrasonography (EUS). Futhermore, we investigated internal echo patterns of the cancer which were demonstrated by EUS. The studies were done in 14 cases consisted of 4 cases of early cancer and 10 cases of advanced cancer. The results were as follows : 1. Diagnosis of depth of invasion of cancer with EUS could be accomplished by evalvating the changes of the five-layer structure of the colonic wall. It was very important to pay attention to a ghost effect which appeared during the scanning of the elevated type of colonic cancer. 2. It was difficult to distinguish a1 with a2 in the depth of invasion in cases of advanced cancer of the lower rectum. 3. Internal echo of the intermediate type or moderately differentiated adenocarcinoma tended to show a low echoic pattern or a mixed pattern. 4. At the region of the colon which could be examined by conventional type of the ultrasonic endoscope should be limited to the rectum and the anal side of the sigmoid colon for the saftiness of the examination. In order to investigate the entire colon with EUS, it seemed necessary to develope the special ultrasonic endoscope with shorter rigid tip and front view.View full abstractDownload PDF (7179K) -
Hirofumi MIYOSHI, Hogen TEI, Katsuyoshi HAYASHI, Akio MATSUMOTO, Naofu ...1987 Volume 29 Issue 4 Pages 675-682
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESS115 cases with esophageal varices have been treated with endoscopic variceal sclerotherapy (EVS) from Novemver 1983 to May 1986. Of the 115 cases, 11 cases (9.6%) had major complications including empyema thoracis, profuse bleeding, esophageal stenosis, shock, drug-induced liver injury, transient ischemic attack, and hepatic coma. The causes of these complications are 1) technical failure, 2) drugs using for EVS, 3) unknown causes and 4) causes due to patient's clinical states. The most important factor to decrease these complications is to improve the method for EVS and to become skilled for EVS procedure.View full abstractDownload PDF (2766K) -
Yutaka HATATE, Hitoshi TAKAHASHI, Rumiko NISHIGORI, Kimiaki NISHIURA, ...1987 Volume 29 Issue 4 Pages 683-691
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA collective of gastro-duodenal ulcer patients, of which diagnosis has been established in the Cancer Center, Nara Medical University over the period from July 1973 to Dec. 1985 was subjected to statistical evaluation. Conclusions were as follows : 1) Total 2, 920 cases of gastro-duodenal disorder were discovered with gastric mass surveys. These cases were divided into 3 different categories : gastric ulcer (1, 122 cases) ; duodenal ulcer (382 cases) ; and gastro-duodenal coexistent ulcers (270 cases). 2) Among the group of coexistent ulcers, male and female ratio was 5: 1. The highest incidence was noted in the age group of 40 to 49. 3) The incidence of coexistent ulcers among total ulcer cases amounted to 15.2% in total, 16.2% in male and 11.6% in female, respectively. 4) Lineal ulcer was found predominant in duodenal ulcer in this group. 5) Gastric ulcer in coexistent ulcers were mostly located at the gastric angle and antrum. 6) In case of coexistent ulcers, duodenal lesions healed quickly compared to the gastric lesions. 7) Recurrence of duodenal ulcer lesions occurred more frequently compared to those of gastric ulcer lesions. 8) Recurrences from the gastric ulcer scars of gastro-duodenal ulcer group (Coex. II) tended to be more frequent than those from duodenal ulcer scars of gastro-duodenal ulcer group (Coex. III). Recurrences from the gastric ulcer scars tended to be higher than those from duodenal ulcer scars in gastro-duodenal ulcerative scars (Coex. IV).View full abstractDownload PDF (1005K) -
Shigekazu HAYASHI, Masanori ESAKI, Masahiro YAMADA, Takeshi TSUCHIDA, ...1987 Volume 29 Issue 4 Pages 692-698_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe clinical study was made on thirty five cases with colorectal aphthoid lesion (seven cases of infectious colitis, twelve cases of antibiotics associated colitis, and sixteen cases of unknown entiology). This lesion was occurred frequently in women and in the fourth decade. In X-ray examination, small radiolucent spots were noticed only in the half of the cases, therefore the endoscopic examination was important for the diagnosis of the aphthoid lesion. The aphthoid lesion was occurred frequently in rectum and sigmoid colon, but there were no cases localized in the deep part of large intestine. The antibiotics associated cases had more numerous lesion than the cases of unknown etiology and the cases of infectious colitis, and had also higher picking up rate of the lymphfollicule in the biopsy. The antibiotics associated aphthoid colitis were similar to the pseudomembranous colitis from the viewpoint of the age, the symptom, the kinds of antibiotics, the period and the route of administration, the distribution of the lesion, and the existence of positive cases of Dl toxin of Clostridium difficile. Therefore it was suggested that there was a common factor in the mechanism of the occurrence of the both diseases. More accurate study is necessary to the cases of unknown etiology including the possibility of viral infection.View full abstractDownload PDF (8069K) -
Katsuro NISHIGORI, Toshifumi SAITOH, Hiroshi TODA, Shinobu SATOH, Kenj ...1987 Volume 29 Issue 4 Pages 699-705
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe 68-year-old woman visited our clinic in October 1984 with a complaint of epigastric pain. The first X-ray and endoscopic examination in our clinic revealed an ulcer in active stage with ordinary appearance on the posterior wall of middle corpus. Healing tendency was poor in spite of the cimetidine (800mg per day) treatment, and moreover follow-up study with endoscope showed progressive protrusion of the ulcer floor. Finally, it grew into a early gastric cancer-like elevated lesion, gastric resection was performed accordingly in April 1985. Histological study of resected specimen showed no malignancy and the prominent protrusion was considered mainly due to marked fibrosis of the submucosal layer.View full abstractDownload PDF (8919K) -
Hirohisa TANIMURA, Nobuhiro SATO, Sunao KAWANO, Takenobu KAMADA, Akifu ...1987 Volume 29 Issue 4 Pages 706-710_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe have recently experienced a case of splenic artery aneurysm with endoscopically suggesting a submucosal tumor of the stomach. A 76-year-old woman who complained of occasional epigastric discomfort for two years. Laboratory findings showed no abnormality. UGI series and endoscopic examination showed two protruded lesions with bridging folds on the posterior wall of the upper and middle gastric body. Subsequent examinations of the computed tomogrphy and the celiac angiography showed two splenic artery aneurysms located below the posterior wall of stomach. We diagnosed the gastric protruded lesions as the compressions of extragastric masses. It is reported that many deaseases, such as pancreatitis, liver cyst, hemangioma of the liver, cholecystitis, inflammatory tumor and splenic cyst showed a submucosal tumor-like appearance on endoscopic observation. Although the splenic artery aneurysm is found frequently in the arteries of abdominal organs, the splenic artery aneurysm which shows submucosal tumor-like endoscopic findings is rare. It is sometimes difficult to differentiate a submucosal tumor from a protruded lesion caused by the compression of extragastric mass only with endoscopic appearance. Therefore, we must diagnose carefully to differentiate them by various examinations before biopsy or endoscopic therapy.View full abstractDownload PDF (7913K) -
-REVIEW OF JAPANESE LITERATURE-Takeo IMANISHI, Katsuhisa OMAGARI, Shinji HAMAZATO, Masanori SODA, Nor ...1987 Volume 29 Issue 4 Pages 711-716_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of submucosal tumor like lesion which showed a course of so called "vanishing tumor of the stomach" was reported. The patient was a 68-year-old female, with a chief complaint of epigastric pain. The first gastric X-ray (Figure 1) and endoscopic examinations (Figure 3) revealed submucosal tumor like lesion at the fornix. After 4 months, the tumor like lesion had been disappeared completely in the gastric X-ray (Figure 5) and endoscopic examinations (Figure 6). Histologically (Figure 4), severe inflamatory cells infiltration and granulomatous change were observed, and this case was diagnosed as submucosal mass caused by inflamatory change. We reviewed 18 cases of so called vanishing tumor of the stomach reported in Japan.View full abstractDownload PDF (8796K) -
Kunio SATOH, Atsushi KANO, Kousei HATAFUKU, Toshio KOGANE, Masahiro SH ...1987 Volume 29 Issue 4 Pages 717-723
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of Cronkhite-Canada syndrome without remarkable subjective symptoms was experienced. A 58-year-old female was detected as having gastric polyposis in a gastric mass survey in August, 1983. Her hair was thin and there was brown pigmentation on lips and deformities in three fingernails. Further examination disclosed polyposis throughout the whole upper and lower digestive tract except for duodenum. Our case is the fourth reported case in the world in which esophageal polyposis was revealed. Histological structure of the rectal polyp resected by polypectomy showed cystic dilatation of the gland and there was focal stromal edema. No atypism was seen in these glands. Total serum protein decreased slightly (6.4 g/dl) and positive occult blood of feces was present, however, other laboratory data were within normal limits. She did not require any medical treatment and a natural course was observed for 3 years. In the present state, the polyps of the esophagus became less remarkable and number and size of polyps of the stomach and rectum diminished. Total protein is now 6.9 g/dl and there is no anemia. The brown pigmentation on lips was not remarkable and the deformity of fingernails were improved.View full abstractDownload PDF (8762K) -
Masahiro ASANO, Mitsuru SHIMADA, Naoya MISHIMA, Nobutaka FUJIWARA, Haj ...1987 Volume 29 Issue 4 Pages 724-728_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of intrahepatic lithiasis with stenosis of the left hepatic duct which was reduced by microwave coagulation is reported. A 77-year-old female was admitted with a complaint of right hypochondric pain and icterus. Ultrasonography as well as computed tomography showed choledochal as well as intrahepatic lithiasis. PTCD demonstrated a stenosis of the left hepatic duct and numerous stones in its distal branches. The patient did not agree to undergo surgery. For extraction of the intrahepatic stones, percutaneos transhepatic cholangioscopy was performed, but did not pass beyound the stenosis. Therefore, microwave coagulation was performed 24 times at 30 watts for 15 sec.. The stenosis become dilated with this procedure. As a result, the stones were removed completely by endoscopic lithotomy.View full abstractDownload PDF (8620K) -
Ikuo MURATA, Yutaka YAMASHITA, Toshiro TANAKA, Kenji HAYASHIDA, Noriak ...1987 Volume 29 Issue 4 Pages 729-734_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of primary malignant lymphoma arising from the terminal ileum is described. A 43-year-old man admitted because of abdominal pain and melena. Barium enema and colonoscopy revealed a tumor intussuscepting from the terminal ileum into the cecum (Figure 1 and 2). The tumor was gradually replaced into the ileum through the ileocecal valve by means of overinsufflation of air and pushing with colonofiberscope (Figure 3, 4 and 5). Finally, the intussusception was reduced and abdominal pain disappeared. Histological examination of biopsied specimen from the tumor revealed malignant lymphoma (Figure 6). Because of disappearance of the symptoms, it became possible to have a time for further examinations. Abodminal CT showed an isodensity mass in which the density increased with contrast enhancement in the ascending colon (Figure 7). Right hemicolectomy and ileotomy were performed because of recurrence of intussusception. The resected specimen showed a mass with relatively irregular surface in the terminal ileum (Figure 8). Histological examination of the tumor revealed diffuse type of mlignant lymphoma (Figure 9 and 10). Lymphoma was not found in any other sites of the body including mesenteric lymph nodes. Malignant lymphoma originated in the small intestine and diagnosed prior to surgery is relatively rare. A brief review of literatures on small intestinal malignant lymphoma and reduction of intussusception by colonofiberscopy is given.View full abstractDownload PDF (8972K) -
Hitoshi OKANO, Tadashi KODAMA, Hideharu TSUJI, Masahiko TAKAMASU, Shoj ...1987 Volume 29 Issue 4 Pages 735-738_1
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSNew type of balloon dilator for upper digestive tract stricture, Rigiflex TTS (Trough the Scope), was clinically evaluated. This Rigiflex TTS dilatator (18 mm in diameter when maximally dilated) was designed to pass easily through the endoscopic biopsy channel (2.8 mm in diameter). This procedure can be done under direct vision during endoscopy. This system was employed in 6 cases of severe upper digestive tract strictures. In all cases, the strictures was effectively dilated without any complications. It was concluded that Rigiflex TTS balloon dilatalion system was effective, safe and easily performed in cases with upper digestive tract strictures.View full abstractDownload PDF (8171K) -
[in Japanese]1987 Volume 29 Issue 4 Pages 742-757
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
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[in Japanese]1987 Volume 29 Issue 4 Pages 758-784
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
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[in Japanese]1987 Volume 29 Issue 4 Pages 784-790
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
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[in Japanese]1987 Volume 29 Issue 4 Pages 790-831
Published: April 20, 1987
Released on J-STAGE: May 09, 2011
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