GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 30, Issue 11
Displaying 1-29 of 29 articles from this issue
  • Yukiko YAMASHITA
    1988 Volume 30 Issue 11 Pages 2511-2525
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The frequency of IIb type of early gastric cancer is increasing in accordance with the improvement of diagnostic technique with the development of Endoscopic system. But it is not so easy to detect typical IIb type which is flat lesion and there is a difficulty in an X-ray, endoscopic and histological examinations. In the endoscopic finding of IIb type of early gastric cancer, tiny color difference from the normal mucosa was considered to be most important, and we can divide into two types ; Red type and white type. Therefore, it is very important for the diagnosis of IIb type of early gastric cancer to find the difference in tone of the color very precisely. It is possible to identify the IIb type of early gastric cancer correctly, if we could describe this color difference objectively. From this point of view, the following color analysis of spectrum of gastric mucosa was attempted using the rapid scan spectrophotometer/color difference mether (CMS-1200 block diagram system). Basic spectral curve of the normal gastric mucosa has first peak in 500 nm and second higher peak in 690-700 nm. The color analysis was performed on gastric ulcer, IIb type and IIc type of early gastric cancer, and advanced gastric cancer. The analysis curve of IIb (white type) revealed complete difference in color from atrophic mucosa. From this trial, the detection of IIb type of early gastric cancer using color analysis may be easier than single endo-scopical examination. Recently we have been able to analize RGB of the color of the gastric mucosa by video endoscope. Therefore, an introduction of the color analysis into the computer of the video endoscopy system may make it possible to detect the difficult lesions and endoscopic autodiagnosis might become possible in future.
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  • Kazutaka NAKATA
    1988 Volume 30 Issue 11 Pages 2527-2536
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    To predict the healing period of gastric ulcer, the author analyzed the endoscopic ultrasonographic findings of 55 cases of open ulcer in which 50 cases were medically treated and 5 cases operated surgically by using the multiple regression analysis. Results were as follows; 1. The equation of multiple regression analysis to predict the healing period from EUS examination to endoscopic red scar stage was clarified as following. Y (weeks) = 0.9953×(scale of endoscopic stage) + 0.9593×(scale of endoscopic shape) + 1.0429×(scale of ulcer depth) + 0.5326×(scale of section area of ulcer base) -2.5847 2. Predictive value and observed value of the healing period of gastric ulcer showed good correlation (r=0.861). Four cases of relatively slower healed ulcer than the predic-tion had the background factors such as traumatic injury or severe liver disfunction. 3. Mean of the prediction value of the medically treated 50 cases was 6.3 weeks and that of surgically operated 5 cases was 10.4 weeks. Namely, the predictive value was thought to be one of good references to determine the indication of surgical operation for gastric ulcer. In conclusion, the predication of ulcer healing based on the multivariate analysis of the EUS findings was expected to give the very useful information to select the best theraputic method for gastric ulcer.
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  • -INCLUDING A COMPARATIVE INVESTIGATION WITH HISTOLOGY-
    Takayoshi NOGUCHI
    1988 Volume 30 Issue 11 Pages 2537-2549
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The diagnostic ability of endoscopic ultrasonography (EUS) in chronic pancreatitis was investigated in this paper. Subjects were 52 cases with chronic pancreatitis as which were diagnosed by ERCP. These cases were classified into two groups, namely, the first group (40 cases) and the second group (12 cases) on the basis of the diagnostic criteria of ERCP in chronic pancreatitis. At first, the author compared the diagnostic ability of EUS with that of conventional US in the first group. As the results, an accuracy rate of EUS in chronic pancreatitis was highly superior to that of conventional US. Furthermore, the findings of unevenness of internal echo and irregularity of the margin of the pancreas in this group, which were not included now in the diagnostic criteria by conventional US, were more often demonstrated by EUS. Concerning the change of internal echo pattern, this could be classified into three types according to EUS findings. Namely, high echo spots, high echo spots combined with low echoic areas and diffuse low echo were the characteristic findings of chronic pancreatitis in EUS, and these echographic changes were quite different from changes by aging. Concerning the pancreatic margin as visualized by EUS, the change in moderate grade was thought to be a typical finding of chronic pancreatitis. Therefore, the author thought that changes of the internal echo and the margin of the pancreas could be very important findings in the diagnosis of chronic pancreatitis on the occasion of using EUS. In the second group of chronic pancreatitis in which clear diagnostic criteria are not made echographically, the same results mentioned above were obtained. Changes of internal echo of the pancreas were investigated histologically in 11 cases by using autopsy and postoperative specimens. As the results, high echo spots demonstrat-ed by EUS in chronic pancreatitis was consistent with fatty tissue between pancreatic lobules, and low echoic areas corresponded to lobular fibrosis. High echoic area and gathering of linear echo which were characteristic findings demonstrated by EUS in the investigations of aging corresponded to the fatty tissue between the lobules in the former and to the deformed pancreatic ductules in the latter. In conclusion, EUS was highly appreciated as one of the useful procedures in the diagnosis of chronic pancreatitis. Furthermore, it was thought that the changes of internal echo and the margin of the pancreas as visualized by EUS should be added in the echogra-phic criteria in the definite diagnosis of chronic pancreatitis.
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  • Ryosuke OHMURA
    1988 Volume 30 Issue 11 Pages 2550-2559
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    Endoscopic treatment for chronic pancreatitis have been developed in our institution since 1982. They consist of endoscopic pancreatic sphincterotomy (EPST), basket removal of calculi and placement of pancreatic endoprosthesis. We reported mainly on the clinical effect and security of these methods. Since 1986 we have started to collect pure pancreatic juice (PPJ) according to the endoscopic method by Harada et al. PPJ collection has two purposes ; for evaluating exocrine pancreatic function, and for “washing out” viscous pancreatic juice including protein plugs. This report describes the effect on pancreatic secretory function in 7 cases before and after EPST, utilizing PPJ collection and blood chemical tests (75 g OGTT, HbA1c, FBS). The follow up period is from two to 46 months after EPST. The results are as follows : Endocrine pancreatic function had no alteration in general after EPST and seemed to keep the same level as that before EPST. However, it is considered that further follow up studies will be needed to evaluate the effect on endocrine pancreatic function. On the other hand, in exocrine pancreatic function : “Volume” and “Lipase out-put” were improved by EPST (p<0.05), but “Max. HCO-3 concentration” showed no significant alteration before and after EPST. It is suggested that acinar enzyme secretory cells are tend to be damaged by ductal obstruction more easily than ductular cells, but the former is capable of improvement after a relief of ductal obstruction by endoscopic treatments.
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  • Masatake SASABE, Shigeaki YOSHIDA, Hajime YAMAGUCHI, Hisao TAJIRI, Dai ...
    1988 Volume 30 Issue 11 Pages 2561-2566_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Histologically gastric cancers are classified into two major categories, differentiated and undifferentiated types. In the latter, most of the lesions are combined by the ulcerative change within cancerous area (ulcerative cancer) histologically. The endoscopic detection of these cancers is usually easy, because of the macroscopic appearances of ulcerative changes, although they may originate from the non-ulcerative lesions, theoretically, . So, we attempted to clarify whether non-ulcerative cancers of undifferentiated type to be consid-ered as earlier than the ulcerative, or the two types to be considered as originally different each other in the selected cases of similar endoscopic findings (excluding diagnostic bias). During the period between 1962 and 1985, 1, 242 cases of solitary early gastric cancer had been operated at the National Cancer Center Hospital. Of the 1, 242, 71 cases of undifferentiated type were considered to be superficial and nonulcerative, endoscopically, and were analyzed for this study. Of the 71 cases, 51 were ulcerative and the rest 20 non -ulcerative, histologically, in spite of their similar endoscopic appearances. A comparative study was performed between these ulcerative and non-ulcerative cancers, endoscopically and clinicopathologically. The results were as follows : 1) In the non-ulcerative groupe, older and male patients were more dominant than in the ulcerative. And, there was no significant differences (between ulcerative and non-ulcerative cancers) in size, site and vertical invasion of the lesion. 2) In the non-ulcerative groupe, poorly differentiated adenocarcinoma was more dominant than signet ring cell carcinoma histologically, though in the ulcerative groupe. signet ring cell type was dominant (P <0.05) 3) Endoscopically, discoloration was frequently obserebed in the non-ulcerative groupe (60%), while in ulcerative groupe less frequent (37%). 4) Incidence of the cases with less malignant endoscopic appearences was almost the same between ulcerative and non-ulcerative groupe. In conclusion, the above results may suggest that a early gastric cancer of undiffer-entiated type has a tendency to ulcerate within cancerous area at the very early stage. And we concider that non-ulcerative cancers studied at present do'nt develop from the common source of ulcerative cancers.
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  • Michinori HIRAMATSU, Masahiko SAKAI, Haruto UCHINO, Takeo MIYAKE
    1988 Volume 30 Issue 11 Pages 2567-2576_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We studied the early cecal and colonic blood folw changes in rat experimental ulcerative colitis induced by dextran sulfate sodium to investigate whether these blood flow changes are the one of the causes of the cecal and colonic lesions. A 10% aqueous solution of dextran sulfate sodium was added to the rats' drinking fluid. After 7 days, all the rats exhibited typical experimental ulcerative colitis. This model closely resembled human ulcerative colitis with respect to clinical features such as bloody diarrhea and body weight loss, as well as morphorogical features observed by endoscopy and light microscopy. We measured the blood flow in the terminal ileum, cecum, ascending, transverse and descending colon both in the early stage and more advanced active stages of the disease by laser doppler flowmetry. Compared to the control group, the blood flow in the group treated with dextran for 7 days was significantly elevated in cecum and proximal ascend-ing colon, which showed typical lesions with diffuse hemorrhagic shallow ulcerations. The changes in blood flow did not appear to precede the morphorogical changes. The results indicated that cecal and colonic blood flow changes in the early stage of the disease were merely the result, and not the cause, of the lesions.
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  • Toshihiro YAMAZAKI, Nagaki SHIMADA, Motonobu SUGIMOTO
    1988 Volume 30 Issue 11 Pages 2579-2587
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to elucidate a significance of intravenous injection of indocyanine green (ICG) under laparoscopy. ICG-score was laparoscopically assessed for the ICG coloration on the liver surface at 20 minutes after ICG administration in a dose of 3 mg/kg, and comparion was made among 153 patients with various liver diseases. Then, correlations between the ICG-score and liver function tests, hepatic glutathione S-transfer-ase (GST) activity and ICG kinetic parameters of two compartment model were evaluated. Following results were obtained. (1) The ICG-score was high in minimal change (well colored) and low in cirrhosis (poorly colored). (2) The ICG-score was positively correlated with serum albumin level, serum cholinesterase activity and hepaplastin test, and negative-ly correlated with ICG retention rate at 15 minutes. (3) The ICG-score was positively correlated with hepatic GST activity. (4) The ICG-score was positively correlated with parameter "a" (the transfer rate constant from plasma to the liver) and "VL" (the liver compartment volume). In conclusion, intravenous injection of ICG under laparoscopy seems to be a useful method in assessing the liver function for hepatic dye metabolism as well as the hepatic morphology.
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  • Hiroshi NAKAMURA, Katsuo SHIMOJUU, Haruhiro INOUE, Kimiya TAKESHITA, N ...
    1988 Volume 30 Issue 11 Pages 2588-2595_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    During the non-shunting operation for esophageal varices in 8 cases of portal hyperten-sion (liver cirrhosis 6, idiopathic portal hypertension 2), we have investigated collateral circulation and esophageal varices with Endoscopic Ultrasonography (EUS). Continuous observation of intraoperative EUS from stomach to upper mediastinum clearly visualized the fornical varices gathered from the short gastric veins, the cardiac varices from the left gastric veins, the anastomosis of esophageal varices and extrinsic paraesophageal vessels. Most of the extrinsic paraesophageal vessels existed between 33 cm and 41 cm from the fore-teeth. The course of the dilated azygos vein is also detected easily from 37 cm from the fore-teeth up to the azygos arch. After the devascularization and transection of the esophagus, extrinsic collateral vessels and esophageal varices are diminished and the azygos vein is narrowed in size. EUS will become a useful technique in the study of collateral circulation of portal hypertension and will be necessary for determing the indication or the way of treatment.
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  • Sorou TAKEDA, Toshizo TSUJI, Shinichiro FUKUDA, Keisho KATAOKA, Masaki ...
    1988 Volume 30 Issue 11 Pages 2596-2602_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    The prospective study of six cases of the aged patients with early gastric cancer revealed the following results, 1. Progression of type IIc early gastric cancer was slow. Especially, a case of small IIc type in early gastric cancer (Figure 5) was still observed IIc like lesion (Figure 6) on the 69 months after the first endoscopy. The doubling time in case No. l was 407 days (Figure 2, 3). 2. IIa type of early gastric cancer (Figure 8) had developed to Borrmann Type 2 of advanced gastric cancer (Figure 10) after three years to 4 years and 8 Months. Therefore, the growth rate of early stage of gastric cancer was slow but was rapid when it was advanced. 3. It was quite enough to do gastric mass survey in aged group within every two years by endoscopy.
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  • Kozo KAJIMURA, Tooru KAJIYAMA, Akiyoshi NISHIO, Hiroshi TAKAKUWA, Tomi ...
    1988 Volume 30 Issue 11 Pages 2605-2611
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Endoscopic ultrasonography (EUS) was performed in 8 patients with non-Hodgikin Lymphoma of the stomach and its clinical significance was evaluated. I used Kajiyama's classification of EUS echo level. Namely, level 0 denotes an absent echo. Level 1 represents an echoic level of the 4th layer of the stomach, Level 2 the level of the splenic parenchyma. Level 3 the level between level 2 and 4. Level 4 that of the 3rd layer of the stomach. Most of the gastric lesion tended to show a lower echoic pattern or level 1, but some showed a higher echo level 2. EUS showed three types of infiltration. 1) In four cases the infiltration was confined to the 2nd or 3rd layer. 2) In three cases EUS showed transmural infiltration. 3) In one cases it showed infiltration to the surrounding organ. In four cases extragastric lymphnodes were also well demonsterated as low echoic and neary circlular masses. In two cases gastrectomy was performed and in two other cases autopsy was performed. The depth and type of infiltration evaluated by EUS corresponded well to the histological findings of the specimen. We administered chemotherapy to 7 patients and in two cases the therapy was effective, EUS clearly showed diminution of the size of the leision and the echo level increased from level 1 to 3. EUS provided a helpful information not only on the intramural extension of malignant lymphoma of the stomach but also on the effectiveness of chemotherapy.
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  • -A REPORT OF THE CASES AND THE RIVIEW OF JAPANESE LITERATURES-
    Masuho HARAGUCHI, Kazuya MAKIYAMA, Masaki YAMAKAWA, Kazufumi YAMASAKI, ...
    1988 Volume 30 Issue 11 Pages 2612-2620
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    From 1980 to 1984, we have experienced 6 cases of rectal carcinoid treated by endoscopic polypectomy. The size of tumors were 7-17 mm in diameter and the shape of tumors were sessile or semipedunculated, and microscopical examination revealed that the depth of invasion were to submucosa. No cases with local recurrence or distant metastasis were observed in 2-4 years after endoscopic polypectomy. In the literature, among 496 Japanese cases, there were 7 cases with distant metastasis even in small sized tumor (less than 1 cm in diameter). Statistical analysis of 46 cases with small sized tumor (less than 2 cm in diameter) in the literature were done concerning the relationship between various characters of the tumor and the incidence of distant metastasis. There were no significant relationship among shape of the tumor, depth of invasion, the pattern of silver impregnation, central depression and the incidence of distant metastasis. In conclusion, although our cases showed favourable course, it is necessary to evaluate the histological findings carefully and decide the treatment even in the cases with small sized tumor (less than 1 cm in diameter).
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  • Masaki NAKAMURA, Naoto KIKUCHI, Hideto TANIGUCHI, Kiyoshi HOSHINO, Kou ...
    1988 Volume 30 Issue 11 Pages 2621-2627_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The indication of endoscopic hemostasis by local injection of Hypertonic saline-Epinephrine solution (HSE method) for Dieulafoy's ulcer was assessed, based on 10 cases which had been experienced at Yoyogi Hospital between 1981 and 1987. HSE method was performed in 9 of 10 cases with Dieulafoy's ulcer. Sex ratio was 8:2 (M:F). Age distribution was 34-82 years with the mean of 57 years. Surgery was not indicated in 6 cases due to severe complications. There were 4 cases with the past history of gastric ulcer. Five cases were located in the gastric body, 3 cases were located in the incisura region, and 2 cases were located in the gastric antrum. Endoscopically, fresh blood was present in 6 cases. Pulsating bleeding was in 1 case, oozing in 2 cases, blood coagula forming in 1 case, and exposed vessel only in 5 cases. Local injection of HSE was tried 1 to 4 times, with the mean of 1.8 times, and permanent hemostassis was achieved in 8 of 9 cases (88.9%). In the same period HSE method had been performed in 191 cases with bleeding peptic ulcer excluding Dieulafoy's ulcer, and permanent hemostasis was achieved in 93.2% (178/191) with the mean injection of 1.8 times. No difference in the hemostatic effect was found between Dieulafoy's ulcer and other peptic ulcers. There were severe complication in 14.7% (28/191) in which surgery was not indicated. Permanent hemostasis was obtained in 82.1% (23/28) of these cases. HSE method was unsuccessful in the cases with penetrat-ing or nearly penetrating ulcer, multiple ulcers in the gastric body, those complicated with hepatic and renal failure, and those immediately after renal dialysis. It may be ascribed to the absence of penetration in Dieulafoy's ulcer that favorable hemostatic effect was obtained despite severe complications and thick blood vessels exposed. Endoscopic hemostasis by HSE method is considered to be the first choice of treatment for Dieulafoy's ulcer as well as other bleeding peptic ulcers.
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  • Shinichi FURUYA, Katsuhisa KAWAMOTO, Masahide ATSUMI, Satoshi EBISUI, ...
    1988 Volume 30 Issue 11 Pages 2628-2632_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    Recently, endoscopic polypectomy has become a routine procedure. But, the report of endoscopic removal of the duodenal polyp was rare, compared to that of the gastric and colonic polyp. We reported 14 cases of the duodenal polypoid lesions removed endo scopically. All endoscopic polypectomies were performed safely and all resected specimens could be studied histologically. These lesions consist of 5 cases of adenoma, 4 of brunneroma, 2 of hyperplastic polyp, 1 of fibroma, hemangioma and early cancer. Of these cases, 3 with massive bleeding and 1 with early cancer were treated successfully. In summary, endoscopic polypectomy in the duodenum was valuable for definite diagnosis and treatment of the duodenal polypoid lesions.
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  • Yukihito YAMADA, Masahito OHIDA, Wasaburo KOIZUMI, Katsunori SAIGENJI, ...
    1988 Volume 30 Issue 11 Pages 2633-2641
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    A sixteen-year-old male was admitted for epigastralgia and vomiting. The endoscopic examination showed edema, redness and arosions mainly in the pyloric antrum. The patient was prescribed cimetidine and the gastric lesions were healed one month later. After five months he was re-admitted with the same symptoms as before, as well as leg purpura. The endoscopic examination revealed the similar lesions as before in the stomach and the duodenum. The patient was dignosed as recurrent attacks of SHP, and he was prescribed com-bined medication of predonisolone and cimetidine. Two months later, the patient was discharged with a complete remission of gastrointestinal symptoms.
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  • Tadashi SHIGEMATSU, Kazuhiko FUKUI, Hitomi MAEDA, Noboru TANABE, Youit ...
    1988 Volume 30 Issue 11 Pages 2642-2646
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    Gastric syphilis is a rare disease of the stomach. It is difficult distingnish gastric syphilis from malignant disease of the stomach. A 27-year-old male complained of upper abdominal pain. X-ray examination demon-strated irregularity of the angulus and irregularly shaped ulcer with convering folds. Gastroscopic examination showed irregular shaped ulcer with converging folds and surrounding edematous and friable mucosa on the angulus. Gastric biopsy revealed non-specific inflammation with no evidence of malignancy. Repeated biopsy showed no malignant findings. Positive serologic test for syphilis and inguinal lymphnode swelling suggested possibility of gastric syphilis. Upper abdominal pain and gastroscopic findings were immediately improved after anti-syphilitic therapy.
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  • Atsushi KAWASAKI, Mitsuo IIDA, Norio KOHROGI, Toshiyuki MATSUI, Masato ...
    1988 Volume 30 Issue 11 Pages 2647-2651_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    A 62-year-old man was admitted to our hospital because of gastric cancer. Initial examinations including X-ray and endoscopy with biopsy demonstrated a large, irregularly-shaped polypoid cancer on the anterior wall of the gastric body. Three weeks later, the repeated X-ray and endoscopic studies revealed that the polypoid part of the lesion had disappeared spontaneously and an irregularly-shaped flat sessile elevation remained. Biopsy specimens showed adenocarcinoma and total gastrectomy was performed. Pathological examination of the removed stomach revealed that the elevated lesion was well differentiated adenocarcinoma mostly restricted to the mucosa and partly invading the submucosa. There was an intense inflammatory infiltrate in and around the area of carcinoma, thereby suggesting that the protuberant part of the tumor was spontaneously fallen off. This is the very rare case of a large polypoid cancer of the stomach showing spontaneous dislodgment during the clinical course.
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  • Masami MIZUNO, Hironobu KOHDA, Masumi KANAI, Kazuhiro MURAZUMI, Hitoyo ...
    1988 Volume 30 Issue 11 Pages 2652-2656_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    We report here a 35-years-old female who developed primary biliary cirrhosis (PBC) following her third delivery. The patient had been quite healthy until her third pregnancy, during which she started to feel the itch sensation. Jaundice appeared one month after the delivery, and the patient was admitted to a hospital. The laboratory data there revealed a marked elevation of serum bilirubin, Al-p, Ig-M and a moderate increase in transaminase. In addition, antimitochondrial antibody showed positive. Based upon there laboratry findings, the patient was suspected as having PBC. For further examination and treatment, she was transferred to our hospital. Subsequent histological examination performed under a peirtoneoscopy revealed the presence of chronic non-suppurative destructive cholangitis, a characteristic finding of PBC, confirming the diagnosis. The case was classified as the stage II (Sheuer). The elevated levels in the above-mentioned liver function tests signifi-cantly decreased along a course of time without any specific treatment, although pruritus persisted. It was suggested that the hormonal changes caused by pregnancy and delivery might be involved in the development of PBC in this case.
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  • Jiro WATARI, Shin-ichi OZAWA, Yoshimi SHIBATA, Hiroshi KUROKAWA, Rei Y ...
    1988 Volume 30 Issue 11 Pages 2659-2667
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    Four cases of duodenal lipoma removed by endoscopic polypectomy were reported. Age of the cases ranged from 64 to 75 with an average of 70.3. A ratio of male to female was 1 to 3. Location of the lesions was duodenal bulb in one case and 2nd portion of the duodenum in 3 cases. Most patients complained of vague abdominal symptoms. Upper G -I series showed an elevated lesion and endoscopic findings showed a submucosal tumor with yellowish smooth mucosal surfece. CT scan showed a round lesion with fatty density and EUS findings performed in 2 cases showed characteristic findings which consisted of a hyperechoic or isoechoic mass with an uniform internal echo. Thus, the diagnostic modality by combination of CT and EUS seems to be useful in making a differential diagnosis of lipoma from other submucosal lesions. Complication concerning endoscopic removal of duodenal lipoma has not been reported. In conclusion, endoscopic removal of duodenal lipoma seems to be an accurate and safety procedure, especially with double snare method.
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  • Kunihiko TSUJI, Jiro WATARI, Masataka YAMADA, Takahisa SUZUKI, Hiromi ...
    1988 Volume 30 Issue 11 Pages 2669-2672_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    A case of anisakiasis presenting a submucosal tumor at the ascending colon, was reported. A 67-year-old woman was admitted to our hospital because of abdominal symptoms. Physical examination and hematological examination revealed almost no abnomalities. Radiographic and endoscopic examinations of the colon showed a submucosal tumor at the ascending colon (Figure 1, 2). Resection of the right colon was performed and microscopical examination of the tumor revealed an eosinophilic granulom with an old larva. (Figure 3, 4) As Ouchterlony's test for an antibody against anisakis was also positive findings, this case was diagnosed as a colon anisakiasis.
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  • Saeko KAMEYA, Aiji NODA, Motoko TAMADA, Hitoshi KATO, Shigeki HOTTA, E ...
    1988 Volume 30 Issue 11 Pages 2673-2677_1
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    Endoscopic polypectomy using high-frequency voltage is generally thought to be contraindication in patients with an implanted pacemaker. We succeeded in endoscopic polypectomy in a 57-year-old woman who had undergone implantation of a pacemaker for sick sinus syndrome. She was admitted to our hospital with the chief complaint of anal bleeding. Both colonography and colonoscopy revealed a semi-pedunculated polyp in the sigmoid colon. During polypectomy the mode of the pacemaker was changed to avoid the cardiac arrest resulting from oversensing, and care was taken to avert troubles of the pacemaker by taking appropriate distance between the pacemaker and a diathermy snare, as well as by regulating the energy for polypectomy. We believe that endoscopic polypectomy can be performed uneventfully even in patients with an implanted pacemaker in collaboration with specialists of cardiology.
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  • Yoshiki USUI, Masaaki MATSUKAWA, Satoshi YAMADA, Takashi NEGORO, Toush ...
    1988 Volume 30 Issue 11 Pages 2678-2683
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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    A 48-year-old man was admitted to our hospital because of right lower abdominal pain, loose stool and loss of body weight by 5 kg. Double contrast study and colonoscopy showed multiple discrete ulcers which were consisted of Kuromaru's type II, III, IV, VII and VIII from the sigmoid colon to the cecum (Figure 2a, 3a, 4, 5). At this time, Crohn's disease was mostly suspected. A plain chest radiograph showed cavity formation with pleural effusion in the left side of the lung (Figure 1). Biopsy specimen of the ulcers showed an epithelioid cell granuloma with giant cells (Figure 6). Mycobacterium tuberculosis was positive on smears of sputa and gastric juice. Secondary colonic tuberculosis was diagnosed and then chemotherapy was started. Three months later, double contrast study and colonoscopy showed multiple inflammatory polyps without scarred formation in the colon (Figure 2b, 3b). Sputa, gastric juice and stool cultures yielded mycobacterium tuberculosis var. hominis. Retrospectively, these findings which were compatible with tuberculosis are thought to be rare manifestations of active and healed tuberculosis.
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2684-2712
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2713-2733
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2734-2751
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2752-2767
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2768-2772
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2772-2775
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2775-2780
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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  • [in Japanese]
    1988 Volume 30 Issue 11 Pages 2781-2791
    Published: November 20, 1988
    Released on J-STAGE: May 09, 2011
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