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Volume 30, Issue 5
Displaying 1-32 of 32 articles from this issue
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Tatsuoki SHIRAHAMA, Makoto NAKANO, Masasi KATOH, Kazuo FURUKAWA, Kazuk ...1988 Volume 30 Issue 5 Pages 881-890_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSMental and physical stresses, some kinds of drugs and alcohol are well known as the causes of acute gastric ulcerous lesions. But, there have been no sufficient medical studies on the relationship between acute gastric lesion and ranger training that is very stressful. 421 subjects were examined endoscopically after the training from 1978 to 1986. 1. Of the 421 subjects, gastric ulcer : 36 cases (8.5%), duodenal ulcer : 25 cases (5.9%), gastroduodenal ulcer : 5 cases (1.2%), erosivegastritis : 95 cases (22.6%), and erosive duoenitis :19 cases (4.5%) were found. 2. Of 62 lesions of 41 gastric ulcers (5 cases associated with duodenal ulcers), 29 (46.8%) were found at the gastric anglus. 3. Symptoms such as epigastric pain, nausea, vomiting, hematemesis and/or melena tended to appear from the 12 th or 13 th day of action training in the cases of ulcerous diseases, at that time the training was thought to be most hardest, so the trainees were most exhausted. It is natural that such strict training causes great physical, mental and phychological stresses to the trainees. 4. 8 of these acute gastric ulcers needed more than 8 weeks to become complete scars and 4 recurred. These cases indicated the possibility of chronic transformation of the acute gastric ulcers.View full abstractDownload PDF (3931K) -
Mikio KARITA, Masahiro TADA, Takashi KOUCHIYAMA, Atsushi MURAKAMI, Hid ...1988 Volume 30 Issue 5 Pages 893-906_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSStrip biopsy is an endoscopic mucosal tissue excision technique that also contains the submucosal tissue, and the size of the specimen is almost always 1-3 cm. This technique neccesarily causes an artificial ulcer of Ul II at the site of excision. In this study, we examined 84 lesions endoscopically and 39 lesions of post strip biopsy ulceration histologically. The period from excision to scarring confirmed by both endoscopy and operated specimen was nearly 30 days. The period was unrelated to the location of the artificial ulcer. When regenerating epithelium covered the ulceration entirely, the mucous gland were already formed and the secretion actively. The time of regenerating the muscularis mucosae took nearly 100 days. Fold convergency of the artificial ulcer begins from the 7 th day according to the endoscopic finding. The shape of the histological cross section is trapezoid and the grade of the fold convergency of this lesion tends to be severe. This type tends to be observed mainly in the antrum. Strip biopsy induced human gastric ulcer is considered to be a model of regeneration of the epithelium, muscularis mucosae, and fibrous tissue, and it seems to be significant as a control to evaluate the healing process of peptic ulcer.View full abstractDownload PDF (6921K) -
-IN SPECIAL REFERENCE TO THE INCIDENCE AND THE BACKGROUND OF VASCULAR ECTASIA-Fumitoshi WATANABE, Eizo KANEKO, Shigeko OHI, Masayoshi KAJIMURA, Kazu ...1988 Volume 30 Issue 5 Pages 907-912_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopy of 42 hemodialysis (HD) cases revealed gastritis in 50% (21/42), vascular ectasia (VE) in 24% (10/42), duodenitis in 7% (3/42), esophagitis in 5% (2/42), duodenal ulcer in 5% (2/42), gastric ·duodenal polyp in 5% (2/42) and gastric ulcer in 2% (1/42). The incidence of VE in HD cases is significantly higher than non HD cases, and the incidence of VE in upper gastrointestinal (UGI) bleeding in HD cases is significantly higher than non HD cases. There are no significant differences in age, duration of HD, serum creatinin level, serum BUN, and systolic blood pressure between VE cases and non VE cases on HD. The etiology of VE among HD cases is not clear, but VE is an important source of UGI bleeding.View full abstractDownload PDF (3528K) -
Kazuo ICHIKAWA, Saburo NAKAZAWA, Yasuo NAITOH, Masafumi ICHIKAWA1988 Volume 30 Issue 5 Pages 915-925_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSPercutaneous transhepatic cholecystoscopy (PTCCS) has been developed for precise diagnosis and endoscopic therapy of various gallbladder diseases. The time required until PTCCS is shortened considerably up to 6.1 days by establishment of the procedures and improvement of design of the devices. No serious complications have been experienced. Forty four cases including 14 of gallbladder carcinoma were suspected of having gallbladder carcinoma by various procedures of imaging diagnosis. A definitive diagnosis was made by PTCCS in all these cases. In gallbladder carcinoma cases, mucosal expansion towards the neck of the gallbladder was correctly diagnosed in 6 out of 14 cases by the concomitant use of biopsy under endoscopy. Protuberant lesions in the gallbladder were removed by polypectomy in 10 cases, and stones were safely removed in 15 patients with gallstones. This is a safe method and not prerequisite to surgery. This method is not only the best precision method for definite diagnosis of gallbladder diseases, but also an effective therapeutic method for removal of stones, benign polyps, etc.View full abstractDownload PDF (4331K) -
Eisai CHO, Takayoshi MATSUI, Keisuke KIYOTA, Hidekazu MUKAI, Kazuhiko ...1988 Volume 30 Issue 5 Pages 926-935
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic Ultrasonography (EUS) was performed in 46 patients with colorectal cancer with an echo-endoscope (Olympus GF-UM 2). The procedure was done by the water-filled method and it was limited to the rectum and sigmoid colon because of the instrumental problems. The colorectal wall was ultrasonographically recognized as five layers in its structure. Viewing from luminal side, the 1st hyperechoic layer corresponded histologically to the proper mucosa, the 2nd hypoechoic layer to the mucosal muscle, the 3rd hyperechoic layer to the submucosa, the 4th hypoechoic layer to the proper muscle, and the 5th hyperechoic layer to the subserosa and serosa, respectively. The ultrasonographic feature of colorectal cancer was clearly shown as a hypoechoic mass in the wall. EUS proved to have high diagnostic value for the detection of colorectal cancer invasion in comparison with histological diagnosis. From these results it is apparent that EUS of the colon is an effective method for the diagnosis of cancer invasion. Further improvements of the instruments as well as techniques may lead increasing demand for use of EUS in the diagnosis of colonic diseases.View full abstractDownload PDF (10176K) -
Naofumi OSAKA, Masahiro SHIRAKI, Hirofumi MIYOSHI, Kiyoshi ASHIDA, Shi ...1988 Volume 30 Issue 5 Pages 936-941_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe developed RESOLUTION TEST CHART of the image evaluation for electronic endoscopes. The specification of this chart is shown in Figure 1. The degree of resolution was expressed as the ability of line separation, namely, the number of lines/mm. For example, the resolution of 1 line/mm, means discrimination for 0.5 mm width black line with 0.5 mm width white line on its both side (reflection rate, black :2.0%, white :83.0%). The resolution of electronic endoscopes were not superior to that of optical fiber scope with this RESOLUTION TEST CHART (Figure 4). In comparison of the resolution among three new electronic endoscopes, TGI-50 D (Toshiba-Machida) was superior to GIF-V10 (Olympus) and VE-81205 (Welch-Allyn) (Figure 3). There was no difference in the ability of line separation between optical fiber scope and electronic endoscopes. However, the image with electronic endoscopes is more distinct than with optical fiberscope (Figure 5). Because of this characteristic point, we feel the electronic endoscopes show better resolution than that of optical fiber scope.View full abstractDownload PDF (2630K) -
Akihiro YOSHITOSHI, Kou NAGASAKO, Kurato YASHIRO, Kaori HASEGAWA, Bune ...1988 Volume 30 Issue 5 Pages 942-949
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic polypectomy followed by sigmoidectomy was performed in the case of sigmoidal polyp because the pathologic examination revealed massive invassive submucosal cancer. Resected specimen showed local formation of granulomatous polyp. Since mucosal repair after polypectomy is usually accomplished by scarring, restoration with protrusive granulation tissue seemed relatively rare. Cases of polypectomy followed by colectomy were 29 cases (33 lesions) at our institute. We examined the repair of mucosa on 33 lesions and the following results were obtained. # 1: Acute ulcer was noted at the site of polypectomy when colectomy was performed within 10 days after polypectomy. Ulcer formation was not related with the presence or absence of residual cancer. At around 20 days, ulcer entered healing stage and ac-companied with slight mucosal convergence. # 2 : At around 30 days, contraction due to ulcer scar become marked and mucosal convergence was completed. After 30 days almost ulcer was healed and mucosal defect was repaired. # 3 : In cases where the defect was coverd with granulation or regenerative epithelium. They showed flat depressive lesions. # 4 : Except for regrowth of cancer, 2 protrusion occurred in the course of repair consisted of hyperplastic regenerative epithelium and consisted of exuberant granulation. It took more than 30 days after polypectomy to form these protrusions. # 5 : Formation of granulomatous polyp seemed to involve exuberant granulation at the site of defect during 2 to 3 weeks after polypectomy and formation of a protrusion during 4 to 7 weeks. Exuberant granulation sometimes occurred at the site of intestinal anastomosis, but it is rare after endoscopic polypectomy.View full abstractDownload PDF (4237K) -
Norimasa AKEDA, Masaaki OHTSUBO, Ryujirou DANNOURA, Yoshihiro MORIGUCH ...1988 Volume 30 Issue 5 Pages 950-955_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThis is a case report of granular cell tumor of the esophagus. The patient is a 58-year -old woman who was asymptomatic. This tumor was found incidentally during rentgeno-graphic examination of upper gastrointestinal tract. Esophagography demonstrated an elevated lesion, 12X8mm in size, in the middle esophagus. Esophagoscopy revealed a yellowish white elevated lesion of Yamada's type II at about 28 cm distant from the incisors. And another smaller elevated lesion was found at the proximal to the larger tumor. Both were diagnosed as a granular cell tumor by endoscopic biopsy. On histopath-ologic examination, the lesion had no malignant appearance, and evidence was found for Schwann's cell origin of the tumor cells. Larger tumor was resected by endoscopic polypectomy. The granular cell tumor of the esophagus is uncommon, and the case which reported multiple tumors of the esophagus is extremely rare in Japan.View full abstractDownload PDF (5414K) -
Toyoshi ISOMURA, Tadashi SHINAGAWA1988 Volume 30 Issue 5 Pages 956-962_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe present a case of Schonlein-Henoch purpura (allergic purpura) detected in a 17-years-old boy.
The patient visited our hospital with complaints of abdominal pain, hemorrhagic sports on lower extremities and pain in both knee joint. After admission, he developed hematemesis. Subsequent UGI endoscopy revealed severe erosions with bleeding in both stomach and duodenum. From the clinical feautures and endoscopic findings, we made a diagnosis of Schönlein-Henoch purpura on this case.
The patient was effectively treated with predonisolone and f amotidine showing with clinical improvement.
We have followed up the patient with periodic UGI endoscopy. About 3 weeks later, he complained of sudden on set of melena. Thereby, total colonoscopy was done, which revealed edematous mucosa and bleeding throughout the whole colon. This melena subsided with increase in the dose of predonisolone.
We, therefore, suggest the importance of both upper and lower GI endoscopy (to be done) during severe abdominal pain even without melena in supporting the diagnosis and planning the treatment of the Schonlein-Henoch purpura.View full abstractDownload PDF (3191K) -
Yoshiaki MAEDA, Kimitomo MORISE, Yuji OKA1988 Volume 30 Issue 5 Pages 965-972_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 22-year-old female admitted to The Japanese Red Cross Nagoya First Hospital in October 1985, complaining of epigastic pain. Two years earlier, she had an episode of taking clomifen citrate for 3 months. Upper GI series revealed an extra-gastric mass compressing on the lesser curvature of the upper body. Ultrasonography revealed a 6X5 cm solid mass in the left lobe of the liver. Peritoneoscopy and celiac angiography revealed a vascular-rich tumor. Surgical operation was done, and the resected specimen showed an encapsulated tumor of 6X5.5X3 cm in size. The cut surface was white-yellow. His-tologically, the tumor showed typical features of liver cell adenoma (LCA). Among 33 cases of LCA reported in Japan, 6 had an episode of taking contraceptives or hormonal dilivertives. In Japan, oral contraceptives are now planned to go on the public market, so we shoud take careful consideration to LCA when we encountered a patient with liver tumor.View full abstractDownload PDF (7646K) -
Kiyoshi YOKOCHI, Tadahisa MIYAMOTO, Makoto ITOH, Yoshifumi YOKOYAMA, N ...1988 Volume 30 Issue 5 Pages 973-978_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA rare case of gastro-duodenal fistula caused by a swallowed hairpin is reported. A 45-year-woman visited our hospital with a complaint of epigastric discomfort unrelated to meals. Barium X-rays on the stomach revealed a hairpin of which the tip penetrated the lesser curvarture and reached into the duodenal bulb. Although the hairpin was not found on UGI endoscopy performed 3 days after the barium X-rays, a small ulceration covered with a white coat was observed at the penetrated site in the antrum and the mucosa around the ulceration was edematous. A catheter could be inserted endoscopically into the bottom of the ulceration and a contrast medium from the catheter demonstrated a gastroduodenal fistula. Thirteen days after the first barium X-rays, the hairpin was spontaneously discharged with bowel movement without any complications. Healing of the gastro-duodenal fistula was then confirmed by endoscopy A case of gastro-duodenal fistula caused by a swallowed hairpin has not been reported in the literature.View full abstractDownload PDF (5556K) -
Hiroshi KAKUTANI, Masatoshi AJIKATA, Yutaka WATANABE, Hisao MURAYAMA, ...1988 Volume 30 Issue 5 Pages 981-985_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSAn 87-year-old women visited our hospital due to abdominal pain. Endoscopic examination revealed a tumor with smooth surface, 3 mm in diameter, at the duodenal bulb. Histological diagnosis of biopsy specimen was carcinoid which was partially positive with Glimerius Stain. By endocrinological examination, it showed the high concentration of the serum Bradikinin. In this case, because of too old age, we tried ethanol injecthon therapy. After ethanol injection into the tumor, the tumor was disappeared. Three thmes endoscopic examination and histological examination of biopsy specimen from total 20 sites after this therapy confirmed that there was no recurrence of carcinoid.View full abstractDownload PDF (2989K) -
Katsuhisa KAWAMOTO, Hiroya FUJINO, Kazuhiko TOKITA, Yoshihide TATSUMI, ...1988 Volume 30 Issue 5 Pages 986-991_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 81 year old woman was admitted to our hospital because of the further detailed examination for polypoid lesion in the duodenal bulb. Endoscopic examination revealed pedunculated polypoid lesion with nodular surface with partial reddening. The biopsy study showed group V. Endoscopic polypectomy was performed and no accident occurred. The size of the resected tumor was 10X9X6 mm in size. Histological examination revealed tubular adenocarcinoma with the invasion limited to the mucosal layer showing a feature of cancer in adenoma. We also referred to the problems of endoscopic polypectomy of the early duodenal cancer.View full abstractDownload PDF (3240K) -
Yoshihide TATSUMI, Shoji MITSUFUJI, Hiroshi NISHIDA, Hiroya FUJINO, Ka ...1988 Volume 30 Issue 5 Pages 992-998_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTwo cases of cystadenoma of the pancreas were reported. Endoscopic ultrasonogram was very useful to decide whether the lesion belonged to microcystic or megacystic type. Case 1 was a 59-year-old female. Multilocular cysts presenting a honeycomb or spongy appearance were seen at the body and tail of the pancreas. Microscopic findings showed no malignancy. It was diagnosed as cystadenoma of the pancreas (microcystic). Case 2 was a 70-year-old female. Many cystic lesions about 10-30 mm in diameter were seen at the head of the pancreas. Microscopic findings showed no malignancy. It was diagnosed as cystadenoma of the pancreas (megacystic). Both cases were examined by extra-abdominal ultrasonogram, abdominal computed tomograpy, endoscopic ultrasonogram and endoscopic retrograde cholangiopancreatography. Among these examinations endoscopic ultrasonogram showed the internal structure of the cystic lesions most clearly (Figure 3, Figure 8). Compagno and Oertel divided the cystic neoplasms of the pancreas into microcystic adenoma and mucinous cystic neoplasms. The former was composed of small cysts containing serous substance and benign. The latter were composed of large cysts containing mucinous substance and malignant or having a malignant potential. Case 1 was the former and case 2 was the latter. Endoscopic ultasonogram easily distinguished these two types and was a very useful apparatus to examine the pancreatic lesion precisely.View full abstractDownload PDF (1212K) -
Kojiro MATSUMOTO, Saburo NAKAZAWA, Kose SEGAWA1988 Volume 30 Issue 5 Pages 999-1004_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe had a case of mucinous cystadenoma of appendix which was diagnosed precisely before operation. The patient was 71-year-old man with a chief complaint of constipation. Barium enema examination showed a hemispherical filling defect which protruded smoothly at the inside of the cecum. And we could not get a picture of the appendix. Endoscopic examination revealed a elevated lesion of the cecum, which was covered with normal smooth mucosa. The lesion was presented as low echo mass on ultrasonography in which fine grained echoic pattern was showed. Therefore, it was suspected to be a cystic lesion with mucinous fluid. Computed tomography also showed a cystic lesion at the same location. There was no malignant findings such as neovascularity, encasement on angiography. We diagnosed it mucinous cystadenoma from the results of these examinations, and decided to resect the lesion. A fist-sized tumor was found at the cecum on operation. The tumor was pear shaped and contained milky jelly like substance. Even though the epithelium of the cystic wall was almost peeled off, mucin producing epithelial cells which proliferate papilliformly into the lumen were found partially. Preoperative diagnosis of mucinous cystadenoma was assured histologically.View full abstractDownload PDF (1288K) -
Masanori MORITA, Hirochika KITAJIMA, Sinichi IWAMURA, Reiko AKIZAWA, T ...1988 Volume 30 Issue 5 Pages 1007-1010_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe have reported an unusual case of mucosal prolapse syndrome composed of circumferential multiple polypoid lesions in the rectum. Sixteen years old male patient was admitted due to abnormal defecation. A multinodular circumferential mass was palpable by the digital examination. A barium enema examination showed multiple nodular polypoid lesions at the end of the rectum. Colonof iberscopic findings showed multinodular polypoid lesions covered with dirty white coat. Histopathological findings from the biopsy specimen showed a fibro-muscular obliteration in the lamina propria and a mucosal hypertrophy. These clinical and pathological findings were compatible with the mucosal prolapse syndrome. Sulfasalazine and steroid suppositories were administrated however, without improvement. Resection of the lesion through transanal approach was performed. Circumf erential multiple polypoid lesions like this case were rare, and it is some what difficult to differentiate from malignant tumors of the rectum. We would like to emphasize that pathologic findings are very important to diagnose the mucosal prolapse syndrome.View full abstractDownload PDF (766K) -
Mitsuo GOTO, Nobuo YAMADA, Yoshiyuki OOSAWA, Osamu MASAMUNE1988 Volume 30 Issue 5 Pages 1011-1014_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 41-year-old male was admitted to our hospital with chief complaints of abdominal pain, diarrhea and bloody stool. He had a history of having taken mefenamic acid (Pontal) 1, 500 mg/day for the past three years. Endoscopy revealed a semi-oval ulcer accompanied by the surrounding edema and redness in the terminal ileum. Biopsy specimen taken from the surroundings of the ulcer demonstrated edema in the lamina propria and cell infiltration predominantly consisting of lymph cells. A non-caseating granuloma was found. Double contrast X-ray examination revealed that the small intestine was intact except for the ulcer detected in the terminal ileum. A diagnosis of simple ulcer in the terminal ileum was made. Mefenamic acid was immediately discontinued after admission and salazopyrin was administered from the 39 th hospital day. The ulcer was scarred with concentration of the mucosal folds, leaving redness and a shallow depression. Participation of drug was considered as the cause because the ulcer tended to heal with discontinuation of the drug.View full abstractDownload PDF (630K) -
Tsukasa YOSHIDA, Shiro TOMITA, Yoshiaki KAKIZAKI, Masafumi KOMATSU1988 Volume 30 Issue 5 Pages 1017-1021_1
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of colonic Crohn's disease in the early stage demonstrating only aphthoid ulcers and shallow discrete ulcers as the endoscopic findings was reported. The patient was a 38-year-old female who had been followed up for chronic constipation for one year and four months. She developed watery diarrhea associated with abdominal pain of nearly one month's duration and was admitted to our hospital for further evaluation of colonic lesions discovered by x-ray and endoscopic examinations. Colonoscopic examination revealed aphthoid ulcers and irregular-shaped shallow discrete ulcers scattering in the sigmoid colon up to the transverse colon, though rectum was intact. Barium enema examination demonstrated the granular mucosal lesions located only in the descending colon. Upper gastrointestinal tract and small intestine were normal. Colonic infectious diseases such as tuberculosis or amebic dysentery were ruled out, and colonic Crohn's disease was confirmed from demonstration of granuloma in the colonic biopsy specimen in addition to the endoscopic and X-ray findings. Colonic lesons were reversible and disappeared without any scar formation by the treatment of Metronidazole for about three months.View full abstractDownload PDF (802K) -
[in Japanese]1988 Volume 30 Issue 5 Pages 1022
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[in Japanese]1988 Volume 30 Issue 5 Pages 1023
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[in Japanese]1988 Volume 30 Issue 5 Pages 1025-1028
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[in Japanese]1988 Volume 30 Issue 5 Pages 1029
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1988 Volume 30 Issue 5 Pages 1030-1032
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Yanao OGURO1988 Volume 30 Issue 5 Pages 1033-1034
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Yutaka WATANABE1988 Volume 30 Issue 5 Pages 1035-1036
Published: May 20, 1988
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWith the object to establish the indication of the endoscopic therapy for early gastric cancer, some questionaires were performed about the cases of early gastric cancer treated by surgery and by endoscopic therapy at the cancer centers. We obtained the following conclusions based either on the results of the questionaires or on our study about the operated cases and our 10 year period experience. Namely, since type ha and IIc (Ul-) early gastric cancers of less than 1 cm in diameter or polyp cancers are not associated with lymph node metastasis and easy to be treated locally, we consider that endoscopic treat ment is absolutely indicated for these cases. For cases of cancers of more than 1 cm in diameter, incidence of lymph node metastsis becomes higher. If there are some factors which are unfavourable for performing operations such as presence of other disease or high age, the indication should be extended gradually according to such factors. In unoperative cases, endoscopic therapy should be considered even in cases of progressive cancer.View full abstractDownload PDF (219K) -
1988 Volume 30 Issue 5 Pages 1037-1043
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1988 Volume 30 Issue 5 Pages 1044-1048
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1988 Volume 30 Issue 5 Pages 1049-1070
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1988 Volume 30 Issue 5 Pages 1071-1089
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1988 Volume 30 Issue 5 Pages 1090-1114
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1988 Volume 30 Issue 5 Pages 1115-1141
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1988 Volume 30 Issue 5 Pages 1160
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