GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 31, Issue 2
Displaying 1-26 of 26 articles from this issue
  • Makoto HAYAKAWA, Kimitomo MORISE, Nobuyuki HAYASHI, Yuji OKA, Tsuyoshi ...
    1989 Volume 31 Issue 2 Pages 327-333_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We studied radiographic and endoscopic findings in 14 cases of superficial malignant lymphoma (SML) and in 12 cases of reactive lymphoreticular hyperplasia (RLH). In SML, granular mucosal pattern, erosion, and milky white color sign were found in 100% (14/14), 93% (13/14), and 79% (11/14), respectively. In RLH, granular mucosal pattern, erosion, and milky white color sign were found in 100% (12/12), 83% (10/12), and 67% (8/12), respectively. There was no significant difference between the findings of SML and RLH. Analysing granular pattern on X-ray film, irregular granules were found in 86% patients of SML and 14% patients of RLH. Furthermore, the granules in sizes more than 8mm were more frequently found in SML (11/14) than in RLH (0/12). Pathologically, the granular lesion of SML consisted of severe degree of infiltration of lymphoma cells, while the lesion of RLH consisted of moderate degree of lymphocyte infiltration. We suggest that irregular mucosal pattern with large granules is important for early diagnosis of gastric SML on radiography and endoscopy.
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  • WITH SPECIAL REFERENCE TO THE OBSERVATION OF INTESTINAL METAPLASIA BY INDIRECT METHYLENE BLUE STAINING METHOD
    Ken HARUMA, Koji SUMII, Akira INBE, Manabu KIMURA, Hitoshi TESHIMA, Sh ...
    1989 Volume 31 Issue 2 Pages 334-343
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    To investigate the characteristics of atrophic gastritis in patients with hyperplastic polyp of the stomach (HP), indirect methylene blue staining was performed, and gastric acid secretion and serum gastrin level were examined in 61 patients with HP, 9 with gastric adenoma, 8 with protruded type early gastric cancer and 20 with atrophic gastritis (MAO<5mEq/h) which had otherwise no gastric lesions. The development of intestinal metaplasia was severe in the antrum, and antral, extensive or diffuse type, in which intestinal metaplasia extended from the antrum, was common in patients with gastric neoplastic lesion (adenoma or early cancer) and atrophic gastritis. On the other hand, intestinal metaplasia was slight or absent in the antrum, and three types including non-metaplastic, intermediate and fundic type, were more frequent in patients with HP than in those with others. Moreover, serum gastrin level was significant-ly higher in the former than in the latter, although hypochrolhydria or achrolhydria was common in all diseases studied. From the results obtained, it was proved that the location and development of atrophic gastritis in patients with HP was different from that in those with gastric adenoma, protruded type early gastric cancer and atrophic gastritis, although the relation to atrophic gastritis had been previously described in all diseases studied.
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  • Akimichi CHONAN, Fukuji MOCHIZUKI, Takashi IKEDA, Tokiaki TOYOHARA, Na ...
    1989 Volume 31 Issue 2 Pages 344-351
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Endoscopic polypectomy of the stomach was performed for 581 lesions in 413 patients at our center during the past seven years, and among them 554 lesions in 387 patients were hyperplastic polyps which was equivalent to 95.4% of the all. We studied the endoscopic appearance and histopathological findings of focal cancers in hyperplastic polyps. The results were as follows. 1) There were twelve lesions of focal cancer in hyperplastic polyp, which is equiva-lent to 2.2% of hyperplastic polyps. 2) Histopathologically, there were 11 cases of foveolar type (Figure 1) and 1 case of intestinal type (Figure 2) of focal cancer in hyperplastic polyp. Focal cancers were found at the top of hyperplastic polyps and there were no cases of focal cancer with adenoma (Figure 3). 3) Endoscopically, the mucosal surface of these lesions appeared roughly granular and reddish in color. Most of them had white coat or mucus with bleeding. Some had depression on the surface. These findings may suggest the possibility of endoscopic diagnosis of focal cancer in hyperplastic polyp (Table 5), but it generally seems difficult to point out the presence of focal cancer in hyperplastic polyp from the endoscopic appearance.
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  • Hideki NISHIWAKI, Katsusuke SATAKE, Michio SOWA, Kaoru UMEYAMA
    1989 Volume 31 Issue 2 Pages 353-356
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Gastrointestinal bleeding is frequently observed as one of severe complications in hemorrhagic necrotizing pancreatitis. As a defence mechanism gastric mucosal blood flow was investigated in experimental acute pancreatitis of dogs. Acute pancreatitis was induced by bile and trypsin injection into the pancreatic duct of 10 dogs and gastric mucosal blood flow was endoscopically measured by hydrogen gas generated by electrolysis as previously reported elsewhere. Hemorrhagic necrotizing pancreatitis and much bloody ascites were observed macro -and microscopically at 5 hours after induction of pancreatitis but acute gastric mucosal lesions such as erosion or gastric ulcer were not detected throughout the experiments. However, gastric mucosal blood flow showed a trend for decrease during the experiments of 3 to 5 hours and at the same time the reddness of gastric mucosa was gradually getting pale. This study suggests that there are some influences of decreased gastric mucosal blood flow on gastric mucosal damage in acute pancreatitis of dogs.
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  • -IN COMPARISON WITH HEPATIC FUNCTIONAL RESERVE CAPACITY-
    Masaki NAKAYAMA, Eiryo KIKUCHI, Masahiko MATSUMURA, Ryoichi KUBO, Kimi ...
    1989 Volume 31 Issue 2 Pages 357-363
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    The aim of our study was to elucidate the relationship between the development of mucosal lesions of gastroduodenum and hepatic function in cirrhotics especially from the point of view of hepatic functional reserve capacity. Gastroduodenal lesions occurred frequently in cirrhotics (redness of gastric mucosa and gastric erosion ; 46.3%, gastric ulcer ; 20.0%, duodenal ulcer ; 4.8%). Redness of gastric mucosa and gastric erosion were most frequently noted on gastric corpus, and gastric ulcer was found more frequently on gastric angle and corpus than any other parts of stomach. Furthermore, in 13 cases (8.1%) of 160 patients with liver cirrhosis, gastroduodenal lesions caused gastroduodenal bleeding. In tests of hepatic functional reserve capacity and, serum cholinesterase, serum albumin, hepaplastin test and ICG Rmax were significantly lower in cirrhotics with gastroduodenal lesions than those in cirrhotics without gastroduodenal lesions, whereas prothrombin time was longer and 2hr value of serum bile acids by endogenous bile acid loading test were significantly higher in cirrhotics with gastroduodenal lesions than those in cirrhotics without gastroduodenal lesions. Besides, 15 min retention rate of ICG and 15 min ΔcAMP of glucagon loading test were worse in cirrhotics with gastroduodenal lesions. From these results, it is suggested that development of gastroduodenal lesions should be taken into consideration in cirrhotics with diminution of hepatic functional reserve capacity.
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  • Masahiko OHTANI, Kenichi IDO, Norio ISODA, Norifumi HITOMI, Chiaki KAW ...
    1989 Volume 31 Issue 2 Pages 364-370
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    We have examined 71 patients with liver diseases using the ultrasonic laparoscope (US-lapa) with electronic linear scanning system, which was designed and develoved by Toshiba CO. and Machida Co.. Twenty three patients with gallbladder diseases were found and a comparative study of US-lapa with extracorponeal ultrasonography (US), was carried out. US-lapa showed more fine and clear, visualization than US. The 3 layers of the gallbladder wall and number, the character, and the stalk of small polypoid lesions of gallbladder were clearly detected. Furthemore, there were advantage that the laparoscopic findings of gallbladder could be obtained simultaneously and the scanning from any direction could be performed. In conclusion, US-lapa was considered to be of great value in the diagnosis and the fine observation of gallbladder disease.
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  • Hideaki TSUKADA, Hiroshi SEINO, Syunji UEDA, Haruto UCHINO, Masahiko S ...
    1989 Volume 31 Issue 2 Pages 371-378_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    As an experimental model of the human inflammatory bowel disease, We attempted to produce two kinds of experimental colitis in rats. One is the chemical colitis produced by the intracolonic administration of 10% acetic acid and anothes is the colitis produced by oral administration of 5% dextran sulfate sodium (MW 54, 000). The experimental colitis was followed by serial endoscopy (Olympus GIF P-3, Q-10 and GIF V-10). In the acetic acid colitis, mucosal blood flow was also measured by the hydrogen gas clearance method through the biopsy channel. In the dextran sulfate sodium colitis mainly produced in the caecum, endoscopy was performed through the chronic caecal f istura. In the normal mucosa, the submucosal vessels were clearly seen. Immediately after administration of acetic acid, coagulation of the mucus and the mucosal surface appeared, the vessels network disappeared and the mucosal edema, redness, bleeding, ulceration were seen. Subsequently these findings gradually disappeared, but the ulcers lasted more than a month. Immediately after application of acetic aicd, the mucosal blood flow remarkably decreased and then rapidly recovered. The mucosal blood flow was well correlated with the presence of mucosal edema, not correlated with the presence of mucosal ulceration. Two days after administration of dextran sulfate sodium, bloody stools appeared. One week after administration, vascular network disappeared due to the presence of mucosal edema, and multiple hemorrhagic erosion appeared in the caecum of the rat. Subsequently mucosal bleeding gradually increased and the irregular-shaped ulcers appeared. Histologically, the acetic acid colitis showed massive coagulative necrosis in the descending colon and the dextran sulfate sodium colitis showed multiple haemorrhagic erosion in the caemum. This study would be one of the useful methods for studying human inflammatory bowel disease.
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  • Hiroyuki OHSIRO, Yasuhisa YOKOYAMA, Isao YOKOYAM, Manabu KIKUCHI, Masa ...
    1989 Volume 31 Issue 2 Pages 379-387
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    We compared the differences in the clinical features, pathological findings, endoscopic findings as well as biopsy diagnoses between primary malignant lymphoma (ML) (57 cases) and reactive lymphoreticular hyperplasia of the stomach (RLH) (27 cases) in the resected stomachs. The results were as follows 1) There were no age difference among them. Mean age of patients with ML was a little older than that of patients with RLH. 2) The lesions were most frequent on the greater curvature and posterior wall in ML, while, in RLH, on lesser curvature. 3) Macroscopically, superficial type and ulcer type were dominant in ML, while in RLH superficial type was. 4) The accurate diagnosis of both ML and RLH was made infrequetly on the initial endoscopy. 5) Diagnosis of ML by initial biopsy evaluation was definitely made in 81.3%, while that of RLH in 38.9%. 6) As to endoscopic findings of ML, milky white thick coat, thinwalled marginal elevation and cobblestone appearance were frequent, while, in RLH, ulcer with discolored marginal elevation, patchy depression of the mucosa and diffuse reddish branular changes in discolored area were frequent.
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  • Shigeyuki IKEDA, Yumiko YAMAGUTI, Akio TEBAYASI, Yuji YOSIDA, Taro ARI ...
    1989 Volume 31 Issue 2 Pages 388-398
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Among 272, 397 cases who underwent primary photof luorogram in gastric mass survey during a period of 5 years between 1982 to 1986, 37, 658 (13.8%) cases were diagnosed to require close examinations. Among them, 11, 802 cases received close examinations at the Asahikawa Cancer Detection Center, and 218 cases of stomach cancer were detected. The analyses of these stomach cancers resulted in the following classifications: 154 cancer cases detectable with photofluorogram, 39 cases with upper GI series, and 25 cases with endoscopy. Of 7, 702 males aged between 30 to 79, who underwent close examinations, 5, 052 cases initially received routin upper GI series (X-ray group), and 2, 650 initially examined with endoscopy (endoscopy group). Cancers were detected with endoscopy in 9 cases (0.18%) of the X-ray group and in 10 cases (0.38%) of the endoscopy group. This indicated that on close examinations during gastric mass survey, the application of endoscopic examinations at the initial stages showed higher cancer detection ratio compared with performing direct X-ray tests at the initial stages.
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  • Daisuke SHIBUYA, Shigeru ASAKI, Akira SATO, Toshiaki NISHIMURA, Shuich ...
    1989 Volume 31 Issue 2 Pages 399-404_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Efficacy of emergency endoscopy and endoscopic pure ethanol injection hemostasis for upper G-I bleeding in patients with hematological disorders was analysed retrospectively. Twenty-four patients with hematological disorders had emergency endoscopy in our endoscopy clinic during 7 and a half years from June 1979 to December 1986 because of upper G-I bleeding. They were 6 patients with acute leukemia, 9 patients with chronic myelogenous leukemia (CML), 3 patients with multiple myeloma, 2 patients with malignant lymphoma, 2 patients with hemophilia, l patient with von-Willebrand disease and 1 patient with idiopathic thrombocytopenic purpura. Sex ratio was 3: 1, and their mean age was 51 years. Most common bleeding site was gastro-duodenal erosion in acute leukemia (5/6, 83.3%), and peptic ulcer in CML (6/9, 66.7%). Hemostasis with endoscopic pure ethnol injection was performed in 10 patients. Temporary hemostasis was obtained in all cases. Re-bleeding occurred in 5 patients (50%) and was higher in hematological disorders in non-hematological patients. Complete hemostasis was obtained in all cases with repeated hemostasic procedure. It is important to combine with supplement therapy. No complication was seen, such as bleeding and perforation. Platelet transfusion was required if necessary. Therefore, it was considered that emergency endoscopy and endo-scopic pure ethanol injection hemostasis were effective for upper G-I bleeding in the patient with hematological disorders.
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  • Yuichi FUYUHIRO, Kwang-Sa KIM, Hiroji NAKAGAWA, Yukio NISHIGUCHI, Jae- ...
    1989 Volume 31 Issue 2 Pages 405-408_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Under the local anesthesia, we performed endoscopic formation of gastrostomy in 12 patients, and of duodenostomy or jejunostomy in two subtotal gastrectomized patients. All patients were unable to swallow but had normal digestive function. Complication was not experienced except for subcutaneous abscess in one PEG case. This method was very usefull and safe for the patients with poor anesthetic or poor operative risk.
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  • Masahiko TAKAMASU, Yoshinobu FUSE, Katsuhisa KAWAMOTO, Hiroya FUJINO, ...
    1989 Volume 31 Issue 2 Pages 409-414_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    We evaluated appearance of visible blood vessels and so-called "liver area" of the duodenal bulb endoscopically in 300 cases. Both findings appeared more frequently in females than in males with ages. In cases with duodenal ulcer or ulcer scar, few cases showed visible blood vessels. Blood vessels were visible in almost all the cases with "liver area". In operated cases, Brunner's glands were significantly thicker in cases with non-visible blood vessels than in cases with those findings, while there was no significant difference between them in height and density of villi. It was suggested from these results that appearance of visible blood vessels of the duodenal bulb were due to aging process and to decreased thickness of Brunner's glands.
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  • Naotaka FUJITA, Shigeki LEE, Go KOBAYASHI, Akira YANO, Kazuhiro SATOH, ...
    1989 Volume 31 Issue 2 Pages 417-421_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    The clinical importance of endoscopic sphincterotomy (EST) is increasing not only in treatment but also in diagnosis. We developed a new papillotomy knife with a channel for guidewire (P-GC, FUJITA; Figure 1). The method of performing EST with this knife is as follows (Figure 2): 1) selective cannulation beyond the papilla of Vater into the bile duct using an ordinary catheter about 6 French in size for endoscopic retrograde cholangiopancreatography (ERCP), 2) insertion of the guidewire into the intrahepatic duct through the catheter, 3) removal of only the catheter, 4) insertion of the P-GC into the bile duct over the guidewire, 5) removal of the guidewire only, 6) performance of EST. So, once deep cannulation into the bile duct is achieved using an ordinary catheter for FRCP, an endoscopist can accomplish EST with assurance and safety. We could successfully perform EST in 15 cases with this knife and never experienced any sequelae. Stability of suitable direction of the blade toward the, oral protrusion, another characteristic of P-GC, FUJITA, also contributed to the good results. P-GC will be of great help for endoscopists when performing EST.
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  • Akiyoshi SAGA, Masao SAITOH, Norimasa SAKAMOTO, Ricardo MIYASHIRO, Tak ...
    1989 Volume 31 Issue 2 Pages 422-427_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    We devised a new thin and soft colonofiberscope "XCF-P" (Olympus) of which the outer diameter is 9.0 mm, for the purpose of relieving painful discomfort accompanied by colonofiberscopy, and also evaluated clinical availability of the XCF-P on total colonof iberscopy. We succeeded in reaching the cecum in 109 of 113 patients (96.5%), and the average time was 13.8 minutes. Based on the average time, this result was not as good as the result of COL-MS (Fujinon) about which we previously reported, probably because of too much softness of XCF-P's shaft. But in our questionnaire after total colonoscopy, we obtained results that 28% of the examind patients had no pain, and 61% had only slight pain. There was no patient who had severe pain associated with colonofiberscopic examination and we had no case in whom the examination was impossible because of the pain. In conclusion, we demonstrated that XCF-P is very useful instrument for total colonoscopy, but we think that further improvement about stiffness of shaft will be needed.
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  • Hisayoshi HOKAZONO, Nobutaka SATO, Ichiro TAMEGAI, Masahiro IKEGAMI
    1989 Volume 31 Issue 2 Pages 428-435
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    A 68 year-old man with a several year history of gastric ulcer consulted this clinic for a detailed evaluation on July 15, 1986. Initial gastric fluoroscopy revealed an early gastric cancer, type IIc on the posterior wall of the lower corpus. Screening esophageal fluoroscopy as well as detailed examinations failed to reveal any abnormality. Panendoscopy was then performed, and an erythematous, slightly ulcerated lesion was discovered in the direction of 3 o'clock at a distance of 32 cm from the incisor line. Lugol's solution was used to stain this area and revealed a definite non-staining area around the lesion. Endoscopic biopsy of the central portion of the lesion revealed a squamous cell carcinoma. On October 8, 1986, radical surgical therapy was performed consisting of a resection of the thoracic esophagus, total gastrectomy and hemicolonoplasty at the Kosei Hospital. The gastric lesion grossly consisted of a IIc type early gastric cancer accompanied by a ul-II scar. Histologic examination revealed a highly differentiated adenocarcinoma localized within the mucosa. In the esophageal specimen, a superficial mm-type cancer was noted in the Ei portion. Histological examination revealed a highly differentiated squamous epithelial carcinoma. In the tissue around the lesion, multiple isolated foci of carcinoma within the epithelial layer were noted.
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  • Yutaka YAMASHITA, Ikuo MURATA, Seima IWANAGA, Kazufumi YAMASAKI, Youhe ...
    1989 Volume 31 Issue 2 Pages 436-441_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    A 67-year-old man entered our hospital complaining of anorexia and nausea. Roentogenograms showed a smooth elevated lesion in the prepyloric region and deformity of the duodenal cap (Figure 1). Gastrofiberscopic examination revealed a submucosal mass in the posterior wall of the antrum (Figure 2). Selective gastroduodenal arteriography showed a hypervascular area and a tumor stain (Figure 3). An operation was performed because of progression of the symptoms. On the resected specimen, a submucosal mass, measuring 3.0×3.0×3.0 cm, was found in the posterior wall of the gastric antrum. On microscopic examination, the tumor located in the submucosal and proper muscle layer of the antrum and was composed of well-differentiated ductal structures lined by a single layer of dysplastic cuboidal epithelium. The tumor was mixed with heterotopic pancreatic tissue which consisted of acinar and ductal tissue. The overlying gastric mucosal layer was normal. A diagnosis of adenocarcinoma originating from the heterotopic pancreas in the stomach was made. Carcinoma arising in heterotopic gastric pancreas is extremely rare and only 15 cases including ours were reported in Japan. They located in the antral region of the stomach in most cases. Histologically, tubular adenocarcinoma was common. It appears that careful histological examination is necessary for evaluation of histogenesis of such carcinomas.
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  • A CASE REPORT OF "HEPATOID ADENOCARCINOMA OF THE STOMACH"
    Mamoru TAKEUCHI, Shinzo YAMAOKA, Kyohji MATSUMURA, Asahiko KOBARU, Shi ...
    1989 Volume 31 Issue 2 Pages 442-448_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    In many gastric cancers producing AFP, some cases have features of hepatic differentiation. A patient with primary gastric adenocarcinoma with extremely high serum AFP level (61, 200 ng/ml) is described (Table 1). X-ray and endoscopic examination (Figure 1, 2) showed a Borrmann type 1 carcinoma on the anterior wall of the upper to middle body of the stomach. Well-differentiated adenocarcinoma was comfirmed by biopsy. Liver metastasis was not detected by CT, Ultrasonography and angiography (Figure 3). Total gastrectomy was performed. No metastases were found in any ather organs. Postoperative serum AFP level became normal (Figure 6). In the upper to middle body of the stomach, a well-circumscribed nodular tumor of 11 × 7.0 × 4.0 cm in size was found. Bleeding and necrosis were noted on the surface (Figure 4). The tumor cells contained eosinophilic cytoplasm that were similar to hepatocellar carcinoma, and they formed medullary nests. In some area, adenocarcinoma cells were well-differentiated tubular type (Figure 5). Immunohistochemical studies (Table 2) showed that tumor cells were positive for AFP (Figure 7), alpha-1 antitypsin, alpha-1 antichymotypsin, albumin, prealbumin (Figure 8), prothrombin, transf errin, ferritin and CEA (Figure 9), but negative for human chorionic gonadotropin. This case is compatible with “Hepatoidadenocarcinoma of the stomach” reported by Ishikura et al.
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  • Arata HIRAMATSU, Takako MIZUNO, Toshiaki NAKANO, Katsuji MIYAUCHI, Tos ...
    1989 Volume 31 Issue 2 Pages 449-457
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    A 22-year-old male, was admitted to this hospital in June 1985. He had suffered from diarrea, anorexia, vomiting and weight loss for the past 10 years, diagnosed as gastroduodenal ulcer and undergone medical treatment. An upper GI series showed a pyloroduodenal stenosis and multiple irregular polypoid lesions. In the second portion of the duodenum, there was poor distensibility and mucosal nodularities with pseudodiverticula. Endoscopic view of the stomach revealed the mucosal nodularity or "cobble-stone appearance", fissure ulceration and pyloroduodenal stenosis, and the specimens of the endoscopical polypectomized nodule showed a glanuloma, establishing a diagnosis of Crohn's disease. This patient responded well to elemental diet (ED), salazosulfapyridine (SASP) and predonisolone (PLS), and was discharged in December 1985. In May 1986, he was readmitted because of the same symptoms. After treatment with ED and SASP, these symptoms disappeared and he was discharged in July 1984. He remained well since that time on maintenance dose of SASP, after the cessation of ED therapy. Ten cases of gastroduodenal Crohn's disease including the present one have been reported in Japan. Seven cases were treated surgically and only three cases including this case responded to concervative treatment. Our patient had obvious clinical and endoscopic evidence of pyloroduodenal stenosis. He was given ED, SASP and PLS and has remained free of gastric complaints for over 2 years. We suggest that patients with gastroduodenal Crohn's disease can be treated conservatively with careful madical follow up.
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  • Naotaka FUJITA, Shigeki LEE, Go KOBAYASHI, Akira YANO, Kazuhiro SATOH, ...
    1989 Volume 31 Issue 2 Pages 458-463_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    In contrast with bile duct cancer, it is considered that carcinoma of the papilla of Vater seldom shows upstream extension replacing bile duct epithelium. In this presentation, we report a case of carcinoma of the papilla of Vater showing extraordinary spread along the bile duct up to the level of the common hepatic duct. A 59-year-old male with a chief complaint of itching was referred to our department. He had jaundice and an enlarged gallbladder without tenderness. Ultrasonography and CT revealed dilatation of the biliary system and the main pancreatic duct. ERCP demonstrated dilatation of both ductal systems with stenosis at their ends. Endoscopically, the papilla of Vater was covered with normal mucosa and the oral protrusion showed marked swelling. Biopsy after endoscopic sphincterotomy was carried out and a papillotubular adenocarcinoma was proven. Pancreatoduodenectomy was performed and about 65-mm section of the extrahepatic bile duct, from the papilla of Vater to the common hepatic duct, was resected. Extraordinary vast spread along the epithelium up to the hepatic edge was revealed by histological examination.
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  • Hiroyuki FUJITOH, Masaaki OHTSUBO, Toshiaki YOKOTE, Ryujiroh DANNOURA, ...
    1989 Volume 31 Issue 2 Pages 464-470_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    Double pylorus is one of the rare gastrointestinal abnormalities, having a second channel between the antrum of the stomach and the duodenal bulb in addition to the true pyloric channel. Recently we experienced a case of double pylorus which seems to be an acquired origin on the occasion of healing process of gastro-duodenal ulcer. A 70-year-old man came to our hospital complaining of epigastric pain. The first endoscopic examination showed gastro-duodenal ulcer. Six weeks later at the second endoscopic examination, this lesion was found to develope the double pylorus. X-ray examination of the upper gastrointestinal tract also revealed a gastro-duodenal fistula communicating between the lesser curvature of the prepyloric region and the duodenal bulb. In addition, we reviewed 54 cases of double pylorus reported in the literature in Japan.
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  • Tadashi SHIGEMATSU, Hitomi MAEDA, Kazuhiko FUKUI, Yasuhiro OKUMURA, Ta ...
    1989 Volume 31 Issue 2 Pages 471-476_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    A 74 year old female was admitted because of abdominal pain, fever and jaundice. Abdominal ultrasonography, computed tomography of the abdomen and endoscopic retrograde cholangiopancreatography revealed intrahepatic ductal stones and choledocholithiasis, but did not demonstrate the gallbladder and cystic duct. From these findings, we suspected the atrophic changes of the gallbladder with cholicystolithiasis. At operation, the gallbladder and cystic duct were also not detected. Intraoperative cholangiographic examination confirmed the absensce of the gallbladder and cystic duct, choledocholithiasis and saccular dilatation of the choledochus. Cholangioscopic examination also demonstrated saccular dilatation of the choledochus. This is of particular interest in that this saccular dilatation possibly is a rudimentary gallbladder in a case of congenital atresia.
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  • Takuya YAMAMURA, Shigeo IBUKI, Tadakimi UI, Kazuya YOSHIMOTO, Masafumi ...
    1989 Volume 31 Issue 2 Pages 479-482_1
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    A 64-year old man was admitted to Tokyo kyosai Hospital with complaint of anal bleeding. Colonoscopic examination with biopsies showed a small cancer of IIa + IIc type in the sigmoid colon. On April 30, sigmoidectomy was performed. Neither liver metastasis nor lymph node metastasis were observed. On histology the tumor was small early cancer of IIc + IIa type, 8mm in size and an elevated area around the depression was formed by cancerous tissues invading the submucosal layer. Most part of cancerous tissues were present in the submucosal layer. Normal colonic mucosa was adjacent to cancerous tissue and adenoma component was not present neither in the tumor tissue nor in an area between normal colonic mucosa and the cancerous tissue. These findings suggest that this case is a de novo cancer.
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  • Toshikazu SUWA, Susumu HIRAKATA, Tadatoshi SATOH, Kazuya HAYASHIDA, No ...
    1989 Volume 31 Issue 2 Pages 483-489
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    The choledochof iberscope is an essential instrument for treating stone in common bile duct. However, conventional choledochofiberscopy have not been always good against the stone incarcerated at the distal part of the common bile duct or the large stone in the choledochus. We would like to present our newly devised instrument that is expected to be much better because of its much improved function of gripping and crashing the stone. Rough specifications of the instrument are as follows : Outer Diameter ; 6.2 mm Total Length ; 610 mm Forceps ; Located on the tip of the instrument Image guide, light guide and waterfeed hole ; located in the center. From Oct. 1986 till Feb. 1988, 17 cases of stones in common bile ducts were treated with this instrument. Patients consisted of 8 men and 9 women respectively, and average age was 65 years. The average diameter of stone was 12 mm. Three cases of gall stones of which sizes were over 20 mm in diameter were also treated with this instrument. Intraoperative lithotomy was carried out in 15 cases. Two cases were treated through Percutaneous Transhepatic Cholangial Catheterization (PTCC). Lithotomy was successfully performed with no complications in all of the 17 cases. This instrument was so designed as to increase in gripping force by applying bigger forceps. The stone with hardness equivalent to a piece of white chalk could be broken. The instrument will be clinically useful in that the lithotomy can be safely performed both percutaneous transhepatically and intraoperatively. This instrument was developed by FUJI PHOTO OPTI-CAL CO., LTD.
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  • Toshihiko MATSUMOTO, Toshihiko MURASE, Kunihiko KA, Miyako IIDA, Fumik ...
    1989 Volume 31 Issue 2 Pages 490-495
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
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    As pretreatment for colonoscopy, we performed a combination method in the aged examinees (over 70 years old) with sodium picosulfate (SP) and nonabsorbable nonsecretory intestinal oral polyethelene glycol electrolyte lavage solution (PEG lavage solution) and evaluated its usefulness in terms of simplicity, safety and colon cleansing effect. This SP-PEG combination method reduced the time required for pretreatment, time for drinking the PEG lavage solution and the number of defecation, and highly appreciated by the examinees. In addition, this method was overwhelmingly preferred at the time of reexami-nation. The incidence of accompanying subjective symptoms was slightly high, but all of them were very mild. Examination of blood showed significantly small and clinically negligible changes in the hematocrit and serum osmolarity. Endoscopy demonstrated a good cleansing effect on the colon, which was apparently better than those of conventional Brown's method. In respect of simplicity and safety, this SP-PEG combination method seems to be useful especially in the aged examinees. Moreover, because the colon cleansing effect is excellent, this method is highly recommended as pretreatment for colonoscopy.
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  • [in Japanese]
    1989 Volume 31 Issue 2 Pages 496-508
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Download PDF (2052K)
  • [in Japanese]
    1989 Volume 31 Issue 2 Pages 508-522
    Published: February 20, 1989
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Download PDF (2410K)
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