In order to know the mechanism of the peptic ulcers and other gastric mucosal lesions which frequently occurred in patients with liver cirrhosis, serum and gastric mucosal pepsinogen I (PGI) levels, gastric acid secretion and peptic activity were measured as the aggressive factors on the gastric mucosa in cirrhotic patients. Moreover, endoscopic examination and biopsy were performed to observe gastric mucosa. Serum and mucosal PGI levels and gastric peptic activity were significantly lower, and gastric acid secretion tended to be lower in cirrhotic patients than in the control group. The atrophic types of the gastric mucosa in the cirrhotic patients were considered rather milder than those of the control group. Gastric mucosal flecky redness and edema were frequently observed in cirrhotic patients and the marked interstitial edema and dilatation of the capillaries were his-tologically observed. Those morphological findings suggest some relationship to the disturbance in gastric secretion. In comparison to the cirrhotic patients with no ulcer, the cirrhotic patients with gastric ulcers showed a tendency of higher value in gastric acid secretion and in serum PGI levels, and the cirrhotic patients with duodenal ulcers showed definitely higher value with statisti-cal significant difference. These results suggest that the manifestation of peptic ulcers in liver cirrhosis also correlates to the gastric mucosal aggressive factors.

View full abstract

We conducted a prospective randomized trial to compare the efficacy of endoscopic injection sclerotherapy and oral propranolol in the prevention of recurrent variceal hemorrhage. All of 102 patients had recent variceal hemorrhage which had been proven by endoscopy at Taipei Municipal Jen-Ai hospital from Jan. 1986 to Apr. 1988. No selection was made with regards to the severity of the hepatic diseases. The two groups (54 sclerotherapy, 48 propranolol) were similar in demographic, clinical and laboratory data. Sclerotherapy was performed weekly using 2% sodium tetradecyl sulfate as the sclerosing agent until the varices were eradicated. Propranolol was given twice daily at a dose reducing the resting heart rate by 25% (60-280mg per day; mean±SD=138±60 mg per day). The cumulative percentages of patients free of recurrent variceal bleeding 1 and 2 years after inclusion were 80% and 66.5% in the sclerotherapy group and 69.2% and 41.7% in the propranolol group. The difference between the two groups were not significant in lyear, but was statistically significant in 2 years (P<0.01). In remarkable Red Color Sign (RCS) or Child's A and B patients, sclerotherapy was more effective than propranolol in preventing rebleeding, but in mild RCS or Child's C patients, sclerotherapy and propranolol was not significantly different. The cumulative percentages of surviving patients 1 and 2 years after inclusion were 85.2% and 70.2% in the sclerotherapy group, and 76.8% and 60% in the propranolol group ; both differences were not significant. Esophageal ulcer due to sclerotherapy was observed in 12 patients and esophageal stricture in 2. One hepatic encephalopathy and one cardiac failure occurred in the propranolol group. Other complications of sclerotherapy and side effects of propranolol were minor. All of the mortality cases were not associated with propranolol or sclerotherapy. Therefore, we conclude that sclerotherapy was more effective than propranolol in the prevention of variceal bleeding, especially in patients with compensated liver diseases and RCS on varices.

View full abstract

To understand the ultrasonogram of normal gastric wall by EUS, ten stomachs which were resected for gastric cancer were studied by EUS and by histological method. To confirm the correspondence between the two examinations, pinning was applied (Figure 1). The results were as follows ; 1) In all cases, five layers were visualized in the normal gastric wall by EUS (Figure 15). The first layer corresponded to the border echo and the proper mucosal layer (Figure 2, 3), the second one was the proper mucosal layer and the muscularis mucosae (Figure 4, 5). The third layer was the submucosal layer (Figure 6), the fourth was the muscular layer (Figure 7). And the last fifth layer included the subserosal layer, serosa and the border echo (Figure 8, 10). 2) An echogenic thin layer in the fourth layer was frequently seen at cardia and C-site (Table 1). Its echo-source was considered to be the border of the two muscle layers and/or connective tissue between them (Figure 11-14). 3) Next, studies were made on the thickness of the five layers delineated by EUS at four portions of the stomach, i, e. cardia, C-site, M-site, and A-site. The thickness of the first and the second layer of each site was almost equal. The third layer of cardia and A -site of lesser curvature was thicker than that of the other sites. The fourth layer of cardia and C-site was thicker than that of the other site. The fifth layer of lesser curvature was thicker than that of greater curvature (Table 2, 3). 4) The third layer of fixed stomach was delineated thicker than that of fresh one, and the fourth layer of the fixed one was delineated thinner than that of the fresh stomach (Table 4, 5).

View full abstract

Cigarette smoking is known to be associated with a high incidence of peptic ulcer and delay in ulcer healing. However, the mechanism is still obscure. We have reported that cigarette smoking caused a decrease in the gastric mucosal blood volume index and mucosal blood oxygenation in smokers. In this double blind study, the effects of PGEI analog (misoprostol) and cimetidine on gastric mucosal hemodynamics after cigarette smoking were investigated using reflectance spectrophotometry. Eighteen volunteers were fasted overnight, and either 200, ug of misoprostol, 200mg of cimetidine or placebo was administered orally. The spectra were taken from the mucosa of the lesser curvature of the lower corpus every 5 min for 20 min after drug administra-tion. Thereafter, five puffs of a cigarette smoking were taken. The spectra were taken after each puff, and at 5 min and 10 min after the fifth puff. The indices of gastric mucosal blood volume and oxygen saturation of hemoglobin were calculated from the spectrum. The average percent decrease of gastric mucosal blood volume and gastric mucosal oxygen saturation of hemoglobin after smoking were, respectively, -9.2±2.9%, -9.4±2.7% in placebo group, -5.9 ± 0.9%, -9.0 ± 0.9% in cimetidine group. Because misopros-tol prevented completely smoking-induced decrease of gastric mucosal blood volume and oxygen saturation of hemoglobin (average decrease= -0.8±5.5%, +3.3±3.4%), miso-prostol maintained the gastric mucosal blood volume during smoking. In conclusion, cigarette smoking decreases the gastric mucosal blood volume index and mucosal oxygenation, but pretreatment with a PGEI analog, misoprostol, prevents this smoking-induced decrease.

View full abstract

We observed 3 cases of fresh gastric ulcers after strip biopsy and 29 lesions (26 cases) of chronic gastric ulcers. Their stages were defined by Sakita-Miwa's classification, using TV-Endoscope prepared by Toshiba and Machida (TGS-50D, TGI-50D and TGS-50B) and the developing process of regenerated epithelium at their margins was examined. On the healing process of chronic gastric ulcers, a red thin layer consisted of immature regenerat-ed epithelium is originated from the normal mucosa contiguous to the ulcer and then expanding into the center of the ulcer on A2 stage. Subsequently spindle-like and palisadelike regenerated epithelium appears just outside of the red thin layer, adjacent to the normal mucosa on A2 and H1 stage. They are growing in the center of the ulcer on H2 and S1 stage, and transform to the cobble stone-like regenerated epithelium from the distant part of them. The ulcer is covered with cobble stone-like regenerated epithelium up to the center, and its flare fades or disappears on S2 stage. Except for the red thin layer, the spindle-like epithelium is considered to be the most immature regenerated epithelium, and it is suspected that it transits to palisade-like and cobble stone-like epithelium. Although in recurrent gastric ulcers, even on Al or A2 stage spindle-like, palisade-like or cobble stone-like regenerated epitheliums are found around the ulcer margin, where wedge -shaped flare can be observed. This finding is characteristic of recurrent ulcers, and TV -Endoscope enables us to observe such fine structures. Therefore, TV-endoscopy is a valuable method to distinguish recurrent ulcers from fresh ulcers.

View full abstract

We observed enlarged-vascular fluoroscopic patterns which were frequently observed in the duodenal cap, and obtained the following results. 1) The vascular fluoroscopic patterns were greatly varied depending upon air volume, and visualized markedly by large amount of air. 2) When vascular fluoroscopic regions are observed by magnification, blood vessels were visualized in the intervillous spaces, but not visualized on the tip of the villus. 3) When air is gradually removed, intervillous spaces were also gradually narrowed, subsequently blood vessels were not visualized. On the contrary, when gradnally inflated again, intervillous spaces were gradually increased, subseqnently blood vessels were visualized again. 4) As for villous shape, blood vessels were easily observed in the finger shaped villus and there is a difficulty to visualize in the convoluted villus, and no tendency was noted between leaf shaped and ridge shaped villi 5) The vascular floroscopic patterns were not observed around and at lesions such as duodenal ulcer (including scar and ridge), duodenitis with hyperemic and erosive types. As mentioned above, it was considered that vascular fluoroscopic pattern is one of the normal findings without reflecting the existence of inflamnatory disease.

View full abstract

To evaluate the structure of ascending portosystemic shunts in the mediastinum of patients with portal hypertension, we investigated 27 patients (12 with liver cirrhosis, 8 with hepatocellular carcinoma, 3 with chronic hepatitis, 2 with extrahepatic portal obstruction, 1 with idiopathic portal hypertension and 1 with Budd-Chiari syndrome) and 10 controls using an ultrasonic endoscope (EUS, OLYMPUS GF-UM2/EU-M2, a radial type scanner with a frequency of 7.5 MHz). The severity of esophageal varices was simultaneously examined endoscopically.EUS and endoscopic observations were analyzed, with the following results : 1) The azygos vein was recognized as an anechoic lumen located between the posterior esophageal wall and the vertebra at the mid-thoracic level. The cross-sectional area in patients with liver diseases was larger than in controls, with statistical significance. 2) The cross-rection of the azygos vein was usually elliptical in controls while tending to be closer to round in patients with liver diseases. (The difference was statistically significant between controls and patients with liver cirrhosis.) 3) There was a tendency for a positive correlation between the severity of paraesophageal varices and that of esophageal varices. Several patients, however, showed severe pare-esophageal varices with only moderate or without esophageal varices. 4) There was no correlation between the severity of the collateral veins above the azygos arch (which we call "supra-azygos veins" in this paper) with the severity of the esophageal varices. In conclusion, EUS is useful in observing the paraesophageal varices and azygos vein especially in patients with portal hypertension who do not have esophageal varices.

View full abstract

In order to evaluate the diagnostic significance of liver surface fluorescence after intravenous injection of fluorescein, we performed fluorescence laparoscopy in patients with various liver diseases. In cases of non-specific reactive hepatitis, the fluorescence initially appeared in the portal area and gradually spread in the lobules toward the pericentral area. The fluorescent patterns which became apparent on the liver surface at an early stage indicated the shapes and distibution patterns of the portal area. Fluorescence laparoscopy enabled us to identify the small artery. After fluorescein injection, the whitish markings were recognized as bright fluorescent area, whearas the reddish markings showed non-fluorescent area ; in many cases the contrasts were clearly distinct copared to the ordinary laparoscopic observations and to the observations after intra-venous injection of ICG. In cases of liver cirrhosis, bright fluorescence were seen in dilated lymph vessels. The duration time, from the starting of the intravenous injection of fluorescein to its appearance on the liver surface, appeared to be faster in cases of chronic active hepatitis, and slower in cases of liver cirrhosis, compared to non-specific reactive hepatitis. From the above results, it is suggested that observations of liver surface fluorescence after intravenous injection of fluorescein are useful for diagnoses of liver diseases.

View full abstract

Recently, it has been reported that Campylobacter pylori (CP) infetion is occasionally associated with gastroduodenal diseases. The mechanism by which CP may cause gastroduodenal mucosal damage, however, is still obscure. The mucin of the gastric mucosa has been recognized as the first defensive factor which can prevent the gastroduodenal mucosal damage. In this study, the content of intracellular PAS-alcian blue (PAS-AB) positive substance was analyzed using the computer-assisted image analyzing system. Two biopsy specimens from the antrum and body, respectivelly, were obtained from 36 patients who had endoscopically normal gastric mucosa. One of the specimens was examined microscopically and microbiologically to detect whether there were any colonies of CP in the specimens. The other of specimens was stained with PAS-AB, and the index of the content of PAS-AB positive substance, which depicts the ratio of PAS-AB positive area to the area of mucosal surface epithelial cell, was calculated. In CP positive subjects, the index of PAS-AB positive substance of the antral mucosa was significantly smaller than that of the body mucosa, while in CP negative subjects, there was no significant difference in the index of PAS-AB positive sustance between the antral and body mucosa. The result suggests that in the presence of CP, the mucin content in the antral mucosa decreases significantly and that the mucosal deffensive mechanism might be weakened in antral mucosal damage induced by CP.

View full abstract

Epitheloid cell granuloma is the most characteristic finding in Crohn's disease. We performed a retrospective analysis of biopsied specimens obtained under direct vision through fiberoptic colonoscopy to clarify the relationship between the incidence of granulomas and the variety of endoscopic findings. Biopsies were performed from 221 colorectal lesions (57 patients). All biopsies were serially sectioned at 4pm, 50 sections per specimen and were stained with H & E. Endoscopic findings were classified into 6 groups, which consisted on active major lesions (cobblestone appearance and large ulcers), active minor lesions (small and/or aphthoid ulcers), remitting major lesions (pseudopolyposis), remitting minor lesions (small scar), normal-appearing colonic and rectal mucosa. Granulomas were found in 67 (80%) of the 84 active major lesions and in 36 (75%) of the 48 active minor lesions. The incidences of granulomas in biopsied specimens obtained from major and minor lesions in remission endoscopically were 65% (28/43) and 25% (3/12), respectively. On the other hand, 63% (5/8) and 54% (14/26) were positive for granulomas in biopsied specimens obtained from normal-appearing colonic and rectal mucosa. As regard the number of granulomas, active lesions had more. Granulomas in active major lesions were located in both mucosal and submucosal layers, but granulomas in the 5 other groups were located mostly in mucosal layers. There was no significant association of granulomas from normal-appearing rectal mucosa with the presence of perianal disease, location of major lesions or systemic disease activity. Consequently, high incidences of granulomas in biopsied specimens even from remit-ting or normal-appearing mucosa were observed. It is suggested that granulomas may be always present in Crohn's disease and colorectal mucosa of Crohn's disease may be always exposed to etiologic agent (s) even in remitting or normal-appearing mucosa.

View full abstract

Recently, early gastric cancer patient in whom gastrectomy was not possible for some reasons has been endoscopically treated. We compared 25 lesions of early gastric cancer treated by laser with 19 ones treated by microwave. The recurrence rates after laser therapy were small in elevated lesions, lesions smaller than 1cm in diameter, differenciated adenocarcinomas, and intramucosal lesions, respectively. On the other hand, some of the above mentioned lesions treated by microwave have reccured, but some of depressed lesions, lesions larger than lcm in diameter, undifferenciated adenocarcinomas, and submucosal lesions treated by microwave have not been recurrent. To clarify the difference between the two methods, we histopathologically investigated the resected specimens after laser or microwave therapy. The main cause of the recurrence after laser therapy was thought to be insufficient laser effects at the margin of the lesion, and on microwave therapy, insufficient effects were shown at the margin of lesion but also in the coagulated field. Furthermore, 11 lesions of gastric cancer were treated by endoscopical local hyperthermia using Nd-YAG laser. Two of the 11 lesions were advanced gastric cancers, which were treated by laser hyperthermia with chemotherapy. As the result, laser hyperthermia only was unsuccessful to eradicate early gastric cancer. It was thought that the exact plane temperature in the stomach could not be adequately measured by a single thermister and the effective heat sensitivity in early gastric cancer might not be achieved all the time. But laser hyperthermia after polypectomy or other coagulation methods might decrease the recurrence rate, and laser hyperthermia with chemotherapy showed a remarkable partial responce in the treatment of advanced gastric cancer.

View full abstract

Background factors and healing process of intractable gastric ulcers which were resistant to various anti-ulcer drugs including H₂-blockers were studied in comparison with tractable gastric ulcers. Effectiveness and adverse effects of H₂-blockers on intractable gastric ulcers were also investigated. Male was predominat in both types of gastric ulcers. Male to female ratio in intractable gastric ulcers 6/1 whereas that in tractable ones was 2/1, respectively. No significant differences between the two types of ulcers were found in the age distribution, location, number, endoscopical findings of gastric ulcers, presence or absence of duodenal ulcers, and other complications. However, ulcers at the gastric angle, with surrounding edge or with complications were relatively predominant in intractable gastric ulcer group. H₂-blockers did not seem to significantly affect the healing process of intractable gastric ulcers although the curerate increased when these ulcers were treated with different types of H₂-blockers instead of a single one. As an adverse effect of H₂-blockers, a higher incidence of candida infection that may contribute to ulcer persistence progression was found in intractable gastric ulcers and careful use of these drugs, especially, in intractable gastric ulcers is suggested.

View full abstract

Endoscopic ultrasonography (EUS) was performed in 9 cases with untreated malignant lymphoma (non-Hodgkin lymphoma ; 8, cutaneous T-cell lymphoma; 1 case). Proven gastric involvement was observed in 3 patients, EUS could detected all. Tumor was presented as hypoechoic area with the destruction of normal layer-structure and involved gastric wall was thickened diffusely or lumpily to 8 mm or more. At tumor periphery, EUS shows a broken third layer. Swollen lymph nodes of mediastinum and/or upper abdomen were detected with EUS in 6 patients. Proven or possible lymph node lesions in three patients were presented as inhomogeneous hypoechoic areas which showed generally in round shape. The size of most of them ranged from 5 to less than 20 mm in diameter. However, similar findings were noted in one false positive case with non-involved lymph nodes. In the follow-up of 4 patients after chemotherapy, EUS revealed the reduction of wall thickness and the reappearance of layer-structure for gastric lymphoma. The decrease in the size and number or the disappearance of involved lymph nodes were also seen. EUS was useful in staging or follow-up after chemotherapy and could provide the further information.

View full abstract

A 66-year-old-male, who had undergone partial gastrectomy for gastric ulcer 15 years before, was examined for anemia at another hospital and was found out carcinoma of the esophagus. The patient was admitted to our ward for operation. Esophagram showed a superficial, elevated lesion with slightly irregular surface of contiguous epithelium in the upper-middle third of the esophagus (Figure 1). Endoscopic findings showed a superficial elevated lesion with intraepithelial extention which was clearly unstained by iodine (Figure 2-a and 2-b). And also revealed scattered unstained area in the aboral and aboral side of the main lesion (Figure 2-c and 2-d). Subtotal esophagectomy was performed for multiple esophageal cancers. Macroscopic examination of the surgical specimen showed an annuler superficial elevated lesion contiguous with erosive epithelium in the upper third of the esophagus, and slight, longitudinally spreaded, epithelial irregularity and erosion in almost all the resected esophagus (Figure 3). Microscopic findings showed well differentiated squamous cell carcinoma which invaded to submucosal layer with intraepitherial extention and carcinoma in situ which were scattered in the widerspreaded dysplastic epithelium with some inflammatory change (Figure 4 and 5). This case indicated close relation with carcinoma and dysplasia of the esophagus, and suggested that continual stimulation of esophagitis after partial gastrectomy worked on the mechanisms of carcinogenesis.

View full abstract

A 35-year-old woman was admitted to our hospital for the evaluation of refractory peptic ulcer. She was diagnosed to have Zollinger-Ellison syndrome by the high levels of serum gastrin in basal and secretin tests, and by the high acid secretion. Ultrasonography, CT and celiac arteriography did not show any pathological findings. The gastroduodenal endoscopy, however, revealed a polyp in the 2nd portion of the duodenum. The polyp was pedunculated, approximately 1 cm in diameter and umbilicated at the top. Endoscopic polypectomy was performed. The histological examination revealed a carcinoid tissue invading the mucosa and submucosa. The tumor cells contained fine argyrophillic granules and showed a positive reaction to anti-gastrin serum by PAP method with immunoperoxidase staining. Gastrin granules were found in the tumor cells by electronmicroscopy. One day after polypectomy, the serum gastrin level returned to normal. Laboratory examination also demonstrated hypercalcemia and increased serum parathyroid hormon, which were improved by removal of adenoma of the right parathyroid lobe. No abnormal findings were obtained in the pituitary gland. Among her family members, a case with carcinoid tumor of the duodenal cap and three cases with hypercalcemia were found.

View full abstract

A case of 77 years-old female with early cancer of the papilla of Vater was reported. She experienced sudden onset of right hypochondralgia, and abnormal high level of white blood cell count and hyper amylasemia was observed. Hypotonic duodenography, duodenoscopy and ERP suggested a tumor of the papilla of Vater. Biopsy specimen showed the severe atypism from which carcinoma could not be ruled out. From suspect of carcinoma of the papilla and its invasion to the pancreas, the surgical operation (pan-creaticoduodenectomy) was done. Macroscopically this tumor was about 10×12×14mm in size and appeared to be originated from the papilla of Vater with infiltration to the main pancreatic duct. Histologically the greater part of this tumor was recoginized as the carcinoma and the smaller part of adenoma was observed near the orifice of the papilla, which showed the highly cellularity and structural atypism whthin the Oddi's sphincter. The histological transition from adenoma to adenocarcinoma was considered. In conclusion, this tumor would be regarded as the early cancer of the papilla of Vater.

View full abstract

A 62-year-old male was admitted to the hospital because of dysphagia with the duration of about 4 months. He was diagnosed as eaophageal cancer and received radiation therapy. After radiation of 1, 400 rails to the epigastrium, including a part of the left lobe of the liver, the abnormality of liver function test was detected. The liver scintigrams after the radiation of 6, 000 rails showed defect of the left lobe corresponded with irradiated area. Laparoscopic examination and liver biopsy were parformed. Right lobe of the liver showed smooth surface with almost normal color. In contrast, the capsula of the irradiated left lobe became turbid, thickened, and hard with red-brown discoloration. And, atrophic surface of the lower left lobe was observed as white band, but a part of the left lobe out of the radiation field had smooth surface. Histology of the right lobe showed almost normal, but that of the irradiated left lobe area showed distortion of hepatic cell cords, degeneration and atrophy of hepatic cells and fibrosis of Glisson's capsule. Histologic findings were compatible with laparoscopic findings, and we concluded laparoscopic examination was valuable in the diagnosis of radiation hepatitis.

View full abstract

A 46-years-old man who had history of alcohol intake for 16 years was admitted to our hospital, because of nausea, vomiting, general fatigue, anorexia and jaundice. The labora-tory data on admission revealed alcoholic liver disease. A laparoscopic examination on 20th hospital day showed yellowish-white small nodules in left lobe of liver with findings of alcoholic liver cirrhosis. The small nodule was too firm to perform liver biopsy. An open liver biopsy was done on 42nd hospital day. Histological features of liver biopsy specimen showed that the nodules were composed of foamy cell and coagulation necrosis without infiltration of lymphocyte, plasma cell and f ibroblast, therefore diagnosis of xanthoma of liver was made. It was supposed that the origins of xanthoma was he-patocytolysis and cholestasis by alcoholic hepatitis or circulatory failure in pseudolobule of alcoholic liver cirrhosis, in addition to local derangement of cholesterol metabolism.

View full abstract

A case of arteriovenous malformation (AVM) of the colon was reported. A seventy four-year-old woman was admitted to our hospital, complaining of vertigo associated with anemia. No bleeding source could not be detected by barium meal examination, upper GI endoscopy and barium enema. A bleeding from the clusters of dilated tortuous vessels at the transverse colon were finaly found by colonoscopy. AVM was clearly visualized by the superior mesenteric arteriography and confirmed by histological examination of the resected colon. In the Japanese literatures, 41 cases of colonic bleeding due to AVM were reported and 33 cases of them were examined by colonoscopy. AVM of the colon was endoscopically confirmed in 24 of these 33 cases. Colonoscopy was considered to be an important diagnostic investigation of AVM of the colon.

View full abstract

A 51 year old man was admitted to our hospital due to abdominal pain and hematochezia. Barium enema examination, colonoscopic examination and colonoscopic biopsy specimen were consistent with diagnosis of ulcerative colitis in the left colon and rectum. Blood chemistry showed increased levels of serum pancreatic enzymes. ERP demonstrated irregular narrowing of the main pancreatic duct with mild irregularity of the branches in the body of pancreas. After medication of salazosulfapyridine, the symptom disappeared soon and serum pancreatic enzymes decreased gradually to normal. One year after the admission, ulcerative colitis subsided and the findings of subsequent barium enema and ERP became almost normal. Concomittant changes of serum pancreatic enzymes, barium enema and ERP suggest that pancreatitis associated with ulcelative colitis is one of the complications of the latter disease.

View full abstract

A case of mefenamic acid induced colitis associated with multiple ulcers in the terminal ileum was reported. A 52-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) 1.5 g/day for past 8 years. Colonoscopy revealed aphthoid colitis and multiple hemorr-hagic ulcers in the terminal ileum. Biopsy specimens taken from the surroundings of these ulcers demonstrated marked round cell infiltration in the submucosa accompanied by proliferation of lymph follicles. Mefenamic acid was immediately discontinued after admission. The colitis healed on the 24th hospital day and the multiple ulcers scarred on the 70th hospital day. After discharge he took mefenamic acid again. He then developed diarrhea and abdominal pain. Colonoscopy revealed the relapse of aphthoid colitis. Therefore, mefenamic acid was considered as the cause of aphthoid colitis and multiple ulcers in the terminal ileum.

View full abstract

Therapeutic dilation was performed endoscopically using a balloon dilator on a Crohn's disease patient with stricture of the sigmoid. The patient was a 29-year-old man who developed Crohn's ileitis in 1973 at age 16. In May 1975, he underwent resection of the ascending colon and ileocecum with an end-to- end anastomosis. In July 1987, he was admitted for aggravated inflammation and occlusive symptoms of the sigmoid. When the symptoms were alleviated by anti-inflammatory therapy and ED therapy, dilation of three strictures of the sigmoid was performed using a balloon dilator. No remarkable effect was observed radiologically but endoscopic examination seven months later showed definite dilatation of strictures allowing easy passage of the endoscope. This dilation was attempt-ed for the first time in Japan and very few cases have been reported from the Western countries. Consequently, the long-term effectiveness of this dilation is not definite, but this method is considered worth trying if it is applicable before surgical resection as the only means to reserve surgical resection to be the last measure from the point of view of preserving the intestinal tract. The dilator used was the MICROVASIVE RIGIFLEX TTS Balloon Dilator made in U. S. A. The external balloon size at dilatation was 18 mm, balloon length 30 mm and maximum pressure 35 PSI.

View full abstract

Answers of questionaire concerning AGML induced by upper G-I endoscopy were obtained from 172 hospitals in Japan. From 1982 to 1986, 402 cases of AGML induced by endoscopy were reported, which corresponded to 0.02 % of all upper G-I endoscopic examination. An analysis was made on 307 cases. in which the detail data were obtained, and the results were as follows : (1) The most frequently affected age was the fifth decade and 70 % of patents were males. (2) Main symptoms were severe epigastric pain, nausea & vomiting and haematemesis. The most frequent complaints were epigastric pain (90.3%). (3) The mean duration between previous endoscopy and onset of symptoms were 5.8± 2.9 days, and 72.2 % of the patients felt abnormalities after 4 to 7 days. (4) Endoscopic findings were acute multiple ulcers and acute ulceroerosions in 243 patients (79.1%) and acute haemorrhagic erosions in 64 patients (20.9%). And most of the lesions were found in the gastric antrum. (5) 155 of 307 patients showed no abnormalities at the initial endoscopy and 250 were without concurrent illness.

View full abstract