In order to elucidate the characteristics of juvenile chronic gastritis (JCG), the relationship between gastric mucosal changes and extra-gastric irritating factors (bile reflux and gastric pH) or autoimmune factor (parietal cell antibody: PCA) was studied in juvenile and senior patients with acute and chronic gastritis. Out-patients with gastritis were divided into two groups according to age ; one was 47 cases aged 30 y, o. or younger (juvenile group) and the other 66 cases over 30 y. o. (senior group) and each group was classified by endoscopic findings; i. e., chronic gastritis, acute gastritis and normal subjects.
In senior patients with chronic gastritis (SCG), the levels of total bile acids in gastric juice were significantly higher than those in normal subjects (683.9 ± 305.1 vs 27.0 ± 0.9 M), and the most prominent histological changes were atrophy and intestinal metaplasia. The JCG was not significantly affected by bile reflux and gastric pH, but the positive ratio of PCA in JCG (77%) was significantly higher than that in SCG (40%) (p<0.05). Histological-ly, JCG had a lower frequency of atrophic changes and a higher frequency of hyperplastic chagnes (p <0.05) than those in sensior group. In JCG, there were 5 patients with gooseflesh like gastritis, and 4 of them had PCA.
In conclusion, the characteristics of JCG were high positive ratio of PCA, and hyper-plastic changes of gastric mucosal tissues. These findings suggested an autoimmune mechanism nature of JCG and extra-gastric irritating factors were not playing an major important roles in JCG.

View full abstract

This report presents a new method of endoscopic hemostasis with gelatin solution (GS); 1g gelatin powder (Gelfoam) in 30ml of 20% glucose. GS injected into the submucosal layer compresses bleeding vessels of the submucosal layer. In an experimental canine model, safety of this method was comfirmed by histological examination a week after injection of GS revealing no mucosal injury or inflammatory change of the submucosal layer. This hemostatic method was attempted in 24 patients with UGI bleeding (gastric ulcer, 16; duodenal ulcer, 3; telangiectasia, 5;) and 21 patients with LGI bleeding (polypectomy stump, 6; telangiectasia, 2; bleeding polyp, 2; dilated vein, 3; hematocyst, 2; diverticulum, 1; ulcer, 4; malignant lymphoma, 1). Twenty four patients with UGI bleeding and 10 patients with LGI bleeding required blood trasf usion because of marked bleeding when hemostasis was attempted. Complete hemostasis was achieved in 24 patients (100%) with UGI bleeding and in 20 patients (95%) with LGI bleeding. Rebleeding occured in 1 patient with malignant lymphoma of the rectum within a month of hemostasis. Four patients with LGI bleeding, 1 patient with malignant lymphoma and 3 patients with ulcerative colitis were electively operated on following hemostasis. No serious complica-tions were encountered during and after hemostasis. No ulcer was induced at the site where GS was injected. Endoscopic ultrasonography was performed in 3 patients and revealed complete disappearence of GS within two months of hemostasis in all patients without sequela. It is, therefore concluded that endoscopic hemostasis with GS is an ideal, easy method for GI bleeding compared with other endoscopic techniques.

View full abstract

For the diagnosis of chronic liver disease, peritoneoscopic findings of liver surface image are as important as histopathological findings of liver biopsy, especially when the lesions become coarse and inhomogeneous with the progress of the disease. The peritoneoscopic findings, however, tend to depend at least somewhat upon operator's experience, and it is sometimes difficult to obtain objective and quantitative findings.
In the present paper, we studied computer image processing of 2-dimensional Fourier transform, in order to get more objective and quantitative findings of liver surface structure taken by electroperitoneoscopy. After the shading correction of peritoneoscopic image, image data was converted to power spectrum by 2-dimensional Fourier transform. Converting the resulting data to polar coordinate system, spatial frequency was extracted and the frequential distribution of liver surface particle was calculated. Then, the scale calibration was carried out, and the distribution of particle length was obtained.
For the basal approach to check the analyzing procedure, we first used the liver surface particle models, one type of which was made of red sphere particles and was photographed by peritoneoscope, and another type of which was drawn by computer simulation. Secondly, we analyzed clinical liver surface image taken by peritoneoscopy.
The results of model examination indicated that the particle frequency and the particle length obtained by this analyzing method had a good correspondence with the practical value of the particle in each model. In the analysis of clinical image of liver cirrhosis, particle element reflecting the size and distribution of liver surface nodule was detected. We considered that this method was useful to obtain objective and quantitative findings of liver surface image.

View full abstract

Diagnotic efficacy of endoscopic ultrasonography (EUS) using a 7.5 MHz electro linear array ultrasonic endoscope was performed on 82 patients with chronic pancreatitis based on the clinical criteria for chronic pancreatitis of the Japanese Society of Gastroenterology (36 cases of the first group, 26 cases of the second group and 20 cases of the cliniclly suspected group), and 14 cases without chronic pancreatitis including 2 cases with diabetes meritus.
EUS could demonstrate the whole pancreas with high resolution via the upper gastrointestinal wall. Parenchyma of the pancreas were classiffied into 4 patterns ; ‹spotty high›, ‹linear high›, ‹patchy high›, and‹diffuse high›. The diffuse high pattern, additionaly, was divided into 2 groups, which are type A and type B. As the patients with ‹spotty high› pattern were revealed clinically slight disorders of pancreatic functions, it was concluded that this pattern presented the minimal changes in the pancreas. On the other hand, the patients with ‹diffuse high ; type A› pattern were in the advanced state of chronic pancreatitis. ‹Diffuse high ; type B› pattern was considered to demonstrate fatty change in the pancreas. ‹Linear high› and ‹patchy high› patterns were considered to be intermediate or trandient pattern between ‹spotty high› and ‹diffuse high ; type A›, which presented the varied changes in the pancreas due to chronic inframatinn.
EUS was superior to other diagnotic modalities including conventional ultrasonography in the diagnosis of chronic pancreatitis.

View full abstract

Psychological distress was studied in patients who underwent endoscopy due to abnormalities in barium meal study by the preventive health check (Automated health testing and service, AMHTS). The patients who had non-ulcer or non-malignant disease were subject to this study. Thus, gastrointestinal complaints of the examinees were compared before and after endoscopy was indicated, and psychological test (STAI test by Spielberger) was performed just before endoscopy. Results disclosed that patients' com-plaints increased after endoscopy was indicated. Psychological test showed that the strength of state and strait anxiety correlated with the number of GI complaints just before endoscopy. The state anxiety was stronger in the patients who experienced endoscopy for the first time. Thus, we should care the psychological aspect of patients when we perform endoscopy safely, and should explain to the patients carefully how and why the endoscopy is performed when we indicate the examination.

View full abstract

There are two main procedures of endoscopic manometry for sphincter of Oddi, such as opentip method appling low compliance infusion system and microtip method using a microtiptransducer. Comparative studies were performed between opentip method vs. microtip method and general anesthesia vs. local pharyngeal anesthesia for patients with various diseases. Basal pressure and pressure at contraction of the sphincter of Oddi showed lower in the microtip method than opentip method and there was a significant difference in the pressure at contraction (P<0.01). On the other hand, basal pressure and pressure at contraction of the sphincter of Oddi obtained under general anesthesia showed a tendency to be lower than those measured under local anesthesia.
It is suggested that endoscopic manometric studies of the sphincter of Oddi using the opentip method under local anesthesia is more suitable for evaluating the actual function of. the sphincter of Oddi.

View full abstract

A case of early gastric cancer which was difficult to make differetial diagnosis between benign and malignant lesion after endoscopic irradiation was reported.
A 81-year-old male with early gastric cancer (IIc) at the prepylorus was treated by endoscopy due to severe cardiac failure. The ulcer after laser irradiation was treated with cimetidine, sofalcone and pirenzepine. Endoscopic finding showed two abnormal reddish polypoid elevations with converging folds 4 months after Nd: YAG irradiation. Mucosal appearence of the elevations was reddish and slightly roughsurfaced, but smooth-surfaced mucosa. Endoscopic polypectomy was carried out for the elevation to make accurate diagnosis. Histopathological finding was hyperplastic polyp and we concluded an elevated type, gastric ulcer scar induced by endoscopic treatment. It was suggested that this lesion developed from the interaciton between H₂ blocker and endoscopic laser treatment.

View full abstract

A 68-yaer-old man was admitted to our hospital with general fatigue. Laboratory findings on admission showed a slight anemia and occult blood in stool. Barium meal study and endoscopy of G. I. tract revealed a tumor on the posterior wall of the gastric body and a submucosal tumor like lesion with large central ulceration in the second part of the duodenum. A diagnosis was made as sarcoma of the duodenum with gastric carcinoma. Endoscopy and biopsy were the most useful diagnostic procedures in our case.
Total gastrectomy and partial duodenectomy were performed. The resected specimen showed a wide spreading depression and elevated lesion of the stomach and an intra- and extraluminally growing duodenal tumor. The gastric tumor measured 6 by 7 cm and the duodenal tumor measured 9 by 8 by 2 cm.
Histologically, the gastric tumor was a moderated differentiated adenocarcinoma with invasion to the submucosa and metastases to lymph nodes. The duodenal tumor was a leiomyosarcoma.
In Japan, this is the 4th case since 1939 and is the first diagnosed by endoscopy and biopsy.

View full abstract

The patient was 28-year-old man complaining of watery diarrhea. On January in 1985, edema appeared in his legs and he was diagnosed nephrotic syndrome. As watery diarrhea appeared at several times a day in June of 1986, he was admitted in January of 1987. He was diagnosed Crohn's disease on X-ray, endoscopic examination and biopsy. At the same time, amyloid deposition was observed in the submucosal layer of the rectum. Amyloid analysis showed AA type amyloid deposition which is usually seen secondary amyloidosis. However, other comsumptive diseases were not recognized. So that he was diagnosed secondary amyloidosis due to Crohn's disease. The patient was an interesting case preceded by symptoms of nephrotic syndrome due to renal amyloidosis 18 months before diagnosis of Crohn's disease.

View full abstract

Primary sclerosing cholangitis (PSC) is a unknown etiology characterized by diffuse hypertrophy and sclerosis of the bile ducts. In this paper, we report a case of PSC treated in our department, in addition to classifying reported Japanese cases in terms of changes in the bile duct. A 53year-old woman was admitted with complaint of repeated upper abdominal pain for about 10 years. ERCP revealed beaded like appearance in the intra- and extrahepatic bile ducts and PSC was diagnosed on the basis of these findings. The patient's condition improved after administration of corticosteroid hormone, and she is currentry alive after 1.5 years, with occasional abdominal pain. Fifty-nine reported Japanese cases, for which data on changes in the bile duct were available, were classified into intrahepatic dominant type and extrahepatic dominant type on the basis of the location of the major lesion. The intrahepatic dominant type was found to show the following characteristics; 1) a predilection for younger individuals and 2) females, 3) a longer disease period, and 4) lack of associated jaundice. This suggests that PSC is a syndrome composed of several diseases with different etiologies.

View full abstract

We report 2 cases of a younger sister and an elder brother who have Werner's syndrome.
The 31-year-old sister stopped growing in junior high school and who received operations of both eyes for cataracts at the age of 17. Her menstruation stopped at the age of 25. She had no history of drinking alcohol. Her data showed GOT 58^IU/_L, GPT 113^IU/_L, ALP 310^IU/_L, γ-GTP 304.4^IU/_L, T-chol. 233 mg/dl and T. G. 255mg/dl.
The 34-year-old brother received operations of both eyes for cataracta at the age of 33. His data showed GOT 58^IU/_L, GPT 120^IU/_L, ALP 260^IU/_L, γ-GTP 75.1^IU/_L. T-chol. 166mg/dl and T. G.175mg/dl.
In both cases, 75g OGTT showed a diabetic pattern and IRI showed delayed hyperresponse. Faces of senility, loss of hair, flat feet, dermal ulcers and calluses were also observed. Their four limbs were slender but their trunks were slightly obese. X-ray revealed osteoporotic fingers and calcification of the Achilles' tendon. Ultrasound and CT-scan showed a fatty liver in both cases. Their laparoscopic findings revealed the followings. The liver were enlarged, smooth, dull and yellowish brown. Close-up view showed yellowish brown regions and reddish brown ones with terminal portal vein branches. Liver biopsy of the sister showed a fatty liver accompanied with P-P and P-C bridging fibrosis, but a fatty liver without bridging fibrosis was seen in the brother.

View full abstract

We presented a case of abnormal lobulation of the left hepatic lobe diagnosed by the laparoscopy. The patient was a 18-year-old man who was admitted to our hospital because of HBsAg positive and abnormal liver tests. He had no history of the injury to his abdomen. On admission, serum HBsAg and H BeAg were positive. To confirm the histology, laparoscopy was performed. Laparoscopy revealed a large white liver with the increased portal area. There was a shallow fissure in the center of the left lobe. As the fissure was sharp, we suggested that it was inborn in nature. Histological findings of biopsy specimen from the right hepatic lobe showed chronic inactive hepatitis. A diagnosis of Gilbert's syndrome was given by hunger test, laparoscopic appearnance and histology. We reported here a case of abnormal lobulation of the left hepatic lobe associated with chronic hepatitis type B and Gilbert's syndrome.

View full abstract

We presented a case of metastatic liver carcinoid which showed very various picture at laparoscopy. A 66-year-old woman visited our hospital because she had a sensation of fullness in the upper abdomen. The liver was palpable 10cm below the costal margin, but blood chemistry examination was almost normal. Ultrasonography and computed tomo-graphy showed multipule cystic lesions, about 2cm in diameter, in the liver. Aspiration biopsy was done for the cystic lesion. Though we suspected carcinoiid tumor for its histology, Grimelius staining of the specimen was negative. And we could not find the primary tumor in gastrointestinal X-ray series. Angiography showed no tumor stain, and only expansion of hepatic artery.
Then we tried laparoscopy to make a diagnosis. There were white nodules and dark cysts filled with old blood in the surface of the liver. We did biopsy in both lesions, and made a diagnosis of carcinoid. After a year of admission hepatomegaly had progressed and she died for perforation of duodenal ulcer. At the autopsy we found the primary tumor in the 2nd to 3rd portion of the duodenum and the liver was 9, 300 g in weight.
When laparoscopy showed very various surface of the liver as such as this case, carcinoid tumor should be pref ered as the first impression.

View full abstract

We reported a case of drug induced liver injury showing potato-like liver caused by herb drug.
A 28-year-old male took a herb drug "Sakaki Gachyagi's Drug" for the common cold-like symptom. About 2 weeks later after discontinuance of drug, he experienced easy fatigability, anorexia, jaundice and eruptions associated with severe itching. He had no history of blood transfusion. On admission, hepatic encephalopathy was not detected, but prothrombin time showed marked low value of 33.6%. The examinations for the viral antibodies were negative. Lymphocyte stimulating test was positive when "Sakaki Gachyagi's Drug" was added (Stimulation Index 207%). Laparoscopy showed severe necrosis and atrophy in the left lobe and typical potato-like liver appearance in the right lobe of the liver. The liver biopsy specimen revealed a submassive hepatic necrosis accompanied by proliferation of connective tissue and moderate inflammatory cell infiltra-tion at the portal area and bolooning, degeneration and necrosis of the hepatocytes at the parenchymal tissue.

View full abstract

In colonoscopy preparation using polyethylene glycol electrolyte lavage solution (PEG-ELS), we sometimes observed foam formation in the colon. This phenomenon impeded the detailed inspection of the colonic mucosa. In the present study, we evaluated the defoaming effect of adding dimethylpolysiloxane (DMPS, Gascon®) in PEG-ELS.
In the experimental study, DMPS showed defoaming ability at 5 ppm or more. Foams disappeared in about 20 seconds at 20 ppm.
In the clinical study, 44 patients were separated at random into two groups. In the one group, PEG-ELS containing 20 ppm DMPS was administered. In the other, patients were administered PEG-ELS without DMPS. Foam formation in the colon was compared between two groups. In the former group, foams were not observed in most patients at colonoscopic insertion and the colonic mucosa was easily inspected whereas in the latter group foam formation interfered with colonoscopy. Thus, the foam formation was prevented by adding a small quantity of DMPS to PEG-ELS.

View full abstract

In order to clarify the angioarchitecture of the esophagus in portal hypertension, barium added gelatin was injected in the esophagus from the left gastric vein in untreated cases and the vascular running was observed macroscopically and histologically. It is classified in three distinct zones as follows; 1. Palisade zone where numerous parallel thin vessels (i. e., the sudare-like veins) run longitudinally, 2. Truncal zone where esophageal varices are commonly formed, 3. Transitional zone where vertically oriented veins run from the palisade zone to the truncal zone. For cases without portal hypertension, many blood vessels were running in lamina propria of the palisade zone. In contrast, for cases with portal hypertension, the corresponding blood vessels were remarkably dilated. The approximate half of them was running in the submucosa, extending the lamina muscularis mucosae. Critical area where esophageal varises frequently rupture corresponds to the transitional zone. A protrusion of a marked piling up of the veins into esophageal lumen and a steeper draining angle of the veins in the critical area are likely to lead to rupture of the varices. Histologically, red color sign corresponds to the thinning of the epithelium due to variceal vein in the lamina propria, and was frequently found in the critical area. The extent of thrombus formation was examined on esophagi of 18 autopsy cases passing more than 2 months after endoscopic injection sclerotherapy (EIS) with 5%ethanolamine oleate. Thrombus formation was observed most extensively in variceal veins in the submucosa of the truncal zone, but was poor in blood vessels of the lamina muscularis mucosa, as was the same with the palisade zone. This suggests that venous dilatation in the lamina muscularis mucosa in mainly responsible for post-EIS relapse.

View full abstract