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Volume 32, Issue 2
Displaying 1-18 of 18 articles from this issue
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Hiroyuki YOSHIDA, Hiroshi SATA, Yoshio HATTA1990 Volume 32 Issue 2 Pages 325-333
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn order to elcidated the pathogenesis of the gastric mucosal lesion in portal hypertension, the severity of esophageal varices was endoscopically and histopathologically compared in patients between liver cirrhosis and chronic hepatitis. The changes of the gastric mucosa were also studied after endoscopic injection sclerotherapy (EIS). As a result, it was shown that the incidence of gastric mucosal lesions were more frequent in liver cirrhosis with esophageal varices than in chronic hepatitis without varices. Namely, there was a high incidence of the gastric mucosal lesions in esophageal varices. It was suggested that the severity of esophageal varices was related to the gastric mucosal changes in patients with liver cirrhosis. The dilatation of capillaries in biopsied specimen of the gastric mucosa was a characteristic finding. It should be noted, however, that gastric mucosal changes and dilatation of capillaries were not always present in patient with portal hypertension. There was no change of the gastric mucosa and esophageal varices befor and after EIS for short time observation. The development of the gastric mucosal lesions was supposed to the impairment of gastric mucosal blood flow in liver chirrhosis, but some local factors also played an important role.View full abstractDownload PDF (2068K) -
Takashi SHIGENO1990 Volume 32 Issue 2 Pages 334-344
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTo examine the bacterial characteristics of bile, 51 patients treated with ERBD were studied. Some bacterial strains were found to invade into the bile after the procedure of ERBD in all cases. Enterococcus and intestinal flora were the most frequently observed ones and anaerobes were found in 8.4%. Number of bacterial strains and bacteria quantity in bile had no relation to drainage period. Soon after the ERBD tube insertion, several bacterial strains were found in bile, but they had no tendency to be increased with time in cases where no obstruction of ERBD tube occurred. In patients with longstanding ERBD, bacterial strains had changed frequently in number, which indicated the evolution of resistance to some antibiotics previously effective. Therefore, at present, it is important for keeping patency of the tubes to wash ERBD tube or to exchange ERBD tube periodically.View full abstractDownload PDF (1191K) -
Takashi SHIGENO1990 Volume 32 Issue 2 Pages 345-353
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSOccluded ERBD tubes and intact ERBD tubes which were experimentally soaked in bile collected through EN BD tubes were examined mainly by scanning electron microscope. Occluded ERBD tubes were filled with black-brownish materials on gross examination. These materials consisted of bacterial mass and brown-granular layers on light microscopy, and both were piled up each other and formed concentric circle appearance. This brown layer contained bilirubin calcium and others. Serial observations of ERBD tube soaked in bile revealed as follows : first, a few bacteria were attached locally on the tube surface and formed small colonies, and gradually spreaded on the whole surface of the tube, then the materials containing bilirubin calcium and others piled up the bacterial layers. Repeating these process progressed the occlusion of ERBD tube. It is considered that the bile flow volume is one of the most important facter for tube occlusion. It would be requested to develop the material which can interfere with the bacteria attachment to the tube surface or to maintain bile flow as much as possible for avoidance of ERBD tube occlusion.View full abstractDownload PDF (8734K) -
Hidekazu MUKAI, Seiichi HIRANO, Hajime MURAKITA, Shigeto MIZUNO, Tooru ...1990 Volume 32 Issue 2 Pages 355-364_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic ultrasonography (EUS) was performed in 18 resected patients with cancer of the papilla of Vater for the evaluation of its preoperative diagnostic accuracy. EUS image of the periampullary region (sphincter of Oddi, layered structure of the duodenal wall and the pancreas) was clearly demonstrated by the transduodenal scanning with the water-filled technique. Tumor of the papilla of Vater was presented in 17 of 18 patients as a hypoechoic mass by EUS. EUS studies showed almost the same high accuracy rate as ERCP studies. EUS findings of the tumors corresponded well with pathological findings. EUS showed high accuracy rates for detection of canser expansion into the duodenal wall (89%), cancer invasion into the pancreas (89%), and pancreatic head lymph nodes (n1) metastasis (94%). EUS is one of the most useful procedures in the diagnosis for the extension of cancer of the papilla of Vater.View full abstractDownload PDF (10987K) -
WITH SPECIAL REFERENCE TO BACHGROUND FACTORS AND ENDOSCOPIC FINDINGSKiyotaka OKAWA, Atsuo KITANO, Shiro NAKAMURA, Ryuji HUKUSHIMA, Hiromu ...1990 Volume 32 Issue 2 Pages 365-376_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe compared clinical features of 24 patients with ischemic colitis in primary hospitals and 17 such patients in a university hospital. For the patients in primary hospitals, the selection of which patients is not biased, ages were distributed almost uniformly from patients in their twenties to those in their seventies. The male-female ratio was 1 : 2. Arteriosclerosis-related diseases were seen in only 3 patients (13%). The stricture type of ischemic colitis was seen in only 2 patients (8%). These findings suggest that clinical features of ischemic colitis are not as generally believed. For all patients, woman more often had this disorder than man. Constipation, diarrhea following use of a purgative, after straining or after an enema were seen in more than half of the patients, whether the disease was transient or stricture type. Left-sided diverticulosis or laparotomy of the lower abdomen were often associated with ischemic colitis. The colitis often developed after evening meal. The results suggested that increased intraluminal pressure and peristalsis are triggers of ischemic colitis. It was difficult to make an accurate evaluation of the stricture type of this disorder by endoscopic findings within two weeks of the onset. It seemed that circular lesions after two weeks or longitudinal lesions after four weeks develop into the stricture type of this disease.View full abstractDownload PDF (5297K) -
Haruhiro INOUE, Shoichi KATO, Hiroshi NAKAMURA, Tatsuyuki KAWANO, Nari ...1990 Volume 32 Issue 2 Pages 379-387_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTo clarify endoscopic findings of genuine intravariceal injection, 207 injection sites of 26 patients have been studied in accordance with venographic findings. On endoscopic examination to judge genuine intravariceal injection the following requirements must be filled, 1) to observe backflow of blood into an injection needle and 2) no change in size of varices after injection. These critereia for genuine intravariceal injection can be considered to be useful to decide an appropriate dose of injecting sclerosant, to evaluate effectiveness of sclerotherapy and to prevent many complications. Based on this criteria overall rate of accurate intravariceal injection reaches 43% in our series.View full abstractDownload PDF (5290K) -
Haruhiro INOUE, Hiroshi NAKAMURA, Tatsuyuki KAWANO, Naoya MURASE, Nari ...1990 Volume 32 Issue 2 Pages 388-395_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic injection sclerotherapy (EIS) has used widespreadly and a transparent overtube made EIS much easier with its clear visual field. We succeeded to get the venographic findings of "fine-network pattern (FNP)" for the small varices during EIS under negative pressure control.The characteristics of FNP on varicography are described below. 1) FNP can be demonstrated on EIS for small varices, after major varicose vein has been thrombosed. 2) Small varices has been thrombosed with no ulceration by only one injection of FNP on varicography. 3) No patients who were received intravariceal injection to get FNP on varicography have stenosis after EIS. 4) To get FNP on varicography is probably the final aim of treatment with EIS by intravariceal injection technique.View full abstractDownload PDF (6417K) -
-COMPARISON WITH COMBINED PROCEDURE WITH GLUCOSE, THROMBIN AND AETHOXYSKLEROL-Akira TERADA, Manabu MASUZAWA, Eiji MIYOSHI, Keiji YAMAMOTO, Michio KA ...1990 Volume 32 Issue 2 Pages 396-404_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe have studied the effects and complications of a new type of endoscopic sclerotherapy using GT-XIII as an embolic and sclerotic agent. For the control procedure, combined procedure with glucose, thrombin and aethoxysklerol was administered. This procedure had been performed in our hospital until the new procedure was adopted. Results showed that complete hemostasis for more than 7 days after therapy was obtained in 88% (15 out of 17) of the patients with variceal bleeding. Improvement in the F factor when the RC sign had virtually disappeared was obtained in 74% (60 out of 81) of the patients. Both values were similar to those obtained with the control procedure. As major complications of the procedure, fever exceeding 38°C was observed in 51% of the patients, and pain in the vicinity of the esophagus in 36%. The incidence of esophageal ulcers was 12% (15% for the control procedure), while cerebrovascular diseases were seen in 3 patients. More importantly, there was no occurrence of severe complications such as shock or postoperative bleeding, which were observed in 30% and 6%, respectively, of the patients treated with the control procedure. It was speculated by applying a finger-pieace type ICG clearance meter that GT-XIII was retained at local sites of injection. The embolus containing of GT-XIII-specific particles mixed with hemocytes and organizing thrombus were histologically confirmed in autopsied cases. In conclusion, this procedure is considered simple, safe and effective for the treatment of esophageal varices.View full abstractDownload PDF (3350K) -
Yasushi OGIHARA, Motonobu SUGIMOTO1990 Volume 32 Issue 2 Pages 407-413
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn order to minimize the complaints of patients in laparoscopy, we have attempted to use a neuroleptanalgesia-modified (NLA-mod) anesthesia using diazepam and pentazocine, and compared its efficacy and side effects with those of NO2 inhalation anesthesia and local anesthesia. Subjects were 60 patients with liver diseases, to each 20 of whom a type of three anesthesias was randomly selected. Evaluation of each anesthesia was done by questionnaire for the complaints during examination and 24 hours after thet. Changes in blood pressure, heart rate (all cases) and arterial blood gas analysis (some cases) were measured during examination and changes in biochemical data were also checked one week after examination. Following results were obtained. (1) NLA-mod was effective for minimizing the complaints in laparoscopy compared with other types of anesthesia. Especially, total discomfort during examination and abdominal fulness both during and after examination were significantly reduced under NLA-mod than local anesthesia. (2) Changes in blood pressure under NLA-mod were less than the other anesthesias, and changes in blood gas analysis under NLA-mod were similar to local anesthesia. No cases of drug-induced liver injury were noticed.View full abstractDownload PDF (930K) -
Shuichi SEKI, Hiroki SAKAGUCHI, Nobuyoshi KAWAKITA, Atsushi YANAI, Koh ...1990 Volume 32 Issue 2 Pages 414-421
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSRegenerative activity was studied in the liver surface using a monoclonal antibody against DNA polymerase alpha in 25 patients of various liver diseases. In acute viral hepatitis with confluent necrosis, active regenerative foci were found adjacent to small depressed lesion. In chronic active hepatitis, active regenerative foci were predominantly found in periportal zone surrownding the reddish markings. In cirrhotic nudules, the number of hepatocytes stained with DNA polymerase alpha was various. Accordingly, active regenerative foci were not found.View full abstractDownload PDF (6528K) -
Tetsuro HAMAMOTO, Eiji NISHIMUKI, Kazuhiko WATANABE, Ken HIROKAWA, Aki ...1990 Volume 32 Issue 2 Pages 422-426_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 76-year-old woman, having reflux esophagitis for eight years, was admitted for close examination of the multiple polypoid lesions near the esophagogastric junction. The diameter of the largest one was 14mm. The histological study of the biopsy specimens showed granuration tissue with severe inflammation. After one month medical therapy with H2-blocker, endoscopical examination revealed that the multiple polypoid lesions in the lower esophagus had disappeared, but polyps at the cardia were not. We thought this case as inflammatory esophagogastric polyp, developed during the clinical course of reflux esophagitis. The esophageal polyps were thought to have disappeared with improvement of inflammatory changes by medical therapy. However, those lesions may have been mechanically cut off through the frequent esophageal intubations which had been carried out for esophageal functional study.View full abstractDownload PDF (6492K) -
IN COMPARISON WITH REPORTED 37 CASES IN JAPANRyo FURUYA, Kazuhiro MORI, Kazuhiro IMURA, Mamoru NISHINO, Hideo TAKAH ...1990 Volume 32 Issue 2 Pages 427-435
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSMucosal bridges of the esophagus are rare and only 37 cases have been reported in Japan since 1977. We reviewed the reported cases and discussed this case in detail. A 77-year-old male underwent the upper gastrointestinal series to evaluate the cause of anemia. The examination demonstrated the possibility of a mucosal bridge in the middle esophagus. Endoscopic examination showed the mucosal bridge at 25cm from the incisor. Histological examination of the mucosal bridge suggested normal squamous epithelium. The morphological features of the mucosal bridge were extremely characteristic ; (1) The radiologic and endoscopic examinations with the foward-viewing endoscopy revealed unilateral esophageal stenosis in association with fistula. However, lateral-viewing endoscopy disclosed a wide band-like mucosal bridge (width : about 15mm). (2) The surface of the mucosal bridge and the surrounding esophageal mucosa appeared normal. (3) The shape of mucosal bridge was changed as if it contracted. These findings were quite different from the features of acquired esophageal mucosal bridges reported in Japanease literatures and rather mimic to the case of the congenital esophageal mucosal bridge reported in English literature. However, it is necessary to investigate the justification of this assumption.View full abstractDownload PDF (5792K) -
Masayo ARAI, Takashi KOMIYAMA, Takuya HATAKEYAMA, Seiichiro MIYAGAWA, ...1990 Volume 32 Issue 2 Pages 436-441_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe report a case of early synchronous double cancer of the esophagus and stomach. A 63-year-old male was admitted to our hospital because of an abnormal finding of the stomach detected on his medical examination. Barium meal study revealed a slightly elevated lesion which size was 23×8 mm at the anterior wall of the lower esophagus but no findings of the stomach. By endoscopic examination, this elevated lesion was surrounded by reddish and irregular mucosa, which was not stained by Lugol application. Endoscopic examination of the stomach showed a depressed lesion (3×3 mm in diameter) at the anterior wall of the gastric angle but there was no abnormality at the area where an abnormal finding was suspected by X-ray examination. Biopsied specimens of the esophageal lesion showed squamous cell carcinoma and those of the stomach were tubular adenocarcinoma. A total resection of the thoracic esophagus and stomach was performed and reconstruction was done by colon transplant through the retrosternal rout. Pathological examination revealed protruded type esophageal carcinoma associated with superficial flat type (I+IIb, 75×40 mm in diameter) limited to the submucosal layer and superficial depressed type mucosal carcinoma of the stomach (IIc, 4×4 mm in diameter). Only 17 cases of early synchronous double cancer of the esophagus and stomach have been reported in Japanese literatures. This case is the first one in which gastric lesion was a microcancer and this minute lesion was successfully diagnosed before the operation.View full abstractDownload PDF (4882K) -
Masaaki ENDOH, Kenichi TAKAHASHI, Hiromichi NAKACHI, Shigeaki INOUE, R ...1990 Volume 32 Issue 2 Pages 442-449_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of hepatolithiasis with impacted stones in the caudate bile duct (B1) that were demonstrated by ultrasonography (US) and endoscopic ultrasonography (EUS), was reported. The patient was a 44-year-old male with a complaint of upper abdominal pain. US and chlangiography via the percutaneous trashepatic cholangial drainage cathter revealed stones in the superior posterior (B6) and inferior posterior (B7) bile ducts of the liver. In addition, impacted stones in the left B1 (B1 1) were demonstrated by percutaneous transhepatic cholangioscopy (PTCS). These stones were removed successfully by electrohydraulic lithotripy under PTCS. Following US and EUS showed a patent picture of the B1 1, however, they detected another stone-retaining Bl branch which proved to be the right B1 (Blr). On PTCS, a strictured orifice of the Blr was found on the posterior wall of the B6. Lithotripsy in this duct was only partly successful because of the narrowed orifice and tortuous ductal running. It has been a general belief that the Bl is not easy to observe by US or EUS. Our experience, however, suggests a possibility of idetifying this duct with or without stones.View full abstractDownload PDF (11264K) -
Makoto WATANABE, Masahiro TAKESHITA, Yasuhiro UMEKAWA, Toshitsugu KOBA ...1990 Volume 32 Issue 2 Pages 450-454_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 81-year-old female complained of abdominal fullness and pain and low grade fever for 2 months due to cholecystitis and/or cholelithiasis. US demonstrated mild dilatation of the intrahepatic bile duct and thickening of the gallbladder wall with a gallstone. Gallbladder wall was 11 mm thick. Laboratory data on admission showed mild anemia and abnormal liver function tests : AST/ALT 628/461 IU/1, LDH 917 IU/1, biliary enzymes 4-8 times as high as the upper normal limit. AFP and CEA were within normal limits and CA 19-9 was 4 times as high as the upper normal limit. CT revealed the same findings as US. ERCP was tried in failune to disclose the fine structure of the biliary system. Laparoscopy showed cholestatic left lobe of the liver with multiple yellowish spots suggestive of metastases. Two metastatic foci of the ligamentum teres ware observed, one of which being histologically diagnosed as poorly differentiated adenocarcinoma after forceps biopsy. Gallbladder adhered to the adjacent tissue. Direct forceps biopsy was carried out to the gallbladder wall. Histology was the same as that of ligamentum teres.View full abstractDownload PDF (5867K) -
Shinichiro OBATA, Keishi KIMURA, Kazuhiro MAEDA, Masahiko SATHO, Junic ...1990 Volume 32 Issue 2 Pages 457-460_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn general, polypectomy has been considered to be a contraindication for patients with bleeding tendency including blood diseases. The present report, however, deals with successful endoscopic polypectomy perfomed in a patient with leukemia. A 77-year-old male patient with erythroleukemia was admitted to our hospital because of melena for a month. Sigmoidscopy showed a hemorrhagic polyp of the rectum. Bleeding time was normalized after platelet transfusion, and polypectmy was safely performed. He died of cerebral hemorrhage due to DIC, but there was no evidence of hemorrhage after polypectomy at autopsy. Polypectomy might not be considered to be a contraindication for patients with hemorrhagic diathesis including leukemia if the homeostasis is normalized. Polypectomy is useful for treating a bleeding lesion as in this case.View full abstractDownload PDF (2863K) -
Toshihiro MATSUURA, Yoshiaki MAEDA, Hayato MATSUNAGA, Hiroaki IWASE, K ...1990 Volume 32 Issue 2 Pages 461-470_1
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe presented a case of intestinal tuberculosis which developed minute early and advanced colon carcinomas after 14 years from the onset. A 79-year-old woman was admitted to our hospital complaining of diarrhea and lower abdominal pain in 1988. She had been suffering from intestinal tuberculosis since 1974 when the diagnosis was confirmed by the presence of granulomas and positive culture of mycobacterium tuberculosis from biopsy specimen. Barium enema examination in 1988 revealed remarkable shortening of the ascending colon and scattered atrophic scar areas in the transverse and descending colon. Endoscopic examination disclosed a shallow depressed lesion in the transverse colon and a lesion with irregular reddish granules in the descending colon. Biopsy specimen from both lesions showed tubular adenocarcinoma. Histological examination revealed an advanced carcinoma invading into the subserosa in the transverse colon, and a minute early carcinoma in the descending colon. Analysing 65 cases of intestinal tuberculosis complicated with colon carcinoma reported in Japan, most of the carcinomas were advanced ones. So, it was suggested that intestinal tuberculosis should be carefully followed up with endoscopy considering colon carcinoma as a complication.View full abstractDownload PDF (7665K) -
Hitoshi OKANO, Tadashi KODAMA, Shinji FUKUMITSU, Naoki TERAMAE, Chiemi ...1990 Volume 32 Issue 2 Pages 471-475
Published: February 20, 1990
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn Japan, the most frequently used needles for sclerotherapy for esophageal varices are commercially available from five manufacturers (Olympus, Argyle, Sumitomo B, Medical, Top and Microvasive). We developed new injection needles for sclerotherapy with Microvasive co. and compared the following basic features of 23G needles for this purpose (Microvasive 25G needles were also included in the study) : (1) dead space of needle, (2) resistance during insertion, (3) aspiration capacity (the time required for aspirating 100 cc water at 100 mmHg when the needle was inserted via the forceps entrance of an Olympus GIF-Q20 endoscope). The dead space greatly differed between needles (from 0.47 cc to 1.4 cc), suggesting that the dose levels of sclerosing agents need to be decided taking into account the dead space of each needle. The resistance during insertion of Microvasive 23G needle and the Argyle 23G needle was significantly lower than the needles of the other manufacturers. The Microvasive 25G needle could be inserted with less resistance than the 23G needles of the other manufacturers. The aspiration capacity of the Microvasive 23G and 25G needles was superior (30 seconds) than the other needles whose aspiration capacity ranged form 30 to 42 seconds (117 seconds for the Argyle needle), although there was not significant difference except the Argyle needles. These results suggest that the Microvasive needles for sclerotherapy are useful to any other needle of this kind commercially available in Japan.View full abstractDownload PDF (1741K)
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