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Volume 33, Issue 1
Displaying 1-23 of 23 articles from this issue
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[in Japanese]1991 Volume 33 Issue 1 Pages 1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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[in Japanese]1991 Volume 33 Issue 1 Pages 2
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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-COMPARATIVE STUDY BETWEEN EUS AND HISTO-PATHOLOGICAL FINDINGS IN RESECTED STOMACH-Kyoichi ADACHI1991 Volume 33 Issue 1 Pages 3-13
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSRecently, EUS has been frequently performed to detect the depth of invasion of gastric cancer and is thought to be useful in decision of the indication of endoscopic treatment for early gastric cancer. This study is aimed to evaluate the ability of correct diagnosis for depth of the invasion in early gastric cancer by EUS. Forty-nine lesions of early gastric cancer diagnosed by upper GI series and endoscopy were surgically resected, and EUS was performed in deaerated water. Results of a comparative study between EUS and histo-pathological findings are as follows: 1. Structural changes observed by EUS were correspond with those revealed in histo-pathological examination in 9 lesions with protruded type and 23 lesions with depressed type in early gastric cancer without ulcerative change. 2. In 17 lesions with depressed type cancer with ulcerative change, however, there were some differences between EUS and histo-pathological findings. According to the distribution of cancer tissue as more hypoechoic pattern and fibrosis as more hyperechoic compared to normal second layer ultrasonographically, EUS patterns in these types could be classified into 3 categories. Fourteen of 17 lesions (82.4%) were made a correct diagnosis for depth of invasion in early gastric cancer with ulcerative change on the basis of this classification. The other 3 lesions were as follows ; one lesion with microinvasion and 2 lesions without cancer tissue in mixed (hypoechoic and hyperechoic) type echo area histo-pathologically.View full abstractDownload PDF (9743K) -
Toshiaki NAKASHIMA, Masaki IWAI, Takeshi OKANOUE, Kei KASHIMA, Atsushi ...1991 Volume 33 Issue 1 Pages 14-22
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSOf 2, 205 cases done laparoscopy in our department, 629 cases (28.5%) had intraper-itoneal adhesion. The half of them had a history of abdominal surgery. Severe intraper-itoneal adhesion was detected in 17 (59%) of 29 cases unable of laparoscopic examination. Adhesion after prior laparoscopy was found in 40 (33.1%) of 121 cases with repeated laparoscopy. The incidence of adhesion was higher in cases with severe liver diseases. Liver biopsy was successful in the right lobe of the liver in about half of cases with adhesion. In conclusion, laparoscopic examination in cases with intraperitoneal adhesion was satisfactorily performed by selecting a proper site for introduction of trocar and liver biopsy.View full abstractDownload PDF (915K) -
Akimichi CHONAN, Fukuji MOCHIZUKI, Takashi IKEDA, Tokiaki TOYOHARA, Na ...1991 Volume 33 Issue 1 Pages 23-33
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThere were 755 lesions of early gastric cancer in 636 patients who underwent gastrectomy at our center from 1982 to 1989. We studied clinicopathological findings and endoscopic appearance of early gastric cancers at the esophagogastric junction (EGJ). The results were as follows ; 1) There were twelve lesions in twelve patients with early gastric cancers at the EGJ, which was equivalent to 1.6% of early gastric cancers (Table 1). 2) Early gastric cancers at the EGJ were frequently seen as type IIc on the lesser curvature without an ulcer or ulcer scar (Table 2, 3). Histologically, 91.7% of early gastric cancers at the EGJ were differentiated type of adenocarcinoma (Table 4). 3) Endoscopically, it was comparatively easy to detect depressed sm cancers at the EGJ, but it was very difficult to detect depressed m cancers at the EGJ, because of their shallow depression, smooth surface without fold convergence or surrounding elevation (Table 9). 4) To detect depressed m cancer at the EGJ by endoscopy, it is important not to overlook a homogenous redness with thin white coating, easy bleeding and sharp border at the EGJ (Table 9).View full abstractDownload PDF (5951K) -
Takao ENDO, Toshihiro BAN, Eiji RATA, Nobu-o SEKIYAMA, Hiro-o YAMANO, ...1991 Volume 33 Issue 1 Pages 35-41_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA heat probe unit for achieving endoscopic hemostasis is a portable and economic apparatus. We applied this unit to endoscopic therapy for early gastric cancers. An experimental study to determine optimal heat energy for degeneration of the gastric wall using freshly resected human stomach indicated that about 60 joules at the same point was sufficient to cauterize a lesion of early gastric cancer with no risk of perforation. Fourteen cases of early gastric cancer were treated by this endoscopic coagulation method with the heat probe unit. In 8 cases, gastrectomy was performed after this therapy and pathohistological study revealed no remnant of malignant cells in 6 of the cases. On the other hand, 6 cases were followed-up endoscopically every three months after the therapy because of severe complications and/or refusal of surgical treatment. Local recurrence occurred in 3 cases of which 2 cases were estimated as sm cancer by endoscopic ultrasonography. But no recurrence occurred in the remaining 3 cases during the follow-up period (average: 18 months). The crucial factors affecting the therapeutic efficacy were the size, morphologic features and depth of invasion of gastric cancer. Accoriding to these factors, the effective rate is higher in cases of small (less than 2 cm in size) and elevated type than large (over 2 cm in size) and depressed type of early gastric cancer.View full abstractDownload PDF (6687K) -
Tadayuki HARA, Osahumi YAMAGUCHI, Toru SAKAI, Itaru TANIMOTO, Toshikaz ...1991 Volume 33 Issue 1 Pages 42-47_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe experienced three cases of exulceratio simplex (Dieulaf oy's ulcer) of the duode-num. Endoscopic local injection of HSE solution achieved permanent hemostasis in all cases. Case 1: A 55-year-old woman admitted to the hospital with hematemesis. Emergency endoscopy revealed arterial bleeding in the anterior wall of the bulbus. Case 2 : A 57-year -old woman admitted for Pulmonary embolism and tarry stools were followed 16 days later. Emergency endoscopy revealed arterial bleeding in the inferior wall of the bulbus. Case 3 : A 12-year-old man admitted to the hospital with hematemesis. Emergency endoscopy revealed arterial bleeding in the anterior wall of the bulbus. After six months, he readmitted with hematemesis. Emergency endoscopy revealed recurrent arterial bleeding in the same site. We controlled bleeding with local injection of HSE in all cases. We could not find any peptic ulcer surrounding the exposed vessel. Therefore, we diagnosed these three cases as exulceratio simplex of the duodenum. To our knowledge, only 6 cases with exulceratio simplex of the duodenum have been reported in Japan. In the 3 patients reported, satisfactory hemostasis is achieved by local injection of pure ethanol and another 3 patients were transferred to surgery for hemostasis. We think that the treatment for the bleeding of exulceratio simplex of the duodenum is achieved by local injection of HSE solution satisfactry.View full abstractDownload PDF (2840K) -
Mitsuru SEO, Mitsuhiko UEKI, Kenji SUGIYAMA, Shougo MAEDA, Yuiti MASUD ...1991 Volume 33 Issue 1 Pages 48-53_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 39-year-old male was admitted to our hospital because of abdominal distension. Double contrast study of the upper gastrointestinal tract revealed the broad-based polypoid lesion in the duodenal bulb. Endoscopy revealed nodular broad-based polypoid lesion without ulceration on the anterior wall of the duodenal bulb. The biopsy specimen taken from this lesion revealed atypical lymphocytes, and malignant lymphoma was strongly suspected. No localized lesions were found in the esophagus, stomach, small intestine, and colon on radiographic study and endoscopy. Chest X-ray, abdominal ultrasonography, and whole body computer tomography revealed no lymphadenopathy, and finding of the bone marrow was normal. Thus, the patient was diagnosed as primary malignant lymphoma of the duodenal bulb. Gastroduodenal resection was performed. The nodular broad-based polypoid lesion was found in the duodenal bulb of the resected specimen. Histology of this lesion revealed evidence of non-Hodgikin lymphoma, showing diffuse pleomorphic type. Immunohis-tologically, tumor cells showed T-cell type. We reported primary malignant lymphoma of the duodenal bulb, showing T-cell type, and this case was extremely rare.View full abstractDownload PDF (4361K) -
Hiroyuki TAJIMA, Katsuro SAGARA, Takeaki KIYOZUMI, Ryukichi AKASHI, Hi ...1991 Volume 33 Issue 1 Pages 54-59
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe experienced a case with massive bleeding from the duodenal diverticulum. The patient was a 78-year-old male. Chief complaint were hematemesis and tarry stool. He was admitted to a hospital due to hematemesis and tarry stool in 1986. The bleeding source was not detected at that time. After 2 years (1988), he was admitted to the hospital due to heavy tarry stool. He went into a shock condition after a couple of melena and was refered to our hospital. Gastroduodenal fiberscopy showed blood coagula in the duodenal diverticulum and no bleeding from the papillary region. 99mTC-red blood cell study showed the bleeding at the second portion of the duodenum. The celiac angiography showed extravasation of the contrast marerial from the gastroduodenal artery. We diagnosed the bleeding from the diverticulum of the second portion of the duodenum. We detected surgically the bleeding source and stopped the bleeding.View full abstractDownload PDF (3929K) -
Shogo YAMASHITA, Yuji MIZUKAMI, Hiroshi SAKAUE, Yasushi HOSOKAWA, Soic ...1991 Volume 33 Issue 1 Pages 61-67_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 24-year-old female was admitted to our hospital because of right upper quadrant pain after meals. Abdominal ultrasonography, computed tomography of the abdomen and endoscopic retrograde cholangiopancreatography revealed cylindrical dilatation of the common bile duct, cystic dilatation of the common hepatic bile duct associated with anomalous arrangement of the pancreatobiliary duct and multiple polypoid lesions of the gallbladder. At operation, the gallbladder was shown to have diffuse multiple polypoid lesions on the mucosal surface and histologically many foamy cells in the lamina propria. From these findings, a diagnosis of diffuse papillomatous cholesterosis with congenital dilatation of the bile duct associated with anomalous arrangement of the pancreatobiliary duct was made. This case is of particular interest in inventigating the etiology of cholesterosis of the gallbladder.View full abstractDownload PDF (7485K) -
Yukiya HAKOZAKI, Tatsuoki SHIRAHAMA, Masashi KATOU, Kazuo TAKEI, Tsuto ...1991 Volume 33 Issue 1 Pages 68-72
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe patient was a 22-year-old female who had no alcoholic history. Since an upper abdominal pain appeared in September, 1987, she visited a local doctor and was diagnosed to have acute pancreatitis. Subsequently, similar symptoms continued, which led her to be hospitalized at our Department of Internal Medicine on March 8, 1988. Examination on admission demonstrated s-Amylase 7, 831 IU, u-Amylase 9, 982 IU, Elastase 12, 319.5 ng/ml, and specific pictures of pancreatic ducts with sequence of relatively soft dilatation and constriction of the main pancreatic duct in ERP. It was diagnosed as chronic pancreatitis because of upper abdominal pain of 6 months' duration, escape of pancreatic enzyme and specific ERP findings. Consequently, 600 mg/day of camostat mesilate was initially administered. Escape of pancreatic enzyme improved 2 months later, and clinical symptoms 7 months later. An almost normal picture was seen on ERP done one year and 5 months later in August, 1989. This case of pancreatitis, presenting marked improvement of ERP pictures of the pancreatic duct, appeared to be rare.View full abstractDownload PDF (3007K) -
Chikara IWAI, Tetsuji KITAHORA, Hiroshi NAKAMURA, Takeshi YOSHIDA, Sum ...1991 Volume 33 Issue 1 Pages 73-77_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 27-year-old woman was admitted to our hospital with repeated symptomes of tarry stool and upper abdominal pain. Epigastric tenderness was noted by physical examination. The upper gastrointestinal endoscopy revealed bleeding from the orifice of the enlarged papilla of Vater. Laboratory examination revealed elevation of amylase in both serum and urine without liver dysfunction and anemia. Radiographic findings of hypotonic duodeno-graphy also demonstrated enlargement of the Vater's papilla. ERCP performed after improvement of hyperamylasemia also demonstrated tumor-like enlargement of the papilla of Vater covered with normal duodenal mucosa and the common channel showing cystic dilation. Moreover, the pancreatic duct and the common bile duct separetely drained into the dilated common channel comunicated with the duodenal lumen through both the orifice of the papilla of Vater and fistula. Therefore endoscopic papillotomy was performed. A diagnosis of choledochocele of Alonso-Lej III type was made by biopsy because the epithelium of the bile duct with inflammation was found in the tissue biopsied from the inner lumen of the common channel. After endoscopic papillotomy, upper abdominal pain was subsided and hyperamylaseuria had disappeared, and the patient is now leading a normal social life without any symptomes suggesting recurrence.View full abstractDownload PDF (3650K) -
Hitoshi TAKAHASHI, Yoshikuni OKAMURA, Shyokaku HASHIMOTO, Akihiro KAWA ...1991 Volume 33 Issue 1 Pages 78-83
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 75-year-old woman was admitted to our hospital because of cerebral bleeding. On the 48th day of hospitalization, she complained of abdominal pain and fresh anal bleeding. Sigmoidoscopic examination demonstrated multiple ulcers with bleeding in the sigmoid colon. Histology of the biopsy specimen confirmed the diagnosis of ischemic colitis. Seven days later, the 55th day of hospitalization, sigmoidscopic examination confirmed that the multiple sigmoid ulcers had healed. On the 76th day of hospitalization, she complained of massive fresh anal bleeding without abdominal pain. Colonoscopic examination showed multiple rectal ulcers 2 cm from the dentate line on the anterior wall, one of which exhibited fresh bleeding from an exposed artery in the center of ulcer. Since ischemic colitis is thought to be caused by ischemia, this case suggests that ischemia and arterioscle-rosis may also play an important role in the pathogenesis of acute hemorrhagic rectal ulcer.View full abstractDownload PDF (2495K) -
Makoto SHIMAZAKI, Mitsuo NINOMIYA, Tetsuya YAMADA, Junko SHIROKO, Kazu ...1991 Volume 33 Issue 1 Pages 84-88_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA natural history of ulcerative proctitis was endoscopically observed in a 41-year-old female case. Her chief complaint was bloody stool, and the barium enema showed fine granularity in the rectum. The colonoscopic examination revealed granular and eryth-ematous mucosa with multiple hemorrhagic spots in the rectum. Marked inflammatory cell infiltration, goblet cell depletion and disarrangement of the glands were seen on biopsy. Endoscopic examinations repeated every four months showed the same findings as that of the first one. Twenty months after the initial episode, the patient developed severe bloody stool and high fever with flu like symptoms. The endoscopic examination and the barium enema study at the 20th month revealed the total colitis. The patient had refused to take any medicine prescribed during the entire clinical course up to the 20th month. Hence, it was suggested that, in this case, ulcerative proctitis had extended to total colitis in the natural course.View full abstractDownload PDF (4779K) -
Hitoshi HACHIYA, Masao KOZUKA, Katsuhisa SASOU, Asamitsu HIRANO, Haruh ...1991 Volume 33 Issue 1 Pages 89-95
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 34-year-old man was admitted to our hospital with abdominal pain and fullness of 8 months' duration. Barium enema and colonoscopy showed a polypoid lesion intussuscepted into cecum from terminal ileum. Biopsied specimens from the tumor showed malignant lymphoma. Right hemicolectomy was performed. Pathological analysis after the surgery revealed that the tumor, 6 cm in diameter, was located at terminal ileum and his tologically diffuse lymphoma ; intermediate type. Patient has been in good health for over 23 months since the surgery. Small intestinal tumor is usually not diagnosed preoperatively. This is uncommon case diagnosed with endoscopy due to the intussusception.View full abstractDownload PDF (4250K) -
Tadashi SHIGEMATSU, Mituru YONEDA, Masahito YAMAGAMI, Takashi MATSUMOT ...1991 Volume 33 Issue 1 Pages 97-102_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe experienced 6 cases of acute hemorrhagic rectal ulcer (AHRU) which caused sudden onset of fresh anal bleeding with neither abdominal pain nor anal pain. The patients were 3 males and 3 females. Of whom 5 were over seventy in age. The mean age was 68.3 years. All cases had severe underlying disorder (2 brain infarctions, one chronic bronchitis, one fever of unknown origin, one pancreatitis with pneumonia and one multiple organ failure) and our cases had no suspicion of stercoral ulcer. Hypovolemic shock due to massive anal bleeding occurred in 3 cases, 2 of which needed an electrocoagulation method using "Heater Probe" for endoscopic hemostasis. Endo-scopic findings indicated an irregularly shaped ulcer from 2 to 6 cm from the dentate line. One case had a solitary lesion and the others had multiple lesions.All cases healed within 58 days.View full abstractDownload PDF (2874K) -
Ryuzo KONISHI, Motonori HAYASHIDO, Nobuji KONO, Ichiro NAGAYAMA, Takek ...1991 Volume 33 Issue 1 Pages 103-107_1
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSMucinous carcinoma of the small intestine is scarcely known in literature. This is a case report of mucinous carcinoma of the jejunum. A 58-year-old female was admitted to our hospital for inventigation of bloating in January 1989. Small intestinal follow-through examination revealed an obstruction of the jejunum. Endoscopically (using Olympus SIF type 10), a 4×4 cm sized tumor was found, which was thickly coated with mucus. As histology of the biopsies proved adenocarcinoma of the jejunum, laparotomy was performed. A tumor was found in the jejunum 20 cm below the Treitz's angle with evident serosal infiltration. There was no evidence of hepatic or lymphatic metastasis. Histological findings of the resected tumor were consistent with papillary adenocarcinoma in the mucosal layer and carcinoma cells in large mucous lakes in the submucosal layer. These features are characteristic of mucinous adenocarcinoma of the jejunum.View full abstractDownload PDF (5945K) -
Hiroshi IKEDA, Hiroshi YAMAMOTO, Shimako KAWANO, Kazuhiro MATSUEDA, Sh ...1991 Volume 33 Issue 1 Pages 108-113
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTwo cases of mucosal prolapse syndrome (MPS) of the rectum are reported. The first case was a 17-year-old male who admitted to this hospital with bleeding on defecation. Digital examination revealed two elastic hard masses on the rectal wall distanted 1 cm from the anus. Transanal exision of the lesions was performed. His-tological study of the resected specimen revealed fibromuscular obliteration of the lamina propria. Six months after the operation, endoscopy showed flat reddish mucosal lesion on the anterior wall 6 cm above the primary lesion. Fifteen months after the operation, this lesion had become the protruded lesion with an erosion. Biopsy specimens revealed fibromuscular obliteration. Over 30 months, the appearance of this lesion did not change and develop to ulceration. The second case was 53-year-old female who was admitted to this hospital with bloody stools. Endoscopy showed a solitary ulcer on the anterior wall of the rectum distanted 2 cm from the anus. Histological examination showed fibromuscular obliteration of the lamina propria. She had a habit of strain. For treatment, she was advised not to strain for more than 5 minutes at defecation. Six months later, her symptons had disappeared and the ulcer had healed to a scar. These cases seem to be interesting from the view point of the pathogenesis and the treatment of MPS.View full abstractDownload PDF (4289K) -
[in Japanese]1991 Volume 33 Issue 1 Pages 114-124
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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[in Japanese]1991 Volume 33 Issue 1 Pages 124-162
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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[in Japanese]1991 Volume 33 Issue 1 Pages 162-177
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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[in Japanese]1991 Volume 33 Issue 1 Pages 177-185
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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[in Japanese]1991 Volume 33 Issue 1 Pages 185-198
Published: January 20, 1991
Released on J-STAGE: May 09, 2011
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