To clarify the mechanism of the recurrence of esophageal varices after sclerotherapy, we examined extension of thrombi in esophageal varices of eighteen autopsy cases with portal hypertension subjected to sclerotherapy using 5% ethanolamine oleate. These cases survived more than two months after sclerotherapy. Histological examination was made on the respective specimens taken from the gastric, palisade and truncal zones classified by Vianna, and comparison of the condition of variceal thrombosis in the lamina propria with that in the submucosa was made. The examination showed that in the truncal zone, there were a few thrombi and rather dilated veins in the lamina propria, while adequate variceal thrombi were present in the submucosa. Similar tendency was observed in the palisade zone. It was suggested that in cases which did not develop innvocation of the collateral pathway in the palisade zone after sclerotherapy, the blood flow increased in the lamina propria, likely leading to recurrence of varices.

View full abstract

We have examined 49 patients with esophageal varices to assess the usefulness of endoscopic color doppler ultrasonography (ECDUS) for evaluation of endoscopic injection sclerotherapy (EIS). We tried to detect intramural and extramural blood flow of the esophagus and observe left gastric vein (LGV), short gastric vein (SGV) and azygos vein by ECDUS before and/or after EIS. In all patients with F₂ or F₃ formed varices, color display indicating intramural blood flow by ECDUS could be obtained. Endoscopically, the forms of varices were improved to F₀ in 10 of 27 patients and to F₁ in 17 patients after EIS. Color display could not detect intramural blood flow by EIS in all patients in whom the forms of varices changed to F₀. On the other hand, 8 patients whose varices improved to F₁ after EIS still kept color flow indicating intramural blood flow of the esophagus. Prognosis was good in patients whose esophageal intramural and LGV/SGV blood flow disappeared. We concluded that ECDUS could analyze hemodynamics of esophageal varices and was a useful modality for the evaluation of therapeutic effects by EIS.

View full abstract

Laser hyperthermia using low power Nd : YAG laser for pancreatic carcinoma of Syrian golden hamster was attempted. N-nitroso-bis-(2-oxy-propyl) amine (BOP) was injected subcutaneously with a dose of 10mg/kg 8times a week to twenty female hamsters which were 8 weeks old. Ten of them were sacrificed and the pancreas was examined histopathologically at the 14, and 20th week after BOP injection. The remaiming 10 were treated with laser hyperthermia for the pancreatic tumors at the 19 to 20 to week after BOP injection. Their abdomens were opend under anesthesia and an interstitial probe was punctured directly into the pancreatic carcinoma by controlling the temperature of the siteat 42-43°C, 5mm apart from the probe with 3W for 3 to 5 minutes. Seven days after the treatment they were sacrificed and examined histopathlogically. Histopathological study of the pancreatic tumors treated with laser hyperthermia showed a large amount of coagulated necrosis around the center of the punctured point and tumor cells disappeared in almost all cases. Furthermore, the effects of laser hyperthermia themselves were minimal in the surrounding areas of the pancreatic tumors though pancreatitis secondary to pancreatic carcinoma was seen. On the other hand, histopathological examination of normal pancreatic tissue with laser hyperthermia showed hemorrhage and coagulated necrosis only in the surrounding areas of the punctured point. It is concluded that laser hyperthermia was one of safe and effective therapeutic methods for solid carcinomatous tumors.

View full abstract

We reviewed 142 endoscopic sphincterotomies (EST). The indications (Table 1) included common bile duct stones (78.9%), placing catheters or endoprostheses in patients with malingant stricture of the bile duct (13.4%), papillary stenosis, chronic pancreatitis, and miscellaneous (biopsy, and peroral choledocho-pancreatoscopy). Early complications (Table 2) occurred in 13 patients (9.2%) : hemorrhage in 7, pancreatitis in 4, perforation in 1 and pneumoretroperitoneum in 1. No patients died. Two patients (1.4%) required operation for complications. All patients with hemorrhage following EST (Table 3) were elderly (age < 70, mean 82.7) including 3 patients with no symptoms. All the patients were treated conservatively. Their hemoglobin values reached the bottom 6 to 14 (mean 8.5) days after EST. Five patients did not bleed during EST but bled later. These findings suggest that late bleeding or continuous hemorrhage can occur after EST. Therefore, periodical follow-up of hemoglobin values are important for early detectin of late or continuous bleeding following EST. Perforation of the common bile duct occurred in 1 patient who required surgery, although some reports have suggested that most perforations can be managed conservatively with providing drainage of the bile duct by ensuring adequate sphincterotomy, inserting a pernasal catheter or a biliary stent where appropri-ate. Precut papillotomy was performed in 6 patients. Two patients developed pancreatitis (Table 4) and three developed hyperamylasemia. The incidences of pancreatitis and hyperamylasemia in patients with precut procedure were much higher than those in patients without percut procedure. Therefore it was concluded that precut procedure should be avoided whenever possible.

View full abstract

Five cases of sessile sm cancers supposed to have originated from superficial type early cancer were studied. They were divided into two types according to their appear-ance ; taller and shorter ones. The taller tumors were caused by massive sm invasion of cancer from one point of mucosal muscle. They were somewhat irregular in shape and resembles the outlook of potato. The shorter tumors were the result of submucosal invasion via multiple points of mucosal muscle. They are even and trapezoid in outlook. All of them were polypectomized and two of them were surgically intervened after the polypectomy. However, no residual tumor nor lymph nodal involvement were noticed.

View full abstract

This case report is described a patient with candidiasis of the hypopharynx. A 74-year-old woman with esophageal stenosis has been treated by the pneumatic dilator when she complained of dysphagia for last 5 years. She complained of sore throat, 10 days after the dilatation therapy in May, 1989, and the symptom was continued. In November, dysphagia was appeared again and persisted in spite of the dilatation therapy. In March, 1990, endoscopic examination showed an ulceration at the hypopharynx. On gastrointestinal roentgenogram, the lesion was 20 mm in size. Histrogical examination of the specimen taken from the lesion did not supported the diagnosis of malignancy and yeasts were observed in the specimen. She was treated by fulconazole. On culture of the biopsied specimen taken from the lesion endoscopically, Candida albicans was identified. Dysphagia and sore throat were disappeared after the therapy and the lesion was almost healed in July, 1990. Only 39 cases of candidiasis of the pharynx was reported in Japan over past 50 years (1941-1990).

View full abstract

We reported a case of endoscopically resected esophageal leiomyoma on which top intramucosal carcinoma was detected. A 81-year-old male was admitted to Yuri Kumiai General Hospital in April 1989 for further evaluation of submucosal tumor in the upper esophagus detected in July 1988. The biopsy specimen taken from the top of submucosal tumor showed squamous cell carcinoma. Because of his poor general condition, endoscopic resection of the tumor was performed. Histology of the resected specimen revealed leiomyoma with size of 0.9 × 0.8 × 0.6 cm coexisting with intramucosal carcinoma on the top. His postoperative course was uneventful and no reccurrence occurred 19 months after discharge. In addition to this case report, 14 cases of esophageal leiomyoma coexisting with carcinoma reported in Japan were briefly reviewed.

View full abstract

A 45-year-old male in shock condition due to massive hematemesis was urgently admitted to our hospital. Urgent endoscopic examination of upper GI tract demonstrated an advanced gastric cancer with massive spurting bleeding from exposed vessel in an ulcerated lesion. Endoscopic hemostasis was succesfully carried out with local injection of absolute ethanol. After further examination, scheduled radical operation (total gas-trectomy and splenectomy with lymphnode dissection) was performed. Pathological study proved the presence of a ruptured artery 850μm in diameter in the ulcerated cancerous lesion. The wall components of that artery were degenerated with ethanol injection. The incidece of gastric cancer with massive hemorrhage, which was considered to need urgent operation, was rare. However, it is very difficult to determine whether urgent operation is needed or not because of poor general condition of the patient due to malignancy. Recenly, the massive hematemesis from exposed artery in benign gastroduodenal ulcer was successfully controlled by injecting ethanol. Likewise, massive gastric bleeding from exposed vessel in cancer tissue was also thought to be controlled with this method. This method should be taken in consideration for scheduled radical operation after hemostasis. Relatively low incidence of massive bleeding from gastric cancer in comparison with gastroduodenal ulcer was due probably to rare presence of exposed large vessels in the lesions.

View full abstract

A patient, 55 years old male, had undergone Billroth II reconstruction for gastric cancer 20 years ago. He visited to our hospital because of frequent vomiting and epigas-tralgia. There were epigastric pain and tenderness, but abdominal mass and peritonism were not recognized. Gastroendoscopy was done on the following day. The mucosa of gastric remnant showed normal findings, but the jejunum invaginated into the stomach, and jejunal mucosa demonstrated redding, edematous, and ischemic change. Upper G-I series with gastrographin showed a large sausage shaped filling defect with coil-spring sign in the gastric remnant. Abdominal CT also revealed a spherical mass with coil-spring sign in the stomach. Based on the these findings emergency operation was done 38 hours after the onset of the symptom. On laparotomy, about 20 cm portion of the efferent loop from the retrocolic gastrojejunostomy had intussuscepted into the stomach. Reposition of the intussuscepted jejunal loop was difficult due to ischemia and end to end anastomosis of the jejunum was performed after resection of 20 cm intussuscepted intestine from the anas-tomotic site. Jejunogastric intussusception is a rare complication of gastrojejunal anastomosis. this time we have reported about its clinical caracteristics and literature reviews in japan.

View full abstract

A 71-year-old male patient who had no history of being abroad suffered from mucous bloody diarrhea since September, 1982, and conservative therapy was done under the diagnosis for ulcerative colitis. Entamoeba histolytica was detected from the biopsy specimen of the erosion in the rectum at the colonoscopic examination in Octover, 1984. By the administration of Metronidazol, symptom disappeared and erosion healed endo-scopically. Six years later, the patient again suffered from mucous bloody diarrhea. Colonoscopic examination showed small ulcer, erosion and hemorrhage in rectum, sigmoid and transverse colon, and biopsy specimen from the lesion showed the presence of Entamoeba histolytica. By the administration of Metronidazol, the lesion healed endo-scopically. Concerning of the recurrent mechanism, incubation of the protozoa within intestinal canal or reinfection was supposed.

View full abstract

A case of mucus-producing cancer of the gallbladder causing obstruction of the cystic duct and dilatation of the gallbladder is reported. A 70-year-old woman was admitted to our hospital because of general fatigue. Ultrasonography and computed tomography showed elevated lesions in the gallbladder which led a diagnosis of cancer of gallbladder. Endoscopic retrograde cholangiography showed obstruction of the cystic duct and a shadow defect in the cystic duct. Operation was carried out. Much mucus and a papillary tumor covered with mucus were disclosed in the gallbladder. Histologically, the tumor was demonstrated to be papillary adenocar-cinoma. The literature of mucus-producing cancer of the gallbladder was reviewed.

View full abstract

A 24-year-old woman was diagnosed to have primary biliary cirrhosis (PBC) in an asymptomatic stage. Serum alkaline phosphatase and γ-glutamyl transpeptidase levels were elevated, while serum antimitochondrial antibody was negative. Laparoscopy revealed a smooth liver surface with "reddish patch" which is a diagnostic feature of PBC. Histological examination of the liver biopsy specimen showed chronic nonsuppurative destructive cholangitis without piecemeal necrosis and granuloma. To our knowledge, this patient was the youngest one among the patients who have been reported as an asymptomatic PBC without antimitochondrial antibody in Japan. Laparoscopy combined with liver biopsy was very useful in the diagnosis of this patient.

View full abstract

This time, we have experienced to use multi-data filing system deviced by OLMPUS. It was able to input synchronously many data of electronic endoscopic pictures by using of this system. In addition, we developed a new system, which was combined with the data filing system and remote search unit, color videoprinter. In case of using this new system, we could take out the endoscopic data on TV monitor by using this new system during input of another data. In educational institute to which many electronic endoscopies and endoscopist belon-ged, it was useful to educate endoscopic techniques. And, immediately after the examina-tion, we could draw up the endoscopic picture using this system. Hereafter, more develope-ments of these systems are expected.

View full abstract