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Volume 34, Issue 8
Displaying 1-18 of 18 articles from this issue
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Akimichi CHONAN, Fukuji MOCHIZUKI, Takashi IKEDA, Naotaka FUJITA, Shig ...1992 Volume 34 Issue 8 Pages 1833-1843
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTo evaluate the ability of endoscopic ultrasonography (EUS) in diagnosing malignant lymphoma of the stomach, 14 lesions in 13 cases examined by EUS were studied. By EUS, we devided the lesions into 3 groups; type A (6 lesions), type B (5 lesions) and type C (3 lesions). The results are as follows; 1) Nodular echoic pattern and low echo level were shown in type A by EUS (Figure 1). Homogenous, diffuse echoic pattern and very low echo level were shown in type B (Figure 2). In type C, it was very difficult to distinguish from gastric ulcer or ulcer scar with echoic pattern (Figure 3). 2) Histologically, type A corresponded to a part of follicular lymphoma of LSG classification whose follicle-like structure was clear. Type B corresponded to diffuse lymphoma and a part of follicular lymphoma whose follicle-like structure was not clear. 3) This EUS classification was useful for diagnosing the depth of invasion and extent of infiltration in malignant lymphoma of the stomach (Table 6, 7).View full abstractDownload PDF (6906K) -
AFTER ENDOSCOPIC INJECTION SCLEROTHERAPY AND ITS CLINICAL SIGNIFICANCEYoshihisa URITA, Masayuki NAKATA, Masue MUTOH, Manabu ISHIHARA, Akihik ...1992 Volume 34 Issue 8 Pages 1844-1855
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe purpose of this study was to elucidate the cause of the chest complications after endoscopic injection sclerotherapy (EIS) including esophago-bronchial fistula, pleural effusion, chest pain, and fever, and to consider a counterplan. Bronchofiberscopy was performed in 35 patients with portal hypertension before and after EIS. Before EIS, the bronchial venous dilatation, mainly in the left main bronchus, was found in various degree. The degree of bronchial venous dilatation correlated with form and location of esophageal varices, and subsided after EIS in a few patients. In 8 of 35 patients (22.9%), multiple small ulcerations appeared in the main bronchus after EIS. This bronchial ulceration did not correlate with total volume of sclerosant (1%polidocanol), hepatic reserve function classified by Pugh's score, esophageal ulcer after the first EIS, and minor complications as pleural effusion, chest pain, and fever. The causative factors seemed to be the direct effect of sclerosant, endoscopic examination itself, and the change of bronchial mucosal circulation during EIS. Bronchial ulceration was suggested to be local influence by EIS. These bronchof iberscopic findings are not generally unknown. The fact should be kept in mind and we must make an effort to detect these bronchial changes in their early stages and cope with these bronchial complications after EIS.View full abstractDownload PDF (3021K) -
Hiroaki IWASE, Kimitomo MORISE, Yoh HORIUCHI, Atsuo KUROIWA, Hirofumi ...1992 Volume 34 Issue 8 Pages 1856-1862_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThirty one patients with esophageal, gastric varices and their collateral veins were evaluated using color Doppler endoscopic ultrasonography (CDEUS: FG-32UA, HITACHIPENTAX, Japan). Twenty nine patients with varices more than 2 mm in diameter were possible to be evaluated. The forms of varices were endoscopically classified into 3 types; straight varices (F1 type), tortuous varices (F2 type), and nodular varices (F3 type). Ultrasonographically, the mean diameter of F1 type was 2.8±0.8mm, F2 type was 5.1±1.1 mm, and F3 type was 8.3±2.2 mm. The blood flow of varices was 10.8±1.5 cm/s in varices under 4 mm in diameter, 12.8±2.5 cm/s in varices between 5 mm and 7 mm in diameter, and 13.7±3.2 cm/s in varices more than 8 mm in diameter. Among the 3 types, there were no statistically significant differences in the blood flow. The variceal blood flow was turbulent but not synchronized with cardiac rhythm. Characteristically, the color flow mapping and color Doppler spectrum revealed a vortex flow in 8 patients with dilated varices more than 8 mm in diameter. Most of the variceal flow in the collateral veins were hepatofugal, turbulent and non-pulsated, while some of them showed hepatopetal, and laminal flows with pulsation. The diameters of collateral veins showed a close correlation with those of the varices. In conclusion, a color Doppler endoscopic ultrasonography is very useful for evaluating hemodynamics of the esopageal, gastric varices and collateral veins.View full abstractDownload PDF (2875K) -
Fumio ARIMURA, Jun MATUMOTO, Kazuaki NAKASIO, Junichi YOSHIKAWA, Yasua ...1992 Volume 34 Issue 8 Pages 1863-1870
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic ultrasonography (EUS) was performed in 16 patients with cancer of the extrahepatic bile duct by the transduodenal balloon contact method. EUS pictures of the tumors were investigated and their expansion to the bile duct wall, the pancreas and the portal vein were compared with histological findings in 14 resected cases and with operative findings in 2 unresected cases. Moreover, accuracy rates of EUS for malignant spread were compared with those of computed tomography and angiography. From above ivestigations, extrahepatic bile duct cancers were generally presented as heterogenious, irregular, low echoic tumors by EUS and EUS was thought to be one of the most useful procedures in the diagnosis of the extension of extrahepatic bile duct cancer.View full abstractDownload PDF (6068K) -
Masahide UCHIZAWA, Masanori HIRAO, Osafumi YAMAGUTI, Hiroji NAKA, Tatu ...1992 Volume 34 Issue 8 Pages 1871-1878_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe already reported a new method of endoscopic resection with local injection of hypertonic saline epinephrine solution (herein after abbreviated as ERHSE) which was an excellent curative techniqe for gastric tumors and esophageal tumors in 1982. We also applied ERHSE to colorectal lesions of sessil and subpedunclated type from Janualy, 1990, to December, 1990. These included 4 cases of ha type early carcinoma and 6 cases of flat elavated type adenoma in colon and rectum. The curative rate was 100%. The maximum axis of lesion was 25×25mm, the minimum was 7×9mm. The results showed that ERHSE was able to excise the lesion over 20mm in size. Complications of ERHSE were not experienced in this period. ERHSE is an excellent curative technique for flat elevated tumors in colon and rectum.View full abstractDownload PDF (3633K) -
ESPECIALLY ON SUPERFICIAL HEPATIC VESSELS IN THE DIFFERENCE IN COMPLICATED CASESAkihito TSUBOTA, Naoya MURASHIMA, Kazuo TAKEUCHI, Masao NAKAJIMA1992 Volume 34 Issue 8 Pages 1879-1887
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSTwenty one cirrhotic patients with negative HBs antigen, whom second generation were measured, were classified into three groups, and a peritoneoscopic study was made. The classifications were as follows: C group includes positive second generation HCV antibody assay (second generation) with scant or no history of alcohol abuse, AL group has negative second generation in heavy drinkers without history of blood transfusion or liver disease, Mix group has positive second generation in heavy drinkers. There were marked difference of peritoneoscopic findings on size of the liver and the nodules, colour of the liver surface between C group and AL group. There were also high incidence and vascularity of superficial terminal portal veins, which presented as "twig-like" in appearance in C group, and superficial arterial branches, which presented a "curly hair" in appearance in AL group.View full abstractDownload PDF (3530K) -
Yoshiharu UNO, Yoshihiro SASAKI, Akihiro MUNAKATA1992 Volume 34 Issue 8 Pages 1888-1893
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSStrip biopsy, which is an endoscopic resected technique for sessille or flat type lesion is possibly applied to the resection for the colonic submucosal tumors such as lymphangioma or lipoma. In conventional strip biopsy, saline is firstly injected into the submucosa around a lesion in order to elevate the target lesion from the submucosal layer and then a snare device is placed around the elevated mass which is resected by use of electrocoagulation. Only local application with saline, however, is not able to make clear a border line between the target lesion and its surrounding mucosa especially in resection of submucosal tumors. Inadequate positioning of snare device is sometimes resulted in complications such as perforation or incomplete resection of the tissue. Instead of saline, we used the saline containing methylene blue (SCMB) to get the clear border of a tumor or correct snare position. Based on this technique, we performed safely 4 complete resections of colonic submucosal tumors including 2 lipoma and 2 lymphangioma.View full abstractDownload PDF (4539K) -
Keiichi FUJINO, Takashi ICHIKURA, Hirotsugu IKAWA, Souichi TOMIMATSU, ...1992 Volume 34 Issue 8 Pages 1895-1899_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe report a case of malignant lymphoma of the stomach developing large foci of squamous metaplasia during follow-up. A 45-year-old man complained of epigastric pain. A protruding lesion with the central depression was observed in the posterior wall of the upper body of the stomach by the initial endoscopic examination. Repeated endoscopic examinations demonstrated the disappearance of the elevation of the surrounding mucosa and another ulceration developed 4 months after the initial endoscopic examination. Six months later, a milky whitish mucosa appeared along the lesser curvature from cardia to angulus and the giant fold was observed along the greater curvature. Under the diagnosis of primary malignant lymphoma of the stomch, total gastrectomy, splenectomy and liver biopsy were performed. The histological examination revealed that the milky whitish mucosa was stratified squamous epithelium spreading 3.5×3 cm in size. The invasion of malignant lymphoma was limited to the submucosal layer and the histological type was diffuse, large cell type. Only three cases of large foci of squamous metaplasia of the gastric mucosa have been reported.View full abstractDownload PDF (4350K) -
Mitsurou KATO, Manabu YONESHIMA, Masao HONDA, Yoshirou KITANO, Sigeho ...1992 Volume 34 Issue 8 Pages 1900-1907
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 41-years-old man visited our clinic with complaints nausea and epigastric pain. X-ray and endoscopic examinations showed a round elevated lesion with mucosal bridges on the posterior wall of the lower body of the stomach. Histological examination of the lesion by endoscopic biopsy revealed Heinrich-II aberrant pancreas. Endoscopic ultrasonography showed a high ecohic mass in the 3rd layer. There were ductal shadows and some high ecohoic areas with acoustic shadows in the mass. CT scan revealed some calcifications on the posterior wall of the stomach. Gastrectomy was performed. There were some stones in the dilated ducts of the aberrant panceatic tissue. On the aberrant pancreas, histological findings of ductitis but not of chronic pancreatitis were demonstrated. We suggested that the stone formation in the aberrant pancreas was due to obstruction of pancreatic ducts by inflammation, in its etiology.View full abstractDownload PDF (6767K) -
Sadao TAKAHASHI, Satoshi OKABE, Minoru SUGAWARA, Ichirou MATUKURA, Yas ...1992 Volume 34 Issue 8 Pages 1908-1913_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe experienced a 46-years-old male patient with a IIc-type early gastric carcinoma, which showed remarkable change of its shape for one month. On initial endoscopic examination, 1cm sized ulceration covered with white coat developed to a slightly depressed lesion with obscure margin about for one month. We diagnosed that lesion as type-IIc like a shoal with a broken-down areolae at margin, based on stereomicroscopical examination. The marked change of shape of this lesion in a short time was supposed to be a malignant cycle of early gastric carcinoma. It was considered that the border of this lesion was made uncertain because it was located not only at the posterior wall of the ‘C’ area but also in fundic gland's area adjacent to the F-boundary line.View full abstractDownload PDF (7674K) -
Kazuhiro MAEDA, Sinichirou OBATA, Atuko TUKAMOTO, Keisi KIMURA, Tadahi ...1992 Volume 34 Issue 8 Pages 1914-1918_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSGastrointestinal vasucular ectasia (VE) is rare, but VE is an important cause of UGI bleeding. We experienced a case of hemorrhagic vascular ectasia of the duodenalbulb. A 61-year old man undergoing chronic hemodialysis due to diabetic renal failure was admitted to our hospital because of intermittent tarry stool during seven years. Repeated UGI endoscopic examination revealed a vascular ectasia, approximately 5mm in diameter, at the posterior wall of the duodenal bulb just below the pyloric ring. It was successfully treated by endoscopic electrocoagulation, and scar was noticed at the same lesion two months later. Thereafter, he had never experienced tarry stool for sixteen months.View full abstractDownload PDF (2908K) -
Teruyuki KANE, Toshihiko OKAMOTO, Hisayuki INOUE, Shigeki KOYAMA, Utak ...1992 Volume 34 Issue 8 Pages 1921-1927
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 29-year-old female came to hospital with complaints of tarry stool and general malaise. Bleeding focus was not detected by gastrofiberscopy, colonoscopy and abdominal angiography. Surgery was performed to make a correct diagnosis. Five small ulcers were shown by pathohistological examination of the resected jejunum. These lesions were finally diagnosed as nonspecific multiple ulcers of the small intestine. Nonspecific multiple ulcers of the small intestine are rare cases. Only about 130 cases were reported in the past days.View full abstractDownload PDF (7396K) -
Hiroshi TOKUYAMA, Fuyuhiko HIGASHI, Hidehito TAMAKI, Toshihiko KUNISHO ...1992 Volume 34 Issue 8 Pages 1929-1932_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 79-year-old woman visited a local hospital with a chief complaint of epigastric pain. UGI x-ray examination revealed a protruding lesion extending from the first portion to the second portion of the duodenum. She was referred to the department of internal medicine in our hospital for further examination. Endoscopic examination showed an elongated protrusion at the upper end of the second portion of the duodenum. Endoscopic polypectomy was performed. Histologically, the outer side was covered with normal duodenal mucosa and the inner side was consisted of proliferated Brunner's glands partly at the tip, loose connective tissue including dilated vessels and enlarged cystic glands of varying size. However, the amount of tissues affected with these changes was relatively small in the entire protrusion and it was unlikelly that these changes were responsible for developing this protrusion. This case is considered to be identical with the concept of intraluminal duodenal protrusion (IDP) as proposed by Inamoto et al.View full abstractDownload PDF (4204K) -
Kose SEGAWA, Takashi SUZUKI, Tomiyasu ARISAWA, Yasumasa NIWA, Hidemi G ...1992 Volume 34 Issue 8 Pages 1933-1937_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of appendicitis complicated with colonoscopy was reported. A patient, 49-year -old male, underwent colonoscopy for the follow-up study of colonic polyp. The examina-tion was performed without any trouble including biopsy. Four hours later, however, he began to complain of severe abdominal pain. Intestinal perforation due to mechanical damage with colonoscope was suspected and laparotomy was performed. Surgical findings showed no traumatic lesions of the colon, but a reddish, swollen and gangrenous appendix was found and removed. Post-surgical course of the patient was uneventful. There were no symptoms and signs of appendicitis before colonoscopy including colonoscopic findings around the cecal end and appendicular orifice, and the symptom began shortly after colonoscopy. These facts suggested colonoscopy causing acute appendicitis. Elevation of intraluminal pressure with infused air, pushing intestinal content into the appendix and secondary obstruction of the appendicular orifice could be the causative factors. Thus, appendicitis should be taken into consideration when acute abdomen was encountered after colonoscopy.View full abstractDownload PDF (4437K) -
A CASE OF LOW GRADE INTUSSUSCEPTION OF THE ILEUM DUE TO MALIGNANT LYMPHOMA OBSERVED WITH COLONOSCOPYAkiyoshi NISHIO, Shunji UEDA, Minoru OKUMA, Masahiko SAKAI, Tomikazu Y ...1992 Volume 34 Issue 8 Pages 1938-1942_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 74 year-old waman was referred to Tenri hospital with the diagnosis of a tumor of the ileocecal region. She complained of right hypogastralgia for two months and a tumor of the terminal ileum was pointed out by small bowel enema by a home doctor. Colono-scopic examination revealed a round mass which moved to-and-fro through the ileocecal valve. The tumor was diagnosed as malignant lymphoma by biposy. Garium scintigram demonstrated swelling of the regional lymphnodes in addition to the tumor and was useful in determining the clinical stage preoperatively. Resection of the ileocecal segment was performed. The tumor was diagnosed as B cell malignant lymphoma, diffuse, large cell type, histologically. This is an uncommon case of low grade intussusception of the ileum due to malignant lymphoma observed with colonoscopy.View full abstractDownload PDF (4805K) -
Masataka SHINODA, Kimitomo MORISE, Kazuo KUSUGAMI, Yuichirou SAITOU, J ...1992 Volume 34 Issue 8 Pages 1945-1950_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 31-year-old man was admitted to our hospital complaining of abdominal pain in June, 1990. He had been suffering from constipation since his birth. Barium enema on admission demonstrated a remarkably dilated sigmoid colon and rectal narrow segment. Colonoscopy showed multiple erosions in the dilated colon. He was operated on by Duhamel's procedure under the diagnosis of Hirschsprung's disease. Despite adequate preoperative treatments, he had a fecal stone in the megacolon. Microphotograph of the resected specimen from the narrow segment revealed lack of ganglionic cells. Analyzing 51 adult cases of Hirschsptung's disease having reported in Japan since 1964, most of them had been complaining of severe constipation since early childhood. Since those cases were not infrequently complicated with colonic perforation or ileus, surgical treatment is recommended as the first choice.View full abstractDownload PDF (4803K) -
Masaya TOMINAGA, Tadahiko FUCHIGAMI, Akinori IWASHITA1992 Volume 34 Issue 8 Pages 1953-1957_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 67-year-old woman was admitted to our hospital on May 2 1987 with complaint of bloody stool. Barium enema showed a submucosal tumor-like lesion in the lower rectum measuring approximately 14 × 13mm in size, on which the mucosal pattern of the central surface disappeared widely. Endoscopic examination showed a plateau-like tumor with widely spreaded reddish irregular erosion on the top. These findings led to a clinical diagnosis of malignant lymphoma, carcinoid or IIa+IIc type early rectal cancer. But endoscopic biopsy specimens revealed hyperplastic lymphoid follicles and mucosal ulcera-tion. There were no malignant changes and the pathological diagnosis was "rectal tonsil". Local excision was performed on May 26, 1987. The resected specimen showed a sessile tumor measuring approximately 10 × 10mm in size. Histologically, the tumor was mainly located in the submucosal layer. The tumor was composed of hyperplastic lymphoid tissue with a few, small germinal center, consisting mainly of mature lymphocytes mixed with some histiocytes, plasma cells and eosinophils. There were no malignant changes. All these findings led to the final diagnosis of benign lymphoid polyp.View full abstractDownload PDF (6469K) -
Masao FUJIMOTO, Saburo NAKAZAWA, Kenji YAMAO, Junji YOSHINO, Kazuo INU ...1992 Volume 34 Issue 8 Pages 1958-1964_1
Published: August 20, 1992
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 70-year-old female was visited to our hospital because of a hypoechoic tumor in the pancreas head with the dilated main pancreatic duct detected by US in another hospital. We diagnosed it as a mucin producing tumor of the pancreas by US, endoscopic ultrasono-graphy (EUS) and endoscopic retrograde cholangiography (ERCP). And then we diagnosed it as adenoma or carcinoma in situ by EUS and intraductal ultrasonography (ID-US). Peroral transpapillary pancreatoscopy (POPS) was useful to determine the resection line. Histological diagnosis of the resected specimen was cystadenoma. EUS, POPS and ID-US is advantageous to make a differential diagnosis between neoplasm and hyperplasia, and to delineate its intraductal and extraductal extension.View full abstractDownload PDF (9471K)
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