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Volume 35, Issue 9
Displaying 1-18 of 18 articles from this issue
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Toshikazu SAGAMI1993 Volume 35 Issue 9 Pages 2079-2091
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe introduced peroral micro-cholangiopancreatoscopy using an ultra-thin fiberscope that can be inserted in a target site through normal papilla. The results led us to conclude that the technique is useful in diagnosing various diseases of the pancreas. This paper deals with the process behind the development and improvement of the instrument and the results of the clinical trial. We used two types of f iberscopes : the MS-75L, which has 3, 000 image fibers with outer diameter of 0.75 mm and the MS-45 L, which has 1, 600 image fibers with outer diameter of 0.45 mm. There were two kinds of systems : the FVS-1000 made by M & M, Inc. and a modified version, the FVS-3000. The FVS-3000 was able to photograph in real time, the images formed by the ultrathin fiberscope, constituting an improvement in the reproducibility of endoscopic pictures both in color tone and visibility. Although the system works in over 90% of all cases, allowing the fiberscope to be inserted in a target site for observation, further improvements must be made to secure a better visual field and ensure prolonged fibescope durability. However, this mode of micro-pancreatoscopy is a useful tool in diagnosing diseases of the pancreas.View full abstractDownload PDF (8006K) -
Hiroaki OMORI, Choichi SUGAWA1993 Volume 35 Issue 9 Pages 2093-2097
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSContinuous monitoring of arterial oxygen saturation (SaO2) and blood pressure during upper gastrointestinal endoscopy was performed to investigate the incidence of significant cardiopulmonary compromise requiring medical intervention. Four-hundred and four patients at an urban university hospital were monitored using a pulse oxymetry and the latter 212 patients were additionally monitored with an automatic sphygmomanometry. These measurements were carried out before examination, at the insertion of an endoscope, during operation, and after examination. Hypoxemia (SaO2 <90%) occurred in 32 patients (8%) while inserting the endoscope. Hypertension and hypotension (systolic blood pressure≥ 200mmHg, < 90mmHg) were found in 30 patients (14%) and 12 patients (6%) during or immediately after the procedure respectively. In 111 patients who had a history of a cardiac or pulmonary disease, the incidence of hypoxia was significantly higher. Eleven of 12 patients who required interventions for oxygen desaturation, had a history of cardiopulmonary disease. All of these patients recovered within 15 minutes of medical intervention. It is concluded that not a few effects on cardiopulmonary function during upper gastrointestinal endoscopy are considered especially for patients having a previous history of CPD, where the pulse oxymetry and sphygmomanometry are valuable and useful monitoring techniques.View full abstractDownload PDF (717K) -
Kunio SUZUKI, Takuji KATOU, Yoshihiro KOHLI1993 Volume 35 Issue 9 Pages 2098-2105
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSUsing a monoclonal antibody to proliferating cell nuclear antigen (PCNA), PC-10, we investigated an immunohistochemical analysis of human gastric lesions in formalin-fixed, paraffin-embedded tissue sections of biopsy specimens. At first, the distribution pattern of the positive cells of PCNA was studied. In Group I and Group II lesions, PCNA positive cells were observed mainly in the neck area of glands. In Group III lesions, the diffuse distribution of the labeled cells were seen in the areas of atypical glands, however, adenomatous glands somewhat preserved the generative cell zone. In Group IV and Group V lesions, many PCNA positive cells were irregularly distributed in all areas of the atypical glands. Secondly, the proportion of PCNA positive cells were examined. The labeling index of PCNA (percentage of PCNA positive cells per 1000 atypical cells) were 40.6 ± 11.0% in atypical glands of Group V lesions, 34.9±7.7 % in Group IV lesions, 25.3±6.6% in Group III lesions. Statistical difference was found between Group V and Group III lesions, Group IV and Group III lesions, but no difference was found between Group V and Group IV lesions. The distribution pattern and proportion of PCNA positive cells in Group IV lesions were similar to those of Group V lesions. The results suggested that immunohistochemical staining for PCNA would be useful as a cell proliferative marker by using routinely processed tissue and be beneficial for clinical application of the histological diagnosis of gastric lesions by endoscopic biopsy.View full abstractDownload PDF (6330K) -
A COMPARISON WITH SURGICALLY RESECTED CASESHisanobu TOMIMATSU, Yasumasa BABA, Sachio KAKU, Hiroshi SHIMIZU, Noris ...1993 Volume 35 Issue 9 Pages 2106-2115
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSOver the past 10 years at our hospital, multiple early gastric cancers were detected in 12.5% of surgically treated patients and in 14.4% of endosopically treated patients (ER group). In the ER group, 5.4% had synchronous multiple gastric cancers and 9.0% has metachronous lesions. The macroscopic types of the main and secondary foci were the same in both the surgical and ER groups. The most common histologic type was well differentiated carcinoma, and many of the patients were elderly males. The background mucosa of the cancers in the surgical group was pyloric gland mucosa in about 90% of the main and secondary foci. The sites of both the main and secondary foci were often the same or neighboring segments of the M and A regions (CMA classification) in both the surgical and ER groups. The Pathological detection rates for secondary foci in the surgical group was about 90% for foci ≤ 5mm in size and about 30% for those 6-10mm. Thus, the detection of minute and small gastric cancers during life appears to be an important problem. The interval until the detection of metachronous foci in the ER group was an average of 31 months (4-70 months). About half of the metachronous foci were discovered within 2 years, and there were also cases in which tumors were completely overlooked.View full abstractDownload PDF (1200K) -
ON THE RELATIONSHIP BETWEEN AGING AND GASTRIC MUCOSAL BLOOD FLOWHanzo KUROSAKA, Takahito AOKI, Tatsuo HIROOKA, Yoshihisa SADANAGA, Syo ...1993 Volume 35 Issue 9 Pages 2116-2127
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSVarious methods have been employed for measurement of gastric mucosal blood flow. In the present study, this was performed using a laser doppler velocimetry, which permits simple and convenient endoscopic measurement with excellent reproducibility. Using this instrument, mucosal blood flow was measured at a total of 16 points of the lesser curvature, greater curvature, anterior wall and posterior wall in 240 healthy male and female subjects ranging from the 3rd to the 8th decade in order to ascertain age related changes in gastric mucosal blood flow. The results showed that in the mucosa of the lesser curvature, from the antrum to the middle portion of the body, blood flow diminished as age increased, while in the mucosa of the greater curvature, anterior wall, and posterior wall, no significant age related changes were observed in any gastric regions. Moreover, comparison of the mucosal blood flow in the regions of the lesser and greater curvatures revealed that the mucosal blood flow in the regions of the lesser curvature was definitely higher that in the corresponding regions of the greater curvature.View full abstractDownload PDF (1430K) -
Masahiro IIZUKA, Mitsuro CHIBA, Yasuo HORIE, Nobuaki ISII, Masahiko MU ...1993 Volume 35 Issue 9 Pages 2128-2136_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSSurveillance colonoscopy in the patients with longstanding ulcerative colitis has been done in order to detect dysplasia before developing cancer or to detect cancer in early stage. In our department, surveillance colonoscopy has been done since 1987. The methods and results were summarized as follows. Surveillance colonoscopy was performed eighteen times in ten patients who had ulcerative colitis over ten years. All patients were female. The age of the patients ranged from 38 to 69 years old (mean 53.9 yrs) and onset of the disease ranged from 23 to 59 years old (mean 49.7 yrs). The ten cases consisted of 2 cases of entire colitis and 8 of left-sided colitis; 1 case of severe type, 7 of moderate type and 2 of mild type when the utmost severity during the course was assessed. All patients were relapsing-remitting type. Five hundred ml of enema containing 0.03% methylene blue was injected around one hour before total colonoscopy. Two biopsy specimens were taken from each ten regions from the cecum to the rectum. In addition, specimens were also taken from the lesions suggesting dysplasia. Dysplasia was detected in two cases ; mild dysplasia in the rectum of left sided colitis having 12 years history of ulcerative colitis : moderate dysplasia both in sigmoid colon and descending colon of entire colitis having 19 years history of ulcerative colitis. Follow-up colonoscopy in the latter case revealed double early colon cancers three years later. This case was the third case of early colorectal cancer detected by cancer surveillance of ulcerative colitis in Japan. Our experience supported the view that surveillance colonoscopy is useful to detect dysplasia or cancer in early stage in patients with longstanding ulcerative colitis.View full abstractDownload PDF (7137K) -
Yukinori NAKAE, Mitsutaka KUMAMOTO, Yohko OZAKI, Masaya HIROSE, Nobuyu ...1993 Volume 35 Issue 9 Pages 2137-2143
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSChromocolonoscopy has become an important diagnostic procedure. Concentric circle sign, concentric circle pattern of colonic mucosa, is a specific finding for diverticulum and prediverticulum. Dye retention enema is very effective for the visualization of this sign. Endoscopical differential diagnos between inverted diverticulum and polyp is easy by recognizing concentric circle sign. Further studies will be necessary to clarify the mechanism of concentric circle formation.View full abstractDownload PDF (5095K) -
Naoki SHIMADA, Shigeaki OGURA, JUN FUJITA, Akiko KANAYA, Tomoaki ADACH ...1993 Volume 35 Issue 9 Pages 2144-2150_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSUsing a silver staining technique, nucleolar organizer regions associated proteins (Ag-NORs) were studied in paraffin sections of 5 normal mucosa, 97 colonic polyps (17 adenomas with mild dysplasia, 43 with moderately dysplasia, 18 with severe dysplasia, and 19 with carcinoma in adenoma) and 11 advanced carcinomas of the colon. Significant differences were found among the respective degrees of dysplasia (The number of Ag-NORs per nucleus was 2.2 ± 0.2 (mean ± SD) for normal mucosa, 3.1 ± 0.4 for mild dysplasia, 3.7±0.5 for moderately dysplasia, and 4.7±0.4 for severe dysplasia.). On the other hand, there were no significant differences among adenoma with severe dysplasia, carcinoma in adenoma and advanced carcinoma (The number of Ag-NORs per nucleus was 4.6±0.4 for carcinoma in adenoma and 4.9±0.7 for advanced carcinoma.). There were no significant correlations between the size of polyps and the number of Ag-NORs in respective degrees of dysplasia. These results indicate that adenomas in the colon have higher potentiality of proliferation as the histological findings of the polyps become more atypical. And adenoma with severe dysplasia has similar potential proliferation as colonic carcinoma. The number of Ag-NORs depend on the degree of dysplasia rather than the size of polyps.View full abstractDownload PDF (3378K) -
Tuneo KAWASAKI, Shouji MARUYAMA, Eigo SATO, Yousuke IZUMI, Togo AOI, T ...1993 Volume 35 Issue 9 Pages 2153-2158_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 76-year-old man admitted to our hospital with complaints of malnutrition and dysphagia. Radical fundectomy of the stomach for fundic cancer (IIc+III like advance) was performed in our hospital 3.5 years before. After discharge from our hospital, he had been suffering from the reflux esophagitis, and so twice endoscopic examinations for the Upper G. I. tract were performed and revealed the granular congromelated papilloma of the esophagus at 3-4 cm region just above the anastomosis. We could't differentiate exactly from aggregated O-IIa type esophageal cancer and then endoscopic mucosal resection (EMR) was performed for total biopsy. Histological diagnosis was benign squamous cell papilloma. EMR was extremely effective for differentiate diagnosis for this lesion. There was no same case as this granular congromelated papilloma of the esophagus in the review of references.View full abstractDownload PDF (7733K) -
Manabu KIKUCHI, Masao MIZUTA, Hayato UNO, Isao YOKOYAMA, Yasuhisa YOKO ...1993 Volume 35 Issue 9 Pages 2159-2165_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 42-yrer-old male with a chief complaint of dysphagia visited our hospital. Esophagoscopy showed the lower half of the esophagus to be replaced with reddish mucosa, where two lesions, a raised, partly ulcerated mass, 7.5 × 5.5 cm, at the middle of the esophagus, and a granular, depressed lesion (IIc), 1.5 × 0.7 cm, in the lower part of the esophagus were found. Biopsy revealed squamous cell carcinoma in the raised mass, signet ring cell carcinoma in the IIc lesion, and columnar epithelium in a reddish mucosa. Esophagogastrectomy was performed. Histological examination showed the reddish mucosa to be composed of Barrett's esophagus with mild to severe dysplasia. The proximal lesion was composed of well differentiated adenocarcinoma and adenos-quamous cell carcinoma invading the adventitia (al). The IIc lesion showed partly poorly differentiated and partly well differentiated adenocarcinoma invading the submucosa. In Barrett's esophagus, various degrees of dysplasia of the columnar epithelium are often found and this fact is suggestive of consequent carcinomatous transformation. For this reason, it is mandatory to keep patients with Barrett's esophagus under strict follow-up with endoscopic biopsy. Surgical treatment should be undertaken only when carcinomatous change becomes evident, because dysplastic changes are known to persist for years in some cases.View full abstractDownload PDF (8344K) -
Hiroya NAKATA, Hidekazu ITOH, Yukihiro YOKOYA, Jun KAWAI, Shinya KAWAG ...1993 Volume 35 Issue 9 Pages 2166-2171_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThere have recently been some reports of stomach cancer developed in the reconstructed stomach tube after resection of esophageal cancer. However, reports on early gastric carcinoma are uncommon in the reconstructed stomach. We have encoutered a case of early gastric carcinoma developed in reconstructed stomach tube after resection of early esophageal cancer. The patient was a 65-year-old woman, who had a subtotal esophagectomy because of esophageal cancer 7 years ago. Endoscopic examination revealed the early gastric carcinoma of type I in the reconstructed stomach tube during follow-up observation. After hospitalization, the lesion was resected endoscopically by strip biopsy. In view of such a special structure, the follow-up observations by endoscopy for the early detection of stomach cancer after the operation of esophageal cancer are necessary.View full abstractDownload PDF (5339K) -
Yoshinobu HATTORI, Toru WATANABE, Seisaku KAMIBAYASHI, Hirofumi SATOH, ...1993 Volume 35 Issue 9 Pages 2172-2179
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 40-year-old male admitted to hospital for the purpose of further investigation for melena. Upper gastrointestinal endoscopy pointed out a tortuous protruding lesion on the upper posterior wall of the gastric body, while no other lesions to explain melena, such as esophageal varices or ulcers were identified. Under the preoperative diagnosis of localized gastric varices, we carried out an operation. During surgery, the short gastric veins and the posterior gastric vein were found to be dilated. Although splenectomy and the posterior gastric vein were ligated, the gastric protrusion did not disappear. Proximal gastric devascularization and resection of the upper posterior wall of gastric body including the lesion were performed. Histopathological examination of the resected specimen revealed the gastric arter-iovenous malformation. This is the first case of gastric arteriovenous malformation mimicking localized gastric varices in Japan. Gastric arteriovenous malformation as a differential diagnosis of localized gastric varices should be considered.View full abstractDownload PDF (5000K) -
Mitsuhiro SOHMA, Seiji WATANABE, Taketoshi SATOH, Tomoko KITAGAWA, Yuh ...1993 Volume 35 Issue 9 Pages 2180-2187
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 32-year-old man who had pigmented spots on his lips, fingers and toes, complained of bloody stool. An upper gastrointestinal series showed numerous sessile polyps throughout the stomach and several polyps in the duodenum. A barium enema study showed multiple pedunculated and sessile polyps throughout the large intestine. Thus, the patient was diagnosed as having Peutz-Jeghers syndrome. Thirty polyps of the large intestine were endoscopically polypectomized. The diagnosis of the 30 polyps were all hamartomatous polyps. However, a focus of well differenciated adenocarcinoma was recognized on the luminal surface of the pedunculated polyp of the descending colon, 25 × 17mm in size. To date, 48 cases of Peutz-Jeghers syndrome developing colorectal cancer have been reported in Japan. It was possible that the focal cancer in the descending colon in our case may have developed directly from the hamartomatous polyp without adenomatous component.View full abstractDownload PDF (5156K) -
Shinya MAEJIMA, Osame HASEBE, Yoshiaki MATSUDA, Taiji AKAMATU, Kenji M ...1993 Volume 35 Issue 9 Pages 2189-2195_1
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe report three cases which have been followed up for three years after endoscopic therapy for pancreatic diseases. Case 1: A 48-year-old man with the history of operation for acute hemorrhagic pancreatitis was referred to our hospital for abdominal pain. Computerized tomography showed a pseudocyst in the pancreatic body. Endoscopic cystogastrostomy and endoprosthesis placement was performed. Case 2 : A 63-year-old woman was referred to our hospital for abdominal pain caused by obstructive pancreatitis accompanying pancreatolithiasis. Endoscopic pancreatic sphincterotomy and removal of pancreatic stone were performed. Case 3 : A 28-year-old woman was referred to our hospital for recurrent attacks of pancreatitis associated with pancreas divisum. Endoscopic stent placement through the minor papilla and papillotomy of the accessory papilla were performed. For up to three-years, case 1 and 2 showed improvement of their clinical symptoms and abnormal laboratory findings on pancreatic diseases. Symptoms were free for about 2 months during stent placement in case 3, but the dorsal pancreatogram showed irregularity and dilatation after stent placement and she experienced recurrent attacks of pancreatitis again.View full abstractDownload PDF (10027K) -
Tsuyoshi SASAGAWA, Youichi KITAMURA, Kiyotaka YAMAMOTO, YUMIKO Yamase, ...1993 Volume 35 Issue 9 Pages 2196-2203
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn Japan, expandable metallic stent (EMS) has seldom been used for intestinal stenosis. In this paper, we report that EMS was applied for treatments of benign stenosis in the jejunum after Billroth-II operation, and stenosis in the jejunum due to peritoneal dissemination after total gastrectomy. Case 1 is a 93-year-old male. A hard ring stenosis occurred at an efferent loop approximately 3 cm away from gastro-jejuno-anastomosis after Billroth-II operation. No improvement was seen by repeated bougienage, and so EMS of 19 mm in diameter and 4.5 cm in length was placed at the stenotic site. The effect of dilatation was good, and the patient was able to eat an entire bowl of wet rice 3 days after the procedure. The stent is still open even after 6 months. Case 2 is a 57-yaers-old male. A stenosis occurred in the jejunum approximately 2 cm away from esophago-jejuno-anastomosis due to peritoneal dissemination after total gastrectomy. The stent was placed at the stenotic site. The effect of dilatation was achieved temporarily, but the stent was crashed in about 40 days. Mucosa of the jejunum proliferated from the interspace of the stent and obstructed it. There are various problems regarding EMS such as obstruction of stent due to tumor proliferation in mesh interspace, resistance against pressure, and long term patency. However, further improvement may be possible to apply EMS for intestinal stenosis.View full abstractDownload PDF (5306K) -
1993 Volume 35 Issue 9 Pages 2204-2258
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (8887K) -
1993 Volume 35 Issue 9 Pages 2259-2290
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (5173K) -
1993 Volume 35 Issue 9 Pages 2291-2302
Published: September 20, 1993
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (1864K)
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