The present study was performed in an attempt to clarify the clinicopathological characteristics of AGML and also to evaluate preventive regimens, both clinically and experimentally. The subjects consisted of 360 AGML patients (45.5±16.4 years old, mean±SD; male-to-female ratio of 2.1:1), who were endoscopically diagnosed among 26, 162 patietns who received upper gastrointestinal endoscopic examinations in our hospital from 1988 through 1992. As to the etiology of AGML, psychological stress ranked the 1st (55.6%), followed by drugs (22.2%), spicy foods/drinks (6.9%), miscellaneous (7.5%) and unidentified (7.8%). It was noted that the number of AGML cases due to drugs doubled in the last 2 years. While stress was deeply associated with AGML observed in patients aged less than 65, drugs were related to AGML in patients over 65. The seasonal analysis of incidence of AGML revealed that the occurrence rate of AGML relative to the total number of endoscopic examinations performed in each season was significantly lower in summer than any other season. It also was found that AGML was more frequently observed in people residing in downtown area than those in suburb an area. Further detailed analysis of 80 patients with drug-induced AGML demonstrated that nonsteroidal anti-inflammatory drugs (NSAIDs) with diclofenac being most prevalent were the most common causal agent (72.5%), and then antibiotics (17.5%), steroids (5.0%) and miscella-neous (5.0%). In a clinical trial to compare the preventive efficacy of the H₂-receptor antagonist ranitidine and the mucosal protective agent teprenon against diclofenac-in-duced AGML, ranitidine significantly reduced the severity of mucosal lesions induced by the NSAID, but teprenon was without effect. Experimentally, interleukin-1(0.01-1μg/rat, ip) protected dose-dependently the gastric mucosa from ulcerogenic stimuli such as stress, NSAID and absolute ethanol, indicating a possibility that cytokines may be incorporated into comprehensive strategies for a better treatment of peptic ulcers.

View full abstract

To determine the therapeutic effect of photodynamic therapy (PDT) using a new photosensitizer 2, 4-bis (1-decyloxyethyl)-Ga-deuteroporphyl diaspartic acid (ATX-70), 33 female nude mice transplanted human pancreatic cancer were irradiated with a pulsed Nd: YAG laser with a Q-switch after the administration of ATX-70. Human pancreatic cancer (undifferentiated carcinoma) was transplanted to the back of nude mice. Five of 33 mice served as a control group. The other 28 mice received treatment when each tumor grew up to lcm in diameter. The treatment conditions were as follows; Group 1: only adminis-tration of ATX-70, Group 2: the irradiation with a pulsed YAG laser under an average power of 0.5 W and a repetition rate of 50Hz without ATX-70, Group 3: a pulsed YAG laser (0.5W, 50Hz) with ATX-70, Group 4: a pulsed YAG laser (0.5W, 300Hz) with ATX-70, Group 5: a pulsed YAG laser (2W, 300Hz) with ATX-70. ATX-70 at 25mg/kg body weight was intraperitoneally injected 24 hours before irradiation. The tumors were irradiated with a pulsed YAG laser with a contact probe for 10 minutes. The effectiveness of treatment in group 3 was better than in group 2. There was no significant difference between the effectiveness of group 3 and that of group 4. The treatment in group 5 was the most effective among all experimental groups, but its temperature was above 60°C in the center of the tumor which caused a strong thermal effect. Considering these results, the administration of ATX-70 enhanced the effectiveness of a pulsed YAG laser and ATX-70 could become a clinically valuable photosensitizer in combination with a pulsed YAG laser using a Q-switch.

View full abstract

For evaluation of endoscopic transmission of bacteria and virus and their prevention, 9 parts of the gastrofiberscopes were cultured quantitatively for bacteria and 5 parts were examined for occult blood as illustrated in Table 1 and specimens were isolated at four time periods relative to procedures. Number of positive cultures for bacteria were only 3, incidence rates of positive cultures were 3/330 (0.9%). And bacterial counts were 102, 102 and 102. Mycobacteria was also not detected and not cultured. When endoscopes were recultured after a storage period, quantitative bacterial counts and positive cases did not increase. It is effective that manual cleanig protcols and disinf ection with 0.2% Tego51 in Automatic endoscope washing-machine before subse-quent routine endoscopic study, and with 0.2% Tego and 3.5% glutaraldehyd in the same machine and combined with disinf ection with 70% isoplopylalcohol and drying before storage were done meticulously. Reports of many in vivo, in vitro contamination-cleaning assays (HBsAg-positive and HCVAb-positive serum and blood subjects) demonstrated that cleaning and disinf ection procedures for endoscopes were effective in removal of these subjects from sufaces and channels of endoscope. If occult blood test is positive on the surface of endoscopes or their accessories after cleaning, it would mean poor cleaning. The number of positive tests for occult blood in flushed water through biopsy channel in this study were resulted in 5/63 (7.9%) positiv rate, and all the five were included in 28 cases of biopsy performed (17.9%), as illustrated in Table 4. Then, suction with 50 ml water through suction channel from biopsy valve to suction connector, and flush with 25 ml water through biopsy channel into the stomach, combined with the routine cleaning and disinf ection, were done immediately after biopsy and bleeding in the stomach or the esophagus. These procedures decreased a positive rate for occult blood in biopsy channel down to 2/42 (4.8%) as illustrated in Table 7.

View full abstract

The images of esophageal varices by infrared rays electronic endoscope (TREE) with a laser diode light source under rapid intravenous administration of indocyanine green (ICG) were investigated. The contents studied were comparison of images between visible rays and infrared rays, and numerous evaluation of change of ICG enhancement in region of interest and histogram of circular esophagus by computer analysis. The subjects for this study were 15 cases performed initial endoscopic sclerotherapy, which were observed under infrared rays (IR) before and after sclerotherapy. Before sclerotherapy the esophageal varices and superficial vessels around varices were more cleary under IR after ICG administration than under visible rays. But after sclerotherapy the esophageal varices and superficial vessels were not seen and the degree of enhancement after ICG administration under IR became significantly lower after sclerotherapy than that before scierotherapy. Comparing the numerous evaluation of change of ICG enhancement between before and after sclerotherapy by computer analysis, reduction of enhancement was showed objectively. The histogram of circular esophagus after sclerotherapy, peak of intensity was reduced both before and after ICG administration, drawn more gently curved line than before sclerotherapy. These results suggested that TREE images after intravenous administration of ICG showed changes in the blood flow of esophageal varices and architecture of vascular system beneath the esophageal mucosa after sclerotherapy and the degree of ICG enhance-ment was able to be evaluated objectively by computer analysis. In prognosis after sclerotherapy, the difference between recurrence rate under infrared rays and visible rays was noted statistically significant (p <0.05). In conclusion, TREE is an useful method for precious observation of esophageal varices and evaluation of endoscopic sclerotherapy.

View full abstract

We investigated mucosal redness in the upper third of the stomach observed by esophago-gastroscopy. The prevalence of mucosal redness among the patients without esophageal varices was 3.2% (895/28, 255). There was no sex difference but it was slightly high in the middle age. Its higher prevalence in duodenal ulcer suggests that the gastric acidity may contribute to its formation. The prevalence is significantly higher among the patients with esophageal varices (17.4%) (p <0.001). Endoscopic sclerotherapy of the esophageal varices did not affect the degree of redness in 69% of cases and worsen it in 22%. The induction of mucosal redness in the upper part of the stomach is multif actorial and the elucidation of its cause needs further investigation.

View full abstract

A 80-year-old woman who was diagnosed to have pemphigus vulgaris in 1987 was admitted to our hospital because of severe anorexia and general malaise. Endoscopic examination showed a duodenal ulcer (stage A1) which was considerd to be induced by steroidal therapy and some esophageal erosions. Steroid was discontinued and she was treated with f amotidine. Although duodenal ulcer was improved, esophagitis worsened. Biopsy of the esophageal mucosa and cytology of the vomitus revealed esophageal pemphigus vulgaris. Steroid was resumed with subsequent clinical improvement.

View full abstract

A 90-year-old man was admitted to our hospital because of loss of appetite and weight. Upper gastrointestinal X-ray and endoscopy showed a well-defined elevated lesion in the cardia and an irregular depressed lesion at the gastric angulus. Under a diagnosis of multiple early gastric cancers, total gastrectomy was performed. By histological examination, the elevated lesion was a mucosal cancer and the depressed lesion was a cancer invading the submucosa. Both are well differentiated tubular adenocarcinoma. The type AL amyloidosis was also demonstrated in the vessels of the submucosa mainly in the cardia. Eight cases of amyloidosis associated with cancer of the stomach in the Japanese literature are discussed.

View full abstract

An unusual case with synchronous malignant transformation in two out of three hyperplastic polyps of the stomach was reported. An 89-year-old woman was admitted to the hospital because of anorexia. Through gastric endoscopy, three gastric polyps, including a subpedunculated polyp having a smooth glistening surface (Polyp 1), 10 × 8 × 8mm in size, on the greater curvature of the antrum, a pedunculated polyp with a thin reddish and rough surface (Polyp 2), 12 × 7 × 10mm in size, on the greater curvature of the lower gastric body, and a slightly unevenly surfaced pedunculated polyp (Polyp 3), 15 × 10 × 10mm in size, on the anterior wall of the upper gastric body, were polypectomized. Although all of them were histologically compatible with hyperplastic polyps, a malignant transformation was noted in two polyps ; an intramucosal focus of well differentiated tubular adenocarcinoma in Polyp 2 and of moderately differentiated tubular adenocarcinoma in Polyp 3. Hyperplastic polyp is common in the stomach. However the malignant transformation is rare. Moreover a case of synchronous minute cancer in two hyperplastic polyp of the stomach is extremely rare.

View full abstract

A 21-year-old man was admitted to our hospital hoping for the follow-up of gastric polyps. X-ray and endoscopic examinations revealed multiple polypoid lesions in the esophagus, and multiple polyps in the stomach and colon. Esophageal epithelial thickening was demonstrated in the esophageal polypoid lesions. Gastric and colonic hyperplastic polyps were confirmed histologically. Although typical skin findings were absent, Cowden's disease was strongly suggested by clinical features such as adenoid appearance, goiter, arteriovenous malformation and gingival papillomatosis. Cowden's disease is characterized by multiple hyperplastic or hamartomatous development originating from three embryonic germ layers in the whole body. Cowden's disease is frequently complicated with malignant tumors and should be considered in the differential diagnosis of various diseases with gastrointestinal polyposis.

View full abstract

We reported a case of carcinoid tumor of the duodenal major papilla diagnosed preoperatively. A 57-year-old male was examined for billiary tract stones. When ERCP examination was performed, a yellowish mass was found at the papilla Vater. The tumor was smooth, dome shaped and 5mm in diameter. Histological diagnosis was carcinoid tumor. The serum somatostatin level was high. The fact that the level became normal after the removal of the tumor suggest that the neoplasm was a somatostatin producing one. Carcinoiod tumor of the duodenal major papilla is rare. The cases reported in Japan were reviewed and compared with ours.

View full abstract

A 19-year old male was performed emergent sigmoidectomy due to ileus. The time of onset of ulcerative colitis was uncertain, but sometimes he had had symptoms of bloody stool and diarrhea. The resected colonic tissues showed moderately differentiated adenocarcinoma invading to subserosa and widespread dysplasia surrounding main tumor. Other parts of the resected colon showed markedly atrophic mucosa with distorted tubules. Colonoscopic examination after operation showed whitish flat elevations in the transverse and discending colon, which were recognized clearly with spraying an indigocarmine solution. The biopsied specimen from flat elevations revealed high grade dysplasia. p53 was diffusely expressed in the carcinoma and high grade dysplasia.

View full abstract

A 54-year-old man underwent colonoscopy because of positive occult blood test of stools. A single pedunculated polyp of 1.2 cm in size with irregular surface was found in the ascending colon and easily excised. Most part of the polyp consisted of serrated glands with depletion of goblet cells, characteristic for a hyperplastic colonic polyp. On the top of the polyp, adenocarcinoma is found without adenomatous dysplasia. Malignant transformation of the colonic hyperplastic polyp is scarcely reported. High power view demonstrates goblet cell immaturity, upper zone mitosis, and prominebce of nucleoli, which coincide with mixed hyperplastic adenomatous polyp discribed by Longacre et al. Immunohistochemical study reveals its more resemblance to adenoma than hyperplastic polyp. The mixed hyperplastic adenomatous polyp is supposed to be neoplasm derived from more differentiated cell within the crypt, but its entity and malignant potential are not fully recognized.

View full abstract

A 59-year-old woman was admitted because of abdominal fullness, a little ascites, weight loss and positivity of the inflammatory reaction. CT and MRI demonstrated the presence of a tumor about 3 cm in size, near the midline of abdominal wall. Laparoscopy confirmed the presence of a tumor with smooth surface, yellow, two globe like a diplococcus, and calcification. Tumor resection was performed. The resected specimen showed histologically mucin producing adenocarcinoma. This case suggests that laparoscopy may become a benef ical examination for the dignosis of urachal tumor of abdominal wall.

View full abstract

In order to evaluate the depth of superficial colorectal cancer invasion as accurately as possible, we used a 2-channel electronic videocolonoscope and 15 MHz ultrasound probe (MP-PN series, Aloka Co. Ltd.). Through one channel, we pushed or withdrew the mucosa near the lesion by forceps. Through the other channel, we evaluated the depth of superficial colorectal cancer invasion using the ultrasound probe. By these procedures, we manipulated the mucosa near the lesion, and scanned the lesion vertically. We applied this examination to 6 patients with colorectal cancer (2 mucosal cancer, 4 submucosal cancer). We obtained a high diagnostic accuracy rate of 83.3%.

View full abstract

Recent progress in colonoscopic examination has made it possible to diagnose many rectal carcinoid tumors in early stages. Moreover, endoscopic ultrasonography (EUS) has enabled us to make considerably accurate evaluation of the depth of invasion and metastasis to the pararectal lymph nodes. Newly developed endoscopic aspiration mucosectomy (EAM) was performed in three cases of rectal carcinoid tumors less than 10 mm in diameter. EUS revealed the tumors to be localized within the submucosal layer without swelling of the pararectal lymph nodes. On EAM, we attached transparent plastic cylinder to the tip of a colonoscope, and a Teflon guide tube to the outside of the scope. Then a polypectomy snare was introduced into the guide tube and tightened the outer side of the cylinder. After injecting glycerine solution below the lesion, it was easy to lift the lesion into the cylinder by using endoscopic suction and catch it in the snare. We were able to resect round specimens with the lesions located in the center without difficulty. No complications occurred in any of the cases. The surface of the specimens had little damage except mucosal congestion. Pathological examinations revealed typical carcinoid tumors infiltrating into the submucosal layer, but no residual tumors were found at the lateral and bottom edge of the specimens. We concluded that EAM was a very useful technique for complete resection of small carcinoid tumor localized within the submucosal layer.

View full abstract