GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 37, Issue 4
Displaying 1-22 of 22 articles from this issue
  • Ryujin ENDO, Masaaki INOMATA, Tetsumaru KIYOKAWA, Yoshinori GOTO, Tets ...
    1995 Volume 37 Issue 4 Pages 711-719
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Between October 1992 and July 1993, endoscopic variceal ligation (EVL) was perfor-med in 12 patients with esophageal varices. we noticed certain problems with this therapy. The 12 subjects consisted of 11 males and 1 female. A mean age of the patients was 57.3. The therapy was performed as emergency in 3 cases, elective in 1 case, and prophylactic in 8 cases. Hepatic function prior to the procedurewas classified into the Child's A in 3 cases, B in 1 case and C in 8 cases. F factor remained F1 on E-C junction in 8 of 10 cases treated by EVL alone. Five cases had a past history of endoscopic injection sclerotherapy or esophageal transectian and bleeding occurring during EVL in 4 cases. As for prognosis, recurrent varices were foundin 3 of 8 follow-up cases, indicating a high frequency of the recurrence. In addition, we encountered a case developing gastric varices after EVL. As reported previously, EVL is an easy and safe procedure; but we must take these problems into consideration.
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  • Yoshio KITANO, Takeshi URABE, Takayoshi KOURA, Hidero OGINO, Shuichi T ...
    1995 Volume 37 Issue 4 Pages 720-726_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    In order to clarify pathophysiology of gastric mucosal lesions observed in patients withportal hypertens20n called portal hypertensive gastropathy, (PHG), we compared thefindings of gastro-esophageal varices, gastric mucosal lesions and portal vein pressurebefore and after transjugular intrahepatic portosystemic shunt (TIPS) in nine patients withportal hypertension. Eight of those patients were admitted for variceai bleeding, and twoof them had a history of bleeding from PHA. Portal pressure (mmHg) was decreased from27.7 ± 7.6to 19.3 ± 5.1 imrnediately after TIPS. Endoscopic findings showed improvementof gastric mucosal lesions and gastro-esophageal varices in all nine patients after TIPS;especially in four of five patients with severe PHG, TIPS resulted in a marked improve-ment of PHA. These observations suggest that portal hypertension may contribute directlyto the development of PHA, and that TIPS which can reduce the portal pressure immedi-ately is a useful treatment far the bleeding from PHG.
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  • Shigehiko OGAWA, Katsuyuki KOICHI, [in Japanese], Naoki IKEDA, Tokio W ...
    1995 Volume 37 Issue 4 Pages 727-732
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    We studied the changes in gastroesophageal reflux on occasions with or withoutnasogastric tube in 6 patients feeding via nasogastric tube and after perCutaneous endo-scopic gastrostomy(PEG)placement, using a radioisotopic method. The gastroesophagealreflux indices measured immediately after extraction of nasogastric tube were lover thanthe values under nasogastric tube placement in 3, patients. In 4 patients, the gastroeso-phageal reflux indices after PEG placement were lower than those before PEG placement, and the post-PEG values gore almost similar to those measurod immediately after extrac-tion of nasogastric tube. These results suggest that PEA may improve gastroesophagealreflux induced by nasogastric tube, but may not improve the native gastroesophagealreflug which was not caused by nasogastric tubes. The gastroesophageal reflux indicesmeasured immediately after extraction of nasogastric tube may predict the values afterPEG, and the method may contribute to the decision of indication for PEG.
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  • Shigehiko OGAWA, Katsuyuki KOICHI, [in Japanese], Naoki IKEDA, Tokio W ...
    1995 Volume 37 Issue 4 Pages 733-738
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    We studied the effect of erythromycin on gastric ernptying in 7 patients after per-cutaneous endoscopic gastrostomy (PEG) placement, using a radioisotopic method. Thegastric emptying eras not significantly changed pre-and post-PEG. The intravenousadministration of erythromycin (200mg)shortened the gastric ernptying (P< 0.05) and thecorrelation between percentage changes in gastric emptying on PEA placement and onintravenous administration of erythromyci:n was statistically significant(P< 0.01). Gastricemptying also improved, but to lesser degree, in 50f 7 patients after four weeks oftreatment with oral erythromycin (200mg three times a day). The oral administration oferythromycin shortened the gastric emptying that had been particularly prolonged in 2patients after PEA placement to the same value as before PEG placement. These resultssuggest that erythromycin may decrease the chance of reflux of gastric contents in thepatients fed via PEA, because erythromycin improve gastric emptying.
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  • Tomoyuki OHTA, Yutaka ORII, Jiro WATARI, Masanori MURAKAMI, Atsushi CH ...
    1995 Volume 37 Issue 4 Pages 739-744_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Colorectal creeping tumors were endoscopically studied in 411esions (39 cases) for thediagnosis of depth of invasion in comparison with histopathological results. Creepingtumors were classified into 3 types for the variation of the size of'nodules. Type I (211 esions) : The size of each nodule is uniform. Type II (8 lesions) : The size of each noduleis multiform. Type III (21 esions) : Giant nodules are seen m the tumor. The mean size oftumors in Type II and III was significantly larger than that of Type I. The incidence ofcarcinoma in adenoma was 91.7% in Type III, 50.0% in Type II, and 19.0% in Type I. Theredness of mucosal color or the depression on tumors was reliable sign for histologicaldiagnosis of carcinoma. There were 71esions of invasive carcinoma (sm ; 5cases, mp, 2cases) . Its characteristic features were giant nodules (3 cases) and depression on tumors (3 cases) . The indications for endoscopic rnucosal resection are Type I and II, bud Type III or the other types with depression may be considered as invasive carcinoma. We have todiagnose the depth of invasion correctly and select an adequate management, whichincludes a surgical operation, for the treatment of creeping tumors.
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  • Yoichi TANOUE, Shuji TADA, Takihiro KAMIO, Takahisa FUJIMOTO, Kazutaka ...
    1995 Volume 37 Issue 4 Pages 745-753_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    To determine the management of colorectal sessile tumor with nodule-aggregating surface, we investigated the endoscopic, histalogic, and stereomicroscopic findings of the tumors in 25 cases detected by colonoscopy. The specimens resected endoscopicaly or surgically revealed 11 adenomas and 14 carcinoma in adenomas, which included 10 intramucosal carcinomas and 4 submucosal invasive carcinomas. Endoscopic findings of the surface were classified into the following four types uniformly conglomerated nodular surface in 5 cases, gyrus-like appearance in 12, large sized nodules in conglomerated nodular surface in 7, and mixed type in one. The cases with large sized nodules and gyrus-like appearance frequently contained cancerous foci. Stereomicroscopic examination indicated that the frequency of malignancy was strikingly high in the cases with cerehriform appearance with sharply elongated and irregularly distorted pits and that substantial invasive carcinoma was demonstrated in one case with the devastated mucosal appearance. These results suggest that careful observation under endoscapy is useful to detect the cancerous foci and the invasive depth in the sessile tumor with nodule-aggregating surface. Indication of endoscopic treatment should be determined bythe surface structure and the location of the tumor.
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  • Kenji WATANABE, Kiyotaka OKAWA, Shingo ISHIGURO, Hiroko OBA, Yasuko MO ...
    1995 Volume 37 Issue 4 Pages 754-759_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We investigated 18 cases (18 1esions) of colorectal creeping tumors. Cancer was demonstrated in thirteen patients with creeping tumors. Moreover, 7 patients with creeping tumor had colorectal cancer at the same or at some other time. Eleven patients had colorectal adenoma. The rates found in our study were higher than the rates reported inthe literature. Consequently, total resection of creeping tumor is indispensable. Furthermore, patients with creeping tumor should undergo total colonoseopic examination periodically.
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  • Yasushi ODA, Takahiro FUJII, Ikuro KOBA, [in Japanese], Key MURO, Nari ...
    1995 Volume 37 Issue 4 Pages 760-766_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    To examine the diagnostic significance of endoscopic findings, location, sex and age in 76 1esions of sessile colorectal polyps. we conducted statistical analysis of chi-square test, correlation analysis and logistic regression. Degree of histolagieal atypism corresponding to response variables was divided into mild and severe ones. The farmer indicates the atypism corresponding to adenoma with mild or moderate atypia and the latter to adenomawith severe atypia or early cancer. The endoscepic findings corresponding to explanatoryvariables were classified into two or three degrees according to the grade. With chi-squaretest for independence, the following 7 endoscopic findings were significant (p=0.05) tohistolagical atypism;size, depression, expansiveness, erosion, unclear lobulatian, whitespots and polyp on polyp appearance. For the following analysis, either of degrees numbers (0, 1 or 0, 1, 2, ) were allocated to the above 7 findings, according to the estimated risk formalignancy. With correlation analysis examined on the 7 findings, expansiveness andunclear lobulation were the significant variables related to histological atypism (γ =0.58respectively) and depression is not so much correlated(γ =0.4), indicating that sessilepolyps show both expansiveness and unclear lobulation endoscopically, in proportion to the degree of histolagical atypism, but not in case of depression. With logistic regression of multivariate analysis, Odds'ratio, the risk that polyps are alternatively diagnosed frommild to severe atypism, are 27 times on depression, 5.3 times on expansiveness, 3.7times on erosiorl and 3.6times on size, respectively. These results suggest that depression can be regarded as a highly risky finding for severe histological atypism, but it's very low incidence in the severe atypism. The expansiveness can be also regarded as a highly risky finding for malignancy. It ofteraccompany the finding of unciear lobulation, which is rued out as a confounding factor atthe logistic regression analysis. The findings of erosiveness and larger size are alsoassessed as high risk far severe atypism, as most of the papers pointed out.
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  • Masaki MATSUOKA, Yukiya YOSHIDAI, Kazuo HAYAKAWA, Sotaro FUKUCHI, Yosh ...
    1995 Volume 37 Issue 4 Pages 767-772_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 39-year-old woman underwent a routine upper gastrointestinal series revealing apolyp on the anterior wall of the gastric fornix. Endoscopic examination revealed a pedunculated poiypoid lesion with a smaath surface like submueosal tumor. When enda-scopic ultrasonography was performed, multiple large and small aechoic areas were detected in the polypoid lesion. Endoscopic resection was performed. Histology of the resected specimen revealed that the tumor (18× 17mm in size) was a spongy tissue withmultiple cystic dilatation composed of proliferation of non-atypical ectopic gland cells inthe suhmucosal layer. Thus the lesion was diagnosed as a gastic hamartomatous polyp. Itwas expected that aechoic areas on endoscopic ultrasonography corresponded to the cysticdilatations. This finding was useful in the diagnosis of gastie hamartomatous polyp.
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  • Hideyuki KOJIMA, Hitoshi YOSHIJI, Hiroshi FUKUI, Tadasu TSUJII, Kimio ...
    1995 Volume 37 Issue 4 Pages 775-781_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    Acase of primary jejunal poorly differentiated adenocarcinoma is reported. A 67-year-old female complainted of vomiting and body weight loss. Contrastexamination of the small intestine was perfarmed. Circularly stenotic jejunal tumor wasfound at 11cm below the Treitz's ligament. A tumor that easily bled was found byintestinal endoscopy. Histological examination of biopsy specimen revealed poorly differentiated adenocarcinoma. A4× 2cm sized tumor that invaded to the serasa and complisated lymphnode metastasis were also resected. It is seemed that this case is rare because most of jejunal carcinoma is well to moderately differentiated adenocarcinoma and moreover circularly stenotic tumor is rarein poorly differentiatcd adenocarcinoma.
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  • Hideyuki SEKI, Junichi SUZUKI, Kimihiro TAKEYABU, Shuichi KITAHAMA, Hi ...
    1995 Volume 37 Issue 4 Pages 782-786_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Metastatic duodenal tumor is rare. We report 2 cases of the metastatic duodenal tumor whose primary site was the lung. Case 1; A 49-year-old man was admitted to our hospital for further examination of neck tumor. Histological findings of the tumor showed undifferentiated adenocarcinoma. Chest X-ray films showed infiltrate shadow in right upper lung field. Cytology obtained by endoscopic brushing of the lung tumor revealed adenocarcinoma. He developed hematernesis. Upper gastrointestinal endoscopic examination repealed multiple polypoid lesions with central depression in the 2nd portion of the duodenum. Biopsy from these lesions showed poorly differentiated adenocarcinoma. Case 2;A 72-year-old man was admitted for further examination of chest abnormal shadow.Chest X-ray films showed left hilar tumor (4× 5cm). Endobronchial biopsy of the lung showed squamous cell carcinoma. Because of occult bleeding in the feces, gastrointestinal endoscopic examination was done and multiple polypoid lesions with central depressionwere found in the bulbs and the 2nd portioh of the duodenum. H istologically, these tumorsproved to be squamous cell carcinoma.
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  • Michihiko MIYAZAKI, Ichiro FUKUDA, Ikuo KOKUFU
    1995 Volume 37 Issue 4 Pages 789-791_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    We report a rare case of Pneumatosis cystoides intestinalis (PCI) of the sigmoid colon. A 68-year-old man visited our hospital because of mutinous bloody stools. A plain abdominal X-ray film findings showed a honey comb like shadow. Barium enema demonstrated multiple palypoid lesions in the sigmoid colon. Endscopic examination revealed partly reddish submucosal tumors of varying sizes in the same location. He had no therapy and the course is observed.
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  • Shin-ichi KATO, Akira TORII, Toshihiro MITA, Tornoko NAKABAYASHI, Shig ...
    1995 Volume 37 Issue 4 Pages 792-796_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    A 62-year-o1d male was referred to our hospital because of positive Hemoccult test of stool. Barium enema and colonoscopy revealed a large yellowish and left, elevated lesionin the ascending colon. Lipoma was suspected. However, well differentiated adenocarcinoma was found in the fragments taken from a slightly granular area on the tap. Twenty cases of colonic liponma coexisting with cancer have, been deported in Japan. However, there were only two cases of intramucosal cancer located on the tap of the lipoma including our case. It is recommended to resect endoscopically a lipoma of the colon showing an increasing tendency in size.
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  • Kinya FUJITA, Kuniko YOSHIDA, Chizu KITAMURA, Yoshiyuki ITOH, Mitsushi ...
    1995 Volume 37 Issue 4 Pages 799-804_1
    Published: April 20, 1995
    Released on J-STAGE: February 13, 2012
    JOURNAL FREE ACCESS
    We reported a case of Cawden's disease in a 55 year-old woman associated with inflammatory fibroid polyp of the colon. She hadf acial papules, acral keratosis and gingival papillamatosis, and diagnosed as Cowden's disease. Endoscopic and radiological examination of the gastro-intestinal tract revealed polyposis of esophagus, stomach, small intestine, colon and rectum. The histological diagnosis of these polyps was hyperplastic polyp. We also found a pedunculated polyp in the ascending colon, which was proven to be an inflammatory fibroid polypafter surgery. This is the first reported case of Cowden's disease associated with inflammatory fibroid polyp.
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  • Kinya FUJITA, Kuniko YOSHIDA, Chizu KITAMURA, Yoshiyuki ITOH, Mitsushi ...
    1995 Volume 37 Issue 4 Pages 800-804_1
    Published: April 20, 1995
    Released on J-STAGE: May 19, 2011
    JOURNAL FREE ACCESS
    We reported a case of Cawden's disease in a 55 year-old woman associated with inflammatory fibroid polyp of the colon. She hadf acial papules, acral keratosis and gingival papillamatosis, and diagnosed as Cowden's disease. Endoscopic and radiological examination of the gastro-intestinal tract revealed polyposis of esophagus, stomach, small intestine, colon and rectum. The histological diagnosis of these polyps was hyperplastic polyp. We also found a pedunculated polyp in the ascending colon, which was proven to be an inflammatory fibroid polypafter surgery. This is the first reported case of Cowden's disease associated with inflammatory fibroid polyp.
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  • Takahiro KINOSHITA, Masamichi SATOMI, Tetsuya MATSUMURA, Shin FUKUI, T ...
    1995 Volume 37 Issue 4 Pages 805-811_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    A 53 yr. -old man with Cronkhite-Canada syndrome is described. He was performed right hemicolectomy, 3 years after the onset of syndrome, due to complication with intussusception for attributable large cecal labuleus polyp. The size of resected giant polypwas 6.5cm× 6.0cm in diameter. Other 4 pedunculated polyps measured up to 1.0cm eachother. Histological fendings of the resected specimen of the colon polyps showed expandededematous lamina propria with inflammatory cell infiltration and cystic glands resembled “ Juvenile polyps” . Two of these polyps showed definite adenamatous changes at thesurface epithelium. However, there were no evidence of adenoma or cancer involving alarge cecal lobulous polyp. Currently his postoperative course is uneventful.
    We analyzed association with adenoma or cancer of the colon in Cronkhite-Canadasyndrome in Japanese literature reviewed before 1993, Twenty-eight of 211 patients with Cronkhite-Canada syndrome had associated carcinomas (13.3%) and 20 of them (9.5%) had associated with adenoma of the colon respectively. Cronkhite-Canada syndrome complicated with intussusception, all led to surgical management, has been reported in only 4 cases.
    Although generally accepted as a benign disease, the Cronkhite-Canada syndrome, may be a premalignant disorder. The potential risk of cancer is not an indication forcolectomy, however, surgical intervention will be carried out at an early and appropriate stage for complications of Cronkhite-Canada syndrome such as prolapse, intussusception, bowel obstruction and sulspection of malignancy for giant polyp.
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  • Ichiro YASUDA, Eiichi TQMITA, Toshiki YAMADA, Yoriko INO, Hirotaka SHI ...
    1995 Volume 37 Issue 4 Pages 812-819
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    A case of bile duct cancer simulating foeal chronic pancreatitis is reported. A 71-year-old man was admitted to our hospitai with jaundice. US and EUS reveaied a low-echoicmass with hyperechoic regions in the head of the pancreas, and dilatation of the distal main pancreatic duct and the common bile duct. Slight and homogeneous enhancement of the mass was observed on CT scans. Endoscopic examination revealed no abnormalities of the papilla of Vater. ERCP demonstrated stenosis of the main pancreatic duct in the pancre-atic head, but the branches were not occluded. Portography showed compression at thejunction of the portal vein and the superior mesenteric vein on the right, but celiacangiography showed no encasement or occlusion of the gastroduodenal artery or itsbranches. On admission, the serum amylase was increased, but it gradually decreased tonormal and the patient's icterus also disappeared. We considered that the mass was focal chronic pancreatitis. However, endoscopic pancreatic biopsy revealed adenocarcinoma. Subsequently, pancreato-duodenectomy was performed. The final diagnosis was bile ductcancer invading the pancreatic parenchyma on pathological examination of the resected specimen. Interlobular fibrosis and acinar atrophy were found in the pancreatic head adjacent to the tumor.
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  • Eishiro MIZUKOSHI, Yasushi KITAMURA, Tornoyuki NEMOTO, Sakae OHBA, Toh ...
    1995 Volume 37 Issue 4 Pages 820-826_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    A 60-year-old man, who had been treated for alcoholic liver cirrhosis and esophagealvarices, was admitted to our hospital with hemorrhea. Emergency colonoscopy wasperformed, and showed the bleeding from near the splenic flexure of colon. Suspected ofthe bleeding associated with portal hypertension, and because of multiple bleeding points, we selected the treatment by transjugular intrahepatic portosystemic shunt(TIPS). Afterthe TIPS, the bleeding from colon was controlled and the colonoscopic findings showedportal hypertensive colopathy, including multiple erosions, vascular spider like lesions, tree angiodysplasia-1ike lesions with coagula, and rectal varices. These findings were improvedafter one month of the TIPS. TIPS may become a useful treatment for bleeding fromportal hypertensive colopathy.
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  • Takanori AOKI, Hiroya SAITOH, Akio TAKAMURA, Yasuo SAKURAI, Kouhei OON ...
    1995 Volume 37 Issue 4 Pages 827-832_1
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    Esophago-respiratory fistulas were closed using Gore-Tex expandable metallic stemsin one patient with lung cancer and 6 with esophageal cancer. In 6 patients oral feeding became possible and remained impossible in only one patient with paralysis of the recurrent nerve. Four patients (57.1%) were freed from dependence on total parenteral nutrition, and two patients (28.6%) could be discharged from hospital and could spend theirlast days comfortably at horne. Complications developed in only 2 cases(28-6%): migra-tion in both cases which was not associated with any clinical symptoms. No cornplications such as perforation or oppressive necrosis of the esophageal wall were noted when placing the covered EMS. The technique of placing the covered EMS is easy and safe, and is associated with little pain to the patient. For these reasons and because it helps enhancethe general quality of life this method is considered to be very useful in closing esophago-respiratory fistulas.
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  • Seiji SAITO, Ikuko RYUMON, Kiyohiro HIGUCHI, Michio TANAKA, Akiharu WA ...
    1995 Volume 37 Issue 4 Pages 835-840
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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    A screening examination for blood-borne infectious diseases was performed on 984 patients who received gastrointestinal endoscopy at gastrointestinal Diagnosis and Research Center, Campinas University, Brazil. This study was planned to know the incidence of high-risk patients and how to prevent the transmission of the diseases during endoscopic examination at an international medical cooperation project. The positive rates of hepatitis B surface antigen (HBsAg), hurnan ilnmunodeficiency virus (HIV) antibody, and Treponema Palidum hemagglutination antibody (TPHA) were 1.2%, 2.3% and 8.4%, respectively. The HIV positive rate was significantly high in male patients younger than 30 yrs. Nine patients were positive for HIV and TPHA, simultaneously. Only aprox. 15% of the patients who showed positive infectious markers were predicted before examination by the clinical information obtained from attending clinicians. These findings suggest that, in the practical field of international medical cooperation projects, screening examinations for blood-borne infectious diseases should be performed before digestive endoscopic examination.
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  • 1995 Volume 37 Issue 4 Pages 841-892
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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  • 1995 Volume 37 Issue 4 Pages 893-908
    Published: April 20, 1995
    Released on J-STAGE: May 09, 2011
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