To assess the healing process of gastric ulcers in proton pump inhibitor (PPI) treatment qualitatively, I investigated the regenerating capacity of the gastric mucosa by using regenerating epithelial cell turnover as an index. Cell turnover was determined by an immunohistochemical technique with anti-Bromodeoxyuridine (BrdU) antibodies. The regenerating capacity of gastric mucosa in PPI treatment was compared with that in H₂ receptor antagonist (H₂-RA) treatment and in untreated haelthy controls. The percentage of labeled cells of the regenerative mucosa in the DNA synthetic phase was calculated as the Labeling index (LI). The LI of the ulcer margin, ulcer scar or the opposite side of the ulcer in both PPI group and H₂-RA group were higher than that of the healthy control group. The LI of the ulcer margin or ulcer scar were higher than that of the opposite side of the ulcer. The LI of the ulcer margin or ulcer scar in PPI group tended to be higher than that in H₂-RA group, and the gastric ulcers treated with PPI appeared to have higher regenerative ability than those treated with H₂-RA. Furthermore, the LI of the gastric ulcer scars initially treated with PPI tended to decrease graduall after the transition to maintenance therapy and was found to reach the same level as that of healthy control mucosa nine months later.

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During the period from March, 1977 to December, 1995, 22 infants and children with colorectal juvenile polyps with an average age of 5.2 years (range: 1-11 years) were treated by colonoscopic polypectomy. The commonest symptom was painless intermittent hematochezia, which developed in all of the 22 patients. Abdominal pain occurred in 5 cases and rectal prolapse of polyp was noted in one patient. No severe signs including anemia and intussusception were observed. The number of resected polyps was 27, which ranged 2 to 23mm in size (mean: 12.2 mm). The number of patients with two polyps was 4. Twenty-four (88.9%) of the polyps were found either in the rectum or sigmoid colon, and 2 (7.4 %) were located in the descending colon and one (3.7%) in the transverse colon. Histological examination showed no cancerous or adenomatous transformation in the obtained specimens. Colonic perforation associated with colonoscopic polypectomy was observed in one patient, who recovered uneventfully by surgical operation. In one patient, recurrence of a rectal polyp at the polypectomy site was observed 4 years after colonoscopic polypectomy and the second polypectomy was successfully performed. It was concluded that colonoscopic polypectomy was a safe and effective procedure and was recommended for the treatment of juvenile colorectal polyps in infants and children.

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We evaluated the effect of reduction of portal venous pressure by placement of transjugular intrahepatic porto-systemic shunt (TIPS) on portal hypertensive gastropathy (PHG). Among 24 cirrhotic patients, nine complicated with PHG were well improved within two weeks after the TIPS treatment and four with severe, uncontrolled bleeding due to PHG were all managed to stop the bleeding by that treatment. During the follow up period of around 506 days, percutaneous transluminal angioplasty (PTA) had to be performed for 19 patients because of shunt dysfunction. Seven out of 16 patients who were free from PHG after TIPS suffered again from PHG with the appearance of shunt dysfunction. Among seven PHG positive patients, 6 could be controlled by PTA treatment. Thus, PHG can be controlled either by TIPS or PTA through the reduction of portal venous pressure. In particular, TIPS is effective to control bleeding from PHG. As long as we have investigated, there were no significant difference in portal venous pressure between PHG positive patients and negative ones. These results suggest that other factors except portal hypertension should be considered to explain the mechanism of PHG occurrence.

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A 57-year-old man was undergone colonoscopic examination for positive stool occult blood. It disclosed a polyp (adenoma) at the descending colon and ulcerations at the terminal ileum. The polyp was polypectomized and the ulcerations at the terminal ileum were followed by periodic colonoscopic examination for over 2 years and 3 months. One of the ulcerative lesions became protruded and transformed into a submucosal tumor-like lesion with ulceration. Although biopsied specimen showed normal ileal mucosa, a possibility of malignant tumor could not be ruled out. Therefore, ileocecal resection was performed. The resected lesion was diagnosed as Inflammatory Fibroid Polyp (IFP) by histological study. IFP at the terminal ileum was rare, and, moreover, its growing process has not been well known. We could follow the developing process of IFP at the terminal ileum by periodic colonoscopy. Our observation suggested that one of the developing cause of IFP could be persistent mechanical stimulations to a mucosal damage.

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A 45-year-old male patient visited to our hospital complaining of abdominal pain. On colonoscopy two yellowish-white I sp type submucosal tumors were detected in the cecum and in the ascending colon. Polypectomized tumors were 7×7mm, and 8×7mm in size respectively. The excised specimens microscopically showed a well demarcated tumor in the submucosa. Tumor cells had fine eosinophilic granules in the cytoplasm and small oval hyperchromatic nuclei in H-E staining. PAS staining showed acidophilic granules in the cytoplasm. A detailed immunohistochemical staining revealed that the cells were positive for S-100 protein and neuron specific enolase (NSE). 19 cases of granular cell tumor of the large bowel have been reported in Japan. Only two cases including our case had multiple lesions. Endoscopic excision is recommended for these lesions as first choice of treatment.

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A rare case of adenoma of the appendix was experienced in a 49 years-old male. The chief complaint was lower abdominal discomfort. Endoscopic examination demonstrated a pedunculated polyp extending from the appendiceal orifice. Histological examination of the biopsied specimen from the polyp revealed the features of adenoma. Barium enema studies showed that the pedunculated polyp was linked with the appendix. A diagnosis of adenoma of the appendix was therefore made and appendectomy was performed. On postoperative examination of the vesected specimen, the pedunculated polyp, 16×6×6mm in size, was found to be located in appendix 3cm from the appendiceal orifice. It was diagnosed as tubular adenoma histologically.

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A 51-year-old female presenting bloody diarrhea was treated with steroid, 60-80 mg/ day, i. v., but her symptons did not improve. She also developed disseminated intravascular coagulation (DIC), and recovered from DIC with medical treatment. Then she developed toxic megacolon and operation was performed. No cases complicated with both DIC and toxic megacolon, and cured by operation like this case, have been reported in Japan. The resected specimen showed peculiar longitudinal residual mucosa like islands. DIC may have occurred by inflow of endotoxin into blood.

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A 57-year-old man was admitted to our hospital for close precise examination because of the detection of a polyp of the gallbladder while treated at the hospital for liver cirrhosis. On abdominal US, a tumor with low echoes, measuring 20 mm in diameter, was detected at the fundus of the gallbladder. On EUS, this lesion had parenchymatous inner echoes with nodular surface. ERC and endoscopic double contrast cholecystography demonstrated polipoid lesion with papiilo-granular surface. We attempted to observe the lesion with a peroral choledochoscope following endoscopic papillary dilation by a balloon catheter, without EST. On observation with PCCS, the lesion within the gallbladder appeared as a papillary protuberance, surrounded by granural mucosa. We performed biopsy under direct vision, and could definitely diagnose the lesion as a carcinoma of the gallbladder. The inside of the gallbladder could be definitely diagnosed histologically by biopsy performed under direct vision, suggesting the usefulness of PCCS.

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In the past 10 years, we experienced endoscopic hemostasis in 245 of 1143 patients having upper gastrointestinal bleeding. Of the 245 patients, bleeding ceased in 225 (91.8%) and still persisted in the remaining 20 patients. Of the former 225 168 were patients with gastric ulcer bleeding on the posterior wall. Most of the latter 20 were patients with gastric ulcer including Dieulaf oy's ulcer, bleeding on the posterior wall The hematostatic rate of projecting arterial bleeding was low. Thirteen of those 20 patients had complications and have been given a large-scaled blood transfusion (more than 2000m1). Difficulties in hemostasis using the endoscopic methods were found to be related to the following factors : (1) cases with difficulity to maintain a wide field due to large-scale bleeding ; (2) cases with thick blood vessels (more than 2 mm) exposing on the base of the ulcer ; (3) cases with many new exposed blood vessels ; (4) cases with errythemia on exposed blood vessels. In 20 patients who had difficulties in endoscopic hemostasis mentioned above, hemostasis by TAE and surgical hemostasis were obtained in 12 and 7 patients, respectively and one patient died by DIC.

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Endoscopic hemorrhoidal ligation (EHL) was tried on 20 patients with bleeding or prolapsing internal hemorrhoids who presented at our outpatient department. The average number of treatment sessions was 1.6±0.8 and the average number of ligations was 4.1±1.9 (Mean±S. D.). A therapeutic effect was demonstrated in 85% of patients. The patients experienced mild pain and bleeding after EHL, but those symptoms were improved by conservative treatment. EHL provides a clearer evaluation of internal hemorrhoids than does conventional ligation therapy and permits more ligations in each session. Accordingly, a therapeutic effect was achieved in shorter periods of time. EHL is an effective modality that can be employed at outpatient department.

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Purpose ; Laparoscopic cholecystectomy has been introduced into routine surgical practice. To estimate the usefulness of laparoscopic cholecystectomy (LC) and complication of this procedure, a questionnaire was mailed to 85 institutes. Methods ; We made a questionnaire survey for LC to the institutions in Nagasaki prefecture and some other hospitals related to Nagasaki University. The questionnaire contained the total number of LC, time of beginning of LC, simultaneous open cholecystectomy (OC), complications for 4 years (from 1991 Feb.to 1994 Dec.) Results ; The first LC case in Nagasaki was made in Feb. 1991. LC cases increased year after year, i. e. 173 cases in 1991 to 659 cases in 1994. Total number of cases in this survey were 1865 at 35 institutions. Number of OC during the same period was 170-200 without significant changes. No death was found in this series. Uncontrollable intraoperative bleedings were noted in 42 cases (2.3%). Biliary injury encountered in 25 cases (1.3%); 10 were converted to have OC, 6 had re-laparotomy after operation and 9 were followed by conservative therapy. Repeated cholangitis occurred in 3 cases after biliary injuries. A subcutaneous abscess was found in 23 cases. Conclusion ; LC was accepted as the first choice of cholecystolithiasis in Nagasaki prefecture. An adequate training system was required to reduce complications of LC.

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