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Volume 39, Issue 10
Displaying 1-15 of 15 articles from this issue
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Masahiro TADA1997 Volume 39 Issue 10 Pages 1745-1752
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSColorectal cancer is increasing in Japan, and today's concern in this field is thediscovery and endascopic treatment in its early stage. Same early colorectal cancer andmost adenoma can be curatively treated by endoscopy(endoscopic polypectomy, endoscopic mucosai resection, heat probe method, etc.). Endoscopic treatment for colorectaltumors is effective from the standpoint of patients QOL, however, the procedure is notcompletely free from hazards and complications and. the indication and limitation must bestrictly determined. Using several available devices to prevent bleeding after resection, our experiences of endoscapic treatment for large polyps have been increasing. Dn the other hand, usingchromoscopy or electronic endoscopes, minute polyps are inspected easily even in youngerpersons without any complaints. Almost all adenomas and metaplastic polyps are reagrdedas physiological phenomenon but not precancerous lesions. Therefore demunitiveadenomas and metaplastic polyps are not an indication of endoscopic treatment. Sm2 and sm3 carcinomas are beyond the indication of endoscopic polypectomy, because they are in danger of having lymphnodal metastasis. They should be requiredsurgical operation. Endoscopic ultrasonography and electronic image analysis by a computer can precisely determine the extent of cancer and mare rigid indication of endoscopictreatment can be decided.View full abstractDownload PDF (1810K) -
IRRADIATIGN TG THE RESECTED PGRCINE GASTRIC BALLS AND CANINE GASTRIC WALLS UNDER LAPAROTOMYTakuya HAYASHI, Tsunenori ARAI, Hisao TAJIRI, Masahiko KUROKI, Masanor ...1997 Volume 39 Issue 10 Pages 1753-1765
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSHigh-power diode laser ablation with indocyanine green(ICG)solution injection to thesubmucosal layer was evaluated for the treatment of early gastric cancer. The diode laserbeam with 805nm in wavelength was irradiated to the resected porcine gastric wall andcanine gastric wall under laparotomy with ICG solution(1 mg/ml)injection. The injectedICG solution was used to enhance the tissue absorption of the submucosa to the diode laseremission. The gastric wall with 5%glucose solution injection was also prepared tocompare the ablation characteristics. Using 12 or 25 W of the laser power with 2mmdiameter beam, we found the ICG injected submucosa was completely ablated by the diodelaser radiation. We could apply the high intensity diode laser beam, because ICG dyedlayer prevented direct laser penetration to muscularis propriae. Although the laser irradiation easily removed the mucosal layer in the ease with saline injection, it could not ablatedthe submucosa with 12 W. We could easily judge the ablated depth by surface color change.When ICG dyed submucosal layer was completely removed, the muscularis propriae wasrecognized by thin brawn color. we think these findings were extremely important, because we can prevent gastric perforation by endoscopic observation of color change ofthe ablated surface.View full abstractDownload PDF (10389K) -
-ENDOSCOPIC IRRADIATION TO THEI CANINE STOMACH-Takuya HAYASHI, Tsunenori ARAI, Shoryoku HINO, Hisao TAJIRI, Masahiko ...1997 Volume 39 Issue 10 Pages 1766-1774
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic diode laser ablation using indocyanine green(ICG)was performed to thecanine stomach to assess the safety and efficacy for the treatment of early gastric cancer.Approximately 8 ml of ICG solution with the concentration of 1 mg/ml was administratedto the submucosal layer so that the mucosal surface was elevated Within the limits of 4 cmin diameter. Twenty five watts non-contact with 3 mm beam spot diameter was irradiatedto the gastric wall by the l second pulse mode. With this irradiated condition, 4 or 5 rcpeatirradiation could remove the mucosal layer without carbonization. The ICG containingsubmucosal layer was efficiently ablated even with laserRutput of 5W. By observing thecolor tone of the irradiated surface, we could judge the ablation depth. Histologicalexamination revealed the submucosal layer was almost eliminated when the irradiatedsurface presented light green or yellowish green, In this case the muscularis propriae wasnot damaged because the ICG solution blocked the direct laser penetration. Six days afterirradiation, endascapic examination and histolagical examination showed satisfactoryhealing process. We thihk this combination therapy using diode laser irradiation and theICG solution inlection into the submucosal layer would be useful for early gastric cancerwith/without the submucosal invasion, especially in inoperable cases.View full abstractDownload PDF (9208K) -
Hironori TOKUMO, Hironao KOMATSU, Kunio ISHIDA, Kenji MORINAKA, Masahi ...1997 Volume 39 Issue 10 Pages 1775-1780
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEndoscopic mucosal resection(EMR)is the standard method for treating gastricmucosal lesions. In many institutions, a two-channel endoscope is used for the procedure.However, It is well known that there are some difficult areas in the stomach for EMR, i.e., the lesser curvature or posterior wall of the body, angulus and lesser curvature of theantrum. To salve the problem, we developed a new method of EMR using percutaneousendoscopic gastrostomy(PEG)technique, and named transgastrostomal EMR(TG-EMR).After fixing the gastric wall and the abdominal wall by a ffixation device (CREATEMEDIC), an angiosheath is inserted into the gastric Iumen. Using the combination of a hardshaft type grasping forceps through the gastrostomal access and an orally inserted onechannel endoscope, EMR can be successfully and safely performed. TG-EMR has beenapplied to nine cases in our hospital. We have never encountered any major complicationssuch as massive bleeding or perforation. It is concluded that this new procedure is useful for EMR of gastric mucosal lesiens.View full abstractDownload PDF (1693K) -
Satoru TAMURA, Shi-ei KUDO, Takashi NAKAJIMA, Hiroo YAMANO, Michio ASA ...1997 Volume 39 Issue 10 Pages 1781-1792
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDuring the period from 1985 Dec.1896, 11234 colorectal neoplastic lesions wereexamined. Lesions were histopathologically classified into two types:adenoma(n=10215)and early cancer(n=1019). Of the early cancers, 771 were confined to the mucosa and 248had invaded the submucosa. Endo5coplC findings were evaluated by the multivariatestatistical analysis. We classified the submucosal extension of early cancer according tothe vertical and horizontal level of invasion. We also classified pit pattern into 6 types. Inthe examination of submucosal invading cancer, vessel invasion occurred in smlb extensioncancer and lymphonodus metastasis occurred in smlc and rnore advanced stages extensioncancer. Therefore endoscopic mucosal resection is su.itable in smla and smlb extensionwithout vessel invasion. Based on this result, we evaluated endoscopic findings thatinfluence to the depth diagnosis of early colorectal cancer by the multivariate statisticalanalysis. The factors that are associated strongly with the depth diagnosis are as fellows1.grass configuration, tumor size, type V pit pattern, sclerous change, sharply demarcateddepressed surface, prominence from the surface of depression in the case of depressed typeearly cancer, 2. tumor size, type V pit pattern, expanded change, sclerous change in the caseof protruded type, 3. grass configuration, tumor size, type V pit pattern, sclerous change, radiating fold in the case of LST. The accuracy of the depth diagnosis from endoscopicfindings by the multivariate statistical analysis in any forms early cancer were more than 90%.View full abstractDownload PDF (7297K) -
Fuminaka SUGAUCHP, Hajime YAMAGUCHI, Hitoshi KONDOU, Kuniaki SHIRAO, H ...1997 Volume 39 Issue 10 Pages 1793-1798
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe report an esophageaI metastasis of breast cancer in a 39-year-old woman whodeveloped dysphagia 4 years ofter a right modified radical mastectomy and chemothrapyfor breast cancer. On barium swa110w, the patient had a tight stricture at the level of thelower-esophagus. Mucosal patten was intact, suggesting that extrinsic compression ormural mass caused the stricture. Esaphagoscopy revealed a tight strincture with normalappearance of overlying mucosa and computed tomography of the chest comfirmedthicking of the esophageal wall. Therefore We diagnosed that this lesion representsesophageal metastasis of breasts cancer and patient was treated with a self-expandingmetal stent as palliative therapy. The stent expanded fully and complication did notoccurred. Dysphagia disapPeared dramatically. Four month later, the patient died as aconsequence of metastatic lung cancer. This case is the first report of the palliativetherapy for an esophageal metastasis from breast cancer with self expanding metal scent, which should be chosen as an option for metastatic tumor of esophagus.View full abstractDownload PDF (4112K) -
Sakae NAGAOKA, Takafurni BANDOH, Hiroshi TOYOSHIMA, Toru ISOYAMA, Take ...1997 Volume 39 Issue 10 Pages 1799-1804
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 46myear-old female was found to have a suhmucosal tumor with ulceration in thebody of the stomach on endoscopic examination. wedge resection of the. stomach wasundergone. Grossly, the tumor was a 20 X 12 X 6mm in site with white-yellowish eutsurface.On histological examination, it consisted of polygonal cells with granular eosinophiliccytoplasm. The granules were positive for PAS, and not offacted by diastase pretreatment.Immuunohistochernical investigation revealed positive staining for 5-100 protein. Ultrastructurally, it consisted of electric-dense granules in the cytoplasm. Final diagnosis wasmalignant granular cell tumor, because it showed 3-5 mitotic figures/10 HPF and venousinvasion. To our knowledge, a granular cell tumor with venous invasion has not beenpreviously reported.View full abstractDownload PDF (6351K) -
Tomoyuki KOIKE, Yasutoshi SAITOH, Katsuhisa SATOH, Michiya SAITOH, Tos ...1997 Volume 39 Issue 10 Pages 1805-1811
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe patients was 49-year-old man. Endoscopic examination showed a diffuse elevatedlesion with irregular ulcer at the greater curvature of the gastric anglus in September 1991.With the histologic findings of biopsy specimens, we made a diagnosis of localized gastricamyloidosis. In October 1993, this lesion was re-diagnosed as gastric plasmacytoma withendoscopic biopsy, and total gastrectomy with splenectomy was performed in May 1994.The tumor was histopathologically gastric plasmacytoma and immunahistochemical studyrevealed to be classified in IgA/ κ type. A part of the turner and amyloid deposits extendedto the submucosal layer. This case suggests the possibility of the association betweengastric plasmacytoma and amyloid production.View full abstractDownload PDF (8278K) -
Itsusei SOU, Kiyonori KOBAYASHI, Tomoe KATSUMATA, Kaoru YOKOYAMA, Hiro ...1997 Volume 39 Issue 10 Pages 1812-1817
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 45-year-old female admitted to our hospital far the purpose of treating colonicpolyp, Barium enema study demonstrated a giant peduneulated polyp in the cecum and theascending colon, and the polyp was 20X1.5cm in size. Colonoscopic examination alsorevealed a giant polyp with an elongated stalk and deep ulceration at the top of the polyp.Endoscopic ultrasonography revealed that the tumor tissue was mainly Iacated in thesubmucosal Iayer. Endoscopic polypectomy was performed, and the polyp was diagnosedhistologically as an inflammatory fibroid polyp. Inflammatory fibroid polyp of the colon is very rare, and the size of the polyp is thelargest in Japanese reported cases. We treated completely by endoscopic po1ypectomy inspite of giant size of the polyp. We evaluated that endoscopic polypectomy is useful fordiagnosing and treating the inflammatory fibroid polyp of the colon.View full abstractDownload PDF (4939K) -
Masakazu KOBAYASHI, Kazuyuki UEMURA, Masahiko SAKATO, Hidehito MIYAHAR ...1997 Volume 39 Issue 10 Pages 1818-1822
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 63-year-old Japanese female v as admitted to our hospital because of a thoroughexamination of chronic hepatitis. Abdominal US revealed the liver with dull edge andirreglar surface, but no findings suggestive of turner of the gallbladder. Laparoscopy disclosed an enlarged lesion which was clearly demarcated, 2cm in size, on the fundus of the gallbladder. Computed tomography revealed an elevated lesion of the gallbladder which had some low density areas. ERCP revealed a filling defect in the gallbladder. From these findings, a diagnosis of adenomyomatosis was made. But, she had elevated serum CA19-9 on admission. As carcinoma of the gallbladder in adenomyomatosis was suspected, cholecystectomy was done. Histology of the resected gallbladder showed adenomyoma-taxis and no evidence of malignancy. This is a rate case of adenomyomatosis which was detected by lapascopy.View full abstractDownload PDF (6113K) -
Toshihito TANAHASHI, Tadashi KODAMA, Youichi IMAMURA, Keimei KATO, Hid ...1997 Volume 39 Issue 10 Pages 1823-1828
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe present a rare case of gallbladder carcinoma associated with acute emphysernatous cholecystitis. A 77-year old women was admitted with complaints of righthypochondralgia, fever and jaundice.'The laboratory data on admission revealed mildleukocytosis, increased CRP, jaundice and liver injury. Abdominal plain film and CT scanshowed extensive gas in the gallbladder and the intrahepatic bile ducts. ERCP(endoscopic retrograde eholangiopancreategraphy)revealed the filling defect of the wall of the gallbladder and debris. With a diagnosis of emphysematous cholecystitis by imaging study, thepatient was treated with intravenous alimentation and antibiotics. However, the gallbladder carcinoma could not completely be ruled out, surgical operation was performed 45 daysafter admission. Muddy material without stone and turnor were present in the gallbladder.The histopathological findings of the resected gallbladder showed poorly differentiatedtubullar adenacarcinoma. In this case, unclear images due to severe inflammation prevented us from making appropriate preoperative diagnosis. Even if image diagnoses could notoffer the apparent evidence of carcinoma, careful observation and inspection should becarried out with consideration of hidden malignancy.View full abstractDownload PDF (5447K) -
Akihiko SUZUKI, Osamu HASEBE, Kenji MUKAWA, Taiji AKAMATSU, Yoshifumi ...1997 Volume 39 Issue 10 Pages 1829-1834
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA61-year-old female was adrnitted because of epigastric pain and low-grade fever. Abdominal US and CT showed a large mass(4X4cm in diameter)in the head of thepancreas. ERCP showed a stenosis of the main pancreatic duct and a compressive stenosisof the inferior bile duct. The biopsy from an ulcerative lesion of the stomach revealed non-Hodgkin's lymphoma. In this case, the tumor and ERCP findings were remarkablyimproved after chemotherapy.View full abstractDownload PDF (4131K) -
Masao NODA, Tadashi KODAMA, Naoki SAWAI, Masahide ATSUMI, Hiroshi UEHI ...1997 Volume 39 Issue 10 Pages 1835-1839
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe designed and developed an original technique of endoscopic resection using apartial transparent hood(ERPH), to treat difficult cases with lesions located on theposterior wall or on the upper portion of the stomach. We used as a basic model a hoodwhich can be attached to the two-channel scope(GIF-2T200), and manufactured the1/3type and the 1/4 type. For a resection procedure, we attached the hood on the right side of the endoscope, inserted it into the stomach, pressed the oral side of the lesion slightly, and resected the lesion using grasping forceps and a high frequency electric current snare. We performed this procedure in five cases and the average diameter of specimens was 26±9mm, which was 6mm larger than that obtained by the previous method. Using thisprocedure, we could observe the lesion precisely, and grasp and lift the lesion vertically, taking a frontal view of the lesion located on the posterior wall. This procedure v asconsidered to be extremely useful as a mucosal resection method for the posterior walllesions of the stomach, especially for larger ones.View full abstractDownload PDF (3193K) -
1997 Volume 39 Issue 10 Pages 1840-1841
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (207K) -
1997 Volume 39 Issue 10 Pages 1842-1843
Published: October 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (221K)
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