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Volume 39, Issue 8
Displaying 1-16 of 16 articles from this issue
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[in Japanese]1997 Volume 39 Issue 8 Pages 1345-1346
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (374K) -
Atsushi TOYONAGA1997 Volume 39 Issue 8 Pages 1347-1357
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe current concept and placement of treatment variety for esophageal and gastricvarices are described. There seems to be no objection against the management policy thatendoscopic therapy for acute variceal bleeding is the ffirst choice of treatment. Endoscopicinjection sclerotherapy(EIS)and endoscopic variceal ligation(EVL)have been establishedin the management of esophageal varices. However, EVL ensues higher incidence ofvariceal recurrence than that of EIS. Then, ccmbinatian therapy of EVL and EIS isdeveloped and considered to be safer procedure with less recurrence of varices. In the treatment of large sanitary gastric varices, endoscopic infection of tissueadhesive agent(histoacryl glue)is markedly effective, bud ligation therapy remains controversial despite utilizing endoscopic detachable snare ar improved large ligating device. The end-point of treatment for esophageal and gastric varices is complete eradicationby the procedure with less recurrence in Japan. For the elective and prophylactic purpose, the introduction of balloon-occluded retrograde transvenous obliteration(B-RTO)i. e. angiographic sclerotherapy is an epochmaking in the treatment modalities. This is highly effective for large solitary gastricvarices by a single session of treatment and can be employed even for cases of acutebleeding. When once successfully treated with B-RTO, variceal recurrence or rebleedingcan hardly be encountered. In the variety of treatment modalities for varices, one should select the procedureoption according to the patient's condition, not to doctor's condition.View full abstractDownload PDF (6779K) -
-QUANTIFIED VASCULAR DENSITY USING COMPUTER ANALYSISWITH SPECIALL RELFERENCE TO THE COLLOR OLF ENDSCOPIC LFINDINGS-Keiichi FURUKAWA, Kenshi YAO, Akinori IWASHITA, Toshiyuki MATUI, Tuney ...1997 Volume 39 Issue 8 Pages 1358-1369
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSOne hundred twenty-one specimens resected from patients with depressed type earlygastric cancer (differentiated type:70 case, undifferentiated type:51 case) were investigated by staring with the CD34 monoclonal antibody which expressed by endothelium. wetried quantified mucosal microvascular density using computer arialysis. The ratio ofmicrovascular density in cancer tissues to those of surrounding noncancerous tissues arecalculated as C/N ratio, and investigated the relation to the histologic subtypes and thecolor of endscopic findings. As a result, differentiated carcinomas were significanthypervascular (compared to the C/N ratio of undifferentiated carcinomas) . The C/N ratios are significantly different (among the three groups in color of endoscopic findigswhich are redness group, unchangeable group and pale group) . Therefore the color ofendoscopic findings was intimately concerned with the mucosal microvascular density;most of the differentiated type were hypervascuiar and redness, and most of the undifferentated type were hypovascular and pale. These findings supprated that our method ofquantified microvascular density using computer analysis is very simple and useful tocompare that between cancerous and surrounding noncancerous tissues.View full abstractDownload PDF (8430K) -
Yoshie IWAMOTO, Kou NAGASAKO, Sigeru SUZUKI, Naoaki HAYASHI1997 Volume 39 Issue 8 Pages 1370-1375
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn the diagnosis of colorectal sessile tumor, it is the most important to differentiateinvasive submucosal cancer(sm-m cancer)from cancer with scanty sm invasion(sm-s ca)Accuracy of endoscopic evaluation as for the depth of invasion was studied. The subjectswere 109 colorectal sessile tumors that were treated for the past 6 years. The followingparameters were studied;size, irregularity of the surface, easy bleeding, erosion andredness in color. In conclusion, According to the advance of the invasion, the following three findingswere increased;irregularity of the surface, easy bleeding, erosion.The difference inirregularity between sm-s ca and sm-m ca was significant(p=0.05).These three findings(irregularity of the surface, easy bleeding, erosion) of tumor seemed to make it possible toevaluate the depth of colorectal sessile tumors endoscopically.View full abstractDownload PDF (2334K) -
TO THE EFLFICACY OLF NEW PUNCTURE SYSTEM LFOR PANCREATIC AND PERIPANCREATIC MLASS LESIONSSayoko TERAMOTO, Kenji YAMAO, Sabrou NAKAZAWA, Jyunji YOSHINO, Kazuo I ...1997 Volume 39 Issue 8 Pages 1376-1383
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSEUS-guided FNA cytology was attemped in 44 paitients with pancreatic and peripancreatic tumors(19 were benign and the other 25 malignant). The rate of adequ-atespecimens by FNA aspiration was 86%. Malignant diseases were easier to obtain enoughmaterials for cytology than benign diseases. The predictive value of EUS-guided FNAcytology for malignancies in our series was as follows. The sensitivity was 79%, specificity 100%, true positive value 100%, true negative value 74%, overall accuracy rate 87%. Asfor the efficacy of cytological diagnosis, the new type of aspiration needle is superior to theold type of aspiration needle. No complications were encountered. In conclusion, EUS guided FNA cytology is an effective modality to enhance thespecificity of ELTS diagnosis. This modality also is becoming very advantageous for thetherapeutic purpose as well as the diagnostic purpose of pancreatic and peripancreatictumors.View full abstractDownload PDF (3453K) -
Shuji MIZUMACHI, Takahiro YAMASAKI, Yoshiko YABUSHITA, Yuhki YAMAGUCHI ...1997 Volume 39 Issue 8 Pages 1384-1391
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe characteristics of endoscopic findings and age were statistically evaluated in 128 patients with bleeding gastric ulcers who had been treated over thepast 5 years. The ulcers were treated by localinjection of (1) pure ethanol, (2) hypertonic saline epinephrine solution (HSE), (3) a combination of pure ethanol and HSE, and (4) clipping with or without HSE. Permanent hemostasis was obtained in 114 of 128 patients (89.1%). Endoscopic hemostasis succeeded after rebleeding in 5 (3.9%), transarterial embolization (TAE) was needed in 3 (2.3%) and surgery was performed in 6 patients (4.7%). The 7 factors studied were: ulcer location (L-factor), ulcer size (S-factor), ulcer depth (D-factor), location of exposed vessel on the ulcer bottom (L/V-factor), protrusion of the exposed vessel (P-factor), active bleeding (A-factor) and age. Two of these factors (P-factor and A-factor) were found to be statistically correlated with the prognosis( P-factor:r=0.29602, p=0.0010, A-factor:r=0.29797, p=0.006). In conclusion, the major two factors indicating a high risk of unsuccessful endoscopic hemostasis were P-factor and A-factor.View full abstractDownload PDF (2283K) -
Shoichi SAITO, Hisanobu TOMIMATSU, Naohir HAMAMOTO, Haruo IKENOBE, Hei ...1997 Volume 39 Issue 8 Pages 1392-1397
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 40-year-old man was reffered to our clinic with tarry stools. X-ray examination of the upper gastrointestinal tract revealed a polypoid lesion (Yamada III shaped), 12mm in diarneter, located on the greater curvature of the fornix. Endoscopically, this polypoid lesion showed well defined boundaries, which was whitish in color with smooth surface and without erosion or ulceration. Histologically, the lesion mimicking foveolar epithelium was a very well differentiated-type of early carcinoma arising from the fundic gland mucosa. As a result, we concluded that this lesion was adenocarcinoma of gastric type (foveolar type) because of containing GOS positive cancer cells by mucin histochemical staining.View full abstractDownload PDF (5285K) -
Yoshihisa URITA, Yukihiko NARUKI, Mamoru NISHINO, Hiroshi KOYAMA, Eiko ...1997 Volume 39 Issue 8 Pages 1398-1405
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 59-year-old woman visited our hospital with bomplaints of gastric discomfort for along time. The first endoscopy revealed atrophic gastritis, with Helicobacter pylori (Hp) infection. Two months after the completion of Hp eradication therapy with lansoplazoleand clarithromycin, Hp eradication was comfirmed by the method of histology andcultures. A complaint disappeared soon afterward, however, she complained of heartburn8months after the last endoscopic examination. The third endoscopy revealed grade Areflux esophagitis'with an area of linear erythema less than 5 mm long. She was given 30mg of lansoplazole again, and after that, a medical treatment was continued with a halfdosage of H2-receptor antagonist. The fourth endoscopy was done about one year later.Despite of disappearance of a mucosal break, a scar remained on the distal esophagealmucosa. Histological finding of the specimens taken from the middle body on the greatercurvature dernonstrated a decrease of inflammatory cell infiltration. It was uncertainwhether an atrophic change of gastric mcosa improved after therapy. However, there wassignificant rise from a pretreatment value of 1.5 to a posttreatment value of 9.9in serumpepsinogen (PG) I/PGII ratio, which was reported to correlate well with the grade ofgastric mucosal atrophy. Because there was a fall in serum gastrin concentration aftertherapy in addition to a fall of serurn PGI and PGII, it was suspected that lower esophagussphincter pressures decreased after Hp eradication. In conclusion, we should be careful ofreflux esophagitis in'patients whose Hp had been eradicated.View full abstractDownload PDF (5218K) -
Masato MURAKAMI, Yuji MIZUKAMI, Yasuyuki MIYAKE, Akira MATSUURA, Sanae ...1997 Volume 39 Issue 8 Pages 1406-1411
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSLocalized gastric varices with spleno-renal shunt without portal hypertension is extremely rare. We report a patient with localized gastric varices suggessted to gastric arterio-venous malformation. A 81-year-old female admitted to the hospital for hernatemesis and melena. Her liver function test was within normal limit and had no splenomegaly. Upper gastrointestinal endoscopy indicated not only vascular ectasia on the lesser curvature of the gastric body but also middle-sized localized varices on the fornix. Abdominal arteria1graphy revealed spleno-renal shunt by venous phase of selective celiac arterialgraphy, arterio-venous malforrnation on the place of vascular ectasia by left gastric arterialgraphy (LGA), fundic plexus and left gastric vein by the venous phase of LGA.View full abstractDownload PDF (3195K) -
Takanori OHYAMA, Yukihiro SAKURAI, Morihiro OKADA, Fuyuhiko YAMAMURA, ...1997 Volume 39 Issue 8 Pages 1412-1418
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSMethicillin-resistant Staphylococcus aureus(MRSA)colitis is usualy occurs in thesmall intestine. Few reports are found about the colonoscopic findings of MRSA colitis.We reported 3 cases of MRSA colitis observed by colonoscopy. Symptoms were fever, diarrhea and hematochezia. MRSA colitis were found in only 3 cases among the 48 patientswhose stool culture were positive for MRSA, from oct.1993 to sept.1995. Lesions werelocated in right side colon in al13cases. Endoscopic features varied from ulcerative lesionsto erosive lesions. Vancomycin treatment was effective and follow up colonoscopyrevealed pseudopolyps. Severe inflammation, leulocyte infiltration were the commonfinding of biopsied specimens.View full abstractDownload PDF (3515K) -
Tomohisa OWAN, Ryoichi NOZAKI, Mikio TAKECHI, Koichi TAKAGI, Masahiro ...1997 Volume 39 Issue 8 Pages 1419-1424
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 48-year-old male complained of colonic polyp and colitis. Barium enema showedelevated lesion traversing longitudinally and transversely, producing an exaggerated foldedappearance. Colonoscopic examination showed tortu.ous, partially nodular, bluish submucosal elevated lesion extended from the upper rectum to the terrninal ileum. Endoscopicultrasonography revealed luminal structures in the submu.cosal layer, corresponding to theelevated lesion. Endoscopic color doppler u.ltrasonography(ECDUS)demonstrated colorflow image of continuous wave Iin the submucosal layer. Therefore, we diagnosed as lowergastrointestinal(GI)varices in this case. Abdominal computed tomography scan andultrasonography showed no findings suggestive of portal hypertention. There were noabnormal findings at endoscopic examination of the upper GI tracts. Selective mesentericarteriography and portography via superior and inferior mesenteric arteries demonstratedneither abnormal arterio-venous communication nor portal occulusion. It was assumedthat the lower GI varices were due to a congenital vascular anomaly. Only 7 cases ofdiffuse lower GI varices without portal hypertention, including our case, have been reportedin Japan, and this case seems to be the first report of lower GI varices diagnosed by ECDUS.View full abstractDownload PDF (3179K) -
Yoshihiro MOGI, Toshiro KURA, Rishu TAKIMOTO, Hiroshi MURAMATSU, Hisas ...1997 Volume 39 Issue 8 Pages 1425-1429
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe report a case of acute hemorrhagic rectal ulcer induced by a NSAID suppositoryin a patient with no serious illness. A 82-year-old man was admitted to our hospitalhecause of apoplexy and senile dementia, and he was treated with daily 25 mg of diclofenacsuppository with a complaint of lower leg pain. After one month, he noticed hematemesisand fresh anal bleeding. Endoscopic examination revealed a giant hemorrhagic ulcer of thegastric angle and exposed vessel on the anterior wall of the rectum aproximatory 5 cmabove from the anal verge. The rectal ulcerous lesion healed by a conservative supportivetherapy. It is supposed that NSAIDs supposittories should be considered as one of thecausative factors of acute hemorrhagic rectal ulcer.View full abstractDownload PDF (1685K) -
Marniko TAKEUCHI, Masahumi ICHIKAWA, Junichi KANOU, Osamu TAKAHARA, Ak ...1997 Volume 39 Issue 8 Pages 1430-1434
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 68-year-old man v as admitted to our hospital far general fatigue and jaundice.Endoscopic retrograde cholangiography demonstrated a stenosis of the common bile duct.Apancreaticoduodenectomy vvas performed. The surgical specimen disclosed a sub-mucosal tumor, measuring 25 X8 mm in the common bile duct. Microscopically, the tumorvvas found to be a nouroma of the bilo duet. As far as we know, no other case of neuroma of the bile duct in the absence of previoussurgery and gallstone have been reported previously.View full abstractDownload PDF (3959K) -
Hiroaki SATO, Masayuji ITOH, Yasushi AMAKA, Kazue MURATA, Shigeru WATA ...1997 Volume 39 Issue 8 Pages 1435-1439
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA-71-year old woman who had been hospitalized for hyperglycemia revealed to haveadilatation of a common bile duct on abdominal US and CT without a deffinite tumor atits lower part in February 261996. On MRI, a tumor projected to Vater's ampulla, withadiameter of 10 mm, was noticed having low signal intensity on the T1-weighted imageand iso signal intensity on the T2-weighted image. ERC demonstrated a defect 10 mm insize at the lower part of bile duct. On EUS, a papillary tumor projected to the lowercommon bile duct with I500r low echoes including multiple small echo free spaces wasdetected. The operation was performed because of being unable to rule out malignancy.Pathohistological examination of the resected specimen taken by papilloplasty revealedlymphangioma of common bide duct.View full abstractDownload PDF (3156K) -
Tetsuya AOKI, Kiyotaka OKAWA, Kouji SANO, Hiroko OOBA, Yasuko MORIYOSH ...1997 Volume 39 Issue 8 Pages 1440-1445
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe patient was a 66-year-01d man who was admitted to a certain hospital urgentlydue to repeated melena. At the time of hospitalization, a marked anemia was obserbedwith 2.5g/dl of hemoglobin and 8.1%of hematocrit. Detailed examination could notidentify the source of bleeding though melena was continued and, thus, the patientintroduced to our department. An arteriovenous malformation in the head of the pancreaswas suspected by the dynamic CT and color doppler ultrasonography and confirmed by theabdominal angiography. Aconservative therapy was continued due to poor generalconditions. The patient was discharged from the hospital temporarily since melenadisappeared. The source of bleeding could not be confirmed accurately though the bleedingsite was suspected to be near the common bile duct by the images.View full abstractDownload PDF (5267K) -
Masato MURAKAMI, Yuji MIZUKAMI, Harumi YANO, Keiichiro NISHINO, Sanae ...1997 Volume 39 Issue 8 Pages 1446-1453
Published: August 20, 1997
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSArgon plasma coagulation(APC)is a non-ontact coagulation technique in which ahigh frequent current is applied to tissues by ionized argon gas. APC was introduced intothe field of endoscopic treatment using the endoscopic probe. Histologically, the influenceof heat coagulation was found only on the surface. Even when we forced to coagulatelonger than usual, heat degeneration was limited within the submucosal layer. We performed APB in g patients of which 5, including 2 with malignant tumor hadbleeding. complete hemostasis was achieved in all patients. Two patients were treated byAPC as an additional therapy after endoscopic mucosal resection for malignant tumors andno residual malignant cells were found in a short-term fallow up. A case was inoperableadvanced esophageal cancer without tumor regrowth after APC. As a new trial, onepatient was treated for the purpose of mucosa fibrosing after endoscopic sclerotherapy for esophageal variees. No serious complications were encountered. APC is non-contact coagulation andwidely applicable. APC, therefore, is useful for the endoscopic treatment.View full abstractDownload PDF (6212K)
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