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Volume 42, Issue 12
Displaying 1-11 of 11 articles from this issue
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Kenji OGAWA, Yoshihiko NARITAKA, Takeshi SHIMAKAWA, Yoshihisa WAGATSUM ...2000 Volume 42 Issue 12 Pages 2241-2248
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe long-term clinical results of transjugular intrahepatic portosystemic shunt (TIPS) were investigated, mainly in patients undergoing the treatment at our hospital. TIPS reduced the portal venous pressure by about 50%, achieving the control of esophageal variceal bleeding in more than 95% of the patients. More than 10% of the patients developed complications other than hepatic encephalopathy. Although this rate was relatively low, complications related to vascular injury were lethal in some cases. Although this procedure has little effect on liver function, there is a possibility of liver failure occurring in patients with advanced liver dysfunction. The effect on esophageal varices and ascites depends on the function of the shunt. During follow-up, the shunt eventually failed in 40 to 70%. Although this failure rate is relatively high, function could be restored by percutaneous transluminal angioplasty (PTA). It is essential to detect a stenosis or obstruction at an early stage by color doppler ultrasonography (CDUS) or other methods. Regarding the long-term prognosis, patients who survived the longest were alive 6 years after TIPS. The 1-, 3-, and 5-year survival rates were approximately 70%, 60%, 40%, respectively. Only a few patients require liver transplantation after TIPS in Japan. In Europe and the United States, about 30% undergo liver transplantation. TIPS may be the treatment of choice for patients with intractable esophago-gastric varices or refractory ascites. When this procedure is indicated, the potentially lethal complications should be carefully taken into consideration.View full abstractDownload PDF (9489K) -
Shigeyuki TAMURA, Kentarou KISHI, Kouji YOSHIDA, Jin MATSUYAMA, Kenji ...2000 Volume 42 Issue 12 Pages 2249-2255
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSWe evaluated the usefulness and complication of Ultraf lex stent for patients with eso-phageal malignant stenosis. From July 1996 to December 1998, stents were intubated in 13 patients with esophageal stricture caused by inoperable or recurrent esophageal cancer. The stent was placed success-fully in all patient under local anesthesia. Persistent pain over 1 week occurred in only 2 patients and fever on the third day after stenting was found in only one patient with pneumonia. Dysphagia improved in all patients but two suffered from pneumonia 2 weeks after stent intubation. As the stent troubles, insufficient expansion because of rigidity of tumor (2 bare type stents), tumor ingrowth (a bare stent) and pressure necrosis with esophagobronchial fistulla (a covered stent) occurred in 4 patients, but these complications were managed with re-insertion of stent in stent. Aspiration pneumonia was the most frequent complication (8 cases : 54%) after stenting and 7 patients died of pneumonia. Median survival time from stenting was 95 days (range: 19-428 days). Although patients who were discharged were only 7 (54%), the Ultraflex stent offers promise for the effective palliation of malignant esophageal obstruction. To improve the quality of life, it is important not to cause the complication at the time of stent insertion, to manage quickly for stent trouble and to continue the treatment for esophageal cancer.View full abstractDownload PDF (5613K) -
Hiroaki YOSHIKANE, Hitoshi HIDANO, Akira SAKAKIBARA, Tadao ARAKAWA, No ...2000 Volume 42 Issue 12 Pages 2256-2262
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe patient was a 43-year-old man. He was pointed out to have a gastric submucosal tumor in 1993. The tumor proved to be a carcinoid by bioptic histology in 1999. He was referred to our hospital for treatment. The gastric carcinoid, located in the middle body, 9 mm in diameter, oval in shape and confined to the submucosal layer as seen by endosonography, was associated with type A chronic atrophic gastritis. Endoscopic aspiration submucosectomy was performed on him using mucosector (Top Co., Japan). The tumor was successfully resected. Nine months later, follow-up endoscopy revealed no finding of residual or recurrent tumor. This technique was considered useful for the resection of the submucosal tumor approximately 1 cm in diameter confined to the submucosal layer.View full abstractDownload PDF (18468K) -
Ryuhei NISHINO, Kaheita KAKINOKI, Yasuhiro TAKEMORI, Yatsugi NODA, Hir ...2000 Volume 42 Issue 12 Pages 2263-2267
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 57-year-old man who had been suffered from relapsing gastric ulcer on the posterior wall of the upper body received eradication of Helicobacter pylori (HP) with LPZ, AMPC, and CAM in December 1994. While HP eradication had been successful, the gastric ulcer relapsed at the same site in July 1996. In September 1998, gastric ulcer relapsed again at the same site, and histological findings of the biopsy specimen around the ulcer revealed adenocarcinoma. At this time HP analysis were still negative. Although the ulcer became scar by the therapy with LPZ alone. About 4 weeks later, total gastrectomy was done in October 1998, as cancerous tissue was widely spread in the mucosa of the upper body of the stomach. This case suggested that gastric cancer might be developing, if gastric ulcer relapses after successful eradication of HP.View full abstractDownload PDF (14923K) -
Kiyoaki ITO, Noboru HIRASHIMA, Kenji SAKAKIBARA, Noboru SHINKAI, Izumi ...2000 Volume 42 Issue 12 Pages 2268-2272
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSAn 88-year-old woman was admitted to our department due to anemia. Though bleeding was not seen in the fast, upper gastrointestinal endoscopy after meal showed bleeding from capillary bessels of the antrum small amount, and the disease was diagnosed as diffuse antral vascular ectasia (DAVE). Gastrectomy of the broad lesion was performed and anemia was improved. Postprandial endoscopy was useful for establishing the diagnosis of DAVE, and surgical operation seemed to be a radical treatment for DAVE.View full abstractDownload PDF (11312K) -
Kazuhiro MAEDA, Yasuhiro KOYAMA, Hirokatsu NISHIMURA, Kunihiko AOYAGI, ...2000 Volume 42 Issue 12 Pages 2273-2278
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 71-year-old man with Brunner's gland hyperplasia in the duodenal bulb is reported. He presented with a complaint of tarry stool. Upper gastrointestinal X-ray and endoscopic examinations showed a large pedunculated polyp with erosion in the duodenal bulb. Endoscopic ultrasonography revealed a slightly hyperechoic mass in the third layer and a cystic lesion in the tumor. Endoscopic polypectomy was performed. The resected tumor was 30×28×20mm in size and pathologically diagnosed as Brunner's gland hyperplasia. Cystic lesion in the tumor was characteristic endoscopic ultrasonographic apperance, and was benef itly diagnosis of Brunner's gland hyperplasia.View full abstractDownload PDF (15311K) -
Akihiko TACHIBANA, Naoto FUKUDA, Shigeru SAKAI, Tatsuo YAMAKAWA, Junzo ...2000 Volume 42 Issue 12 Pages 2279-2283
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA case of non-specific simple ulcer in the small intestine was reported. Fifty-eight-year-old woman was admited to our hospital with symptoms including massive melena and anemia. She had a past history of alcoholic liver dysfunction that had been treated for two years. Bleeding source was not found out on gastroscopy, colonoscopy and other examinations. Surgery was performed under the diagnosis of ulcer of the small intestine. Intraoperative endoscopic examination showed a small ulcer at the ileum 60 cm proximal to the ileocecal valve, and partial resection of the ileum was carried out. Pathological findings of the resected specimen revealed the ulcer with sharp margin, 5 × 3 mm in size, and its depth was Ul-II. Slight infiltration of inflammatory cells were histologically noted. No specific findings suggesting other disease were noted and diagnosis of non-specific simple ulcer in the small intestine was made.View full abstractDownload PDF (11652K) -
Youichiro BABA, Hirotaka MOTOYAMA, Terasu HONMA, Masaaki KOBAYASHI, Ma ...2000 Volume 42 Issue 12 Pages 2284-2288
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 75-year-old woman, who had been followed up due to liver cirrhosis for 13 years, was admitted to our hospital because of severe iron deficiency anemia (Hb 5.5 g/dl) and positive fecal occult blood. The examination of the gastrointestinal tract revealed some vascular ectasias in the terminal ileum, cecum and ascending colon. Blood pool image of the abdomen after injection of 99mTc-RBC demonstrated hot accumulation corresponding to the ileocecal region. From these findings, the vascular ectasias were thought to be the source of bleeding. Therefore, endoscopic mucosal resection of these lesions was performed. After this treatment, fecal occult blood test became negative and the anemia had subsided. We should take into consideration that portal hypertensive colopathy is a potential source of gastrointestinal bleeding in patients with liver cirrhosis.View full abstractDownload PDF (16354K) -
Mizuho KAKIHARA, Shouji MITSUFUJI, Naoki WAKABAYASHI, Kensaku KOJIMA, ...2000 Volume 42 Issue 12 Pages 2289-2293
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 5-year-old boy who had hereditary spherocytosis (HS) was admitted to our hospital with having symptoms of abdominal pain and icterus. Gallbladder stones and common bile duct stones (CBD stones) were recognized by abdominal CT scan and ultrasonography. It was thought that gallbladder stones occur from HS and they fell down into common bile duct, so we carried out endoscopic papillary balloon dilatation (EPBD) and endoscopic removal of the CBD stones for preserving the function of the Sphincter of Oddi. Owing to that, we could carry out laparoscopic cholecystectomy and splenectomy, and diminish his burden to his body. Endoscopic removal of the CBD stones after EPBD is an effective approach for the management of choledocholithiasis in children in point of diminishing their burden and preserving the function of their Sphincter of Oddi.View full abstractDownload PDF (12392K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2000 Volume 42 Issue 12 Pages 2294-2301
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (3115K) -
[in Japanese]2000 Volume 42 Issue 12 Pages 2305-2308
Published: December 20, 2000
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (611K)
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