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Volume 44, Issue 12
Displaying 1-11 of 11 articles from this issue
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Hideyuki KASHIWAGI2002 Volume 44 Issue 12 Pages 2059-2069
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSLaparoscopic fundoplication has replaced open fundoplication as the gold standard for the surgical management of patients with gastroesophageal reflux disease (GERD). This approach combined the antireflux aspects of the original open operation with the benefits of minimally invasive access. Its effectiveness is similar to that of its open counterpart. Laparoscopic fundoplication is a cost-effective alternative to long-term maitenance therapy with proton pump inhibitors. Nissen procedures (complete wraps) or Touepet repairs (incomplete wraps) are frequently used as a laparoscopic fundoplication. Nissen fundoplication is a standard procedure, but Collis gastroplasty is added for esophageal foreshortening laparoscopically or thoracoscopically. The indication for surgery, the choice of antireflux procedure, and the technical quality of the operation have all been shown to determine the incidence of failed antireflux operations. Transoral treatments for GERD, which have been recently reported, are attractive. They safely improve symptom and QOL, but inhibitory effect on esophageal acid exposure is not enough. Further study is necessary to define their precise role in the long-term management of GERD.View full abstractDownload PDF (17233K) -
A CASE OF IDIOPATHIC THROMBOCYTOPENIC PURPURA ASSOCIATED WITH A GIANT ESOPHAGEAL SUBMUCOSAL HEMATOMAKazuhito YAMAMOTO, Yoshio OGAWA, Masahito TAKITA, Kouichi BANDOU, Shig ...2002 Volume 44 Issue 12 Pages 2070-2076
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 52-year old woman suffering from upper abdominal pain visited our hospital. She had been diagnosed as having idiopathic thrombocytopenic purpura (ITP) 2 years previously but had not experienced any symptoms and consequently had not visited a hospital. The patient was admitted to the emergency department after an upper gastrointestinal endoscopy revealed a giant esophageal submucosal hematoma that was leaking. The hematoma extended from the upper esophagus to the upper stomach. The patient was not anemic, but her platelet count was 1.6×104/μl at the time of hospitalization. The patient was given a platelet transfusion and treated with predonisolon ; the esophageal submucosal hemorrage healed without bleeding, even though her platelet count did not increase. Her ITP was resistant to the predonisolone. A follow-up upper gastrointestinal endoscopy performed 2 weeks after the initial treatment showed a large area of erosion with regenerating mucosa. The area of erosion was completely covered with regenerated mucosa when a follow-up endoscopy was performed 2 months later. Though gastrointestinal bleeding is a common clinical manifestation in patients with ITP, submucosal hematoma of the esophagus is very rare. Here, we describe the process of the healing in submucosal hematoma of the esophagus in a patient with ITP and discuss the case with references to relevant literature.View full abstractDownload PDF (9874K) -
Tadashi ODA, Toshikazu KITADE2002 Volume 44 Issue 12 Pages 2077-2082
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 56-year-old man, who had a history of operation of achalasia and diabetes mellitus, was diagnosed to have an incomplete type of Behcet's disease because of aphthous stomatitis, uvenitis, acnelike exanthem at the age of 40. He developed epigastric pain and high fever without specific causes during hospitalization. Endoscopic examination showed a submucosal tumor-like lesion on the posteior wall of the upper body of the stomach. The submucosal tumor -like lesion showed continuous white pus discharge from the central depression. There were many neutrophils but no fungi and no cancer cells in the pus. The pus culture grew Streptococcus species. Abdominal CT scan demonstrated thickening of gastric wall on the posterior wall of the body. We made a clinical diagnosis of gastric wall abscess and then an antibiotic was given. Therefore, abdominal symptom and inflammatory signs were improved. Fifty days after the first examination, endoscopic examination showed a small hole of 5 mm diameter in the lower esophagus near the esophagogastric mucosal junction, and the submucosal tumor-like lesion of the stomach revealed scar formation which had a small hole on the central depression. A guide wire could enter the stomach through the hole of the esophageal lumen, which was proven to be a fistulous tract. Barium swallow examination also showed the presense of a fistulous tract connecting the esophagus and stomach. The fistula has been unchanged in the appearance over 4 years.View full abstractDownload PDF (8792K) -
Toru KOBAYASHI, Shigehiro KIN, Shigeru FUNABIKI, Hiroshi SASAHARA, You ...2002 Volume 44 Issue 12 Pages 2083-2086
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 70-year-old man underwent UGI endoscopy for a health check-up which revealed a whitish tubular object, approximately 15mm long, at the superior duodenal flexure. We obtained it through the biopsy channel by holding it with biopsy forceps. This fragment was considered as a parasite because it had head, neck and body. As the result of investigation, it was concluded to be an immature male acanthocephalan, probably a species of bolbosoma. In his medical history, the route of infection was not identified and he had no symptoms. The perforation did not occur. It was thought to be very recent infection. There is no previous report that such a parasite was discovered endoscopically.View full abstractDownload PDF (5509K) -
Yuh TSUBOUCHI, Harukazu KOUYAMA, Teruaki KAWANISHI, Hiroyuki NISHIMORI ...2002 Volume 44 Issue 12 Pages 2087-2094
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSIn Crohn's disease, characterized by longitudinal ulcers and a cobblestone appearance of the intestinal mucosa, massive lower intestinal bleeding requiring blood transfusions to maintain normal vital signs is a relatively rare complication (1-3% of all cases). Although surgery may be the most appropriate treatment for such massive bleeding, recurrent hemorrhage is occasion-ally encountered. We describe a 23-year-old male patient with Crohn's disease who suffered massive bleeding three times within a two-year period, and successful hemostasis was obtained by endoscopic local injection of hypertonic saline epinephrine (HSE) and clipping on each occasion. It is rare for episodes of massive lower intestinal bleeding in Crohn's disease to be repeated over a relatively short period. In the present patient, emergency colonoscopy was diagnostically helpful, and the bleeding was successfully controlled by endoscopic therapy. Thus, endoscopic therapy should be used conservatively in Crohn's disease with recurrent major hemorrhage to avoid multiple abdominal surgery.View full abstractDownload PDF (11695K) -
Shinichi KADOYA, Kenji DOHDEN, Yasuharu KAIZAKI, Osamu HOSOKAWA, Shige ...2002 Volume 44 Issue 12 Pages 2095-2100
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 21-year-old woman with abdominal pain and vomiting was admitted to our hospital. Abdominal computed tomography and ultrasonography showed distension of the small intestine and a multilocular cyst of the right ovary. Under the diagnosis of intestinal obstruction, laparotomy was performed. Operative findings revealed adhesions around the ovarian cyst. After resection of the cyst, she was in a state of shock. The post-operative clinical course was eventful, and she had bloody stools. Colonoscopic examination demonstrated edematous mucosa of the rectum with multiple erosions and ulcers. Histological study of the biopsy specimen of the rectum and the resected specimen of the right ovarian cyst revealed troph-ozoites of Entamoeba histolytica. In amebic colitis, it is important to take the fulminant course into account. Colonoscopic examination is thought to be very useful for the early diagnosis.View full abstractDownload PDF (9249K) -
Koji NAKAMUTA, Keiichiro MATSUNAGA, Kenji SHIRONO, Ikuo MURATA, Tomayo ...2002 Volume 44 Issue 12 Pages 2101-2105
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSA 44-year-old man was referred to our hospital for further examination and treatment of a rectal tumor. The first endoscopic examination with biopsy revealed a carcinoid tumor of the first tumor. During the second endoscopic session for endoscopic therapy, another carcinoid was found at the opposite site of the rectum. Both tumors were removed by means of saline injection-assisted polypectomy. Multiple rectal carcinoids are rare, and only 20 cases including the present case have been reported in Japan. Although rare, we should bear in mind that carcinoid may be multiple and try to search for possible other lesions carefully whenever we find single one.View full abstractDownload PDF (8166K) -
Yousuke IRIGUCHI, Touzou HOSOI, Teiko NAKAI, Hisashi NAKAMURA, Akihiko ...2002 Volume 44 Issue 12 Pages 2106-2111
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSThe patient was a 82-year-old man who had been diagnosed as a non granular type of the so-called laterally spreading tumor, approximately 30mm in size, of the transverse colon by colonoscopy and barium enema 2 years ago. At that time, pathologic examination of the biopsy specimen revealed moderately differenciated adenocarcinoma. He refused to undergo a surgical resection because he underwent sigmoidectomy for the early colorectal cancer 2 years previously. Furthermore 2 years later, colonoscopy and barium enema revealed an invasive tumor exactly at the same site of the transeverse colon, suggesting that the lesion had developed from the non granular type. He underwent the partial resection of the transeverse colon. Pathologic examination of the resected specimen revealed well to moderately differenciated adenocarcinoma without adenomatous component, ss, 31 × 22mm in size. The findings of this case and the cases disgnosed as the non granular type of the laterally spreading tumors in our center, suggest that non granular type invade the submucosal layer, at the size of approximately 20mm and, furthermore invade into the muscular and serosa layer, at the size of approximately 30 mm.View full abstractDownload PDF (9471K) -
Shouichi TANAKA, Takeyuki OHTA, Eisuke KAJI, Tsunenori KOSAKA2002 Volume 44 Issue 12 Pages 2112-2115
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSCases of ischemic colitis during pregnancy are extremely rare. Here, we report a case of ischemic colitis occurring in the sixth month of pregnancy in a 26-year-old woman without any underlying disorders. She presented suddenly with lower abdominal pain and bloody stools, and emergency colonoscopy was performed. Colonoscopy revealed typical longitudinal ulcers from the sigmoid colon to the descending colon. She rapidly became symptom-free after admission and was discharged after five days. It is necessary to be aware of the possibility of the occurrence of ischemic colitis during pregnancy.View full abstractDownload PDF (5171K) -
[in Japanese]2002 Volume 44 Issue 12 Pages 2119-2121
Published: December 20, 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (418K) -
2002 Volume 44 Issue 12 Pages 2166
Published: 2002
Released on J-STAGE: May 09, 2011
JOURNAL FREE ACCESSDownload PDF (90K)
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