A comprehensive assessment including subjective and objective parameters seems to be essential for evaluation of disease activity in Crohn's disease. The aim of the present study was to develop an activity index (AI) of Crohn's disease, composed of both subjective and objective variables. Date composed of a total 132 clinical examinations in 100 patients with Crohn's disease were used to determine the Al. Three physicians independently evaluated disease severity in each patient. Stepwise multiple regression analysis was carried out with the overall evaluation as a dependent variable, and with 18 parameters as independent variables. Analysis showed that the following seven variables had a significant correlation with physician's overall evaluation : abdominal pain, abdominal tenderness, complications, C-reactive protein (CRP), body temperature, diarrhea, and body mass index (BMI). Al was expressed as follows : Al = 3.5×abdominal pain + 3×abdominal tenderness + 3×complications + CRP + 3×body temperature + 4×diarrhea-0.4×BMI. AI values below 15 corresponded to inactive disease, values between 15 and 25 to mild disease, values between 25 and 35 to moderate disease, and values above 35 to severe disease. This study suggests that the activity index is useful for evaluation of the effect of medical treatment in Crohn's disease.
To clarify relation between macroscopic appearance and the mode of tumor growth in the superficial lesion of colorectal neoplasms, we compared their colonoscopic findings with histological architecture of tumor cells. Macroscopic type was classified into the superficial elevated lesion (IIa, n=42, mean 5.14mm) and the superficial depressed lesion (n=42, mean 3.84mm). The latter was further divided into 3 subtypes ; subtype A, an irregular depression with high marginal elevation (Dep (A), n=20) ; subtype B, an irregular depression with irregular marginal elevation (Dep (B), n=7) ; subtype C, a clear and wide depression without marginal elevation (Dep (C), n=15). Histological architecture was evaluated by the transmucosal growth index (TGI) of tumor cells, which is a ratio of tumor width contacting with the muscularis mucosae against that of tumor surface, and by the distribution of proliferating cells detected by Ki-67 antibody (MIB-1). In adenomas TGI increased with a degree of central depression (IIa<Dep(A)<Dep(C)). In carcinomas TGI was high irrespective of their macroscopic forms. Ki-67 labeling indices tended to increase with histological atypia. Adenomas with severe atypia showed a high labeling consistent with carcinomas. In both adenomas and carcinomas, Ki-67 positive cells were mainly noted in upper third of neoplastic glands in IIa, Dep (A) and Dep (B) neoplasms. By contrast, Dep (C) neoplasms lost a preferential distribution of proliferating cells, which reached the whole neoplastic glands. These results suggest that Dep (C) adenomas and carcinomas have a unique histopathological architecture in terms of a high TGI and an enlarged distribution of proliferating cells, implying a high malignant potential.
Changes of liver functions associated with endoscopic injection sclerotherapy (EIS) in which less than 6 ml of 5 % ethanolamin oleate was used were investigated in 50 patients with remarkable esophageal varices. The index used for evaluating hepatic reserve was the difference of total bilirubin in serum between immediately and 15 hours after EIS and was tentatively named as “ΔTB” (normal range≤0.1). In the patients classified as Child-Pugh A (n=25), Child-Pugh B (n=19) and Child-Pugh C (n=6), dTB was 0.04±0.30, 0.23±0.41, and 0.54±0.21, respectively. One month after the entire sessions of EIS, the changes of liver function tests before and after EIS were compared in 45 cases. It was disclosed that dTB was elevated in parallel with the severity of their liver dysfunction before EIS. Also, dTB seems to reflect the prognosis of the patients treated by EIS for some extent, since the survival period of the cases treated by EIS were correlative with ΔTB (r=-0.734, p<0.01), and dTB of 20 cases who survived for longer than 5 years after EIS was 0.04±0.32. Therefore, ΔTB seems to be a useful marker for estimating the influence of EIS on liver function.
Seventy-one patients with untreated hepatocellular carcinoma (111 tumors) were studied angiographically to investigate the pathological features of multiple carcinoma. The 111 tumors comprised 23 lesions resected from 14 patients and 88 lesions mesuring 3 cm or less in diameter detected in 57 patients who did not undergo resection. Hemodynamically, major lesions exhibited an increase in frequency of tumor angiogenesis and intensity of tumor stain with an increase in diameter. Analysis of angiographic features of tumors mesureing 2 cm or less in diameter revealed a greater vascularity in intrahepatic metastatic foci than in primary foci, demonstrating a difference between them. When multiple tumors were classified into the isolated, concentric or disseminated type in terms of the pattern of their distribution, their angiographic findings suggested that min or lesions of the concentric or disseminated type might represent local metastases spread from the primary focus, and that those of the isolated type might represent multicentric occurence in the liver.
The preoperative diagnosis of less than ss depth gallbladder cancer is difficult. Its preoperative diagnosis rate was low (27.5%), and even lower with the presence of concomitant gallstone. In the latter case, the diagnosis rate was particularly low when the stones diameter was greater than 1 cm. Gallstones are frequently associated with macromorphologically invasive type of gallbladder cancer and this may be the reason for the lower diagnostic rate. We compared preoperative diagnosis rate of ultrasonography (US), computed tomography (CT) and drip infusion cholecystography (DIC) for each invasion depth. In US, the preoperative diagnosis rate for m depth invasion was 6/16 (37.5%), pm depth was 1/13 (7.7%), and ss depth was 14/41 (34.1%). In CT, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss depth was 11/37 (29.7%). In DIC, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss was depth 1/23 (4.3%). None of the currently used imaging techniques were very accurate in diagnosing gallbladder cancer. Thus, during preoperative work up, if one discovers a gallbladder full of stones, stones of greater than 1 cm in diameter, thickened gallbladder wall, or a non visualized gallbladder with DIC, gallbladder cancer must be highly suspected.
This study investigated diagnostic indications of malignancy and parenchymal invasion of so-called mucin-producing tumor of the pancreas (MPT). We reviewed 40 patients with this type tumor. In diagnosis of malignancy, jaundice, mural nodule (EUS), displacement or compression of the portal vein (angiography), compression of the common bile duct (cholangiography) and Group IV-V in biopsy, Class III-V in brushing cytology were important. In diagnosis of parenchymal invasion, solid mass (US, EUS, CT), arterial encasement (angiography), defect in the common bile duct (cholangiography), stenosis or obstruction of the MPD (pancreatography) and elevation of serum CA19-9, CEA levels were important. By these findings, MPT diagnosed as benign can be observed without surgical treatment. On the other hand, MPT diagnosed as malignant must be treated by surgical resection, and operative procedure must be chosen according to whether the MPT was accompanied by parenchymal invasion or not.
We discuss the usefulness of Helical scanning CT (Helical CT) in the 52 patients with space occupying lesions of the pancreas. Information acquired during the early phase was found to be particularly useful in the evaluation of the extent of pancreatic carcinoma. The diagnostic rate of pancreatic tumors by Helical CT was 78% in 18 operative cases. The detection rate of involvement of the major arteries around the pancreas was compared with angiographic results in 22 cases each other, and the overall accuracy of Helical CT was 100%. On the other hand, the detection rate of PV invasion by Helical CT was compared with histological results in 14 cases, and the overall acuracy was 71.4%. In the cine mode and the multiplanar reconstruction (MPR) image, the courses of the major blood vessels and the degree of invasion into the blood vessels by pancreatic carcinoma could be continuously observed, both enabled reconstruction of the lesion and surrounding areas three dimensionally.