Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
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59 巻, 2 号
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掲載論文カラー写真集
内視鏡の器械と技術
臨床研究
  • ベトナム人と日本人におけるHelicobacter pylori感染，背景胃粘膜の比較観察
    松久 威史, 松倉 則夫, 山田 宣孝, Le Kim Sang, Nguyen Tien Su
    2001 年 59 巻 2 号 p. 27-31
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_27
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    　ベトナム人のHelicobacter pylori（Hp）感染，胃十二指腸疾患，背景胃粘膜の特徴を当内視鏡科における症例と比較観察した。その際，ベトナム社会主義共和国（ホーチミン市）で診断を行った516例と，当科の1,994例を対象とした。各検討項目の比較には年齢，性別あるいは年齢，性別，内視鏡診断をマッチさせた。日本人のHp感染率は加齢に伴い高くなり，50歳代でピークを示し（83.7％），それ以降徐々に低下していた。ベトナム人も日本人と類似した傾向を示していたが，全ての年齢層において日本人よりも陽性率が低かった。ベトナム人のHp感染率（51.9％）は日本人のそれ（74.4％）に比し低値であった（p＜0.00001）。両国の内視鏡診断を比較すると，日本人では84.4％に何らかの病変がみられたのに対し，ベトナム人では49.1％と約半数であった。その内訳をみると，日本人はベトナム人に比べ消化性潰瘍，胃ポリープが多かった。消化性潰瘍について観察すると，日本人は胃潰瘍，ベトナム人は十二指腸潰瘍の多い民族であることが示された。生検切片の腺萎縮，腸上皮化生スコア，大島の基準に基づく胃体下部小彎側の内視鏡的胃粘膜スコアはベトナム人に比し日本人で高値であった。日本人のPGⅠ/Ⅱ比平均値（4.3）はベトナム人のそれ（4.7）よりも低く（p＝0.0193），日本人の胃粘膜萎縮傾向を反映していた。
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  • 慢性腎不全症例における内視鏡所見に関する検討
    阿部 朝美, 佐藤 慎一, 西村 元伸, 後藤 剛貞, 山田 英夫
    2001 年 59 巻 2 号 p. 32-36
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_32
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    　慢性腎不全患者の上部内視鏡所見について最近2年間の実態をまとめ検討した。慢性血液透析患者100例の胃病変の頻度は，点状出血34％，びらん病変17％，潰瘍7％であり，腎不全保存期例85例も同様の傾向であった。一方，腎機能正常者（非腎不全例22例）の胃病変はびらん病変13.6％，潰瘍4.5％，点状出血4.5％であった。透析例，保存期例ともに点状出血を含めた非潰瘍性粘膜病変の頻度が高く，腎不全に特徴的な所見であった。また出血性病変例では貧血と腎障害が高度であり，これらが粘膜性病変の出現に関与していることが示唆された。
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  • 十二指腸潰瘍穿孔に対する保存的治療の経験
    長浜 雄志, 丸山 道生
    2001 年 59 巻 2 号 p. 37-41
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_37
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    　かつては開腹術の適応であった十二指腸潰瘍穿孔例に対して保存的治療が行われるようになってきている。今回当科において保存的治療を試みた十二指腸潰瘍穿孔症例について考察し報告する。
    　1999年より十二指腸潰瘍穿孔例5症例に対して保存的治療を試みた。十二指腸潰瘍穿孔を示峻する上腹部痛症例に対して上部消化管内視鏡検査を行い，最低限の送気のもと病変が十二指腸に存在することを確認する。観察後経鼻胃管を留置し，H2blocker，抗生剤，鎮痛剤投与を行って保存的な治療を試みた。
    　保存治療を試みた5例中4例で腹膜炎は軽快し2～3日後には平熱化し，開腹することなく軽快治癒した。1例は治療開始2日後に熱発の改善がみられないため開腹ドレナージを施行した。この例は内視鏡診断後の胃内減圧が不十分で胃内容の腹腔内への漏出をきたしたものと考えられた。
    　内視鏡的に十二指腸潰瘍と確診された潰瘍穿孔例に対しては，十分な胃内の減圧と腹腔内滲出液の量を考慮すれば保存的に治療可能であった。熱発の状態は保存治療の効果を判断するにあたり重要な要素であった。
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  • 内視鏡的超音波断層法と対比した大腸Angiectasiaの内視鏡的検討
    阿部 剛, 大竹 陽介, 倉岡 隆, 荒井 順也, 佐藤 浩一郎, 太田 昭彦, 古谷 正伸, 石塚 俊一郎, 掛村 忠義, 吉田 光宏, ...
    2001 年 59 巻 2 号 p. 42-46
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_42
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    　当院にて診断したAngiectasia65例についてクモ状血管腫様病変のA型と血管怒張を主体とするB型とを分類する意義について内視鏡的超音波断層法（EUS）で検討した。65例の内訳は単発例が多く，大きさは7mm以下で，男性に多い傾向にあった。ほとんどがA型で，部位の偏りはなく全大腸に分布していた。B型はA型に比べ好発年齢が高く，有症状が多かった。多発例は単発例に比較して有症状や基礎疾患合併例，特に肝硬変例が多く，種々の内視鏡像を呈していた。EUSにて5例8病変を検討したところA型は有意な血管拡張はなかったが，B型は粘膜下層内に1mm前後の血管として描出し得た。A型に対して内視鏡的摘除術を行ったところ，生食水局注のみで消失した例や摘出標本では拡張血管が不鮮明となる例もあり，組織学的には粘膜下層浅層までの血管拡張であった。粘膜下層浅層までの拡張であるA型は明らかにB型と別に扱うべきであり，治療が必要な際にはAPCなどの表在性の治療が推奨され，対して比較的太い血管拡張として描出できたB型はクリッピングなどを考慮すべきと考えられた。
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症例
  • 胃横軸捻転を伴い食道裂孔内に陥入した進行胃癌の1例
    堀場 光二, 山下 精彦, 田中 宣威, 京野 昭二, 横井 公良, 樋口 勝美, 石川 紀行, 瀬谷 知子, 松本 智司, 瀧田 雅仁, ...
    2001 年 59 巻 2 号 p. 48-51
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_48
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    　食道裂孔ヘルニアは比較的頻度の高い疾患であるが，胃軸捻転を伴い，脱出部位に胃癌を伴った症例となると極めて稀である。われわれは今回，リウマチ性多発筋痛症治療中に発見された，胃幽門側が横軸捻転し横隔膜上に脱出した食道裂孔ヘルニアと脱出部位に進行胃癌を伴った1症例を経験したので，文献的考察を加えて報告する。症例は，74歳女性，平成12年9月下旬頃より37℃台の発熱あり，肩関節痛，股関節痛を自覚。精査目的で平成12年10月18日紹介入院となり，リウマチ性多発筋痛症の診断にてプレドニン10mgの内服を開始し，症状軽快。貧血，便潜血認められたため，消化管精査を施行。上部消化管透視，内視鏡検査にて食道裂孔ヘルニアに併発した進行胃癌が発見され，平成12年12月25日，幽門側胃切除術，食道裂孔ヘルニア根治術を施行した。術後8カ月の現在，再発の兆候なく外来経過観察中である。
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  • 貧血と低蛋白血症を伴った胃限局性若年性ポリポーシスの1例
    原田 久, 岡田 安郎, 鈴木 聡明, 池田 啓浩, 丸山 俊秀, 射場 敏明, 木所 昭夫, 朝廣 純子
    2001 年 59 巻 2 号 p. 52-55
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_52
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    　症例は49歳男性。平成12年初旬より続くめまい・立ちくらみを訴え，7月中旬に近医受診。貧血と低蛋白血症を指摘され，精査加療目的で当院転院となった。上部消化管内視鏡で胃粘膜全体に無数の丈の高い隆起が多発し，鍾乳洞様所見も認められた。生検所見では若年性ポリープが疑われた。内科的治療に抵抗性であったため胃全摘術を施行した。摘出標本では，内視鏡所見同様の多発隆起と，一部，壁の肥厚が認められた。他の消化管や皮膚・粘膜・毛髪・爪に異常所見を認めず，胃限局性若年性ポリポーシスと診断した。本邦での本疾患の報告例は17例で，うち7例では腺癌の合併が報告されている。自験例では癌の合併は見られず，治療方針の決定に苦慮したが，内科的治療に抵抗性であり，積極的な手術が必要と考えられる。極めて稀な胃限局性若年性ポリポーシスを経験したので，若干の文献的考察を加えて報告した。
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  • PTEN遺伝子変異を認めたCowden病の1例
    高垣 信一, 石川 尚之, 丸田 和夫, 平良 悟, 清水 直樹, 須藤 一郎, 宮岡 正明, 森安 史典
    2001 年 59 巻 2 号 p. 56-59
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_56
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    　症例は39歳，男性。平成元年頃より手指の小丘疹に気付いていた。平成11年10月，顔面・頸部から腋窩にかけ多発する丘疹がみられたため，翌年8月皮膚科を受診した。Cowden病を疑い注腸透視を施行したところ，直腸に多発する小隆起を認め当科紹介となった。大腸内視鏡では下部から上部直腸にかけて密集する褪色調ポリープのほか，下部食道，胃体部から穹窿部および十二指腸下行脚に多発するポリープがみられた。PTEN遺伝子の解析では，exon 5 codon 124でTGTからTATのpoint mutation, intron 7にT15 repeatsからT16 repeatsへの変異を認めた。近年，PTEN遺伝子はCowden病の原因遺伝子として注目されており，併せて報告した。
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  • 魚骨による食道穿孔，縦隔洞炎の1例
    中野 史郎, 大野 隆, 河野 静, 平澤 陽子, 北村 匡, 川添 一哉, 橘田 輝雄, 西元寺 克禮
    2001 年 59 巻 2 号 p. 62-63
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_62
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    A 64-year-old man came to our hospital with a chief complaint of discomfort in swallowing. He ate fish 3 days before. Chest radiograph did not show fish bone. As we suspected an esophageal perforation, we examined his esophagus and stomach endoscopically and performed CT. In result we found a large fish bone stabbing into the esophageal wall. Fortunately in this case conservative treatment resulted in success.
    Some esophageal perforation cause critical complications revealed death. We consider that CT should be performed immediately when an esophageal perforation was suspected to evaluate mediastinum as well as detection of site and cause of the perforation.
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  • 線維脂肪腫様組織を呈した食道粘膜下腫瘍の1例
    三角 みその, 寺角 匡弘, 長野 裕人, 竹内 浩紀, 浜田 節雄, 辻 美隆, 北郷 邦昭, 平山 廉三, 茅野 秀一, 広瀬 隆則
    2001 年 59 巻 2 号 p. 64-65
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_64
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    A case of fibrolipomatous submucosal tumor of esophagus was reported. A 59-year-old male complained of dysphagia and he was pointed out esophageal tumor at medical checkup. Upper GI study showed a elevated lesion at middle and lower esophagus, in size 10×3 cm. Endoscopic examination showed a smooth submucosal tumor and EUS reveraled it's hypoechoic, isogenic tumor in 3rd layer. We diagnosed the benign submucosal tumor, but there were symptom and possibility of malignancy, so operation was performed. Histologically, the tumor, which was consisted of spindle cell and large amount of fibrous tissue, was diagnosed as GIST. It also was conteined many fat cells, which resembled fibrolipoma. Immunohistochemical staining indicated S-100 negative, α-SMA negative, CD34 positive and c-kit negative. However the tumor was classfied as uncommited type of GIST according to Rosai's classification, histology and the result of Immunohistochemical examination was atypical.
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  • 噴出性出血を認めた胃Gastrointestinal stromal tumor（GIST）の1例
    栫 弘太郎, 今井 幸紀, 頼 文恵, 本谷 大介, 田中 陽二郎, 江口 有一郎, 朝倉 泰, 柿沼 徹, 木下 学, 稲生 実枝, 新井 ...
    2001 年 59 巻 2 号 p. 66-67
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_66
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    A 51-old man was admitted to our hospital because of sudden tarry stool and dizziness. Upper gastrointestinal endoscopy revealed an elevated lesion with erosions located at the posterior wall of upper gastric body. A pulsatile bleeding was seen from the surface of this tumor. On the CT, this tumor had a relation to the muscular layer of the stomach and developed into extra-gastric wall. An operation was performed. On the immunologic examination, since tumor cells were positive for CD34 and c-kit, but negative for α-smooth muscle actin and desmin and S-100 protein, this tumor was diagnosed as a gastrointestinal stromal tumor (GIST) ．
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  • 胃癌と胆石症を併存した骨髄異形成症候群の1例
    岩瀬 博之, 渡部 脩
    2001 年 59 巻 2 号 p. 68-69
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_68
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    　骨髄異形成症候群（以下MDS）に胃癌と胆石を併存した1例を経験したので報告する。症例は76歳，男性。1999年9月に貧血症状で外来受診。ヘモグロビン8.2g/dlで骨髄穿刺所見では骨髄は正形成で，顆粒球系は低形成，赤血球系形態に異常を認め，micromegakaryocyteも認められた。また末梢血中，芽球は1％以下で環状鉄芽球は10％であり，MDS（RA type）と診断された。また精査にて胃癌および胆石症の診断も受け，幽門側胃切除，胆摘術を施行した。胃癌はⅡc病変で，病理はtubular adenocarcinoma depth 3 ly（1＋）v（1＋）n 1（＋）であり胆石はビリルビンカルシウム石であった。本邦で消化器癌を併存したMDSは自験例を含めて12例であった。男性8例，女性4例で，RA type, RAEB typeともに5例ずつであった。RAEB typeでは早期死亡例があり，消化器癌との予後の比較による適切な治療が大切と考えられた。また自験例はMDSに消化器癌と胆石を併存した初めての症例であり，胆道疾患との関連の解析が今後は待たれる。
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  • 食道・胃・十二指腸・結腸にmultiple lymphomatous polyposis（MLP）様の病変を認めた悪性リンパ腫の1例
    佐藤 泰弘, 池上 雅博, 佐々木 寿彦, 鳥居 明, 戸田 剛太郎
    2001 年 59 巻 2 号 p. 70-71
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_70
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    A 80-year-old male patient referred to our hospital because of constipation and fresh bloody stool. On admission, superficial lymph nodes were palpable in the inguinal resions, and spleno megaly was detected by CT scan examination. Endoscopic examination revealed multiple polypoid lesions in the whole colon, esophagus and duodenum, and tuberous lesions with central depression in the stomach, cecum and rectum. Histopathological examinations of biopsy specimens showed diffuse proliferation of abnormal lymphocytes. Immunohistochemical staining demonstrated that these consisted of L-26, CD-79α positive, and of UCHL1, DFT1, CD3 negative. Consequently this case was diagnosed as B-cell malignant lymphoma, diffusemedium sized cell type. We think that it should be appropriate to deal lymphomatous tumors forming multiple polypoid lesions with distant lymph node involvement as an advanced type of MLP, even if they can not be confirmed as gastrointestinal origin. Further discussion should be raised on diagnostic criteria of MLP.
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  • 急性胆囊炎に合併した胃膿瘍の1例
    田畑 美帆, 古市 好宏, 植田 健治, 西巻 学, 片上 利生, 日高 道生, 武田 一弥, 杉木 修治, 高瀬 雅久, 白鳥 泰正, 宮 ...
    2001 年 59 巻 2 号 p. 72-73
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_72
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    The patient was a 59-year-old woman with the chief complaints of abdominal pain and fever. Upon palpation of a tumor the size of an egg accompanied by precordial tenderness, she was hospitalized. Leukocytosis and positive CRP were observed, and abdominal US and CT revealed a tumor measuring 40 mm by 60 mm protruding out of the stomach wall. Endoscopic examination of the upper gastrointestinal tract disclosed a smooth-surfaced hemispheric elevation near the posterior wall of the antrum, and a white pus-like exudate was seen oozing from part of the mass. As she was suspected of having gastric abscess, an antibiotic was administered to control IVH. The symptoms and inflammatory reaction improved, and the tumor was reduced in size on the scan. On the 26th hospital day, however, subtotal gastrectomy and cholecystectomy were performed. At surgery, a tumor measuring 30 mm by 53 mm was seen adhering to the ligament of the transverse colon near the posterior wall of the antrum. The gallbladder wall was prominently thickened, and the gallbladder was found to contain many bilirubin stones. Considering that the gallbladder showed notable adhesion to the surrounding organs, gastric abscess seemed to have developed from pericholecystitis.
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  • Helicobacter pylori除菌療法後短期間で消失した2cm大の山田Ⅲ型腺窩上皮性胃過形成性ポリープの1例
    萩原 廣明, 吉永 輝夫, 樋口 次男, 樋口 達也, 清水 直樹, 田中 良樹, 菅原 更細
    2001 年 59 巻 2 号 p. 74-75
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_74
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    A hyperplastic foveolar polyp (about 2cm in diameter) on greater curvature of antrum was found in a 56 year-old-man who had gastro-duodenal ulcers. H. pylori infection was detected by histological examination and cultures of biopsied spiecimens taken from greater curvature of antrum and upper body. H. pylori IgG antibody was positive in serological examination. As the initial H. pylori eradication by 1-week triple therapy (rabeprazole 20mg, amoxicillin 1500mg and clarithromycin 600mg) was not succeeded, he was re-treated by 1 week course of lansoprazole 60mg, amoxicillin 1500mg and metronidazole 750mg 3 months later. 6 months after re-treatment, the polyp was disappeared endoscopically and histologically and H. pylori eradication was confirmed by 13C-urea breath test.
    Eradication of H. pylori may be an effective treatment in cases with hyperplastic foveolar polyp of stomach.
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  • 15年の経過後，超音波内視鏡下吸引生検・腹腔鏡下切除を施行しえた胃平滑筋肉腫の1例
    吉田 美奈子, 小澁 敬治, 床井 伸介, 藤本 秀明, 小野沢 祐輔, 天川 孝則, 山田 哲夫, 河内 洋, 中村 恭一, 伊藤 邦泰, ...
    2001 年 59 巻 2 号 p. 76-77
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_76
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    Before surgery, precise diagnosis of submucosal tumors in the gastrointestinal tract remains quite difficult. A 75-year-old female was endoscopically pointed out a gastric submucosal tumor, less than 1 cm in diameter, on the greater curvature of the antrum at a health checks in 1985. Subsequent endoscopic examinations were followed up periodically for 15 years. In 2000, the lesion enlarged to 2 cm. The internal echo pattern on endoscopic ultrasonography (EUS) was almost homogenous but partially hyperechoic. On EUS guided fine needle aspiration biopsy, it was diagnosed as leiomyoma. Because the malignancy could not be excluded, it was resected by laparoscopic approach. Histopathologically, it was mainly composed of uniform myogenic cells, but included abnormal cells in localized area. By immunohistochemical staining for α-smooth muscle actin, malignant cell infiltration to lamina propria was confirmed.
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  • Hand assisted laparoscopic surgery（HLS）下切除が可能であった巨大胃Schwannoma（神経鞘腫）の1例
    亀山 哲章, 安井 信隆, 戸泉 篤, 田村 洋一郎, 影山 隆久
    2001 年 59 巻 2 号 p. 78-79
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_78
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    We report a case of hand assisted laparoscopic surgery (HLS) for gastric schwannoma. The patient was a 65-year-old woman, who had been asymptomatically diagnosed to have gastric extramural tumor, and gallbladder polyp. Because of its growing in 8 months, she was hospitalized for surgical treatment. We started the operation under the open method of laparoscopic surgery using the intraabdominal pressure of 8 mmHg. Three ports were inserted into the abdomen as follows ; upper umblication (15mm) , below the xiphoid process on the median line (5mm) , and the right abdomen (11.5mm) . The tumor of the maximum diameter of 7 cm was observed on the greater curvature without any adhesion to other organs. After I enlarged the wound of the port below the xiphoid process on the median line to 5cm, I put my right hand into the abdomen using LAP-DISK and performed the partial resection of the stomach by Endo-GIA. The cholecystectomy underwent simultaneously performed for the gallbladder polyp. The size of the gastric tumor was 6.5cm×4.3cm×4.0cm. The tumor was diagnosed as gastrointestinal stromal tumor by frozen sections, but the added immunohistochemical staining of the tumor was positive only for S-100 protein. It was eventually diagnosed as gastric schwannoma.
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  • ステント留置に工夫を要した胃癌術後吻合部再発の1例
    逢坂 由昭, 佐藤 滋, 高木 融, 田村 和彦, 岡田 了祐, 篠原 玄夫, 青木 達哉, 小栁 泰久
    2001 年 59 巻 2 号 p. 80-81
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_80
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    A 90-year-old man was admitted to our hospital in March of 2000 because of the difficulty of oral ingestion. He underwent distal gastrectomy with the reconstruction of Billroth I method due to the gastric cancer in 1994. Gastrointestinal endoscopy showed the stenosis due to the cancerous recurrence at the oral side of anastomosis, in which the endoscope could not be passed through it. Pathological specimen showed the poorly differentiated adenocarcinoma. Instead of reoperation, the stent (Ultra-Flex®, 10cm in length) was placed because the patient was too old and his general condition was also poor. Concerning on the technique of stent placement, endoscope was first inserted with leaving the delivery system in the stomach, because it could not be passed through the stenosis due to bending. Then, the delivery system was grasped with the forceps and was endoscopically placed in the stenosis. After the stent placement, the patient could ingest the rice gruel and leave the hospital.
    The stent placement for the pyloric or duodenal stenosis is relatively difficult. Our technique is thought to be one of the useful methods for these diseases.
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  • 癌の進展に伴い計4個のステントを挿入した噴門部胃癌の1例とその問題点
    斎藤 淳一, 栗原 英二, 山本 純, 岩田 憲治
    2001 年 59 巻 2 号 p. 82-83
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_82
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    A 58-year-old male complaining of swallowing disturbance was admitted to our hospital. Exploratory laparotomy for cardiac gastric cancer performed because of peritoneal dissemination and invasion to phren of the cancer. Seven months later, he was diagnosed as cardiac stricture by progression of the cancer. Non-covered stent was applied to improve the stricture. Five months later, the oral portion of the stent developed stenosis due to tumor growth, and placement of a covered stent through the first stent was performed to obtain the patency. Two months later, the oral portion and the anal portion of these stents developed stenosis due to tumor growth, and additional placement of each two covered stents was done at both oral and anal side of formed treatment. As a result, he could take semi-solid food for about eleven months after cardiac stenosis till cancer death. Our case showed problem in placing stent in stent without full stent expansion. Inadequate expansion maked food impaction and dead space between esophageal wall and stent. So far, we think that expandable metaric stent theraphy for gastric stenosis is useful to the inprovement of quality of life and hope more development of expandable metaric stent.
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  • 異時性多発結腸癌にmicrosatellite instability陽性多発胃癌が併存した1例
    小林 敬明, 大村 健史, 野澤 宏彰, 森田 博義, 関川 敬義, 薬丸 一洋, 渡邊 聡明, 纐纈 真一郎
    2001 年 59 巻 2 号 p. 84-85
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_84
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    A 60-year-woman was admitted to our hospital complaining of the anastomotic reccurence tumor of rectum. She underwent sigmoidectomy for sigmoid colon cancer, extended left hemicolectomy for descending colon cancer and endoscopic-mucosal-resection for ascending colon cancer.
    Endoscopic examination showed two lesions in the stomach, one was IIa in greater curvature of lower body and the other was depressed lesion in lesser curvature of antrum. The biopsy specimen of the former lesion was pathologically diagnosed as well～modalately differenciated adenocarcinoma.
    Distalgastorectomy and super low anterior resection was performed. Three lesions were detected in the resected stomach. All three lesions pathologically showed carcinoma, IIa in the lower body showed tub1 (m) , IIc in the antrum showed papillary adenocarcinoma (m) , IIc in the prepyloric lesion showed tub1 (sm) .
    Microsatellite instability (MSI) of all lesions and nomal mucosa of the stomach were positive. Rectal tumor was well differenciated adenocarcinoma and MSI of tumor and normal mucosa of the rectum was negative.
    MSI of multiple cancer shows higher positive rate than that of single cancer. We think that MSI may be usefull for genetic diagnosis of gastric cancer as well as hereditary nonpolyposis colorectal cancer.
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  • 特異な形態を示し，粘膜筋板内のリンパ濾胞に中～低分化型腺癌成分の浸潤を認めた0-Ⅰ型胃粘膜癌の1例
    角嶋 直美, 藤城 光弘, 矢作 直久, 榎本 祥太郎, 建石 綾子, 岡 政志, 清水 靖仁, 城戸 正開, 辻 正弘, 和田 友則, 元 ...
    2001 年 59 巻 2 号 p. 86-87
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_86
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    A protruded tumor on the lesser curve of lower gastric body was detected by a barium meal for medical check-up in a 64-year-old man. Endoscopically, it was a doom-like protruded lesion, 3 cm in diameter, and biopsy revealed a well differentiated adenocarcinoma. Endoscopic ultrasonography showed that it was semi-pedunculated and the depth seemed to be limited in mucosal or shallower submucosal layer. Therefore, the tumor was treated endoscopically and pathological diagnosis revealed a mucosal cancer with lymphatic vessel infiltration. Furthermore, beneath it, remarkable lymph follicle formation was observed in the mucosal muscle layer and component of moderately to poorly differentiated adenocarcinoma invaded those lymph follicles. Because lymphatic vessel infiltration and component of poorly differentiated adenocarcinoma were observed, the patient underwent an additional surgery, but no residual tumor or lymph node metastasis was found. This case was well worth reporting, because of the rare macroscopic shape and remarkable lymph follicle formation in the mucosal muscle layer accompanied with the tumor invasion.
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  • 著明な壁外性発育を示した胃癌の1例
    竹中 能文, 山崎 真敬, 宮田 量平, 似鳥 修弘, 小柳 和夫, 佐藤 宏喜, 佐久間 正祥
    2001 年 59 巻 2 号 p. 88-89
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_88
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    A 77-year-old male was admitted with appetite loss and abdominal tumor. His tumor markers were of high levels : CEA 176.2 ng/ml and CA 19-9 115.8 U/ml. Examinations such as gastrofiberscopy, CT, MRI, ultrasonography, and angiography revealed a gastric carcinoma with extraluminal growth. A distal gastrectomy was performed palliatively, as well as a resection of the infiltrated transverse colon. The operative findings were : T4, N3, H1, P0, CYX, M1 (LYM) , and Stage IV. The pathological finding of the intragastric specimen was well-differentiated adenocarcinoma (4×3.5×2.5 cm) , but one of the extraluminal growth specimens showed mucinous carcinoma (11×9×4.5 cm) . In between the gastric carcinoma and the extraluminal area, a malignant cystic area was discovered, but the connective area was not pointed out. Four months after the surgical operation, the patient died of peritonitis carcinomatosae.
    We found only 79 relative case reports in the Japanese literature, with patient ages ranging from 25 to 87 with average of 60.2 years of age. The primary tumors, as per our case, originated in the greater curvature side of the antrum in most of the reported cases. Their prognoses were poor due to infiltration, or metastasis, and exceptionally, only 10 patients survived over one year. We present an extremely rare type of gastric carcinoma with extraluminal growth.
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  • 診断と治療方針決定に難渋した微小signet-ring cell carcinomaの1例
    文 善姫, 熊井 浩一郎, 今枝 博之, 相浦 浩一, 緒方 晴彦, 松永 美恵デニーゼ, 菅沼 和弘, 桑野 雄介, 杉野 吉則, 向井 ...
    2001 年 59 巻 2 号 p. 90-91
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_90
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    A 67-year old man underwent endoscopic examination because of abnormal findings in upper GI series at the other hospital. Multiple erosions were observed at the lower gastric body and the antrum. And histological findings of the biopsied specimen at the anterior wall of the lower gastric body showed signet-ring cell carcinoma. Although endoscopic findings at our hospital showed the same as ones there, however histological findings of the biopsied specimen could not reveal malignancy. After 1.5 and 3 months, the patient underwent endoscopic examination again, however malignancy was not detected. Nine months after primary examination, slightly depressed lesion with small redness (0'IIc type) was obseved at the greater curvature of the lower gastric body in the fourth endoscopy, and histological findings showed signet-ring cell carcinoma. The best treatment among gastrectomy, local resection of the stomach and endoscopic mucosal resection was discussed. As histological typing was signet-ring cell carcinoma, 9 months had been already passed from the first diagnosis, and it was difficult to detect the site of this lesion, distal gastrectomy was selected. Hisotological findings of resected specimen showed minute signet-ring cell carcinoma (0IIb type) 3 mm in diameter in the lamina propriae mucosae without vascular invasion and lymph node metastasis. Strict diagnosis and decision of the treatment were difficult in this case.
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  • 原発性腸リンパ管拡張症の1例
    塩崎 裕士, 田原 利行, 山岸 由幸, 中田 功
    2001 年 59 巻 2 号 p. 92-93
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_92
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    A 20-year-old female was admitted to our hospital because of bilateral lower limb edema for 2 months. Her symptom developed one month after the birth of her first child. Laboratory tests on admission showed hypoproteinemia (TP4.6g/dl, Alb2.4g/dl) without proteinuria or liver function disorder. Serum anti-nuclear antibody was negative. Her cardiac finding and thyroid function were normal.
    Esophagogastroduodenoscopy showed scattered white spots in the second portion of duodenum. Biopsy specimen of the lesion demonstrated dilated lymphatics in the lamina propria microscopically. Abdominal image 5 minutes after intravenous injection of 111In-transferrin revealed a leak of radioisotope into the upper gastrointestinal tract, indicating the presence of protein-losing gastroenteropathy. Other examinations showed neither neoplasm nor inflammatory disease, so she was diagnosed as primary intestinal lymphangiectasia. Elemental enteral alimentation with low fat diet led to increase her serum protein (TP6.0g/dl, Alb3.1g/dl) . Although a few other cases were reported, which presented protein-losing gastroenteropathy due to primary intestinal lymphangiectasia after delivery, the pathogenesis remains unclear.
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  • 内視鏡的静脈瘤結紮術単独で治療した十二指腸静脈瘤出血の1例―経過観察と問題点の分析―
    江口 有一郎, 樋口 健, 柿沼 徹, 新井 晋, 藤盛 健二, 松井 淳, 名越 澄子, 今井 幸紀, 下地 克典, 持田 智, 太田 慎 ...
    2001 年 59 巻 2 号 p. 94-95
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_94
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    A 55-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hemorrhagic shock after repeated episode of tarry stool. Endoscopic examination disclosed a solitary duodenal varix at the third portion of the duodenum with white plug on the surface. EVL was performed for the varix, and she recovered from hemorrhagic shock. Additional therapy was not done, because both trans-superior mesenteric arterial portography and magnetic resonance angiography revealed no collateral vessels toward the esophagus, stomach and duodenum. At 4 months later, tarry stool recurred. On endoscopic examination, there was a newly developing duodenal varix at anal side of the third portion of the duodenum, which was treated with EVL. However, intestinal endoscopic examination performed 7 days later revealed another small varix at the same side, but this varix was not treated. She was followed up only by endoscopical observation thereafter, and was quite well for 8 months despite of the remaining varix. It is concluded that EVL may be useful as an emergent therapy for massive hemorrhage from ruptured duodenal varices, but from the prognostic aspect, its efficacy must be evaluated precisely in future.
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  • 内視鏡的粘膜切除術にて切除した早期十二指腸球部癌の1例
    寺井 潔, 権田 厚文, 藤井 佑二, 関 英一郎, 関根 庸, 松岡 隆, 大坊 昌史, 櫻井 秀樹, 田村 友則, 斎藤 大雄
    2001 年 59 巻 2 号 p. 96-97
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_96
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    A 56-year-old man was admitted to our hospital because of diabetes mellitus, meanwhile endoscopic examination revealed a elevated lesion at the second portion of the duodenum. The biopsy specimen showed adenoma with severe dysplasia, Endoscopic mucosal resection (EMR) was performed safely with a detacable snare and a bipolar snare. Histological examination revealed a well differentiated tubular adenocarcinoma with depth of invasion into the mucosal layer, and the resected margin were tumor-free.
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  • 内視鏡的に切除し得た回腸終末部の無症候性巨大脂肪腫の1例
    浅井 浩司, 梅沢 裕信, 大柳 裕登, 斎藤 徳彦, 平原 美孝, 堀口 潤, 石川 勉, 五十嵐 誠治
    2001 年 59 巻 2 号 p. 98-99
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_98
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    A 60-year-old male visited our medical center for presenting positive reaction in stool occult blood test. Barium enema showed a gigantic tumor, which stalk was on terminal ileum and which head was into ascending colon. Colonoscopy revealed that it was a cushion-sign-positive submucosal tumor that was smooth in surface and good in mobility. On the same day, snare excision was performed combining with snare holding method. The specimen was 75×38×30mm in size. Histology proved the tumor to be lipoma. Among our experience of 5 small intestinal lipoma cases treated by endoscopic resection, the size of this case was largest.
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  • 大腸憩室出血に対して緊急動脈塞栓術が奏効した1例
    高島 良樹, 松田 健, 沖浜 裕司, 永嶋 裕司, 平本 義浩, 江上 格, 吉岡 正智, 山下 精彦, 恩田 昌彦
    2001 年 59 巻 2 号 p. 100-101
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_100
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    　大腸出血の原因の一つとして，近年，大腸憩室が増加している。憩室出血の大半が保存的治療で止血するが，遷延する場合には積極的止血処置を必要とする。今回，盲腸憩室出血に対し緊急動脈塞栓術が奏効した1例を経験したので報告する。症例は65歳の男性で，突然の下血が出現し来院した。緊急大腸内視鏡検査では，新鮮血液凝固塊を大量に認めるものの病変部位は同定できなかった。下血が続き，患者がショック状態となったため，同日，緊急血管造影検査を施行した。上腸間膜動脈造影にて盲腸内側部の回結腸動脈末梢枝に出血点が認められ，動脈塞栓術（coiling）を施行し止血を確認した。後日，大腸内視鏡検査を施行したところ，出血部に一致して多数の盲腸憩室が認められ，盲腸憩室からの出血と診断した。患者は，第20病日に軽快退院となり，その後も再出血は認められていない。
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  • 5アミノサリチル酸注腸療法が奏効した潰瘍性大腸炎の1例
    松田 健, 永嶋 裕司, 平本 義浩, 高島 良樹, 沖浜 裕司, 江上 格, 吉岡 正智, 山下 精彦, 恩田 昌彦
    2001 年 59 巻 2 号 p. 102-103
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_102
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    　潰瘍性大腸炎（UC）の治療は，従来，ステロイド剤やサラゾピリンなどを中心とした薬物療法が一般的であるが，その治療および緩解の維持には難渋するものも少なくない。今回，5アミノサリチル酸（5-ASA）注腸療法が奏効したUCの1例を経験したので，内視鏡所見を中心に報告する。症例は19歳，男性で，全大腸型UCに対し，約1年にわたってステロイド療法，メサラジン内服療法などを繰り返すも，直腸からS状結腸に大腸炎が持続し，副腎機能低下症などを併発したため，当科を紹介された。5-ASA注腸療法を開始したところ，持続していたUCが軽快し，ステロイドの使用を中止でき，さらに副腎機能の回復をみた。現在，患者は外来にて5-ASA注腸療法を継続し，経過良好である。5-ASA注腸療法は大量の長期投与でも安全で，とくに今回の結果では病変部が下部大腸に限局している軽～中等度のUC症例に対して有効性が認められた。
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  • 虚血性腸炎の発症を契機に発見された大腸癌の1例
    丸田 和夫, 宮口 信吾, 額賀 健治, 安田 有利, 五頭 三秀, 須藤 一郎, 宮岡 正明, 森安 史典
    2001 年 59 巻 2 号 p. 104-105
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_104
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    The patient was a 70-year-old female. She noticed abdominal pain, which was followed by diarrhea and hematochezia on the night of April 1, 2000. She was taken to the emergency department and hospitalized for further examination. Colonoscopy revealed ulceration complicated by edema in sigmoid colon. The ulcerous lesion had spread over the entire circumference of the deeper portion of sigmoid colon. A tumorous lesion of 20 mm in diameter was detected remaining in the normal mucosa within the inflamed mucosa. The tumorous lesion was biopsied and a diagnosis of colon cancer was made. In this case, ischemic colitis was found to accompany colon cancer. The patient was placed on dialytic therapy because of chronic renal failure. A CT scan and X-ray examination revealed marked arteriosclerosis, which was assumed to be responsible for ischemia. A review of literature yielded many case reports on so-called obstructive colitis, ischemic colitis that occurred on the oral side of colorectal cancer. There appeared to be a limited number of cases of colorectal cancer detected at colonoscopy performed to examine ischemic colitis. This rare case was reported in the present study.
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  • 転移性と考えられる4型大腸癌の1例
    河原 秀次郎, 矢野 文章, 田部井 功, 長 剛正, 柏木 秀幸, 平井 勝也, 青木 照明, 金綱 友木子
    2001 年 59 巻 2 号 p. 106-107
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_106
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    51 year-old male who had undergone total gastrectomy with splenectomy 4 years ago was admitted to our hospital for examination and treatment for melena. Type 4 tumors were found in the vermiform appendix and the rectum by endoscopic examination. Histopathological fingings showed signet ring cell carcinoma similar to that of the gastric cancer. Therefore it was diagnosed as metastatic diffuse infiltrative type 4 carcinoma of the appendix and rectum. Lymphangio-metastasis and peritoneal dissemination of the gastric cancer was determined negative in relation by pre- and opelative examination. Therefore hematogenous metastasis of the signet ring cell carcinoma from the original gastric cancer through SMA for the appendix and IMA for the rectal lesions were most suspected for the route of metastasis.
    A rare case of gastric cancer with hematogenous metastasis to the appendix and rectum is reported.
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  • GVHDにみられた腸炎の1例
    川上 浩平, 須藤 一郎, 小田 常人, 石塚 大輔, 丸田 和夫, 清水 直樹, 宮岡 正明, 森安 史典, 荘司 奈穂子, 加藤 雪彦
    2001 年 59 巻 2 号 p. 108-109
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_108
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    The patient was a 38-year-old male suffering from acute myelocytic leukemia. He had been treated in the department of hematology at this hospital since November 1998. On May 30, 2000, he was admitted to this hospital for surgical treatment. He underwent a bone marrow transplant on June 22. From July 19, he became febrile and erythema was present all over the body. A skin biopsy specimen was collected from the inside of the upper arm and a diagnosis of acute graft versus host (GVHD) was made on the basis of the results obtained. He had frequent diarrher from July 28, and was transferred to this department for further examination on August 7. He underwent colonoscopy on August 8, and the large intestine was endoscopically observe up to the sigmoid colon. Edematous mucosa was observed and irregular rubefactions and erosions were occasionally detected among severe edemas. There findings and his clinical symptoms were suggestive of GVHD of the intestinal tract or of TMA. In the treatment of patient suffering from repeated episodes of diarrhea after bone marrow transplantation, the possibility of GVHD of the intestinal tract or TMA must be born in mind and implementation of colonoscopy should generally be considered.
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  • 腸重積合併虫垂粘液嚢胞腺腫の1例
    海老沼 浩利, 今枝 博之, 緒方 晴彦, 鏑木 淳一, 加藤 悠太郎, 菊池 潔, 露木 晃, 池田 栄二, 斎藤 英胤, 井上 詠, 岩 ...
    2001 年 59 巻 2 号 p. 110-111
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_110
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    A 58-year-old woman visited our hospital complained of right lower abdominal pain. The ultrasound sonography and computed tomography examination showed intussusception in the ileocecal lesion. Barium enema examination revealed an elevated lesion in the ostium of appendix and the contrast barium was not fully filled in the appendix. Endoscopic examination also revealed an elevated lesion with redness in the ostium and obstruction of the hole, which is called volcano sign. These findings suggested that the mucocele in appendix caused ileocecal intussusception. During her admission the lower abdominal pain due to ileocecal intussusception was frequently occurred and therefore ileocecal resection was performed. Histological findings showed mucinous cystadenoma in the distal appendix and fibrous change in the appendix wall. It was suggested that this fibrous mucosa caused intussusception in the cecum. Mucinous cystadenoma in the appendix causing intussusception is rare, and in most of the cases preoperative diagnosis has not been made because emergency operation has been performed. Here we report a rare case of mucinous cystadenoma causing intussusception which was preoperatively suggested from the findings of the barium enema and endoscopic examination.
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  • Cronkhite-Canada症候群の1例
    片上 利生, 田畑 美帆, 古市 好弘, 植田 健治, 日高 道生, 武田 一弥, 杉木 修治, 高瀬 雅久, 白鳥 泰正, 宮岡 正明, ...
    2001 年 59 巻 2 号 p. 112-113
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_112
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    The patient was a 59-year-old man. He visited a neighborhood clinic because of diarrhea. He had alopecia at the top of his head and swelling of finger tips around that time. As barium enema examination revealed multiple polyps in the entire colon, he visited our hospital. Endoscopic examination disclosed numerous red polyps of irregular size, and histologic examination revealed cyst-like dilation of the ducts, interstitial edema, and cellular infiltration which were consistent with hamartomatous polyps. Endoscopic examination of the upper gastrointestinal tract similarly disclosed multiple polyps. Nail exfoliation and pigmentation were also observed. The patient was diagnosed as having Cronkhite-Canada syndrome and was started on corticosteroid therapy. The subsequent course was uneventful and favorable.
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  • 小腸狭窄に対して大腸内視鏡的バルーン拡張術が有効であったクローン病の1例
    寺本 忠, 江上 格, 萩原 信敏, 渡邊 秀裕, 長谷川 博一, 飯田 信也, 宮本 昌之, 中村 孝, 鈴木 成治, 横山 正, 中村 ...
    2001 年 59 巻 2 号 p. 114-115
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_114
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    Therapeutic balloon dilation was performed colonoscopically, using a balloon dilatation catheter, on a patient who had a stricture of the terminal ileum resulting from Crohn's disease. The patient was a 53-year-old man who had undergone 4 abdominal operations for Crohn's disease between 1990 and 1995. He had been treated with medical and nutritional therapy, and had obtained symptomatic relief.
    The patient consulted our hospital complaining of lower abdominal pain and loss of appetite, and was admitted with a diagnosis of ileus on August 5, 2000. Contrast study of the small intestine showed a 6-cm-long stenosis of the terminal ileum. Conservative therapy for 2 months did not relieve the symptoms. Endoscopic treatment was considered preferable to surgery because the patient's multiple resections in the past increased the risk of short bowel syndrome. Balloon dilation was performed 3 times using a commercially available balloon dilatation catheter (CRE, Boston Scientific) , and sustained improvement was observed during a 9-month follow-up period.
    The present authors believe that endoscopic balloon dilation is a safe and effective therapeutic option for patients with intestinal strictures resulting from Crohn's disease, which has a high rate of symptomatic recurrence and re-operation.
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  • 悪性大腸狭窄に対しステント挿入が有用であった2例
    吉永 秀哉, 田代 淳, 小飯塚 仁彦, 二上 敏樹, 藤沢 智雄, 大塚 隆文, 望月 雅恵, 春日井 俊史, 河村 晴信, 秋山 純一, ...
    2001 年 59 巻 2 号 p. 116-117
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_116
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    The use of a metal stent in malignant colorectal obstruction is not well established in Japan. The traditional method of managing inoperable colonic obstruction has been palliative colostomy or insertion of long tube. However, these methods were invasive and/or umcomfortable for patients. We report two cases of malignant rectal obstruction which was treated with expandable metal stent. Case 1 is a 65-year-old female diagnosed to have advanced gastric cancer with Schnitzler metastasis. Barium enema and colonoscopy showed severe stenosis due to extraluminal compression. Case 2 is an 89-year-old female diagnosed to have rectal cancer. They were inoperable and developed abdominal pain due to ileus during hospitalization. EMS with the inner diameter of 18mm (Ultraflex prosthesis) was inserted for their rectal obstruction. Stent expansion brought about immediate decompression of the obstructed bowel. After the treatment, their abdominal symptom were relieved and no complications were developed in both cases. In our opinion, the treatment could maintain patient's QOL until their death compared with traditional method. Stent decompression could be palliative treatment for inoperable malignant colonic obstruction.
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  • 内視鏡的に摘除しえたS状結腸神経鞘腫の1例
    大竹 陽介, 阿部 剛, 太田 昭彦, 佐藤 浩一郎, 玉山 隆章, 古谷 正伸, 石塚 俊一郎, 掛村 忠義, 吉田 光宏, 五十嵐 良典 ...
    2001 年 59 巻 2 号 p. 118-119
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_118
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    A 63-year-woman visited our hospital for further evaluation of submucosal tumor in the sigmoid colon. The lesion was hard and was approximately 10mm in diameter. Endoscopic ultrasonography demonstrated a hypoechoic lesion located mainly in the shallow part of the third layer without swelling of the lymph nodes. We strongly suspected it to be a carcinoid. Endoscopic resection with aspiration and ligation was performed. By this procedure, the lesion was completely resected with submucosal tissue between tumor and resected surface. Microscopic examination including immunohistological study of the specimen diagnosed a benign schwannoma.
    Endoscopic resection with aspiration and ligation was considered to be an effective and safety procedure for diagnosis and therapy of submucosal tumor when the lesion was comparatively small (less than 10mm in diameter) and located in the shallow part of submucosa without swelling of the lymph nodes.
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  • 内視鏡的粘膜切除術を施行した直腸mucosa-associated lymphoid tissue lymphomaの1例
    渡辺 綾子, 山門 進, 篠澤 功, 永井 俊彦, 岡田 夢, 相田 順子, 伊藤 雄二
    2001 年 59 巻 2 号 p. 120-121
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_120
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    A 89 year-old woman visited to our hospital with a complaint of right lower abdominal pain. Colonoscopic examination revealed a Isp type protruding lesion in 7mm diameter in lower rectum. We performed endoscopic mucosal resection to this lesion for accurate diagnosis because biopsy specimen revealed the atypical lymphocyte infiltration. Pathological findings of the resected tissue showed marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALToma) . Because of her age was high and the lesion located in the lower rectum without any other lymphoma lesions, we followed up this ulcer lesion with endoscopic examination. As Helicobacter pylori (HP) infection to her stomach was positive, we eradicated HP infection by triple therapy. After EMR to this rectal MALToma, she has not a relapse until today.
    We suggested to be able to treat with EMR for gastrointestinal primary MALToma when its lesion was the indication for EMR and patient was senile and/or had any inoperable complications.
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  • 自己免疫性膵炎の1例
    宮田 和則, 安部 宏, 町野 裕之, 半田 祐一, 崎村 恭也, 家富 克之
    2001 年 59 巻 2 号 p. 122-123
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_122
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    A 38-year-old male was admitted to our hospital because of jaundice. 18 months before admission, he was diagnosed as insulin-dependent diabetes mellitus. Then we could detect no abnormalities of abdominal CT scan.
    On this admission abdominal US revealed hypoechoic swelling of pancreas. ERCP demonstrated focal narrowing of the main pancreatic duct and constriction of the common bile duct in the pancreas with dilatation of upstream.
    Pathological finding of pancreas was infiltration of inflammatory cells (lymphocytes, eosinophils and plasma cells) and fibrosis. Pathological findings of gall bladder and lymphnode were similar to that of pancreas. We diagnosed his illness as autoimmune pancreatitis. After surgery jaundice improved but swelling of pancreas continued. Though we recommended steroid therapy, he refused it. We are carefully following.
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  • 内視鏡的逆行性膵胆管造影検査（ERCP）におけるグルカゴンの有用性の検討（第1報）
    春山 航一, 西野 隆義, 土岐 文武, 久田 生子, 福屋 裕嗣, 小山 祐康, 鈴木 茂, 林 直諒
    2001 年 59 巻 2 号 p. 124-125
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_124
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    Glucagon has been shown to depress the gut motility and pancreatic secretion and it has also been reported that glucagon has a beneficial effect on experimental pancreatitis in mice.
    The present study investigates whether glucagon administration decreases duodenal moltility and prevents the increase of serum pancreatic enzymes after endoscopic retrograde chlangiopancreatography (ERCP) . ERCP was performed in 29 consecutive cases (18 males and 11 females) , which were divided into two groups. Scopolamine butylbromide was given at a dose of 20 mg to Group B, and glucagon was given at a dose of 1 mg to Group G. Each drug was administered by intramuscular injection before ERCP, and then duodenal motility was evaluated by modified Niwa's criteria : (1 : complete supression to 5 : no supression) . Serum pancreatic enzymes were determined to be suppresed at 0h, 4h and 24h after ERCP.
    Result : 1. The glucagon treatment suppressed duodenal motility slightly more than the scopolamine butylbromide treatment (1.5±0.7 vs 2.0±0.4) . 2.Serum lipase levels at 4h after ERCP in patients in Group G were slightly lower than in patients in Group B ; however, there was no differece at 24h between two groups.
    In conclusions, the glucagon treatment suppressed duodenal motility sufficiently in ERCP. Further research is needed to determine whether the incidence of postcannulation pancreatitis can be reduced by glucagon.
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  • 重症急性膵炎に続発した肝膿瘍に対し経鼻胆道ドレナージが奏効した1例
    今村 綱男, 野津 史彦, 坂本 仁, 石川 晶久, 片寄 耕蔵, 小野 仁志, 柳川 達郎, 塙 勝博, 三代川 章雄, 池上 覚俊, 吉 ...
    2001 年 59 巻 2 号 p. 126-127
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_126
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    A 76-year-old woman was admitted to our hospital for severe acute biliary pancreatitis. The patient was evaluated as“severe”according to the severity criteria of the Japanese Ministry of Health and Welfare Study Group. The patient was treated by continuous regional arterial infusion using nafamostat mesilate and imipenem for 7 days. Symptoms of pancreastitis improved but high fever appeared on 15th hospital day. Liver abscess was suspected on the findings of the abdominal computed tomography. Antibiotic was intravenously administered but fever persisted. We judged that the patient has a indication of percutaneous abscess drainage, but we could not performed this because of bleeding tendency of idiopathic thrombocytopenic purpura. We performed endoscopic naso-biliary drainage (ENBD) for treatment of liver abscess. Endoscopic retrograde cholangiography visualized the dilated bile duct and connection between this duct and the liver abscess. A 7.5Fr. ENBD tube was placed in the abscess through the dilated bile duct. The clinical symptoms improved dramatically. Our experience suggests that ENBD is one of the effective treatment for liver abscess after biliary tract infection.
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  • 外傷性膵仮性囊胞に対し一期的内瘻チューブ留置が著効した1例
    大島 忠, 石原 武, 山口 武人, 門野 源一郎, 露口 利夫, 税所 宏光
    2001 年 59 巻 2 号 p. 128-129
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_128
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    A twenty-year-old male had failed with the conservative treatment of a traumatic pancreatic pseudocyst and had documented cyst persistence for over four weeks. The size of the pseudocyst was 110mm in diameter and CT scans showed apposition of the pseudocyst in the pancreatic body to tail against the stomach wall. We performed EUS-guided transgastric puncture of the pseudocyst with a 19 gauge ultrasound needle (ECHO TIP. Wilson-Cook Medical) , then a 0.035 inch guide wire was passed into the pseudocyst after with drawn of a stylet and a 7-F stent coaxially inserted into the pseudocyst. There were no complications associated with the procedure. The pseudocyst had collapsed in five days after the drainage. The pseudocyst had completely resolved at follow-up of six months after the drainage.
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  • 慢性膵炎の経過中に膵臓癌を発症した1例
    神澤 輝実, 藤原 崇, 鈴木 瑞佳, 雨宮 こずえ, 江川 直人, 榊 信廣
    2001 年 59 巻 2 号 p. 130-131
    発行日: 2001/12/05
    公開日: 2014/05/22
    DOIhttps://doi.org/10.11641/pde.59.2_130
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    A case who had pancreatic cancer during the course of the chronic pancreatitis is reported. A man of heavy drinker was diagnosed as pancreatolithiasis in 33 years old. He continued drinking. Abdominal CT and ERCP demonstrated typical findings of chronic pancreatitis in 50 years old. He was admitted to our hospital again complaining of back pain in 55 years old. Abdominal CT showed irregular mass in the uncus of the pancreas. ERCP showed stenosis of the main pancreatic duct in the head and body of the pancreas. In laparotomy, a 7cm-sized mass was detected in the head and body of the pancreas. Histological examination was moderately differentiated adenocarcinoma. This is the first case who had pancreatic cancer in the course of chronic pancreatitis, in 130 patients with chronic pancreatitis in our hospital.
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