Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 34, Issue 2
Displaying 1-15 of 15 articles from this issue
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Contents
  • A Diagnostic Study of Colo-rectal Villous Tumors
    SUNG-MOO YANG
    1988 Volume 34 Issue 2 Pages 171-180
    Published: September 20, 1988
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.171
    JOURNAL FREE ACCESS
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    Thirty eight, from 35 patients, resected or polypectomied colo-rectal villous timors were radiologically and colonoscopically analyzed in comparison with their macroscopic and histological findings, in order to define the features benign and malignant villous tumor. Colo-rectal villous tumors could be macroscopically classified into the pedunculated type (20 lesions), the seesile type (10 lesions) and the plaque-like type (8 lesions). A positive identification of adenocarcinoma was made in 7 out of 20 pedunculated lesions (35%), in 6 out of 10 sessile lesions (60%) and in 5 out of 8 plaque-like lesions. The cancerous invasion was confined to the mucosa in all 7 pedunculated malignant villous tumors. Out of the 6 sessile lesions, 4 were intramucosal cancer, 1 was submucosal cancer and the remaining one was advanced cancer. Among the 5 plaquelike malignant tumors, cancerous invasion was confined to the mucosa in 4 and was seen in the submucosa in the remaining 1 lesion.Radiologically, the nodular or reticular surface pattern characteristic of villous tumors could be visualized on the double contrast view in 21 out of 2 2 tumors more than 2.0cm in diameter. Furthermore, a shaggy tumor margin, very helpful in making a diagnosis of villous tumor, could documented by the double contrast technique in 7 out of the 38 lesions. On colonoscopy, the margins of tumors could be determined by observation with the bowel loop moderately distended, or by use of the dye-spraying method. In conclusion, a diagnosis of villous tumor can be established by the double contrast method in tumors more than 2.0cm in diameter by visualizing the characteristic surface pattern, and radiological identification of tumor characteristics on lateral view (peduncilated, sessle or plaque-like) is useful for estimating the depth of cancerous in vasion.
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  • A Study on ERCP Classification of Carcinoma of the Pancreas
    KAZUHIKO OHHASHI
    1988 Volume 34 Issue 2 Pages 181-190
    Published: September 20, 1988
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.181
    JOURNAL FREE ACCESS
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    One hundred sixty seven cases of pancreatic carcinoma accumulated in the ten years between January, 1975 and December, 1984 are reviewed. After careful analysis of the pancreatograms, 7 cases with the characteristic findings on pancreatogram of mucin-producing pancreatic cancer are reported. This is the first clinical report dealing with mucin-producing pancreatic cancer. Furthermore, 13 cases of cancer in the head of the pancreas which showed no dilatation of the main pancreatic duct, due to the existence of a patent Wirsung or Santorini duct, are discussed. Diagnosis of such cancers requires fine demonstration of both ducts or canulation of the major and minor papilla. Several classifications of the ERCP findings in pancreatic cancer have been proposed, but each depended only on the radiographic analysis of stenosis and obstruction of the main pancreatic duct, and they had little predictive significance for either surgical resectability or prognosis. This new ERCP classification in which tumors divided into four types, including mucin-producing pancreatic cancer and cancer in the head of the pancreas without dilatation of the main duct, has proved to have a close relation to resectability and prognosis. Six patients survived more than five years after resection, showing a five years survival rate of 3.6%.
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  • Radiological Appraisal of Extent of Disease in Ulcerative Colitis
    YOSHITOSHI WAKABAYASHI
    1988 Volume 34 Issue 2 Pages 191-200
    Published: September 20, 1988
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.191
    JOURNAL FREE ACCESS
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    Radiological findings obtained by double contrast barium enema in 82 patients with ulcerative colitis, who were longitudinally followed for one to 15 years, were evaluated to estimate the extent of the disease, to trace a longitudinal change in the extent of disease, and to correlate the extent of the disease with prognosis. The following conclusions were reached. 1. The findings of oral end of the disease were classified into two groups, in the 24 patients who were examined at the initial onset of the disease. Group A. There was an abnormal network pattern indicating a transitional zone between the normal portion and the main disease site in 15 of the 24 patients. The size of this zone ranged from 3 to 13 cm, (average 6.9 cm). Histological examination of biopsy specimen taken from this zone showed the infiltration of inflammatory cells, edema, or some cryptal abscesses. It was concluded that the portion with abnormal network pattern should be included also in the disease area. Group B. The diseased and normal areas were clearly distinct in these nine patients. The majority of the patients in this group had the disease to a slight degree only. 2. In 19 of the 63 patients who were followed long-term, the extent of the disease observed at the initial onset changed. The time interval needed for this change or the extent of change during observation remained uncertain. The change in extent of the disease was classified into three groups, (a) enlargement (five cases), (b) diminution (five), and (c) mixed (nine). 3. Three of the five patients with enlargement in extent were operated upon within 10 years after onset and the prognosis in this group was poor. No patient with diminished disease underwent surgery in a 10-year period of observation and the prognosis was good. Three of the nine patients with mixed changes had surgical treatment with-in 10 years of the disease onset, and the prognosis of this group was relatively good. 4. In one of the 15 patients with proctitis type the disease extended orally within 10 years of onset.
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  • An Experimental Study of the Vascularization of the Island Flap
    --Part I : Survival Rate after Ligation of the Vascular Pedicle--
    KENICHI TSUZUKI, AKIRA YANAI
    1988 Volume 34 Issue 2 Pages 201-206
    Published: September 20, 1988
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.201
    JOURNAL FREE ACCESS
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    It is commonly accepted that the inital survival of an island flap depends on adequate blood flow in its pedicle. After that period, revascularization from the surrounding tissue begins and the flap eventually becomes independent of this pedicle. The type of the flap, the state of the recipient site, and the blood flow volume passing through the vascular pedicle are among the factors taking part in the timing and the degree of revascularization. This study was undertaken to investigate how soon the flap becomes independent of the vascular pedicle, using the island flaps in Wistar rats. An epigastric flap was elevated on the right side of the abdominal wall and the vascular pedicle was ligated on various days following flap elevation. When the vascular pedicle was ligated on first day after the operation, almost total necrosis of the flap occurred. Partial flap survival was seen when the ligation was done on third day after operation. In the group in which the vascular pedicle was ligated on fifth day after operation, the mean flap survival rate rose to about fifty percent. Application of the T test showed statistical differences between these groups. With the passage of time, the mean survival rate increased and flap survival was almost complete in the group ligated on the fourteenth day. From these result, in Wistar rats, it appears that revascularization from surrounding tissue begins on about the third day after operation and the flap can survive independently of its pedicle by the fourteenth day after operation.
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  • Electroencephalographic Studies of Borderline Personality Disorder
    YUTAKA TANAHASHI
    1988 Volume 34 Issue 2 Pages 207-219
    Published: September 20, 1988
    Released on J-STAGE: November 20, 2014
    DOIhttps://doi.org/10.14789/pjmj.34.207
    JOURNAL FREE ACCESS
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    The diagnostic criteria of borderline personality disorder (BPD) were provided by DSM-III and its concept was made clear. However, there has been very little biological or electroencephalographical study of BPD. Most cases of BPD show affective instability and impulsivity as their characteristic symptoms. We have previously reported that cases of attempted suicide had a high rate of EEG abnormalities. Accordingly, we examined the EEGs and Rorschach tests of cases with BPD, in order to investigate the correlation between the biological and psychological characteristics of BPD. The subjects (BPD group) were 32 cases (3 males and 29 females), who satisfied the diagnostic criteria for BPD. They presented to Juntendo Hospital from 1979 to 1985 and their ages ranged from 15 to 37 (average 21.3). We examined the EEGs of all cases and the Rorschach tests of 29 cases. As a age matched control group, 75 schizophrenic patients who were hospitalized during the same period, were selected (schizophrenic group). We also examined their EEGs and then compared the two groups. The BPD group showed 27 (84.4%) definite and 3 (9.4%) marginal EEG abnormalities, characterized by a slowing of the basic rhythm and a 6 Hz spike and wave pattern (phantom spike and wave), which occurred significantly more often in the BPD group than in the schizophrenic group. In the BPD group, the 21 cases with paroxysmal discharges showed a significantly increased tendency to perform “physically self-damaging acts” (e. g. suicidal gestures) compared with the 11 cases without such discharges. In the results of the Rorschach tests, inclinations toward impulsivity (e. g. suicide indicator) were recognized. Twenty four patients in the BPD group with EEG abnormalities were given antiepileptic drugs (e. g. Carbamazepine, Valproic acid, Phenytoin), singly, or together with psychotropic drugs. Sixteen cases showed improvements such as an increased emotional stability and a cessation of suicidal tendencies. It is concluded that BPD subjects show a high rate of EEG abnormalities associated with their affective instability and impulsivity. Therefore, the author emphasizes that the neurophysiological approach is valuable as well as the psychological approach in the diagnosis and treatment of BPD.
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