bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Intravariceal Injection Sclerotherapy with 5% Ethanolamine in 187 Acute Oesophageal Variceal Bleeding Patients
Authors: WILAIRATANA Sommai , WILAIRATANA Polrat
Published: August 2007

One hundred and eighty seven patients (161 males and 26 females) with endoscopically proven active variceal bleeding underwent endoscopic sclerotherapy by the intravariceal method (EST). All of the patients were cirrhotic and 37.4 percent (70/187) had associated underlying diseases. The patients' status before EST, according to Child‐Turcotte's classification, were class A % 6.4%, class B = 49. 7%, and class C = 43% respectively.

An intravariceal injection with 4 ml of ethanolamine oleate per varix through an Olympus fiberoptic scope was performed. Then sclerotherapy sessions required for each patients was different. Seventy four percent (138/187) required only one session. Neither a compression balloon nor sliding tube after injection were used. Bleeding was arrested in all cases after this method.

The results revealed that recurrent bleeding developed in 17.6 percent of the patients (33/187) and occurred between one day (one case) to two years afer EST. Hemorrhagic gastritis (22/187) was the major cause of post sclerotherapy bleeding. Complications related with EST in this report occurred in two patients (1.06 percent). The first case had a low grade fever after treatment which spontaneously subsided on day three after EST without any specific medication. The other one had oesophageal perforation and died with severe post operative sepsis.
Laparoscopic Trial of Fundoplication (Nissen) and Cardiac Myotomy (Heller) in Animals
Authors: INOUE Haruhiro , YOSHINO Kunihide , TAKESHITA Kimiya , NAGAHAMA Yuji , MURAOKA Yukihiko , YONESHIMA Hideo , Endo Mitsuo
Published: August 2007

We studied two kinds of laparoscopic upper gastrointestinal surgery: fundoplication for reflux esophagitis and myotomy for achalasia of the esophagus. Two basic and common procedures which are required for the successful completion of these two operations are: 1) retraction of the left liver lobe to obtain a clear visual field of the esophageal hiatus, and 2) taping of the abdominal esophagus to sufficiently pull the esophagus down into the operative visual field. The operations were successfully performed on pigs using five animals and no major complications such as uncontrollable bleeding were incurred. In only one subject a laceration of the mucosa occurred after myotomy due to careless overinflation of the endoscopic balloon situated in the lumen of the esophagus, but this could easily be avoided in future operations. We believe that these laparoscopic procedures will soon be ready for clinical application.
Laparoscopy in a Case of Primary Sclerosing Cholangitis with an Ultrasonographically Detected Portal Thrombus
Authors: WATANABE Makoto , UCHIDA Yasushi , KOHGE Naruaki , AKAGI Shuji , ASHIZAWA Nobuo , ADACHI Kyoichi , KISHIDA Keiko , ONO Naomi , FUKUMOTO Shiro , ONO Masakazu
Published: August 2007

A case of sclerosing cholangitis is presented. The patient was a 65 year‐old male and visited a hospital because symptoms of a biliary tract infection suddenly appeared. These symptoms improved in the short term with antibiotic therapy. As a high level of serum CA19–9 was found and the double wall structure of the intrahepatic bile duct and a portal thrombus were observed during an abdominal ultrasonography, the patient was transferred to our clinic for further examination of his hepatobiliary system. A malignant lesion was suspected from an endoscopic retrograde cholangiography and celiac angiography, although the patient's serum CA19–9 level rapidly decreased after admission. A liver with a smooth surface, some focal wide depressions, and an increase of white markings was observed laparoscopically. An adenomyomatosis‐like lesion was observed in the gallbladder. Bile duct destruction with periductar fibrosis was histologically proven. This is a case of histologically diagnosed sclerosing cholangitis but without the typical findings usually found during an endoscopic retrograde cholangiography.
Repeated Laparoscopy of 27 Patients with Chronic Non‐A, Non‐B Hepatitis Showing a Complete Response to IFN Therapy
Authors: ITO Toshio , UKIDA Minoru , YAMAMOTO Kazuhide , TANIMIZU Masahito , MIZUTAMARI Koukichi , KAKIO Takeshi , KOBASHI Haruhiko , SAKAI Nobuyuki , MATSUO Ryuichi , MORIMOTO Youichi , MIYAMOTO Rieko , OMOTO Masaki , NAKANISHI Sousuke , MIKAMI Masayuki , OMORI Nobuhiko , TERAOKA Tadashi , TSUJI Takao
Published: August 2007

The laparoscopies and liver histology results of 27 patients with chronic non‐A, non‐B hepatitis who had a complete response to the longterm administration of IFN‐alpha were studied. When comparing the liver surface before IFN therapy, code number 1 using Shimada's classification, i. e., whitish markings, increased from 14.0% to 57.9%, code number 2, i. e., dilated vessels, decreased from 34.9% to 10.6%, code number 4, i. e., reddish markings, decreased from 11.6% to 2.6%, and code number 7, i. e., patchy markings, decreased from 16.3% to 2.6%. Improvement of the liver edge dullness and a decrease of the liver consistency after the IFN therapy were also observed in 40. 7%, and 14. 8% of the patients, respectively. Liver histology after the therapy showed normal liver or liver fibrosis in chronic hepatitis patients, and liver cirrhosis with active hepatitis developed into liver cirrhosis without activity. The hepatitis activity index score decreased significantly after the therapy. The present report seems to be the first which describes detailed changes of the liver surface before and after IFN therapy in patients with chronic non‐A, non‐B hepatitis who had a complete response to the therapy
The Diagnosis of the Anomalous Connection of Pancreaticobiliary Ducts Without Biliary Dilatation—The Usefulness of US/EUS Serial Examination—
Authors: YAMAO Kenji , NAKAZAWA Saburo , YOSHINO Junji , INUI Kazuo , YAMACHIKA Hitoshi , KANEMAKI Naoto , FUJIMOTO Masao , WAKABAYASHI Takao , MATSUMOTO Sumio , SEGAWA Kose , SUZUKI Takashi , MITAKE Masahiro
Published: August 2007

The anomalous connection of the pancreaticobiliary duct (ACPBD) without accompanying dilatation of the bile duct (non‐dilated type of ACPBD) has recently been found to be associated with gallbladder cancer at a rather high rate. We analyzed the diagnostic process of 5 patients with non‐dilated type of ACPBD including 3 asymptomatic cases and reviewed the literature. Symptoms and laboratory data were not useful in detecting this type of lesion. All our patients were checked by ultrasonography for gallbladder lesions which are suggested by: wall thickening, multiple polyps, intramural gall stones, cholecystolithiaisis, and debris. ACT revealed only wall thickening of the gallbladder. An EUS revealed a high rate of ACPBD in addition to the ultrasonographic findings of gallbladder lesions obtained by US. An ERCP was effective in clearly demonstrating ACPBD, but was not so useful for the diagnosis of concomitant gallbladder lesions. Therefore, an US is considered to be a useful means for screening this disease, and EUS is useful as a procedure to follow in order to select patients with or without ACPBD, because EUS can be conducted on an outpatient basis and is highly sensitive in detecting ductal anomalies in ACPBD. Therefore, the US/EUS serial examination is thought to be an effective means for diagnosing this disease.
A Basic Study on the Eye Fixation Points in Endoscopic Observation with Special Reference to the Difference Between the Beginners and Experts
Authors: KUROSAKA Hanzo , AOKI Takahito , HIROOKA Tatsuo , SADANAGA Yoshihisa , SUZUKI Hiroo , KANEKO Shohnosuke , KOZASA Kiyoshi , ISHIKAWA Masazumi , IWAI Chikara , TAJIRI Inaho , AONO Giichi , UKAWA Shiro , JYOHJIMA Yoshiaki , KAMINISHI Michio , OOHARA Takeshi
Published: August 2007

Accurate image analysis is essential for correct diagnosis in gastrointestinal endoscopy. In the past, the process of diagnosis has varied based merely on the personal experience of the examiner, and yet there has been no basic study concerning its improvement. We conducted a basic study on endoscopic image analysis particularly with regard to eye fixation points, and noticed that there was a significant difference between beginners and experts. The beginners tended to fix their eyes on the area showing a larger color tone difference, whereas the experts tended to have their fixation points on areas with less of a color tone difference
A Case of Endometriosis of the Appendix
Authors: FUKE Hirofumi , SATO Hyoe , HIGASHIYAMA Hirotaka
Published: August 2007

A 51‐year‐old woman visited our clinic her chief complaint being right hypogastric discomfort. An abdominal ultrasonography revealed a circular, cystic mass in the right hypogastric region. A colorectal radiography disclosed a semi‐globular shadow defect at the end of the cecum and did not visualize the appendix. A colorectal endoscopy revealed a submucosal tumor accompanied by a central dimple which seemed to represent the ostium appendicis vermiformis. Based on a preoperative diagnosis of submucosal tumor, the patient underwent a partial resection of the cecum. A histopathological examination of tissue removed led to a diagnosis of endometriosis of the appendix.

In Japan, 7 cases of endometriosis of the appendix have been reported to date. In those cases, endometriosis of the appendix was detected as a lesion accompanying endometriosis of some other site or during laparotomy was based on a diagnosis of acute appendicitis. Unlike these cases, the patient presented here had been diagnosed by a preoperative colorectal radiography and endoscopy as having a submucosal tumor of the appendix.
Laparoscopic Follow‐up of Asymptomatic Primary Biliary Cirrhosis with Negative Anti‐mitochondrial Antibody
Authors: WATANABE Makoto , UCHIDA Yasushi , ADACHI Kyoichi , KOHGE Naruaki , ONO Naomi , FUKUMOTO Shiro
Published: August 2007

Abstract: The case of a 59 year‐old female with asymptomatic primary biliary cirrhosis with negative anti‐mitochondrial antibody is presented. According to the results of the first laparoscopy and liver biopsy, reddish patch was observed but chronic non‐suppurative destructive cholangitis could not histologically be confirmed. A follow‐up laparoscopy with liver biopsy conducted 39 months after the first laparoscopy revealed progress in the laparoscopic findings, i. e. a focal appearance of mesh‐like white marking and undulation, when chronic non‐suppurative destructive cholangitis was histologically demonstrated. Following the diagnosis of primary biliary cirrhosis, ursodeoxycholic acid treatment was begun, and the patient's serum levels of transaminases and biliary tract enzymes showed a rapid improvement.

The importance of a laparoscopy with liver biopsy for the diagnosis of asymptomatic primary biliary cirrhosis in a case with negative anti‐mitochondrial antibody is emphasized, and the follow‐up of such a case discussed.
Endoscopic Characteristics of Gastric Polyps and Their Background Mucosa on the Gastric Body
Authors: TAKECHI Keishi , ENDO Junko , FURUHASHI Kazutoshi , SAITO Yoshio , YAMADA Tetsuya , MORIWAKI Hisataka , MUTO Yasutoshi
Published: August 2007

Abstract: We investigated the endoscopic and histopathological characteristics of 112 gastric polyps on the gastric body. According to the histopathological findings of the glands in the biopsy specimens, we classified the polyps into 6 categories; dense fundic gland type (group A), sparse fundic gland type (B), mixed fundic and pyloric gland type (C), pyloric gland type (D), complete atrophic gland type (E) and others (F).

The grade of atrophic gastritis was defined by the fundic‐pyloric border type of the stomach, and was found to change from mild to severe respectively in groups A to E. The gastric area type of background fundic gland mucosa also changed from F0 to F3 in parallel with the order of the groups A to E. Thirty‐five of the 36 polyps in group A, all 19 in group B, 2 out of 3 in group C, 1 of 4 in group D, and the 1 in group E were located on the dye‐endoscopically defined fundic gland mucosal area. The gland type of biopsy specimens which were obtained from the mucosa adjacent to the polyps changed from fundic to fundic‐pyloric and to pyloric type in groups A to E respectively.

In conclusion, the histopathological findings of polyps on the gastric body reflect the background mucosa, and in particular the extent of the atrophic change of the stomach. The majority of polyps, either fundic gland polyps (groups A and B) or hyperplastic polyps (groups C, D and E), on the gastric body were found to be the same gland type as their respective background mucosa. They thus seem to fall into the same category as hyperplastic polyps of background mucosal origin but are not the same as a hamartomatous polyp.
The Colon Mucus Test in Comparison with the Fecal Occult Blood Test in the Detection of Gastrointestinal Disease
Authors: WATANABE Hiroyuki , MOURI Ikurou , YAMAGUCHI Yasushi , YAMAKAWA Osamu , KAWAKAMI Hiroyasu , SATOMURA Yoshitake , Ohta Hideki , MOTOO Yoshiharu , OKAI Takashi , FUKUI Masanori , SAWABU Norio
Published: August 2007

Abstract: This study was undertaken to assess the diagnostic significance of the colon mucus test (CMT) by which the cancer‐associated carbohydrate antigen, β‐D‐Gal (1 ‐ 3)‐D‐GalNAc (T antigen) is measured in rectal mucus, chiefly in patients with various alimentary tract diseases. The incidence of a positive CMT was relatively high in colorectal cancer (69%) and gastric cancer (40%), and was similarly high in some benign colorectal diseases such as colonic diverticulum (42%) and colonic polyps (39%), and in gastric polyps (75%). On the other hand, the incidence of a positive CMT in other benign diseases or in healthy controls was less than 10%. A positive CMT was significantly more common in colorectal disease and in gastric tumors (cancer and polyps) than in the other diseases (p < 0.001). Of 28 colonic polyp patients, 20 (71%) had negative fecal occult blood test results (FOBT), and nine of them (45%) had positive CMT results.

These results suggest that the CMT may be a useful screening test for alimentary tract disease, particularly colorectal disease and gastric tumors, although its specificity for colorectal cancer is only moderate. Furthermore, a combination assay using FOBT plus CMT may help to improve the diagnostic rate.
A Case of Terminal Ileum Lipoma Treated by Endoscopic Polypectomy
Authors: KAGAMI Akihiko , ARINO Toru , USUI Toshirou , SEKI Shingo , TSUCHIYA Masahito , OKUMURA Mitsuru , TANAKA Fumio , IWAI Takaaki , HIROTA Yoshiyuki , KOMORI Akihiko , SAKATO Hideyoshi , TAKAHASHI Kaoru , MOCHIZUKI Seibu , NAGANO Makoto , SUZUKI Hiroaki
Published: August 2007

Abstract: This study reports on the case of a 71‐year‐old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth‐surfaced polypoid tumor (Yamada type III) located in the terminal ileum.

An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically.

After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum.

In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception.

We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal ileum.
New Endoscopic Approach to Diagnosing Pancreatic Diseases Using an Intraductal Ultrasound System
Authors: FURUKAWA Tsuyoshi , TSUKAMOTO Yoshihisa , NAITOH Yasuo , MITAKE Masahiro , ISHIHARA Akira , HIROOKA Yoshiki , KATOH Tadashi , OHSHIMA Youichi , KANAMORI Shinichi , KUROIWA Masanori
Published: August 2007

Abstract: We found that pancreatic diseases can be accurately visualized and diagnosed from the main pancreatic duct via the major papilla using an intraductal ultrasound (IDUS) catheter at a frequency of 30 MHz to create a 360 real‐time image. Herein we present the problems and potential future development of the IDUS system in visualizing pancreatic diseases. The clinical application of the IDUS was evaluated in 16 patients with pancreatic diseases (3 with pancreatic cancer, 6 with a mucin‐producing tumor and 7 with chronic pancreatitis). Insertion was successful in all 4 patients (100%) with a wide‐open orifice and in 9 out of 12 patients (75%) with a normal orifice.

We encountered four primary difficulties using this modality : 1) As the IDUS catheter is only 135 cm long, it could not be inserted all the way to the pancreatic tail in some patients. Therefore, we had to resort to an unmanageable gastroscope instead of the preferred duodenoscope for scanning. 2) The tip of the catheter is fragile and can be easily damaged during endoscopic examination. 3) Anatomical problems from n reversed Z configuration at the head of the main pancreatic duct prevented insertion all the way to the pancreatic tail in a few patients. 4) The scanning area around the main pancreatic duct was limited to a radius of about 10 mm due to the frequency setting of the IDUS catheter.

Further developments of the clinical applications of IDUS in the pancreas may eventually result in more accurate diagnoses, particularly in differential diagnoses between focal chronic pancreatitis and pancreatic carcinoma. The IDUS may also provide valuable details regarding invasion into the pancreatic Parenchyma in patients with mucin‐producing tumors. The IDUS may also be useful in determining the extent of excision necessary in patients with pancreatic diseases.
A Comparative Study of Acupuncture Anesthesia and Conventional Premedication for Panendoscopy
Authors: HO Ming‐Yin , CHEN Juei‐Chang , TWU Shiing‐Jer , WONG Jau‐Min , LIN Jaw‐Town , WANG Teh‐Hong
Published: August 2007

Abstract According to previous reports, there are few side effects and it is easy to perform in acupuncture administration for anesthesia or pain relief Acupuncture anesthesia as an alternative method to conventional premdication in panendoscopy was inziestigated in tzvo hundred outpatients who were divided into a conventional anesthesia group and an acupuncture anesthesia group by their own choice. Sentype two pairs of patients were selected from these two groups of patients using the casecontrol matching method. The conventional group way premedicated with an intramuscular injection of 0.6 mg trospium chloride (an anticholinergic) and a local spray of 0.3 cc 8% Xylocaine to the orophurynx. The acupunctrrro group was premedicated by needling the left Hogu and Neigun‐ Yaiguan points. All patients in both, groups tolerated the endoscopy procedure and the efficacy of these two methods were analyzed. There were no statistical differences (p>0.05) in terms of the patients’discomfort, cooperation, gastric peristalsis during the procedure, the mean pulse rute before examination, and the patients’willingness to undergo another panendoscopy, between the two groups. Only belching during examination was noted to be more seviere in the acupuncture group (p=0.022). Acceleration of pulse rate after examination was found to hc more significant in the conventional group (p<0.001). Our study showed that acupuncture anesthesia was a safe and effective premedication method for panendoscopy and can be an alternative to conventional premedication especially for patients with benign prostatic hypertrophy or glaucoma which precluded the usage of anticholinergics and patients with a history of heart disease or an allergy to lidocaine.
Significance of Helicobacter Pylori Infection in Human Peptic Ulcers
Authors: KOHLI Yoshihiro , KATO Takuji , ITO Shigeji , IWAKI Makoto , SUZUKI Kunio , UEDA Takashi , ABE Yoshimichi , NISHIKAWA Kunihisa
Published: August 2007

Abstract:Experimental studies have suggested that the continuous administration of 0.02% NH, solution, induced by Helicobacter pylori (H, Pylori), leads to a glandular atrophy of the gastric mucosa, and adversely affects healing of acetic acid ulcers in rats, because of the suppression of cell kinetics of the regenerative epithelial cells and connective tissues at ulcer margins. To visualize the distribution of H. pylori in human gastric mucosa, a phenol red dye spraying endoscopy was performed in 45 patients with gastric ulcers, and 43 patients with duodenal ulcers, who were medicated with a full dose of H2‐blocker until ulcer healing, and with half doses thereafter. In the H. pylori negative cases, 8 (88.9%) of 9 gastric ulcers healed within 3 months after medication, with no relapse discernible up to 6 months after healing of the preceding ulcer. The relapse rate was 25% up to 12 months after ulcer healing. In contrast, only 22 (66.1%) of 36 gastric ulcers healed within 3 months after medication in the H. pylori positive cases. The relapse rate was 12.5% up to 3 months, 30.4% UP to 6 months and 63.6% up to 12 months after ulcer healing. In addition, all 6 duodenal ulcers healed within 2 months after medication in the H. pylori negative cases, with no relapse discernible up to 12 months after healing of the preceding ulcer. In contrast, in the H. pylon positive cases, 20 (53.1%) of 37 duodenal ulcers healed within 2 months, and the relapse rate was 14.3%, 33.3%, and 66.7% up to 3, 6 and 12 months respectively after healing of the preceding ulcer. These data suggest that H. pylori is likely to interfer with ulcer healing, and promotes peptic ulcer relapse.
Glycogenic Acanthosis of the Esophagus—An Analysis of Clinically Relevant Factors (Glycogenic Acanthosis of the Esophagus)
Authors: IKEDA Masahiro , KOJIMA Yuichiro , NAKAMURA Toshiya , MOROZUMI Atsuro , FUJINO Masayuki A.
Published: August 2007

Abstract: Glycogenic acanthosis (GA) of the esophagus is often found in routine endoscopic examination of the upper GI tract but has not received much attention. However, there is controversy concerning the nature, clinical significance and prevalence of this condition. An endoscopic study of 654 patients studied consecutively revealed a higher incidence of the lesion (72.3%) than previously reported. Its incidence was found to be significantly higher in males (p<0.01). An increasing incidence tendency was observed with respect to age in patients in their twenties to sixcties, but in patients in their seventies the incidence was lower than in those in their sixties, Smoking increased the frequency of GA. Extensive lesions were significantly more prevalent in smokers in their 40's (p<0.01). The number of cigarettes per day had a positive correlation with the incidence. GA did not have a clear relationship with alcohol intake, dietay, habits, condiments or acid reflux. Therefore, age, sex and smoking appear to be risk factors of GA, as in esophageal carcinoma.
Effect of Endoscopic Injection Sclerotherapy on Acute Bleeding from Esophageal Varices in Cirrhotic Patients with Advanced Hepatocellular Carcinoma
Authors: KATO Tomohiro , KOSHINO Yosuke , NINOMIYA Mitsuo , KATO Masahiko , SAKAI Tsutomu , NAGAKI Masahito , YAMADA Tetsuya , YOSHIDA Takashi , MORIWAKI Hisataka , MUTO Yasutoshi
Published: August 2007

Abstract: The effect of endoscopic injection sclerotherapy (EIS) on acute bleeding from esophageal varices in sixteen cirrhotic patients with advanced hepatocellular carcinoma (HCC) was analysed using the Cox proportional hazard model. Only EIS was found to have independently and significantly affected the survival rate (P = 0.0385), while clinical variables such as the extent of HCC, the presence of ascites and portal thrombosis, laboratory data and therapeutic modalities other than EIS showed no significant effect. EIS should be considered one of the treatments of choice when a cirrhotic patient with advanced HCC has acute bleeding from his/her esophageal varices.
Experience with Laparoscopic Appendectomy —The Technique and Our Views of its Indications—
Authors: KANO Nobuyasu , YAMAKAWA Tatsuo , ISHIKAWA Yasuro , SAKAI Shigeru , HONDA Hiraku , KASUGAI Hisashi , OHTAKI Shuji
Published: August 2007

Abstract: Since June, 1991 a laparoscopic appendectomy (LA) was performed on eleven patients with suspected appendicitis which could not be confirmed by the conventional diagnostic methods. The patients included 7 males and 4 females, with a mean age of 27, 9, ranging from 16 to 46 years. No postoperative complications were encountered. The laparoscopic diagnoses included gangrenous appendicitis in 2, suppurative appendicitis in 2, catarrhal appendicitis in 4, salpingitis in 2 and an appendiceal mass in one patient (Case 7). Histopathological diagnoses were phlegmonous appendicitis in 3, mucinous cystadenoma in one and catarrhal appendicitis in 7 patients. Two cases of salpingitis and a case with ovarian bleeding were treated conservatively after incidental laparoscopic removal of the appendix. Case 7 was histopathologically diagnosed as having mucinous cystadenoma. The patients’postoperative hospital stay was from 5 to 8 days, with an average of 6.9 days. All patients had been given the permission to be discharged by the third POD but they stayed longer because of benefits given by the health insurance system very specific to Japan.

LA in our clinic has so far been limited to selected patients in whom the diagnosis of appendicitis could not been confirmed and laparoscopic examination was indicated, mainly due to manpower problems involving surgeons, anesthetists and operating room nurses. However, LA provides not only benefits for patients but also several merits for surgeons including better exposure of the operating field in most cases when compared with an open appendectomy. We feel, therefore, that the indications for LA might be extended more widely, probably to most cases of appendicitis.
Reactive Lymphoreticular Hyperplasia of the Stomach Showing a Submucosal Tumor
Authors: TSUCHIGAME Tadatoshi , OGATA Yoshiya , ISHIMARU Yasuji , ARAKAWA Akihiko , MIYAYAMA Haruhiko , TAKAHASHI Mutsumasa
Published: August 2007

Abstract: Reactive lymphoreticular hyperplasia of the stomach has been reported rarely. Furthemore, submucosal tumors of the type found in this condition are rare and only 7 such cases have been reported. A 57‐year‐old male visited our hospital with his chief complaint being tarry stool. An UGI and endoscopy showed a submucosal tumor with a central depression in the posterior wall of the gastric body. Microscopically and immunohistochemically, lymphoid hyperplasia of the stomach was recognized, but it was very difficult to differentiate the condition from malignant lymphoma. The patient is in good health with no medication 2 years after surgery.
A Case of a Patient with a Rectal Ulcer Who Had an Unusual Defecation Habit
Authors: HOSHIKA Kazunori , MIZUNO Mitsuru , KIHARA Tsuyoshi
Published: August 2007

Abstract: This case report describes a patient with a rectal ulcer who had an unusual defecation habit. Complete healing was recognized colonoscopically after the patient was instructed to break this habit.

A polyp of the ascending colon was detected by a barium enema in a 37‐year‐old man complaining of anal bleeding. He was admitted to our division to undergo a polypectomy. At the time of the polypectomy, a round ulcer, measuring 1 cm in diameter, was detected on the right wall of the rectum 3 cm from the anal verge. A diagnosis of mucosal prolapse syndrome of the rectum could not be made because the patient did not exhibit the characteristic habit of excessive “straining” mentioned by patients with this syndrome, and no characteristic finding of fibromuscular obliteration was found on histological examination of biopsied specimens taken endoscopically from the lesion. Repeated history taking, however, revealed that the patient had the unusual habit of inserting his finger into his rectum after defecation. He broke this habit following instruction to do so. As a result, on colonoscopic examination 15 month later, the ulcer was found to have become a scar:
Portal Hypertensive Colopathy —Endoscopic, Hernodynamic and Morphometric Study—
Authors: ELEFTHERIADIS E. , KOTZAMPASSI K. , KARKAVELAS G. , TZIOUFA V. , PAPADIMITRIOU K. , ALETRAS H.
Published: August 2007

Abstract: Although it is widely accepted that congestive gastropathy is a well recognized manifestation of portal hypertension, the influence of the latter on the lower gastrointestinal tract has not been adequately studied. Therefore, we evaluated prospectively, by total colonoscopy, 30 consecutive cirrhotic patients after their varices were obliterated by endoscopic sclerotherapy. All of them had not had any bleeding episode for some time and all had varying degrees of congestive gastropathy identified by an UGI endoscopy at the time of the study. Additionally, colonic mucosal perfusion was assessed by means of laser‐Doppler flowmetry at 4 defined points on the transverse colon and two mucosal biopsy specimens were obtained from the same area for histology and morphometric analysis of mucosal capillaries. Seven non cirrhotic patients who had undergone colonoscopy for various reasons but had no findings, served as controls. Twenty‐eight patients [rate 93%] were found to have multiple vascular ectasis of differing degrees of severity. These vascular‐looking lesions were mainly located in the right colon and rectosigmoid. Less frequent lesions were non specific mucosal edema, sparse mucosal veins and rectal varices. The statistical evaluation of mucosal perfusion revealed a highly significant decrease of blood flow in the cirrhotic patients [p = 0.00001]. A morphometric analysis revealed a significantly higher mean number of capillaries [p = 0.0012] and a higher mean cross‐sectional vascular area per field in the cirrhotic patients than in the control subjects [p=0.0055]. We concluded that portal hypertension affects the lower gastrointestinal tract giving an endoscopic, microcirculatory and histopathologic pattern quite similar to that of the gastric mucosa.
Gastric Pit Density and Depth of Foveolae of the Gastric Body Mucosa Assessed by Dye Endoscopy
Authors: TAKECHI Keishi , OHASHI Miyoji , KODA Koji , SHIMOJO Hirofumi , MORIWAKI Hisataka , MUTO Yasutoshi , YAMADA Tetsuya
Published: August 2007

Abstract: We examined the histological characteristics of the foveolar zone of the gastric body mucosa, using dye endoscopy and endoscopic biopsy. In 63 patients, the gastric area type of the gastric body was placed in one of the following categories; fundic gland type 0 (F0), where small and fine areas are arranged closely to one another; F1, where the areas are largest in size, round and high; F2, where the areas are intemediate in size but not so high; F3, where small and flat areas are loosely arranged; pseudo‐pyloric gland type 1 (Pb1), where the areas are regular in size and arrangement; and the completely atrophic gland type (Pb2) with areas irregular in size and arrangement. The histological characteristics of the foveolar zone were emmined on printed microphotographs of the biopsy specimens of the gastric body. The density of the gastric pit was defined as the number of pits in a 1 mm width of the mucosal surface and depth of the foveolae was measured as the distance between the top and bottom (or the isthmus) of the foveolae as seen on vertical sections. The gastric pit density and depth of the foveolae were dense and shallow, respectively, in FO and sparse and deep, in Pbl and Pb2 respectively. The degree of these factors showed independency in area types F0, F1 and Pb2 and there were correlations of P<0.033 and P<0.001 between F2 and Pb1, F3 and Pb1, respectively.

Our observations may be useful to define atrophic gastritis in the gastric body mucosa, in terms of the gastric area types.
A Nodule‐aggregating Lesion of the Rectum Associated with Gastric Adenoma —A Case Report—
Authors: FUJIMURA Yoshinori , MIZUNO Mitsuru , TAKEDA Masaharu , SATO Ichiki , YAMAUCHI Mie , HOSOBE Masayo , OHTANI Kimihiko , KAMOI Ryuichi , HONDA Keisuke , KOZUKA Kazushi , HOSHIKA Kazunori , UCHIDA Junichi , KIHARA Tsuyoshi , KIMOTO Masatoshi , SANO Kaiso
Published: August 2007

Abstract: A 81‐year‐old female was admitted to our hospital to undergo endoscopical treatment for a gastric adenoma and received YAG‐laser therapy. The gastric adenoma was completely removed by laser therapy. However, following treatment, she complained of having mucous feces. Although she had undergone a colonoscopy twice during the previous six month, we examined her large intestine using colonoscopy and barium enema. A colonoscopy revealed a large‐flat elevated lesion of the same color as the surrounding mucosa and no transmucosal vascularity of the rectum. A well demarcated flat lesion 4 cm in size with conglomerated nodules on its surface was confirmed using the dye‐spraying contrast method with 0.2% indigo carmine solution. A lower anterior resection of the rectal lesion was performed and the patient is now living and well 16 month following surgery. We believe that, if we encounter gastric adenomas, more careful observation and use of the dye‐spraying contrast method are necessary for the detection of adenomas or cancers in the colon.
Clinical Study of Primary Gastric Malignant Lymphoma
Authors: IWASAKI Ariyoshi , HIRAI Takashi , KUNIYOSHI Nobutoshi , MATSUDA Masakazu , KAWAMURA Fumio , TAKEUCHI Katsuhiro , AIZAWA Toshiharu , ARAKAWA Yasuyuki
Published: August 2007

Abstract: Twenty‐eight cases of primary gastric malignant lymphoma treated in this unit over the last 16 years were clinically evaluated. More male patients were affected than female, with a sex ratio of 1.6: 1. Most of the patients were in their 50′s. rising the Naqvi classification there were 10 patients in stage I and 18 patients in stage II, respectively. About 40% of the patients complained of epigastralgia, 30% of the patients were asymptomatic. The macroscopic type according to Sano's classification system was the ulcerative or protruded type in most of the patients. While most patients with superficial type lesions were in stage I, all of the patients with excavated or giant fold type lesions were in stage II. The lesions were located in area M in the largest number of patients, followed by area C, with these two areas accounting for 80% of the total. The histological type determined according to LSG classification was the diffuse type in about 80% of patients, in whom the large cell type accounted for about 70% of the cases. While the stage was I and II in the same number of patients with follicular type lesions, it was II in 2/3 of patients with diffuse type lesions. The 5‐year survival rate was 100% in stage I patients compared to only 35% in stage II patients. The mortality rate of stage II patients increased significantly after 7 years, and the prognosis was significantly better in the stage I patients than in the stage II patients (p < 0. 05).
A Case of Gallbladder Perforation in Which the Developmental Pattern was Demonstrated by Laparoscopy
Authors: MATSURA Tatsuya , WATANABE Makoto , FUKUMOTO Shiro , NAGAOKA Saburo , GOBARU Yoshiyuki
Published: August 2007

Abstract: A 58‐year‐old man with diabetes mellitus was referred to our clinic because of epigastric colicky pain of sudden onset with fever. An ultrasonography (US) and endoscopic ultrasonography (EUS) demonstrated marked thickening of the gallbladder wall and a pericholecystic echo‐free space. A laparoscopy showed tight adhesion between the greater omenturn and the parietal peritoneum, and pooling of bile on the liver surface, the greater omenturn, and in the perisplenic area. The gallbladder itself could not be seen. A surgical laparotomy revealed perforation of the gallbladder with a pericholecystic abscess. No laparoscopic observation of free bile has been reported in cases of gallbladder perforation.

In the present case, US, EUS and laparoscopy were useful for early diagnosis of gallbladder perforation. In addition, laparoscopy played an important role in determining the type of gallbladder perforation.
Primary Gastric Carcinoma with the Bull's eye Sign in a Case of Breast Cancer — Immunohistochemical Differentiation from Metastatic Cancer—
Authors: KISHI Hisayo , IKEDA Masahiro , MURAI Masami , MASUZAWA Manabu , KURATA Akihiko , ARIMA Ryouichi
Published: August 2007

Abstract: A 53‐year‐old female, who had undergone a mastectomy for breast cancer 4 years previously, was found to have gastric cancer. Judging from the Bull's eye sign of the upper GI series and endoscopy, it appeared to be a metastatic gastric cancer. Histopathological findings of biopsy specimens revealed adenocarcinoma and metastases from the breast cancer were not negligible. However, the surgically resected specimen had different immunohistochemical staining for CEA, Alcian blue, 115D8, and C‐erb B2 from the breast cancer. The tumor was finally diagnosed as a primary gastric carcinoma. This case shows that immunohistochemical studies are useful for differentiation between metastatic and primary gastric cancer
Endoscopic Treatment of Hepatolithiasis in a Patient Undergoing Pancreatoduodenectomy
Authors: OBATA Shinichiro , MIZUTANI Junichi , ARAKI Keisuke , FUJIOKA Yasunari , MATSUMOTO Yuzaburo , KIMURA Keishi , MAEDA Kazuhiro
Published: August 2007

Abstract: Our subject was a 70‐year‐old woman who had undergone a pancreatoduodenectomy for cancer of the head of the pancreas 5 years prior to this study. She had prominent signs of jaundice and fever, which had started several days before admission, and which responded to intravenous antibiotic therapy. A peroral biliary fiberscope (XQ‐20, Olympus) was introduced into the afferent loop to the anastomosis of the bile tract, and an endoscopic cholangiograpy revealed hepatolithiasis. Endoscopic balloon dilatation was performed and the stones were removed using the balloon. Endoscopic therapy for hepatolithiasis was successfully performed after a pancreatoduodenectomy.
Fine‐needle Aspiration Biopsy of a Submucosal Tumor of the Stomach Using Endoscopic Ultrasonography
Authors: HARADA Noboru , KOUZU Teruo , ISONO Kaichi
Published: August 2007

Abstract: We report here on the use of the new fine‐needle aspiration biopsy under endoscopic ultrasonography (EUS), developed in the course of our research into an EUS‐guided puncture. From a specimen obtained using this method, a submucosal tumor of the stomach was identified as a leiomyosarcoma by histologic examination. As our equipment for aspiration biopsy was confirmed to be useful, we hope to establish a new system of EUS diagnosis by collecting more clinical data and improving the technique and instruments further.
Gastric Ulcer Relapse
Authors: OGOSHI Kazuei
Published: August 2007

Abstract: In this review we found that the rate of gastric ulcer relapse reached near! 70% over a 13 year period and was nearly 10% after one year from when they reache the white scar stage. A H2‐RA or proton pump inhibiter had a high relapse rate the reason being the fragile re‐epithelization of the scar3)4). Factors involved in gastric ulcer relapse are considered to be the fragile re‐epithelization of the ulcer, disturbance c blood flow due to fibrosis underneath the ulcer scar, and etiological factors such a smoking and so on. Endoscopic findings of the ulcer scar can statistically suggest th gastric ulcer relapse rate. The main cause of peptic ulcers, especially duodenal ulce relapse, is strongly related to Helicobacter pylori infection. The causes of gastric ulcer relapse are very complicated and variegated. H. pylori infection contributes to les gastric ulcer relapse than duodenal ulcer relapse.

To prevent gastric ulcer relapse, therefore, one should consider the eradication c H. pylori, the endoscopic features of the ulcer scar and etiological factors.
An Unusual Form of Aphthoid Proctocolitis
Authors: CHIBA Mitsuro , SUZUKI Toshio , HORIE Yasuo , MASAMUNE Osamu
Published: August 2007

Abstract: An unusual form of aphthoid colitis is presented. A 21 ‐year‐old man complained of hematochezia for about 2 years. Examinations revealed crowded polypoid lesions in the lower rectum: the closer to the anus the site was, the bigger the size of the polypoid lesions. Polypoid lesions were also observed in the terminal ileum and on the ileocecal valve. Biopsy specimens revealed that these polypoid lesions were lymph follicles. Lymphoid hyperplasia was observed in the upper rectum and proximal colon but not in the transverse colon. The patient was given a salicylazosulfapyridine suppository followed by a rapid ceasing of hematochezia on the following day and disappearance of most lymph noduli in the rectum by the second week. About two years later hematochezia recurred. The findings of the lower rectum and the response to the suppository were the same as in the first episode. Known diseases associated with aphthoid colitis were ruled out.

The present case is unusual in several respects compared to typical apthoid colitis: the clinical course is not acute self‐limited but chronic protracted; the lesions are distributed not evenly in the large bowel or its segment(s) but in the lower rectum, in addition, the lesions become more pronounced toward the anus; skipped lymph noduli are observed in the ileocecal valve and the terminal ileum. The other characteristics of this case include a marked response to salicylazosulfapyridine, recurrence, no precedence of flu‐like syndromes, no symptoms except for hematochezia, and normal laboratory data.
Significance of Follow‐up Total Colonoscopy after Resection for Colorectal Cancer
Authors: NAKAGOE Tohru , FUKUDA Yutaka , ISHIKAWA Hiroshi , NAKAZAKI Takayuki , SAWAI Terumitsu , IKENAGA Hidetsune , KUSANO Hiroyuki , AYABE Hiroyoshi , TOMITA Masao
Published: August 2007

Abstract: This is a retrospective study of the results of total colonofiberscopy performed on 180 postoperative patients with colorectal cancer. We divided the patients into two groups: “Group A” that had no concurrent polyp and/or synchronous multiple carcinoma besides the main lesion at the time of surgery and “Group B” that had a concurrent polyp and/or synchronous multiple carcinoma besides the main lesion at the time of surgery, and compared them. Colorectal polyps were found in 77 patients (42.8%), recurrent cancers in 9 patients (5.0%). and metachronous cancers in 6 patients (3.3%). respectively. In Group A, no abnormality was found in 65.7% (69/ 105), which was significantly higher compared with 33.3% (25/75) of Group B (p< 0.0001). The detection ratio of polyps in Group B was significantly higher than that of Group A (61.3% versus 29.5%. p<0.0001). The number of detected polyps in Group B was also large. As for the time required to detect the polyps, no difference was found between the two groups. There was no certain tendency for the location in which the polyp developed, and polyps were found in any portion of the residual colon and rectum. The development of metachronous cancer was found in 3 patients (2.8%) in Group A and 3 patients (4.0%) in Group B, which indicated a higher ratio for Group B, but statistically no significant difference was confirmed. In the metachronous cancer group, more than half were in the early stage, and even with the advanced cancers, the diameter of the tumor was small. In all of them, a curative resection were performed, and they were found to be Dukes’A and B in which no spreading was found to the lymphnodes.

From the above, we can conclude that a follow‐up using total colonoscopy is useful, and that a postoperative follow‐up total colonofiberscopy should be performed on postoperative patients with colorectal cancer within 6 months after surgery regardless of the presence of a concurrent polyp and/or synchronous multiple carcinoma besides the main lesion at the time of surgery. Also a follow‐up schedule must be conducted once a year after the first follow‐up using the endoscopic method. (Dig Endosc 1994; 6: 7–16)
Morphological Study of Pancreas Divisum in Niigata Using ERCP
Authors: NARISAWA Rintarou , ASAKURA Hitoshi , NIWA Masayuki , OGOSHI Kazuei
Published: August 2007

Abstract: The morphological characteristics and incidence of pancreas divisum (PD) in Niigata were investigated by studying 16,646 cases diagnosed by ERCP. These cases had been patients in 16 hospitals located in Niigata prefecture.

PD was found in 114 (63 cases confirmed, 51 cases unconfirmed) of these 16,646 cases (0.68%). An unconfirmed case was defined as being a patient in whom only the short ventral pancreatic duct was visible through the main papilla, and the confirmed cases were classified into the 3 types according to the ductal systems of the dorsal and ventral pancreas. The classification of these 3 types was as follows.

Type 1: Nonfusion between the ventral (VPD) and dorsal pancreatic ducts (DPD), which was visualized through the main papilla (MP) and the accessory papilla (AP), separately.

Type 2: Only DPD was visualized through the AP. In spite of the cannulation of the MP, the VPD was not demonstrated.

Type 3: Miscellaneous cases.

The frequency of Type 1, Type 2, and Type 3 was 58.7% (37 cases), 28.6% (18 cases), and 12.7% (8 cases), respectively. Type 3 consisted of two subtypes. One (7 cases) was regarded as being when the patient had a very fine communicating branch between VPD and DPD, whether an obvious communicating branch could be detected or not by ERCP. The other subtype (only one case) showed very strange findings in which through the AP a short pancreatic duct distributed to the head of the pancreas and to the uncinate process was visualized and in which through the MP a long pancreatic duct to the tail was demonstrated, separately.
Analysis of Cell Proliferation in Endoscopically Biopsied Specimens of Stomal Mucosa of the Gastric Remnant
Authors: ONODA Naoyoshi , NAKANISHI Itsuo , CHUNG Yong‐Suk , MAEDA Kiyoshi , NISHIMURA Shigehiko , SATO Sei , KUBO Toshiaki , KATO Yasuyuki , YOSHIKAWA Kazuhiko , MATSUI‐YUASA Isao , OTANI Shuzo , SOWA Michio
Published: August 2007

Abstract: Carcinoma of the gastric remnant is thought to occur more commonly in the stomal than in the other areas, particularly following Billroth II surgery (BII). An attempt was made to determine the status of cell kinetics in the gastric remnant using endoscopically biopsied specimens, with assay of ornithine decarboxylase (ODC) activity and flow cytometric analysis of the cell cycle parameters. Fifty‐two partially gastrectomized patients were studied. Significantly higher ODC activity was recognized in the stomal mucosa than in the greater curvature; this difference was especially pronounced for the group of BII patients. The S‐phase cell percentage was also significantly higher in the stomal area than in the greater curvature; this was particularly so in the patients who had undergone BII 5 or more years prior to this study. Our results suggest that activation of cell proliferation is present in the stomal area of the gastric remnant following BII surgery. This activation increased with time following surgery. Activation of cell proliferation occurred in association with histological changes in the stomal glands, and may play a role in carcinogenesis within the gastric remnant.