bluuebunny/crossref_metadata_2025 huggingface dataset:
A Survey of Regenerating Capacity in Patchy Liver and in Nodular Liver—with Special Reference to DNA Synthesis Estimated by BrdU Labeling Index—
Authors: TARAO Kazuo , SHIMIZU Akio , KUNI Yukifusa , ITO Yoshihiko , TAMAI Setsuo , IIMORI Kazuto , KUBO Kiyoshi , TAKAGI Seiichi , OIKAWA Yuko , KIYOHASHI Atsushi , UNAYAMA Shiro , HOSHINO Hiroshi , MIZUNO Tadaoki , SHINDO Kunihiko
Published: August 2007

Abstract: Laparoscopically, patchy liver and nodular liver were considered as features of regeneration of liver cells. In this study, the regenerating capacity of liver cells obtained by a liver biopsy from laparoscopically identified patchy liver and nodular liver was estimated by Bromodeoxvuridine (BrdU)‐anti‐BrdU method. BrdU labeling indices (L. I.), of liver cells in biopsy specimens from 6 normal livers, 12 patchy livers, and from 15 nodular livers were examined using an in‐vitro labeling technique. Liver biopsy specimens obtained by a Tru‐cut needle were immediately incubated for 45 min. in 0.1% BrdU solution in RPMI 1640 at 37°C under a pressure of 3 atmospheres in a mixture of 95% O2 and 5% CO2. Immunohistochemical detection of BrdU was performed by the Avidin‐Biotin‐Peroxidase Complex (ABC) method. The mean BrdU L. I. (±SE) of normal liver, patchy liver, and of nodular liver was 0.25±0.09%, 1.4±0.2%, and 1.7±0.4% respectively. Among the nodular liver, flat shaped ones showed a low level (0.5±0.1%), in contrast to the high level (2.4±0.7%) in the semispherical nodular liver. The BrdU L. I. of both the patchy liver and the nodular liver was significantly higher than that in the normal liver (p<0.001, p<0.01 respectively).

Interesting enough, there was a significant difference (p<0.05) between flat shaped nodular livers and semispherical ones. The semispherical nodular liver demonstrated the highest capacity of DNA synthesis in all the groups examined.
Endoscopic Variceal Injection Sclerotherapy for Liver Cirrhosis with Hepatocellular Carcinoma—A Prognostic Evaluation—
Authors: ISHIDA Motoo , MASUYAMA Hironori , SUZUKI Takuji , EBIHARA Tetsuro , UENO Akihiko , KATOH Yoshihisa , HARADA Takashi
Published: August 2007

The prognostic evaluation of endoscopic injection sclerotherapy (EIS) for patients with severe esophageal varices in unresectable hepatocellular carcinoma complicated with advanced liver cirrhosis (HCC c̄ LC) was studied. (1) Cumulative survival rate and cause of death were compared in cases of variceal bleeding managed by EIS (18 cases) to cases with variceal bleeding without EIS (12 cases). (2) Cumulative percentage of patients free of bleeding, cumulative survival rate and cause of death were compared in cases managed by prophylactic EIS (14 cases) to cases without prophylactic EIS (30 cases). In the two bleeding groups with and without EIS, and in the non‐bleeding groups with and without prophylactic EIS, patients of each group were comparable in respect to sex ratio, age, and Child's classification. In the bleeding groups, cumulative survival rate at 30 days after EIS was significantly higher in cases with EIS than cases without EIS (P < 0.01). The rate of death after initial bleeding was 16. 7% in cases with EIS and 66.7% in cases without EIS: statistical significance was demonstrated in these two groups (P < 0.01). In the non‐bleeding groups, cumulative percentage of patients free of bleeding and cumulative survival rate were significantly higher in cases with EIS than those without EIS (P < 0.01 and P < 0.05, respectively). Furthermore, no bleeding fatalities from varices were seen in cases with prophylactic EIS. We suggest that EIS improves survival rate and prophylactic EIS prevents variceal bleeding leading to death in cases of unresectable HCC c̄ LC.
Six Cases of Small Leiomyoma of the Rectum
Authors: ITO Ryo , KODAMA Koh , CHIBA Mitsuro , MASAMUNE Osamu , UESAKA Yoshiyuki , IGARASHI Kiyoshi
Published: August 2007

Six cases of rectal leiomyoma, measuring less than 10 mm in diameter, are reported. The color of the overlying mucosa was similar to that of the surrounding mucosa. No central depression or ulceration was observed endoscopically in any of the six cases. In five cases, the tumors were sessile or semipedunculated and mobile, and were thus snare polypectomised. In the remaining case, the tumor was flat‐elevated and immobile, and removed surgically by transanal wedge‐resection. All six cases were benign leiomyoinas without malignant changes such as cellular atypia or mitosis.
A Case of Pancreatic Somatostatinoma Found Endoscopically with Metastasis to the Duodenal Periampulla
Authors: MATSUNAGA Takashi , IWAOKA Hideaki , TSUBURA Yukimasa , SATOH Shin‐ichi , HACHISU Tadashi
Published: August 2007

A case of pancreatic somatostatinoma with duodenal metastasis is reported. The presenting feature was severe right hypochondrial pain with cholecystolithiasis and mild diabetes mellitus. Duodenogastroscopy revealed a small polypoid lesion at the duodenal peri‐ampulla of the major papilla. A biopsy specimen demonstrated a neuroendocrine tumor. Selective gastroduodenal arteriography disclosed a spherical hypervascular lesion in the pancreaticoduodenal arcade. Pancreatoduodenectomy was performed and pathological examination demonstrated pancreatic islet cell tumor and metastasis to the duodenal peri‐ampulla. Immunocytochemical examinations demonstrated intra‐cytoplasmic somatostatin and calcitonin in both tumors. The patient's basal plasma somatostatin level was 4 times higher than the normal range, however her plasma calcitonin level was within the normal range. After the operation, plasma somatostatin levels were within the normal range and her clinical course was good. In this case endoscopy was very useful in detecting the early stage duodenal metastasis of pancreatic somatostatinoma.
Early Gastric Lymphoma Coexisting with Reactive Lymphoreticular Hyperplasia (RLH) ‐A Case Report‐
Authors: TAKECHI Keishi , FURUHASHI Kazutoshi , USUI Toshio , MAEKAWA Hiroyuki , KIZAWA Akira , TANABE Hiroshi , IKEDA Youko , SHIMOKAWA Kuniyasu
Published: August 2007

A 34‐year‐old female visited our hospital because of epigastralgia. We performed an upper gastrointestinal x‐ray examination, and both conventional endoscopy and dye‐spraying endoscopy (indigo‐carmine contrast method). We diagnosed early gastric lymphoma which simulated Borrmann 3 type gastric cancer with IIb type early gastric cancer on the middle body and reactive lymphoreticular hyperplasia (RLH) of cobble stone‐like granular pattern by endoscopic appearance on the lower body. Although dye‐spraying endoscopy showed the details of the mucosa, it was very difficult to diagnose the lesions correctly by gross appearance alone. Because gastric lymphoma arises from the mucosal or submucosal layer and spreads in the mucosa diffusely, ultrasonic visualization by echo‐endoscopy might be useful in the diagnostic procedure. We report a case of early gastric lymphoma coexisting with RLH; both lesions showed uncommon endoscopic features.
Evaluation of Cancer‐Associated Carbohydrate Antigen (NCC‐ST‐439) Measurement in Pure Pancreatic Juice Collected by Endoscopic Aspiration
Authors: TAKEMORI Yasuhiro , SAWABU Norio , OHTA Hideki , SATOMURA Yoshitake , WATANABE Hiroyuki , YAMAKAWA Osamu , KAWAKAMI Hiroyasu , KIDANI Hisashi , TAKAHASHI Hirokazu , WAKABAYASHI Tokio
Published: August 2007

Abstract: This study was undertaken to elucidate the diagnostic significance of the measurement of a cancer‐associated carbohydrate antigen, NCC‐ST‐439 (ST‐439), in pure pancreatic juice collected by endoscopic cannulation, chiefly from patients with pancreatic diseases.

The mean concentrations of ST‐439 in each of the 4 fractions collected were significantly higher in patients with pancreatic cancer than in controls, but patients with chronic pancreatitis or cholecystolithiasis did not have higher levels. Similarly, a significant increase in the mean output of ST‐439 was observed only in patients with pancreatic cancer. When the cut‐of value was set at the mean concentration+ 2 X the standard deviations of the controls, significant concentrations of ST‐439 were found, in the first fraction (washout phase) in 56% of the pancreatic cancer cases, 31% of the chronic pancreatitis cases and 0% of the cholecystolithiasis cases; in the third fraction (secretory phase) results were 50%, 7% and 0%, respectively. Furthermore, when the cut‐of value was set at the highest concentration found among patients with chronic pancreatitis (to enhance the specificity for pancreatic cancer), the prevalence of significant ST‐339 levels among Pancreatic cancer patients was 50% in the first fraction and 44% in the third fraction.

These results indicate that the measurement of ST‐439 in pancreatic juice is useful as a specific marker for pancreatic cancer, although its sensitivity is less than was initially hoped,
Long‐term Efficacy of Percutaneous Transhepatic Choledochoscopic Y AG Laser Therapy for Malignant Biliary Obstruction
Authors: KUBOTA Yoshitsugu , SEKI Toshihito , KUNIEDA Kouji , NAKAHASHI Yoshitsugu , YAMAGUCHI Takashi , TATEIWA Jiro , MIZUNO Takako , SHIOZAKI Yasuko , SAMESHIMA Yoshiko
Published: August 2007

Abstract:The long‐term effect of percutaneous transhepatic choledochoscopic YAG laser therapy for malignant biliary tract obstruction was evaluated. Ten consecutive patients underwent laser therapy to alleviate the obstruction. All patients were followed up for 8 months or more (range: 8–33 month, average: 15). Cholangiography was performed when re‐elevation of the alkaline phosphatase level was observed during the regular checkup. Choledochoscopy was performed when any sign of recurrence was observed on cholangiography. Sufficient re‐opening of the bile duct was obtained in every case, without complications. Indwelling of the internal drainage tube was perfomed in 5 patients, the remaining 5 having “tube free” internal drainage. Five patients showed no rise in alkaline phosphatase levels during their 8‐ to‐13 month follow‐up period. Re‐elevation of the alkaline phosphatase level was observed 9 times in 5 patients, mostly from internal drainage tube occlusion. The cholangiogram performed on each occasion revealed a patent bile duct without any sign of recurrence (6/9), slight narrowing (2/9) or tumorous obstruction (1/9). Cholangitis was complicated 6 times in 3 patients, mostly from internal drainage tube occlusion. Choledochoscopy was performed in the 3 patients suspected of tumor recurrence on cholangiogram. In 2 of them, no signs of recurrence were noted endoscopically or histologically, but the tumor was revealed to have recurred only at the part previously treated, in the remaining. Thus, choledochoscopic I'AG laser therapy can locally control the malignant biliary tract obstruction for a long period of time. “tube free” internal drainage may serve as a means to prevent cholangitis, which is one of the complications frequently occurring with conventional stent therapy.
Treatment of Malignant Biliary Obstruction with a High‐Dose‐Rate Remote Afterloading Device Using a 10 Fr Nasobiliary Tube
Authors: SIEGEL Jerome H. , URBAN Michael S. , VIKRAM B. , TUVIA J. , GELB Alvin M. , PAVLOU W.
Published: August 2007

Abstract: The role of intracavitary radiation therapy for palliative treatment of malignant biliary obstruction has been previously described, incorporating both preloading and afterloading techniques. We present an approach which combines nasobiliary intubation with the use of a remote afterloader unit, the Microselectron HDR (Nucletron Corp, The Netherlands), which is capable of delivering high‐dose radiation treatments in a matter of minutes. This method offers decreased treatment time, thus reducing the hospitalization period, and minimizes problems associated with conventional intracavitary radiation therapy such as potential radiation exposure to hospital personnel, drifting of the iridium source, and risk of nosocomiai infection. The combined endoscopic‐radiation technique has been used in 5 seriously ill Patients without complications. To date all patients are alive, (follow‐up range 2–6 months). This safer, more efficient method of brachytherapy has not only improved the delivery of intracavitary therapy, but may offer longer term benefits. Further follow‐up is needed.
ENDOSCOPIC AND CLINICAL STUDY ON HEMORRHAGIC GASTRITIS IN PATIENTS WITH LIVER CIRRHOSIS
Authors: IWAO Tadashi , TOYONAGA Atsushi , TANAKA Johji , YAMASHITA Fumihiko , IRIE Akira , HARADA Hiroshi , MITSUYAMA Keiichi , SUMINO Michihiro , TAKAGI Kohsuke , SASAKI Ei , TANIKAWA Kyuichi , SHIMOTSUURA Yasuhiro , IDE Kohichi
Published: August 2007

Abstract: During a 5‐year period from 1984 through 1988, an emergency endoscopy was performed for an upper digestive tract hemorrhage in 283 consecutive patients with 290 lesions. Of these, 54 patients were diagnosed as having hemorrhagic gastritis on the basis of the endoscopic findings and were employed as the subjects of the present study. They were classified on the basis of the presence/absence of liver cirrhosis into two groups, i. e. the cirrhosis group (C‐group) and non‐cirrhosis group (NC‐group), and the two groups were comparatively studied.

The incidence of hemorrhagic gastritis in hemorrhagic sources of the upper digestive tract was higher in the C‐group than in the NC‐group, and it was seen in the gastric body most frequently. In addition, no clear causes for hemorrhagic gastritis could be identified in many of the cases in the C‐group. These clinical findings were thought to indicate that, in patients with liver cirrhosis, the gastric mucosa itself, especially of the gastric body, is in an impending state of mucosal hemorrhage. A hemorrhage was the major cause of death in the C‐group.

In patients with liver cirrhosis, the incidence of hemorrhagic gastritis had no correlation with the grade of esophageal varices, but was high in patients with severe liver cirrhosis. Thus, patients with severe liver cirrhosis were considered to be a high risk group of hemorrhagic gastritis.
Quantitative Evaluation of Mucosal Regeneration in Gastric Ulcers by Electronic Endoscopy —Comparison between Tractable and Intractable Ulcers—
Authors: OSAKA Naofumi
Published: August 2007

Abstract: The electronic endoscope named TGS‐50B (TOSHIBA) provides a fine resolvable image (Fig. 6) and flat white balance covering a wide range (Fig. 7). Using this electronic endoscope, the regenerative mucosal patterns in 15 cases with intractable and 30 cases with tractable gastric ulcers (Table 1) were observed at 2‐week intervals until the healed stage or until 12 weeks after the start of H2‐blocker administration.

To clarify the difference between intractable and tractable gastric ulcers, the electronic endoscopic images were fed into an image analyzer; SPICCA (AVIONICS). The regenerative mucosal pattern was converted into 20 binary digited particles by the image analyzer (Fig. 4, Color) and quantified by the oval specification (OSF) value (Fig. 5).

The OSF value of the tractable ulcers significantly increased in the healing stage I (H1) and healing stage 2 (H2), in comparison with those of intractable ulcers (Fig. 8). Moreover, the OSF value of the tractable ulcer significantly increased at 4 weeks after the start of an H2‐blocker, comparing with that at 2 weeks. Consequently, the OSF values of the tractable ulcers were significantly high in comparison with those of the intractable ulcers, at 4, 6 and 8 weeks after the start of administration of H2‐blockers (Fig. 9).

By histological study of the biopsy specimen, an increase in the OSF value suggested an extension of the regenerative mucosa by a well progressed annular contraction of the gastric wall.

In conclusion, it is thought that intractability of gastric ulcers may be objectively predictable in its early healing stages by determination of the OSF value using the electronic endoscope and the image analyzer.
Endoscopic Sclerotherapy for Esophageal Varices after Renal Transplantation: Report of One Autopsy Case
Authors: SHIBUYA Susumu , TAKASE Yasuhiro , AOYAGI Hiroyuki , CHIKAMORI Fumio , SHARMA Niranjan , KAWASHIMA Takahiko , IWASAKI Yoji
Published: August 2007

Abstract: Endoscopic sclerotherapy has been used to manage esophageal varices. Severe complications resulting from this therapy including renal dysfunction have been reported. Therefore, particular caution must be taken with patients who have serious renal damage. Sclerotherapy was performed for esophagogastric varices in a patient that had received a kidney transplant following chronic renal dysfunction. Ethanolamine oleate was used as the sclerosant, and contained a contrast medium for varicealography in order that the flow of the sclerosant be monitored by fluoroscopy. Varicography during the injection allowed us to stop injection into the varices and into the irregular passageways of the feeders to the varices before the agent entered the systemic circulation. There were no complications during therapy. The patient died due to respiratory failure 41 months after the first treatment. Macroscopic findings of the autopsied specimens showed no esophagogastric varices and microscopic findings showed organized varices with recanalization into the submucosal layer of the esophagogastric lesions. Injection sclerotherapy using varicography with sclerosant‐contrast medium mixture allowed treatment of this patient without incurring renal dysfunction.
Selective Endoscopic Retrograde Pancreatography (Selective ERP) Using a Radifocus Gllidewire–A New Technique for a Diagnostic Pancreatogram
Authors: MAGUCHI Hiroyuki , OBARA Takeshi , OKAMURA Kiyoshi , ARISATO Satoshi , ITOH Akinori , SAITOH Yusuke , SOHMA Mitsuhiro , KITAMORI Shigeru , SHIBATA Yoshimi , NAMIKI Masayoshi , ORII Yutaka , MINEMOTO Hiromasa
Published: August 2007

Abstract: We have developed a new method called the “Selective Endoscopic Retrograde Pancreatograpy (Selective ERP)” which uses a Radifocus guidewire to obtain a more precise pancreatogram than a standard ERP. The deep cannulation of a catheter guided by a Radifocus guidewire following standard ERP was easily and rapidly accomplished and precise pancreatograms were successfully obtained. The Selective ERP was very useful not only for obtaining detailed pancreatograms beyond severe stenosis of the main pancreatic duct in ductal cell carcinoma of the pancreas but also in revealing whether mucinous cystadenoma/cystadenocarcinoma communicated with the pancreatic duct or not. In the case of a mucin producing pancreatic tumor, Selective ERP successfully enabled us to obtain a whole pancreatogram and the location and extent of a tumor that standard ERP often fails to reveal because of an abundant accumulation of mucin in the duct.

A Selective ERP is a simple and useful method for diagnosing pancreatic tumors and can provide precise and whole pancreatograms. We recommend Selective ERP as it enables us to obtain more complete diagnostic pancreatograms following standard ERP.
Immunohistochemical Identification of S Phase Cells in the Gastric Mucosa Using Bromodeoxyuridine and Its Monoclonal Antibody
Authors: WANG Jin‐Town , SHEU Jin‐Chuan , SHUN Chia‐Tung , LIN Jaw‐Town , WANG Cheng‐Yi , WANG Teh‐Hong
Published: August 2007

Abstract: Using in vitro bromodeoxyuridine (BrdU) labelling of endoscopic biopsied gastric mucosal tissue and immunohistochemical staining using a monoclonal antibody against BrdU, we studied the S phase fraction of normal gastric mucosa. Twenty‐one patients who had undergone an endoscopic examination and who had normal gross mucosa were biopsied from the antrum, body and fundus. Eighteen of the 21 subjects were successfully labelled using BrdU in a tissue culture medium, sectioned in a longitudinal orientation and stained using the peroxidase‐anti‐peroxidase complex method using a monoclonal antibody against BrdU. The mean labelling index of these. 18 subjects was 36.1 ± 15.3, 21.2 ± 8.2, 23.0 ± 11.5 per 1000 nuclei for the mucosa of the antrum, body and fundus, respectively. The S phase fraction of the antral mucosa was significantly higher than the mucosa of the body and fundus. We conclude that the BrdU‐anti‐BrdU monoclonal antibody method is stable and rapid in the study of cell proliferation of gastric mucosa and the S phase fraction in antral mucosa is higher than those of the body and fundus. The biological significance of this finding needs further investigation.
Experience with Laparoscopic Cholecystectomy
Authors: YAMAKAWA Tatsuo , TAN Daniel , ISHIKAWA Yasuro , SAKAI Shigeru
Published: August 2007

Abstract: Laparoscopic cholecystectomy is rapidly replacing conventional cholecystectomy as the treatment of choice for gallbladder stone disease because of its lower morbidity. Our study began on 29th May, 1990 and continued until February 28th, 1991. 40 laparoscopic cholecystectomies were successfuly performed. 4 patients had an open cholecystectomy instead because of bleeding in 1, dense adhesions in 2 and Mirizzi's Syndrome in 1. The two technical measures taken to avoid common bile duct injury, were 1) exposure of both the cystic duct and cystic artery in the same field before clipping and division 2) demonstration of the continuity between the cystic duct and the Hartman's pouch. Technical difficulties often encountered were extensive adhesions, multiple or giant stones, inflamed gallbladder and a short or dilated cystic duct. There were 4 complications; one diaphragmatic injury resulting in a pneumothorax, one periumbilical subcutaneous emphysema and 2 mild bile leaks. On average, each patient required 1.3 intramuscular analgesic injections and spent 10 days recuperating in hospital. In Japan, many patients insist on staying longer in hospital. We believe that laparoscopic cholecystectomy will rapidly become the preferred treatment for gallbladder stone disease.
Clinicopathological and Endoscopic Studies on Gastric Cancer Located; the Cardia
Authors: MURAMATSU Hirohito , SAITO Daizo , YOSHIDA Shigeaki , WATANABE Shichiroku , BOKU Narukazu , FUJII Takahiro , YOSHINO Mitsuya , TAJIRI Hisao , YAMAGUCHI Hajime , YOSHIMORI Masayoshi , OGURO Yanao , SASAKO Mitsuru , KINOSHITA Taira , MARUYAMA Keiichi , ITABASHI Masayuki , HIROTA Teruyuki
Published: August 2007

Abstract: In this study the definition of cardiac cancer (histologically adenocarcinoma) was taken to be a cancerous lesion, the size of which is less than 4 cm and the center of which is located within 2 cm from the esophagocardiac junction. 42 patients (0.8%) fit the above definition of cardiac cancer out of 4,958 patients with solitary gastric cancer operated on at the National Cancer Center Hospital daring the period between 1962 and 1988. The clinicopathological and endoscopic findings of these 42 patients were compared with those of 132 patients with gastric cancer located in the upper third of the stomach other than in the cardia (cancer in the other C‐area). In the group with cardiac cancer, the male patients (M/F ratio: 3.7), the elderly patients (mean age: 61.3 years), a differentiated type of adenocarcinoma (90%), lesions located at the lesser curvature (62%) and the elevated type of lesion were found to predominate. The incidence of early cancer (60%) and the incidence of small lesions less than 2 cm (32%) in diameter were lower than in the patients with cancers in the other C‐area. In the group with cardiac cancer, however, the incidence of such types of early cancer as the depressed lesion, a small lesion less than 2 cm in diameter and lesions difficult to diagnose endoscopically, have been increasing. In recent years, cardicac cancers have been found not only on the lesser curvature, but also in different areas of the cardia.

These results suggest an improvement in endoscopic diagnosis for cardiac cancer. To make early detection more precise, it will be indispensable not to overlook even faint or indistinct mucosal abnormalities at the area adjacent to the esophagocardiac junction.
α‐Fetoprotein Producing Early Gastric Cancer
Authors: TAKAGI Hitoshi , SAKURAI Seiji , ABE Takehiko , IKEYA Toshirou , YAMADA Shoji , KOBAYASHI Setsuo , AOYAGI Yutaka
Published: August 2007

Abstract: A 53‐year‐old male suspected of having a testicular tumor associated with a moderately high titer of α‐Fetoprotein (AFP), was shown to have a IIa + IIc type early gastric cancer in the cardia. The urological diagnoses made from the operated specimen were orchitis and epididimitis. Because of the moderately high titer of AFP (30–80 ng/ml), it was suspected that he had a hepatocellular carcinoma (HCC). A routine upper gastrointestinal endoscopy performed prior to the celiac angiography to assess for a liver tumor revealed gastric cancer. HCC was ruled out using celiac angiography and a total gastrectomy was performed. The operative findings of: P0 H0 N4 S0 corresponded with stage IV gastric cancer. Subsequently his AFP decreased to an undetectable level and the patient is in a good postoperative condition.

The resected tumor was a well differentiated tubular adenocarcinoma and stained positive for AFP.

A differential diagnosis with the subtype of AFP excluded the possibility of a yolk sac tumor but did not permit differentiation of the HCC from gastric cancer. A diagnosis of AFP producing gastric cancer must be carefully considered when HCC has been excluded in patients with high AFP titers.
Application of Peroral Cholangio‐Pancreatoscopy on Bilio‐Pancreatic Diseases
Authors: FUJITA Rikiya , FUJITA Yasuyuki , BONARDELLI Paolo , HIRATA Nobuto
Published: August 2007

Abstract: Peroral cholangiopancreatoscopy has a long history of development since 1974. It has been called a mother‐babyscope system or babyscopy. Although peroral approaches to the bilio‐pancreatic diseases have produced some other methods a babyscopy has established its position as a method for digestive endoscopy. An instrument with angulation and forceps channel system has become useful in therapeutic endoscopy since 1986. It made possible procedures such as the diagnostics of biopsy or brushing cytology under direct vision and the therapeutics of lithotripsy or guide‐wire insertion have been included. Since 1989 an ultrathin endoscope system using television monitoring was developed to expose the next step. We are aware that a new system endoscopy will advance procedures, feasibilities and applicabilities.
The Rigiflex TTS: A New Method to Dilate Benign Esophageal Stenosis
Authors: SPADA F. LA , CASABLANCA G. , BARONE M. , BONARDELLI P.
Published: August 2007

Abstract: This paper dicusses the use of esophageal dilatation with a Rigiflex TTS balloon. This method was used 45 times on 11 patients affected by anastomotic or a severe grade peptic esophageal stenosis. Fluoroscopic guidance was used in 36 procedures (80%) without effecting the mean duration of the treatment (12 minutes). The results were considered satisfactory when these goals had been achieved: a) dilatation of the stenosis over 15 mm; b) a dysphagia free‐time of more than 6 months. A satisfactory result was achieved in 10 patients (90.9%), without deaths and major complications. 5 patients received 1 dilatation and the other 5 needed, 3‐3‐4‐7–11 procedures respectively to obtain a satisfactory result. On these basis we consider that its great efficacy, security and tolerability depend on the following characteristics of the Rigiflex TTS balloon: 1) “radial” dilatation; 2) the possibility of introducing the balloon through the operative channel of the fiberscope; 3) direct visualization of the stenosis during dilatation.

The following disadvantages with this method are: the absence of a tactile sensation of dilatation and the elevated cost of the instrument. We conclude that the Rigiflex TTS balloon is an important alternative to guide‐wire techniques, especially for the treatment of severe esophageal strictures.
Prophylactic Effect of Famotidine on Acute Gastric Ulcers due to Ranger Training
Authors: SHIRAHAMA Tatsuoki , TAKEI Kazuo , TAKEHARA Masanobu , KOGA Kosaburo , NOMURA Tsutomu , KATO Masashi , HAKOZAKI Yukiya , MAGATA Yoshihiko , OHBA Kenichi , YAMADA Shoichi , NAKAGAWA Katsuya , SATO Ryogo
Published: August 2007

Abstract: Since 1978, we performed endoscopic examinations of the upper gastrointestinal tract in trainees before and after ranger training to study the relationship between the training program and the occurrence of acute gastrointestinal disease. Since 1987, the H2 blocker famotidine has been administered to all ranger trainees as a prophylaxis against stress ulceration. In the 617 subjects studied, the following conditions were detected following the completion of the training: gastric ulcers occurred in 42 subjects (6.8%), duodenal ulcers occurred in 27 subjects (4.4%), and gastroduodenal ulcers occurred in six subjects (1%). Ulcers occurred in 41 out of 421 trainees (9. 7%) during the nine years between 1978 and 1986. Since 1987, however, ulcers have occurred in only seven out of 196 trainees (3.6%).
Development of Gastroesophageal Varices and Risk of Variceal Bleeding in Patients With Cirrhosis
Authors: IWAO Tadashi , TOYONAGA Atsushi , SUMINO Michihiro , TAKAGI Kohsuke , OHO Kazuhiko , SAKAKI Munenori , IKEGAMI Motoki , OHKUBO Kazunori , INOUE Rintaroh , SASAKI Ei , TANIKAWA Kyuichi , NISHIZONO Masatoshi
Published: August 2007

Abstract: We studied the relationships between portal pressure measured using the portal venous pressure gradient, the development of gastroesophageal varices, and the risk of variceal bleeding in 56 patients with cirrhosis. Portal pressure was higher in patients with varices than in those without (P>0.01), and 11 mmHg was the lowest portal pressure measured in the patients with varices. The size of the varices was not associated with the portal pressure. There was no difference in the value of portal pressure measurements for the patients with variceal bleeding and those without and there was no linear‐relationship between the degree of portal hypertension and the rate of variceal bleeding. 12 mmHg was the lowest portal pressure measured in the patients with variceal bleeding. The size of the varices was related to the rate of variceal bleeding (P>0.05). We conclude that (a) a portal pressure of 11 mmHg is necessary for the formation of varices, (b) 12 mmHg of portal pressure is necessary for variceal bleeding to occur but the degree of portal hypertension has no predictive value for the risk of variceal bleeding, and (c) the size of the varices does not depend on the degree of portal hypertension but is associated with the risk of variceal bleeding.
Endoscopic Sclerotherapy for Esophageal Varices After Surgical Procedures for Congenital Biliary Atresia
Authors: SHIBUYA Susumu , TAKASE Yasuhiro , SHARMA Niranjan
Published: August 2007

Abstract: The effectiveness of injection sclerotherapy for esophageal varices due to congenital biliary atresia has not yet been established. Sclerotherapy was performed to treat esophageal varices in four children with variceal bleeding who had received a hepatic portoenterostomy for congenital biliary atresia. Ethanolamine oleate was mixed with a contrast medium for the varicealography in order to determine the flow of the sclerosant by fluoroscopy. Varicealography which was conducted during the injection allowed us to stop the procedure so that mixture would fill up the varix and its feeders but would not enter the systemic circulation. Between 0.5 ml to 2.0 ml of sclerosant was injected at the variceal puncture. There was one case bleeding from the esophageal ulcer. However, it was resolved by conservative treatment. All four children experienced no rebleeding after the therapy. Therefore, injection sclerotherapy using varicealography with sclerosant–contrast medium mixture is recommended for children who develop esophageal varices after surgical procedures for congenital biliary atresia.
Effects of Sclerosing Agents on the Local Blood Flow of the Mesenteric Vein in Rabbits
Authors: NISHIWAKI Hideki , ASM Takeshi , SOWA Michio , UMEYAMA Kaoru
Published: August 2007

Abstract: To investigate the pathophysiology of scleroembolization as a treatment for esophageal varices, studies were made of the effects of the intravenous administration of Aethoxysklerol (AS), Ethanolamine Oleate (EO), ethanol and thrombin on the local blood flow of the mesenteric vein, the systemic hemodynamics and thrombus formation in blood vessels in rabbits.

The dosages and concentrations of Aethoxysklerol used were from 0.5 to 2 ml and from 0.5% to 2%, respectively. This was done to ascertain the possible relationships of these variances of Aethoxysklerol on the local blood flow in vessels with a low‐flow and a high‐flow.

99% ethanol, 50 U thrombin and 5% Ethanolamine Oleate were also administered into low‐flow and high‐flow vessels in doses of 0.5 ml and 1 ml, respectively.

The increase in AS concentration from 0.5% to 2% caused no remarkable changes in the degree of blood flow inhibition in vessels with either a low‐or a high‐flow, but the time required for inhibition was 45–50 min in vessels with a high flow, which was longer than the 25 min necessary in vessels with a low‐flow. The increase in AS dosage from 0.5 to 2 ml was negligible for enhancing the inhibitory effect of the drug upon the blood flow, but the blood flow inhibition was significantly increased in the low‐flow vessels compared with the high‐flow vessels even when the AS was administered in the same volume and concentrations.

The AS‐induced changes on the systemic blood pressure were minimal even with high dosages and high concentrations.

99% ethanol and thrombin were less effective in blood flow inhibition in both the low‐and the high‐flow vessels. 5% Ethanolamine Oleate when administered in a volume of either 0.5 ml or 1 ml significantly inhibited the flow in the low‐flow vessels as compared to the flow in the high‐flow vessles.

On the other hand, when AS was administered with thrombin, the inhibitory effects were accelerated to 88±26% in the low flow vessels and 44±16% in the high‐flow vessels as compared with administration of AS alone in both the low‐flow and the high‐flow vessels, respectively.

We concluded that the embolizing effect of AS alone is rather weak, although it is a relatively safe drug. We consider it wise to combine it with thrombin.
The Capability of Three Dimensional Display during Endoscopic Ultrasonography
Authors: HASHIMOTO Hiroshi , YOKOYAMA Satoshi , NAKAO Kyoko , HARUKI Kousuke , CHIBA Motoko , KATO Akira , MITSUNAGA Atsushi , MURATA Yoko , HARADA Nobuhiko , SUZUKI Shigeru , KUROKAWA Kimie , OBATA Hiroshi , TAKEMOTO Tadayoshi
Published: August 2007

Abstract: Endoscopic ultrasonography (EUS) has been found to be useful in determining the depth of invasion of gastric cancer, the diagnosis of submucosal tumors and extramural compressions. A problem with this procedure is that it is difficult to determine stereoscopically the relative position of the lesion as a whole, even though EUS may be an excellent diagnostic tool for determining tomographies. In this paper, we made three‐dimensional displays of EUS images using a personal computer to facilitate understanding of the relative anatomical positions of the lesions. During EUS examination, the distance from the incisors was acccurately measured, and the EUS image was recorded on U‐matic tape. To measure the distance from the incisors, we devised a new instrument for measuring the endoscopic insertion length. The recorded tape was edited for input into the computer. The soft‐ware for the three‐dimensional display program was made by Photoron. Inc. A patient with esophageal cancer, a patient with a common bile duct stone and a patient with pancreatic cancer are presented as examples for definition of the relationship with the surrounding organs. A patient with a gastric ulcer is used as an example to clarify the pathological structure of the lesions. Using our method on these patients, it was easy to obtain a stereograph and to obtain complete images of the lesions. EUS was available for three ‐dimensional displays of the lesions in the gastrointestinal tract and in the surrounding area, and this has clinical significance.
A Case Report of Anomalous Pancreaticobiliary Duct Connection with Choledocholithiasis and Acute Pancreatitis
Authors: DEKIGAI Hiroshi , MURAKAMI Motonobu , HAMATO Noriyuki , KATO Hitoshi , KIMURA Toru , MORIYASU Fuminori
Published: August 2007

Abstract: A 25‐year‐old man was admitted to hospital with epigastric pain. He had had a history of episodic abdominal pain since early childhood. An anomalous pancreaticobiliary duct connection was seen by endoscopic retrograde cholangiopancreatography. In many cases, this type of abnormality is caused by an anomaly in the ventral pancreas. In this case, however, the common bile duct, with calculi, was joined to the pancreatic duct which did not arise from the ventral pancreas but from the dorsal pancreas. The pancreatic duct arising from the ventral pancreas was absent in this case. The patient underwent a prophylactic cholecystectomy, a transduodenal sphincteroplasty, a choledocholithotomy, a partial resection of the common bile duct, and a hepaticojejunostomy, performed by a Roux‐en‐Y anastomosis. His postoperative recovery was satisfactory. An anomalous pancreatobiliary duct connection allows pancreatic juices and bile to mix. This is considered to be an etiological factor in pancreatitis and choledocholithiasis.
Topical Application of an Anti‐tumor Agent Through a PTBD Catheter for Management of an Incurable Malignant Biliary Obstruction —a PTBD Option—
Authors: AIZAWA Kenichi , TOKUYAMA Hiroshi , YONEZAWA Takayuki , DOI Misako , MATSUZONO Yasuhiko , MATSUMOTO Mamoru , URAGAMI Kazuhiro , NISHIOKA Shingo , YATAKA Isao
Published: August 2007

Abstract: The treatment of a 69‐year‐old woman with obstructive jaundice due to the direct invasion of metustutic lymph nodes by gastric cancer at the porta hepatis is reported. In this case topical infusion chemotherapy via a percutaneous biliary drainage (PTBD) catheter with Cis‐Diammine Dichloro‐Platinum (CDDP) plus Adriamycin (ADM) was found to be an effective treatment to achieve internal biliary drainage with the aid of a percutuneous transhepatic cholangioscopy. This result, in our opinion, suggests that the topical use of anti‐tumor agents via a PTBD catheter might be considered an option for the treatment of patients with incurable malignant biliary obstruction.
Multiple Early Gastric Carcinoma in Cases Treated Endoscopically
Authors: SUGIURA Junsaku , IDA Kazunori , FUJII Takaaki , FUKUSHIMA Tatsuki , KANETAKE Yasufumi , YAGI Nobuaki , KAWASE Kouhachirou , KOJIMA Takao , KATOH Takahiro , OKUDA Junichi
Published: August 2007

Multiple gastric carcinoma was endoscopically diagnosed in 14 patients (13.6%) with 33 lesions (27.3%), out of 103 cases of early gastric carcinoma treated by endoscopic surgery. The sex ratio of these patients was 11 males to 3 females, and their mean age was 61.7 years old. In 79% of the patients the macroscopic type of the lesions was the same. Twelve of 33 lesions were metachronous lesions diagnosed by endoscopy using the dye contrast method. All of the metachronous lesions were evaluated as invading only as far as the mucosa. Almost all of the metachronous lesions were located at a height similar to that of the initial lesion or in a more oral direction. Eleven of 12 metachronous lesions were less than 2 cm in diameter, including 5 minute cancer lesions which were less than 5 mm in size. All these lesions were treated again endoscopically without gastrectomy. These results suggest that an annual endoscopy using the dye contrast method permits early detection of gastric carcinoma at a stage at which it can be treated endoscopically.
A Case of Spontaneous Regression of Primary Malignant Lymphoma of the Stomach
Authors: HAYAKAWA Kazuo , FUKUCHI Sohtaro , YOSHIDA Yukiya , HASHIMOTO Mitsuyo , HOSHIHARA Yoshio , MIYAKOSHI Shigesaburo , NANAUMI Kyoo , UNAKAMI Masamitsu
Published: August 2007

A 62‐year‐old female who complained of discomfort in her upper abdominal region and a poor appetite had an endoscopically documented polypoid lesion with a shallow irregular central depression at the lesser curvature of the angulus. A diagnosis of malignant lymphoma was made following a gastric biopsy. A gastric endoscopy performed about 20 days later revealed a marked increase in size with an ulcerated surface the margin of which had an auricle‐like shape. These findings were compatible with a diagnosis of malignant lymphoma of the stomach. No medical therapy, such as antineoplastic agents, was given during the follow‐up period. A gastric resection was performed 1.5 months after the initial endoscopy. A detailed histopathological examination of the resected gastric specimen revealed a U1‐II type ulcer scar but no malignant lymphoma cells. Very few cases of a complete spontaneous regression of a malignant lymphoma of the stomach have been reported either within or outside of Japan though it is well known that lymphomas show rapid morphological changes in some patients who are followed‐up without any specific therapy. These rare case reports in the literature are reviewed and discussed together with our present case.
Peptic Ulceration in Patients with Chronic Obstructive Pulmonary Disease
Authors: FUKUMURA Motonori , MACHIDA Makiyo , KOIDE Kouhei , YOSHIIKE Yasuhiro , MIZUNO Tadaoki , SHINDO Kunihiko
Published: August 2007

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by peptic ulceration. Recent studies strongly suggest that the major cause is hypersecretion of gastric juice induced by hypoxemia or hypercapnia. To determine the incidence of peptic ulcers in COPD, we surveyed 267 patients with COPD seen at our hospital as inpatients or outpatients between 1984 and 1988. There were 90 patients with pulmonary emphysema, 93 with chronic bronchitis, and 84 with bronchiectasis. The prevalence of gastric ulcer in the patients with COPD was 23 out of the 267 patients (8.6%) surveyed. These included 13 patients with pulmonary emphysema, 6 with chronic bronchitis, and 4 with bronchiectasis. One‐half of the patients with pulmonary emphysema had hypoxemia and hypercapnia: These observations suggest it is necessary to improve the abnormal blood gas concentration in patients with COPD in order to promote the healing of the peptic ulcer.
Colonic Lipoma Removed by Endoscopic Polypectomy:—A Report of Three Cases—
Authors: NAKAGOE Tohru , FUKUDA Yutaka , NAKAZAKI Takayuki , ISHIKAWA Hiroshi , SHIMIZU Teruhisa , KUSANO Hiroyuki , AYABE Hiroyoshi , TOMITA Masao
Published: August 2007

We report on three cases of colonic lipoma removed by endoscopic polypectomy. Patient 1 was a 46‐year‐old female, Patient 2 a 63‐year‐old male and Patient 3 a 76‐year‐old female, with their afflicted regions being the; ascending colon, ascending colon and transverse colon, respectively. All the three lipomas were pedunculated and smooth on the surface, with the subrnucosal figure presenting yellowish or reddish in color. In Patient 1 and Patient 2, both tumors were totally removed, and in Patient 3, a “half resection” of the polyp was performed by endoscopic polypectomy. The resected specimens were 1.5 cm, 2.6 cm and 1.0 cm, respectively, in size at their maximum diameter and soft tumors with uniformly yellow cut‐surfaces. All were histopathologically diagnosed as being “lipoma”. Because the colonic lipoma is benign, an endoscopic polypectomy should be tried as the treatment of choice in selected patients.
Chemotherapy of Gastric Cancer with Complete Endoscopic Remission: Report of a Case
Authors: YANG Hong‐Jen , WANG Jin‐Town , UEN Wu‐Ching , LIN Jaw‐Town , WANG Teh‐Hong
Published: August 2007

We report on a case of a 31‐year‐old male patient who had advanced gastric cancer with distant lymph node and liver metastasis. A panendoscopy revealed a huge Borrmann's type III advanced gastric cancer involving the esophago‐cardiac junction, cardia, fundus, body, angle and part of the antrum. After 2 courses of VP‐16, adriamycin, cisplatin (EAP), a 4 cm diameter benign looking ulcer was noted at the lesser curvature side of the high to mid‐body. After 4 courses of EAP, a long linear scar was noted at the cardia to low body, while the biopsy revealed only chronic inflammation. A follow‐up abdominal echo and CT scans indicated a complete disappearance of liver metastasis and lymphadenopathy. Although recurrence was noted 2 months later, the new chemotherapy protocol provides a promising treatment for unresectable gastric cancer.
A Case of Pancreatolithiasis Treated by a Combination of Endoscopic Extraction and Extracorporeal Shock Wave Lithotripsy
Authors: OKUSHIMA Kazumu , NAKAZAWA Saburo , YAMAO Kenji , YOSHINO Junji , INUI Kazuo , YAMACHIKA Hitoshi , KANEMAKI Naoto , IWASE Teruhiko , KISHI Katsuhiko , FUJIMOTO Masao , WATANABE Masumi , HIRANO Ken , HARADA Kou , MIYOSHI Hironao , NIMURA Yuji
Published: August 2007

We report on the case of a 50‐year‐old woman with idiopathic chronic calcifying pancreatitis and diabetes. An endoscopic retrograde pancreatography showed a stone with a diameter of 23 mm and multiple small stones in the head of the pancreas. An endoscopic pancreatic sphincterotomy was performed. However, the stone could not be removed endoscopically. So we performed an extracorporeal shock wave lithotripsy (ESWL) using a Tripter X1. The stone was located in the shock wave focus by fluoroscopy. Under intravenous sedation, the patient received 5 ESWL sessions (a total of 11700 shock waves with an energy of 18kv). ESWL permitted stone disintegration and successful endoscopic extraction of the fragments. Complete clearance in the main pancreatic duct was achieved. No severe complications were observed. After treatment, an improvement in the PFD test was seen. ESWL is an effective method for treatment of endoscopically unextractable pancreatic ductal stones.
Quantitative Measurement of Fluorescent Intensity of the Rat Liver Surface Using Video Fluorescence Laparoscopy Following Intravenous Fluorescein Injection
Authors: WAKABAYASHI Hiroto , SHINZAWA Haruhide , TODA Hirotaka , AOYAMA Ichiro , KUBOKI Makoto , ISHIBASHI Masamichi , SAITOH Takahumi , UKAI Katsuaki , YAMADA Nobuo , TOGASHI Hitoshi , TAKAHASHI Tsuneo , ISHIKAWA Makoto
Published: August 2007

Abstract: A new method for the quantitative measurement of fluorescent intensity of the rat's liver surface after fluorescein injection is described. The measuring system of fluorescent intensity on the rat liver surface consisted of a video laparoscopy with a video densitometer. An excitation filter was placed in the light source and an absorbing filter was attached to the eyepiece of the magnifying scope in this fluorescence video laparoscopy system. Fluorescein was injected intravenously into the inferior vena cava. Video fluorescence images of the liver surface were recorded with a CCD TV camera which was connected to the scope. In measuring the mean intensity of video images, a region of interest was designated on the TV monitor. The fluorescent intensity in this region was measured by a video densitometer and expressed in volts. The time‐intensity curve was graphically presented using a pen recorder. In this way, the time course of the liver surface fluorescent intensity could be analyzed with data expressed in volts. In normal livers, the fluorescent intensity began to rise 4.0 ± 0.5 seconds after fluorescein injection and reached a peak at 14.4 ± 1.5 seconds. Thereafter, the intensity fell slightly but then rose again to a second peak 170±50 seconds after injection.