bluuebunny/crossref_metadata_2025 huggingface dataset:
Infrared Peritoneoscopy Using Vidicon and Charge Coupled Device Television Camera Systems
Authors: TANIMIZU Masahito , ITOSHIMA Tatsuya , TSUJI Takao
Published: August 2007

Abstract: Two infrared television (TV) camera systems (a vidicon camera and a charge coupled device (CCD) camera) were used for clinical peritoneoscopy. Under infrared (IR) rays, the liver, stomach, intestine, abdominal walls and arteries appeared white, whereas the gallbladder, spleen and veins appeared dark. Compared with the images seen under visible light, small markings were less distinct. Intravenous injection of indocyanine green (ICG; 5 mg/kg) entranced the appearance of the arteries and the veins as black lines. 0.5 to 3 minutes after the ICG (0.5 to 5 mg/kg) injection, the liver parenchyma turned black, yielding a good contrast with unstained areas such as the interstitia, areas of necrosis, granulomas and carcinomas. In some cases, localized areas of the liver parenchyma, indistinguishable by conventional peritoneoscopy, turned black at an early phase of ICG staining (0.5‐2 minutes) while other areas remained white. This suggests a localized disturbance in liver circulation or liver dysfunction. Although the vidicon camera exhibited better sensitivity to IR rays tlian the CCD camera, the latter produced better images without residual image problems. In conclusion, IR peritoneoscopy by TV camera systems is a neiv and useful method, because it provides us with new information about the liver and gastrointestinal surfaces.
Inflammatory Fibroid Polyp of the Ileum Which Could be Endoscopically Diagnosed —A Case Report and Review of the Literature—
Authors: NOMURA Masafumi , TAKAHASHI Atsushi , TAKANO Hideya , HIRAI Katsuyuki , UGAJIN Wakato , FURUSHO Yasushi , SUGA Masaru , SUZUKI Tomokatsu , UEHARA Akira , OKAMURA Kiyoshi , NAMIKI Masayoshi
Published: August 2007

Abstract: Inflammatory fibroid polyp (IFP) of the small intestine is a very rare disease. Our review of the literature revealed only 40 cases of small intestinal IFP were reported from July 1975 through August 1989 in Japan. It is extremely difficult to make a definite diagnosis of IFP prior to surgery; none of the cases reported were diagnosed preoperatively. We describe here the first case of small intestinal IFP in Japan whose diagnosis was strongly suspected from an endoscopic examination prior to surgery.

A 62‐year‐old woman was admitted to our hospital with diarrhea, abdominal pain, nausea and vomiting. A plain abdominal x‐ray revealed the presence of an ileus. The subsequent contrast x‐ray performed via a long intestinal decompression tube and colonoscopic observation found an ileo‐ileal intussusception caused by a spherical mass (about 30 mm in diameter) in the ileum. When pushed with forceps, the tumor demonstrated a rubber‐like hardness, suggesting the presence of an IFP. Surgery was performed to treat the intestinal obstruction, and the ileo‐ileal intussusception was confirmed at a site 30 cm proximal to the ileocecal valve. At the leading point of the intussusception there was a semipedunculated tumor of 30X30X25 mm in size. The intestinal tumor was histopathologically diagnosed as IFP.
A Study on Atypical Endoscopic Findings of Ulcerative Colitis: Longitudinal Ulcers, Mucosal Bridges and Red Spots
Authors: OSHITANI Nobuhide , KITANO Atsuo , OBAYASHI Makoto , TABATA Akihiro , FUKUSHIMA Ryuji , OKABE Hiromu , KASHIMA Kazutoshi , NAKAMURA Shiro , OBATA Akishige , MATSUMOTO Takayuki , OKAWA Kiyotaka , KOBAYASHI Kenzo
Published: August 2007

Abstract: One hundred and twenty‐one ulcerative colitis patients diagnosed during the period of 1984 to 1988 were examined endoscopically on repeated occasions. Forty‐six patients had total colitis, 56 had left‐sided colitis, 15 had proctitis, and 4 were postoperative patients. When classified according to their macroscopic findings, 28 of the patients had the polyposis type of this disease, 88 had the atrophic type, and 5 had the mixed type. Longitudinal ulcers were found in 9 patients, occuring usually in the sigmoid colon. There was no pathological evidence of ischemic changes in these 9 patients. Mucosal bridges were found in 13 of the patients with total colitis, occurring somewhere from the cecum to the rectum. The mucosal bridges tended to be present during the mildly active stage of the disease. Red spots, which sometimes looked like vascular spiders, were found in 10 patients. The spots tended to appear before the disease went into the inactive stage. Histological observation showed regenerating vessels, sometimes with intramucosal bleeding; therefore the spots seemed to be intractable changes.
Endoscopic Retrograde Pancreatography and Brushing Cytology Using a Guidewire with Special Reference to the Recanalization Method in Patients with Main Pancreatic Duct Obstruction
Authors: TADA Hideki , TAKEDA Yoshinobu , SHINDO Hiroaki , NISHIHARA Tokufumi , HASHIMURA Naotaka , TAKASHIMA Tetuya , NAKAJIMA Shuzo , HIGASHINO Takeshi , HONGO Yasushi , ADACHI Gakuji , YONEHARA Toru , NOMURA Toshiyuki , FUKUMOTO Nobusuke , MATUMOTO Taizo , AZUMI Haruhiko , SHIOZAKI Michiaki , OSHIBA Saburo
Published: August 2007

Abstract: We attempted endoscopic retrograde cholangiopancreatography (ERCP) using guidewires on 32 patients: 16 with main pancreatic duct (MPD) stricture and 16 with MPD obstruction which had been detected by ordinary ERCP. We also performed brushing cytology for pancreatic ductal lesions in 24 of these patients. In 15 of the 16 patients with a MPD stricture, an ERCP catheter was inserted up to the stricture and then the catheter was passed into the proximal MPD through the stricture using a guidewire (recanalization method). In 14 of the 16 patients with a MPD obstruction, the lesion was reached using guidewires. In addition, the recanalization method was possible in 12 of these 14 patients and the pancreatic ductal system proximal to the obstruction was visualized.

ERCP using guidewires, especially using the recanalization method, allowed us to obtain detailed information, not only about the lesion itself but also on the pancreatic ductal system proximal to the lesion. Employing these methods, we obtained pancreatograms cliaracteristic of chronic pancreatitis or pancreatic cancer with a high detection rate and could evaluate whether the lesion was benign or malignant even in cases difficult to diagnose using ordinary ERCP. Furthermore, an assessment of the lesion expansion was possible to some degree with the recanalization method. The diagnostic accuracy of brushing cytology of the ductal lesion using guidewires was 79%. Although one subject experienced acute pancreatitis after these procedures, she recovered following conservative treatment. No other serious complications were observed.
A Basic Study on the Chromatic Responses of the Liver Surface by the Infrared Ray TV Camera After ICG Injection
Authors: TODA Hirotaka , SHINZAWA Haruhide , WAKABAYASHI Hiroto , TAKAHASHI Tsuneo , ISHIKAWA Makoto
Published: August 2007

Abstract: In basic studies, infrared ray television pictures of rats' livers were made with the aim of: (1) assessing, continuously and correctly, changes over time in liver surface coloration following an intravenous injection of Indocyanine green (ICG) and (2) quantifying the degree of ICG coloration of areas of the liver surface of interest by changing the image obtained into electrical signals and thereby obtaining an objective measure of coloration status. An Olympus CLE‐F10 (Olympus, Tokyo) was used as a light source for infrared ray TV imaging, while a monochromic CCD camera (Toshiba, Tokyo) was used as a television camera, with a visible light cut filter attached to the eyepiece of the scope. By means of a video mean densitometric apparatus (Hoei, Tokyo) the degree of ICG coloration was determined as a luminosity, which was recorded after being changed into electrical signals. Infrared ray television imaging made it possible to distinguish areas of shades of coloration even after an intravenous injection of ICG in as small dose as 0.5 mg/kg. It made a continuous clear record of changes over time in the coloration of ICG‐stained liver surface areas. The changes in the degree of coloration of the liver surface recorded as luminosity consisted of an early, steep component (vascular phase) and a subsequent slow component (parenchymal phase).

The vascular component was influenced by the dosage of ICG while the parenchymal phase was influenced by the severity of hepatic injury.
A Foreign Body in the GI Tract After EST and Stone Extraction –A Case Report–
Authors: PORTO Amicis M. F. , KANNAN Eduardo
Published: August 2007

Abstract: We investigated the case of a patient who had complications after EST and stone extraction. A 55‐year‐old woman had EST for choledocholithiasis and 12 hours later developed epigastric pain. As the pancreatic enzymes and white blood cell count were within the normal limits, a plain abdominal X ray film was done and revealed the papillotome's wire still in the stomach and duodenal loop. Its removal relieved the sympoms and this was followed by an uneventful recovery.
The Distribution of Helicobacter pylori in Human Gastric Mucosa in vivo
Authors: KOHLI Yoshihiro , KATO Takuji , IWAKI Makoto , YAMAZAKI Yukinao , HATA Masanori , SUZUKI Kunio , ITO Shigeji
Published: August 2007

Abstract: To estimate the distribution of Helicobacter pylori in human gastric mucosa in vivo, the phenol red dye spraying endoscopy lias been successfully developed and is performed after an oral and/or intravenous premedication of famotidine 20mg. This technique was conducted on 25 patients with chronic, atrophic gastritis, on 21 patients with a gastric ulcer and on 14 patients with duodenal ulcers. The red color changes which occurred on the gastric mucosa were classified into three types; the diffuse staining type, the regional staining type and the patchy staining type. In the chronic gastritis group, the diffuse staining type, the regional staining type and the patchy staining type occurred in 11 patients (44%), 7 patients (28%) and 2 patients (8%), respectively. The remainder of the patients' mucosa was unstained. In addition, the regional staining type occurred most frequently in the gastric ulcer group, while the diffuse staining type was dominant in the duodenal ulcer group. Notably, a recurrent and intractable ulcer was surrounded by regional staining fields in the stomach, and showed a diffuse staining at the antrum of the duodenum. These facts suggest that Helicobacter pylori prevented ulcer healing. This concurs with the results of our previous experimental study which found that the low concentration NH3 solution, produced by Helicobacter pylori, prevented an acetic acid ulcer healing in rats and resulted from the suppression of the cell kinetics of the regenerative epithelial cells and the fibroblasts in the connective tissues at the ulcer margins.
Evaluation of Endoscopic Resection of Gastric Tumors Following Local Injections of HSE (Hypertonic Saline‐Epinephrine Solution)
Authors: NAKAMURA Masaki , ISHIBASHI Tomoko , TANIGUCHI Hideto , YAMAMOTO Hitoshi , NAKAJIMA Yukihiro , UMEZU Hitoshi , CHIBA Kanenobu , HOSHINO Kiyoshi , KIMURA Kanae , ISHII Keiichi , NAKAMURA Youichi , UMETANI Kaoru
Published: August 2007

Abstract: The Endoscopic resection of gastric tumors following local injections of hypertonic saline‐epinephrine solution (ERHSE) was performed on 72 lesions (69 patients) of gastric tumors at Yoyogi Hospital etc. from March, 1983, to December, 1989. These included 40 cases of adenoma, 31 cases of carcinoma, and one carcinoid tumor.

The average length of the major axis of the endoscopically resected tumors was 12 ± 9 mm. The curative rate at the first attempt was 94% (64 of 68 lesions). The curative rate of the final procedure was 99% (67 of 68 lesions). This excluded 4 lesions in 3 patients in whom a follow‐up examination was not possible.

There was no relationship found between the final cure rate and the form and location of the lesions.

Fifty four lesions were resected with one session of snare cautery; the average length of their major axis was 9 ± 6mm. The resection of 18 lesions was done piecemeal, and the average length of their major axis was 20 ± 10mm. A statistical significance was noted between the size of the lesions which could be resected with one session of snare cautery and those treated by the piecemeal method, but no difference was noted in the location of lesions for the two groups.

The indication for ERHSE was assessed in accordance with the cases that resulted in piecemeal resection, those in which the first ERHSE left residual tumor tissues, and those with perforation. ERHSE could be performed with difficulty on lesions which were (1) on the sharply bending gasric wall, (2) observed only tangentially, (3) inadequately observed.

These lesions were situated on the gastric fornix, cardia, and their vicinities, the gastric angulus, posterior wall and greater curvature of the gastric body, and anterior wall and lesser curvature of the middle to the upper gastric body.
Two Cases of Eosinophilic Gastroenteritis with Colonic Involvements and Rare Complications
Authors: KINOUCHI Yoshitaka , HIWATASHI Nobuo , YAMAZAKI Hideo , TANNO Naoaki , KUMAGAI Yuji , SASAKI Takashi , HIRANO Hiroyuki , ITO Kaoru , ENDOU Itaru , KAWARADA Hiroaki , KAYABA Yoshiro , KOIZUMI Masaru , KIMURA Mitsuo , MURAKAWA Junichi , TOYOTA Takayoshi
Published: August 2007

Abstract: Two cases of eosinophilic gastroenteritis with colonic involvements and rare complications are described. Case 1. A 39‐year‐old male was admitted with diarrhea. He had a previous medical history of early gastric cancer two years prior to this admission. A barium enema showed a diffuse nodular granularity from the transverse colon to the rectum. A sigmoidoscopic examination demonstrated nodular granularity, spotty erythema and shallow irregular ulcers with normal intervening mucosa in the rectum and the sigmoid colon. Mucosal biopsies obtained from the rectum and the sigmoid colon revealed infiltrations of eosinophils in the lamina propria and histological reexamination of the resected stomach also revealed an infiltration of eosinophils in the subserosa. One year later the patient suffered from eosinophilic cellulitis. Case 2. A 25‐year‐old female was admitted for the investigation of suspected cholestasis. Based on the findings of a liver biopsy and an endoscopic retrograde cholangiography (ERC) a diagnosis of primary sclerosing cholangitis (PSC) was made. A barium enema showed moderate granularity, lack of haustration from the cecum to the splenic flexure with a rigid ileocecal valve which was open to reflux. A colonoscopic examination revealed mucosal granularity, diffuse erythema and friability in the same regions. Mucosal biopsies obtained from both the abnormal and the normalappearing mucosa showed infiltrations of eosinophils into the lamina propria. Blood peripheral eosinophilic was present in each case.
A Type IIc Like Advanced Carcinoma of the Sigmoid Colon —A Case Report—
Authors: TOGASHI Kazutomo , KONISHI Fumio , SAITOH Yukio , KANAZAWA Kyotaro , KIHIRA Ken , KIMURA Ken , KAMOSHIDA Toshiro , SAITOH Ken
Published: August 2007

Abstract: We studied a patient with a sigmoid colon carcinoma, which looked like a type IIc carcinoma when it was, in fact, an advanced carcinoma. This lesion was considered to have developed from an early carcinoma with a depressed appearance. A 79‐year‐old woman was admitted complaining of a small amount of rectal bleeding. A barium enema examination revealed a flat elevated lesion with converging folds. A colonoscopy revealed a slightly reddish lesion with a central depression 40∼50 cm from the anal verge. A biopsy specimen revealed the features of a well differentiated adenocarcinoma. A sigmoidectomy with lymph node dissection was performed. The resected specimen showed a tumor which looked like a so‐called type IIc advanced carcinoma, measuring 10×6 mm in size. This lesion was histologically diagnosed as being a well differentiated adenocarcinoma without any adenomatous component. The tumor showed a massive invasion into the submucosal layer and a slight invasion into the proper muscle layer.
A Case of Melanosis Duodeni in Which Pigmentation Disappeared After the Discontinuation of Hydralazine Administration
Authors: WADA Satoshi , FUJIKAWA Harunobu , HORIKITA Minoru , HIBINO Shingo , OKAHISA Toshiya , OKAMURA Seisuke , HAYASHI Hiroshige , HONDA Hirohito , SAIJO Tetsuya , YANO Mitsuyasu , SYUNDO Joji , SHIMIZU Ichiro , ITO Susumu , SANO Toshiaki
Published: August 2007

Abstract: The endoscopic examination of the duodenum of a 70‐year‐old man who had received hydralazine for a long period showed a marked pigmentation of the duodenal mucosa. However, this pigmentation disappeared within three months after the discontinuation of hydralazine administration. Histological and electron microscopic examinations, as well as electron‐probe X‐ray analysis of this patient demonstrated that the pigment was not true melanin, but some substance containing Fe and S. The medications which our patient received were those which were also used in 54 cases reported in the literature. Our results indicated that hydralazine was the causative agent of the pigmentation present in this patient, and that not all drugs with a benzene ring as was previously thought were the cause of the pigmentation. Hypertension, gastrointestinal hemorrhage, renal insufficiency and anemia also seemed to be factors involved in pigmentation of the duodenum.
A New Technique for Endoscopic Esophageal Mucosectomy Using a Transparent Overtube with Intraluminal Negative Pressure (np‐EEM)
Authors: KAWANO Tatsuyuki , MIYAKE Satoshi , YASUNO Masamichi , TAKAMATSU Susumu , KATOH Shoichi , NAKAMURA Hiroshi , SUGIHARA Kunio , HATANO Makoto , YOSHINO Kunihide , TAKESHITA Kimiya , INOUE Haruhiro , YAMAGIWA Akinaga , ENDO Mitsuo
Published: August 2007

Abstract: We devised a new technique for endoscopic esophageal mucosectomy using a transparent overtube (OT) with intraluminal negative pressure (np‐EEM) (Figs. 1,2). Basic studies were performed on six dogs. The following two methods were utilized in the np‐EEM technique in line with standard approaches used for mucosal resection: (1) A “snare” method was used in which the esophageal mucosa protruded, similar to a polyp, through the slit of the OT and was resected by an electro‐snare passing through the endoscope biopsy channel or the injection channel of the OT. A high‐frequency current was used for the resection (Figs. 2‐a 2‐b, Fig. 3, Color). (2) A “cutter” method was used in which the mucosal protrusion was resected by a recently developed electro‐cutter (Figs. 2‐a, 2‐c, 2‐d, Fig. 3, Color).

A mucosal protrusion, similar to a polyp, can be caused by intraluminal negative pressure at any point in the esophageal area. Mucosa up to 1.5 cm in diameter can be resected by both methods (Tables 1, 2; Figs. 5, 6, 7). The cutter method showed many advantages in terms of the ease of procedure, predictablility, and the ability to control the width and depth of the resection.

Therefore, np‐EEM, especially using the cutter method, has significant advantages for application with esophageal mucosal lesions for both diagnosis and treatment.
Esophageal Stenosis and Thickening of the Muscularis Propria Diagnosed by Endoscopic Ultrasonography (EUS Diagnosis of Esophageal Muscle Thickening)
Authors: IKEDA Masahiro , FUJINO Masayuki A. , KOJIMA Yuichiro , NAKAMURA Toshiya , SUZUKI Hiroshi
Published: August 2007

Abstract: Thickening of the muscularis propria of the esophagus was diagnosed by endoscopic ultrasonography as being the fourth hypoechoic layer larger than 2 mm in thickness. A thickened muscularis propria was observed in 40 patients with dysphagia caused by esophageal stenosis. In the patients with esophageal cancer, the thickening appeared at the proximal end of a layer‐destructive tumor. In the patients with reflux esophagitis, the thickening of the muscularis propria was distinguished from the thickened submucosal layer at the stenosis. In the patients with achalasia, the thickening ivas maximal at the level of the stenosis and the thickness was significantly greater than in the other cases. The thickening of the muscularis propria tapered gradually and disappeared within 10 cm except in the patients with achalasia in whom the thickening reached the upper esophagus. The prestenotic thickening of the muscularis propria depended on the duration of the history of dysphagia and the narrowness of the stenosis.
Ornithine Decarboxylase Activity of the Mucosa of the Gastric Remnant Using Endoscopic Biopsy Specimen, Comparison Between B‐I and B‐II.
Authors: SOWA Michio , NAKANISHI Kazuo , CHUNG Yong‐Suk , KATO Yasuyuki , KUBO Toshiaki , FUJIMOTO Yasuhisa , NISHIWAKI Hideki , YOSHIKAWA Kazuhiko , UMEYAMA Kaoru , KOBAYASHI Kenzo , OTANI Shuzo
Published: August 2007

Abstract: In this study, the stomal portion of the gastric remnant mucosa following a gastrectomy for gastric cancer was examined endoscopically and histopathologically. The ODC activity was assayed from biopsies from the stomal portion of the gastric remnant and from the greater curvature. The results obtained can be summarized as follows:

1. Endoscopic changes in the stomal mucosa (redness) were found significantly more often in patients following a B‐II than in patients who had had a B‐I. Histopathological changes consisting of glandular dilatation and an irregular glandular structure were detected in many of the stomal mucosal specimens.

2. The ODC activity was significantly higher in the stomal portion of the remnant stomach tlian in the greater curvature. As for the stomal portion, ODC activity was significantly higher following a B‐II titan following a B‐I.

In summary, the present findings suggest that active cell proliferation occurs in the gastric remnant mucosa, particularly in the region of anastomosis, and that an enhancement of cell proliferation kinetics plays a role in the pathogenesis of primary cancer in the stomal portion of the remnant stomach.
Percutaneous Endoscopic Gastrostomy for Elderly Patients; A Comparative Study with Nasogastric Feeding
Authors: YAMADA Tamaki , OHNISHI Hayato , MATSUURA Tohru , ADACHI Satoru , YAMAMOTO Toshiyuki , TATEMATSU Masae , KATAGIRI Kenji , MIYAJI Makoto , ITOH Makoto , TAKEUCHI Toshihiko
Published: August 2007

Abstract: Elderly patients who are unable to swallow due to disorders of the central nervous system and other disorders require parenteral alimentation for nutritional maintenance. Nasogastric feeding (NGF) which is widely employed for this purpose often causes problems such as the removal of the tube by the patient, difficulty of insertion or changing of the tube, and the induction of wheezing or even aspiration pneumonia. To avoid these difficulties, we performed a percutaneous endoscopic gastrostomy (PEG) on 10 patients, aged 80.7±19.3 years, who had previously been managed by nasogastric feeding for an average period of 10.8±19.3 months. No severe complications occurred during or after the operation. A comparison between 10 patients receiving gastrostogavage (PEG) and another 20 on NGF also revealed that PEG resolved the problems associated with NGF and achieved alimentary effects similar to NFG in the serum levels of albumin and hemoglobin. The autopsies of two elderly PEG patients who died of cardiac disease demonstrated that the serosa of their stomach and anterior abdominal wall firmly adhered. Our observations suggest that PEG is a safe and beneficial means of feeding for certain aged patients.
Laparoscopic Findings of Asymptomatic Primary Biliary Cirrhosis —Particular investigation in early PBC—
Authors: SHIBATA Minoru , UENO Yukihisa , YAMAMURO Wataru , ISHII Kunihiko , KUBO Shuichi , SATO Genichiro , YOSHIDA Naoya , HATORI Tomoki , HATTA Yosio , ENOMOTO Makoto
Published: August 2007

Abstract: of 17 cases of asymptomatic primary biliary cirrhosis (PBC), seven cases whose ALP (alkaline phosphatase) was less than twice the upper limit of the normal range were defined as being “early PBC”, and ten cases whose ALP was more than twice the upper limit of the normal range were defined as being “classical PBC” in order to investigate their clinical pictures and laparoscopic findings.

There were no significant differences between early PBC and classical PBC in terms of sex differences, age, a positive rate of antimitochondrial antibody and histological findings. On the other hand, apart from IgM being as high as 86%, laboratory studies indicated that early PBC cases showed relatively low abnormal levels of GOT (29%), ALP (43%), γ‐GTP (57%), and erythrocyte sedimentation rate (ESR) (57%). Classical PBC cases exhibited almost 100% abnormal values.

Laparoscopic examination of all the classical PBC cases revealed such specific characteristics of PBC as reddish patches, protuberance formations and mesh‐like white markings. Early cases revealed one of the following nonspecific findings: proliferation of the portal veins, irregularity of the liver surface, dullness of the liver edge and enlargement of the liver. However, in terms of the specific findings, none of the patients had reddish patches, and half of the patients demonstrated protuberance formations and mesh‐like white markings in part of the liver.
Endoscopic Biliary Drainage for Malignant Obstructive Jaundice: Clinical Analysis and Assessment of Biliary Decompression
Authors: KON Yoichi , HIGUCHI Tsugio , YOSHIHAMA Yutaka , AOKI Takashi
Published: August 2007

Abstract: The efficiency of non‐operative methods of biliary decompression was evaluated in 74 patients with malignant obstructive jaundice.

Endoscopic biliary drainage (EBD) was performed in 54 patients and included nasobiliary drainage (NBD) in 18 patients, duodenobiliary drainage with a endoprosthetic tube measuring 7. 2 Fr in diameter (7.2DB) in 22 patients and duodenobiliary drainage with a endoprosthetic tube measuring 10 Fr in diameter (10DB) in 14 patients. 20 patients had percutaneous transhepatic biliary drainage (PTBD).

A “Jaundice Reduction Index” was calculated for each group using the regression coefficient analysis of the fall in serum bilirubin levels measured at 1 week intervals. Values of 0.23, 0.30, 0.62 and 0.65 were obtained for the 10DB, 7.2DB, NBD and PTBD groups respectively.

Our results indicate a statistically significant superiority in the efficiency of biliary decompression in the 10DB and 7.2DB patients when compared with the NBD and PTBD patients. The difference between the 10DB and the 7.2DB groups was not statistically significant. Moreover, endoprosthesis using a stent tube, measuring 7.2 Fr in diameter, provided sufficient biliary decompression on initial drainage. A stent tube with a larger diameter is preferable for endoprosthesis, but our results suggest that the use of stent tube with a bigger internal diameter is not necessary for the increased efficiency of biliary decompression.
Ectopic Sebaceous Glands in the Esophagus: Report of Two Cases
Authors: HOSHIHARA Yoshio , HASHIMOTO Mitsuyo , YOSHIDA Yukiya , HAYAKAWA Kazuo , FUKUCHI Sohtaro , UNAKAMI Masamitsu
Published: August 2007

Abstract: Reports of ectopic sebaceous glands in the esophagus are rare. Six postmortem cases and eight antemortem cases have been reported. In 1990, we studied two patients with ectopic sebaceous glands in the esophagus that were found during endoscopy and confirmed histologically. These lesions macro‐scopically resembled gastric xanthomas.
Colonoscopic Follow‐up Study after Polypectomy
Authors: BABA Rika , NAGASAKO Kou , YASHIRO Kurato , SATO Shuichi , SUZUKI Shigeru , OBATA Hiroshi
Published: August 2007

One hundred and forty‐seven patients with colonic adenoma and early cancer were followed by one or more total colonoscopies. A very precisely planned colonoscopic follow‐up schedule for the polypectomized patients was then assessed. In patients who received a single follow‐up examination, the incidence of developing new polyps was 46.7% (1 year), 53.9% (2 years) and 73.3% (3 years or more). Patients who received multiple follow‐up examinations showed an average incidence of developing new polyps (polyp positive examinations/total examinations) of 46.9%. With regards to the location and histology of the polyps, there was no difference found between the initial and new polyps. Seventeen colon cancers (14 mucosal, 2 early invasive, 1 advanced) were detected in 16 patients in the follow‐up examinations. The time elapsed from a diagnosis of ‘clean colon’ to a new cancer developing was 1.9±1.0 years. The rate of new pedunculated polyps was found to be significantly low (p <0.01), and their size was significantly smaller (p<0.01) when compared with polyps in the initial early colon cancer. Follow‐up examinations every two years are recommended
Helicobacter pylori Distribution in Human Gastric Mucosa with Chronic, Atrophic Gastritis
Authors: KOHLI Yoshihiro , KATO Takuji , ITO Shigeji , IWAI Makoto , HATA Masanori , YAMAZAKI Yukinao
Published: August 2007

In animals a continuous administration of 0.02% NH3 induced by Helicobacter pylori is well known to lead to glandular atrophy of the gastric mucosa and to induce active, chronic gastritis. In addition, this organism has been demonstrated to be closely related to chronic, active gastritis in man. In the present study, a phenol red dye spraying endoscopy was re‐formed in 54 patients with chronic, atrophic gastritis to elucidate the distribution of this organism in the human gastric mucosa, and to clarify the relationship between its presence and chronic, atrophic gastritis. No red color reaction was found in 12 (92.3%) of 13 patients who had no glandular atrophy of the stomach. A diffuse and/or regional red color reaction was most prominent in those with slight degrees of glandular atrophy of the stomach, and was less striking in those with severe atrophy of the gastric mucosa associated with intestinal metaplasia. In addition, no red color reaction was visible in 14 (87.5%) of 16 patients showing a C0 pattern in the fundic‐pyloric border classification, whereas a diffuse and/or regional red color reaction was observed in over 75% of patients showing C1 ‐O2 patterns and less frequently in those with an O3 Pattern. These data suggest a positive relationship between the presence of this organism and chronic, atrophic gastritis in man.
Turcot's Syndrome: Report of an Adult Case
Authors: MINAMI Takeshi , SHINOMURA Yasuhisa , TARUI Seiichiro , MONDEN Takuji , SHIMANO Takashi , YONEDA Norio , SAKURAI Masami
Published: August 2007

Abstract: This study reports on a non familial case of Turcot's syndrome in a 40‐year‐old man with an astrocytoma (grade II) in the pineal region, colonic polyposis and four adenomas in the gastric antrum. In previous reports, most patients with Turcot's syndrome revealed symptoms until early in the fourth decade of their lives. In most cases, a complete resection of the brain tumors were impossible, and/or colonic polyps had already developed malignant transformation at the time of diagnosis, which led to a poor prognosis. In our case, however, the brain tumor was completely resected and a detailed histological analysis of the polyps in the colectomy specimen revealed no malignant transformation. A good prognosis, therefore, could be expected with a careful follow‐up. In this paper, we compare our case with 50 previous cases of Turcot's syndrome histopathologically confirmed and reported in the literature, with special reference to their gastrointestinal manifestations.
An Alternative Procedure for Endoscopic Sphincterotomy in Patients with Billroth II Gastrectomy
Authors: HASHIBA Kiyoshi , CAPPELLANES Carlos Alberto , D'ASSUNCAO Marco Aurélio , de PAULA Aureo Ludovico
Published: August 2007

An EST was performed on 33 patients with choledocholithiasis and a previous Billroth II gastrectomy according to an alternative technique, using a cannula as a cutting guide. This seems to be an easy and safe technique which may be used in cases in which the deep cannulation of the common bile duct is possible.
Depressed Type Mucosal Cancer of Large Intestine with Converging Mucosal Folds —Report of a Case—
Authors: OZEKI Yutaka , SAIGA Toshio , MATSUBARA Nagaki , KOYAMA Akihiro , HONMA Mitsuo , KOYAMA Noboru
Published: August 2007

Abstract: A case of depressed type mucosal cancer of the large intestine with converging mucosal folds is discussed.

A 71‐year‐old female was admitted to our hospital with melena. A total colonoscopy revealed a type IIa + IIc lesion measuring 1. 5cm in diameter with converging mucosal folds in the transverse colon. An endoscopic biopsy revealed an adenocarcinoma. A diagnosis of submucosal carcinoma was made and a partial colectomy was performed. The resected specimen showed a type IIc + IIa cancer. Histologically, a well differentiated adenocarcinoma which was limited to the mucosa in association with fibrosis in the submucosa was revealed. The submucosal fibrosis was thought to be a cause of the converging mucosal folds.
Induction and Aggravation of Mid‐esophageal Ulcers by Endoscopic Biopsy—Report of a Case—
Authors: IKEDA Masahiro , KIMURA Kiminori , SATO Tadashi , NAKAMURA Toshiya , YAMAMOTO Yasuyuki , FUJINO Masayuki A.
Published: August 2007

Abstract: A 33‐year‐old male was admitted to our hospital with a seven months history of retrosternal pain and odynophagia. On admission the patient could take only liquid or soft diet. An endoscopic examination revealed a mid‐esophageal ulcer. The ulcer was intractable. No known etiological factor of esophagitis was found. A biopsy of the ulcer exacerbated the ulcer and symptoms. Biopsies of normal‐looking esophageal mucosa gave rise to new ulcers at the site of biopsy accompanied by an increase in the symptoms. While these newly formed ulcers healed within 6 weeks, it took an additional 6 months for the primary ulcer to completely disappear. The elimination of hard and hot foods, large boluses, condiments and alcohol from the patient's diet appeared to improve the condition of the ulcer and prevent recurrence. The esophageal mucosa of this patient may have an exaggerated potential to react to mechanical stimulation. Such intractable esophageal ulcers rarely appear in healthy young men and the mechanism of the abnormal reactivity of the esophageal mucosa needs to be clarified.
Clinical Significance of Sterilization of Endoscopic Instrument
Authors: KOHLI Yoshihiro , KATO Takuji , IWAKI Makoto , ITO Shigeji , YAMAZAKI Yukinao , HATA Masanori
Published: August 2007

Abstract:Since the first successful isolation of Helicobacter pylori (H. pylori) from human gastric mucosa, this Organism has been demonstrated to be closely related to chronic, active gastritis and peptic ulcerations. It also promotes glandular atrophy of the gastric mucosa, and adversely affects healing and or relapse of peptic ulcers in man. However, the source of H. pylori infection has remained controversial. In our clinic, AGML developed in 2–3% of patients endoscoped. In some of these patients, phenol red dye spraying endoscopy was performed before and after the test, and H. pylori infection after the preceding endoscopy wm ascertained with the phenol red reaction and in culture.

To prevent H. pylori infection from contaminating endoscopic instruments, several sterilization methods using running water, 70% ethanol, 0.2% benzalkonium chloride and 2% glutaraldehyde were compared. The results obtained showed that sterilization of endoscopic instruments with running water or 70% ethanol was insufficient to eliminate the risk of H. pylori infection, whereas sterilization with 0.2% benzalkonium chloride or 2% glutaraldehyde was sufficient. It was especially important that the biopsy channel was washed with these latter solutions.
Role of Laparoscopy in the Diagnosis of Pancreatic Cancer
Authors: WATANABE Makoto , AKAGI Shuji , UCHIDA Yasushi , KOHGE Naruaki , FUKUMOTO Shiro
Published: August 2007

Abstract: The role of laparoscopy in the diagnosis of pancreatic cancer was evaluated. Twenty two patients who were suspected of having pancreatic cancer, following physical examination, laboratory tests, and imaging techniques, received a laparoscopy at our clinic. The laparoscopic and histological findings were analyzed retrospectively. Eighteen patients in whom the pancreas was observed were laparoscopically diagnosed as having pancreatic cancer, and one other patient from a laparoscopic ultrasonography. Among 14 patients in whom a direct forceps biopsy of the pancreas was done, pancreatic tissue was obtained from 11 patients (78.6%) and cancer was histologically proven in only 3. Liver metastasis were observed in 11 patients, among whom an aimed biopsy to the hepatic lesion was done in 10, and adenocarcinoma was histologically proven in all of these patients. Peritonitis carcinomatosa was confirmed in 4 patients and adenocarcinorna was proven in all of the patients by histology after a punch biopsy to the lesion. Thus, histological evidence of cancer was obtained in 13 out of the 22 patients studied (59.1%).

By doing laparoscopy, histological evidence of pancreatic cancer could be obtained by a less invasive procedure than lapayotomy. Conclusively, laparoscopy seems to be useful in the diagnosis of pancreatic cancer.
A Case of Inflammatory Bowel Disease Accompanied by Myasthenia Gravis
Authors: TAKECHI Keishi , MIHARA Masahiro , SAITO Yoshio , YAMADA Tetsuya , MORIWAKI Hisataka , MUTO Yasutoshi , SHIMOKAWA Kuniyasu , ENDO Junko , TAKEDA Noriyuki , TANABE Hiroshi
Published: August 2007

Abstract: A 62‐year‐old female visited our unit complaining of persisting diarrhea. She underwent a thymectomy for myasthenia gravis (MG) and a thyroidectomy for malignancy at age 58, and she was treated medically for MG fbllowing surgery. She also received a partial ileo‐colectomy because of an intramural suppurative abscess of the terminal ileum at age 60. In her laboratory data, the anti‐acetylcholine receptor antibody and antinuclear antibody were positive, and IgG as well as IgA were a high titer. X‐ray and endoscopic examinations revealed the presence of stiff and narrow lesions accompanied by longitudinal ulcers of the descending colon, and rough and granular mucosa of the rest of the colon and stomach. An elemental diet was not effective, but her condition was relieved by the oral administration of prednisolone. This case was considered a case of inflammatory bowel disease ac‐companied by MG and systemic immunological disorders.
Analysis of Comparative Studies Using Different Contrast Agents for Endoscopic Retrograde Cholangiopancreatography
Authors: CHONG James , BARKIN Jamie S.
Published: August 2007

Abstract: Pancreatitis induced by ERCP ha been associated with numerous pathogenic factors such as a previous history of pancreatitis, acinarization, mechanical and thermal injury, medications, and lastly the type of contrast agent used. Conventional contrast agents are characterized by both ionicity and high osmolality. These traditional agents have demonstrated deleterious effects upon multiple organ systems. Newer contrast agents have been developed with properties of low osmolality and non‐ionicity in efforts to their decrease potential toxic effects, This review analyzes the current literature regarding the role of different contrast agents in the incidence of ERCP related pancreatitis.

Nine randomized, double‐blind, prospective studies have been published comparing low and high osmolality contrast agents for ERCP. Although five studies have shown lower degrees of amylase/lipase elevation after ERCP for the low osmolality agents, only three studies demonstrated a statistically significant advantage for the reduction of clinical pancreatitis among the low osmolality agent groups. In addition, these studies also varied in terms of specific contrast agents used, inclusion and exclusion criteria, rates of acinarization, and definition of clinical pancreatitis. However, after combining all of the data from these studies, there was a statistically significant advantage in reducing ERCP induced pancreatitis for non‐ionic, low osmolality agents (1.44%) compared with the ionic, high osmolality agents (7.39%) [p = 0.007] and the ionic, low osmolality agents (9.67%) [p = 0.0001]. There was no statistical difference between the ionic, high osmolality agents and the ionic, low osmolaltiy agents [p = 0.5481. This data seem to suggest that ionicity rather than osmolality may play a more significant role in the incidence of ERCP induced pancreatitis. The major disadvantage of the use of low osmolality, non‐ionic agents is their relatively high cost. Overall, controversy remains about whether these newer agents should be utilized in all patients or be selectively used in only high risk patients. Presently, we utilize these agents routinely.
Laser Photocoagulation Versus Ethanol Injection Therapy after Preinjection with Epinephrine in the Treatment of Bleeding Peptic Ulcers
Authors: YANG Suk‐Kyun , KIM Hae‐Ryun , MIN Young‐II
Published: August 2007

Abstract: A prospective, randomized trial was performed to compare the efficacy of Nd: YAG laser photocoagulation (LP) and absolute ethanol injection therapy (AEIT) in the treatment of peptic ulcer bleeding. Of 396 patients who underwent endoscopy for acute gastrointestinal hemorrhage over a 18‐month period, 185 were found to have peptic ulcers. The patients who had an ulcer with active bleeding (n = 25) or with a nonbleeding visible vessel (n = 35) were randomized to receive either LP (n = 29) or AEIT (n = 31). The two treatment groups were comparable in terms of age, severity of bleeding, site of ulcer, and endoscopic stigmata of recent hemorrhage. There were no significant differences between the LP and AEIT groups in terms of their transfusion requirements after treatment (0.6 ±1.0 vs. 0.5±0.9 unit), rate of initial hemostatic failure or rebleeding (13.8 vs. 9. 7%), emergency surgery (0 vs. O%), median hospital stay (6 us. 8 days), and mortality (0 us. 6.5%). All of the seven patients who rebled received a second session of endoscopic therapy with the other modality and bleeding was controlled. The cause of death in the two expired patients was not related to bleeding. We concluded that LP and AEIT are equally effective in the treatment of peptic ulcer bleeding but AEIT may be preferred over LP because of its simplicity and lower cost.
A Case of Rectal Carcinoma in a Part of a Giant Periproctal Abscess
Authors: KOBAYASHI Hirohisa , NARUMI Hiroyuki , SORIMACHI Jinichi , TEI Yoshihiro , HASEBE Tetsunori , SHIRAI Takayuki , KIKUCHI Kazuhiro , HARASAWA Shigeru , MIWA Takeshi , ISHIDA Hideki , YASUDA Seiei , KIJIMA Hiroshi
Published: August 2007

Abstract: A 58‐year‐old male was admitted to our hospital complaining of perineal pain and weight loss. On digital examination, a hard mass with a central depression was palpable in the circumference of the rectum. A barium enema study revealed a giant periproctal abscess formation, and a colonoscopy showed a giant irregular‐shaped ulceration in the circumference of the rectum. Biopsy specimens obtained from the rectal ulcer revealed a well differentiated adenocarcinoma, and this case was diagnosed as being carcinoma of the rectum with periproctal abscess formation. A pelvic exenteration and colostomy were performed. The macroscopic findings of the resected rectal specimen showed a giant abscess formation measuring 13 cm over the anal verge in the circumference of the lower rectum. The abscess, with a thickened wall measuring 50 mm, was accompanied by an ulcerated lesion on its oral and anal side. The tumor was adherent to the bladder and prostate with direct invasion. The post operative diagnosis made was an unclassified type of rectal carcinoma (type 5). Its clinical staging was stage 5 (HIPON1A3) in gross appearance. The histopathological findings of the resected specimen indicated a poorly differentiated adenocarcinoma partly containing signet ring cell carcinoma. The frequency with which a rectal carcinoma with a regional abscess has been reported is less than 1%. It has been assumed that a regional abscess is caused by the perforation of the rectum contributing with the invasion of carcinoma over the proper muscle layer. In this case, it was inferred that the rapid development of this tumor caused secondary, ischemia at its center and then an abscess was formed with tumor necrosis.
A Case of Turner's Syndrome with Crohn's Disease
Authors: BAMBA Tadao , HASHIGUCHI Masahiro , DOI Hisakazu , SASAKI Masaya , KOYAMA Shigeki , FUJIYAMA Yoshihide , NAKAJO Shinobu , HOSODA Shiro , CHIKAMOCHI Nobuo
Published: August 2007

Abstract: A case of Crohn's disease that developed during the follow‐up of Turner's syndrome is presented in this paper, together with references to the literature. This case had a mosaic pattern (45X46Xi (Xq)) in chromosomal analysis and BW52, DR2 in HLA typing with autoantibodies.
Follow‐up Study of Early Colorectal Cancer After Endoscopic Resection
Authors: IGARASHI Masahiro , KATSUMATA Tomoe , NAITHO Yoshitaka , KOBAYASHI Kiyonori , OHHARA Akihiko , SAIGENJI Katsunori , MITOMI Hiroyuki , ATARI Eio
Published: August 2007

Abstract: This study was conducted to determine the significance of long‐term follow‐up observation of early colorectal cancer following endoscopic resection. The subjects included 100 patients who had undergone early colorectal cancer resection by endoscopic polypectomy with prior injection of the base (73 patients with mucosal carcinoma (m cancer), 24 Patients with submucosal carcinoma (sm cancer), and 3 patients with multiple early colorectal cancers. Posttherapeutic observation was carried out by endoscopy. The results were, briefly, as follows: 1) No cases of local recurrence or metastasis were observed during the follow‐up observation period for up to a period of 14 years. 2) 3 cases (3%) of metachronous carcinoma were detected, 2 of these patients had early carcinoma and 1 had advanced carcinoma. The mean period which elapsed before the detection of metachronous cancers was 35.0 ± 15.3 months. 3) The incidence of adenoma during the follow‐up period was 40%, the frequency of newly detected adenoma was relatively high among the patients with coexisting adenoma at the time of treatment for early carcinoma and among the elderly patients aged 60 years or over, 4) No cancer was detected after establishing a clean colon, and the incidence of adenoma in such cases was relatively low, i. e., 14.5%. The mean period of time which elapsed until the detection of the adenoma was 24.4 ± 18.0 months. The results of this study indicated that endoscopic examination is necessary and useful for surveillance of local recurrence or metachronous carcinoma as well as the detection of adenoma.
Gastric Mucosal Injury by Transendoscopic Compressed Air Delivery of Powdered NaCl, KCl or NSAIDs in Dogs
Authors: HOSHINO Teruo , ENDO Toru , KUSAKARI Koji , ISHIDA Masashi
Published: August 2007

Abstract: Seven kinds of NaCl, KCl, aspirin, indomethacin, diclofenac sodium, lactose and sucralfate, all in powder form, were administered by an endoscopic compressed air drug delivery system, in doses of 25 mg each, to specific target sites of the gastric mucosa of dogs. Changes in the gastric mucosa were endoscopically observed. When NaCl, KCl and aspirin were administered, mucosal lesions were observed but were limited to the target site of the gastric mucosa. Indomethacin (2/7 dogs) and diclofenac sodium (3/7 dogs) were observed to induce superficial gastritis at the pyloric antrum but did not induce gastric mucosal lesions at the target sites. In addition, no lesions were induced by either lactose or sucralfate.

In the present study, it was possible to induce an experimental gastric mucosal lesion at the target site of the gastric mucosa by administration of a small amount of powdered drugs via an endoscope and compressed air. The administration of the powdered drugs by endoscopy is useful for investigation of the direct effects of drugs such as aspirin, NaCl and KCl on the gastric mucosa. Furthermore, this method is applicable in order to investigate and develop drugs (such as sucralfate) for direct therapy of gastric mucosal lesions.