bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Poorly Differentiated Early Adenocarcinoma of the Stomach Forming a Protruded Type Lesion
Authors: SAKANE Masayoshi , KASHIWAGI Ryoichi , MITSUTSUJI Masaaki , YASUDA Takeo , TAKAHASHI Tsuyoshi , SHINMARU Hiroshi , TANIOKA Yasuki , TABATA Tomomi , TABATA Fumihira , UEDA Yoshihiko , FUJIMORI Takahiro
Published: December 2007

Abstract: A case of poorly differentiated adenocarcinoma (undifferentiated type by Nakamura, diffuse type by Lauren) of the stomach infiltrating the submucosa and forming a protruded type lesion is reported. A 60‐year‐old man underwent endoscopic examination, which revealed a protruded type lesion with a nodular configuration and shallow ulceration accompanied by slough along the greater curvature of the upper gastric body, which was proved to be poorly differentiated adenocarcinoma by endoscopic biopsy. The patient underwent radical surgery, consisting of total gastrectomy with pancreato‐splenectomy. Macroscopic observation of the resected specimen revealed a protruded type lesion, measuring 30 mm in diameter, in the fundus along the greater curvature. The surface of the lesion had an irregular and nodular configuration with erythema and superficial erosions. Although, in the setting of early gastric cancer, poorly differentiated adenocarcinomas are usually macroscopically depressed or ulcerated type, this case presented a protruded type lesion (polypoid type). We report this unusual case because of its extremely important implications in the discussion of gastric cancer therapy.
A Case of Esophagitis Associated with Stevens‐Johnson's Syndrome
Authors: GOMI Hiroko , MIMURA Harumi , SHIOJIMA Junko , KOYANAGI Mituhito , MINAGAWA Yasutaka , ARIMURA Takashi , KUROSAWA Susumu , YAKABI Koji , MASTUO Isturo , NAKAMURA Takashi
Published: December 2007

Abstract: Stevens‐Johnson's syndrome (SJS) is a severe type of erythema multiforme with involvement of the mucous surfaces of the mouth, nose and conjunctiva. Although various complications have been described, reports of digestive tract lesions associated with SJS are rare. A 21‐year‐old woman developed erythematous lesions on the limbs three days after receiving antibiotic and anti‐inflammatory agent treatment for common cold‐like symptoms. On initial consultation at our hospital, endoscopy was performed to investigate the cause of a disagreeable sensation in the esophagus and mucosal exfoliation of a white membrane‐like substance was recognized as involving the entire esophagus. Sporadic white mucosal protrusions were also observed, suggesting exfoliative esophagitis. No abnormal findings were noted in the stomach or duodenum. After admission, the skin lesions rapidly expanded to involve the entire body including the mucous membranes of the lips, oral cavity, conjunctiva and vulva. Nikolsky's sign was positive. A diagnosis of SJS was made and systemic corticosteroid administration was initiated. Both the esophagitis and the skin lesions improved within 2 months of starting treatment. Esophageal lesions constitute a relatively rare manifestation of SJS, and only 10 cases have been reported in the international literature.
Photographic Monitoring under Intravenous Sedation
Authors: ITO Toshio , NIIYAMA Gouichi , KAWANAKA Miwa , YAMADA Gotaro , HASEGAWA Akira , TAKAGUCHI Kouichi , KOJYO Kenji , SHIMOE Toshinari
Published: December 2007

Abstract: To reduce the time and patient discomfort associated with laparoscopy, intravenous administration of a hypnotic sedative and photographic monitoring were used. The time needed to complete laparoscopy was reduced from 39 ±7 to 35 ±6 min with use of the monitoring equipment. Questionnaires completed by 66 patients revealed 64 (97.0%) to have virtually no memory of pain caused by the intravenous anesthesia during laparoscopy, and 54 (81.8%) requested intravenous anesthesia for the next laparoscopy. The photographs taken were of excellent quality. Intravenous anesthesia and the use of photographic monitoring were found to be useful means of reducing patient discomfort and facilitating performance of the procedure.
Pulsatile Wave in Esophageal Wall Blood Vessels after Endoscopic Therapy for Esophageal Varices
Authors: SATO Takahiro , YAMAZAKI Katsu , TOYOTA Jouji , KARINO Yoshiyasu , OHMURA Takumi , SUGA Toshihiro
Published: December 2007

Abstract: This study was designed to evaluate the clinical significance of the pulsatile wave in esophageal wall blood vessels after endoscopic therapy using endoscopic color Doppler ultrasonography (ECDUS) in 53 patients with esophageal varices. Ten of the 53 had recurrent intramucosal venous dilatation (F0 type) of the esophagus, four of F3 type and 39 of F2 type. The endoscopic therapy techniques used in this study included endoscopic injection sclerotherapy (EIS) and heat‐probe coagulation treatment (HPT) in 23 cases, endoscopic variceal ligation (EVL), EIS and HPT in 14, EVL and HPT in six, and HPT only in ten. The pulsatile wave in esophageal wall blood vessels was delineated in 10 of 53 (18.9%) patients using ECDUS after endoscopic therapy. Herein, we describe the ECDUS findings of pulsatile wave‐positive cases. The esophageal wall was thickened yielding a low echoic pattern, and the pulsatile wave in blood vessels was delineated by color flow from the extra to the intra‐esophageal wall in all patients. We calculated the maximum velocity (Vmax), minimum velocity (Vmin) and pulsatility index (PI). Vmax of the pulsatile wave in blood vessels was found to be 9.7–24.0cm/sec (16.9±4.8cm/sec), Vmin 3.0–14.3cm/sec (5.6±3.4cm/sec), and PI 0.81–1.72 (1.33±0.28). We also investigated the prognosis of pulsatile wave‐positive patients. Esophageal varices recurred in two of the 10 cases. The PI of these cases were 0.81 and 0.98. There was no recurrence of esophageal varices in cases with PI values over 1.0.
Studies on Vascular Endothelial Cell Damage by Polidocanol in Relation to Concentration, Ethylene‐oxide Chain Length and Exposure Time
Authors: SHIMADA Hideo , MAKUUCHI Hiroyasu , MACHIMURA Takao , CHINO Osamu , TANAKA Hikaru , INOKUCHI Sadaki
Published: December 2007

Abstract: In sclerotherapy for esophageal varices, the mechanism of intravariceal thrombus formation produced by a sclerosant (polidocanol, ethanolamine oleate, etc) is thought to be endothelial cell damage.

Polidocanol (polyoxethylene monododecyl ether) has an average ethylene oxide chain length of 9 (ñ= 9) and is a non‐ionic surfactant. The extent of vascular endothelial cell damage is thought to be dependent on (1) the concentration (%) of polidocanol, (2) the length of ethylene oxide chains(n), and (3) the duration of exposure of endothelial cells to the sclerosant. Using these parameters, we evaluated the efficacy of sclerotherapy in two experimental systems employing cultured human endothelial cells and canine mesenteric veins. As the sclerosant concentration was increased, the extent of cell damage became greater, suggesting that thrombus formation can be more effectively induced with a higher concentration of sclerosant. As for the length of the ethylene oxide chains, a sclerosant with ñ=12 showed markedly reduced cytotoxicity as compared to those with ñ= 6 and ñ= 8. Cytotoxicity increased in proportion to the duration of exposure to the sclerosant, suggesting that exposure time is a key determinant of vascular endothelial cell damage. From these results, it is concluded that sclerotherapy for esophageal varices will be more effective if a high concentration of sclerosant is used for large varices with high blood flow, provided that a suitable ethylene oxide chain length is used and that the sclerosant is retained in the varices for 30–60 seconds.
Upper Gastrointestinal Irritation and Arrhythmia
Authors: KONG Xianming , ZHAO Xianchun , ITAKURA Masaru
Published: December 2007

Abstract: The influence of endoscopic examination on the occurrence of arrhythmia was investigated electrocardiographically in 30 patients with cardiovascular disease who underwent transesophageal echocardiography (TEE) (group A) and 38 patients with digestive tract disease who underwent upper gastrointestinal endoscopy (UGIE) (group B). The mode and frequency of arrhythmia during the examination were compared between the two groups. (1) Arrhythmia was more frequently observed in group A (22 of 30, 73.3%) than in group B (9 of 38, 23.7%) patients (p<0.001). The common arrhythmias in both groups were supraventricular premature beat and ventricular premature beat. Serious arrhythmias, such as 2nd degree atrioventricular block and ventricular fibrillation were detected only in group A patients. (2) The region of the esophagus where the tip of the probe or scope was located was classified into three segments: upper (0–15 cm), middle (15–35 cm) and lower (35 cm<). Arrhythmias tended to be frequent when the tip of the probe or scope was located in the middle segment of the esophagus. These data indicate that arrhythmias observed during TEE or UGIE are related to the underlying heart disease. Furthermore, the middle segment of the esophagus appears to be particularly susceptible to the provocation of arrhythmia.
Endoscopic Mucosal Resection (EMR) of Early Gastric Cancer
Authors: CHONAN Akimichi , MOCHIZUKI Fukuji , ANDO Masao , ATSUMI Minoru , MISHIMA Toshiyuki , FUJITA Naotaka , YUKI Toyohiko , ISHIDA Kazuhiko
Published: December 2007

Abstract: We conducted this study to clarify the effectiveness of aspiration endoscopic mucosal resection (EMR) using a cap‐fitted scope for early gastric cancer in the C and M regions of the stomach. EMR was performed in 111 early gastric cancer patients with 123 lesions in the C and M regions. The patients were divided into three groups. The EMR‐1CS group consisted of patients who had undergone EMR with a one‐channeled scope, the EMR‐2CS group those who had received EMR in which a two‐channeled scope was utilized. The EMRC group consisted of patients who had undergone aspiration EMR with a cap‐fitted scope.

The rate of complete resection improved to a statistically significant degree in the EMRC group in comparison with that in the EMR‐1CS group. In type lie, a statistically significant improvement was achieved in the EMRC group in comparison with the EMR‐2CS group. In the M region or in lesions 10 mm or less in diameter, the rate of complete resection improved in the EMRC group as compared with that in the EMR‐2CS group. Our results suggest that EMRC is useful for lesions of early gastric cancer in the C and M regions.
A Case of Postbulbar Duodenal Ulcer with Jaundice
Authors: MAEKAWA Takeo , YABUKI Kiyotaka , SATO Koichi , HABA Takanori , OGAWA Kaoru , MATSUMOTO Michio
Published: December 2007

Abstract: A 63‐year‐old man was hospitalized because of jaundice and anorexia. An upper gastrointestinal series and hypotonic duodenography revealed circumferential sclerosis and stenosis of the duodenal wall. Endoscopic examination disclosed an ulcer, the upper margin of which was located at the papilla of Vater. The papilla was situated in the base of the ulcer. Endoscopic retrograde cholangiopancreatography disclosed mild dilatation of the common bile, intrahepatic bile and pancreatic ducts, but with neither severe stenosis nor occlusion. Nevertheless, there was some degree of circumferential compression and mild stenosis of the terminal portions of the bile and pancreatic ducts, as potential causes of obstructive jaundice in this patient. Computed tomographic examination of the abdomen revealed a tumorous lesion at the duodenal bulb. Because malignancy in the duodenum could not be ruled out, a pancreatoduodenectomy was performed. Histopathological examination showed a postbulbar duodenal ulcer, associated with inflammation of the papillary orifice and fibrosis of the region near the papilla. There was no evidence of a tumorous lesion. In this case, a postbulbar duodenal ulcer may have caused obstructive jaundice.
Report of a Case of Mucoepidermoid Carcinoma of the Esophagus
Authors: MURAKAMI Masahiko , SHIMIZU Yoshinori , KAMEYAMA Hideto , FUKOE Yoshihiro , KAMEYAMA Shinichirou , KUSANO Mitsuo
Published: December 2007

Abstract: We report a very rare case of mucoepidermoid carcinoma (MEC) of the esophagus. The patient was a 47‐year‐old man with a tumor of the submucosal type, associated with erosion on its top in the mid‐esophagus, detected by esophagoscopy. The lesion was stained with 3% iodine solution, but the site of the erosion was not. Endoscopic ultrasonography revealed a hypo‐echogenic tumor located mainly in the submucosal layer, preserving the muscle coat intact. Distal esophagectomy with esophago‐gastrostomy was performed via the retrosternal route. Microscopic study revealed the lesion to be compatible with a mucoepidermoid cancer (O‐l sep type, sm massive invasion, Iy2, v0, n3 (+) based on the classification of the Japanese Society of Esophageal Diseases). The diagnosis of MEC is very difficult, because this lesion grows and develops like a submucosal tumor. Considering this feature of MEC, endoscopic ultrasonography must be carried out for small submucosal tumors of the esophagus in order to detect MEC. Clarification of the endoscopic ultrasonographic characteristics of MEC is eagerly awaited.
A Case of Duodenal Carcinoid Tumor Associated with Carcinoma of the Head of the Pancreas
Authors: SATO Koichi , MAEKAWA Takeo , YABUKI Kiyotaka , ANDO Takao , MATSUMOTO Michio
Published: December 2007

Abstract: We describe a case of duodenal carcinoid tumor associated with carcinoma of the head of the pancreas. The patient was a 77‐year‐old man who was admitted to our hospital with jaundice and pruritus cutaneous. Carcinoma of the head of the pancreas was diagnosed on the basis of findings obtained by abdominal computed tomographic scan and endoscopic retrograde cholangiopancreatography. Upper gastrointestinal endoscopy revealed a protrusive hemorrhagic lesion with a flushed surface and a diameter of about 1 cm in the anterior wall of the duodenal bulb. On May 25, 1996, pancreaticoduodenectomy was performed. On histopathological examination, this carcinoma of the pancreatic head was found to be a well‐differentiated tubular adenocarcinoma. Immunohisto‐chemically, the protrusive lesion in the duodenal bulb stained positive for chromogranine and IMSB and was slightly positive for S‐100 protein. It was also slightly positive on Grimelius staining and negative on Masson‐Fontana staining. These findings led to a diagnosis of carcinoid tumor arising from the anterior intestinal line.
Superficial Epithelium in the Biopsied Sections Taken from Malignant Bile Duct Stenosis
Authors: SATO Masahiro , UKITA Takeo , ISHIGURO Jun , OGAWA Satoshi , MAETANI Iruru , IGARASHI Yoshinori
Published: December 2007

Abstract: Although percutaneous transhepatic cholangioscopy (PTCS) with biopsy is useful for the diagnosis of superficial spreading carcinoma of the bile duct, sections of biopsy specimens sometimes do not contain superficial epithelium. We sought to clarify the factors influencing the presence of superficial epithelium in biopsy specimens in a retrospective microscopic analysis of 168 hematoxylin and eosin‐stained sections of specimens from 54 patients with malignant bile duct stenosis. We correlated the presence of superficial epithelium with various factors using logistic regression analysis. Factors examined were whether the site was stenotic, the mucosal pattern at the biopsy site (papillo‐granular or smooth), specimen size, and whether the biopsy specimen was the first one taken at that same site. Bile duct tissues were present in 165 of 168 specimens (98%), and 93 (55%) contained superficial epithelium. By logistic regression analysis, mucosal pattern and order of biopsy at the same site were significantly related to presence of superficial epithelium on the histologic section (odds ratio with papillogranular mucosal pattern, 6.082; with first biopsy at the site, 2.628). Therefore, it is important to carefully choose biopsy forceps and to take multiple specimens at various sites to obtain superficial epithelium, especially with the smooth bile duct mucosal pattern.
Usefulness and Limitations of Endoscopic Ultrasonography in Diagnosis of Adenomyomatosis of the Gallbladder
Authors: MUGURUMA Naoki , OKAMURA Seisuke , BANDO Terumi , ICHIKAWA Soichi , SOGABE Masahiro , TAOKA Satoko , TSUTSUI Akemi , OKITA Yoshio , FUKUDA Tamotsu , HAYASHI Shigehito , YASUDA Mitsugi , OKAHISA Toshiya , SHIBATA Hiroshi , ITO Susumu
Published: December 2007

Abstract: Although endoscopic ultrasonography (EUS) is commonly used to examine lesions in the gallbladder, its ability to accurately diagnose adenomyomatosis (ADM) has not been evaluated. We compared the accuracy of EUS and various other imaging techniques in the diagnosis of ADM. Thirty‐one patients undergoing cholecystectomy after elevated lesions were found in the gallbladder by various imaging techniques were studied retrospectively. Based on histopathologic examination, the sensitivity and specificity of EUS were evaluated in ADM. The sensitivity of abdominal ultrasonography, CT and ERCP in ADM were also evaluated. Of the 11 patients diagnosed with ADM by EUS, 9 cases were confirmed histologically (81.8%). Of the 11 patients with histologic diagnosis of ADM, 9 were accurately diagnosed preoperatively by EUS (81.8%). EUS proved more reliable for diagnosis of ADM than the other imaging techniques. Important diagnostic features include preservation of the three‐layered structure of the gallbladder, wall‐thickening exceeding 3 mm, and 2 or more Rokitansky‐Aschoff sinuses occurring within a 1 cm area of the gallbladder.
New Classification for the Accessory Pancreatic Duct by ERP
Authors: KAMISAWA Terumi , TU Yuyang , EGAWA Naoto , SAKAKI Nobuhiro , ISHIWATA Jun-ichi , OKAMOTO Atsutake
Published: December 2007

The head of the pancreas is formed embryologically from two anlage. The pancreatic duct system in the head is a complex structure. We devised a new classification for the accessory pancreatic duct (APD) based on the junctional point of the APD and the main pancreatic duct (MPD) in addition to the shape of the APD, which was found to be applicable to most cases. We reviewed 385 random endoscopic retrograde pancreatograms of normal pancreatic head of the pancreas which demonstrated satisfactory imaging of the entire APD. All accessory duct pancreatograms could be classified into four types according to the length of the MPD from the orifice to the junction with the APD, as well as the shape of the APD. The APD joined with the MPD at the neck portion in the long type, between the first inferior and superior branches of the MPD in the intermediate type, and near the first inferior branch of the MPD in the short type. The APD had an arched course over the MPD in the ansa type. The APD of the long type frequently exhibited a straight course from the upper dorsal pancreatic duct, representing a persistent main drainage duct of the dorsal pancreatic primordium. This novel clasification may be adapted to most cases and may reflect the embryogenesis of the APD.
Treatment of Chronic Gastric Volvulus by Percutaneous Endoscopic Gastrostomy
Authors: JOSHI Mohan A. , DEWOOLKAR Vinayak , SUBRAMANYAN Prabhakar , SHIRAHATTI Rajendra , CHANGLANI Tikamdas
Published: December 2007

Five adult cases of chronic gastric volvulus were treated by percutaneous endoscopic Gastrostomy (PEG) between October 1992 and September 1997. Four cases were organoaxial volvulus and one was mesentericoaxial volvulus (Fig. 2). Diagnosis of volvulus was made by upper Gl barium examination. The volvulus was reduced endoscopically and fixed by PEG using an indigenous PEG catheter. The tube was kept for 6 to 8 weeks. All patients were found to be asymptomatic at 3 months after removal of their PEG catheter. Barium examination revealed no recurrence. There was no procedure‐related mortality. PEG is a safe and effective method for treating chronic gastric volvulus.
Percutaneous Microwave Coagulation Therapy Using Cholangioscopy for Recanalizing Self‐expanding Metallic Stents Occluded by Tumor Ingrowth: Preliminary Results
Authors: MAETANI Irum , INOUE Hirokazu , OGAWA Satoshi , SATO Masahiro , IGARASHI Yoshinori , SAKAI Yoshihiro
Published: December 2007

Current ablative techniques for recanalizing self‐expanding metallic stents occluded by tumor ingrowth are limited by the risk of perforation or destruction of the stent filament. A previous experimental study revealed that microwave coagulation therapy for recanalizing occluded metal stents would be safe and effective, and we investigated the clinical application of this procedure. In this in vivo study, microwave coagulation therapy was performed for occluded metallic stents in 5 patients with pancreatic cancer and one patient with gallbladder cancer. This procedure was performed under percutaneous cholangioscopy and fluoroscopic control. Cumulative stent patency before and after microwave coagulation was estimated using the Kaplan‐Meier method supplemented with the log‐rank test. Tumor growing through the stent mesh was successfully removed without any complications using this technique. Analysis of stent patency did not reveal any significant difference between one session of coagulation therapy (115.0±18.4 days) and initial stent (102.3±.22.3 days). In contrast, none of the group after two sessions of this intervention was obstructed until their death. The results indicated that microwave coagulation therapy for recanalizing occluded metallic stent is effective and safe even in vivo. This procedure may be an alternative to placement of another stent through the occluded metallic stent. (Dig Endosc 1999; 11: 209–214)
Assessment of Underlying Blood Vessels in Gastric Ulcers with Bleeding Episode by Endoscopic Color Doppler Ultrasonography
Authors: YOSHINO Junji , NAKAZAWA Saburo , INUI Kazuo , YAMACHIKA Hitoshi , WAKABAYASHI Takao , OKUSHIMSA Taketo , KOBAYASHI Takashi , NISHIO Hiroshi
Published: December 2007

We used endoscopic color Doppler ultrasonography to detect hemorrhagic gastric ulcer, and to determine whether this modality could show blood vessels present deep to ulcers and whether these vessels influenced clinical course. Subjects were 20 patients with hemorrhagic gastric ulcers which had visible vessels on the ulcer base endoscopically. In 11 of 20 patients (group P) color signals indicating blood flow were observed, in which a weak pulsatile wave was detected in five cases. In two operated cases the signals were confirmed as blood vessels histologically. The diameters of these vessels were over 0.35 mm. It was thought that in cases undetectable on endoscopic color Doppler ultrasonography (group N) the diameter of vessels was too narrow or the velocity of blood too slow. There were no differences in the clinical background of group P and group N. However, ulcer bleeding was more severe in group P cases (P<0.05). Many patients in whom blood flow was detected experienced repeated ulcer bleeding as well as ulcer recurrences. Patients with hemorrhagic ulcers and in whom ultrasonic imaging demonstrates blood flow should be managed with great care. (Dig Endosc 1999; 11: 231–235)
Small Cell Carcinoma of the Gallbladder Arising in a Patient with Pancreaticobiliary Maljunction without Bile Duct Dilatation
Authors: SAITO Seiji , ATARASHI Yoshinari , WATANABE Akiharu , KITAGAWA Masanobu
Published: December 2007

We report a 36–year‐old female patient with small cell carcinoma of the gallbladder with liver metastasis, that was associated with pancreaticobiliary maljunction (PBM) without bile duct dilatation. On admission, a gallbladder mass and multiple liver tumors were detected by US, CT and ERCP. Moreover, ERCP clearly demonstrated an abnormally long common channel between the pancreatic and bile ducts, indicating PBMwithout choledochal dilatation. US‐guided biopsy of the tumor histopathologically confirmed small cell carcinoma. The serum neuron‐specific enolase (NSE) level was very high. Transarterial chemo‐embolization followed by systemic chemotherapy resulted in marked tumor reduction, but this was followed by rapid exacerbation. The patient died of the tumor 145 days after admission. The proposed mechanism of the car‐cinogenesis of this rare gallbladder malignancy under the preexisting condition of PBM was discussed. (Dig Endosc 1999, 11: 246–249)
Crohn's Disease Initially Suggested by Minute Esophageal Erosions—Report of a Case
Authors: ENDO Tetsu , SATO Hirohiko , KOEDA Junichi , TAKAHASHI Osamu , HAGA Yohichi , SATOH Toshinobu , CHIBA Yoichi , MATSUMOTO Kazuhito , MUNAKATA Akihiro
Published: December 2007

A 19–year‐old woman visited our hospital complaining of fever and epigastral‐gia. Upper gastrointestinal endoscopy showed minute discrete erosions surrounded by elevated mucosa about one millimeter in diameter in the esophagus and aphthoid erosions in the stomach. Biopsy samples obtained from the esophagus showed non‐caseating epitheloid granulomas, suggesting Crohn's disease. Colonoscopy showed a small erosion in the cecum adjacent to the vermiform appendix and biopsy showed non‐caseating epitheloid granulomas and Crohn's disease was diagnosed. In hospital, she was treated with elemental diet and 5–aminosalicyclic acid. Clinical symptoms disappeared rapidly and laboratory data became normal. We thus report a rare case of early‐stage Crohn's disease initially indicated by biopsy of minute esophageal erosions. (Dig Endosc 1999; 11: 255–258)
Reflected Illumination‐Type Imaging System for the Development of Infrared Fluorescence Endoscopy
Authors: TAOKA Satoko , ITO Susumu , MUGURUMA Naoki , HAYASHI Shigehito , KUSAKA Yoshihiro , II Kunio , NAKAMURA Kazunari , IMAIZUMI Katsuichi , TAKESAKO Kazuhiro , SHIBAMURA Seiichi
Published: December 2007

Fluorescent labeled monoclonal antibodies against carcinoembryonic antigen (CEA) may provide a specific label for lesions of the GI tract. We previously developed an indocyanine green (ICG) derivative (ICG N‐hydroxy sulfo succinimide ester; ICG‐sulfo‐Osu) as a fluorescent label that is excited by infrared rays and is suitable for vital immunohistochemical staining. We also previously developed a transmitted illumination‐type (transmitted type) fluorescence imaging system that uses infrared rays to detect ICG‐sulfo‐Osu. In this paper we describe a new reflected illumination‐type (reflected type) imaging system for infrared fluorescence endoscopy. We tested the efficacy of this system on sections of human esophagus and normal skeletal muscle stained with ICG‐sulfo‐Osu labeled anti‐epithelial membrane antigen (EMA) antibody, and on sections of human gastric cancer tissue stained with ICG‐sulfo‐Osu labeled anti‐CEA antibody. Infrared fluorescent images were obtained with both fluorescent antibodies, and results correlated well with oxidized DAB‐positive sites. Vital immunohistochemical staining of micro cancers should be detectable by exciting an ICG‐sulfo‐Osu labeled antibody specific to the tumor cells with infrared rays, using this reflected type imaging system.
Esophageal Lyrnphoepithelial Cyst: The First Reported Case
Authors: KATAOKA Shinichi , CHIKUGO Takaah , HIROOKA Takashi
Published: December 2007

We report a case of esophageal lymphoepithelial cyst that was found and resected with endoscopy. To our knowledge this is the first ever description of lymphoepithelial cyst in the esophagus. A 69‐year‐old man presented with dysphagia and the endoscopic study showed a submucosal tumor in the upper esophagus. The resected tumor was found to be composed of epithelial cysts surrounded by lymphoid tissue. The esophageal gland had continuity with the cyst wall and there was lymphocytic infiltration in the cyst wall. These findings suggest that the esophageal lymphoepithelial cyst had arisen from the dilated esophageal gland with reactive lymphoid aggregation.
Reversal of Portosystemic Encephalopathy after Endoscopic Embolization of Recurrent Gastroesophageal Varices
Authors: CHIKAMORI Fumio , KUNIYOSHI Nobutoshi , SHIBUYA Susumu , TAKASE Yasuhiro
Published: December 2007

Chronic portosystemic encephalopathy (CPSE) due to a shunt via gastroesophageal varices is uncommon. We were able to control a case of CPSE due to recurrent gastroesophageal varices using endoscopic embolization (EE). A 68‐year‐old man presented at our hospital in a confused, apathetic and tremulous state. He had undergone devascularization, proximal gastric transection and splenectomy for esopha‐geal varices due to liver cirrhosis 16 years previously. The patient had hyperammone‐mia (228 µg/dl), and endoscopic examination revealed nodular cardiac varices and large recurrent esophageal varices. Superior mesenteric arterial portography revealed that a large volume of superior mesenteric venous blood drained into the cardiac and esophageal varices through the remnant left gastric vein. The plasma ammonia level in the esophageal varices taken at the time of EE was 419 pg/dl, which was a much higher level than that of peripheral vessels, the superior vena cava and azygos vein, and suggested that the encephalopathy was due to the portosystemic shunt via the gastroesophageal varices. EE was performed using 5% ethanolamine oleate with iopamidol under fluoroscopy. The esophageal and cardiac varices were successfully embolized, the CPSE disappeared, and the plasma ammonia level decreased to 27 pg/dl. No complications were observed, and the patient was discharged on day 37 after EE. We conclude that EE is an effective and safe treatment for CPSE due to gastroesophageal varices.
A Case of a Giant Lipoma of the Duodenal Bulb
Authors: OGATA Tatsuro , SHIMIZU Ichiro , HORIE Takahiro , OSHIMA Takashi , MIHARA Miyuki , YAMASHITA Masatoshi , OZAKI Yuji , YAMAMOTO Koji , IUCHI Arata , YATA Seigo , TADATSU Masaya , OKITA Yoshio , MUGURUMA Naoki , OKAHISA Toshiya , OKAMURA Seisuke , ITO Susumu
Published: December 2007

We describe a 58‐year‐old male whose major complaint was epigastric pain. A pediculate mass located in the anterior wall of the duodenal bulb and extending into the descending portion of the duodenum was noted on endoscopy of the upper digestive tract. The mass nearly completely occupied the duodenal lumen and was covered by normal mucosa with a tiny ulcer. Ultrasound endoscopy showed a nearly homogeneous hyperechoic pattern localized in the submucosa, and abdominal CT showed fatty density, suggesting a lipoma. The mass was resected by laparotomy, because it was large and extended to near the duodenal papillae. The tumor measured 55X35X30 mm and was histologically confirmed to be a lipoma which had originated in the submucosa. Giant duodenal lipomas more than 50 mm in maximum diameter have only been reported in 5 cases in Japan including our present case and 9 cases abroad, but some differences were observed in the description of the Japanese cases versus the non‐Japanese cases, such as the fact that the non‐Japanses cases often presented with severe symptoms such as bloody stools and intussusception.
A Case of Penetration of the Large Intestinal Wall by a Toothpick
Authors: OSHIMA Takashi , SHIMIZU Ichiro , HORIE Takahiro , OGATA Taturo , FUJIMOTO Miyuki , OZAKI Yuji , YAMAMOTO Koji , IUCHI Arata , ITO Susumu
Published: December 2007

A 66‐year‐old man was admitted to hospital with symptoms of acute abdomen. Based on colonoscopic findings, localized peritonitis due to penetration of the sigmoid colon by a toothpick was diagnosed. During colonoscopy, the toothpick was removed using a grasping forceps, meaning that surgery was avoided. In cases where abdominal pain of unknown origin is observed, physicians should proceed with routine medical care while considering the possibility of foreign body ingestion, and work toward an early diagnosis.
Solitary Metastatic Malignant Melanoma of the Small Intestine: Findings Obtained during Intraoperative Enteroscopy
Authors: MIZUNO Mitsuru , IIDA Mitsuo , MATSUMOTO Takayuki , INOUE Shigeo , HOSHIKA Kazunori , SHIMIZU Michio , TSUNODA Tsukasa
Published: December 2007

Abstract: A 59‐year‐old male with an established diagnosis of malignant melanoma of the nasal cavity plus multiple pulmonary metastases was referred to our hospital because of abdominal pain and vomiting. Double‐contrast study of the small intestine revealed a filling defect in the middle of the ileum. lntraoperative enteroscopy revealed that the ileal tumor was ulcerated, and that it was covered by ileal mucosa of normal appearance. Because no other lesions were identified within the intestine, the ileal segment with the tumor was surgically removed. The tumor was diagnosed as malignant melanoma with a histology similar to that of nasal mass. The patient has survived for the subsequent 13 months, during which no gastrointestinal symptoms recurred. Our case suggests that metastasis should be included in the differential diagnosis of a single small intestinal tumor. (Dig Endose 1999; 11: 47–51)
A Small Polyp of Brunner's Gland Hyperplasia Causing Hemorrhage
Authors: YAMAMOTO Takatsugu , KUYAMA Yasushi , OBARA Masayuki , SANAKA Masaki , ISHII Taro , HIRAMA Sachio , YAMANAKA Masami , IMAMURA Tetsuo
Published: December 2007

Abstract: A rare case of a small Brunner's gland hyperplasia (BGH) of the duodenum which represented hemorrhage is presented. An 84‐year‐old male was admitted because of tarry stool and anemia. Endoscopic examination revealed a small, subpedunculated duodenal polyp with blood and clots on its surface, which was considered responsible for the tarry stool. The lesion was polypectomized without any complications. Since complications of BGH including bleeding and obstruction, are more likely to occur as the size of the lesion increases, small BGH lesions tend to be regarded as benign and are left alone in clinical settings. The present case showed the possibility that such a seemingly harmless small polyp may eventually lead to massive hemorrhage. (Dig Endosc 1999; 11: 52–54)
Large Duodenal Tumor with Positive K‐ras Mutation Mimicking Lateral Spreading Tumor of the Colon — a Case Report
Authors: TAGA Hironi , WATANABE Hiroyuki , YAMAGUCHI Yasushi , OHTSUBO Kohshiro , HA Aiguli , HU Yu‐Xin , MOTOO Yoshiharu , OKAI Takashi , MIZOGUCHI Masayuki , MAI Masayoshi , KAWASHIMA Atsuhiro , ABU Norio SAW
Published: December 2007

Abstract: A 69‐year‐old woman was referred to our hospital with discomfort on swallow ing. Endoscopic examination revealed a large elevated tumor with multiple nodules at the end portion of the duodenal bulbus. The diagnosis obtained by biopsy was tubular adenoma with severe atypia. Upper gastrointestinal series and CT showed a tumor ap proximately 3.5 cm in diameter and the possibility of malignancy could not be ruled out. Partial duodenectomy was performed. Macroscopically the tumor measured 4.7X 3.1 cm. Endoscopic appearance and operational specimen of the tumor mimicked so‐called lateral spreading tumor (LST) of the colon, which spreads horizontally and cir‐cumferentially along the wall. Microscopically the tumor involved the mucosal and sub‐mucosal layers, with no invasion of the muscular layer. Pathological diagnosis of the resected specimen was a borderline lesion between well‐differentiated adenocarcinoma and adenoma with severe atypia. Using polmerase chain reaction and hybridization protection assay (PCR‐HPA), we identified a point mutation at codon 12 of the K‐ras onco‐gene from glycine (GGT) to alanine (GCT). The tumor stained negative for p53 on immunohistochemistry, and PCR non radioisotopic single strand conformational polymor phism (non RI PCR‐SSCP) for the analysis of exons5–8 of the p53 gene was also negative. This case seemed to be a duodenal epithelial tumor mimicking colonic LST with a rather benign nature despite its large size. (Dig Endosc 1999; 11: 70–75)
Significance of Periappendiceal Inflammation in the Patients with Distal Ulcerative Colitis
Authors: HORIE Hisanaga , KONISHI Fumio , TOGASHI Kazutomo , KASHIWAGI Hiroshi , KANAZAWA Kyotaro
Published: December 2007

Abstract: To study the clinical significance of periappendiceal inflammation in patients with distal ulcerative colitis, we reviewed sixteen patients who underwent total colono‐scopy from January in 1995 to September in 1998 in our department, and compared the clinicopathological findings in the patients with and without this lesion. Four of sixteen patients (25%) had periappendiceal inflammation. The patients with periappendiceal inflammation tended to be younger and had a significantly shorter duration of disease. Two of the patients with periappendiceal inflammation were one‐attack‐only type and 2 cases were relapse‐remitting type, while all the other cases without this inflammation were relapse‐remitting type. The periappendiceal lesion was observed on initial colono‐scopy in 3 of the 4 patients. Severity was mild in all patients with periappendiceal inflammation while 4 cases were moderate and 1 case was severe in the other patients. The periappendiceal lesion and main lesion of the patients with periappendiceal inflammation were histological grades 2 or 3, while the main lesion varied up to grades 4 or 5 in the other patients. These findings suggested that distal ulcerative colitis patients with periappendiceal inflammation may have a relatively mild disease course. In addition, periappendiceal inflammation was thought to develop in the early stage of the disease course. (Dig Endosc 1999; 11: 119–124)
Findings of Portal Hypertensive Gastroenteropathy Using Infrared Electronic Endoscopy
Authors: NARIMIYA Norichika , JOKI Mari , SATO Hiromitsu , SUGIMOTO Izumi , TANAKA Teruji
Published: December 2007

Abstract: The aim of this study was to ascertain how and in what form portal hypertensivive gastroenteropathy affects the submucosal vasculature using an infrared electronic endoscope (IREE), which is capable of visualizing the submucosal vasculature. Subjects were 46 patients with liver cirrhosis (19 in Child‐Pugh class A, 21 in B, and 6 in class C). In 37 of 46 patients, the submucosal vasculature of the stomach was visualized using IREE and morphologic features were studied in relation to the severity of portal hypertensive gastropathy (PHG; none, mild and severe). In the remaining 9 patients, the submucosal vasculature of the rectum and sigmoid colon was observed with IREE. IREE images of blood vessels of the gastric submucosa demonstrated withered branch‐like vessels (35.1%), multiple dotted or spotted stains at terminations of branches (32.4%), vascular ectasia‐like circular stains (11%) and dilated tortuous venules of relatively large caliber around the cardia and in the upper region of the stomach (18.8%). This feature around the cardia was observed more frequently in patients with complications of gastric varices (55.6%). In relation to the severity of PHG, the incidence of withered branch‐like vessels was significantly higher in the severe gastropathy group than in the non‐gastropathy group. Dotted or spotted stains were most frequently observed in the severe gastropathy group. Visual examination of the colorectal mucosa with IREE noted withered branch‐like vessels in 7 of 9 cases. In 3 of 9 patients, dilated venules were seen running in the anorectal submucosa and joining the rectal varices. In conclusion, morphological changes due to congestion were found in portal hypertensive gastroenteropathy using IREE in submucosal venules of relatively large caliber and even in the venous plexus in the vicinity of the muscularis mucosa. (Dig Endosc 1999; 11: 144–149)
A Case with Intrahepatic Stones followed up for Over 22 Years after Complete Cholangioscopic Stone Extraction
Authors: YAMAKAWA Tatsuo , NAOE Tetsuro , KASUGAI Hisashi , ISHIYAMA Junji , MARUNO Kaname
Published: December 2007

Abstract: In this paper, we describe the technological know‐how, diagnostic and therapeutic significance of cholangioscopy. In addition, a case who had had recurrent stones after 22 years in the sites different to those of the previous stones was presented, and therapeutic strategy for the management of intrahepatic stones was discussed. The main value of cholangioscopy lies in the fact that retained or unsuspected stones are readily removed with endoscopically‐guided instruments. Moreover, cholangioscopy not only resolves the question as to the presence or the absence of stones, but also indicates inflammation or minute carcinomatous lesions in the biliary tract which would otherwise go undetected. Percutaneous transhepatic cholangioscopy is especially useful for management of intrahepatic stones, because it provides very important information on the location and extent of lesions which is necessary for deciding appropriate therapeutic procedures. The authors firmly believe that better therapeutic results of biliary surgery can be expected if this reliable endoscopic approach becomes more routinely used by surgeons. (Dig Endosc 1999; 11: 169–173)
A 56 Year‐Old Female with Congenital Hepatic Fibrosis Diagnosed by Laparoscopy
Authors: SHIOMI Susumu , SASAKI Nohumitsu , KADOYA. Hirokazu , LEE Chulyoo , ENOMOTO Masaru , TATSUMI Nohuyuki , MORIKAWA Hiroyasu , OGAMI Masayuki , MASUICHI Hideo , NAKATANI Kazuki , TAMORI Akihiro , HABU Daiki , SAKAGUCHI Hiroki , NISHIGUCHI Shuhei , SEKI Shuichi , KUROKI Tetsuo
Published: December 2007

Abstract: We describe a 56‐year‐old woman with congenital hepatic fibrosis. Blood tests and liver scanning with Tc‐99m‐labelled galactosyl human serum albumin revealed mild liver dysfunction. Per‐rectal portal scintigraphy with iodine‐123 iodoamphetamine showed severe abnormalities in the portal circulation, and the portal pressure measured during percutaneous transhepatic portography was high (350 mmH2O). Idiopathic portal hypertension was suspected. Laparoscopy disclosed diffuse, intense dendritic white markings around the liver. Congenital hepatic fibrosis was confirmed on histologic examination of a biopsy specimen obtained during laparoscopy. In summary, we report a rare and relatively elderly case of CHF, in which laparoscopy was useful in the diagnosis. (Dig Endosc 1999; 11: 174–178)
CHEMILUMINESCENCE OF HYDROCARBON OXIDATION
Authors: Lundeen Gerald , Livingston Robert
Published: January 2008

Abstract— That chemiluminescence accompanies autoxidations and decompositions of some peroxides has been known for some time.(1) Recently mechanisms have been proposed(2) to explain such chemiluminescence. This paper is a report of an experimental study of the luminescence which accompanies the autoxidation, spontaneous and induced by the decomposition of benzoyl peroxide, of tetralin and amyl benzene. Anthracene, 9, 10‐diphenyl anthracene and 9, 10‐dibromoanthracene were used as intensifiers of luminescence.
THE INFLUENCE OF LIGHT UPON SEED GERMINATION. POSSIBLE INTERPRETATIONS OF DATA
Authors: Rollin P.
Published: January 2008

Abstract— The response of seeds to irradiation by white light varies with the species: induction of germination, inhibition of germination or both according to the time‐irradiation. The low energy reaction (LER) which acts via phytochrome can explain many cases of influence of light upon germination. It seems possible that a second reaction, the high energy reaction (HER), acts through another photoreceptor.
ACTION SPECTRA FOR LIGHT‐INDUCED DE‐EPOXIDATION AND EPOXIDATION OF XANTHOPHYLLS IN SPINACH LEAF*
Authors: Lee K. H. , Yamamoto H. Y.
Published: January 2008

Abstract— The action spectra for violaxanthin de‐epoxidation and zeaxanthin epoxidation in New Zealand spinach leaf segments, Tetragonia expansa, were determined at equal incident quanta of 2·0 × 1015 quanta cm‐2 sec‐1. Precise action spectra were not obtained due to variable leaf activity. The de‐epoxidation action spectrum had major peaks at approximately 480 and 648 nm. Blue light was slightly more effective than red light and little activity was observed beyond 700 nm. The epoxidation action spectrum showed major peaks at around 440 and 670 nm. Blue light was more effective than red light and light beyond 700 nm showed definite activity.

The net result of de‐epoxidation and epoxidation is a cyclic scheme, the violaxanthin cycle, which consumes O2 and photoproducts. The action spectra indicate that the violaxanthin cycle is more active in blue than in red light and therefore could account for O2 uptake stimulated by blue light. However, the violaxanthin cycle is not the pathway for O2 uptake by photosynthetic system 1. It was suggested that the violaxanthin cycle may function as a pathway for the consumption of excess photoproducts generated in blue light or the conversion of these photo‐products to other forms of energy.
Properties of human spinal interneurones: normal and dystonic control
Authors: Marchand‐Pauvert Véronique , Iglesias Caroline
Published: December 2007

The muscles that control wrist posture receive large inputs from reflexes driven by hand afferents. In several studies, we have investigated these reflexes by electrical stimulation of cutaneous (median nerve) and proprioceptive (ulnar nerve) afferents from the hand. Median stimulation produced short latency inhibition in all motor nuclei investigated, possibly through inhibitory propriospinal‐like interneurones. Ulnar stimulation produced similar inhibition but only in wrist extensors. In the other motor nuclei, ulnar stimulation produced short latency excitation mediated by group I motoneuronal drive through both monosynaptic and non‐monosynaptic pathways involving excitatory propriospinal‐like interneurones. This was followed by late excitations mediated through spinal group II and trans‐cortical group I pathways. These results show that these pathways are concerned with the integration of afferent inputs, proprioceptive and cutaneous, to control of wrist posture during hand movements. Patients with focal hand dystonia exhibit abnormal postures. To investigate whether these spinal pathways contribute to these conditions, the effects of ulnar stimulation on wrist muscle activity during voluntary tonic contraction were examined in patients who suffer writer's cramp. Ulnar‐induced inhibition of the wrist extensors was reduced on the dystonic side of patients compared with their normal side and controls. In patients who exhibited abnormal wrist posture, group II excitation of the wrist flexors was also modified on the dystonic side. Cutaneous stimuli, by contrast, increased wrist flexor EMG on both sides and only in patients who exhibited normal posture. We conclude that spinal interneurones have a significant role in integrating afferent inputs from the hand to control wrist posture during hand movements and that altered function in these spinal networks is associated with the complex pathophysiology of writer's cramp.
Regulation of synaptic signalling by postsynaptic, non‐glutamate receptor ion channels
Authors: Bloodgood Brenda L. , Sabatini Bernardo L.
Published: December 2007

Activation of glutamatergic synapses onto pyramidal neurons produces a synaptic depolarization as well as a buildup of intracellular calcium (Ca2+). The synaptic depolarization propagates through the dendritic arbor and can be detected at the soma with a recording electrode. Current influx through AMPA‐type glutamate receptors (AMPARs) provides the depolarizing drive, and the amplitudes of synaptic potentials are generally thought to reflect the number and properties of these receptors at each synapse. In contrast, synaptically evoked Ca2+ transients are limited to the spine containing the active synapse and result primarily from Ca2+ influx through NMDA‐type glutamate receptors (NMDARs). Here we review recent studies that reveal that both synaptic depolarizations and spine head Ca2+ transients are strongly regulated by the activity of postsynaptic, non‐glutamate receptor ion channels. In hippocampal pyramidal neurons, voltage‐ and Ca2+‐gated ion channels located in dendritic spines open as downstream consequences of glutamate receptor activation and act within a complex signalling loop that feeds back to regulate synaptic signals. Dynamic regulation of these ion channels offers a powerful mechanism of synaptic plasticity that is independent of direct modulation of glutamate receptors.