bluuebunny/crossref_metadata_2025 huggingface dataset:
LOW CORONARY DRIVING PRESSURE IS ASSOCIATED WITH SUBENDOCARDIAL REMODELLING AND LEFT VENTRICULAR DYSFUNCTION IN AORTOCAVAL FISTULA
Authors: Guido Maria C , De Carvalho Frimm Clovis , Koike Márcia K , Cordeiro Fernanda F , Moretti Ana IS , Godoy Luiz C
Published: August 2007

The role of haemodynamic changes in left ventricular remodelling has been poorly investigated, especially in the context of volume overload cardiac hypertrophy. Low diastolic blood pressure and high left ventricular filling pressure are expected to affect coronary driving pressure negatively and thereby put in jeopardy subendocardial perfusion in particular. The consequences to global left ventricular remodelling remain undetermined. The aim of the present study was to investigate the role of coronary driving pressure in the development of subendocardial remodelling and the conceivable effects on cardiac function, using a rat model of aortocaval fistula.

Wistar rats, weighing 330–350 g, were submitted to aortocaval fistula (ACF group) or sham (control group) operations. Two haemodynamic measurements were determined following surgery, the initial measurement at week 1 and the final measurement at week 8. Cytokine expression, myeloperoxidase (MPO) activity, metalloproteinase expression and activity and fibrosis were assessed in two distinct left ventricular myocardial layers: the subendocardium (SE) and the non‐subendocardium (non‐SE).

The ACF group showed lower initial and final coronary driving pressure and lower final +dP/dt and –dP/dt compared with the control group. Multivariate analyses disclosed initial coronary driving pressure as the only haemodynamic parameter independently associated with SE fibrosis (R2 = 0.76; P < 0.0001) and with +dP/dt (R2 = 0.55; P = 0.0004) and –dP/dt (R2 = 0.91; P < 0.0001). Matrix metalloproteinase (MMP)‐2 expression and activity predominated in the SE of ACF animals, particularly in those with low coronary driving pressure. Increased levels of interleukin (IL)‐6 and IL‐1β also predominated in the SE of the ACF group. Otherwise, MPO activity and levels of tumour necrosis factor‐α and IL‐10 were similar in both groups. Final coronary driving pressure correlated with both the expression and activity of MMP‐2.

Low coronary driving pressure early in the course of ACF determines SE damage and, by this mechanism, interferes negatively in left ventricular function.
FUNCTIONS OF SK CHANNELS IN CENTRAL NEURONS
Authors: Faber ES Louise , Sah Pankaj
Published: August 2007

SK channels are small‐conductance calcium‐activated potassium channels that are widely expressed in neurons. The traditional view of the functional role of SK channels is in mediating one component of the after‐hyperpolarization that follows action potentials. Calcium influx via voltage‐gated calcium channels active during action potentials opens SK channels and the resultant hyperpolarization lowers the firing frequency of action potentials in many neurons.

Recent advances have shown that, in addition to controlling action potential firing frequency, SK channels are also important in regulating dendritic excitability, synaptic transmission and synaptic plasticity.

In accordance with their role in modulating synaptic plasticity, SK channels are also important in regulating several learning and memory tasks and may also play a role in a number of neurological disorders.

The present review discusses recent findings on the role of SK channels in central neurons.
ROLE OF MACROPHAGES IN COMPLICATIONS OF TYPE 2 DIABETES
Authors: Tesch GH
Published: August 2007

Macrophage accumulation is a feature of Type 2 diabetes and is associated with the development of diabetic complications (nephropathy, atherosclerosis, neuropathy and retinopathy). The present article reviews the current evidence that macrophages contribute to the complications of Type 2 diabetes.

Macrophage‐depletion studies in rodent models have demonstrated a causal role for macrophages in the development of diabetic complications.

Components of the diabetic milieu (high glucose, advanced glycation end‐products and oxidized low‐density lipoprotein) promote macrophage accumulation (via induction of chemokines and adhesion molecules) and macrophage activation within diabetic tissues.

Macrophages mediate diabetic injury through a variety of mechanisms, including production of reactive oxygen species, cytokines and proteases, which result in tissue damage leading to sclerosis.

A number of existing and experimental therapies can indirectly reduce macrophage‐mediated injury in diabetic complications. The present article discusses the use of these therapies, given alone and in combination, in suppressing macrophage accumulation and activity.

In conclusion, current evidence supports a critical role for macrophages in the evolution of diabetic complications. Present therapies are limited in slowing the progression of macrophage‐mediated injury. Novel strategies that are more specific at targeting macrophages may provide better protection against the development of Type 2 diabetic complications.
HUMAN HEART β‐ADRENOCEPTORS: β1‐ADRENOCEPTOR DIVERSIFICATION THROUGH ‘AFFINITY STATES’ AND POLYMORPHISM
Authors: Molenaar P , Chen L , Semmler ABT , Parsonage WA , Kaumann AJ
Published: August 2007

In atrium and ventricle from failing and non‐failing human hearts, activation of β1‐ or β2‐adrenoceptors causes increases in contractile force, hastening of relaxation, protein kinase A‐catalysed phosphorylation of proteins implicated in the hastening of relaxation, phospholamban, troponin I and C‐protein, consistent with coupling of both β1‐ and β2‐adrenoceptors to stimulatory Gsa‐protein but not inhibitory Gia‐protein.

Two ‘affinity states’, namely β1Hand β1L, of the β1‐adrenoceptor exist. In human heart, noradrenaline elicits powerful increases in contractile force and hastening of relaxation. These effects are blocked with high affinity by β‐adenoceptor antagonists, including propranolol, (–)‐pindolol, (–)‐CGP 12177 and carvedilol. Some beta‐blockers, typified by (–)‐pindolol and (–)‐CGP 12177, not only block the receptor, but also activate it, albeit at much higher concentrations (approximately 2 log units) than those required to antagonize the effects of catecholamines. In human heart, both (–)‐CGP 12177 and (–)‐pindolol increase contractile force and hasten relaxation. However, the involvement of the β1‐adrenoceptor was not immediately obvious because (–)‐pindolol‐ and (–)‐CGP 12177‐evoked responses were relatively resistant to blockade by (–)‐propranolol. Abrogation of cardiostimulant effects of (–)‐CGP 12177 in β1‐/β2‐adrenoceptor double‐knockout mice, but not β2‐adrenoceptor‐knockout mice, revealed an obligatory role of the β1‐adrenoceptor. On the basis of these results, two ‘affinity states’ have been designated, the β1H‐ and β1L‐adrenoceptor, where the β1H‐adrenoceptor is activated by noradrenaline and blocked with high affinity by beta‐blockers and the β1L‐adrenoceptor is activated by drugs such as (–)‐CGP 12177 and (–)‐pindolol and blocked with low affinity by beta‐blockers such as (–)‐propranolol. The β1H‐ and β1L‐adrenoceptor states are consistent with high‐ and low‐affinity binding sites for (–)‐[3H]‐CGP 12177 radioligand binding found in cardiac muscle and recombinant β1‐adrenoceptors.

There are two common polymorphic locations of the β1‐adrenoceptor, at amino acids 49 (Ser/Gly) and 389 (Arg/Gly). Their existence has raised several questions, including their role in determining the effectiveness of heart failure treatment with beta‐blockers. We have investigated the effect of long‐term maximally tolerated carvedilol administration (> 1 year) on left ventricular ejection fraction (LVEF) in patients with non‐ischaemic cardiomyopathy (mean left ventricular ejection fraction 23 ± 7%;n = 135 patients). The administration of carvedilol improved LVEF to 37 ± 13% (P < 0.005); however, the improvement was variable, with 32% of patients showing £ 5% improvement. Upon segregation of patients into Arg389Gly‐β1‐adrenoceptors, it was found that carvedilol caused a greater increase in left ventricular ejection faction in patients carrying the Arg389 allele with Arg389Arg > Arg389Gly > Gly389Gly.
ORAL MITEMCINAL (GM‐611), AN ERYTHROMYCIN‐DERIVED PROKINETIC, ACCELERATES NORMAL AND EXPERIMENTALLY DELAYED GASTRIC EMPTYING IN CONSCIOUS DOGS
Authors: Onoma Mitsu , Yogo Kenji , Ozaki Ken‐ichi , Kamei Kenshi , Akima Michitaka , Koga Hiroshi , Itoh Zen , Ōmura Satoshi , Takanashi Hisanori
Published: August 2007

We examined effects of orally administered mitemcinal, an erythromycin‐derived motilin agonist, on gastric emptying and antroduodenal motility in conscious normal dogs and conscious dogs with experimentally delayed gastric emptying. For comparison, we also examined the effects of orally administered cisapride.

Gastric emptying was assessed by adding paracetamol to the test meal and determining three of its pharmacokinetic parameters as indices of gastric emptying. Antroduodenal motility was assessed from the output of force transducers chronically implanted in the gastric antrum and duodenum.

In normal dogs, mitemcinal (0.25, 0.5 and 1 mg/kg) dose‐dependently accelerated gastric emptying, significantly increasing all three indices at doses of 0.5 and 1 mg/kg; cisapride (1, 3 and 10 mg/kg) had no significant effect. Mitemcinal also dose‐dependently stimulated antroduodenal motility in the interdigestive and digestive states. Cisapride, at 100‐fold the dose, produced similar effects in the interdigestive state, but mixed results in the digestive state.

In dogs with delayed gastric emptying induced by subcutaneous clonidine (0.03 mg/kg), mitemcinal (0.25, 0.5 and 1 mg/kg) dose‐dependently improved delayed gastric emptying, significantly increasing two of three indices at a dose of 1 mg/kg. Cisapride (1, 3 and 10 mg/kg) caused non‐significant increases in the indices of gastric emptying, with roughly bell‐shaped dose–response curves. The highest dose of mitemcinal (1 mg/kg) also stimulated antroduodenal motility.

In dogs with delayed gastric emptying induced by vagotomy, mitemcinal (0.125, 0.25 and 0.5 mg/kg) dose‐dependently improved delayed gastric emptying, significantly increasing all three indices at doses of 0.25 and 0.5 mg/kg. Cisapride (3 mg/kg) restored the indices to roughly prevagotomy levels, but none of the increases was significant. Mitemcinal, at a dose of 0.25 mg/kg, also stimulated antroduodenal motility.

Because delayed gastric emptying is the basic characteristic of gastroparesis, the fact that mitemcinal accelerated gastric emptying in dogs with normal and delayed gastric emptying much more robustly than cisapride adds to the evidence that mitemcinal is likely to be useful for the treatment of patients with gastroparesis.
The Transduodenal Endoscopic Treatment of Acute Cholangitis
Authors: AKASHI Ryukichi , YAMABE Hiroshi , KIYOZUMI Takeaki , HOKAMURA Masanori , SAGARA Katsuro , WAKI Sumi , ARITA Tetsumasa , INAYOSHI Atsushi , HAYASHIDA Nobuo , YAGI Yasushi , IKEDA Tsunekazu , HATTORI Masahiro
Published: August 2007

Mortality due to acute cholangitis (AC) has been tremendously reduced by the advent of endoscopic sphincterotomy (EST). This study investigates whether EST is really a curative procedure for the treatment of AC, or not. Diagnosis of AC, in 159 out of 1,061 cases in which EST was performed, had been made by infected bile which was recognized as green or pyobile collected during ERCP. Emergency drainage by EST was performed immediately after AC was diagnosed. The causes of AC were attributable to benign diseases in 128 cases (80.5%) and malignant diseases in the remaining 31 cases. Clinical symptoms included abdominal pain, fever, and obstructive jaundice, but Charcot's triad was noticed in 66 cases (43.3%) and Reynolds pentad in only 7 cases (4.6%). As to the relation between clinical symptoms and properties of bile, pyobile was more likely to be recognized in patients with severe symptoms.

Four patients treated at our hospital died of AC (2.5%). All were over 80 years old, and their conditions were already complicated by disseminating intravascular coagulation (DIC) syndrome. Compared with the results obtained in patients treated with percutaneous transhepatic biliary drainage (PTBD), the resulting mortality rate was less. Therefore, we feel the best approach for treating AC, which progresses to acute obstructive suppurative cholangitis (AOSC) in the final stage of the disease, is to diagnose early, by ERCP, and to promptly obtain decompression by subsequent EST, or to perform radical surgery.
Clinical Experience with Prototype Pancreatoscopes
Authors: AKIYAMA Tetsuji , FUJI Tadasu , TANAKA Shinya , HARIMA Kenzo , SASAKI Toshiyuki , NAKAMURA Masaaki , PUA Shirley C. , OKITA Kiwamu , TAKEMOTO Tadayoshi
Published: August 2007

Abstract: Peroral pancreatoscopy (PPS) was introduced at our institute in 1982, with the aim of improving diagnostic accuracy in patients with pancveatic diseases, and as a preliminary, procedure for therapeutic interventions to the pancreas. However, limitations in instrumentation permitted us to observe only the main pancreatic duct. This is a report of our experience with 2 types of peroral Pancreatoscopes and our findings in patients with chronic pancreatitis and pancreatic cancer.

We subjected 30 patients suspected to have pancreatic diseuse to PPS, using either the CPF‐29X, which has an external diameter of 2.9 mm (Olympus: Japan), or the PA‐08, which has an external diameter of 0.8 mm (a modification of the angioscope, Fujinon: Japan).

PPS with the CPF‐29h was attempted in 18 cases (pancreatic cancer, 11; chronic pancreatitis, 7), and was successfully introduced into the main pancreatic duct in I 6 cases. This allowed good visualization of the main pancreatic duct and a more definitive diagnosis in 11 cases. On the other hand, PPS with the PA‐08 was successfully introduced in all 12 of the cases in which it was attempted (pancreatic cancer, 7; chronic pancreatitis, 5) and permitted satisfactory endoscopic observation and accurate diagnosis in 9 cases.

Puncreatic cancer appeared as an irregular elevation of the pancveatic duct mucosa, while chronic pancreatitis presented as a smooth stenosis, without significant mucosal changes.

Thus, PPS is a valuable alternative or supplementary procedure to present‐day diagnostic imaging methods of arriving at a more definitive diagnosis in difficult cases. For the biopsy of lesions under direct vision and the possibility of therapeutic interventions to the pancreas, however, we propose the development of a pancreatoscope equipped with a forceps channel and which has an external diameter of less than 1 mm.
A Case of Boerhaave's Syndrome —Evaluation of Diagnostic Value of Endoscopy—
Authors: Matsumoto Fumiko , Matsumoto Toshihiko , Takasu Masashi , Ka Kunihiko , Murase Toshihiko , Iida Miyako , Mizuno Takako , Kawaguchi Mitsugu , Nishino Hiroji
Published: August 2007

Abstract: We experienced a case of Boerhaave's syndrome. The patient, a 47‐year‐old male, vomited after drinking a large quantity of alcohol and thereafter, complained of epigastralgia, back pain, and dyspnea. Leukocytosis, positive CRP, fever, tenderness of the upper abdomen and muscular defense were noted on admission. Endoscopy revealed an ulcer at the lower esophagus. Since a chest X‐P and CT showed thoracic effusion and subcutaneous and mediastinal emphysema, rupture of the esophageal ulcer was suspected. The diagnosis of Boerhaave's syndrome was established by esophagography. A rupture along the longitudinal axis of about 3cm was found at the left posterior wall 3cm above the E‐G junction, and was surgically sutured.

Of many cases of Boerhaave's syndrome reported in the literature in Japan, endoscopy was performed in 70 cases. Recently, endoscopy has been adopted as the first choice for the diagnosis of this syndrome as well as for emergency examination of the esophagus and the diagnosis is established by endoscopy alone in many cases. Actually endoscopy was useful for the diagnosis of this disease in 88.2% of the above cases. These results as well as our case indicate diagnostic value of endoscopy, if performed carefully.

Boerhaave's syndrome,

Endoscopy
Small Cell Carcinoma of the Esophagus Concurring with Early Stomach Carcinoma (IIa); A Case Report
Authors: IMAMURA Akimichi , BETSUYAKU Takashi , KADONO Yutaka , AKASAKA Yoshinobu , SASAKI Michiro , YAMASHIRO Katsushige , MIYAKAWA Akira
Published: August 2007

Abstract: The most common histologic type of carcinoma of the esophagus is squamous cell carcinoma. Small cell or oat cell carcinoma is rare. Only 95 cases have been reported as far as we have investigated in both the English and Japanese Literature since the first description by Mckeown1) in 1952.

A case of small cell carcinoma of the esophagus concurring with early stomach carcinoma (IIa) in a 71‐year‐old male is reported.

Gross, radiological and endoscopic features in sufficient photographs obtained from literature on the 95 cases and in the present case, were analyzed. A major morphological feature of the lesion is well‐defined ulceration with marginal swelling similar to that in a submucosal tumor.

From the viewpoint of double cancer, no case of small cell or oat cell carcinoma of the esophagus concurring with early stomach carcinoma is found in the 95 cases reported. Therefore, the present case is thought to be the first reported case of small cell carcinoma of the esophagus concurring with early stomach carcinoma (IIa).
Colorectal Carcinomas Following Ulcerative Colitis in Japanese Patients
Authors: KAWAGUCHI Atsushi , NIWA Hirohumi
Published: August 2007

Abstract: Colorectal carcinomas occuring following ulcerative colitis in Japanese patients discussed in the literature were analyzed in order to review their characteristics.

1) Of the 74 cases reported from 1962 to November 1989, 29 were males and 45 were females. The sex differences in Japanese ulcerative colitis were almost 1: 1, so females with colorectal carcinomas occured more often than males.

2) Male patients had a bimodal peak in their 30's and 40's, while female patients had the peak in their 40's and 50's. More colorectal carcinomas were found among younger people than in the general population.

3) Universal colitis was the most common type of colorectal cancer occuring following ulcerative colitis. 57 patients out of 74 were classified into this type.

4) The duration of the disease prior to the diagnosis of colorectal cancer was generally 10 years or longer.

5) The rectum was the commonest site of cancer, and was seen in 44 cases out of 74. Rectosigmoid colon carcinomas occurred in 61 of 74 cases.

6) Histologically, colonic malignancy associated with ulcerative colitis was an adenocarcinoma, displaying a wide spectrum of differentiation. Poorly differentiated (4 males and 6 females) and signet ring cell carcinoma (3 males and 5 females) were also reported.

7) The so‐called type 4 tumor occurred in 3 males and 6 females out of a total of 74 cases. This type of tumor is usually rare in colorectal cancer.

8) Most of the patients with early carcinomas had suffered from ulcerative colitis for more than 15 years and the characteristics of their macroscopic appearance were protruded lesions.

9) Foci of dysplasia accompanied carcinoma in as many as 80% of the Japanese cases reported. (56 out of 74 cases)

Based on these, we should take consideration that:

1) Patients with pancolitis lasting more than 10 years whose forms are chronically active or intermittently active should be recognized as a high‐risk group. 2) Full colonoscopy every one or two years may be sufficient to find dysplasia as well as carcinoma even if the condition of disease is stable. 3) Protruded lesions should be biopsied to detect early cancer as well as dysplasia on colonoscopy. 4) A change in the disease condition, i. e. rectal bleeding, weight loss and a change of bowel habits should not be mistaken for an exacerbation of colitis and should be investigated without fail.
Effects of Cyanoacrylate on the Gastric Mucosa of Dogs –Endoscopic and Histopathological Studies for Sclerotherapy of Gastric Varices–
Authors: OKUYAMA Shuji , SHIBATA Yoshimi , ASHIDA Toshifumi , AYABE Tokiyoshi , YOKOTA Kinichi , HARA Hisato , OKUMURA Toshikatsu , KITAMORI Shigeru , OBARA Takeshi , OKAMURA Kiyoshi , NAMIKI Masayoshi
Published: August 2007

Abstract: The effect of cyanoacrylate tissue adhesive (C. A.) on the gastric mucosa of dogs was investigated endoscopically and histopathologically. When C. A. was applied to the surface of the gastric mucosa, the endoscopic findings the next day showed local redness at the applied site (Fig. 1‐a) and histopathology revealed degenerative changes in the gastric mucosa (Fig. 1‐b). When C. A. was endoscopically injected into the gastric mucosa, the endoscopic findings revealed a submucosal tumor‐like lesion (Fig. 2‐a). One day after treatment, the endoscopic findings showed a hemorrhagic erosion on the surface of the lesion (Fig. 2‐b). An histopathological examination of the resected stomach revealed C. A. in the submucosal layer (Fig. 3‐a, 3‐b) and the lymph duct around the muscularis mucosa with severe acute inflammation (Fig. 4‐a, 4‐b). One week after treatment, a deep ulcer (Ul‐IV) was observed (Fig. 5, 6) and a histopathological examination of the resected specimen revealed C. A. at the site of the ulcer and inflammatory cell infiltration by fibroblasts and giant cells (Fig. 7‐a, 7‐b). One month after treatment, the ulcer had healed and was replaced by a scar (Fig. 8). Histopathological examination of the resected stomach revealed C. A. in both the muscularis mucosa and the submucosa and also inflammatory cell infiltration by giant cells in addition to the fibrosis (Fig. 9). When using endoscopic sclerotherapy with C. A., it should be kept in mind that there is the possibility of such a lesion occurring as demonstrated by our study.
A Study of Malignant Bile Duct Stenosis Using Percutaneous Transhepatic Cholangioscopy
Authors: NISHIKAWA Kunihisa , OGAWA Satoshi , SATO Masahiro , HOSHI Hajime , OHASHI Shigeki , YOSHIOKA Hideki , MAETANI Iruru , IGARASHI Yoshinori , FUJINUMA Sumio , SAKAI Yoshihiro
Published: August 2007

Abstract: From June, 1987 to November, 1989, 11 patients with malignant bile duct stenosis, which was later confirmed by surgery or autopsy, were examined by percutaneous transhepatic cholangioscopy (PTCS) and by an endoscopic biopsy. The endoscopic findings obtained with the usual observation methods and methylene blue staining and the histological findings of the biopsy specimens were compared. A fine vascular proliferation was seen in all of the patients and a granular appearance was noted in patients with carcinoma of the major papilla. The papillary appearance was noted in one case each of pancreatic carcinoma, bile duct carcinoma and carcinoma of the major papilla. Marginal protrusion was not noted in patients with pancreatic carcinoma. A distorted narrow segment was seen only in cases of pancreatic carcinoma. The presence of a granular appearance indicated that the carcinoma was exposed on the surface. A high degree of fine vascular proliferation and a papillary appearance tended to indicate a carcinoma which invaded mainly into the fibromuscular layer without invasion of the mucosa. The methylene blue staining method was simple and effective for better visualization of the surface structure of the abnormal area, normal mucosa and the border zone.
Endoscopic Hemostasis in Hemorrhagic Gastric Ulcer—Effectiveness of the Hemoclipping, Ethanol Injections and Heat Probe—
Authors: TAKAHASHI Hiroshi , FUJITA Rikiya , SUGIYAMA Keiichi , SUZUKI Satoshi , KOHSEN Kenzo , SEKI Morihito , FUJITA Yasuyuki , SATAKE Yoshiharu , SUGATA Fumio , NAMATAME Kimio
Published: August 2007

Abstract: The hemostatic effects of hemoclipping, the pure ethanol local injection method and the heat probe methods on hemorrhagic gastric ulcers associated with exposed blood vessels, were compared. The locations of the ulcers and exposed blood vessles, as well as characteristics and the severity of the hemorrhage were discussed. The hemoclipping method was used on 59 patients, the pure ethanol local injection on 32 patients, and the heat probe methods on 26 patients. The hemoclipping and pure ethanol local injection methods were effective in all of the patients in whom the exposed blood vessels were present around the margin of ulcers. The efficacy rate was 91%, 92% and 92%, respectively, when exposed blood vessels were found at the base of the ulcer. The efficacy rate was 94%, 100% and 80% for the three hemostatic methods, respectively, when an oozing hemorrhage was present. The three methods had an efficacy rate of 100% when only blood clots were present. The efficacy rate for a spurting hemorrhage was 86%, 71% and 67%, respectively, for the three methods. The hemoclipping and pure ethanol local injection were effective in 100% of slight and moderate hemorrhage cases, while the heat probe method was effective in only 89% of moderate cases. The efficacy rate was 85%, 85% and 83%, respectively, for severe cases. Overall, the efficacy rate was 93% for the hemoclipping method, 94% for the pure ethanol local injection and 92% for the heat probe method, and there was no significant difference between the three methods with regard to the overall efficacy rate.
A Case of Pachydermoperiostosis with Watery Diarrhea, Giant Gastri Rugae, and Endocrine Disorder
Authors: KISHIDA Keiko , FUKUMOTO Shiro , WATANABE Makoto , ADACHI Kyoichi , AMANO Kazutoshi , OHTANI Miyako , ARIMA Noriyuki , IKEDA Satoru , SHIMADA Yoshihiro
Published: August 2007

Abstract: A 31‐year‐old man, cook, who had had persistent watery diarrhea for about a month visited our hospital. He had already been diagnosed as having pachydermoperiostosis. An examination of the upper gastrointestinal tract revealed that he had giant gastric rugae. The histology was compatible with hypertrophic gastritis accompanied with marked hyperplasia of the fundic gland and foveolar epithelia. The output of gastric juice was high in volume, although its acidity normal. The barium transit time of the small intestine was reduced to 15 minutes. His diarrhea was, thus, considered to be induced by gastrointestinal hyperfunction. The patient's glucose tolerance was abnormal and basal Cortisol secretion level was high. Pachydermoperiostosis has been the focus of attention for skin and bone changes, and the frequency of this disease with endocrine disorders seems rather high, but accompanying gastrointestinal disorders have so far not often been reported in Japan. The results of our investigation strongly suggest that pachydermoperiostosis is a systemic disease.
Role of Endoscopy in the Diagnosis of Papillary Dysfunction
Authors: KOBAYASHI Kenzo , OZAKI Shoichi , TAKAISHI Osamu
Published: August 2007

The role of endoscopy in the papillary region was analyzed in order to review the functional disturbances of the papillary region and the mechanism of excretion of bile into the duodenum. There are several procedures for the diagnosis of reversible or irreversible papillitis. Many investigators try to clarify the pathogenesis of papillary dysfunction by using the endoscopic method. Endoscopic manometry fills an important role in evaluating papillary dysfunction. Nevertheless, physiological and pathophysiological investigation of the mechanism of excretion of bile are not satisfactory, and the significance of the effects on the papillary region of gastrointestinal hormones such as cholecystokinin (CCK) is not clear. More studies using the endoscopic method are necessary to elucidate the function of the papillary region.
Study on the Phenomenon of Locational Variation in the Speed of Discoloration During the Endoscopic Congo Red Test The Second Report: Ultrastructural Studies on Parietal Cell Populations
Authors: KIMURA Norio , TANI Norio , KARASAWA Hiroyuki , MIYAZAWA Masayuki , MUTOH Nobuyoshi , MIWA Takeshi
Published: August 2007

Both quantitative and morphological studies of parietal cells were done in order to investigate the cause of the phenomenon of locational variation in the speed of discoloration during the endoscopic Congo red test. The endoscopic Congo red test was performed in twelve patients with a peptic ulcer and/ or chronic gastritis. In each case, at the times when spotty discoloration was observed, five biopsy specimens were obtained from both the quickly discolored portion (already discolored portion) –Q and the slowly discolored portion (not yet discolored portion) –S of the greater curvature of the middle body at the same time and were separated into two groups (the Q‐group and the S–group). Quantitative studies of the parietal cells were performed using the cell isolation method described in our first report. A morphological study was performed with an electron microscope. Two specimens were fixed in glutaraldehyde and osmium tetroxide, and finally embedded in Epon resin. Ultra‐thin secretions contrasted with uranyl acetate and lead citrate were viewed with a JEOL‐1200EX electron microscope. Each parietal cell was classified according to the classification of ultrastructual stages put forward by Black et al. The number of parietal cells per milligram wet weight of the quickly discolored portion was significantly larger than that of the slowly discolored portion similar to the results of our first report. However the ultrastructural aspects of the parietal cells were not found to be different between the Q–group and S–group portion. It is concluded that the locational variation of the speed of discoloration during the endoscopic Congo red test may be due to the unequal distribution of parietal cells and that the sensitivity and responsiveness of parietal cells to the stimulation may be almost the same in all of the acid secreting area.
Cellular and Structural Atypia of the Early Colorectal Cancers
Authors: SATAKE Yoshiharu , FUJITA Rikiya , KAMINAGA Norihiro , KATAKURA Shigehiro , TSUBOMIZU Yoshio , TAKAHASHI Hiroshi , SUGATA Fumio , MITSUYA Toshiyuki , SAGAWA Fumiaki
Published: August 2007

Cellular and structural gland atypia in lesions of early colorectal cancer removed by endoscopic polypectomy in 101 patients were histopathologically studied. The following results were observed. Cellular atypia was frequently found in lesions with a high rate of nuclear polarity loss and multiple nuclear mitoses (99. 0%). The most frequent findings in the glands with structural atypia was intraglandular glands and crowding of neoplastic glands (85. 1%). Most of the appearances of the cellular and structural atypias showed no marked relationship with the sizes of the lesions, depth of invasion and association of adenoma components. Early cancer had both cellular and structural atypia in 95% of the patients and could be diagnosed by conventional histopathological criteria. However five patients with early cancer showed no structural atypia and were diagnosed as having cellular atypia. These cancers were early intramucosal cancer and four lesions were associated with adenoma components 20 mm or less in size. The loss of nuclear polarity and nuclear pleomorphism may be considered more important than nuclear stratification and mitoses in the diagnosis of early cancer.
A Gastrointestinal Endoscopic Study on Secondary Amyloidosis Complicating Rheumatoid Arthritis
Authors: SHIMADA Yutaka , TOSA Hiroyori , TERASAWA Katsutoshi , TANAKA Michio
Published: August 2007

Abstract: Biopsy specimens endoscopically obtained from the stomach, duodenum, sigmoid colon and rectum of 58 patients with rheumotoid arthritis (RA) were examined for amyloid deposition by light microscopy. Six cases (10.3%) were diagnosed as being amyloidosis. In cases with more than moderate amyloid deposition, amyloid was most notable in the lamina propria mucosae. In cases with slight amyloid deposition, amyloid was seen in the blood vessel walls of the lamina muscularis mucosae and tela submucosa. On the whole, amyloid deposition was most marked in the duodenum. Endoscopically, whitish, irregular, partially nodular thickening of mucosa was characteristic in the sites with severe amyloid deposition. A fine granular appearance was observed in the sites with moderate amyloid deposition. No particular abnormal findings were noticed in the sites with slight amyloid deposition. Erosions, redness and a tendency for easy mucosal bleeding appeared frequently in the sites with more than moderate amyloid deposition. The endoscopic abnormal findings were most remarkable in the duodenum, and mildest in the recto‐sigmoid colon. It was suggested that these abnormal findings were correlated with the degree of amyloid deposition especially in the lamina propria mucosae. All the amyloidosis cases were in advanced anatomical stages of RA. The degree of anemia was more severe, and total protein, albumin and total cholesterol values were lower in the amyloidosis cases than in non‐amyloidosis cases. It is clear that when endoscopic examinations of RA patients are done to rule out amyloidosis, a biopsy should be taken from a depth including the submucosa even if the endoscopic finding is normal.
Expandable Metallic Stents: in the Benign Strictures of Intrahepatic Ducts in Patients with Primary Intrahepatic Stones
Authors: KIM Myung Hwan , LEE Sung Koo , MIN Young II , SUNG Kyu Bo , LEE Sung Gyu , MIN Pyung Chul
Published: August 2007

Abstract: In Korea there is a prevalence for primary intrahepatic stones. Patients with primary intrahepatic stones and oriental cholangiohepatitis ofen have accompanying intrahepatic strictures. Despite complete removal of the intrahepatic stones, sustained intrahepatic strictures will evoke bile stasis and impairment of liver function. So the correction of intrahepatic strictures in addition to the removal of the stones is important in the management of primary intrahepatic stones.

We inserted self‐expandable metallic stents in 16 patients with primary intrahepatic stones for the correction of intrahepatic strictures after complete removal of their intrahepatic stones. All of the patients had a previous history of abdominal surgery for the removal of intrahepatic stones. The criteria for insertion of expandable metallic stents was recurrent stenosis after successful balloon dilatation. The metallic stents inserted were Gianturco‐Rosch stents (24F) and the stents were inserted via a T‐tube or percutaneous transhepatic biliary drainage (PTBD) track. In the follow‐up period of an average of 12 months (9–15 months), 14 (88%) out of 16 patients experienced relief of pruritus and improved liver function. But two patients (12%) with secondary biliary cirrhosis showed no improvement of their clinical symptoms and signs.

In conclusion, these findings suggest that expandable metallic stents will be useful in the management of intrahepatic strictures, which recurred after successful balloon dilatation, in patients with primary intrahepatic stones.
Successful Hyperbaric Oxygen Therapy of Pneumatosis Cystoides Intestinals : A Report of Two Cases
Authors: INA Kenji , MORISE Kimitomo , CHIN Kenshou , HAYAKAWA Makoto , MAMIYA Naoto , SAKAI Tetsu , NAGAI Hirofumi , YAMAGUCHI Takeo , MATSUURA Toshihiro , SHINODA Masataka , KUROIWA Atsuo , HARUTA Jun‐ichi , HORIUCHI Yoh , FURUSAWA Atsushi , KANYAMA Kazuhiro , IWASE Hiroaki , KUSUGAMI Kazuo , TAKAHASHI Hideyo
Published: August 2007

Abstract: Two patients with pneumatosis cystoides intestinalis (PCI) successfully treated with hyperbaric oxygen are described, The first patient was a 52‐year‐old male who presented with bloody stools and was diagnosed as having primary PCI. The second was a 61‐year‐old male whose occupation entailed prolonged exposure to trichloroethylene. Following hyperbaric oxygen therapy, the colonic gas cysts completely disappeared in both patients, and there has been no evidence of recurrence. The relevant literature from 1980 to 1992 is reviewed, and hyperbaric oxygen therapy for PCI is discussed in detail. The data accumulated thus far suggest that hyperbaric oxygen is superior to high‐flow oxygen breathing in PCI therapy.
A Case of Lymphangioma Coexistent with Tubular Adenoma in the Descending Colon and a Review of the Literature
Authors: MATSUMOTO Toshihiko , MATSUMOTO Fumiko , HASHIMOTO Norihiro , HIROTA Toshiya , IIDA Miyako , MIZUNO Takako , HOSOKAWA Kouichi , MAEKURA Syunji
Published: August 2007

Abstract: We recently encountered a case of lymphangioma of the colon which coexisted with a tubular adenoma. The patient was a 71‐year‐old male who was admitted for physical therapy for lumbago caused by osteoarthritis. He had no evident abdominal symptoms and no weight loss. Although mild anemia and hypoproteinenia were observed, his stool occult blood test was negative and tumor markers revealed no significant changes. A barium enema revealed two elevated lesions in the descending colon. The proximal lesion appeared to be semipedunculated and its form changed following postural changes. The distal lesion was pedunculated. When the patient changed his posture, the head and stalk of the lesion were identified, Both lesions were removed by endoscopic polypectomy. The proximal lesion was histologically diagnosed as being a cavernous lymphangioma, while the distal one was found to be a tubular adenoma.

Lymphangioma of the colon is considered to be rare. In Japan, 102 cases including the present case have been reported to date. The coexistence of this disease with neoplasmic lesions of the colon has been reported in 20 cases, including 7 cancer cases and 16 adenoma cases; some cases had overlapping coexistence. The frequency of coexistence of a lymphangioma with cancer or adenoma seems to be rather high. The relationship between lymphangioma and these lesions is unknown. The coexistence of neoplasmic lesions may be accidental. The patients with this coexistence had no characteristic features, except for a high incidence of gastrointestinal bleeding. At least 43% of the coexisting cancers were found in the cecum, the vermiform appendix and the hepatic flexure, indicating the necessity of a detailed examination of the entire colon in cases where a lymphangioma is detected.
A Case of Early Gastric Cancer Manifesting as a Submucosal Tumor
Authors: MATSUSHITA Masanori , SHIROEDA Osamu , INOKUCHI Hideto , HIROTA Makoto , HABU Yasuki , KIYOTA Keisuke , HIRAI Kiyoshi , YOKOTA Takashi , INOUE Kyoichi
Published: August 2007

Abstract: Gastric cancer manifesting as a submucosal tumor (SMT) is not common. A gastric barium meal and endoscopic studies performed on a 49‐year‐old male with epigastric pain, revealed an elevated lesion with bridging folds and central depression on the posterior wall of the lower body. An endoscopic ultrasonography (EUS) revealed a hypoechoic mass lesion within the submucosal layer. Due to an increase in the size of the tumor and its central depression during the subsequent year and a half, the patient was admitted for closer examination. Endoscopic biopsy material from the deeper layer, obtained by mucosal resection, revealed a poorly differentiated adenocarcinoma. Microscopic examination of the resected stomach showed a poorly differentiated adenocarcinoma within the submucosal layer, with considerable lymphocyte infiltration. Immunohistological examination disclosed marked T cell infiltration adjacent to the cancer cells. We suggest that considerable lymphocyte infiltration, particularly T cells, may have some role in the protective reaction against cancer cells. Our case was diagnosed as being cancer 18 months after the first endoscopic study. The biopsy material taken from the depression at the time of the first examination showed benign findings and a EUS revealed typical SMT. In the case of SMT shown by EUS to be a hypoechoic mass lesion in the submucosal layer, it is recommended that biopsy material be obtained from the deeper layer using methods available such as artificial ulcer formation.
Continuous Endoscopic Variceal Ligation with a Three‐shooter
Authors: SHIBUYA Susumu , TAKASE Yasuhiro , CHIKAMORI Fumio , NAKAHARA Akira , FUKUTOMI Hisayuki
Published: August 2007

Endoscopic variceal ligation with an elastic O band has been performed in the treatment of esophageal varices. Generally, after ligating the varix during the treatment the endoscope is removed and the O band is changed each time until the desired result is achieved. However, it is thought that a shorter time to change the O band would make endoscopic variceal ligation more convenient. Therefore, we designed continuous endoscopic variceal ligation with three elastic O bands. To release three bands continuously, a self recoiling spring is attached at the endoscopic side between the inner and outer cylinders. After releasing one band by pulling the wire, the inner cylinder is returned to its original position by recoiling the spring and the next O band is automatically set up. Continuous endoscopic variceal ligation was performed for one case of esophageal varices due to hepatocellular carcinoma with liver cirrhosis. This technique enabled the ligation of three varices concomitantly, thus eliminating the necessity of repeated extraction and insertion of the endoscope every time the varix was ligated. The operation time was considerably shortened. The case reported did not develop any complications. Hence, it was thought that our technique of a three‐shooter is easier to perform and more convenient for the patient.
Study on Numerical Expression of Gastric Mucosal Color with a Videoendoscope and an Image Processor
Authors: TAKAHASHI Yoshinobu , NAKAZAWA Yoshihiko , OKAZAKI Kazuich , YAMAMOTO Yasutake
Published: August 2007

This study was conducted to determine the numerical expression of gastric mucosal color using the L*a*b* color system to analyze an image obtained by videoen‐doscopy (GIF‐V10, Olympus, Tokyo). These data were then quantitated using an image processor (LA‐500, PI AS, Osaka), and the results were compared with the gastric mucosal blood flow determined by laser Doppler flowmetry to determine if a correlation exists between gastric mucosal blood flow and color.

The ΛHue and the ΛChroma were defined as the difference between the reference region and a white disk on the gastric mucosa, respectively. The ΛHue represents the degree of redness relative to the white disk. The ΛChroma represents the vividness of the red color. Both were calculated in patients with flat erythema, erosion, gastric ulcer, and early gastric cancer type lie.

In the early stages of gastric cancer, the ΛHue of poorly differentiated adenocarcinoma was more reddish than that of well differentiated adenocarcinoma. However, we should pay attention to the ΛHue difference between the cancer and the background, with that of well differentiated adenocarcinomas being higher than that of poorly differentiated lesions. This is due to the Color Contrast Effect. Endoscopically, lesions of well differentiated adenocarcinoma are more reddish than those of poorly differentiated adenocarcinoma. Furthermore, we demonstrated a correlation between AHue and gastric mucosal blood flow in normal gastric mucosa.

We conclude that color analysis of analog imaging using a videoendoscope and image processor is a potentially important clinical aid in endoscopic diagnosis.
Recurrence of Common Bile Duct Stones Correlates with Stenosis Following Endoscopic Sphincterotomy
Authors: QIAN Li‐Wu , KONOMI Hirouyki , KIMURA Hiroshi , YOKOHATA Kazunori , OGAWA Yoshiaki , CHUIIWA Kazuo , DEENITCHIN Georgi P. , TANAKA Masao
Published: August 2007

Although stenosis is regarded as one of the causes of recurrence of common bile duct stones after endoscopic sphincterotomy, there is a lack of direct evidence. Endoscopic retrograde cholangiography and manometry were performed in 131 patients 2.2–111.1 months (mean 29.9 months) after sphincterotomy, either for follow‐up or at presentation of biliary symptoms. Recurrent stones were found in 33 patients (25%) (recurrent group). The remaining 98 patients (75%) proved not to have recurrence (nonrecurrent group). The common bile duct‐to‐duodenum pressure gradient in the recurrent group (3.3 ± 1.4 mmHg, mean ±SEM) did not differ from that in the nonrecurrent group (2.9 ±1.5 mmHg) (p=0.85). However, as judged by endoscopic findings, we found a significantly elevated frequency of stenosis of the spincter‐otomy orifice in the recurrent group (4 of 33 patients) as compared with the nonrecurrent group (none of 98 patients) (p=0.0035). Recurrence of common bile duct stones appears to correlate with stenosis following sphincterotomy, although manometry does not necessarily indicate the presence of stenosis.
Magnifying Observation of Ectopic Gastric Mucosa of the Cervical Esophagus
Authors: URITA Yoshihisa , NISHEVO Mamoru , KURITA Toshio , KOYAMA Hiroshi , MIYAFUJI Yasunori , SASAJIMA Masahiko , KANDA Eiko , ARIKI Hisashi , HOJO Hiroshi , MIURA Fumihiro , YONEYA Takashi , KONDO Eisaku , MATSUZAKI Hiroshi , HACHIYA Akihiko , NARUKI Yukihiko , OTSUKA Sachio
Published: August 2007

We attempted to investigate the fine mucosal patterns of inlet patches using a transparent‐tip‐hood‐fitted magnifying electronic endoscope (Olympus, GIF‐200Z). The prevalence of inlet patch was 10.1%, 26 out of 257 patients undergoing screening endoscopic examination using a GIF‐200Z. This rate was higher than that of previous reports in Japan, higher in the young group than in the aged group, and higher in males than in females. The mean inlet patch size, measured by the new method using a transparent hood, was 5.2 mm. Large inlet patches, above 8.1 mm, were found more frequently in males than in females. The number of inlet patches in one patient was one in 19 patients and two in seven. The inlet patches were oval and had a smooth margin in 23 (69.7%) cases, and irregular in 10 (30.3%). The oval patches with smooth margins were significantly larger than those with an irregular form. The fine mucosal pattern of inlet patches was mixed with B, BC and C type. Inlet patches with acid production were suggested to be fewer in number than expected, and patients with an inlet patch appear to have minimal, if any, complaints. A transparent‐tip‐hood‐fitted magnifying electronic endoscope was thought to facilitate accurate diagnosis of the inlet patch.
Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor
Authors: SASAGAWA Tsuyoshi , SUZUKI Hiroyoshi , KITAMURA Youichi , OGUMA Ffidetoshi , ISHIZUKA Naoki , ENDO Akihiko , SUZUKI Shigeru , TAKASAKI Ken
Published: August 2007

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.