bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Resection of Small Gastric Adenoma
Authors: HARADA Hiroshi , TOYONAGA Atsushi , OHMAGARI Kazuhiro , IKEDA Hideo , TANIKAWA Kyuchi
Published: December 2007

Abstract: We endoscopically resected 32 small adenomas of the stomach. The diagnosis was made using a bite biopsy technique in each case. On histological examination it was found that 34% of the totally resected specimens contained focal cancer. Endoscopic features, such as shape, surface texture and color, were not useful in identifying lesions harboring focal cancer. Nuclear DNA analysis of the biopsy specimens was not useful for differentiating between adenomas and lesions with focal cancer. We therefore recommend total endoscopic resection, as a biopsy, in all patients with a small adenoma of the stomach.
A Case of Leiomyosarcoma with a Cartilaginous Matrix
Authors: MAEKAWA Takeo , YABUKI Kiyotaka , SATOH Koichi , MIKAMI Youshi , MATSUMOTO Michio
Published: December 2007

Abstract: Leiomyosarcomas with a cartilaginous matrix are extremely rare. A 72‐year‐old man presented with a mass approximately the size of a hen's egg, on the posterior wall of the lesser curvature of the stomach, near the esophagogastric junction. On endoscopic ultrasonography, the size of the tumor was estimated to be 30X20 mm. On histopathological exmination of sections of the lesion stained with hematoxylin and eosin, the tumor was found to be composed of densely packed spindle cells with mitotic figures. A hyaline‐like matrix was seen at the center of the tumor. This matrix contained cells with vacuoles around the nuclei. On immunohistochemical staining, the tumor cells stained positively for vimentin and desmin. The cartilaginous portion of the tumor was positive for S‐100 protein. We describe herein our experience and discuss similar cases reported in the literature.
Gastric Mucosal Interleukin (IL)‐8 Level and IL‐8 mRNA Expression in Endoscopic Biopsy Specimens from Patients with Peptic Ulcers
Authors: TAKAGI Atsushi , KABIR Abu MA , WATANABE Sumio , MIWA Takeshi
Published: December 2007

Abstract: To determine the pathological role of interleukin‐8 (IL‐8) which has been implicated in the gastric mucosal injury caused by Helicobacter pylori (H. pylori) infection, the gastric mucosal IL‐8 level and IL‐8 mRNA expression rate were studied in patients with peptic ulcers and chronic gastritis. The IL‐8 levels in biopsy homogenates were determined by Enzyme‐linked immunosorbent assay (ELISA). Expression of IL‐8 mRNA was studied by the reverse transcriptase polymerase chain reaction (RT‐PCR) method. The gastric mucosal IL‐8 levels were significantly higher in patients with peptic ulcers than in those with normal mucosa. The IL‐8 level correlated with urease activity. Eradication therapy for H. pylori decreased both the IL‐8 level and IL‐8 mRNA expression. Treatment with omeprazole also decreased the IL‐8 level without eradication of H. pylori. Our findings suggest that IL‐8 plays an important role in the pathogenesis of peptic ulcers.
Endoscopic Ligation of Esophageal Varices Using a Detachable Snare and Transparent Cap with Rim
Authors: HACHISU Tadashi , SATOH Shin‐ichi , FUJII Takayuki , YAMADA Hideo
Published: December 2007

Abstract: The authors developed a new method of endoscopic varix ligation (EVL) using a detachable snare and a transparent cap with rim (EVLsc). The advantages of EVLsc are as follows; 1) no need for an overtube, 2) multiple varix ligation can be achieved in a relatively short time after an easy preparation, and 3) the procedure is associated with less discomfort for the patient. Between August 1995 and December 1996, 31 patients with esophageal varices were treated in Sakura National Hospital by EVL, and were randomized into two groups; 16 with EVLsc and 15 with conventional EVL. Each patient was treated only by the randomly chosen method for the purpose of achieving complete hemostasis and/ or eradicating esophageal varices at risk for bleeding. The only major complication was pharyngeal injury due to overtube insertion in the EVL group. There were no complications in the EVLsc group. Eradication was achieved in 14 of 16 cases (87.5%) in the EVLsc group, and 13 of 15 (86.7%) in the EVL group, there being no statistically significant difference between the two groups. The EVLsc was not associated with discomfort, required no complex techniques, and satisfactory results were obtained.
Late Radiation Injury of the Large Intestine
Authors: KAWAMURA Norio , ISHIBASHI Tomoko , KOIZUMI Kouichi , KAI Shunkichi , TAKEKOSHI Takao , MARUYAMA Masakazu
Published: December 2007

Abstract: Late radiation injury of the colon and rectum after radiotherapy for a pelvic malignancy is a not uncommon complication. Although the colonoscopic appearance of radiation injury is well known, few reports have focused on the progression of radiation proctocolitis. The colonoscopic examinations of 103 patients with late radiation injuries were reviewed. The radiotherapy had originally been administered for carcinoma of the uterine cervix (79 patients), prostate (13), uterine corpus (3), ovaries (3), urinary bladder (2), vagina (2), and pelvic metastasis of breast cancer (1). In 31 patients, changes in colonoscopic appearance were followed‐up. Anal bleeding was the major initial symptom, with more than half experiencing bleeding within 2 years of radiotherapy. Lesions were limited to the rectum and sigmoid colon. The incidence of late radiation injury, according to cancer site, was calculated to be 3.8% for the cervix uteri, 5.1% for the prostate, 0.60% for the corpus uteri, 0.80% for the ovary and 0.35% for the bladder. Seventeen patients underwent colostomy. Between eight and 37 years after radiotherapy, six patients developed a second colorectal cancer. As to radiation injury, two response types, bleeding and stricture, occurred. Virtually no resolution of the strictures was observed in this series. The grade of radiation injury did not correlate with radiotherapy dosage.
A Study on the Management of Ileus Caused by Cancer in the Left Colon
Authors: OCHIAI Takumi , SUGITANI Michihiro , TOYODA Tadayuki
Published: December 2007

Abstract: As nasal tube insertion is minimally effective for the management of ileus caused by cancer in the left colon, emergency operations are often necessary for such cases. Recently, a new preoperative colonoscopic procedure, designed with the aim of avoiding emergency operations, was invented. This method, termed colonoscopic retrograde bowel drainage (decompression) (CRBD), can be described as follows : After confirming the lesion colonoscopically, the drainage (decompression) tube is inserted beyond the obstructive lesion along a guide wire or dilator. This method was applied in 17 patients (11 males and 6 females), with an average age 66.8 years (range 44‐88 years), one with descending colon cancer, 9 sigmoid colon cancer, 5 rectal cancer and 2 Schnitzler metastasis. The interval from CRBD to surgery was 11.5 days. During this period, preoperative examinations and complete preparation of the colon could be performed. This allowed surgery to be performed electively with the patient in satisfactory condition. The most important benefit of CRBD is that a forward view of obstructive lesions can be obtained with a colonoscope. This direct view procedure reduces the risk of complications. Thus, in properly selected cases, CRBD may allow emergency surgery to be avoided. We conclude that CRBD should be attempted as the initial treatment, before proceeding to surgery.
Five Cases with Ectopic Esophageal Sebaceous Glands
Authors: NISHISAKI Hogara , YASUTAKE Koichi , NAKASHIMA Takatoshi , HASEGAWA Hiroshi , HIROHATA Sigeya , HORITA Kazutugu , SANO Wataru
Published: December 2007

Abstract: Sebaceous glands in the esophagus are considered to be rare and are of particular interest because of their as yet unknown origin. Six postmortem and 48 antemortem cases with this condition have been reported. We report herein five cases diagnosed by endoscopy and biopsy, with a review of the pertinent literature. The hypotheses that gastroesophageal reflux disease (GERD), alcohol consumption, smoking, and hyperlipidemia play roles in the pathogenesis of ectopic sebaceous glands of the esophagus are not supported by current evidence. Given the gradual increase in reports of adult cases with ectopic esophageal sebaceous glands, we suspect that these lesions may not be as rare as generally assumed.
Severe Henoch‐Schönlein Purpura with Intestinal Hemorrhagic Ulcers: Treated by Steroid Pulse Therapy
Authors: KATAOKA Hiromi , JOH Takashi , OHSHIMA Tadayuki , TAKAHASHI Nobuo , WATANABE Katsushi , IMAEDA Kenrou , SASAKI Makoto , MIYATA Mitsuki , TSUCHIDA Kenji , IKAI Masayuki , SENOO Kyoji , YOKOYAMA Yoshifumi , ITOH Makoto
Published: December 2007

Abstract: Henoch‐Schönlein purpura, associated with severe duodenal hemorrhage and gastrointestinal dysfunction, was dramatically suppressed by steroid pulse therapy. A 22‐year‐old male was admitted with abdominal pain, purpuric rash, and neutrophilic leukocytosis. C‐reactive protein was increased and coagulation Factor XIII was markedly decreased. Upper gastrointestinal endoscopy disclosed multiple ulcers and erythema with petechiae in the postbulbar duodenum. Based on laboratory findings including examination of a skin biopsy specimen, this patient was diagnosed as having Henoch‐Schönlein purpura. Despite aggressive administration of prednisolone, intravenous hyperalimentation, and Factor XIII concentrate, symptoms worsened. Steroid pulse therapy was then given for three days, resulting in amelioration of all clinical findings. The duodenal ulcers showed scarring on endoscopy. Gastrointestinal complications of Henoch‐Schönlein purpura. Factor XIII concentrate therapy, and pulse steroid therapy are discussed herein.
Improvement of the Guide Wire in the Long Intestinal Tube Used for Endoscopic Intubation in Patients with Intestinal Obstruction
Authors: KAWAMURA Ryoki , AKIYAMA Yasuhiro , NAMIKAWA Kazuo
Published: December 2007

Abstract: In 1980, an endoscopic intubation method utilizing a long intestinal tube for ileus was developed. However, with this method the success rate of jejunal intubation was 89.4%, and the intubation time was 17.5±8.1 minutes (Mean±S. D.). These results were unsatisfactory as “rapid and reliable intubation” was the initial objective. Because the earliest guide wire was excessively elastic and therefore pliable, it formed a loop in the stomach. The guide wire was then improved by increasing its rigidity by approximately 20%. With this improvement, the force needed to advance the guide wire can now be effectively transmitted to its tip. As a result, the initial objective of improving the rate of jejunal intubation with the long tube (to 100%) and shortening the intubation time (to 8.9±3.9 min.) was achieved.
Immunoreactive Transforming Growth Factor β‐1, Its Receptor, bcl‐2 Protein, and p53 Protein in Colorectal Adenomas
Authors: MATSUMOTO Koichi , INOUE Takahito , MIKI Chikao , FUKUURA Tatsuki , SHIGEMORI Chika , SUZUKI Hiroshi
Published: December 2007

Abstract: Immunoreactive transforming growth factor‐β1 (TGF‐β1), its receptor (TGFR), bcl‐2 protein, and p53 protein were stained in 47 samples of normal colonic mucosa and 33 samples of colorectal adenoma, with the aim of exploring an alternate, novel pathway of colorectal tumorigenesis. There was no difference in the percentage of cells positive for TGF‐β1 immunoreactivity between normal mucosae and adenomas. TGFR immunoreactivity was detected in a significantly higher percentage of normal mucosae than of adenomas (p ±0.05). Bcl‐2 protein and p53 protein immunoreactivities were detected in a significantly higher percentage of adenomas than of normal mucosae (p ±0.01). Expression of these immunoreactive proteins did not correlate with any of the clinicopathological features of adenomas, except for a significant negative correlation between TGFR expression and large tumor size (p±0.05) and a positive correlation between p53 protein expression and the grade of dysplasia (p±0.05). These findings indicate that (1) TGF‐β1 plays little role in the tumorigenesis of colorectal adenomas, (2) TGFR is lost in most adenomas during tumorigenesis, (3) bcl‐2 protein plays an important role in transformation of normal mucosa into adenoma, and (4) p53 protein is involved in the very early phase of malignant transformation from adenoma to carcinoma.
Development of an Imaging System Using Fluorescent Labeling Substances Excited by Infrared Rays
Authors: ITO Susumu , MUGURUMA Naoki , HAYASHI Shigehito , TAOKA Satoko , TSUTSUI Akemi , FUKUDA Tamotsu , OKAHISA Toshiya , OHKITA Yoshio , MATSUNAGA Hiroko , SHIMIZU Ichiro , NAKAMURA Kazunari , IMAIZUMI Katsuich , TAKESAKO Kazuhiro , SHIBAMURA Seiichi
Published: December 2007

Abstract: An indocyanine green (ICG) derivative (ICG N‐hydroxy sulfosuc‐cinimide ester; ICG‐sulfo‐OSu) has been developed as an antibody labeling substance suitable for vital immunohistochemical staining. However, an appropriate fluorescence imaging system for ICG‐sulfo‐OSu using infrared rays has not as yet been reported. Therefore, we developed such a system. The absorption maxima of ICG and ICG‐sulfo‐OSu in buffer solution are both at 795 nm, the excitation maxima of their fluorescence spectra in buffer solution at 768 nm, and their emission maxima at 807 nm. An imaging system using an excitation filter with transmission at 710‐790 nm and a barrier filter with transmission at 810‐920 nm was constructed, and fluorescent images of ICG‐sulfo‐OSu labeled anti‐epithelial membrane antigen (EMA) antibody were obtained with this system. Thus, vital immunohistochemical staining of microcancers under infrared ray excitation should now be possible, by exciting an ICG‐sulfo‐OSu labeled antibody specific to the tumor cells with infrared rays, using this imaging system.
Macrocystic Serous Cystadenoma of the Pancreas
Authors: KAMISAWA Terumi , EGAWA Naoto , ISHIWATA Jun‐ichi , TSURUTA Koyji , OKAMOTO Atsutake , TAKAHASHI Takashi , KOIKE Morio
Published: December 2007

Abstract: The case of a 61 ‐year‐old man with macrocystic serous cystadenoma of the pancreas is reported. Abdominal ultrasonography and computerized tomography showed a multilocular cystic lesion in the body of the pancreas. The major cysts ranged in size from more than 2.0 cm up to 6.0 crn. Endoscopic ultrasonography (EUS) showed a few small cysts in addition to the large cysts. The preoperative diagnosis was either mucinous cystic tumor or congenital cyst of the pancreas and tumor enucleation was performed. Histological examination revealed serous cystadenoma of the pancreas with macrocysts. Detecting small cysts with EUS may be useful for distinguishing this unusual tumor from mucinous cystic tumors.
Gastric Ulcer Hemorrhage Treated by Endoscopic Hemostasis with Histoacryl
Authors: JOKI Mari , NARIMIYA Norichika , KUNIHIRO Naoko , HAMADA Hiroko , ITO Yoshihiro , MARUYAMA Tatsushi , MIYAJIMA Hiroto , SATO Hiromitsu , ODAGIRI Masayoshi , SUGIMOTO Izumi , WATANABE Toshiaki , NAKADA Tetsuya , TANAKA Teruji
Published: December 2007

Abstract: We report a case of hemorrhagic gastric ulcer in which endoscopic injection of Histoacryl effectively achieved hemostasis. The patient was an 86‐year‐old woman with complaints of hematemesis and melena, and emergent endoscopic examination revealed fresh bleeding from the gastric ulcer. Neither endoscopic injection of Aethoxysklerol and ethanol nor clipping stopped the active bleeding, while the injection of Histoacryl produced an immediate hemostatic effect. Unfortunately, she died of pneumonia and heart failure seven days after this treatment. Autopsy revealed Histoacryl polymer localized in the gastric wall, but the gastric ulcer that had caused the massive bleeding was covered with exudate and the site of arterial rupture was unclear. The significant hemostatic effect of Histoacryl injection and the histological findings in this case suggest that this procedure may be useful for managing refractory hemorrhagic gastric ulcer.
A Case of Melanosis Duodeni Alleviated by the Discontinuation of Ferrous Sulfite
Authors: HIRASAKI Shoji , KOIDE Norio , OGAWA Hiromichi , UJIKE Kozo , OKADA Hiroyuki , MIZUNO Motowo , UKIDA Minoru , TSUJI Takao
Published: December 2007

Abstract: A case of melanosis duodeni is presented. The patient was an 80‐year‐old Japanese woman who had received oral ferrous sulfite for 19 months. Endoscopic examination of the duodenum showed marked pigmentation of the duodenal mucosa. Histological and electron microscopic examinations revealed that the pigment had histochemical features compatible with hemosiderin and was located mainly within macrophage lysosomes in the lamina propria. We discontinued the administration of ferrous sulfite and commenced follow‐up endoscopy. The pigmentation disappeared within 7 months of discontinuing treatment. Thus, the ferrous sulfite was speculated to be the causative agent of the pigmentation in the present case. The patient had concomitant hypertension, rheumatoid arthritis, anemia and chronic renal failure. The possible associations of these complications with the development of duodenal pigmentation were also considered.
Ultrasonic Tactile Sensor: An Experimental Study to Evaluate the Depth of Invasion in Esophageal Squamous Cell Carcinomas
Authors: YOSHIDA Tatsuya , INOUE Haruhiro , NISHIKAGE Tetsuro , YANO Kenichi , NAGAI Kagami , KAWANO Tatsuyuki , YOSHINO Kunihide , TAKESHITA Kimiya , ENDO Mitsuo
Published: December 2007

Abstract: To date, an objective scale for evaluation of tissue stiffness has been lacking. A new instrument, the “ultrasonic tactile sensor (UTS)”, allows objective evaluation of stiffness. For the purpose of evaluating cancer stiffness, we first introduce an experimental study on tissue stiffness using surgically resected specimens of esophageal squamous cell carcinomas with no special preoperative treatment. From November 1995 to January 1996, the authors examined 11 esophageal cancer specimens. Although this experiment revealed no differences between normal mucosa and mucosal cancer in the esophagus, significant differences between mucosal and submucosal cancers in terms of tissue stiffness were clearly demonstrated. Therefore, UTS examination is useful for assessing malignant invasion, thereby providing valuable information for determining appropriate indications for endoscopic mucosal resection. We currently perform this UTS examination using a miniature probe during preoperative endoscopy. We anticipate that this new method will become an essential tool for evaluating the depth of invasion in esophageal cancer preoperatively.
Correlation Between the Depth of Invasion and Hardness of Resected Gastric Carcinoma Specimens Using a New Ultrasound Tactile Sensor
Authors: KATO Kazuyoshi , TAJIRI Hisao , BOKU Narikazu , ISHIF Hiroshi , ONO Masato , ARAI Tatsuo , Ryu Munemasa , OHTSU Atsushi , FUJII Takahiro , YOSHIDA Shigeaki
Published: December 2007

Abstract: We assessed the objective measurement of gastric wall hardness in gastric cancer specimens with a new tactile sensor. The basic principle of measuring hardness and/or softness of living tissue is based on changes in the frequency of the tactile sensor. The change in resonance frequency, Δf=fx‐fo, is the difference between the frequency of the sensor in contact with the specimen, fx, and the non‐contact frequency, fo. The change in resonance frequency increases as tissue hardness decreases. We measured hardness at 5 points in 13 fresh specimens obtained by gastrectomy and analyzed the histopathological features corresponding to each point. We found that the more deeply the tumor had invaded, the harder the cancerous areas tended to be as compared to normal areas. However, the hardness of gastric cancer areas was influenced not only by the depth of invasion, but also by tumor size, the presence of associated fibrosis within the lesion, and the tumor stroma quantity. Gastric wall hardness correlated with the depth invasion of lesions less than 40 mm in size, the absence of tumor fibrosis, and medullary type tumor extension.
A Case of Glucagonoma with Liver Metastasis: Complete Response to Dacarbazine
Authors: ISOMOTO Hajime , MIZUTA Yohei , MATSUNAGA Keiichiro , TOMONAGA Michio , SHIMOKAWA Isao , OMAGARI Katsuhisa , TAKESHIMA Fuminao , MURASE Kunihiko , KOHNO Shigeru
Published: December 2007

Abstract: We report a case of glucagonoma syndrome with liver metastasis, who responded completely to dacarbazine chemotherapy. A 77‐year‐old woman complained of itching skin eruptions (diagnosed as necrolytic migratory erythema) and weight loss. She was found to have glucose intolerance, anemia, hypoproteinemia and hyperglucagonemia. Abdominal CT and celiac arteriography showed a hypervascular tumor in the pancreatic tail and a metastatic tumor in the left hepatic lobe. Immunohistochemical examination of the metastatic liver tumor obtained by laparoscopic biopsy revealed the tumor cells to be positive for glucagon. The patient was treated with 20 courses of 300 mg/day intravenous dacarbazine for 5 consecutive days followed by a 4 week drug‐free interval. No major side effects were noted. Treatment resulted in disappearance of the skin lesions and correction of anemia, glucose intolerance, hypoproteinemia and hyperglucagonemia. Follow‐up abdominal CT showed complete resolution of both the primary pancreatic tumor and the metastatic liver tumor. We suggest that dacarbazine be considered as the treatment of choice for metastatic glucagonoma.
Removal of a Large Common Bile Duct Stone Using Endoscopic Balloon Sphincter Dilation and Extracorporeal Shock Wave Lithotripsy
Authors: UENO Norio , TOMIYAMA Takeshi
Published: December 2007

Abstract: Although endoscopic balloon sphincter dilation (EBSD) appears to be an attractive treatment modality, the rate of bile duct clearance is apparently reduced due to limited enlargement of the bile duct opening when the stones are large and/or numerous. We present the case of an 87‐year‐old woman who developed an extremely large bile duct stone. To crush the stone sufficiently to allow grasping by a mechanical lithotriptor or a basket catheter with the EBSD procedure, extracorporeal shock wave lithotripsy was performed and the fragments were removed successfully.
The Endoscopic Detection and Treatment of Vascular Ectasia in the Gastrointestinal Tract —A One Year Experience at Karolinska Hospital—
Authors: SHIRAI Masato , JARAMILLO Edgar , BEFRITS Ragnar , JONAS Eduard , LJUNG Tryggve , SLEZAK Premysl
Published: December 2007

Abstract: Vascular ectasia of the upper and lower gastrointestinal tract (GIT) is occasionally seen at diagnostic endoscopy. The therapeutic relevance of these lesions are not always immediately clear. The aim of this study was to review a single institution's experience in the endoscopic diagnosis and treatment of GIT vascular ectasia. In order to identify and determine the characteristics and clinical course of patients with vascular ectasia, records of all adult patients undergoing upper or lower GIT endoscopy between September 1996 and August 1997 were reviewed.

During the study period 2547 gastroscopies and 1759 colonoscopies were performed. Eighteen patients (0.7%) were diagnosed with vascular ectasia of the upper GIT and 23 patients (1.6%) the lower GIT. Mean age was 72.7 years and the majority of patients were male. A large percentage of patients had coexisting systemic disease. Anemia without overt GIT bleeding was the presenting clinical sign in 67% of upper GIT and 43% of lower GIT vascular ectasia. Fourteen patients received endoscopic treatment for upper GIT and 18 for lower GIT vascular ectasia. Endoscopic treatment was effective in 12 (86%) and 14 patients (78%) with upper and lower GIT vascular ectasia, respectively. Follow‐up ranged from 2 to 12 months. There was only one death in each group, both due to systemic diseases unrelated to vascular ectasia. Vascular ectasia of the GIT is a not infequent cause of upper and lower gastrointestinal bleeding and might be occult. Patients are usually elderly with coexisting systemic disease. Multi‐modality endoscopic management is the first line of treatment for this condition and seems both effective and safe.
Amyloid Colitis: Successful Treatment with Colchicine Therapy
Authors: HIRASAKI Shoji , KOIDE Norio , NAKAGAWA Kazuhiko , SHIMA Yasuo , OGAWA Hiromichi , UJIKE Kozo , OKADA Hiroyuki , MIZUNO Motowo , UKIDA Minora , TSUJI Takao
Published: December 2007

Abstract: We treated a case of systemic amyloidosis which exhibited clinical symptoms of amyloid colitis. The patient was a 61‐year‐old man with bloody diarrhea. Endoscopic examination revealed multiple erosions and small ulcerations with bleeding, bloodshot mucosa and loss of the normal vascular pattern in the transverse colon. Histological examination revealed infiltration by inflammatory cells in the lamina propria, and congo red dye showed deposition of amyloid material in the submucosa and in the walls of blood vessels. Endoscopic examination of the upper digestive tract revealed an erosive reddish area in the antrum, and a biopsy specimen from this lesion showed amyloid material histologically. With ultrasonic cardiography, amyloid deposition was suspected in the heart. Therefore, the patient was diagnosed with systemic amyloidosis. We started the administration of colchicine 1 mg/day and commenced follow‐up endoscopy. The patient's diarrhea was improved after the administration of colchicine, and mucosal lesions of the transverse colon were improved endoscopically. Moreover, amyloid deposition in the cardiac wall seemed to have disappeared on ultrasonic cardiography. From these observations, colchicine therapy was considered to be an effective treatment for systemic amyloidosis in the present case.
Gastric Carcinoid Tumor Associated with Graves' Disease: A Case Report
Authors: SAITOH Osamu , TAKIUCHI Hiroya , EGASHIRA Yutaro , SAKANE Sadaki , SASAKI Ichiro , TAKAMATSU Junta , HIRATA Ichiro , KATSU Ken‐ichi
Published: December 2007

Abstract: We report a patient with hyperthyroid Graves' disease associated with type A gastritis and a gastric carcinoid tumor. A 45‐year‐old female visited our hospital because of exophthalmos, and hyperthyroidism was found. TSH receptor antibody and anti‐parietal cell antibody were positive in the patient's serum. An endoscopic examination revealed type A gastritis and a gastric carcinoid tumor. The diagnosis of type A gastritis was determined histologically. The gastric carcinoid tumor was solitary and small (less than 5 mm in diameter), and was removed by biopsy. The patient's hypergastrinemia continued after the thyroid function was normalized by treatment with methimazole. Endoscopic surveillance for metachronous gastric carcinoid tumors will therefore be required. The association of Graves' disease, type A gastritis and a gastric carcinoid tumor is discussed.
A Case of Gastric Lipoma Removed by Endoscopic Polypectomy
Authors: YAMAMOTO Takatsugu , KUYAMA Yasushi , OBARA Masayuki , TANAKA Hideyo , SANAKA Masaki , ISHII Taro , TAMURA Mizue , YAMANAKA Masami , IMAMURA Tetsuo
Published: December 2007

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64‐year‐old female was found to have a polypoid lesion in the stomach on periodic X‐ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy.

The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.
A Huge Polypoid Type Early Gastric Neuroendocrine Cell Carcinoma
Authors: KUSAKA Toshihiro , SANO Yasushi , ARAO Jun , ICHIKAWA Kazuhito , Yamamura‐IDEI Yuka , SHIMIZU Shin‐ichi , TSUCHIYA Kazuhiro , UEDA Yoshihiko , CHIBA Tsutomu , FUJIMORI Takahiro
Published: December 2007

Abstract: We report a case of a huge polypoid‐type early gastric neuroendocrine cell carcinoma. Upper gastrointestinal endoscopy in a 77‐year‐old man revealed a gastric polyp on the anterior wall of the corpus. Endoscopically biopsied material from the polyp suggested that the lesion was malignant; specifically a poorly and moderately differentiated tubular adenocarcinoma or adenocarcinoma with neuroendocrine differentiation. Endoscopically the lesion was a huge polypoid type with a broad stalk approximately 40 mm in diameter, and its surface was tabulated with a white coat and erosion. The patient underwent total gastrectomy. The resected specimen histopathologically showed a polypoid mass with medullary carcinoma and indicated endocrine cell differentiation. Immunohis‐tochemical findings supported the diagnosis of endocrine cell carcinoma. This case was an early and polypoid‐type gastric endocrine cell carcinoma. Since examples of such cases are rare in the literature, we report this case in brief.
A Case of Early Gastric Carcinoma with Lymphoid Stroma: Diagnostic Usefulness of Endosonography
Authors: ENDO Takao , OKUDA Hiroyuki , ARIMURA Yoshiaki , YAMASHITA Kentaro , KUROKAWA Sei , AZUMA Naoki , SAKAMOTO Hirofumi , ITOH Fumio , HINODA Yuji , DENNO Ryuichi , SATOH Masaaki , IMAI Kohzoh
Published: December 2007

Abstract: A case of early gastric carcinoma with lymphoid stroma (GCLS) showing features of submucosal tumor is reported here. A characteristic endoscopic ultrasonographic (EUS) finding was helpful for preoperative diagnosis. The patient, a 75‐year‐old woman without any previous complaints, visited our hospital for detailed examination of a small gastric lesion. Upper Gl studies revealed a submucosal tumor‐like lesion measuring about 1.8 cm with a central slight depression on the greater curvature of the middle gastric body. Histologic findings of the specimens obtained by conventional biopsy indicated a poorly differentiated adenocarcinoma, although the possibility of malignant lymphoma was not completely ruled out. EUS examination was, therefore, performed in order to obtain further detailed information about the tumor. EUS disclosed that the tumor, which existed in the third layer, was composed of many small round clustered lesions, the echogenicity of which was lower than that of the muscle layer, and was almost covered with a normal mucosal layer. Taking these findings into consideration, a gastric cancer with lymphoid stroma whose invasion would be limited within the submucosa was highly suspected. It was proven by histological analysis of a surgically resected specimen that this peculiar multiple small round hypoechoic lesion was equivalent to the lymphoid aggregates infiltrating the GCLS. Since it has been reported that the prognosis of GCLS is better than that of common gastric cancers, accurate diagnosis is important for the selection of optimal treatment. While it is still not definitively proven that EUS is useful for diagnosis of GCLS, this procedure may potentially provide an excellent image of this special tumor and be of use for preoperative diagnosis.
A Pediatric Case with Gallstones Treated with Laparoscopic Cholecystectomy
Authors: YOGI Yoshikuni , TSUCHIMOCHI Akio , KIKUCHI Jiro , TAKE Hiromichi , SETOGUCHI Toshiaki
Published: December 2007

Abstract: We report herein a case of a 13‐year‐old Japanese boy with symptomatic cholelithiasis. The patient was admitted to our hospital for investigation of right hypochondrial pain. An abdominal plain X‐ray film showed calcifications at the right upper quadrant of the abdomen. Ultrasonography and computed tomography of the abdomen revealed several stones in the gallbladder. He underwent laparoscopic cholecystectomy under a diagnosis of idiopathic and radiopaque gallstones. Twelve calcium bilirubinate stones were found in the gallbladder. Reports of laparoscopic cholecystectomy in children are rare, and only 29 cases of 15 years of age or younger have been reported in Japan. This paper presents an additional case report of laparoscopic cholecystectomy in a pediatric patient, body weight 32 kg, with symptomatic and pigment gallstones. We believe that laparoscopic cholecystectomy should be the procedure of choice for removal of the gallbladder even in children.
p53 Overexpression and K-ras Codon 12 Mutations in Submucosal Invasive Colorectal Cancer
Authors: SAITO Kenichi , OGAWA Akira , OHKI Ichiro , MORI Masatomo
Published: December 2007

We examined histological findings, p53 overexpression and K‐ras codon 12 mutations and the histology of submucosal invasive (sm) colorectal cancers. Sixty specimens of sporadic sm cancer were obtained by surgical resection or endoscopic polypectomy. p53 expression was examined by im‐munohistochemical staining using the streptavidin‐biotin method. K‐ras codon 12 mutations were detected by polymerase chain reaction (PCR) and dot blot hybridization. These tumors were classified as horizontal or nonhorizontal growth sm cancers. Fifteen of 60 (25%) superficial type horizontal growth cancers gave rise to sm cancers. There was no significant difference in size between horizontal and nonhorizontal growth sm cancers. There was no significant difference in the frequency of p53 expression between horizontal [8/15 (53.3%)] and nonhorizontal [22/45 (48.9%)] growth sm cancers. The frequency of K‐ras codon 12 point mutations was significantly lower in horizontal growth [0/15 (0%)] sm cancers as compared to nonhorizontal growth [22/45 (48.9%)] sm cancers. We conclude that the development of superficial type horizontal growth cancers may involve a distinct genetic pathway.
Texture Analysis of Laparoscopic Images in Chronic Liver Disease
Authors: OGAWA Masahiro , YAMAMOTO Yoshinobu , GOTOH Iori , TANAKA Naohide , ONO Yoshiki , ARAKAWA Yasuyuki
Published: December 2007

Determination of the site of progression of chronic liver disease is important for prognosis. In the present study we used texture analysis to quantitatively assess progression based on the appearance of the surface of the liver during laparoscopy. A total of 34 chronic liver disease patients who underwent laparoscopic examinations over a 2‐year period were enrolled in this study. Their laparoscopic photographs were classified into a chronic hepatitis or a liver cirrhosis group, and image analysis was performed with intraoperative photographs of laparotomy patients without associated liver disease serving as the normal control group. The photographs of the 3 groups were input into a digital image processorr (NEXUS6400) by a film scanner, and the image data obtained were analyzed by the gray level difference method, the run length method, and fractal number. Significant differences were observed between the quantitative values in the three groups by each of these methods, but it was not possible to evaluate fine changes at the liver surface occurring during the progression of chronic hepatitis to liver cirrhosis.
Endoscopic Diagnosis of Biliary Tract Lesions Using Hydrostatic Balloon Sphincter Dilation: A Preliminary Experience
Authors: UENO Norio , TOMIYAMA Takeshi
Published: December 2007

We report some encouraging results of endoscopic balloon sphincter dilation (EBSD) and discuss its clinical relevance in the diagnosis of bile duct lesions by endoscopically accessing the biliary tree. Endoscopic approach to the bile duct was performed in seven patients with various biliary tract diseases (bile duct cancer in 2 cases, pancreatic cancer in 1, Caroli disease with bile duct stones in 1, gallbladder cancer in 1, and hepatocellular carcinoma in 2) after passing a baby scope through the papilla of Vater using EBSD. The instrument used was a Maxforce 5 French balloon‐tipped biliary catheter for EBSD, an Olympus CHF‐BP30 or Pentax FCP‐9P baby fiberscope, and an Olympus TJF‐M20 mother fiberscope for endoscopic examination. Using EBSD, it was possible to advance a baby fiberscope through the papilla of Vater in all cases. In 6 patients, endoscopic observation was successfully achieved. Apart from minimal self‐limiting venous oozing seen following balloon deflation, there was no papillary hemorrhage or perforation observed. Pancreatitis developed in one patient and was resolved within 24 hours. Although our series is limited and several technical issues remain to be solved, this new procedure has potential for endoscopic diagnosis of biliary tract lesions. One of the major advantages may lie in the possibility of preserving sphincter function. We favor the use of EBSD for diagnostic evaluation of bile duct diseases.
Low Grade MALToma and Early Cancer of the Stomach in a Patient with Helicobacter pylori Infection: A Case Report
Authors: KAJIMURA Masayoshi , OOTAKE Mamiko , NAKAGAWARA Masanori , NAGASAWA Masamichi , YOSHIDA Ken-ichi , KATAOKA Hideki , SHIRAI Naohito , SHIMIZU Shin-ichi , KOBAYASHI Hiroshi , NAGATA Hitoshi , NAKAYA Yuzo
Published: December 2007

A causal relationship has been suggested between Helicobacter pylori infection and gastric malignancy, including both gastric cancer and low grade lymphoma of mucosa‐associated lymphoid tissue (MALToma). We describe a rare case of simultaneous occurrence of low grade MALToma and early cancer of the stomach in a 72‐year‐old woman. In this patient, low grade MALToma not only had preceded gastric cancer by 5 years, but had also disappeared, and subsequently reappeared coexisting with early cancer of the stomach and Helicobacter pylori infection. Eradication therapy for Helicobacter pylori was performed immediately prior to subtotal gastrectomy for early gastric cancer of the pyloric area. Thereafter, regression of MALToma was observed. These results, taken together with a previously reported case of low grade MALToma, suggest that low grade MALToma of the stomach may fluctuate, at least in the initial stages, even in the presence of constant Helicobacter pylori infection.
Role of Endosonography in Diagnosis of Esophageal Bronchogenic Cyst
Authors: TOMIZAWA Michiko , KON Youichi , KUROSAKI Mariko , AKIYA Toshikazu , NAGASAKO Kou
Published: December 2007

Bronchogenic cyst is very difficult to diagnose preoperatively. We report two cases of bronchogenic cyst of the esophagus diagnosed and treated by thoracoscopic resection or endoscopic mucosal incision. Thoracoscopic resection was performed to diagnose and treat case 1, while in case 2, histological diagnosis was obtained with an endoscopic mucosal incision. On endoscopic ultrasonography, the lesion characteristically demonstrated two components consisting of an anechoic and homogeneous echoic pattern. Although it is very rare for bronchogenic cyst to be complicated by malignancy, histological diagnosis is necessary. If tumor localization is in the esophageal wall and the safety of a mucosal incision can be confirmed, endoscopic incision is a good alternative that allows less invasive diagnosis and treatment than surgery or thoracoscopy.
Regression of Gastroduodenal Mucosa‐Associated Lymphoid Tissue Lymphoma after Eradication of Helicobacter pylori: A Case Report
Authors: KAJIMURA Masayoshi , NAKAGAWARA Masanori , YOSHIDA Ken‐ichi , KATAOKA Hideki , SHIRAI Naohito , SHNIZU Shin‐ichi , KOBAYASHI Hiroshi , SUCHI Taizan
Published: December 2007

Increasing evidence suggests that eradication therapy of Helicobacter pylori (H. pylori) may be an effective treatment for gastric lymphoma of mucosa‐associated lymphoid tissue (MALToma), but it remains unclear whether a similar therapeutic effect may be obtained for MALToma at other sites. We describe here a case of regression of gastroduodenal MALToma after eradication therapy for H. pylori. A 39‐year‐old man underwent gastroscopy at a routine check‐up, which demonstrated protruding lesions like a raised erosion in the antrum and multiple whitish granular lesions in the fornix. Simultaneously, multiple coarse nodular lesions were also found in the duodenal bulb. Forceps biopsy specimens obtained from both the stomach and bulb showed infiltration of small‐ to medium‐sized lymphocytes with cleaved nuclei, centrocyte‐like cells, together with atypical large lymphoid cells into the glandular lesion, and the rearrangement of immunoglobulin was positive, thereby allowing diagnosis of low grade MALToma with large cell transformation. H. pylori was positive in the stomach, while the presence of H, pylori was not detected microscopically in the bulb, although ectopic gastric mucosa was identified in the bulb. Regression of multiple coarse or granular lesions in both the stomach and bulb were observed three months after eradication of H. pylori. Thereafter the disappearance of MALToma was verified histologically a further six months later. There was no recurrence of MALToma detected over a two‐year follow‐up period. These findings suggest that eradication of H. pylori could be a treatment of first choice for MALToma occurring in the gastrointestinal tract outside the stomach.
A Case of Hemophilia B with Esophageal Varices Treated by Sclerotherapy with Factor‐IX Complex
Authors: KAYASHIMA Shinsuke , MURASHIMA Naoya , TAKEI Kazuo , NAKAYAMA Satoshi , MATSUOKA Masaki , YOSHIDA Yukiya , HAYAKAWA Kazuo , FUKUCHI Sohtarou , FUJIOKA Takahiro , OHBA Ken‐ichi
Published: December 2007

A 64‐year‐old man with hemophilia B and HCV‐positive chronic hepatitis who had been followed at our hospital presented with hematemesis. Gastrointestinal fiber‐scopy (GIF) demonstrated a small active gastric ulcer (Az stage) at the pyloric ring and esophageal varices (F1 Lm Cw RC(+)). He was admitted and the esophageal varices were safely and successfully treated by sclerotheapy. Sclerotherapy was performed by in‐traluminal injection of 4 mL 5% ethanolamine oleate with sufficient supplementation of factor‐lX complex (PPSB ‐HT) for four days to a total amount of 24,000 U. The patient was followed with GIF and endoscopic ultrasonography. Sclerotherapy proved effective after six months. We report a rare case of hemophilia B with esophageal varices successfully treated by sclerotherapy.
A Device for Simultaneous Application of Sclerotherapy and Endoscopic Ligation for Management of Esophageal Varices
Authors: MURASHIMA Naoya , KOBAYASHI Masahiro , KOBAYASHI Mizuho , TSUBOTA Akihito , SUZUKI Yoshiyuki , SAITOH Satoshi , ARASE Yasuji , CHAYAMA Kazuaki , IKEDA Kenji , KUMADA Hiromitsu
Published: December 2007

A device developed for simultaneous application of sclerotherapy and endoscopic variceal ligation to treat esophageal varices is described. This device took less than 14 sec to attach to the endoscope, compared to 71 sec using the conventional device. The success rate of intravariceal injection using a 3‐cm or 4‐cm long hemostatic balloon or a conventional balloon was not significantly different. This device had the added advantage that simultaneous sclerotherapy and ligation were possible without changing the endoscope.
A Detailed Survey of Superficial Esophageal Cancer with Histological Features Other than Squamous Cell Carcinoma in Japan
Authors: ARIMA Miwako
Published: December 2007

Abstract: A questionnaire‐based survey of cases of superficial esophageal cancer with histological features other than squamous cell carcinoma (SCC) was conducted prior to The 37th Conference of the Japanese Research Society for Early Esophageal Cancer and Chromoendoscopy. The data of cases resected between 1986 and 1996 at 25 Japanese institutions were evaluated. Among 2,381 cases of superficial esophageal cancer, 93 patients (3.9%) were diagnosed with histological features other than SCC. These included 6 cases of mucosal cancer and 87 cases of submucosal cancer, and were referred to as superficial nonsquamous cell carcinoma (NSCC). Most cases were grossly classified as O‐I type. Elevated tumors, which included O‐I and O‐lla types, accounted for 80% of all lesions. Many cases of adenoid cystic carcinoma (ACC), adenosquamous carcinoma (ASC), basaloid carcinoma (BSC) and undifferentiated carcinoma (UND) were classified as O‐lpl or O‐lsep types. Almost all cases of carcinosarcoma (CASA) and malignant melanoma (MM) were classified as O‐lp type. A small number of O‐llc type tumors were observed and diagnosed as adenocarcinoma (AC), ACC ASC and BSC. All cases of AC were classified as unilocular tumor, and many cases were observed at the abdominal esophagus. However, the superficial esophageal tumors could not be differentiated by endoscopic features. The frequency of lymph node metastasis was slightly higher in UND and MM (60%), while the other histological types of esophageal cancer had an equivalent frequency to SCC (20–40%). Although the frequency of tumor recurrence was usually approximately 20%, the frequency of recurrent UND and MM was as high as 50–60%. Distant organ metastasis was the most commonly observed pattern of tumor metastasis. The five‐year survival rate was approximately 60%, and there were no significant differences in the survival rate among the patients. However, the prognosis of UND and MM tended to be poor. (Dig Endosc 1999; 11: 12–23)
Risk Factors of Hepatocellular Carcinoma in Chronic Hepatitis C and Cirrhosis: Special Reference to Laparoscopic Findings
Authors: SHIBAYAMA Takao , MORI Shin‐iciro , OHTAKE Hiroo , HAYASHI Seishuu , SAEKI Shunichi , TANAKA Takahi , TANAKA Satoshi
Published: December 2007

Abstract: It remains unclear whether the hepatitis C virus genotype is associated with the severity and outcome of HCV‐related liver disease. The aim of this study was to determine whether hepatitis C virus genotype influenced the risk of developing hepatocelMar carcinoma. Two hundred and sixty nine patients who had chronic hepatitis C and cirrhosis without hepatocellular carcinoma were studied. The stage and activity of hepatitis were determined at laparoscopy and patients were followed up until the development of hepatocellular carcinoma or for a maximum of 16 years. Hepatitis C virus genotypes were determined by a genotyping enzyme‐linked immunosorbent assay. A cross‐sectional study revealed that the prevalence of hepatitis C virus genotype 1 increased and that of genotype 2 decreased with the progression of liver disease (pc 0.01). A follow‐up study using the Kaplan‐Meier method showed that hepatocellular carcinoma occurred more frequently in patients with hepatitis C virus genotype 1 (p<0.01), patients with a more advanced disease stage (p<0.01), and patients with reddish markings (p<0.05). Cox multivariate proportional hazards analysis confirmed that these three risk factors were independent. Hepatocellular carcinoma developed more frequently in patients with hepatitis C virus genotype 1 and pre‐cirrhosis (stage 3 chronic hepatitis with nodules) or liver cirrhosis, in whom hepatitis showed continued activity and progression. (Dig Endosc 1999; 11: 24–31)
Temporary Pancreatic Duct Stenting to Prevent Pancreatitis Induced by Endoscopic Sphincter Dilation
Authors: AIZAWA Toshiyuki , UENO Norio , OZAWA Yoshifumi
Published: December 2007

Abstract: To investigate whether prophylactic temporary stenting of the main pancreatic duct would decrease the incidence of pancreatitis after endoscopic sphincter dilation (ESD), we conducted this procedure subsequent to ESD in 13 patients who had common bile duct stones. After ESD and extraction of stones, a stent was placed into the pancreatic duct across the papilla of Vater. The stent was removed endoscopically three days later. Stents were successfully placed in 12 (92.3%) patients. In 11 of the patients, there was no significant elevation of serum amylase values before and after the procedure. The remaining patient, whose stent was identified as occluded, demonstrated elevated serum amylase values. However, there were no other procedure‐related complications. Although our report was only limited to 12 cases, our results suggest that temporary pancreatic stenting may help prevent postprocedual pancreatitis. (Dig Endosc 1999; 11:32–36)