ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00690.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:With the widespread use of laparoscopic cholecystectomy (LC), the role of pre‐ and postoperative endoscopic retrograde cholangiopancreatography (ERCP) and / or endoscopic sphincterotomy (ES) has become very important. Indications for ERCP with possible ES before LC include clinical suspicion of a common bile duct (CBD) stone alone, evidence of jaundice, recent cholangitis or pancreatitis that is probably due to a duct stone or dilated CBD. Local endoscopic and surgical expertise are important factors in deciding the approach to the pre‐LC patients. The success rate of ductal clearance of stones by ES approaches 90 to 95% in expert hands. ERCP is very effective in the management of post‐LC patients with symptoms, as well as in diagnosing and treating complications such as retained stones, ductal leaks and stric

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00691.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:We examined esophageal varices using the new technique of endoscopic ultrasonography (EUS) that employed a high‐resolution 15/20 MHz ultrasonic probe. EUS employing the direct contact method, in which the forceps‐channel probe was in direct contact with the lumen, was used in patients with esophageal varices (58 cases) and in control patients without varices (32 cases). Findings were also compared with additional EUS employing the conventional balloon method which was performed on 21 of the patients with esophageal varices.The direct contact method visualized all the varices (endoscopic Grade 1 varices; 2.0 ± 0.7 mm in diameter (mean ± SD) and 11.9 ± 3.1 cm in length, endoscopic Grade 2 or 3 varices; 5.8 ± 3.2 mm in diameter and 16.3 ± 3.0 cm in length).In the 21 patients who underwent EUS by the two different methods, varices were displayed by both methods in 9 cases (7 endoscopic Grade 2 varices, and 2 Grade 3 varices). In the other 12 cases (8 endoscopic Grade 1 varices, and 4 Grade 2 varices) varices were displayed only by the direct contact method, and not by the balloon method.The direct contact method can be regarded as a useful technique for the evaluation of esophageal

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00692.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:We studied 14 patients using endoscopic color Doppler ultrasonography (ECDUS) to evaluate the hemodynamics of gastric varices, and evaluated the endoscopic therapeutic effects on gastric varices in 8 patients. Three patients had F3type gastric varices and eleven had F2. The ECDUS was performed with a PENTAX FG‐32UA (7.5MHz, convex type) and a HITACHI EUB 565 was used as a display machine. The intramural blood flow in the gastric varices and inflows from the extra‐gastric wall were clearly observed with the ECDUS in all 14 patients. The extramural blood flow (gastro or spleno‐renal shunts) was detected in 9 of 14 patients. The velocity of the intramural flow in tumorous type varices (F3) was higher than in the nodular or flat elevated type (Fa). Next, we evaluated the therapeutic effects on gastric varices of the ECDUS. The successful disappearance of intramural blood flow was observed in 6 of 8 patients who had this endoscopic therapy. In two of the 8 patients, there was not enough therapeutic effect on the intramural blood flow. The extramural blood flow, however, did not change before or after endoscopic therapy with the ECDUS.Therefore, we concluded that ECDUS is a very useful modality for the diagnosis of hemodynamics and to evaluate the therapeutic effects on gastric va

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00693.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The endoscopic ultrasonography findings at the lower esophageal sphincter (LES) were compared in patients with reflux esophagitis and esophageal achalasia to clarify the differences in wall structure between these diseases. In reflux esophagitis, the esophageal wall was hypertrophied at the LES and featured both irregularity and interruption of the submucosa, muscularis propria, and adventitia. In achalasia, there was generalized hypertrophy of the esophageal wall at the LES including the mucosa, submucosa, muscularis propria and adventitia but for each layer the normal 5‐layer structure was visualized well.Thus achalasia and reflux esophagitis both featured hypertrophy at the LES, but the detailed findings were quite different. This difference was thought to arise from the presence of inflammation in reflux esophagitis and no inflammation in achalasi

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00694.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:To determine changes in pathophysiology during the healing process of gastric ulcers, gastric acid secretion, gastric emptying, fasting gastrin levels (FGL) and the integrated gastrin response (IGR) were studied in normal volunteers and in each stage of gastric ulcers. In a study of patients with gastric ulcers in the lesser curvature of the ventricular angulus including 20 in the active stage, 49 in the healing stage and 11 in the healed (scar) stage, gastric acid secretion (BAO and MAO) and FGL gradually decreased as the patients progressed from the active stage through the healing and healed stages. IGR values did not change, but gastric emptying showed marked prolongation in the active and healing stages although this was alleviated in the healed stage. In 11 of the same gastric ulcer patients who were followed up, gastric acid secretion, especially BAO, was lower in the healed stage than in the active stage. No fixed tendency was seen for gastric emptying and IGR, but FGL showed higher values in the active stage than in the healing stage. These findings indicated that changes in the pathophysiology of the stomach occur during the healing of gastric ulcers, and it was assumed that these changes are closely related to the stage of the ulcer.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00695.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Much remains to be clarified about the mechanisms of Helicobacter pylori (H. pylori)‐associated gastritis. We considered the possibility of neutrophil involvement and investigated the role of polymorphonuclear leukocyte elastase (PMN‐E) in the etiology of H. pylori‐associated gastritis.Methods:In 60 patients with gastritis, infection by H. pylori was diagnosed by a combination of the ELISA method and conventional culture method. The hexosamine contents of the mucosal tissues and plasma polymorphonucler leukocyte elastase complexes (PMN‐EC) were determined.Results:PMN‐EC was found to be elevated in H. pylori‐positive gastritis patients, and the degree of elevation was proportionately related to the grade of gastritis inflammation. The hexosamine concentration of the gastric antral mucosa was significantly lower in H. pylori‐positive patients than in the H. pylori‐negative patients. The ratio of PMN‐EC/gastric mucosal hexosamine concentration was significantly higher in the H. pylori‐positive group than in the negative group.Conclusion:These data suggest that one of the mechanisms of the H. pylori‐associated gastritis may be the infiltration of neutrophils into the gastric mucosa followed by the release of PMN‐E which is responsible for the degradation of gastric mucosal proteins and r

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00696.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Phlebosclerosis of the mesenteric vein is a rare cause of ischemic colitis. The current report includes two patients with segmental ischemic colitis associated with marked calcifications of the mesenteric vessels. No evidence of systemic vasculitis, tuberculosis nor amyloidosis was observed. The patients were previously healthy and had no history of drug use of any kind. Clinical findings included abdominal pain in the right upper quadrant and diarrhea alternating with constipation, and colonic narrowing were discoverd by barium enema. An abdominal X‐ray examination revealed some patchy calcifications in the right and left upper quadrants. An angiography of the superior mesenteric artery revealed sclerosis of the artery, disturbance of colonic blood flow, and calcifications of the mesenteric vessels. The patients were treated with an anticoagulant. In follow‐up studies, barium enema and colonoscopy revealed a gradual progression of the disease over the last five years. Treatment with an anticoagulant may have prevented rapid advancement of the disease and thereby eliminated the need for emergency operations. These unusual venous lesions have been rarely reported, and their etiology and pathogenesis remain unkn

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00697.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Accessory hepatic ducts, especially the left ducts, are relatively rare anomalies of the biliary tract. We present here a patient with this anomaly complicated by the presence of multiple stones. Endoscopic retrograde cholangiography (ERC) and ultrasound (US) were very useful in establishing the diagnosis preoperatively and in determining our surgical strategy. ERC demonstrated the left accessory hepatic duct with multiple radiolucent stones at the level of the cystic duct on the opposite side of the gallbladder. US demonstrated a hyperechoic mass measuring 15×10 mm with an acoustic shadow at the hepatic hilus. It also showed the internal “honey‐comb” structure of the mass which contained numerous stones measuring 5–6 mm in diameter and a fine tubular structure between the accessory hepatic duct and the caudate lobe. Intraoperatively the sac‐like, dilated (35×10 mm), left accessory hepatic duct was filled with numerous bilirubin stones originating at the cystic duct from its contralateral side. A few fine bile ducts communicated with the accessory hepatic duct and the c

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00698.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1994.tb00699.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY