ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00385.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The application of laparoscopic] cholecystectomy, first reported in 1987, has grown rapidly worldwide, replacing the open cholecystectomy. This trend is attributable to the benefits of minimal surgical access, i. e. a smaller incision, less postoperative pain and faster recovery. However, doubts persist concerning the role of laparoscopic cholecystectomy in elderly patients. The purpose of this study was to assess morbidity and mortality in elderly patients who underwent laparoscopic cholecystectomy at Teikyo University Hospital at Mizonokuchi. Forty‐eight patients, 65 years or older, underwent attempted or successful laparoscopic cholecystectomy. To assess operative risk in these patients, the American Society of Anesthesiologist's Surgical Risk (A. S. A.) category was used. The risk ranged from 1 to 3 with a median of 2. Twenty‐five percent of the patients were defined as A. S. A. I, 61% as A. S. A. II and 14% as A. S. A. III. Four patients required intraoperative conversion of the procedure to open cholecystectomy (conversion rate of 8.3%). The indications for conversion in three patients were severe adhesion and thickened gallbladder wall and in the other were secondary to gallbladder bed oozing. This conversion rate is similar to that reported in other series. The conversion was not related to the surgical risk. The morbidity rate was 4.5%. the mortality rate zero. These results compared favorably with those reported for open cholecystectomy in elderly patients and with the overall published morbidity‐mortality rate of laparoscopic cholecystectomy in large series. We conclude that laparoscopic cholecystectomy is a suitable procedure for elderly pat

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00386.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The gallbladder is a suitable target of endoscopic ultrasound (EUS). However, the interpretation of the layer structure of the gallbladder wall delineated by EUS is still controversial. To confirm the relationship between the layers demonstrated by EUS and the histological structure, we performed a study using the pinning method. In most slices, the gallbladder wall was demonstrated to be a two‐or three‐layer structure, consisting of a low echoic layer, sometimes with an overlying hyperechoic layer, and a high echoic layer from the mucosal side. The slices were pierced with pins at random depths. Among the twelve pin echoes demonstrated in the low echoic layer, four were located in the muscularis propria, two in the border between the muscularis propria and the subserosa, three in the fibrous layer of the upper portion of the subserosa, and three in the adipose layer of the lower portion of the subserosa. The three sites where the pin echoes were seen at the border between the low echoic and high echoic layers were located in the fibrous layer, the border between the fibrous layer and the adipose layer, and in the adipose layer, respectively. The twelve sites at which pin echoes were observed in the high echoic layer were confirmed to be in the adipose layer. These results indicate that the inner hypoechoic layer includes not only the muscularis propria but also the fibrous layer of the subserosa. This should be kept in mind when assessing the depth of invasion of a gallbladder carcin

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00387.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Biliary obstruction has been recognized to inhibit excretion of antibiotics into bile. In the present study, using cefpirome sulfate (CPR), we sought to determine the effect of biliary pressure on antibiotic transfer into bile in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Thirty‐six patients with a variety of biliopancreatic diseases (free of renal disease or hypoproteinemia) received a single intravenous dose of CPR (1 g) prior to ERCP. Under fluoroscopy a diagnostic catheter with a metal ball tip was advanced into the middle portion of the extrahepatic bile duct or, in cases of common bile duct obstruction, above the obstruction. Biliary pressure was measured via the same catheter using duodenal pressure as a reference. Subsequently, bile was aspirated, and blood was withdrawn simultaneously. The mean interval between CPR administration and the bile and blood samplings was 67±12 minutes. The bile CPR concentration and the bile/serum ratio of CPR concentrations showed a significant inverse correlation with biliary pressure, but the serum CPR concentration did not. The bile CPR concentration and the bile/serum ratio of CPR concentrations differed significantly between the group with normal biliary pressures, below 10 mmHg, and that with biliary pressures exceeding 10 mmHg. The serum CPR concentrations of the two groups were similar. These results suggest that biliary pressure plays an important role in determining antibiotic transfer into bi

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00388.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The Sydney System is a relatively new classification system for gastritis that includes two divisions: histological and endoscopic. To evaluate the endoscopic division, we assessed the endoscopic appearance of the gastric mucosa according to the Sydney System. One thousand seventeen cases of gastritis were diagnosed endoscopically from July 1992 through June 1993. According to the eight categories of endoscopic gastritis used in the Sydney System, 58.8% of cases were diagnosed as atrophic gastritis, 18.7% as erythematous gastritis, 7.8% as raised erosive gastritis, 5.0% as flat erosive gastritis, 5.0% as hemorrhagic gastritis, 3.1% as congestive gastropathy, and 1.5% as enterogastric reflux gastritis. The topography of atrophic gastritis correlated significantly with the extent of endoscopic atrophy, while the severity of the atrophic gastritis grading correlated significantly with the histological severity of atrophy. Although some difficulties remain with regard to the description of endoscopic gastritis in the Sydney System, these issues could be resolved by modifying a few parts of the descriptive definition of gastritis. Our results indicate that the endoscopic division of the Sydney System is applicable to the classification of gastritis in Japanese patients.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00389.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI‐IV ulcers was significantly higher than those in UI‐II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurre

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00390.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:We investigated the expressions of SLX, ST‐439 and PLAP, which are regarded as having high specificity for cancer, in borderline lesions of the stomach to ascertain the significance of these potential markers in distinguishing between benign and malignant lesions. SLX, ST‐439 and PLAP expressions in gastric biopsy specimens, from 73 patients with gastric lesions, were visualized using avidin‐biotin‐peroxidase. Although the prevalence of SLX in Group V was 90%. it was also high in intestinal metaplasia (40%) and adenoma (75%). The prevalences of ST‐439 in intestinal metaplasia and adenoma grades l and 2 were 5, 23, and 17%. respectively. On the other hand, the prevalence of ST‐439 was about 60% in adenoma grade 3 and in Groups IV and V. The prevalence and immunostaining range of ST‐439 increased concomitantly with increasing grades of cytological and architectural atypia. The prevalence of PLAP in gastric biopsy materials was 30% overall, but was higher among the differentiated types. Moreover, PLAP was highly specific for cancer because of the negative immunostaining observed in benign lesions such as intestinal metaplasia and adenoma. These results suggest the following: 1) SLX is relatively non‐specific for cancer and thus not useful in the pathological diagnosis of gastric lesions, and 2) borderline lesions with positive ST‐439 mandate careful follow‐up. Moreover, lesions with apparently extensive and intense ST‐439 immunostaining may be gastric cancer and require urgent attention. Furthermore, 3) PLAP may provide additional diagnostic information useful for distinguishing between well‐differentiated adenocarcinoma and borderline le

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00391.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Protection of the gastric mucosa, based on its high affinity for mucosal lesions, has been reported as one of the antiulcer effects of ecabet sodium. We investigated the adhesive effect of this drug on mucosal lesions in a porcine gastric ulcer model (freshly isolated stomach) and on human mucosal lesions resulting from endoscopic gastric mucosal resection (EMR) and polypectomy. After ulcer lesions had been induced by EMR in the isolated porcine stomach, ecabet sodium and sucralfate suspensions were applied. After washing with citrate buffer, at a pH of 1, 3 or 5, the adhesion of each drug to the gastric mucosa was measured. At pH 1, both drugs showed satisfactory adhesion to the ulcer lesions. When the acidity of the ulcer surfaces was decreased to pH 3 and then to pH 5, the adhesion of sucralfate showed a marked decrease (100%→31→% 13%). while that of ecabet sodium showed only a slight decrease (100%→75%→64%). Futhermore, the activity of thrombin in the ecabet sodium suspension remained high at pH 1, 3 and 5. Since the ecabet sodium suspension produced a satisfactory covering effect on gastric mucosal lesions and this effect was maintained even at low acidity, this drug is considered suitable for endoscopic directsprinkling therapy for gastric mucosal

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00392.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The effects of acetyl salicylic acid and cetraxate on gastric mucosal blood flow (GMBF) were examined in human subjects. GMBF was determined endoscopically using a laser Doppler flowmeter. The normal value in 16 adults ranged from 1.7 ± 0.8 volts (mean ± SD) at the lesser curvature of the antrum to 3.72 ± 0.79 volts at the greater curvature of the body. In four normal volunteers, the time course of GMBF was measured after the oral intake of 0.5 g acetyl salicylic acid with or without cetraxate. GMBF was significantly lower after intake of acetyl salicylic acid at 15 min at the lesser curvature of the body (3.6 ± 1.0 to 2.3 ± 0.7, P<0.05) and at 20 min at the lesser curvature of the antrum (2.7 ± 0.6 to 1.4 ± 0.2, P<0.05), as compared with the values at 5 min. This adverse effect of acetyl salicylic acid on GMBF was inhibited by concomitant administration of 0.8 g cetraxate. It was concluded that cetraxate prevented the acetyl salicylic acid induced decrease i

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00393.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Various forms of image processing have been attempted since the development of the electronic endoscope; band enhancement is an image processing technique designed to accentuate minute surface structures. We observed 161 colorectal tumors with an electronic colonoscope and compared the pit pattern identification rate among ordinary, edge‐enhanced and bandenhanced images. We found that the pit pattern identification rate was significantly higher with band‐enhanced than with other image types. Furthermore, band enhancement was especially useful in the differential diagnosis of small lesions. Accordingly, this technique was considered to be useful for determining endoscopic treatment indications for colorectal tum

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00394.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY