ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00421.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We analyzed the expression of CEA, CA19‐9, CA125, CA15‐3 (DF3), PCNA and p53 immunohistochemically in 14 tissue specimens of mucosal cancers in adenoma, seven tubulovillous adenoma specimens, and 16 tubular adenoma specimens. The rates of positive staining for mucosal cancer in adenoma, tubulovillous adenoma and tubular adenoma specimens, respectively, were: for CEA: 100%, 85.7% and 75%; for CA19‐9: 71.4%, 71.4% and 56.2%; for CA125:0%, 0% and 0%;for CA15‐3 (DF3): 64.3 %, 0% and 0 %; for PCNA: 100%, 88.9% and 56.2%; and for p53: 35.7%, 0% and 0% . The results suggest that the expressions of CEA, CA19‐9, CA15‐3 (DF3), PCNA and p53 are related to colorectal tumorigenesis. None of the specimens studied showed staining for CA125, suggesting that CA125 is not involved in the early stages of colorectal carcinogenesis. There was no significant difference in the rates of positive staining for CEA and CA19‐9 among mucosal cancer in adenoma, tubular adenoma and tubulovillous adenoma specimens. However, the rates of positive staining for PCNA and p53 were significantly higher in mucosal cancer in adenoma specimens than for tubular adenoma specimens (p<0.05), and the rate of CA15‐3 (DF3) positive staining was significantly higher for mucosal cancer in adenoma than for tubulovillous adenoma (p<0.01) and tubular adenoma (p<0.001) specimens. Therefore, the CA15‐3 (DF3) antigen is an immunohistochemical marker for colorectal carcinomas. The present results suggest that CA15‐3 (DF3), PCNA and p53 play important roles in the genesis of

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00422.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study was designed to determine the actual incidence, distribution and morphology of minute neoplastic polyps, under 5 mm in diameter, in the so‐called normal colon obtained at autopsy. In order to increase the sensitivity of detection of minute lesions, this study was done with the aid of electronic endoscopy using the dye spraying method. The case‐occurrence of minute neoplastic polyps among the 49 autopsy cases was almost 50% and the ratio of cases without adenomas or cancers of the colon was no more than 50%. The ratio of minute neoplastic polyps among the total number of neoplastic polyps, based on electronic endoscopy, was much higher than that of minute polyps of autopsy cases reported previously with macroscopic observation. Regarding the grade of atypia of the minute neoplastic polyps, only one polyp (5 mm in diameter) among 85 lesions was a carcinoma. The results of this study indicate the possibility of considerable numbers of minute neoplastic polyps which are likely to go undetected by endoscopy, probably due to technical difficulties in endoscopic control and the lack of sufficient examination time for each pati

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00423.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A total of 44 patients with long‐standing ulcerative colitis were studied to elucidate changes over time in colonoscopic and histological inflammatory activity. More than two years of symptomatic remission without melena or bloody diarrhea was achieved in 63.6% (28/44). All patients underwent total colonoscopic examinations. Compared with findings of the previously involved area, 70.5% (31/44) showed a reduction or disappearance of the inflammatory area on endoscopic and histological examinations; however, the rectal inflammation disappeared in 31.8% (14/44) of patients. Moreover, it became apparent that the remaining active inflammatory area tended to show discontinuous spread with patchy inflammatory foci. Thus, the mucosal inflammation in long‐standing ulcerative colitis may be characterized by a reduction in both extent and deg

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00424.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Percutaneous endoscopic gastrostomy (PEG) has been suggested to affect gastric emptying. The aims of this prospective study were to examine the effects of erythromycin, known to act as a motilin agonist, on gastroesophageal motility in nine patients fed via PEG tubes and nine fed via nasogastric tubes. The gastric emptying time and gastroesophageal reflux index were simultaneously measured in each patient after the intravenous administration of erythromycin (200 mg) or a placebo on different days, using a radioisotopic method. The alteration of gastric emptying time produced by intravenous erythromycin in the PEG group was smaller than that in the nasogastric group (p<0.05). However, gastroesophageal reflux indices in the two groups were similar. We conclude that PEG may impair gastric emptying subclinically without affecting gastroesophageal reflux.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00425.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The transpapillary technique of intracavitary irradiation has not gained wide acceptance due mainly to the development of the instruments used being in a relatively early stage. Intracavitary irradiation using a new high‐dose rate remote afterloading 192‐iridium brachytherapeutic device was performed utilizing an endoscopic transpapillary technique in four patients with cholangiocarcinomas obstructing the bile ducts. Via a prepositioned 10‐Fr nasobiliary catheter, a 12 Gy dose was administered at a distance of 1.0 cm from the radiation source at each procedure. Irradiation lasted several minutes (7.8 minutes on average). The procedure was repeated at 3‐day intervals, and the total dose ranged from 24 to 36 Gy. Cholangiography, performed immediately after completion of a series of irradiation treatments, disclosed various degrees of recanalization of the bile duct, and transpapillarily obtained biopsy specimens showed disappearance of tumor cells. All patients tolerated the radiation procedure well, and no procedure‐related complications were observed. The present preliminary experience suggests that transpapillary intracavitary irradiation has become technically feasible. Further experience in a larger series may demonstrate a role for this therapeutic modality in the treatment of unresectable cholangio

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00426.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Accurately diagnosing the depth of invasion in small early gastric cancers is essential for determining whether endoscopic resection of a lesion is indicated. It is often difficult, however, to demonstrate such small lesions by conventional endoscopic ultrasonography (EUS) which is considered to be a useful tool for assessing depth of invasion. To facilitate demonstration by EUS, we injected 2‐5 ml of saline into the submucosal layer at an appropriate point 1 ‐2 cm from the lesion. With the collection of saline serving as a guide, the lesion was demonstrable on the same EUS image (“para‐lesional” injection method). Using this method, we were able to evaluate all 12 of the small early gastric cancers we examined. Five of these lesions were endoscopically resected uneventfully after EUS examination. The accuracy of the diagnosis of vertical invasion with this method was 83% (10/12). Histologically, fibrotic changes were observed beside the lesion, but no EUS‐related effects were recognized beneath the lesion. The present results suggest that the “para‐lesional” injection method is useful for assessing small early gastric cancers by

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00427.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We developed a rotatable, highly durable clipping device (rotatable clip‐device) and a long clip which can be used to effectively grasp a large bite of tissue. However, application of the long clip required a special reinforced clipping device. The new rotatable clip‐device can be appropriately used in combination with the long clip because of its improved strength and rotatability. The rotatable clip‐device was used for endoscopic treatment of 133 patients, including 43 requiring hemostasis of gastrointestinal bleeding, 43 with prophylactic clipping following polypectomy, 39 with mucosal closure following endoscopic mucosal resection (EMR), and 10 undergoing prophylactic ligation of esophageal varices. The long clips were used mainly for mucosal closure after EMR. The rotatable clip‐device was found to be especially useful for hemostasis of soft bleeding lesions. Prophylactic clipping following polypectomy prevented complications in 40 out of 41 patients. Mucosal closure by means of clipping following EMR prevented complications in all 39 patients, and the rotatability of the rotatable clip‐device and the large bite capacity of the long clip greatly facilitated closing mucosal defects, especially large defects. In the 10 patients who underwent prophylactic clipping of esophageal varices, the rotatable clip‐device allowed the varices to be grasped securely and ligated effectively. During endoscopic treatment, three of the four clip‐devices functioned normally despite frequent auto‐claving and clip

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00428.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The normal esophageal mucosa was observed in detail using ultra‐high magnification endoscopy (UHM endoscopy). The UHM endoscope has a magnification capacity ranging from eight to 150x. High‐quality UHM endoscopic pictures can be continuously obtained by attaching a 2‐mm depth soft distal attachment to the tip of the UHM endoscope. The vascular architecture, which extends from the submucosal vessels through the proper mucosal layer, can be continuously visualized, thereby demonstrating the characteristic fine‐vascular network pattern, and the intrapapillary capillaries in the epithelium. With UHM endoscopy, intrapapillary capillaries can be clearly demonstrated as single loop vessels which we have termed “intrapapillary loops.” These structures cannot be observed with an ordinary magnifying endoscope which is capable of only 35x magnification. We conclude that a technique for obtaining high‐resolution endoscopic pictures has been established. The images obtained are useful for elucidating the microstructure of the esophageal mucosa, especially the fine‐vascular network and the newly recognized intr

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00429.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We designed and produced a new instrument that measures the color of the gastrointestinal mucosa during conventional endoscopic examination. The instrument consists fundamentally of an optical fiber sensor and a light source. One end of the optical fiber sensor is connected to the light source and a commercially available spectrophotometric colorimeter, while the other end is passed through the biopsy channel of a commercially available endoscope and placed in contact with the gastrointestinal mucosa. The color of the mucosa is then measured. To evaluate the accuracy of color measurement, the instrument was used to measure the color of 108 color chips belonging to the color range of the gastrointestinal mucosa or surrounding regions, selected from the Munsell Book of Color. The instrument correctly determined the relative hue, chroma and value of all 108 color chips tested. It also had the advantages of consistently measuring the color chips under standardized conditions and of promptly displaying the color readings during endoscopic examination.This instrument was also used to measure the color of the mucosa at different sites of the upper gastrointestinal tract in 20 patients. There were no noteworthy problems in using the instrument clinically. Mucosal color (hue, value and chroma) of the upper gastrointestinal tract was demonstrated to have specific characteristics according to the region measured.The instrument provided highly accurate, objective information that facilitated the distinction of slight differences in mucosal color, an important factor in the endoscopic diagnosis of gastrointestinal diseases.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00430.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY