摘要:

Abstract:The following paper is a study of 119 gastric cancer lesions that were not diagnosed as malignant in the first gastroscopic examination. These cases were classified according to their endoscopic appearance, and the frequency with which they appeared was compared with the frequency of that type of lesion in the population that receives endoscopy.Gastric ulceration, adenomas, polyps, submucosal tumors, acute gastric mucosal lesions, and gastric redness appeared more frequently in the false negative group than in the population that receives endoscopy.Atrophic gastritis, duodenal ulceration, gastric ulcer scar and gastric erosion appeared less frequently in this group titan in the population that receives endoscopy.To evaluate whether malignancy should really have been suspected in the lesions, the gastroscopic pictures were reviewed by an expert endoscopist. In only 15% of the lesions was cancer not suspected by the expert endoscopist.Chromoscopy as an auxiliary method for the endoscopist was used in only about half of the cases. Depending on the experience of the endoscopist, some endoscopic findings appeared more often than others:i‐ INTERMEDIATE and BEGINNING endoscopists mainly mistook cancer for gastric ulceration.ii‐EXPERT endoscopists confused many more adenomas and polips.We conclude that some gastric lesions are more easily confused in regard to malignancy than others, and that the experience level of the endoscopist stakes hint or her more prone to confusing certain kinds of lesi

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00333.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:This study was undertaken to elucidate the diagnostic significance of the measurement of a cancer‐associated carbohydrate antigen, NCC‐ST‐439 (ST‐439), in pure pancreatic juice collected by endoscopic cannulation, chiefly from patients with pancreatic diseases.The mean concentrations of ST‐439 in each of the 4 fractions collected were significantly higher in patients with pancreatic cancer than in controls, but patients with chronic pancreatitis or cholecystolithiasis did not have higher levels. Similarly, a significant increase in the mean output of ST‐439 was observed only in patients with pancreatic cancer. When the cut‐of value was set at the mean concentration+ 2 X the standard deviations of the controls, significant concentrations of ST‐439 were found, in the first fraction (washout phase) in 56% of the pancreatic cancer cases, 31% of the chronic pancreatitis cases and 0% of the cholecystolithiasis cases; in the third fraction (secretory phase) results were 50%, 7% and 0%, respectively. Furthermore, when the cut‐of value was set at the highest concentration found among patients with chronic pancreatitis (to enhance the specificity for pancreatic cancer), the prevalence of significant ST‐339 levels among Pancreatic cancer patients was 50% in the first fraction and 44% in the third fraction.These results indicate that the measurement of ST‐439 in pancreatic juice is useful as a specific marker for pancreatic cancer, although its sensitivity is less tha

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00334.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:The authors investigated clinical data and pathological findings of eight cases of IIa+IIc type early colorectal cancer which showed minimal invasion in the mucosal laver, but massive invasion in the submucosal layer (deep invasion type). The average age of these 8 patients was 57.8 years (6 out of 8 cases were between 55 and 61‐years‐old). 6 patients were males; 2 were females. Five patients were asymptomatic with a positive reaction for fecal occult blood; the other 2 had anal bleeding. All but 1 patient were diagnosed as having the IIa+IIc type of cancerous lesion, by barium enema examination and colonoscopy. Five patients had lesions in the sigmoid colon, 2 had lesions in the rectum, and 1 had a lesion in the ascending colon. The maximum lesion diameters ranged from 5 to 25 mm, averaging 15.9 mm. Six lesions were less than 20 mm in maximum diameter; 3 of these were less than 10 mm. Pathologically, 5 cases were moderately differentiated adenocarcinoma, 2 were well differentiated adenocarcinoma, and one was poorly differentiated adenocarcinoma. None of the lesions had a coexisting adenomatous component. The incidence of lymph node metastasis was considerably higher than expected (2 out of 8 cases) for early invasive colorectal cancer.Our results suggest that the deep invasion type of early colorectal cancers (which probably arise de novo) are, though small asa rule, considered to have great potential to be malign

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00335.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:The long‐term effect of percutaneous transhepatic choledochoscopic YAG laser therapy for malignant biliary tract obstruction was evaluated. Ten consecutive patients underwent laser therapy to alleviate the obstruction. All patients were followed up for 8 months or more (range: 8–33 month, average: 15). Cholangiography was performed when re‐elevation of the alkaline phosphatase level was observed during the regular checkup. Choledochoscopy was performed when any sign of recurrence was observed on cholangiography. Sufficient re‐opening of the bile duct was obtained in every case, without complications. Indwelling of the internal drainage tube was perfomed in 5 patients, the remaining 5 having “tube free” internal drainage. Five patients showed no rise in alkaline phosphatase levels during their 8‐ to‐13 month follow‐up period. Re‐elevation of the alkaline phosphatase level was observed 9 times in 5 patients, mostly from internal drainage tube occlusion. The cholangiogram performed on each occasion revealed a patent bile duct without any sign of recurrence (6/9), slight narrowing (2/9) or tumorous obstruction (1/9). Cholangitis was complicated 6 times in 3 patients, mostly from internal drainage tube occlusion. Choledochoscopy was performed in the 3 patients suspected of tumor recurrence on cholangiogram. In 2 of them, no signs of recurrence were noted endoscopically or histologically, but the tumor was revealed to have recurred only at the part previously treated, in the remaining. Thus, choledochoscopic I'AG laser therapy can locally control the malignant biliary tract obstruction for a long period of time. “tube free” internal drainage may serve as a means to prevent cholangitis, which is one of the complications frequently occurring with con

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00336.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Colitis was found in 302 out of 5803 patients (5.2%) who underwent colonoscopy for the first time. Unclassified colitis (with slight edema, hemorrhage etc.) accounted for 89.1 % of these cases. Most of the colitis (93 cases, 40.1 %) was found to affect the sigmoid colon, followed, in order of decreasing frequency, by the rectum, cecum, transverse colon, descending colon and ascending colon. A comparison of the percentage revealed that of colitis found in two groups which were given different pre‐treatments, 80 out of 3280 cases (2.4%) were found among those examinees pre‐treated by the modified Brown method (B‐method), while 152 out of 2513 cases (6.0%) were found in those pre‐treated by the PEG oral lavage method (P‐ method). About 40% of the diagnosed colitis cases were free from symptoms (diarrhea, abdominal pain, etc.); the results of the guaiac test on their stool samples were negative. We hypothesized that, in these cases, signs of colitis were actually pretreatment‐induced artifacts. No significant differences were found among groups with regard to sex and age, nor was the fraction of colitis cases represented by artificial colitis significantly different between pre‐tre

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00337.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Endoscopic biopsy specimens of the remnant gastric mucosa (and of the stomal mucosa in particular) were investigated in 219 patients who had received subtotal gastrectomy for gastric cancer. Dilated glandular lumina (glandular dilatation) and curved ducts (irregular glandular structure) were detected significantly more freguently in the group gastrectomized long before, or by Billroth II resection, than in those treated recently, or by Billroth I resection. DNA histograms showed a distribution of epithelial cells from the remnant gastric mucosa which was somewhat different from the normal histogram. The occurrence rates of polyploid cells were significantly higher than normal, and tended to increase in the same individuals with advancing time after gastrectomy. These observations suggested that the pavticulav environments of the gastric remnant might have nonphvsiologic influences upon the gastric mucosa, although further studies are essential for the clarification of the possible relationship of these environments to oncogenesis in the remnant stomach.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00338.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Three cases of peptic ulcer in children under two years of age are reported, and 33 cases of infants with peptic ulcer reported in Japan between 1955 and March, 1989 are reviewed.Case 1 was an 8‐month‐old male complaining of melena, and endoscopic examination showed a gastric ulcer on the lesser curvature of the antrum. Cases 2 and 3 were a 15‐month‐old mule and an 18‐month‐old male, respectively, with complaints of melena and hematemesis. Endoscopic examination revealed an active duodenal ulcer in both cases. All 3 infants were successfully treated with H2blocker and/or antacid. In these 3 cases, infection or drugs were speculated to be predisposing factors, and the fathers of these three infants all had histories of duodenal ulcer.Among 33 cases of infants under 2 years old with peptic ulcer in Japan, 9 had a gastric ulcer and 24 had a duodenal ulcer. Seventeen were treated with conservative therapy and 16 were operated on because of perforation or bleeding.We should always keep in mind that peptic ulcer does occur in infancy, and that endoscopic examination should be promptly performed when peptic ulcer i

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00339.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:A case of typhoid fever was studied colonoscopically. Several scattered ulcers were observed at the ileocecal area and the course of their healing was followed by colonoscopic examination. The ulcers were discrete and punched out in appearance. Chloramphenieol was administrated, and the ulcers were observed to gradually diminish in size and number

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00340.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:A small primary leiomyosarcoma of the liver detected in a 58‐year‐old man is presented in this paper. In addition to the findings obtained by gray scale ultrasonogruphy and computed tomography, the possible diagnosis of this very rare tumor was suggested by endoscopic retrograde cholangiopancreatography (ERCP). The characteristic findings of leiomyosarcoma of the liver obtained by ERCP were skipping strictures at the intrahepatic bile ducts. The ERCP findings and diagnosis were verified bv pathological studies of the resected material. This appears to be the first report discussing the usefulness of ERCP in vnaking a diagnosis of primary leiomyosarcoma of the li

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00341.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:A 63‐year‐old female with von Recklinghausen's disease was referred to us because of intermittent periumbilical pain and vomiting. Abdominal ultrasonography showed a segment of the bowel with intussusception in the left ripper quadrant. After intestinal decompression, small‐intestinal endoscopy was performed. Endoscopy revealed multiple protruding lesions in the esophagus, stomach, and jejunum, the largest one markedly stenosing the proximal jejunum. We were able to identify a tumor as the lead point preoperatively. Segmental jejunectomy was performed for the resection of the tumor. Pathological studies revealed that the tumor was leiomyosarcoma.Gastrointestinal involvement is well documented in von Recklinghausen 's disease. Thus attention should be paid to gastrointestinal involvement in the management of these patients. The present case had intussusception, a rare complication of von Recklinghausen 's disease. Svnall‐intestinal Endoscopy played an essential vole in the diagnosis of gastrointestinal involvement in our

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00342.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY