摘要:

Abstract:Attempting to use ISWL (intracorporeal shock wave lithotripsy) for treating large and difficult biliary stones was started in the mid 1970s, approximately 10 years before the introduction of ESWL (extracorporeal shock wave lithotripsy). However, in contrast to ESWL, ISWL did not quickly become popular in practise. The main reason for this delayed recognition, undoubtedly, lay in the technical difficulties of the peroral applications until the mid 1980s, when the development of an improved cholangios‐cope system and a thin, flexible probe allowed the use of EHL (electrohydraulic lithotripsy) under direct vision during peroral cholangioscopy. Thanks to recent advances in technology, a powerful pulsed laser has begun to be used for ISWL through a 0.2 mm sized quartz fiber. A laser version of ISWL with such a thin probe is expected to facilitate its use by minimizing the endoscope system. The automatic stone‐tissue recognition system which interrupts the laser discharge in case of wall contact is another useful advance in technology which increases the safety and therapeutic efficacy. Whereas laser techniques are still in development, ISWL with a laser will be the first choice technique for treating difficult bile duct stones after failure of mechanical lithotripsy and it also promises to improve its therapeutic efficacy for intrahepatic stones in combination with ESWL.In this article, the recent progresses and results of ISWL treatment were reviewed with a respect to the success of E

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00120.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00121.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00122.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:We examined and clinicopathologically analyzed 422 patients with early colorectal cancer that we encountered, and discussed the problems typical of early colorectal cancers in Japan.In Japan we define early colorectal cancer as consisting of intramucosal cancer and cancer with submucosal invasion. Because histopathologists subjectively diagnose patients with intramucosal cancer, their diagnoses for the same specimen often differ from each other. The only way to avoid such confusion caused by diagnostic differences and to reach a consensus on the diagnosis of intramucosal cancer is to make a diagnosis of intramucosal cancer only in those patients who clearly show the structural atypia and/or the cellular atypia, that are typical of cancer.No one will deny the importance of the depressed type early cancer, the number of cases of which have recently been increasing in Japan. However, it is also important to assert that endoscopically‐discovered depressed neoplastic lesions are not always cancer. In the depressed neoplastic lesions discovered in our patients, the number of adenoma was almost three times that of cancer. Forty percent of the patients with depressed type early cancer also had an adenoma component. Therefore, at this moment we cannot conclude that early cancer with a depression is de‐novo‐genetic colorectal cancer.Eighty percent of early colorectal cancers are discovered to be the protruded type of early cancer. Twenty‐six percent of early cancers with submucosal invasion, including early cancers with massively submucosal invasion, are 6 to 10 mm in diameter and 76% of these are protruded early cancers. These facts indicate that colorectal tumors, protruded or depressed, which are more than 6 to 10 mm in diameter should be endoscopically removed to prevent them from becoming advanced

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00123.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:A rapid diagnostic system for Helicobacter pylori (H. pylori) was developed based on an urease analyser using a pH‐sensitive field effect transistor (pH‐FET). The system is composed of a solid‐phase capillary‐tube and a pH‐measuring cell. The solid‐phase tube, with an inner diameter 0.55 mm and coated with a monoclonal antibody against H. pylori's urease, was used to selectively capture the urease in endoscopically collected gastric mucus. The urease activity on the inner surface of the solid‐phase tube was measured by coupling it with ph‐FET in a pH measuring cell containing urea solution. Before immuno reaction in the solid‐phase, gastric mucus was diluted with a phosphate buffered saline containing 1% n‐octylglucoside, which was effective for accelerating the release of active urease from H. pylori's cells suspended in the sample solution. As a result of preliminary evaluations, it was found that the clinical sensitivity and specificity were 100 and 86%, respectively, using a bacteriological

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00124.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:The ratio of the number of cases of slightly elevated (flat shaped) nodules to hemispherical nodules on laparoscopical examination was studied in male and female histologically proven cirrhotic patients in Child A stage. The bromodeoxyuridine labeling indices (BrdU Lis) of all of the cirrhotic patients were examined using an in vitro labeling technique. Liver biopsy specimens obtained by a Tru‐cut needle were immediately incubated for 45 min. in 0.1% BrdU solution in RPMI 1640 at 37°C under a pressure of 3 atmospheres in a mixture of 95% O2and 5% CO2. Immunohistochemical detection of BrdU was performed using the ABC method. In the 18 male cirrhotic patients in Child A stage, 12 (67%) were found to have hemispherical nodules, and 6 (33%) were found to have slightly elevated nodules. In the 18 female cirrhotic patients, 5 (28%) had hemispherical nodules, and 13 (72%) had slightly elevated nodules (p<0.05). The mean BrdU LI in male cirrhotic patients (2.07 ± 0.36%, SE) was greater than that of the female patients (1.21 ± 0.31%). The average BrdU LI of the hemispherical cirrhotic group (2.41 ± 0.39%) was significantly (p<0.005) greater than that of the slightly elevated cirrhotic group (0.98 ± 0;21%). We found that about 70% of the male cirrhotic patients in Child A stage had a laparoscopically hemispherical nodular liver, as compared to about 30% of the female cirrhotic patients (p<0.05), and that the proliferation of hepatocytes in the hemispherical nodular liver was significantly increased compared with that of the slightly elevated (flat shaped) nodular liver (p<

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00125.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:A 62‐year‐old female, with a forty year's history of Takayasu's arteritis, was admitted to Fukuoka University Hospital, with melena. Endoscopy showed multiple shallow ulcers and edematous mucosa in the terminal ileum, and also showed mucosal redness in the ascending colon. The cultures of feces and biopsy specimens taken from an ulcer in the terminal ileum were negative for bacteria and acid‐fast bacilli. Medication such as nonsteroidal anti‐inflammatory drugs, corticosteroids, and potassium chloride were not used before the onset of melena. She was treated with an elemental diet to rest her bowel. Two months later, the ulcers in the terminal ileum had disappeared. However, two years later, similar ulcers recurred in the terminal ileum. These clinical findings and course strongly suggested that her intestinal ulcers might be associated with Takayasu's disease. In Takayasu's arteritis, intestinal lesions have rarely been r

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00126.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:During intraoperative cholangiography, cystic duct stones were diagnosed in 79 of 898 consecutive patients (8.8%) who underwent laparoscopic cholecystectomy over a 45‐month period. The stones were successfully removed laparoscopically. In addition, it should be mentioned that the stones were identified and retrieved before the cholangiography was started in all but 8 of the 79 cases. Of these 79, only 27 cases (34.2%) had been diagnosed as having cystic duct stones preoperatively by intravenous cholangiography and/or endoscopic retrograde cholangiography. From the results obtained, it can be concluded that intraoperative cholangiography is mandatory to detect unsuspected retained stones not only in the common duct but also in the cystic duct during laparoscopic cholecystectomy, and also provides vital information as to biliary anatomic variations, the proximity of the cystic duct to the common duct, and the confirmation of inadvertent bile duct injur

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00127.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:Balloon dilatation of biliary strictures using a peroral cholangioscope was used on 10 patients who had biliary strictures accompanied by proximally located stones. A dilation sufficient for the passage of a cholangioscope was obtained in 8 of 10 patients including all of the 6 patients with extrahepatic strictures and 2 of the 4 patients with intrahepatic ones. After successful dilatation of the strictures, peroral cholangioscopic lithotripsy was performed in 4 of the 8 patients whose gallstones were too large to be removed with a conventional stone basket: electrohydraulic lithotripsy in 3 patients and Nd: YAG Laser lithotripsy in one patient. Complete stone clearance was achieved in 5 patients with extrahepatic strictures. Three patients, 1 with the extrahepatic strictures and 2 with the intrahepatic strictures had partial stone clearance. A follow‐up study (27 months on average) disclosed no recurrence of symptoms or elevated laboratory tests indicative of restrictures. Balloon dilatation with a peroral cholangioscope might be a safe and effective treatment as a new approach for biliary strictures especially for extrahepatic lesions, as an alternative to surgical interventio

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00128.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract:In order to measure the sizes of gastric and colonic lesions endoscopically, we established a system composed of an electronic endoscope, image processor, and personal computer. The long and short diameter of the lesion were calculated by a program which corrected the curvature radius of the lens of the endoscope and variables. 1) To evaluate its accuracy, we measured a 10 mm scale spherical model at different distances from the lens of the endoscope. The mean value was 9.7 mm, ranging from 9.0 to 10.9 mm. The rate of error was –0.38±4.4 % (mean±SE). 2) Using this system, we measured the sizes of 34 gastric and colonic lesions in 34 patients (3 with gastric cancers, 20 with gastric polyps, and 11 with colonic polyps), and compared them with the real sizes of the resected or polypectomized specimens. The rate of error was–1.1±1.3% (mean±SE). The results showed that our system was useful to evaluate the accurate sizes of gastric and colonic lesions endosco

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1995.tb00129.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY