ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00404.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Endoscopic ultrasonography has become an important diagnostic procedure complementary to endoscopy and histopathological study in the preoperative evaluation of gastric carcinoma. Despite allowing visualization of tumoral infiltration with quite high accuracy, certain factors have limited the accuracy of this modality or even led to misinterpretation. We designed a prospective study to evaluate the accuracy of gastric carcinoma diagnosis with special reference to factors resulting in misdiagnosis. During a 22 month period, 86 patients with early and advanced gastric carcinoma underwent surgical or endoscopic resection on the basis of endosonographic findings. In all patients, endosonographic findings, location and macroscopic type of the tumor and histopathological characteristics including depth of invasion, malignant cell type and/or differentiation, and the presence/absence of ulceration in the tumor focus were recorded. The endosonographic and histopathological results were compared at the end of the study. Overall accuracy was 85% using the TNM staging system. There were no significant differences in accuracy in the location of the tumor, histological grading or macroscopic type of tumor, although the accuracy rate was lower for tumors located in the antrum. Ulceration in the tumor focus was a major factor leading to misinterpretation of the findings of early gastric cancer (p<0.02). The diagnosis of microinvasion is an issue which remains to be resolved.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00405.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Polymerase chain reaction (PCR) is a useful method of detecting H. pylori from gastric juice, which can be obtained more safely and easily than gastric biopsies. We investigated the applicability of PCR assays of gastric juice aspirates to evaluate cure of H. pylori infection. Fifteen H. pylori positive patients with gastric ulcer or gastritis received anti H. pylori therapy. Four weeks after the cessation of treatment, endoscopy and the 13C‐urea breath test (13C‐UBT) were performed to evaluate the status of H. pylori infection. Gastric juice samples were collected and one biopsy specimen each was taken from the antrum and the body of the stomach. Results obtained from PCR of gastric juice aspirates were compared with those from PCR of gastric mucosae and 13C‐UBT. Fourteen of the 15 showed identical results. However, PCR assays of gastric juice aspirates were positive in one patient with negative results on the other two examinations. Restriction fragment length polymorphism of PCR products suggested that this discrepancy was due to detection of another strain passing through the stomach into the duodenum. Despite the detection of transient strains in gastric juice aspirates being infrequent, the results suggest the possibility of oral transmission of this org

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00406.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:In rectal cancer, lateral lymphatic spread is considered to worsen the prognosis. Therefore, accurate determination of lymph node involvement preoperatively is helpful in assessing the malignant character of the tumor and in determining resectability. The present study was performed to evaluate the accuracy, limitations, and usefulness of endoluminal ultrasonography in preoperatively diagnosing the localization of lymph node metastasis in rectal cancer. Seventy‐six patients with rectal cancer underwent preoperative endoscopic ultrasonography. Three of these patients had lateral lymphatic spread and all could be distinguished on endoscopic ultrasonography by the detection of involvement of lymph nodes in the anterior rectal space. These findings suggest that endoscopic ultrasonography plays a potentially useful role in the strategy for dealing with rectal cancer prior to surger

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00407.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We assessed gastrointestinal complications after transcatheter arterial embolization (TAE) performed over the three‐year period from 1991–1994. Gastric erosion, gastroduodenal ulcer and hemorrhagic gastritis were investigated in a series of 273 cases (408 TAEs) with hepatic malignancies. Gastric erosions were found in 60 cases (7.6%), gastroduodenal ulcer in 24 cases (5.9%) and hemorrhagic gastritis in six cases (1.5%). Gastroduodenal complications occurred in a total of 60 cases (61 instances) (15.0%). Neither the formerly occurring geographic ulcers in the gastric antrum nor fatal hemorrhagic gastritis/ ulcers were encountered in the present study. This relative mildness of complications is probably attributable to superselective catheterization into the proximal hepatic artery. Such complications are due not only to ischemic changes resulting from backflow of embolic materials into the gastroduodenal artery, but also to transient liver damage caused by TAE.The incidence of complications in those taking anti‐ulcer medications was 24.7% for Ha‐blockers (p<0.01), 14.3% for combination therapy and 16.5% for no medication, as compared to 9.8% for PGE1 and 9.6% for Teprenone. Therefore PGE1 or Teprenone, which increase gastric mucosal blood flow, should be used to reduce the occurrence of these complications af

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00408.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:This study was designed to assess outcome, morbidity and mortality in patients with a previous history of gastrectomy who underwent laparoscopic cholecystectomy at Teikyo University Hospital at Mizonokuchi.From May 1990 through April 1995, 18 patients who had an upper midline incision from previous gastric surgery underwent attempted or successful laparoscopic cholecystectomy. Previous gastric operations included subtotal gastrectomy with Billroth l/ll anastomosis for ulcer diseases and total gastrectomy with jejunal interposition for gastric cancer. Preoperative ultrasound was done in all cases, ERCP in nine cases and drip infusion cholangiography in three cases to assess and evaluate the biliary system. Intraoperative cholangiography was done in the latter eight cases. Laparoscopic cholecystectomy was successful in all but one patient who had severe adhesions necessitating conversion to an open cholecystectomy. Overall results were very similar in patients with and without a previous history of gastric surgery who underwent laparoscopic cholecystectomy at this institution. It was also found that intraoperative difficulties and a prolonged operative time did not correlate with the nature of the previous operation, but rather with the severity of adhesions identified during surgery.Although the number of cases in this study was very small, the results indicate that if the surgeon is experienced and well prepared patients with a previous history of gastrectomy can also undergo laparoscopic cholecystectomy safely and with maximum benefit. We conclude that these patients should not be denied the advantages of laparoscopic cholecystectomy. A trial laparoscopic procedure is warranted although the conversion rate to open cholecystectomy may be high.

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00409.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Although it has long been thought that granular cell tumor (GCT) is relatively uncommon in the esophagus, in recent years, reports of this disease have increased due to advances in endoscopic examination and endoscopic therapy. The authors recently experienced three cases of esophageal GCT, all of whom underwent endoscopic polypectomy. Endoscopic findings were consistent with Yamada's type I or II, the surface of the lesions being smooth and the color white or whitish‐yellow. These three cases were treated by endoscopic polypectomy. In case 1, the resection was made possible by raising the tumor with forceps under a 2‐channel‐scope. In case 2, the tumor was resectable following submucosal injection of physiological saline. In case 3, the tumor was resected via strangulation with a snare. The lesions described herein were diagnosed as benign and completely resected by polypectomy, though some showed differences in nuclear size or dyskaryosis. As numerous points remain to be clarified regarding the clinical characteristics of this tumor, and some tumors have been diagnosed as malignant despite being small, it appears that endoscopic polypectomy should be performed for the purpose of diagnosis as well as complete rese

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00410.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:We successfully treated esophageal varices by endoscopic variceal ligation (EVL) in a 50‐year‐old female patient with common variable immunodeficiency and liver cirrhosis secondary to hepatitis B. Under the existing disadvantageous conditions including the immunocompromised status, hyperal‐lergic reactions to several drugs, chronic pulmonary infection, and impaired hepatic function, we considered EVL to be of greater potential benefit than endoscopic injection sclerotherapy (EIS). This case highlights the possible merits of EVL over EIS, even in the presence of various restrictions, such as the immunocompromised condition of our pa

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00411.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T‐tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary diseas

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00412.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1996.tb00413.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY