ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00351.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:A white elevated lesion (WEL) was noted in 7 out of 227 ulcer patients treated with an H2‐blocker. These were compared with eight patients with an elevated type of gastric ulcer scarsThe elevated type of gastric ulcer scar (ES) is an elevated lesion covered with regenerating epithelium, showing no whitish exudate, and is foveolar hyperplasia in the histological picture of biopsy. The period prior to the formation of an elevated lesion was as short as 4 weeks on average, and the formed elevated lesion retained the elevated from for as long as several months to several years.The WEL is an elevated lesion covered with whitish exudate, and shows granulation in the histological picture of biopsy. The period prior to the formation of an elevated lesion was as short as 3 weeks on average, and the formed elevated lesion became flattened in a relatively short period of several weeks to several months.From the above results the ES and the WEL are different in the clinical course, morphology and the histological picture, and considered to be of a different qualit

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00352.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:In the comparison of bacteriological and histological methods, the rapid urease (RU) test was considered a specific (100%) method for detection of Campylobacter Pylori (Cp), by which the presence of Cp can be rapidly judged (more than 90% in 20 min.). For an accurate and reliable diagnosis, other methods should be used concurrently, because the sensitivity of this test was inferior to bacteriological methods by 10 to 20%.In the histological study, polymorphonuclear leukocyte infiltration in the antral mucosa clearly reflected Cp infection. This pathological change responded well to antibacterial therapy.Of some endoscopic findings in the gastric antrum, verrucous change was considered to have a relatively close association with Cp infection. However, about 30% of Cp‐present cases had endoscopically no abnormal appearance in the gastric antru

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00353.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Endoscopic gastric mucosal resection (EGMR), by which a large specimen can be obtained, has been developed for the diagnosis and treatment of the borderline lesion (B. L.) or early gastric cancer (EGC), since biopsy specimens obtained by conventional techniques are too small to make an accurate diagnosis in number of cases. Thirty‐eight lesions in 35 cases (26 lesions in 23 cases with B. L. and 12 lesions in 12 cases with EGC) were resected for the purpose of treatment by EGMR, and 24 lesions (6 submucosal tumors, 3 B. L. s, 14 cases of EGC and 1 malignant lymphoma) for the purpose of diagnosis. By means of histological examination of the bite biopsy specimens following EGMR, twenty‐three lesions in 26 cases (89%) with a B. L. and 8 in 12 cases (67%) with EGC for treatment by EGMR were found to have been completely resected.After further histological examination of EGMR specimens obtained for diagnosis, one out of 3 B. L. s was diagnosed as EGC (IIa) and the others as bengin lesions. Out of 14 EGC cases, 6 were diagnosed as carcinoma, 3 as B. L. s and 5 as benign lesions.In Group III lesions obtained by conventional endoscopic biopsy, 8 out of 40 lesions (20%) were defined as EGC, 28 lesions (70%) as a B. L. and 4 lesions (10%) as benign lesions respectively by means of histological examination of the EGMR specimens.Although obvious side effects were observed in 4 cases, these patients could be treated by endoscopic management or drug therapy.It can be concluded that EGMR, by which large specimens can be obtained, is a useful procedure for the purpose of diagnosing and treating gastric mucosal lesions without causing major r

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00354.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:During a 5‐year period from 1984 through 1988, an emergency endoscopy was performed for an upper digestive tract hemorrhage in 283 consecutive patients with 290 lesions. Of these, 54 patients were diagnosed as having hemorrhagic gastritis on the basis of the endoscopic findings and were employed as the subjects of the present study. They were classified on the basis of the presence/absence of liver cirrhosis into two groups, i. e. the cirrhosis group (C‐group) and non‐cirrhosis group (NC‐group), and the two groups were comparatively studied.The incidence of hemorrhagic gastritis in hemorrhagic sources of the upper digestive tract was higher in the C‐group than in the NC‐group, and it was seen in the gastric body most frequently. In addition, no clear causes for hemorrhagic gastritis could be identified in many of the cases in the C‐group. These clinical findings were thought to indicate that, in patients with liver cirrhosis, the gastric mucosa itself, especially of the gastric body, is in an impending state of mucosal hemorrhage. A hemorrhage was the major cause of death in the C‐group.In patients with liver cirrhosis, the incidence of hemorrhagic gastritis had no correlation with the grade of esophageal varices, but was high in patients with severe liver cirrhosis. Thus, patients with severe liver cirrhosis were considered to be a high risk group of hemorr

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00355.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Endoscopic transpapillary catheterization in the gallbladder was attempted in 18 cases and double contrast images of the gallbladder was successfully obtained in 10 cases. In a case with a polypoid lesion, its edge and surface were nicely delineated by this method, but it was still hard to distinguish it from malignant lesions. Precise identification of tiny stones which will be easily missed by conventional ERC was made using this method. As for technology obtaining good cholecystgrams, sufficient aspiration of bile was considered to be important. Our experience with this quite new technique suggested that this method is effective in making an accurate diagnosis of gallbladder diseases. We named it double contrast images of the gallbladder by endoscopic transpapillary catheterization in the gallbladder (ETCG).

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00356.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:Microvascular endothelial changes are thought to be a crucial step in the development of hemorrhagic changes in various pathological states. Tissue‐type plasminogen activator (t‐PA) is an endothelium‐derived fibrinolytic mediator which regulates microvascular permeability. In this study, we determined the activity and amount of t‐PA in the biopsy specimens taken from gastric mucosa of patients with gastric ulcers to evaluate endothelial alterations and vascular permeable changes in situ. In addition, to elucidate the relationship between local fibrinolytic disturbance and systemic blood coagulation, several factors such as plasminogen activator inhibitor were also assayed. The results of this investigation revealed that the mucosal t‐PA amount in the active ulcer proved to be 2–3 folds higher than that in healthy controls, however, t‐PA levels in plasma samples showed no remarkable differences among the groups. Increased t‐PA activity appeared to well correlate to the degree of inflammation of gastric mucosa in contrast to t‐PA amount which was still increased in healed ulcer lesion. PAI‐1 in plasma samples from gastric ulcer patients showed a significantly high level as compared with healthy subjects. The present study indicates that t‐PA activation may play an important role in the pathogenesis of gastric ulcer formation and that t‐PA determination in gastric biopsy specimens may be useful for the evaluation of clinical activity of gastric ulcers in terms of the mucosal microvascu

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00357.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:The electronic endoscope named TGS‐50B (TOSHIBA) provides a fine resolvable image (Fig. 6) and flat white balance covering a wide range (Fig. 7). Using this electronic endoscope, the regenerative mucosal patterns in 15 cases with intractable and 30 cases with tractable gastric ulcers (Table 1) were observed at 2‐week intervals until the healed stage or until 12 weeks after the start of H2‐blocker administration.To clarify the difference between intractable and tractable gastric ulcers, the electronic endoscopic images were fed into an image analyzer; SPICCA (AVIONICS). The regenerative mucosal pattern was converted into 20 binary digited particles by the image analyzer (Fig. 4, Color) and quantified by the oval specification (OSF) value (Fig. 5).The OSF value of the tractable ulcers significantly increased in the healing stage I (H1) and healing stage 2 (H2), in comparison with those of intractable ulcers (Fig. 8). Moreover, the OSF value of the tractable ulcer significantly increased at 4 weeks after the start of an H2‐blocker, comparing with that at 2 weeks. Consequently, the OSF values of the tractable ulcers were significantly high in comparison with those of the intractable ulcers, at 4, 6 and 8 weeks after the start of administration of H2‐blockers (Fig. 9).By histological study of the biopsy specimen, an increase in the OSF value suggested an extension of the regenerative mucosa by a well progressed annular contraction of the gastric wall.In conclusion, it is thought that intractability of gastric ulcers may be objectively predictable in its early healing stages by determination of the OSF value using the electronic endoscope and the image

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00358.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:An 81‐year‐old female was admitted to our hospital with right upper abdominal pain and an abdominal mass. She has suffered from diabetes mellitus for 10 years. She did not have other past history. In addition, her serum level of CA19–9 was remarkably high, 39,000U/ml. Investigations of ultrasonography, computed tomography and angiography were done. These radiological findings showed that a large cystic mass, including the pancreatic head and body, had hypervascularity. Endoscopic retrograde cholangiopancreatography (ERCP) suggested that this cystic mass originated from the main pancreatic duct and was malignant. These studies revealed that this tumor might its histological diagnosis of intraoperative biopsy revealed adenosquamous carcinoma. There have been no reports about adenosquamous cell carcinoma with a large

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00359.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Abstract:We experienced a case of Boerhaave's syndrome. The patient, a 47‐year‐old male, vomited after drinking a large quantity of alcohol and thereafter, complained of epigastralgia, back pain, and dyspnea. Leukocytosis, positive CRP, fever, tenderness of the upper abdomen and muscular defense were noted on admission. Endoscopy revealed an ulcer at the lower esophagus. Since a chest X‐P and CT showed thoracic effusion and subcutaneous and mediastinal emphysema, rupture of the esophageal ulcer was suspected. The diagnosis of Boerhaave's syndrome was established by esophagography. A rupture along the longitudinal axis of about 3cm was found at the left posterior wall 3cm above the E‐G junction, and was surgically sutured.Of many cases of Boerhaave's syndrome reported in the literature in Japan, endoscopy was performed in 70 cases. Recently, endoscopy has been adopted as the first choice for the diagnosis of this syndrome as well as for emergency examination of the esophagus and the diagnosis is established by endoscopy alone in many cases. Actually endoscopy was useful for the diagnosis of this disease in 88.2% of the above cases. These results as well as our case indicate diagnostic value of endoscopy, if performed carefully.Boerhaave's syndrome,E

ISSN:0915-5635    

DOI:10.1111/j.1443-1661.1990.tb00360.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY