Hideki Mitooka

Minute flat depressed neoplastic lesions of the colon detected by contrast chromoscopy using an indigo carmine capsule

Thirty-seven diminutive flat depressed neoplastic lesions of the colon, smaller than 5 mm, were detected by contrast chromoscopy using an indigo carmine capsule and subsequently removed by endoscopic mucosal resection. We investigated the endoscopic, macroscopic, and histologic characteristics of these lesions and also evaluated the usefulness of chromoscopy and the magnifying endoscope for detecting this type of lesion. The lesions were classified into two types according to the measured height of the histologic sections: 28 lesions were truly flat depressed and the remaining 9 lesions were flat elevated. Of the 37 lesions, 18 were adenomas with mild atypia, 14 with moderate atypia, and 5 with severe atypia. The flat depressed lesions included 12 with mild atypia, 11 with moderate atypia, and 5 with severe atypia. No invasive carcinoma was present in either type, and no adenoma with severe atypia was identified in any of the flat elevated lesions. The overall rate of severe atypia was 13.5%; the rate of severe atypia for the flat depressed type was 17.9%, which is approximately 14-fold greater than that of ordinary diminutive polypoid adenomas (1.3%). The detection of these lesions was facilitated by the use of indigo carmine dye, which clearly demonstrated the mucosal irregularities. The frequency of detection of these lesions was increased four to five times with a magnifying endoscope, as occurred in nearly 10% of all of the patients examined. These data suggest that the finding of endoscopically minute flat depressed neoplastic lesions is not at all uncommon when examination is meticulously performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Colon Polyps Detected by Contrast Chromoscopy Using Indigo Carmine Capsule

Contrast chromoscopy of the colon using indigo carmine capsule was performed in 287 patients from July 1990 to March 1991. The distribution and histological features of the polyps detected and resected in these patients were investigated. The overall prevalence of polyps (neoplastic and nonneoplastic) was 85.7% and that of neoplastic polyps was 57.1 %. Moreover, the prevalence of neoplastic polyps in 121 asymptomatic patients was 50.4%. A total of 1179 polyps were resected. Of this total, 1049 polyps were diminutive (>5 mm), and 130 polyps were >5 mm. Histological examinations revealed 35.6% of the diminutive polyps and 83.7% of the large polyps (>5 mm) were neoplastic. Proximally, diminutive neoplastic polyps predominated, accounting for 78% of all of the diminutive polyps in the right colon. The situation was reversed in the distal colon, where diminutive non‐neoplastic polyps comprised 91% of all of the diminutive polyps in the rectum. The number of large polyps was evenly distributed throughout the colon. The incidence of carcinoma was 0.5% of the diminutive polyps and 10.1 % of the large polyps. Approximately 70% of all of the neoplastic polyps were located proximal to the sigmoid colon. These findings suggest that there are many more polyps present throughout the colon than previously estimated. This suggests that total colonoscopy be performed more thoroughly than before, by using for instance chromoscopy. Furthermore, all of the polyps encountered during colonoscopy should be removed due to the high prevalence of neoplasia, especially in the proximal side of the colon.

Effect of synthetic prostaglandin E1 analog (ornoprostil) on gastric emptying and pancreatic polypeptide release after solid-meal ingestion in man

The effect of orally administered ornoprostil, 17S,20-dimethyl-6-oxoprostaglandin E1 methyl ester, on gastric emptying and on pancreatic polypeptide (PP) release after solid meal ingestion, was investigated in man. A radionuclide technique was used to measure gastric emptying of eight healthy volunteers. In addition, four parameters [SI (starting index): the lag time in the start of emptying;K value: the emptying rate;T1/2: the half emptying time; 120 min RR: the percent retention at 120 min] were determined for evaluation. Also, the PP response was analyzed according to two parameters: IPPRSI, the integrated PP response for periods up to SI, and IPPR120, the integrated PP response for 120 min. The results demonstrated that 5 μg of orally administered ornoprostil significantly reduced the gastric emptying rate of solid meal (T1/2 and 120 min RR,P<0.05). However, ornoprostil affected neither the basal PP concentrations nor the cephalic phase of PP secretion which was determined as IPPRSI. This thus suggests that ornoprostil affects the gastric motor function without interfering with the vagal-cholinergic pathway to the stomach.

Applications cliniques de la méthode bleu alcian-hématoxyline (BAH) dans les tumeurs colorectales

RésuméLes auteurs ont classé la structure des tumeurs colorectales en type S (unités sulciformes), type H (unités en nid d’abeille) et type I (unités intermédiaires) conformément aux résultats d’examen au microscope à dissection avec corrélation entre les structures de surface et les données histologiques. Le carcinome de type plat est considéré comme différent des carcinomes colorectaux habituels ayant pour origine un adénome, le type plat étant également distinct des lésions à surface de type H ou de type S. En termes de statistique, le type H est fréquemment observé dans les carcinomes sm, et le type S dans les groupes d’atypies légères et élevées. Dès lors, on a suggéré que les lésions de type H présentent un important potentiel de malignité et doivent être réséquées par voie endoscopique ou chirurgicale. La structure en zigzag est souvent observéc dans le type H, ce qui suggère que les lésions avec dessin en zigzag correspondent à des adénomes porteurs d’atypies sévères ou des carcinomes dont la résection s’impose. En conclusion, l’observation de la morphologie superficielle des tumeurs colorectales de type «plat» est utile à l’évaluation de leur croissance et de leur progression.SummaryWe classified surface structure of colorectal tumors as the S type (sulciform units), the H type (honeycomb-like units) and the 1 type (intermediate units) in accordance with the results of dissecting microscopic observations, and correlated their surface structure with histological findings. Flat type carcinoma has been regarded as different from the usual colorectal carcinoma of adenomatous origin, flat type lesions with H type surface distinctly different from those with the S type surface. Statistically, the H type were frequently observed in the sm carcinoma and the S type were in the low and high group. Thus, it was suggested that the H type lesions may have high malignant potential and should be resected endoscopically or operatively. Zig-zag pattern was frequently observed in the H type, therefore it was suggested that lesions with zigzag pattern may be severe atypia adenoma or carcinoma and also should be resected. It is concluded that observation of the surface morphology of flat type colorectal tumors may be useful in connection with the assessment of their growth and progression.