Hikoo Shirakabe

Clinical evaluation of teprenone, a mucosal protective agent, in the treatment of patients with gastric ulcers : a nationwide, multicenter clinical study

The recurrence rate of gastric ulcers healing to a white scar is low, whereas that of ulcers healing to a red scar is high. Teprenone is a mucosal protective agent that can promote epithelial regeneration by increasing the mucosal hexosamine content. It promotes white scar formation when administered as maintenance therapy for ulcers. A nationwide, multicenter study was performed to determine whether white scar formation was also promoted when teprenone was used during initial therapy. Analysis of the data from 1249 patients showed that teprenone significantly promoted white scar formation. The presence of severe ulcers (large size and active stage), ulcer location at the gastric angulus, and smoking retarded white scar formation irrespective of the use of teprenone.

Experience with percutaneous transhepatic cholangiography using the Japanese needle

Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.

The diagnosis of the small resectable pancreatic carcinoma

ERCP and angiography are essential for the accurate diagnosis of pancreatic carcinoma. ERCP is of value in detecting a pancreatic tumour and is the only examination which makes it possible to detect a small pancreatic carcinoma. Angiography is indispensable for the evaluation of the extent and size of the carcinoma, for prediction of resectability, and for differentiation between pancreatitis and carcinoma. Thirty-one out of 32 pancreatic carcinomas (96%) were correctly diagnosed pre-operatively by the use of a combination of the two examinations. Ten of them (31%) were resectable, and of these six measured less than 2 cm in diameter.

Adenocarcinomas of the stomach induced in beagle dogs by oral administration of N-ethyl-N′-nitro-N-nitrosoguanidine

Two 8-month-old and two 4-month-old male beagle dogs received 250ml of 150μg/ml solution of N-ethyl-N′-nitro-N-nitrosoguanidine (ENNG) and 2% Tween 60 mixed with a pellet diet twice a day for 8 months as the same methods used for mongrel dogs in our first report [Juntendo Medical Journal 19, 579–583 (1973)]. Gastric carcinomas with distant lymph nodes metastases occurred in three beagle dogs except for one died from anesthesia at the endoscopy. Metastases to the liver were observed in two beagles. In the most long-lived beagles, peritonitis carcinomatosa with ascites and metastases to the liver, lungs, bones, and skin were found. Main gastric tumors were located at the subcardia in two dogs (elevated tumor in dog No. 6, ulcerated tumor in dog No. 8), but in dog No. 7 at the angulus (ulcerated tumor). Histologically, carcinomas were composed of poorly differentiated adenocarcinoma, signet-ring cell carcinoma, tubular adenocarcinoma, and undifferentiated adenocarcinoma. In all of three dogs which developed adenocarcinoma of the stomach, Stewarts criteria were completely satisfied. Using our methods the target organ is limited only to the stomach, without any sarcomatous lesion of the intestines.

Angiographic evaluation of the abnormal endoscopic pancreatogram.

Out of 1,269 pancreatograms, 122 were abnormal. Angiography was performed in these patients. Fifty-five were found to have pancreatic carcinoma. In the remaining 67 patients a false positive angiographic diagnosis of either chronic pancreatitis or pancreatic cancer was made in 11%. In one patient a hemangioma was diagnosed as a pancreatic cyst. The remaining 58 patients all had normal pancreatic angiograms in spite of gross ductal abnormality on endoscopic retrograde cholangiopancreatography (ERCP). All these patients were followed for an average of 19 months and showed no clinical evidence of pancreatic disease. It is suggested that angiography should be considered a complementary examination to ERCP and is particularly useful to exclude carcinoma when the pancreatogram is abnormal.

Abstracts Papers presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida

Papers Presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida ESOPHAGEAL NODULARITY A NORMAL VARIANT OF THE ESOPHAGEAL MUCOSA Seth N. Glick, M.D. Steven K. Teplick, M.D. Department of Diagnostic Radiology Hahnemann Medical College and Hospital 230 North Broad Street Philadelphia, PA. 19102 Small superficial round nodules (2-4 mm) are frequently observed on routine double contrast esophagrams. They may be focal or diffuse, and appear as fine granularity or sharply defined filling defects. Endoscopic~lly, they are seen as white excrescences on a normal mucosal background. However, they may not be appreciated, unless specifically sought, becaUse of inadequate lumenal distension. Biopsy reveals normal or slightly hyperplastic squamous epithelium and vacuolated epithelial cells containing abundant glycogen. This has been termed glycogenic acanthosis. Esophageal symptoms are usually absent or cannot be correlated with this morphology. We evaluated 300 consecutive esophagrams considered to demonstrate adequate mucosal detail. Nodularity was found in 30%. These were usually confirmed endoscopically when sought. In addition to true nodules, pseudo-nodules may be caused by several types of artifacts such as transverse esophageal folds. Several pathologicconditions may resemble the normal esophageal nodules, however, radiologic and clinical criteria can usually make the distinction. The Esophageal Survey in Upper Gastrointestinal Radiography Dean D. T. Maglinte, M.D., Katharine L. Krol, M.D., Lloyd D. Caudill, M.D., David L. Brown, M.D., and William Michael McCune, M.D. Gastrointestinal Radiology Section Methodist Hospital and Graduate Medical Center, 1604 North Capitol Ave., Indianapolis, IN 46206 When an upper gastrointestinal study is requested on a patient with non-specific abdominal complaints, there are no guidelines as to what should be the minimum esophageal survey. Of 200 patients referred for upper gastrointestinal series, 40 (20%) had radiographic evidence of esophageal disease. Reflux esophagitis, frequently considered difficult to diagnose radiographically, was demonstrated in 31 (16%). A non-invasive carcinoma, varices and a leiomyoma were found. It is suggested that a thorough evaluation of the esophagus consisting of double contrast, single contrast distention radiograph, fluoroscopic motility assessment and mucosal relief study be included in every upper gastrointestinal series. This minimum multiphasic routine evaluation offers the potential for improvement in diagnostic accuracy with little additional examination time. Barium Swallow After Total Laryngectomy Koehler RE, Balfe DM, Setzen M, Weyman P J, Baron RL, Ogura J Department of Radiology and Divls]on of Otolaryngology, Washington University School of Medicine, St. Louis, Mo Dysphagia is a frequent problem in patients who have undergone total laryngectomy and the barium swallow is often useful for evaluaHng the cause for the symptoms. The examination may be di f f icul t to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor or the operation itself. We analyzed radiographs and clinical information on 43 patients with total laryngectomy with followup periods ranging from g months to 17 years. Recurrent tumor was found in IS patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in nine patients apeared either as a long symmetrical r~arrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 12 patients and presaged the development of recurrent tumor in five. Cricopharyngeal muscular-dysfunctlon accounted for the dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium swallow and the radiographic findings often indicate the correct diagnosis with a high degree of confidence. 0364-2356/82/0007-0087

Intraarterial Digital Subtraction Angiography in the Diagnosis and Treatment of Gastrointestinal Disorders

01.80 9 1982 Springer-Verlag New York Inc.

Corrosive gastritis mimicking linitis plastica carcinoma

During a period of 18 months, intraarterial digital subtraction angiography (IADSA) was performed in 360 patients with various gastrointestinal disorders. This technique was useful both in diagnostic and interventional procedures. Due to increased contrast resolution, hepatic tumors and portal vein systems were better visualized than with the use of conventional angiography. Also, a significant reduction in the dosage of contrast medium resulted in markedly reduced patient discomfort. Small pancreatobiliary tumors were better evaluated on conventional angiograms due to the decreased spatial resolution of IADSA.

Classification of Esophageal Cancer

SummaryA 59-year-old female with depressive tendencies was admitted suffering from hematemesis and abdominal pain, two hours after ingestion of an unknown amount of toilet bowl cleaner (hydrochloric acid, pH 1.0). A barium study 24 days after ingestion revealed rigid narrowing and granulation of the entire stomach. The esophagus and duodenum were normal. The radiographic results were similar to those obtained for linitis plastica carcinoma of the stomach, but biopsy specimens of the stomach revealed no cancer cells. A total gastrectomy was performed about two months after ingestion to relieve the persistent feeling of nausea. Specimens revealed a rigid and thickening lining and a denuded mucosal surface of the stomach. The cut surface of the specimen showed a remarkable fibrous thickening of the submucosal layer. Microscopic examination failed to reveal a normal mucosal layer except in a narrow area of the fornix, and remarkable fibrosis of the submucosal lining was noted. No cancer cells were found. Corrosive gastritis has a linitis plastica appearance with a predilection for the antrum. Radiological examination revealed the very rare manifestion of a rigid narrowing of the whole stomach mimicking linitis plastica type cancer.

Confrontations radiologiques et endoscopiques du pancréas

Thirty-six cases with 45 lesions of early or superficial esophageal cancer have been detected in our department by the combined use of both X-ray and endoscopy between December 1971 and April 1984, inclusive of 15 lesions of intraepithelial cancer (“ep” cancer), 8 lesions of intramucosal cancer (“mm” cancer), and 22 lesions of submucosal cancer (“sm” cancer).