Hiroaki Iwase

Endoscopic injection sclerotherapy for esophageal varices during pregnancy

Pregnancy is uncommon in patients with portal hypertension, and the correct treatment for pregnant women with esophageal varices has not yet been established. There have been only a few reports on endoscopic injection sclerotherapy (EIS) during pregnancy for the control of variceal bleeding. Here we report two women with esophageal varices who underwent EIS. One was a pregnant woman with variceal hemorrhage who was saved by emergency EIS and was delivered safely. The second woman underwent prophylactic EIS for esophageal varices before becoming pregnant. This woman later gave birth uneventfully. Thus EIS appears to be a useful treatment for pregnant women with esophageal varices.

Expression of adhesion molecules and HLA-DR by macrophages and dendritic cells in aphthoid lesions of Crohn's disease: An immunocytochemical study

The phenotypes and ultrastructure of macrophages and dendritic cells in aphthoid lesions of the colon were immunocytochemically observed in patients with Crohns disease. Biopsy specimens were endoscopically obtained from both aphthoid and advanced lesions in Crohns disease patients. Biopsy specimens obtained from patients with infectious colitis and from normal individuals served as controls. Aphthoid lesions contained densely aggregated CD68+ macrophages, which were surrounded by numerous ID-1+ dendritic cells. In the normal controls and infectious colitis patients, however, a few scattered CD68+ macrophages and ID-1+ dendritic cells were noted beneath the surface epithelium. CD3+ lymphocytes were significantly increased in both aphthoid and advanced lesions of Crohns disease, but the CD4/CD8 ratio was similar in all groups studied. The double immunoperoxidase staining method revealed that both CD68+ macrophages and ID-1+ dendritic cells in the aphthoid lesions simultaneously expressed ICAM-1 and HLA-DR antigens. Electronmicroscopic observation revealed that CD68+ macrophages had numerous vesicles and lysosomal granules and few projections, and that ID-1+ dendritic cells had appreciable cytoplasmic protrusions with a few vacuoles. These findings suggested that the colonic mucosa in Crohns disease contained two types of macrophage/dendritic cells in the same lineage that expressed intercellular adhesion molecules and class-II MHC antigens. It also appeared that the aphthoid lesions of Crohns disease featured an increase in macrophages and dendritic cells consistent with immunological activation.

Endoscopic ultrasonography with color Doppler function in the diagnosis of rectal variceal bleeding.

Extraesophagogastric variceal bleeding in patients with portal hypertension is rare, but has been reported after endoscopic injection sclerotherapy (EIS) for esophageal varices. Here, we report rectal variceal hemorrhage following EIS. Endoscopic ultrasonography with color Doppler function (EUSCD) was useful for the diagnosis of rectal varices and complete hemostasis was obtained with EIS. A review of the literature since 1980 revealed a total of 15 patients, including ours, with extraesophagogastric variceal bleeding following EIS. This suggests EIS is the principal emergency treatment for bleeding rectal varices.

Studies on the designing of chemotherapy for gastric cancer in man, based on the tumor tissue concentration of anticancer agents

Summary5-fluorouracil analogs investigated in this study include a combination of uracil and Ftorafur (UFT), Ethyl (±)-t-butoxy-5 -fluoro-hexahydro-2,4-dioxopyrimidine r-5-carboxylate (TAC-278), and 5′-deoxy-5-fluorouridine (5′-DFUR). In a total of 45 patients with gastric cancer, tumor tissue level of 5-fluorouracil (5-FU) was determined at 2, 4, 6, 8, and 12 hours following the oral administration of drug, using a resected stomach specimen as material. As a result, it was demonstrated that oral administration of 200 mg/m2 of UFT maintained above 0.05jΜg/g (minimum inhibitory concentration: MIC) of 5-FU in tumor tissues over 12 hours in 11 of 13 patients. On the contrary, 133 mg/m2 of TAC-278, and 200mg/m2 or 300mg/m2 of 5′-DFUR (which is activated by thymidine phosphorylase in man) did not produce an effective 5-FU concentration in tumor tissues. Serum 5-FU level was high in order of TAC-278, UFT, and 5′-DFUR. Clinical response rates obtained with UFT (200mg/m2 twice a day), or TAC-278 (133–200mg/m2, 3 times daily) were 27.5% (49 of 178 cases), and 8.3% (3 of 36 cases, by Koyama et al.), respectively. Fisher’s direct probability test revealed that there was a significant difference (p<0.05) between them in the response rate. It was considered that the measurement of concentration of anticancer drugs in tumor tissues might provide us useful information for the designing of chemotherapy of gastric cancer.

Successful Hyperbaric Oxygen Therapy of Pneumatosis Cystoides Intestinals : A Report of Two Cases

Abstract: Two patients with pneumatosis cystoides intestinalis (PCI) successfully treated with hyperbaric oxygen are described, The first patient was a 52‐year‐old male who presented with bloody stools and was diagnosed as having primary PCI. The second was a 61‐year‐old male whose occupation entailed prolonged exposure to trichloroethylene. Following hyperbaric oxygen therapy, the colonic gas cysts completely disappeared in both patients, and there has been no evidence of recurrence. The relevant literature from 1980 to 1992 is reviewed, and hyperbaric oxygen therapy for PCI is discussed in detail. The data accumulated thus far suggest that hyperbaric oxygen is superior to high‐flow oxygen breathing in PCI therapy.