Kazuei Ogoshi

Endoscopic Pancreatocholangiography in the Evaluation of Pancreatic and Biliary Disease

Abstract Recent advances in fiberoptic instrumentation permit direct observation of the duodenum and cannulation of the ampulla of Vater with pancreatocholangiography in essentially all cases. An analysis of this technique in 252 consecutive patients with pancreatobiliary symptoms reveals that it is a safe and effective technique that may add significant new information in the evaluation of these patients.

New technic for small intestinal fiberoscopy

A new, small caliber, fiberoptic endoscope is suitable for visualization of the proximal jejunum and allows repeated suction biopsy under direct visual control.

The diagnostic evaluation of ERCP in pancreatic and biliary carcinoma

SummaryEndoscopic retrograde cholangiopancreatography (ERCP) was performed in 77 cases of pancreatic carcinoma, 47 cases of carcinoma of the common bile duct and 45 cases of carcinoma of the gall bladder. In order to evaluate ERCP in pancreatic and biliary carcinoma, success rates of desired duct cannulation and some problems in the interpretation of ERCP findings were discussed. In 2 cases (2.6%) of pancreatic carcinoma, 6 cases (13.0%) of carcinoma of the common bile duct and 8 cases (17.8%) of carcinoma of the gall bladder were failed to visualized the desired ducts by ERCP. In pancreatic carcinoma, false negative cases in the interpretation of ERCP findings were encountered in 4 cases (4.6%). Similarly, false positive cases were encountered in 12 patients (13.6%). On the other hand, 4 false negative.were encountered in cases of which carcinoma of the gall bladder could not detected and 4 false positive cases were encountered in cases with inflamatory disease of the common bile duct.

Gastric ulcer: clinical observations on cure rate, relapse rate, and possible malignant change

Summary1)Cure rate Cure rate of gastric ulcers of the in-patient group are distinctly better than the out-patient group. And cure rates are related to the diameter and to the depth of the crater.2)Relapse rate The relapse rate is highest in the group subjected to the longest periods of follow-up observation. More than 50% of relapsed gastric ulcer group were relapsed within one year and nearly 75% within two years. Relapses occured most commonly in the third, forth and fifth decades, less commonly in the older and younger age groups. And there is no statistical significance in the relationship between the sex, size, depth or location of the initial ulcer and relapse rate. From histological studies of stomachs resected because of relapse, it was noted that the relapsed ulcers occured very close to or at the actual edge of the previous healed ulcer. Relapses occured more frequently in that group which healed their ulcers in a longer time period than the group in a shorter time period. It is to be noted that smoking, irregular mealtime, physical and mental overwork, sleeplessness and general dietary habits were statiscally significant as tiological factors in gastric ulcer relapse. And more than one out of the above six important etiological factors were present coincidentally in a larger number of the relapsed ulcer cases. Relased ulcer take longer to heal than required for the healing of the initial ulcer.3)Malignant changes From our follow-up study on 991 cases of healed gastric ulcers, only 4 cases may have changed from benignity to malignancy. We believe that it is safe to say that the rate of malignant change is extremely low in a ten year follow-up study.

Abstracts of selected papers presented at the 74th general meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 74TH GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY March 24-26, 1988 Sendai, Japan Chairman: Toshio SATO, M.D.

Operative indications on the gastric ulcer, (from medical side), especially from the point of view of malignant change and relapse

ConclusionWe believe that: a) Absolute operative indications of gastric ulcer are as follows; 1) large hematemesis or melena, 2) perforation, 3) pyloric stenosis, 4) markedly deformed stomach due to repeated ulceration and b) Relative operative indications on gastric ulcer are 1) penetration, 2) linear or multiple ulcer, 3) gastro-duodenal ulcer, 4) all cases who will not cooperate to their regular follow-up examinations.

Measurment of the temperature of gastric mucosa with the various gastric pathologies

The H e x o s a m i n i d a s e act iv i t ies in the gas t r i c juice were m e a s u r e d by the m e t h o d descr ibed by Kush ida , u s ing the s u b s t r a t e s wh ich were pheni l -N-/~-D-glucosaminid and /~-D-galactosaminid. T h e resu l t s were the fo l lowing; T h e h e x o s a m i n i d a s e ac t iv i t ies in the gas t r i c juice were s igni f icant ly inc reased over pH 6.0 or were lost unde r PH 4.0, as s a m e as in vitro. We th ink tha t u n d e r PH 4.0, the decrease of h e x o s a m i n i d a s e act iv i t ies in the gas t r i c juice could no t recover the p rev ious act ivi ty. T h e g a l a c t o s a m i n i d a s e act iv i t ies in t he gas t r ic juice was increased more t h a n in the s e rum.

On the differential diagnosis for the atypical benign epithelium studies on differentiation the atypical benign epithelium from the ha by using cyanic filters

It is very i m p o r t a n t to di f ferent ia te the ear ly gas t r i c cancer type IIa f r om the a typical e p i t h e l i u m endoscopical ly , w h e n ever we find some e levated m u c o s a l gas t r i c lesion. But , in the fact , it is ve ry difficult to find d i f ferent po in t s a m o n g t h e m , and s o m e t i m e s it is imposs ib le to different ia te . So, his tological e x a m i n a t i o n s by endoscopic b iopsy are necessa ry . But, in a typical case, ear ly gas t r i c cance r type IIa shows s o m e w h a t d i f ferent character is t ic appea rence in its shape , color and i ts su r f ace c o m p a r i n g wi th the a typica l b e n i g n ep i the l ium. For example , the su r f ace of ear ly gas t r i c cance r type IIa shows more red in color in i tself t h a n t ha t of a typical ben ign epi the l ium. T h e su r face of a typica l ben ign ep i the l ium is colored wi th s a m e r e d n e s s as s u r r o u n d i n g n o r m a l ep i the l ium and s o m e t i m e s it is discolored like as gray . Table 1 shows t he d i f ference in degrees of red color compared ear ly gas t r i c cancer type IIa wi th atypical ben ign ep i the l ium. Bu t as a m a t t e r of fact , we can ha rd ly find a difference in i ts r e d n e s s be tween e leva ted m u c o s a and n o r m a l flat m u c o s a in the film, because the red i l lumina t ion and t he ref lected l igh ts f r om red mucosa l su r f ace m a k e un i f rom red color films.

Studies on enzyme activities of the mucosa obtained from various gastric pathologies under direct vision

We tr ied to apply the es t imat ion of the desoxyribonucleic acid content per nucleus of gastr ic mucosal cell to confirmation of gastr ic cancer. In th is study, normal persons (5 cases), the pat ients with gas t r i t i s (6 cases), gastr ic polyp (6 cases), gastr ic ulcer (7 cases), atypical epi thel ium (2 cases), early gastr ic cancer (5 cases) and advanced gastr ic cancer (11 cases )were examined. Gastric mucosal specimens obtained by biopsy under direct-vision were immediately fixed in 50% formal in for 24 hours. Then these specimens were embedded in paraffin and subjected to Feulgen reaction. DNA content per nucleus was measured by Naora s method wi th us ing Microspectrophotometry. Gastric mucosal smear obtained by b rush ing under direct vision were immediately fixed in formal in vapor for 1 hour and subjected to feulgen reaction. Then DNA content was measured by both Naora s method and Two Wavelength method. The result were as follows; 1) Nuclei of gastr ic mucosal cells in normal persons were almost diploid. 2) Frequency h is togram of DNA content of cancer cells showed wide and i r regular distribution. Octapliody was found in most cases. 3) Frequency of te traploidy was increased in various degree but octaploidy was never seen in the rest of the disease.