Keiichi Ohsato

Gastric lesions in familial adenomatosis coli: Their incidence and histologic analysis

In order to detect accompanying gastric lesions, we examined 22 patients with familial adenomatosis of the colon belonging to 14 families. Various gastric lesions were confirmed in 15 patients (68.2 per cent) belonging to 13 families. The lesions were found histologically to be adenoma in nine cases, fundic gland polyposis in six, carcinoma in three, and microcarcinoid in two. Fundic gland polyposis consisting of simple hyperplasia of the fundic glands seems to be the gastric lesion specific to familial adenomatosis of the colon and rectum. Familial adenomatosis coli not only affects the colon and rectum, but is also capable of inducing tumorigenicity in other organs. The stomach is one of the organs in which extracolonic lesions occur.

Small-intestinal involvement in famialial polyposis diagnosed by operative intestinal fiberscopy: Report of four cases

SummaryOperative intestinal fiberscopy, in which the duodenal fiberscope was introduced during laparotomy for colectomy in familial polyposis via the enterotomy opening, permitted the demonstration of small intestinal polyps in six of seven consecutive cases. Four of the six patients had adenomatous polyps in the proximal jejunum, including one patient with the concomitant presence of ileal adenomas. Polyposis due to lymphoid hyperplasia in the terminal ileum was found in three patients. Preoperative upper gastrointestinal surveys revealed adenomas in the duodenums of all seven patients, adenomas in the gastric antrum in three, and multiple hamartomas in the gastric corpus in two. Thus, in familial polyposis or Gardners syndrome, more or less the entire gastrointestinal tract seems to be involved and the term “gastrointestinal polyposis” seems to describe these conditions.

Clinical application of spectral analysis of bowel sounds in intestinal obstruction

The bowel sounds of 21 patients with mechanical obstruction of the intestine were studied. A computer analysis of bowel sounds was performed using a signal processor. Bowel sounds of patients were classified into 3 types (Types I, II, and III) based on the histograms, although these were not distinguishable on auscultation. The lower, peak, and upper frequencies were 173 ± 25 Hz, 273 ± 64 Hz, and 667 ± 58 Hz, respectively, in Type I; 309 ±121 Hz, 632 ± 94 Hz, and 878 ± 116 Hz, respectively, in Type II; and 330 ± 120 Hz, 612 ± 86 Hz, and 766 ± 82 Hz, respectively, in Type III. High frequency sounds above 900 Hz were recorded in Types I and II but not in Type III. The ratio of the operated patients was 0, 23, and 100 percent in Types I, II, and III, respectively. The intervals between the times of admission and operation were 4.3 days and 1.2 days in Types II and III, respectively. Thus, it appears that the methods described by the authors could provide a very objective assessment of the severity and help determine the treatment (conservative or operative) of each patient.

Endoscopic features of adenoma of the duodenal papilla in familial polyposis of the colon

The duodenal papillae of 24 patients with familial polyposis of the colon were examined in detail by duodenofiberscopy and endoscopic biopsy. Adenomas were detected in 12 of the 24 patients (50%). Endoscopically the duodenal papilla had a white nodular or granular surface in most of the patients in whom adenoma was detected. In two patients, however, the endoscopic picture of the adenoma at the duodenal papilla was almost normal. Based on these observations, endoscopy and biopsy of the duodenal papilla should be added to the usual examination done in patients with this disease.

Simultaneous occurrence of multiple gastric carcinomas and familial polyposis of the colon

Upper gastrointestinal survey in ten patients with familial polyposis of the colon revealed the presence of polyps and/or carcinomas of the stomach or duodenum in eight, including two cases of associated multiple gastric carcinomas with concomitant presence in one case of multiple gastroduodenal adenomatous polyps and in the other without presence of polyp. The rather frequent association of gastroduodenal polyps and cancerous lesions in familial polyposis suggests such association to be a part of the manifestation of this inherited disease and possible malignant change occurring in gastroduodenal mucosa as is generally supposed to be the case in large intestine.

Regression of rectal polyps by indomethacin suppository in familial adenomatous polyposis: Report of two cases

PURPOSE: The effect of indomethacin suppository on rectal polyps was evaluated in two patients with familial adenomatous polyposis who had undergone total colectomy and ileoproctostomy. METHODS: Both patients received intrarectal administration of 50 mg of indomethacin suppository once or twice daily to control the rectal remnant polyps. RESULTS: With this treatment, an almost complete regression was achieved within three months, in both patients. Polyps recurred after the interruption of indomethacin treatment in one patient. At the present follow-up of two to three years, no cancer has developed. CONCLUSIONS: Indomethacin suppository treatment was effective in controlling rectal remnant polyps in the two patients with familial adenomatous polyposis. Intraluminal administration of indomethacin in suppository form seems more beneficial since it allows for direct contact of the drug with the lesions and produces a high local concentration of the drug.

Coagulopathy in Disseminated Intravascular Coagulation due to Abdominal Sepsis: Determination of Prothrombin Fragment 1+2 and Other Markers

To estimate the degree of coagulopathy in abdominal sepsis, we measured the plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complex (TAT) and plasmin-alpha 2-plasmin inhibitor complex (PIC) by the enzyme-linked immunosorbent assay in 38 patients with disseminated intravascular coagulation (DIC). In 20 patients with DIC due to abdominal sepsis, plasma levels of F1 + 2, TAT and PIC were 2.6 nmol/l, 27.9 micrograms/l and 1.5 micrograms/ml, respectively, with a mean antithrombin III (AT III) activity of 41.7%. F1 + 2, TAT, PIC and AT III levels were 4.7 nmol/l, 75.8 micrograms/l, 8.8 micrograms/ml and 70.9% in 18 patients with DIC as the result of malignancy. Though AT III levels in DIC due to sepsis were lower than those in DIC due to malignancy, the levels of F1 + 2, TAT and PIC in the former were not significantly more increased than those in the latter. The plasma levels of F1 + 2 were positively correlated with TAT and PIC in DIC patients with malignancy; however, there was no correlation between F1 + 2 and TAT or PIC in DIC patients with sepsis. In addition, the levels of serum albumin in the two groups were similar. These results suggest that activation of coagulation and fibrinolytic systems may not be so prominent in cases of DIC due to abdominal sepsis, compared to related events in DIC due to malignancy. It is also suggested that the depletion of AT III in cases of sepsis is not only caused by a consumption related to intravascular coagulation or to an alternate distribution of protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Accompanying gastro-enteric lesions in familial adenomatosis coli.

An effort was made to detect accompanying gastro‐enteric lesions in 26 patients with familial adenomatosis coli (FAG) belonging to 18 pedigrees. One or more types of various gastric lesions were found in 17 (65.4%) of the 26 patients, these gastric lesions consisting of adenoma in 11 cases, fundic gland polyposis in six, carcinoma in three and microcarcinoid in two. The fundic gland polyposis composed of simple hyperplasia of the fundic glands seems to be peculiar to FAC. Duodenal lesions were present in all of the 19 patients examined and consisted of “carcinoma in adenoma” in one case and adenoma in 18 cases in which one had a microcarcinoid in addition. Out of 16 cases investigated through the entire jejunum and ileum by endoscopy and/or at autopsy, eight (50%) showed small polyps limited to the proximal jejunum. Histologic study showed adenoma in five of them. In the remaining three, polyps did seem clearly to be adenoma on endoscopy. Only four (25%) cases revealed one or a few neoplastic lesions restricted to the distal ileum. Histologic study showed malignant lymphoma in one case, and adenoma in three. The present study strongly suggests that accompanying gastroenteric lesions are higher in incidence than previously considered, and special attention should be given to the stomach and small intestine as well as to the colon and rectum. ACTA PATH. JAP. 27: 823‐839, 1977.

Ileal adenomas in familial polyposis coli

We treated two patients with familial polyposis coli (FPC) who were found to have multiple adenomas in the ileostomy stoma, five and seven years after colectomy, respectively. These adenomas were dense and 3 to 10 mm in diameter. The adjacent ileal mucosa showed a colonic metaplasia. Ileal adenomas detected using intraoperative intestinal endoscopy at the time of colectomy were less than 2 mm in diameter and sparse in density. These findings suggest that ileal adenomas occurring after colectomy for FPC tend to increase in size and number and to resemble colonic adenomas.

Occurrence of disseminated intravascular coagulation (DIC) in obstructive jaundice and its relation to biliary tract infection.

Coagulation studies were done on 78 consecutive cases of obstructive jaundice with or without biliary tract infection. Among 26 cases with biliary tract infection 20 cases showed no bleeding tendency but remarkable hypercoagulability with decreased fibrinolytic activity. Other six cases developed diffuse bleeding tendency in addition to the signs of hypotension and multiorgan dysfunction such as oliguria, respiratory distress and mental confusion. Most showed marked coagulation defects characterized by thrombocytopenia, decreased fibrinogen, antithrombin III and plasminogen levels and narrowing of maximal amplitude in thrombelastogram as well as the increase of fibrin degradation products and positive soluble fibrin monomer complexes. All except one died and three cases were autopsied. In two cases postmortem examination revealed multiple fibrin thrombi in lungs and other organs. A cause of the development of bleeding tendency in obstructive jaundice presently observed may likely to be due to the occurrence of disseminated intravascular coagulation (DIC), i.e. hypercoagulability caused by the biliary tract infection is responsible.