Kimie Kurokawa

Evaluation of endoscopic ultrasonography for gastric tumors and presentation of three-dimensional display of endoscopic ultrasonography

SummaryWe have studied the usefulness of endoscopic ultrasonography (EUS) for: (1) differentiation between extragastric mural compression (EGMC) and submucosal tumors (SMT); (2) qualitative assessment of these lesions; (3) diagnosis of serosal invasion by malignant gastric tumors; (4) presentation of three-dimensional display of EUS findings. A total of 103 patients with submucosal lesions protruding into the gastric lumen on endoscopy were examined. Differentiation between EGMC and SMT could be made by EUS in all cases. Qualitative assessment of these lesions was made by observing their EUS findings, i.e. their internal and marginal echo pattern and their location in the gastric layers. The correct diagnosis was made in 88% (23/26) of EGMC. Of 50 patients with SMT, comprising myogenic tumor (32), aberrant pancreas (8), lipoma (3), gastric cyst (4) and malignant lymphoma (elevated type; 3), differentiation between malignant and benign myogenic tumors was impossible by EUS alone. In addition, 48 patients with advanced gastric cancer and malignant lymphoma were examined. Invasion to the serosal surface was diagnosed as interruption of the fifth layer of the gastric wall. Invasion to other organs was diagnosed by interruption and fusion of the fifth layer into the border of the adjacent structure. Serosal invasion was diagnosed accurately in 65% of 48 patients. Microscopic invasion was difficult to diagnose, and gastric stenosis by tumor was an obstacle to adequate scanning. EUS can be valuable in the differential diagnosis between EGMC and SMT and in the qualitative diagnosis of gastric lesions. It is also effective in detecting serosal invasion by gastric malignant tumors. Three-dimensional display of pathological lesions is new in EUS. With this method, it is easy to get the stereograph and to obtain a complete picture of the lesions. We present two cases in this report.

The Capability of Three Dimensional Display during Endoscopic Ultrasonography

Abstract: Endoscopic ultrasonography (EUS) has been found to be useful in determining the depth of invasion of gastric cancer, the diagnosis of submucosal tumors and extramural compressions. A problem with this procedure is that it is difficult to determine stereoscopically the relative position of the lesion as a whole, even though EUS may be an excellent diagnostic tool for determining tomographies. In this paper, we made three‐dimensional displays of EUS images using a personal computer to facilitate understanding of the relative anatomical positions of the lesions. During EUS examination, the distance from the incisors was acccurately measured, and the EUS image was recorded on U‐matic tape. To measure the distance from the incisors, we devised a new instrument for measuring the endoscopic insertion length. The recorded tape was edited for input into the computer. The soft‐ware for the three‐dimensional display program was made by Photoron. Inc. A patient with esophageal cancer, a patient with a common bile duct stone and a patient with pancreatic cancer are presented as examples for definition of the relationship with the surrounding organs. A patient with a gastric ulcer is used as an example to clarify the pathological structure of the lesions. Using our method on these patients, it was easy to obtain a stereograph and to obtain complete images of the lesions. EUS was available for three ‐dimensional displays of the lesions in the gastrointestinal tract and in the surrounding area, and this has clinical significance.

Serum and gastric mucosal pepsinogens in atrophic gastritis, particularly in type A gastritis associated with pernicious anemia in Japanese

SummaryThe levels of serum pepsinogen I (PG I) and pepsinogen II (PG II) were determined by IRMA (immunoradiometric assay) and the ratio of PG I/II calculated in 37 patients with type A gastritis and concomitant pernicious anemia (PA) and in 97 with chronic gastritis (type B gastritis) among Japanese. In several patients from each group, PG I and PG II in the gastric mucosa were stained by an enzyme antibody assay to compare the percentage of positively stained cells with levels of serum PG I and PG II. The levels of serum PG I and PG II in chronic gastritis decreased as the degree of atrophy increased. Serum PG I and PG II levels in PA were lower than those of patients with severe atrophy. Most of serum PG I levels in PA were less than 10 ng/ml. The PG I/II ratio also decreased as the severity of atrophy increased, distinctly showing that in PA, the ratio were quite low and most of them are less than 1.0. Gastric mucosal pepsinogen showed a tendency similar to that of serum levels and also refrected the degree of atrophy. Therefore, by measuring these parameters it should be easier to determine the extent of atrophy, and to establish a serological diagnosis of type A gastritis associated with PA.

Clinical course of peptic ulcer and the effect of pharmacotherapy

SummaryComparative clinical trials were conducted by the double-blind technique in a series of 302 cases of gastric ulcer at fifteen medical institutions in order to investigate the clinical course of peptic ulceration and the effect of pharmacotherapy on it, using N-acetyl-L-glutamine aluminum complex (KW) as test drug and basic aluminum sucrose sulfate (UL) as reference drug as well as an inactive placebo of lactose (PL) with the results as follows:In 12 weeks of treatment with inactive placebo, a higher cure rates were noted in inpatients than in outpatients, and in patients with ulceration in the corpus ventriculi than in those with ulceration at the angulus. The overall evaluation of therapeutic responses indicated that, both KW and UL were significantly superior in efficacy to placebo in 12 weeks of therapy. These two medicaments displayed different modes of efficacy, possibly reflecting their different mechanisms of pharmacologic action. The efficacy of the medicaments was particularly superior in outpatients and patients with peptic ulceration at the gastric angle both of which showed lower rates of response to placebo.