Kurato Yashiro

Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.-host disease

Endoscopic appearance of the gastrointestinal tract of a patient with severe hemorrhagic enteric graft-vs.-host disease (GVHD) is presented. A 29-year-old man with chronic myelogenous leukemia suffered from severe enteric GVHD after allogeneic bone marrow transplantation. Endoscopy showed hemorrhagic ulceration of the upper jejunum, terminal ileum, and colon at the onset of melena. Sections of biopsies were compatible with acute GVHD. Repeat endoscopy showed gradual healing of the lesions after steroid pulse and antilymphocyte globulin therapy, but the patient died of cytomegalovirus pneumonitis 14 months later. Autopsy revealed submucosal fibrosis of the small intestine and colon.

Significance of serum sialic acid in patients with Crohn’s disease

SummarySerum sialic acid was measured to evaluate the activity of Crohn’s disease. The sialic acid levels of patients with Crohn’s disease in remission (CRP 0.0 mg/dl) were significantly higher than those of healthy subjects and postoperative patients with Crohn’s disease. In patients in remission, serum sialic acid was significantly correlated with hemoglobin, hematocrit, platelet, and rapid turnover protein. Correlations with platelet, retinol-binding protein, and prealbumin were especially strong. From these findings, it was concluded that serum sialic acid level provides a useful index of the activity of Crohn’s disease.

Extensive varices of ileocecum

A man was admitted to our hospital because of intestinal reddish bleeding. Colonic varices were found at the cecum by colonoscopy. Angiography of the superior mesenteric artery showed that blood vessels were scant from the end of the ileum to the ascending colon. An operative view revealed the varices, but there was no trace of the ileocecal vein. This case, presenting a deficit of the ileocecal vein, indicated that the blood flow could not returnviathe ileocecal vein, and therefore there was an outflow through the varices to the surrounding intestine or abdominal veins. Such a case is probably unrepresented in the literature because it was caused by the total deficiency of the ileocecal vein and it was in the right colon.

Multiple abdominal telangiectases and lymphangiectases. A limited form of Osler-Weber-Rendu disease?

We describe a 23-year-old man with protein-losing enteropathy, iron deficiency anemia, and recurrent gastrointestinal bleeding. The patient eventually developed disseminated intravascular coagulation, portal vein thrombosis, and extensive small bowel infarction. The autopsy showed multiple telangiectases in the intestines, mesentery, liver, gallbladder, renal pelves, and diaphragm. In addition, lymphangiectases were found in the retroperitoneal space, intestines, and liver. These lesions appeared to have been the cause of the gastrointestinal bleeding and the protein-losing enteropathy. The case most likely represents Osler-Weber-Rendu disease without the usual manifestations in the skin and oral-nasal cavities.

Follow-up after polypectomy of colorectal adenomas

SummaryFive hundred eighty-two patients with colorectal adenomas or early cancers were polypectomized from 1974 to 1985. In 100 patients, total colonoscopy was performed more than twice after the initial polypectomies. These patients were divided into three groups: group A patients underwent total colonoscopy at 1-year intervals; group B patients underwent total colonoscopy at 2-year intervals, group C patients underwent total colonoscopy at 3-year or more than 3-year intervals. The frequency and location of newly developed adenomas were investigated. The detection rate for new adenomas was 13% in group A and 50% in group B; thus, there was a significant difference between group A and group B (P<0.01). The transverse colon is the only segment where the topological proportion of newly developed adenomas increased in comparison with that of index adenomas (P<0.05). The detection rate for new adenomas was significantly higher in patients who had carcinoma in situ at the time of initial polypectomy (P<0.05). Questionnaires about colonoscopy and colonic adenomas were therefore mailed to the patients who were lost to follow-up after the polypectomy.

A Study on the Shape of Colorectal Hyperplastic Polyps—Consideration of the Importance of the Location—

Sixty‐nine hyperplastic polyps over 6mm in diameter were studied with respect to their size and location. Of these polyps, 47% in the rectum, 35% in the right colon, and 80% in the left colon were pedunculated. In other words, polyps with stalks were prevalent in the left colon. Horizontally growing tumors like hyperplastic polyps tended to be pedunculated depending on their location.

Colonoscopic Follow-up Study after Polypectomy

One hundred and forty‐seven patients with colonic adenoma and early cancer were followed by one or more total colonoscopies. A very precisely planned colonoscopic follow‐up schedule for the polypectomized patients was then assessed. In patients who received a single follow‐up examination, the incidence of developing new polyps was 46.7% (1 year), 53.9% (2 years) and 73.3% (3 years or more). Patients who received multiple follow‐up examinations showed an average incidence of developing new polyps (polyp positive examinations/total examinations) of 46.9%. With regards to the location and histology of the polyps, there was no difference found between the initial and new polyps. Seventeen colon cancers (14 mucosal, 2 early invasive, 1 advanced) were detected in 16 patients in the follow‐up examinations. The time elapsed from a diagnosis of ‘clean colon’ to a new cancer developing was 1.9±1.0 years. The rate of new pedunculated polyps was found to be significantly low (p <0.01), and their size was significantly smaller (p<0.01) when compared with polyps in the initial early colon cancer. Follow‐up examinations every two years are recommended

A Colonoscopic Study of Aphthoid Ulcers of the Large Intestine

Colonoscopic characteristics of aphthoid ulcers in amebiasis, Crohns disease, and tuberculosis were evaluated. Multiple aphthoid ulcers were featured in 14 out of 15 cases of amebiasis, 7 out of 74 cases of Crohns disease, and 5 out of 24 cases of tuberculosis. Aphthoid ulcers of amebiasis were often confined to the rectum and lower sigmoid colon, being characterized by marginal elevation and erythema. Crohns aphthoid ulcers lacked the red halo in all but one case. No verrucous elevations were observed. The intervening mucosa appeared intact in all cases. Aphthoid ulcers of intestinal tuberculosis were oval or lozenge‐shaped. They were surrounded by a marginal red halo in 4 cases (80%), however, the red halos found in tuberculosis patients were milder than those of patients with amebiasis. Aphthoid ulcers of Crohns disease and tuberculosis showed a tendency to be arranged in a specific direction. Crohns ulcers were arranged in a longitudinal fashion, whereas tuberculous ulcers were arranged in a circular fashion. Ulcers of amebiasis were arranged entirely at random. Biopsy from aphthoid ulcers of amebiasis showed parasites in 64%, whereas cytological studies were positive in 93% of cases.