Masayoshi Namiki

Local treatment of gastric ulcer (II) —Results of 135 cases—

A tota l of 161 cases of r e c u r r e n t ben i gn u lcer who were t r ea t ed medica l ly and were obse rved for one to less t h a n five years , were s tudied . T h e obse rva t ion per iod were less t h a n one y e a r for 5 cases , one to two for 56, two to t h r ee for 50, t h r ee to four for 37 and fou r to five for 13. T h e n u m b e r of t he cases in t he ages was 3 in u n d e r 29 yea r old, 28 in 30 to 39, 48 in 40 to 49, 49 in 50 to 59, and 33 in over 60. T h e rat ic of ma le to f ema le was a p p r o x i m a t e l y 5 to 1 wi th 136 ma le and 25 f ema l e pa t i en t s . T h e f r e q u e n c y of r e c u r r e n c e was one t ime for 124 cases , two t i m e s for 25, t h r e e t i m e s for 9, and fou r t i m e s for 3, t he r e was no s ign i f i can t inc idence in the age. In t he obse rva t ion per iod a n d n u m b e r of r ecu r rence , t he r e is a t e n d e n c y t h a t t h e n u m b e r of r e c u r r e n c e i nc r ea se s in t he ca se s w i t h who have been obse rved for a l onge r period. However , 46.2% of t he cases who had been obse rved for 4 to 5 y e a r s had r e c u r r e n c e only once. T h e per iod f r o m the scar f o r m a t i o n a f te r d i s a p p e a r a n c e of whi te coat con f i rmed endoscopica l ly to r e cu r r ence of u lce r is u sua l ly w i th in 18 m o n t h s in abeu t 70% of t he cases a l t h o u g h s o m e ca se s who had been obse rved for a longer per iod had r e c u r r e n c e la ter t h a n 18 m o n t h s . F r o m t h e s e r e su l t s it can be conc luded t ha t 70% of r e c u r r e n t u l ce r can be d i agnosed wi th obs e r v a t i o n for a t leas t 18 m o n t h s . T h e r e is no s ign i f ican t difference in the n u m b e r of r e c u r r e n c e in t he g r o u p who took an t i u lce r med ic ine c o n t i n u o u s l y a n d t he a n o t h e r g r o u p who did no t t a k e it con t inuous ly . However , t he acidi ty of r e c u r r e n t u lce r pa t i en t s was n o r m o or h y p e r c h l o r h y d r i a in 43 cases a n d hypoch lo rhydr i a in 74 cases . T h e cases of hypoch i o rhyd r i a was twice t hose of n o r m o a n d hype r chlor-acidi ty . In t he g roup in w h o m an t i -u lce r med ic ine was c o n t i n u e d d u r i n g obse rva t ion per iod and the a n o t h e r g roup in w h o m it was d i scon t inued , t he r e is no t e n d e n c y t h a t t he medic ine d i s con t inued cases a re more in t he cases wi th n o r m o or hype rch lo rhyd r i a , a n d also t h a t t h e y a re more in t he cases wi th f r e q u e n t r ecu r r ence .

Concept of chronic gastritis from clinical standpoint with special emphasis on the handling of patients

We reprot here histologic and endoscopic findings of gastric mucosa of various gastric disoders with help of biopsy, gastrocamera and gastrofiberscope. Patients clinicaly diagnosed as primary gastritis were classified into superficial gastritis (57.3%), atrophic gastritis (30.5%)and normal gastric mucosa (12.2%) by means of suction biopsy. As to so calld associated gastritis of peptic ulcer and gastric cancer, the tendency was no correlation between incidence of chronic gastrit is and sex and also the type of gastritis and the severity of pain or pain associated with meals. It was observed that the incidence of atrophic gastitis incereased as the time interval between the onset of symptoms and gastric biopsy performed expaneded, but this could not be applied to gastric cancer accompanied with gastritis. Patients with atrophic gastritis secreted no acid or less than normal on Katsch-Kalk method mostly, while associated gastritis of gastic cancer also showed a n or hypo-acidity even in the presence of normal gastic mucosa or superficial gastritis. There was the parallel relationship between the age and the incidence of chronic gastritis especially atrophic gastritis. The fiberscopic gastrit is amounted to 83% while the accuracy of atrophic gastritis remained 73% being characterized with the high incidence of the wrong diagnosis in the prepyloric area. The greyish or greyish-blueish appearance of gastric mucosa and the increased visuality of blood vessels on fiberscopy corresponded well to the existence of glandular atrophy and intestinal metaplasia in the histological examination.