Seiichi Mizumoto

Primary hypertrophic pyloric stenosis in the adult

A case is reported of a 55 year old male patient with primary hypertrophic pyloric stenosis who was subjected to distal gastrectomy. Adult hypertrophic pyloric stenosis is an uncommon condition which is usually misdiagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal and endoscopically by appearances resembling those of the cervix. This condition is probably congenital although aetiology has not been established. In the absence of symptoms, no clinical treatment is required. However, surgical intervention is advocated, when stenosis gives rise to symptoms, there is a suspicion of malignancy, or the ulceration due to the disease. Distal gastrectomy with gastroduodenostomy is the treatment of choice.

Studies of the mechanisms of gastric bleeding under obstructive jaundice

SummaryMechanisms of gastric bleeding under obstructive jaundice were studied in adult male Wistar rats. Following ligation of the common bile duct, mucosal noradrenaline significantly decreased in both the pyloric and fundic gland areas of the gastric mucosa by 20 days after the operation. Serotonin increased only in the pyloric gland area, and histamine increased in the fundic gland area. Urinary excretion of free noradrenaline significantly increased after the ligation.Three weeks after the ligation, restraint and water immersion experiments were conducted. Under water immersion, gastric blood flow significantly reduced in rats with obstructive jaundice compared to controls. Acid output decreased in both groups. Gastric bleeding was noted in the fundic gland area significantly earlier in the ligated rats than in the non-ligated rats. Administration of noradrenaline s.c. 30 minutes before immersion significantly blocked the reduction in gastric blood flow and protected the gastric mucosa against acute bleeding under immersion.These results suggested that prolonged obstructive jaundice may deplete noradrenaline in the gastric mucosa, and that gastric mucosal ischemia caused by this sympathetic dysfunction plays an important role in the formation of acute gastric bleeding under obstructive jaundice.

Reversible protruded lesion regarded as idiopathic appendiceal intussusception

A patient with a reversible protruded lesion regarded as idiopathic appendiceal intussusception was investigated in this study. The patient was a 78‐year‐old male, who consulted our department as a result of positive occult blood in his stool sample. There was no associated pain, nausea, vomiting, fever, chill or anorexia. He had no prior surgical history. Total colonoscopy detected a sigmoidal polyp and a protruded lesion in the caecum. The protruded lesion (about 12 mm in diameter) covered with normal mucosa was diagnosed as a benign submucosal tumor at that time. The periodic follow‐up colonoscopy showed an orifice on top of the protuberance. Further detailed observation revealed that the lesion reduced by itself, and resulted in showing a normal orifice of the appendix; however, afterwards it protruded again. These observations led to the diagnosis of the lesion as type B of Atkinsons classification in appendiceal intussusception. To our knowledge, approximately 200 cases of appendiceal intussusception have been documented in scientific reports worldwide. In Japan, only 10 cases of idiopathic appendiceal intussusception have been described. This case is considered to be important for presenting the initial stage of the complete intussusception of the appendix.

Mechanisms of acute gastric mucosal lesion accompanying obstructive jaundice

SummaryThe mechanism of acute gastric mucosal lesion (AGML) accompanying obstructive jaundice was studied in male Wistar rats, with special reference to the effect of bile acids in plasma on mucosubstances in the gastric mucosa. Following Iigation of the common bile duct, total plasma level of bile acids increased 24 folds over the control level, and gastric mucosal mucus contents, measured biochemically or histochemically, significantly decreased.Effect of increased bile acids in the blood stream on the gastric mucosa was estimated by continuous intravenous administration of sodium taurocholate. After 24 hours infusion, both gastric acid output and gastric mucus contents significantly decreased. Further imposition of restraint and water immersion stress produced AGML significantly earlier than in control rats with continuous intravenous infusion of 0.9% NaCl.These data suggest that the increased plasma level of bile acids play an important role on the reduction of the gastric-mucosal defense mechanism in obstructive jaundice directly through their toxic effects, and that this easily results in the formation of AGML under additional stresses.

A Case of Kissing Esophageal Ulcers of Unknown Etiology

Abstract: A 41‐year‐old man with esophageal ulcers of unknown etiology is reported. Endoscopic examination was performed for evaluation of swallowing difficulty. The lesions were located in the middle portion of the esophagus. There were no findings correlating with either peptic ulcer or reflux esophagitis. In addition, he had no history of provoking factors, such as bacterial, chemical, traumatic or physical agents. Although the cause of these lesions was not clarified, we diagnosed acute benign ulcers following histological examination of the biopsy specimens. The patient was treated with a proton pump inhibitor and sodium alginate. The dysphagia and other symptoms subsided promptly, and the lesions healed completely within three weeks. We discuss herein the relationship between endoscopic findings and the etiology of kissing ulcer.

Indication for Curative Endoscopic Mucosal Resection for Early Gastric Cancer: Analysis of 290 Surgical Cases

In the present study, lymph node metastasis and incontinuous invasion were evaluated in 290 gastrectomy cases of early gastric cancer. All mucosal cancers (m-cancers) were free of lymph node metastasis whereas 24.4% of submucosal cancers (sm-cancers) showed the metastasis. Grossly, lymph node metastasis was absent in elevated lesions of 20 mm or less in size, depressed lesions of 10 mm or less, and all flat lesions; histologically, well differentiated lesions of 20 mm or less and moderately or poorly differentiated lesions of 10 mm or less. Among 34 cases with the main lesion of 20 mm or less, regardless of the gross and histologic types, incontinuous invasion was located within 2 mm from the main lesion in 97.1%.