Tadashi Misawa

Rectal carcinoid tumor: endoscopic ultrasonographic detection and endoscopic removal

Eight patients with rectal carcinoid tumors were examined by endoscopic ultrasonography (EUS) to assess the depth of invasion of the rectal wall. All resected tumors were contained within the submucosa and their depth of invasion was correctly diagnosed by EUS before treatment. Perirectal lymph nodes were not delineated by EUS. Four patients who were treated only with endoscopic polypectomy were completely cured as were four patients who had a surgical resection. EUS is useful in selecting the candidates for endoscopic removal or local resection and thus may help to avoid unnecessary radical surgery.

Pneumocystis pneumonia during combined therapy of infliximab, corticosteroid, and azathioprine in a patient with Crohn's disease

Pneumocystis pneumonia (PCP) is one of the most frequent and severe opportunistic infections in immunocompromised patients. In recognition of its genetic and functional distinctiveness, the organism that causes human PCP has now been designated Pneumocystis jiroveci [1]. The number of patients who are receiving chronic immunosuppressive medication or have an altered immune system and are thus at risk of PCP is increasing rapidly [2]. A recent report indicated that inflammatory disorders represent nearly 20% of the underlying diseases associated with PCP in HIV-negative patients [3]. Furthermore, patients

Direct contractile effect of motilin on isolated smooth muscle cells of guinea pig small intestine

We examined the direct effect of motilin on longitudinal and circular smooth muscle cells isolated from the guinea pig small intestine. In addition, the effects of 8-(N,N-diethylamino)-octyl-3,4,5-trimethoxy-benzoate hydrochloride (TMB-8, an inhibitor of intracellular Ca(2+)-release), verapamil (a voltage-dependent Ca(2+)-channel blocker), and removal of extracellular Ca2+ were investigated to evaluate the role of intracellular Ca2+ stores and extracellular Ca2+ on the muscle contraction induced by motilin. The effects of atropine (a muscarinic receptor antagonist), spantide (a substance P receptor antagonist) and loxiglumide (a CCK-receptor antagonist) were also examined to determine whether the motilin-induced contraction was independent of those receptors. Motilin induced a contraction of the longitudinal and circular smooth muscle cells in a dose-dependent manner with the maximal effect attained after 30 seconds of incubation. The ED50 values were 0.3 nM and 0.05 nM, respectively. TMB-8 suppressed completely the motilin-induced contraction of both types of smooth muscle cells. Verapamil had only a slight suppressive effect. Removal of extracellular Ca2+ did not have any significant influence on motilin-induced contraction. The contractile response to motilin was not affected by atropine, spantide or loxiglumide. Our findings showed that:1) motilin has a direct contractile effect on both longitudinal and circular smooth muscle cells; 2) this contractile effect is not evoked via muscarinic, substance P or CCK receptors, and 3) the intracellular release of Ca2+ plays an important role in the contractile response to motilin on both types of smooth muscle cells.

Evidence of local mechanism involvement in vasoactive intestinal polypeptide release from canine small intestine

We studied the effect of intraileal administration of a 100-ml test meal, 100 ml of 5% glucose, amino acids, 10% Intralipos, or bile on canine plasma immunoreactive vasoactive intestinal polypeptide (VIP) levels in the mesenteric and femoral veins of dogs. The effects of intravenous administration of caerulein on plasma immunoreactive VIP levels were examined, with or without intraduodenal ballooning, to rule out the effect of bile and pancreatic and gastric juice. In addition, hexamethonium bromide or atropine sulfate was given intravenously before the administration of bile or intravenous caerulein to study the role of the neural pathway on the release of VIP. Basal plasma VIP levels in the mesenteric vein were significantly higher than those in the femoral vein. Intraileal administration of the test meal, 5% glucose, amino acids, or 10% Intralipos induced no variation of mesenteric VIP. Intraileal administration of bile or intravenous caerulein, with or without intraduodenal ballooning, produced a significant increase of plasma VIP in the mesenteric vein. Pretreatment with atropine completely blocked the bile-stimulated VIP release and significantly inhibited the caerulein-stimulated release of VIP. On the other hand, pretreatment with hexamethonium did not significantly decrease the VIP response by bile or caerulein. Thus, the muscarinic receptor probably plays an important role in bile- or caerulein-stimulated release of VIP.

Substance P, vasoactive intestinal polypeptide, and gastrin catabolism in canine liver and kidney

No reports have described the catabolic mechanism of substance Pin vivo. We studied the effects of hepatic or renal transit on substance P, vasoactive intestinal polypeptide, and gastrin in anesthetized dogs. It was found that the liver plays a more important role in vasoactive intestinal polypeptide catabolism than the kidney and the kidney is more important in gastrin catabolism than the liver. Substance P was more rapidly degraded than the other two peptides in both organs. The transrenal substance P loss measured byC-terminal antiserum differed from that measured byN-terminal antiserum, although there was no difference in the liver. This suggested that there were different patterns of cleavage of substance P between the liver and the kidney, and that itsC terminal was degraded more strongly than itsN terminal in the kidney.

Mucosal-incision assisted biopsy for suspected gastric gastrointestinal stromal tumors

To evaluate the diagnostic yield of the procedure, mucosal-incision assisted biopsy (MIAB), for the histological diagnosis of gastric gastrointestinal stromal tumor (GIST), we performed a retrospective review of the 27 patients with suspected gastric GIST who underwent MIAB in our hospitals. Tissue samples obtained by MIAB were sufficient to make a histological diagnosis (diagnostic MIAB) in 23 out of the 27 patients, where the lesions had intraluminal growth patterns. Alternatively, the samples were insufficient (non-diagnostic MIAB) in remaining 4 patients, three of whom had gastric submucosal tumor with extraluminal growth patterns. Although endoscopic ultrasound and fine needle aspiration is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.

Confirmation of Dieulafoy's Vascular Lesion by Endoscopic Ultrasonography in Three Cases

Abstract: We investigated the endosonographic findings in 3 patients with Dieulafoys lesion. The characteristic finding was an elliptical or tortuous anechoic lesion in the submucosal layer that extended to the outer side of the gastric wall. There were no intramural changes suggestive of deep ulcer beyond the Ul‐2. An abnormally large submucosal vessel was observed within 4 cm of the site of bleeding. This vessel was present even in the remnant stomach of a patient who required emergency surgery because an attempt to treat massive bleeding with endoscopic hemostasis failed. These endosonographic findings suggest that Dieulafoys lesion patients risk rebleeding due to shallow ulceration.

A case of combined primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia

SummaryA rare case of primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia is described in a 49-year-old Japanese diabetic woman. Primary biliary cirrhosis was diagnosed by characteristic liver histology and positive serum mitochondrial antibody test. Ulcerative colitis was diagnosed by typical findings of barium enema and colonoscopy, negative fecal test for pathogens and compatible rectal histology. Chronic myelocytic leukemia was determined by representative hematologic findings and positive result for Ph1 chromosome. This is the first case with combination of primary biliary cirrhosis, ulcerative colitis and chronic myelocytic leukemia.

Direct contractile effect of endothelin-1 on isolated circular smooth muscle cells of guinea pig caecum

Smooth muscle cells isolated from the circular muscle layers of the guinea pig caecum were used to determine whether endothelin-1 (ET-1) can cause contraction by exerting a direct action on smooth muscle cells. In addition, the inhibitory effects of 8-(N,N-diethylamino)-octyl-3,4,5-trimethoxybenzoate hydrochloride (TMB-8), an inhibitor of intracellular Ca2+ release, verapamil, a Ca2+ channel blocker, and removal of extracellular Ca2+ on the ET-1-induced muscle contraction were examined. ET-1 elicited a contractile response of isolated smooth muscle cells in a dose-dependent manner (ED50: 2 nM). TMB-8, verapamil, and removal of extracellular Ca2+ significantly inhibited the contraction produced by ET-1. These results strongly suggest that ET-1 has a direct contractile effect on circular smooth muscle cells of the guinea pig caecum, and that this contraction depends on both intracellular and extracellular Ca2+.

Evaluation of Acetic Acid-Induced Gastric Ulcers in Dogs by Endoscopic Ultrasonography

To clarify the ability of endoscopic ultrasonography (EUS) to diagnose gastric ulcer, we induced gastric ulcer (19 open ulcers and 11 ulcer scars) by injecting acetic acid into the stomach via an endoscope in 15 dogs. The stomachs were resected and scanned by EUS in a water bath, and the findings were compared with the histologic observations. The ulcer depth was correctly diagnosed in 29 of 30 instances (96.7%). In active, open ulcers the width and depth of the ulcer crater and the thickness of the gastric wall around the crater measured in the photographs obtained by EUS corresponded with those observed in histologic photographs. In the ulcers disrupting the muscularis propria layer the distance between the disrupted muscularis propria layer in EUS also corresponded to the histologic observations. In all ulcer lesions the low-echoic area below the ulcer in EUS corresponded to the histologic area of granulation or fibrosis. However, it was difficult to distinguish granulation from fibrosis by EUS. EUS is thus considered useful for evaluating gastric ulcers quantitatively in the clinical setting.