Takayoshi Noguchi

Delineation of the gastric muscularis mucosae and assessment of depth of invasion of early gastric cancer using a 20-megahertz endoscopic ultrasound probe.

Using a 20 MHz endoscopic ultrasound system, delineation of the gastric muscularis mucosae and estimation of the depth of malignant invasion was attempted by in vivo scanning during the process of routine endoscopic observation or in vitro scanning of excised sections of 34 early gastric cancers in 32 patients. The muscularis mucosae was visualized as a single hypoechoic layer in 16 of 32 lesions (50%) scanned in vitro. Comparison of lesions in which delineation of the muscularis mucosae was or was not possible revealed no significant differences with respect to either the thickness of the lamina propria and muscularis mucosae or with respect to the degree of inflammatory cell infiltration of the lamina propria or the conditions of the boundary between the lamina propria and the muscularis mucosae. This indicates that improvement of the operability characteristics of the ultrasonic apparatus will be needed to achieve improved delineation of the muscularis mucosae. The accuracy of invasion depth estimation of early gastric cancer was 67% (16 of 24 lesions scanned in vivo) and 73% (8 of 11 lesions) in cases in vivo where the muscularis mucosae and the tumor were delineated on the same screen. The principal factors causing erroneous staging were the presence of dilated benign glandular ducts, ulcer scars, and attenuation of the ultrasound waves.

Simple and sensitive detection of K-ras gene mutations in human pancreatic cancers by nonradioisotopic single-strand conformation polymorphism analysis.

In an attempt to determine the best indications for the classically adopted ileo-rectal anastomosis (IRA) and the new techniques of restorative proctocolectomy, namely, ileal J-pouch-anal anastomosis (IAA) ilea J-pouch-anal canal anastomosis (IACA), we retrospectively studied 72 surgically treated patients with ulcerative colitis (UC) followed in our surgical department in the period between 1963 and 1994. Compared to these new techniques, IRA had a lower incidence of postoperative fecal incontinence, and was one-stepped in the majority of the patients. No significant difference regarding postoperative bowel function, operation time, volume of bleeding, hospital stay, and the need for postoperative prednisolone was observed. We concluded that IRA is a good procedure that is indicated for patients receiving high-dose prednisolone, for those who need a quick return to social activity, and for those with poor anal function. IACA is a good indication for those patients with good anal function assessed preoperatively, who agree to receive a multi-step operation. For those patients with cancer or dysplasia, IAA should be the operation of first choice.

A Case of CholangioDuodenal Fistula Formation After Metallic Stenting for Malignant Biliary Stricture

A 68‐year‐old man presented with melena in June 1993, and was diagnosed as having adenocarcinoma of the rectum with liver metastasis. He underwent anterior resection of the rectum and was given weekly chemotherapy. In October 1993, he developed jaundice due to severe stricture of the middle to lower common bile duct caused by metastatic spread to the lymph nodes around the pancreatic head. A 10mm wide, 51mm long WallstentTM (Schneider) was inserted into the lower end of the bile duct through the papilla, resulting in rapid normalization of the serum bilirubin level. Three months later, the Wallstent eroded through the duodenal wall, causing massive fatal hemorrhage. We, therefore, emphasize the necessity of being alert to the potential for such complications in cases involving placement of a self‐expanding metallic stent for malignant biliary stricture.

The “Stent through Stent Technique” for Hilar Malignant Stenosis Complicated with Common Bile Duct Calculi

Abstract: We report here on a patient who had a Bismuth type III hilar malignant stenosis and a primary common bile duct calculi which was an added complication. This stenosis was effectively treated by a “stent through stent technique”, that consisted of two metal stents braided together by expanding a wire gap in the mesh of the first stent and inserting the last one through this former dilated wire gap, achieving bilateral biliary drainage. The primary common bile duct stone was treated by percutaneous cholangioscopically‐guided electrohydraulic lithotripsy. This technique might be applied on a large series of patients with hilar malignant stenosis and in the case of the uncommon association with primary common bile duct calculi electrohydraulic lithotripsy using the percutaneous approach should be considered as a good approach.

Aberration of the p53 gene in human pancreatic ductal adenocarcinomas

The p53 gene is considered one of the tumor suppressor genes which negatively regulate cell growth and division in the wild type, and its mutations in evolutionary conserved exons are common in diverse types of human malignancies(l). Pancreatic ductal adenocarcinoma is well known as a tumor carrying activated Ki-ras gene(2), but other genes that correlate to multistep carcinogenesis are not yet known. Therefore, we analyzed aberrations of exons 5 to 8 of the p53 gene in 8 cases of advanced pancreatic ductal adenocarcinomas by PCR-SSCP analysis. The method of PCR-SSCP analysis of the p53 gene was described previously by Murakami et al.(3). Genomic DNA were extracted from fresh surgical specimens and, as a noncancerous control tissue the lymphocytes of the same patients were used. The PCR products which were labeled with e_np dCTP were applied to 5% polyacrylamide gel containing 10% glycerol and, after electrophoresis, the gel was dried and subjected to autoradiography. As shown in Figure, mobility shifts which indicate structural abnormalities were observed in 3 of 8 cases, 2 cases in exon 5 and 1 case in exon 6, respectively. No extra-band was seen in noncancerous tissue of the same patients. These results suggest the involvement of the p53 gene aberration in human pancreatic ductal carcinogenesis.

Hepatocellular Carcinoma with Invasion of the Right Intrahepatic Bile Duct Observed by Peroral Cholangioscopy: a Case Report

A 48‐year‐old chronic alcoholic with previous hepatitis B virus infection presented with recurrent episodes of obstructive jaundice secondary to hepatocellular carcinoma. The obstructive nature of the jaundice was confirmed by the peroral cholangioscopic findings of a friable nodular mass partially obstructing the right hepatic duct, and by relief of obstructive signs and symptoms after endoscopic sphincterotomy freed the common bile duct of “dark greenish formed materials”.

Nd: YAG Laser Treatment in Early Gastric Cancer in our Institution

From December 1980 to June 1987, a total of 57 cases (63 lesions) of early gastric cancer were received laser treatment in our institution. Of them, 41 cases with 45 lesions were received follow-up examination for more than 3 months, 5 cases (5 lesions) were operated after laser irradiation, 7 cases (8 lesions) recieved follow-up less than 3 months which made impossible to evaluate therapeutic effect, and 4 cases (5 lesions) were drop-out (Table 1). The operated cases were shown in Table 2.