Takeo Miyake

Endoscopic evaluation of the effect of sucralfate therapy and other clinical parameters on the recurrence rate of gastric ulcers.

A randomized controlled clinical study was conducted to determine (a) whether basic aluminum sucrose sulfate (sucralfate) is effective in preventing or reducing gastric ulcer recurrence, and (b) the clinical parameters contributing to ulcer recurrence after endoscopically proved healing has been effected. A total of 167 patients were assigned on a random basis to either of two treatment groups, control (aluminum hydroxide and magnesium oxide) or sucralfate, and given these medications for 6 months. At the end of this period all medication was withdrawn from both groups and the patients were followed for an additional 12 months. Each patient was examined endoscopically at bimonthly intervals throughout the 18-month observation period. Treatment (sucralfate), ulcer history, size of previous ulcer(s), prestudy healing time, and prestudy healing stage attained (red or white scarring) were associated with a significant reduction in recurrence rate. Ulcer recurrence was markedly reduced in sucralfate patients as compared to control when the pretreatment ulcers had healed slowly (P<0.001).

Correlation of gastric ulcer healing features by endoscopy, stereoscopic microscopy, and histology, and a reclassification of the epithelial regenerative process

Four stages of gastric ulcer healing have been established by correlating endoscopic findings with those obtained from stereoscopic microscopy and histologic observations: I. initial healing stage; II. proliferative healing stage; III. palisade scar stage; IV. cobblestone scar stage. The palisade scar and cobblestone scar stages roughly correspond to Sakitas red and white scar stages, respectively. It is suggested that healing is not complete until the cobblestone stage with attendant micropit formation is achieved.

Dissecting microscope studies on atypical epithelial focus of the gastric mucosa

So, in order to obseve precisely the red gastric mucosal lesions by gastrofiberscope, we tried to use cyanic gelationoid filters attaching the front of camera lenses. In this working, we used the Machida gastrofiberscope (FGS-BL), CX-500 as a light source and took pictures with the Olympus pen-F which was attached outside of the gastrofiberscope. Cyanic gelatinoid filters were adjusted to a case from CC-30 to CC-90 in its density. The results are as follows; 1) We can take high contrast pictures, when we try to observe red elevated mucosal lesions. 2) We have done a microspectrophotometry (used the Olympus model DMSP-II) about this films. The films with cyanic filters showed the different curve from natural film, as is shown table 2. 3) We suppose that reflected lights might be removed by a cyanic filter. 4) For the most part, the density of cyanic filters are adjusted to CC-50 on endoscopic pictures. 5) We believe it is very usefull to differentiate the atypical benign epithelium, the early gastric cancer type IIa from the atypical benign epithelium, because endoscopic pictures were taken with high contrast by using adjusted cyanic gelatinoid filters.

Endoscopic biopsy of esophageal carcinoma: Serial observations of radiation effects (III)

Therapeutic effects of irradiation on esophageal carcinoma were studied in 48 cases with serial endoscopic and bioptic observations. Histological findings were correlated with preoperative bioptic findings in 21 cases which were subjected to extirpation after irradiation. (I) Endoscopic findings--The appearance of the carcinomatous lesion can be divided into two basic types, superficial (ulcerative or tumorous) and submucosal (flat elevated and/or rigid stenotic). The course and effects of irradiation were different in each type, destructive of the surface and responsive in the former and little superficial change and resistent in the latter. Each lesion being intermingled with both types, observations of dominancy can give presumption of therapeutic effects. (2) Serial bioptic cytology; (3) Histological findings; (A) Therapeutic effects were evaluated in respect of total doses (X IOOOR) in I20 bioptic specimens with the following results: X I(0-2X), X 2(2-4) and granulation and nomal mucosa (4-8X). Histology of extirpated specimens, however, demonstrated less therapeutic effects (XI:9, X2:9, X3:3) in contrast with the bioptic findings. Carcinomatous ceils in the resected specimens remained dominantly in submucosa and muscularis propria, being barely detected in mucosa. In spite of apparent healing by endoscopic and bioptic evaluations, carcinomatous infiltrations should be suspected to remain in deeper layers under these conditions (advanced stage after preoperative irradiation. -Ca 5X). (B) Cellular atypism (CAT) was classified into 3 groups on the basis of charactristics in squamous carcinoma--Size of the cells, differentiations of cytoplasm and of nuclei, intercellular bridges and cancer pearl formation. Classification of structural atypism was mainly based on the layer structure in carcinomatous tissues. CAT of pre-irradiated bioptic tissues revealed the following ra te I : I I : I I I I :3 : I . Results of comparative studies in CAT of pre-irradiated bioptic tissues (CAT) and post-irradiated extirpated specimens (RCAT) were the following--CAT (RCAT) : I(I) II(II , I, 0), I II (III, II). These results were caused by disapperance of highly atypical cells and eosionphilic tendency in cytoplasm after irradiation and/or failure in bioptic diagnosis. In no case RCAT was more atypical than CAT. The relation between CAT of preirradiated biopsy and therapeutic effects of post-irradiated tissues was as follows--CAT I (X2.X3) and CAT II, I I I (XI--X3). Further observations were required in the respect of therapeutic effects.

Immunological studies on ulcerative colitis

anaerobic bacilli were found fa r more f requent ly than in those less than pH 4. Among l iver diseases aerobic Gram negative bacilli were found most f requent ly in cases with l iver cirrhosis . Aerobic Gram negat ive bacilli and anaerobic bacilli were found more f requent ly in cases with abnormal A/G ratio, Z. T. T., T. T. T., and al-phosphatase tes t than in those with normal value. Minimal inhib i tory concentra t ion of cholic acid, desoxycholic acid and taurocholic acid against isolated organisms was h igher in the following order : Candida, aerobic Gram negat ive bacilli, Staphylococci, Enterococci, Lactobacilli, anaerobic cocci, and anaerobic bacilli. Sensi t ivi ty of isolated bac ter ia against daily used antibiot ics was not different f rom those of the other clinical origins. In t ramuscu la r injections of 1,000,000 uni ts of penicillin-G and 1 gm of cephaloridine produced negligible concentra t ion in small intest inal juice.

Limits of cytologic diagnosis in early gastric cancer

Clinical significance of endoscopical features of ear ly gast r ic cancer, especially of IIc type, were discussed in the previous repor t in 1963. In th is report, gross findings of resected specimen were studied comparat ively with endoscopical findings, in 38 lesions of 37 cases of IIc type early gast r ic cancer, macroscopically and histologically. GROSS FINDINGS AND EXISTENCE OF CANCER CELLS Cancer cells were found in the site of rugal in te r rupt ion in 26 lesions of 31 lesions, in gradual s lenderness of rugae in 34 of 35 lesions, in discolorated surrounding mucosa in 2 of 5 lesions, in 12 cases cancer cells overspead beyond the demarca t ing line. SIZE AND SPEC1FIC FEATURES OF THE LESIONS In the large lesions almost all features of early gast r ic cancer could be found, in small lesions the margin of the depress ion and the depress ion itself lost thei r specific fea tures of ear ly cancer, but the features of surrouding mucosal pa t t e rn such as in ter rupt ion of rugae, rugal slenderness, lowering of folds and convergement of folds became more impor tan t to find out smaller early cancer with endoscopy. GROSS FINDINGS AND ENDOSCOPIC FINDINGS In ter rupt ion of rugae was fonnd in 32 lesions in resected specimen and in 33 lesions endoscopically, of 38 lesions. Gradual s lenderness of folds was found in 30 lesions and in 20 lesions, macroscopically and endoscopically. Rough velvetin-like surface of the depress ion was found both in resected specimen and endoscopically well. In the comparat ive study of the IIc type early gast r ic cancer, with resected specimen and endoscopic examination, comsider ing optical factors and blood circulation, the following resul ts were obtained; even in small lesions the findings around the depression can be well observed and detected with endoscopy r a the r easily, and in the diagnosis of the small depressed type cancer, the findings of sur rounding mucosa is very important . The changes in color must not be overest imated.