Tetsu Takai

Manometric evaluation of esophageal function in progressive systemic sclerosis with special regard to the disease severity.

SummaryA study was conducted to elucidate the relation between the severity of progressive systemic sclerosis (PSS) and the grade of esophageal function disorder, the extent of which was estimated using esophageal manometry. Fifty two patients with PSS were divided into the mild, moderate and severe groups according to the severity score established by the PSS Research Group supported by The Ministry of Health and Welfare of Japan. Primary peristaltic pressure in the esophageal body at 25 to 35cm from the incisors as well as lower esophageal sphincter pressure (LESP), which represents the function of the smooth muscle of the esophagus, were significantly decreased in parallel with the increasing severity of PSS. In contrast, there was no significant difference in upper esophageal sphincter pressure (UESP) or in primary peristaltic pressure at 20cm from the incisors, indicating that the function of striated muscle of the esophagus was not impaired. In addition, even in the mild PSS group without dysphagia (19 cases), primary peristaltic pressure in the esophageal body at 25 to 35cm from incisors was found to be significantly decreased in comparison with the control. Hence, esophageal manometry was useful for early detection of the pathophysiological state of the esophageal function in PSS.

An autopsy case of stunted growth with fatty liver cirrhosis, hepatoma, hypogonadism, osteoporosis and lipid pneumonia.

An autopsy case of a short statured (140.5 cm), normally proportioned 31‐yearold woman who had had hypogonadism, abdominal obesity, hyperglycemia, glycosuria, and osteoporosis was presented. There were also fatty liver cirrhosis with hepatoma and lipid pneumonia. The possible relationship between the signs and symptoms during life and pathological changes has been discussed. ACTA PATH. JAP. 18: 171–184, 1968.

A Case of Duodenal Crohn's Disease Associated with Ampullar Insufficiency and Cholangitis

Abstract: A 67‐year‐old Japanese woman with duodenal Crohns disease developed cholangitis. Radiographic and endoscopic examinations revealed a marked stenosis of the third portion and a dilatation of the second portion of the duodenum. The endoscopic and histopathological observations showed this disease affected the Vaters papilla. Duodenoscopic manometry indicated a reduced pressure of the phasic sphincter of Oddi, indicating ampullar insufficiency. E. coli was found in the bile culture as the infecting organism. The authors suggest that the cholangitis in this patient was caused by the reflux of duodenal contents into the biliary tract.

Application of a Circular Polarizing Device to an Electronic Endoscope for the Purpose of Prevention of Catch‐Light Phenomenon

Abstract: In recent years the electronic endoscope has been increasingly used by medical practitioners in Japan. However, it has been noted that the problem of too strong light refection, which, not only hampers the procedure but also causes eye exhaustion, at the same time making photographic or computerized image processing difficult, is more frequently experienced and is more serious in magnitude when compared with using a conventional fiberoptic endoscope (catch‐light phenomenon). In order to ameliorate this problem the authors experimented with the use of circularly polarized light. The combined use of a circular polarizing device to the efferent light path and a filter which blocks certain types of Circularly polarized light to the afferent path has proved to be very effective in eliminating the incidence of catch‐light troubles, thus making the endoscopic procedure smooth and efficient.

An adult case of idiopathic chronic paroxysmal cold hemoglobinuria

慢性経過を示した特発性発作性寒冷血色素尿症の1成人例を報告し,文献的考察を加えた.症例は41才,男性. 1978年冬期,先行する熱性疾患を伴わず,寒冷に曝露した後暗褐色尿に気付き,以後毎年同様の症状を繰り返すため, 1984年1月精査目的にて当科入院.貧血なし,肝脾腫なし.入院時検査所見で,ヘモグロビン尿(+), Ehrlich指試験(+), Rosenbach試験(+), Donath-Landsteiner試験(+),抗体価4倍であり発作性寒冷血色素尿症と診断した.血清梅毒反応(-), TPHA(-)で,血清抗体価はマイコプラスマ,ムンプス,麻疹,単純ヘルペス, EBウイルスいずれも陰性ないし低値を示した.経過中,寒冷を避けることで血色素尿は消失した.非梅毒性の症例は検索し得た範囲では本邦28例であり,成人例は6例のみである.さらに先行感染を伴わない例は自験例を含め2例にすぎない.またSokolら3)4)は1981年まで20年間に14例を報告, 13例が急性型で,古典的な慢性型は成人1例のみであつたとしている.本例は,発症年令,先行感染を伴わない点,年余にわたる溶血発作を繰り返す慢性型である臨床経過から極めて稀有な症例であると考えられた.

Follow-up observation on the subjects with normal gastric mucosa and with slight superficial gastritis using blind suction biopsy

SummaryIn the specimens which showed normal gastric mucosa series, 7 of 24 cases developed toward slight superficial gastritis, but other 17 cases remained unchanged for near 10 years.But almost cases of sligh superficial series remained unchanged except 2 cases.Our follow-up observation studies showed that normal gastric mucosa once advanced to superficial gastritis is irreversible and in addition to these, superficial gastritis appeared widely and remains unchanged for long time.

Various courses of Australia antigen in serum with hepatitis and cirrhosis

Since there have been many discussions about Australian Antigen (AuAg) in hepatic diseases, we will further examine its meaning by long term observation in hepatic diseases. The detection of AuAg was performed by Immuno-adherence method. Its occurrence rate was as follows: inAcute hepatitis 35% (nine out of twenty-six cases) Chronic hepatitis (inactive type) 13% (three out of sixteen cases). Chronic hepatitis (active type )32% (nineteen out of fifty-nine eases) Liver cirrhosis 7% (two out of thirty cases). In acute hepatitis, the occurrence rate was not significantly different between serum hepatitis and infectious hepatitis, and AuAg was disappeared within three weeks after the onset except one. In chronic hepatitis, the occurrence rate was significantly higher in (active type) than in (inactive type). In three out of thirteen cases of chronic hepatitis (active type) AuAg was disappeared after one year coincided with clinical improvement, and in another one case AuAg was disappearecd after large amount of blood transfusion during operation of hepatoma resection, which had been secondally developed. In so far as acute hepatitis and chronic hepatitis are concerned, AuAg does not suggest their prognosis. The authors could not observe the change of AuAg negative to positive, even in acute exacerbation of chronic hepatitis and liver cirrhosis. These results suggest us that the acute exacerbation is not the reinfection of acute hepatitis but one course of chronic hepatitis and liver cirrhosis.

Endoscopical and histological examination of gastritis

We have been s tuding on his tochemical diagnosis of gastr ic cancer using phosphorylase reaction. While the mater ia ls were fresh, posit ive phosphorylase react ion was always observed in gastr ic cancer tissue, and it was observed in color of brown violet. Normal non-cancerous covering epithel and intest inal metaplas ia of gastr ic mucous memblane often showed posit ive results of the phosphorylase reaction and the i r positive form was regular . On the other hand, phosphorylase react ion pa t te rn of gastr ic cancer t issue was irregular. Each grandular t i ssue and cell in cancer showed various intensi t ies of reaction. The phosphorylase reaction in the at ipical and non-cancerous grandular t issue was seen to be diffuse and regular pat tern, but the react ion in cancer t issue was seen to be i r regular one. Histochemical examinat ion of gastr ic cancer t issue should be carr ied out on f resh material , and so biopsied mater ia ls f rom gastr ic mucosa were very suitable for th is purpose.

Gastric mucosal findings in diabetic patients

Morphological observations of gastric mucosa were carried out in 66 diabetics using a flexible biopsy tube. Two to four specimens from the body of stomach were randomly obtained from each subjects and were compared with those of control group. The relationship between morphological and clinical findings was discussed. The results were as follows: Gastritis containing intestinal metaplasia were found in 43.1%, superficial gastri t is in 28.6% and normal gastric mucosa in 28.3% in 19l specimens. The incidence of atrophic gastri t is in diabetics was not higher than that in non diabetics constituted by same age population. The subjects were divided into three groups according to their blood suger levels. Gastric mucosal findings did not correlated with seriousness of diabetes. The duration of symptoms had no relationship with gastric mucosal changes.

Cytologic diagnosis by fibergastroscopic abrasion

Abrasive sponge method was applied in 83 cases of gastr ic carc inoma and 11 cases of gastr ic ulcer under fibergastroscopic control, and obtained specimens were examined cytologically. The resul ts were as follows: Cancer cells were posit ive in 77 out of 83 cases of gastr ic carc inoma including 17 cases of ear ly cancer. According to the site of cancer, cancer cells were found in 100% of cases with cancer of gast r ic body, 96% of angle, 92% of an t rum and 67% of pylorus respectively. Cancer cells were posit ive in 54 out of 56 cases of adenocarcinoma, but only in 20 out of 24 cases of carcinoma s implex. Two cases of pyloric carcinoma and one case of antral carcinoma were false negative and in the latter the connective t issue proliferated and cancer cells were scat tered in it. There were no false positive cases in gas t r ic ulcer. It was concluded tha t fibergastroscopic abrasive sponge method was an excellent technic in the cytologic diagnosis of gast r ic cancer, especially early cancer.