Tsunekazu Ikeda

Evaluation of fibergastroscopic biopsy in the diagnosis of gastric cancer: A study of 339 cases

SummaryThree hundred and sixty-five biopsies under direct vision, using a fibergastroscope, were performed on 339 patients with gastric cancer from 1966 to 1975.Diagnostic accuracy improved with an increased in the number of biopsy specimens and reached 100% when 6 or more biopsy specimens were obtained.Positive specimens were obtained with 48.5% of the biopsied tissue from the center of the lesion (A), 52.2% from the inner margin of the lesion (B1), 19.6% from the outer margin of the lesion (B2), and 1.6% from the area around the lesion (C). The combined result of the biopsies from A and B1 was highly positive in 49 out of 51 cases (96.1%).Diagnostic accuracy of the early cancer reached 96.9%. This was significantly higher than that of advanced cancer (80.3%).False negative biopsies were found in 51 (16.3%) of the 313 patients who were gastrectomized and diagnosed by histological examinations. Twenty-three of the 27 patients, who were diagnosed as benign either by x-ray or endoscopie examination, and 4 of the 5 patients who were diagnosed as benign under both examinations, were found to have positive results by biopsy. Positive biopsy examination was particularly helpful with patients showing on inconclusive or benign diagnosis by x-ray and/or endoscopie examinations.

Early diagnosis of esophageal cancer: analysis of 11 cases of esophageal mucosal cancer

We reviewed 11 patients with esophageal mucosal carcinoma in various aspects to improve the early diagnosis of the disease. Eighteen lesions measuring 0.5 to 5.0 cm were confirmed histologically in the 11 cases. Histologically 10 of the 18 lesions were carcinomas in situ (ep cancer), and the other 8 lesions were carcinomas confined to the mucosa other than ep cancer (mm cancer); all 18 lesions were squamous cell carcinomas. Six (85.7%) of the seven mm cancers showed abnormal radiographic findings regardless of the size. Similarly these findings were noted on four of five (80%) ep carcinomas 2 cm or larger in size. All 15 lesions diagnosed before operation showed abnormal findings on conventional endoscopy regardless of the size and depth of transmural invasion. Morphologic change was observed in 9 lesions (53.3%), while 13 (86.7%) showed color change; most of the lesions (80%) were manifested as redness. Dyeing of the resected specimen with Lugol solution (Katayama Chemical Industries, Osaka, Japan) showed all 18 cancerous lesions as unstained areas. Among the 18 lesions, two lesions were unstained areas, which agreed with the areas determined histologically. An additional lesion was visible with dye endoscopy as an unstained area but it was not visible with radiography or conventional endoscopy. Dye endoscopy using Lugol solution is very important because it allows detection and evaluation of the extent of esophageal mucosal cancer.

The Transduodenal Endoscopic Treatment of Acute Cholangitis

Mortality due to acute cholangitis (AC) has been tremendously reduced by the advent of endoscopic sphincterotomy (EST). This study investigates whether EST is really a curative procedure for the treatment of AC, or not. Diagnosis of AC, in 159 out of 1,061 cases in which EST was performed, had been made by infected bile which was recognized as green or pyobile collected during ERCP. Emergency drainage by EST was performed immediately after AC was diagnosed. The causes of AC were attributable to benign diseases in 128 cases (80.5%) and malignant diseases in the remaining 31 cases. Clinical symptoms included abdominal pain, fever, and obstructive jaundice, but Charcots triad was noticed in 66 cases (43.3%) and Reynolds pentad in only 7 cases (4.6%). As to the relation between clinical symptoms and properties of bile, pyobile was more likely to be recognized in patients with severe symptoms.

TWO CASES OF NONPARASITIC HEPATIC CYST TREATED WITH ABSOLUTE ETHANOL INJECTION UNDER ULTRASONICALLY GUIDED PUNCTURE

Two patients with large nonparasitic cysts of the liver were treated with absolute ethanol injection under ultrasonically guided puncture. The first patient, a 63-year-old woman, was admitted to our hospital with the complaints of sense of fullness and epigastralgia. On the ultrasonogram, a cystic mass, 14×9cm in size, was seen in the left lateral segment of the liver. The second patient, a 56-year-old woman, was hospitalized with the complaints of general fatigue and anorexia. Ultrasonogram revealed a cystic mass, 12×9cm in size, in the right lobe of the liver. Neither, cyst showed malignant findings. Both patients were treated with absolute ethanol injection under ultrasonically guided puncture. After the treatment, no major complications were observed, and remarkable shrinkage of both cysts was seen on the ultrasongram. There was no recurrence over a period of two years. As this procedure was simple and harmless, this treatment for hepatic cysts may be considered as an alternative to surgery.

Histochemical studies on possibility of cancer diagnosis by biopsied gastrica mucosa

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.