Tsuneya Nakamura

Carcinoid tumors of the gastrointestinal tract: evaluation with endoscopic ultrasonography

To evaluate the usefulness of endoscopic ultrasonography for carcinoid tumors, we examined 29 patients with gastrointestinal carcinoid tumors (5 gastric, 7 duodenal, and 17 rectal). The smallest size detectable by endoscopic ultrasonography was 2 mm in diameter histologically. The cross-sectional image of the tumors was primarily oval to round. The internal echo was generally hypoechoic and homogeneous. The margins were clearly visualized, and the contour was somewhat smooth. The tumors were mainly located in the third layer. The second layer covered the tumor with the third layer at its base, and it abutted the tumor and became indistinct near its upper interface. These findings were especially recognized in lesions with submucosal invasion and were similar at all sites. The overall accuracy of determining the depth of invasion using endoscopic ultrasonography was 75% (27 of 36 lesions). Limited to the lesions detectable by endoscopic ultrasonography, the accuracy was 90%. Endoscopic ultrasonography was useful in determining the presence of local metastases. Moreover, endoscopic ultrasonography allowed direct detection of perigastrointestinal lymph node metastases (75%, three of four patients). In conclusion, endoscopic ultrasonography was found to be useful for the staging of gastrointestinal carcinoid tumors by determining depth of involvement and presence of perigastrointestinal lymph node metastases.

Quantification of gastric ulcer healing by endoscopic ultrasonography

We studied and quantified the healing process of gastric ulcers in humans by means of endoscopic ultrasonography. Initially, using the water bath method, we scanned specimens of resected human stomachs with gastric ulcers including 9 open ulcers and 14 ulcer scars. Comparison of histological findings and measurement of the cross-section suggested that the ulcers observed in the ultrasonographic photographs were essentially equivalent to those in histological photographs. By using endoscopic ultrasonography, we then examined 16 patients with active, mainly recurrent, gastric ulcers before and after 2, 4, and 8 weeks of H2 blocker treatment, measuring the length and cross-sectional area of the ulcer in endoscopic ultrasonographic photographs. From measurements of the contraction rate of cross-sectional ulcer area during healing, we observed that the healed ulcers showed a relatively rapid rate of contraction in the first 4 weeks of therapy and the non-healed cases showed a poor contraction rate. Endoscopic ultrasonography is useful for the quantitative estimation of histological changes associated with gastric ulcer healing.

Gamna-Gandy body and splenomegaly in portal hypertension

The pathogenesis of splenomegaly in portal hypertension has been the focus of argument yet to be concluded. Conventional histological studies have proved inval id in this regard. The present report is based on a study of 303 cases in our series of portal hypertension totaling 516, cases with insufficient data being excluded. The spleen was histologically studied with special reference to Gamna-Gandy body. Gamna-Gandy body, also called fibrosiderotic nodule, is a fibrous scar tissue with iron deposit which appears in the parenchyma of the spleen subjected to portal congestion. Congestion and local hemorrhage which precede formation of Gamna-Gandy body are almost constantly observed in the spleen of portal hypertension, regardless of the type of the basic disease. Gamna-Gandy body was seen, again without predilection to any specific type of the disease, in approximately half of the cases of each group (51.2~ on the average). The correlation between these histological findings and portal pressure was obscure with wide dispersion. As the mean value, however, the portal pressure was increased as the pathological process advanced from simple congestion toward the formation of Gamna-Gandy body. The portal pressure was also higher in groups with each histological finding than in groups without it. Any difference was seen, however, neither between extrahepatic group (groups I & IV) and intrahepatic group (groups II &I I I ) nor between intrahepatic, cirrhotic group (group III) and non-cirrhotic group (group II). After all, the splenomegaly in portal hypertension has no group-specificity in relation to histological features pertinent to congestion. These results support our assertion that the splenomegaly in portal hypertension has in common an elevated portal pressure due to increased distal flow resistence as the basic causative factor.

Hepatic function and circulation: application of trapezoidal electromagnetic flowmeter to the studies of hepatic clearance with indocyanine green and198au colloid

62 pat ients were studied on liver funct ion tests before and af ter the improvement of congestive hear t failure. The re la t ionship between histological changes of the l iver and l iver function tes ts pr ior to death was also studied in 109 autopsied pat ients died of hear t failure. The se rum protein increased wi th the improvement of the protein fraction. The BSP re ten t ion decreased f rom average 14.4% to 7.4%. The high se rum t r ansaminase act ivi ty obserbed in 4 cases re turned rapidly to normal range af te r t r ea tmen t of the hear t failure. An increase of serum bil irubin, especially indirect bi l i rubin, was observed in some cases wi thout pu lmonaly infarction, however LDH1 and LDH~ did not increase as compared wi th those in hemolytic jaundice due to the ball valve replacement in rheumat ic hear t disease. Whereas elevat ions of a-hydroxybutylic acid in these cases seemed to be reflections of myocardial damage in the pat ients wi th hear t failure. Therefore hemolytic mechanism did not seemed to be a major fatcor to jaundice in hear t failure. The histological diagnosis of the l iver in hear t fa i lure was made on the classification of Nakash ima and Imazato. The prolonged BSP retent ion, a l terd serum prote in f ract ion and high venous pressure were re la t ively correla ted wi th the grade of histological changes. Cases wi th high se rum t r ansaminase act ivi ty were observed in the Grade 1N2 (necrosis and hemorrhage was observed in area more than the one-third including the central vein in lobules). The resul t s obtained in this s tudy were as follow; 1) a l terd l iver function tes ts were revers ib le by t r ea tmen t of congestive hear t failure, 2) the sever i ty and durat ion of congestive hear t fa i lure influenced on the histological changes of the liver, 3) hemolytic mechanism was not a major factor to jaundice in congestive hear t fa i lure and 4) clinical manifes ta t ions and l iver funct ion tes ts could evaluate the sever i ty of the histological changes of the l iver in congestive hear t failure.

Studies on alkaline phosphatase in biliary obstruction

liver carcinoma, high grade increase of alkaline phosphatase in 19s region was demonstrated. In cases of obstructive jaundice, gallbladder diseases or bile duct disorders, same tendency was seen. Sometimes, I have experienced very high titer of alkaline phosphatase value in cases of gastric cancer who have no metastasis of bone, liver or around bile ducts and no liver disorders. In these cases, fractination study of the enzyme showed that 19s fraction increased. Normal human liver showed enzyme activity in 7s region. Normal human small intestine have enzyme activity in 19s and 7s area.