Tsuyoshi Aibe

A Fundamental Study of Normal Layer Structure of the Gastrointestinal Wall Visualized by Endoscopic Ultrasonography

The gastrointestinal wall could be separated into five layers or nine layers by means of the ultrasonic endoscope, and the histological structure of these layers was ascertained by comparing endoscopic ultrasonograms of resected specimens of the gastrointestinal tract with their corresponding histology. The results were as follows: With five layers of the gastrointestinal wall, the first and the second layer corresponded to the mucosa, the third layer was the submucosa, and the fourth layer corresponded to the muscularis propria. The first layer was a border echo demonstrated inside the mucosa. The fifth layer consisted of the serosa and a border echo visualized outside the serosa. When a thin layer was visualized at the same time in both the second and the fourth layers, the gastrointestinal wall was separated into nine layers in total. With nine layers of the gastrointestinal wall, the muscularis mucosae was composed of a thin layer in the second layer and a narrow layer between a thin layer in the second layer and the third layer. A thin layer in the second layer was a border echo visualized inside the muscularis mucosae. A thin layer in the fourth layer of the gastrointestinal wall consisted of a border echo and a connective tissue between the inner circular muscle and the outer longitudinal muscle.

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.

Histopathological Study on Aging of the Pancreas from 423 Autopsy Cases

山口大学第1病理学教室の過去8年間の剖検例423例を年代別にわけて組織学的検索を加え, 加齢によるいわゆる老性変化の有無について検討した. さらに, 慢性膵炎の頻度および成因別頻度についても若干の検討を加えた結果, 次のような結論を得た.1) 加齢による膵のいわゆる老性変化として明らかなのは, 膵内動脈硬化のみであるが, 脂肪細胞浸潤, 膵管上皮の杯細胞化生および扁平上皮化生においても, 加齢とともに頻度の増加がみられた.2) しかし, 結合織の増生および外分泌腺にみられる形態学的変化の多くは, 加齢よりも基礎疾患による2次的修飾像の可能性が強い.3) 慢性膵炎は39例 (9.2%) にみられ, その約半数は60歳以上の高齢者であった. また39例のうち, 臨床的に慢性膵炎の診断がついていたのは, わずかに1例であった.4) 3)が示すように, 剖検例において組織学的に慢性膵炎と診断される症例の頻度は, 臨床的に診断される頻度よりはるかに多く, 潜在性の慢性膵炎はかなり多い.5) 慢性膵炎の成因別頻度をみると, アルコール, 腹部手術, 消化性潰瘍, 胆砂～胆石の順にみられ, 原因不明のものも38.4%みられた.

Endoscopic Findings of Primary Sclerosing Cholangitis—‐Report of a Case—

Abstract: A case of primary sclerosing cholangitis in which an endoscopic inspection through the fistula produced by percutaneous transhepatic biliary drainage was performed for the treatment of progressive jaundice and supprative cholangitis is presented. These treatments benefited the patient to some degree. After 3 years from the onset, the patient died of multi‐organ failure caused by disseminated intravascular coagulopathy. An autopsy revealed primary sclerosing cholangitis. No evidence of ductal stricture due to malignancy or underlying cholelithiasis was noted.

Abstracts of selected papers presented at the 30th Annual meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 30TH ANNUAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY October 20-22, 1988 -Kagoshima, Japan Chairman: Shuji HASHIMOTO, M.D.

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.

Abstracts of selected papers presented at the 73rd general meeting of The Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.