Evaluation of serum amylase and gabexate mesilate with endoscopic papillary balloon dilatation

Gabexate mesilate (GM) relaxes the papilla of Vater in addition to inhibiting the several proteases. We evaluated whether prophylactic administration of GM would prevent the occurrence of acute pancreatitis in endoscopic papillary balloon dilation (EPBD). Nineteen patients with common bile duct stones were separated into two groups according to the admission year. The group A has been administered GM intravenously at 2mg/kg/hr after EPBD till six hours later, and the group B has been administered GM before fifteen minutes of EPBD till six hours later. The mean value of sphincter of Oddi (SO) basal and peak pressure in the group B was significantly lower than that in the group A, moreover the mean value of the pancreatic pressure in the group B was significantly lower than that in the group A. However two cases had mild acute pancreatitis in the group B. GM loosened SO and pancreatic duct pressure by direct stimulation of SO, although it could not have enough effect to prevent the acute pancreatitis in EPBD

Relationship between mucin expression and preoperative bile juice cytology in biliary tract carcinoma

The present study evaluated correlations between preoperative bile juice cytology and mucin expression of surgical specimens in biliary tract carcinoma. Twenty-five patients with biliary tract carcinoma surgically treated at our hospital, whose bile juice cytology had been evaluated before operation, were allocated to this study. Biliary cytology was classified into three categories based on the Papanicolaou classification. Immunohistochemical staining of tissues was performed using MUC1 and MUC2 monoclonal antibodies. Lesions showing MUC1 expression of ＋＋ or higher and MUC2 expression of - were classified as Group A, and the remaining lesions as Group B. According to the epithelial site, preoperative cytology was highly correlated in Group A, while it was negative in Group B (p<0.05). In the advanced site of carcinomas, preoperative cytology tended to highly be positive in Group A, while it tended to be negative in Group B (p<0.05). These results suggest that the bile juice cytology results are affected by characteristics of mucin expression in the tissue. Based on the possibility that mucin expression correlates with the prognosis of each carcinoma, a positive cytological result suggests a poor prognosis for the carcinoma, which may be informative for predicting the post-operative courses and choosing treatments

Asymptomatic case of congenital absence of the gallbladder

Congenital absence of the gallbladder is rare among biliary abnormalities, and its preoperative diagnosis has been considered very difficult. We encountered a patient with congenital absence of the gallbladder and suggest a possible preoperative diagnosis of the abnormality, as well as reviewing the literature

The utility and limitations of an ultrasonic miniprobe in the staging of gastric cancer

To determine the utility and limitations of an ultrasonic miniprobe (UMP) in the staging of gastric cancer, we evaluated 46 patients who underwent endoscopic ultrasonography (EUS) using an UMP and who were histologically determined to have gastric cancers. In every case, UMP findings were compared with histopathological findings after treatment. The total accuracy of UMP relative to the depth of tumor invasion was71.7% (33/46 cases). Accuracy with respect to T1-m tumor diagnosis was 75.7% (22/29cases), and for T1-sm, 76.9% (10/13 cases), but accuracy for T2 tumor diagnosis was low, due to ultrasound attenuation. When the analysis was carried out based on the size of tumor, the accuracy for UMP was 50.0% (9/18cases) for all tumors over 20mm and 85.7%(24/28 cases) for all tumors smaller than 20mm. We conclude that UMP is suitable for investigation of tumor extension when the lesion is superficial and / or small gastric cancers which do not cause ultrasonic attenuation, but not when the tumor is large or located in certain sites, although conventional EUS is useful in some of these cases

Clinical value of the determination of serum guanase activity in patients with chronic hepatitis type C

The study examines the clinical significance of guanase (GU) measurement inpatients with hepatitis C. 688 patients in whom either ALT was abnormal, or in whom HBsAg or HCVAb was detected in the serum, were enrolled into this study. The percentage of cases in which normal ALT while elevated GU was compared among the different disease groups. Then, the percentage of cases with normal ALT but elevated GU was compared between HBV and HCV groups. For the entire population, a significant correlation was observed between ALT and GU (r=0.872). The overall percentage of cases with normal ALT but elevated GU activity was 11.4%. In HCV group, 449 cases had normal ALT. Of these cases, 20.3% had elevated GU, while ALT was normal. Before 1989, no test to check donated blood for HCV antibody was available. However, screening of donated blood for high GU was associated with a reduced incidence of post-transfusion hepatitis. This is probably because following the screening, blood donated by patients with hepatitis C who had normal ALT but elevated GU was rejected. After the introduction of HCV antibody measurement, GU measurement is still useful to reveal the pathophysiological condition in-patients with chronic hepatitis type C

A patient with esophageal hemangioma treated by endoscopic mucosal resection : a case report and review of the literature

In a 58-year-old male, upper digestive endoscopy revealed a protruding lesion in the esophagus on a medical examination. The patient was referred to the Department of Surgery in our hospital to undergo surgery. On the initial consultation, upper digestive endoscopy showed a smooth, soft, black purple, typeⅡprotruding lesion measuring approximately 25mmat 35 cm apart from the incisor. For diagnotic treatment and patient’s request, endoscopic mucosal resection (EMR)was performed. The resected specimen measured 25mm× 25 mm. The histological findings suggested cavernous hemangioma. To treat esophageal hemangioma, esohagectomy, tumor enucleation, or sclerotherapy has been performed. However, recently, thorough preoperative examination, such as endoscopic ultrasonography (EUS), has facilitated endoscopic resection, such as EMR

トウカ ニオケル ラジオハ ショウシャク リョウホウ オ モチイタ カンシュヨウ チリョウ : preliminary report

Radiofrequency ablation (RFA) has recently been used to treat liver tumors. RFA is a safe and effective treatment of liver tumors and requires fewer treatment sessions. Between June 2000 and April 2003, hepatocellular carcinoma (77 patients with 106 lesions) and metastatic liver tumors (21 patients with 30 lesions) and cholangiocellular carcinoma (1 patient with 1 lesion) were treated with RFA. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a LeVeen needle (55 lesions) and cool tip RF needle (82 lesions). To evaluate the response, contrast-enhanced CT scans or MRI were obtained. Most patients experienced moderate pain during RFA procedure, especially when the tumor was superficially located. Complete necrosis was achieved in all HCCs with RFA.This result was obtained with an average of 1.12 sessions per HCC. With a median follow-up of 15 months, HCCs have recurred in 6 of 90 treated lesions (6.7%), and metastatic liver tumors have recurred in 2 of 17 treated lesions (11.8%). We are initiating a combining RFA of hepatic malignancies with regional or systemic chemotherapy will reduce hepatic and extrahepatic recurrence rates and enhance long-term survival rates. We believe that RFA will be effective treatment to achieve in patients with unresectable meastatic liver tumors

Inflammatory bowel disease in Tokushima prefecture : A report of questionnaire investigation

To investigate the number of cases and clinical features of inflammatory bowel disease, a questionnaire was sent to 1,271 hospitals or clinics in Tokushima prefecture. A total of 320 cases were collected from 60 institutes for the period from January to December 1997. Eight cases were excluded from this study because of duplicated report (6 cases) and inadequate diagnosis (2 cases). Finally, 312 cases were investigated on their clinical features, treatments, complications, and prognosis. The cases included 195 ulcerative colitis (male 106, female 83, gender unknown 6 cases, age ranged 9-81, mean 39.5± 14.3 (standard deviation (SD) years old), 69 Crohn's disease (male 39, female 24, gender unknown 6 cases, age ranged 17-87, mean 35.1±10.5 (SD) years old), 28 ischemic colitis (male 11, female 17, mean age 65.9±12.6 (SD) years old), 9 intestinal tuberculosis (male 1, female 6, gender unknown 2, age 66.9±6.1 (SD) years old), 4 intestinal Behcet (male 3, female 1, age 39.0±14.2 (SD) years old), 6 simple ulcers (male 3, female 3, age 67.7±11.8 (SD) years old), and a case of aphtous enteritis. Two toxic megacolon cases and 5 colorectal cancer cases were reported among the 195 ulcerative colitis patients. 44 cases out of 69 Crohn's disease patients were received surgical treatment because of severe complications including perforation (12 cases), stenosis (10 cases), internal fistula formation (8 cases) and so on. However, no case died because of the diseases except 3 untraceable patients

ガン カガク リョウホウ ニオケル ショウカカン ドクセイ ト ケッセイ Diamine Oxidase DAO カッセイ ニ カンスル ケントウ

There are so many patients with advanced gastric cancer who undergo systemic chemotherapy worldwide. The quality of life（QOL）of patients with gastric cancer who receive chemotherapy is often lowed by various gastrointestinal toxicities during the chemotherapy. Nutrition is also impaired by gastrointestinal toxicities. However, it is difficult to predict their occurrence in advance and further there is no good serum marker for nutrition in the patients treated with chemotherapy. Thus, it is important to objectively evaluate and predict the toxicity of the digestive tract during cancer chemotherapy. Diamine Oxidase（DAO）is an enzyme that is expressed in intestinal epithelial cells. Recently it has been reported that DAO activity may reflect damage or atrophy of the intestinal villi, and therefore it may be a sensitive serum marker for nutritional state. In this study, we measured serum DAO activity of patients with gastric cancer treated with systemic chemotherapy, and investigated the correlation between DAO activity and gastrointestinal toxicities. Six patients with gastric cancer, who were treated by docetaxel+cisplatin+S‐１combination chemotherapy, were enrolled. DAO activity was measured by sensitive colorimetric assay. DAO activities diminished after treatment in４patients with moderate to severe gastrointestinal toxicities. In contrast, they did not change in２patients with no gastrointestinal toxicities. Our results may suggest that DAO activity is a good serum marker for the gastrointestinal toxicities as well as nutrition state in patients who receive systemic chemotherapy. More large scale study is needed to warrant