Background: Colonoscopic decompression has been attempted in patients with acute colonic obstruction caused by colon cancer to avoid emergency surgery and multiple subsequent operations but has ...usually been unsuccessful. This is an evaluation of the usefulness of a new device for endoscopic decompression in these patients.
Methods: Nine consecutive patients (6 men, 3 women; 65 to 89 years of age) with acute colonic obstruction resulting from colon cancer underwent endoscopic decompression with a Dennis Colorectal Tube.
Results: In all 9 patients (1 with carcinoma of the sigmoid colon, 3 with carcinoma of descending colon, 2 with carcinoma of the transverse colon, 2 with carcinoma of the ascending colon, and 1 with carcinoma of the cecum), endoscopic decompression was successful. After decompressing and cleansing the colon for several days, a one-stage operation was possible in all patients.
Conclusion: Dennis Colorectal Tube is an excellent device for endoscopic decompression of acute, malignant colonic obstruction.
We describe 2 siblings with multiple gastrointestinal stromal tumors (GISTs) and cutaneous hyperpigmentation. Both had a point mutation of the c-kit gene. The patients were sisters who had exhibited ...cutaneous hyperpigmentation since their late teens, but the diagnosis of multiple gastrointestinal submucosal tumors was not made until they were 41 and 45 years old. Histologic examination showed that these tumors were GISTs expressing CD34 and Kit protein. Both patients died of GISTs. Single-strand conformation polymorphism analysis showed a mutation of c-kit in tumor DNA extracted from paraffin-embedded specimens. Direct sequencing analysis showed that the point mutation occurred at codon 559 of exon 11(Val→Ala). The same single-point mutation was detected in DNA extracted from peripheral leukocytes obtained from the younger sister and her 2 children (who had similar general hyperpigmentation) as well as in DNA from a skin biopsy specimen taken from the older sister. The germline mutation at codon 559 of the c-kit gene found in the present familial GISTs differed from that in a previously reported case of familial GISTs. We propose that GISTs caused by a germline mutation of the c-kit gene should be referred to as GIST—cutaneous hyperpigmentation disease.
The development of a new device and techniques for its use have made it possible to endoscopically decompress acute, malignant colorectal obstruction in 17 patients (5 with rectal carcinoma, 4 with ...carcinoma of the sigmoid colon, 3 with carcinoma of the descending colon, 2 with carcinoma of the transverse colon, 2 with carcinoma of the ascending colon, and 1 with carcinoma of the cecum). Following adequate cleansing of the colon, a definitive surgery was carried out in all patients. We describe here the techniques based upon the above experiences. 1) When abdominal CT suggests acute, malignant colorectal obstruction, colonoscopy should be carried out using a colonoscope equipped with an auxiliary water inlet under fluoroscopy. 2) Following the advance of a colonoscope to the site of the tumor, a hydrophilic guide wire is then introduced through the tumor beyond the point of obstruction using a water-soluble contrast medium and a biliary guide catheter. 3) A drainage tube whose tip is tapered is placed transanally with the aid of a dilator or a sliding tube. When difficulty is encountered in inserting the tube beyond the obstruction, the tube should be introduced into the stenotic segment holding the tube by grasping forceps.
We report two cases of gastric reactive lymphoreticular hyperplasia(G-RLH)whichremarkably improved by the eradication therapy of Helicabacter pylori (Hp). Thoughendoscopic abnormal findings were ...relatively mild in both cases, severe massive infiltrationof mononuclear cells was observed in biopsy specimens, and superficial spreading type ofgastric malignant lymphflma could nat be ruled aut. In each case, B-cell monoclonality ininfiltrated mononuclear cells could not be recognized by the immunohistological stainingnor by the molecular biological examination with polyrnerase chain reaction to immunoglobulin heavy chain. They were treated for Hp after confirmation of Hp-infection. Aftersuccessful eradication of Hp, endoscopic and histological findings improved remarkably.From these clinical courses, the infiltration of these mononuclear cell was thought to becaused by the reaction to chronic Hp infection. When a differentiation between G-RLH and gastric malignant lymphoma is difficultand manaclanality of infiltrated mononuclear cells is hard to by proved, the eradicationtherapy for Hp should be performed.
Endoscopic sphincterotorny (EST) in patients with previous Billroth II gastrectomy isusually difficult to perform for incomplete observation of the cutting point and controlcutting direction, because ...of the reverse approach to the papilla. To solve these problems, we tried to place in advance the endoscopic biliary stenting (EBS) tube or the bilianasaldrainage (BND) catheter into the cornrnon bile duct a saguide for cutting the papilla withaneedle type papillotome. This allowed us easy to observe cutting, point and direction, andEST was done safely and steadily. Moreover, even in the cases whereby the insertion ofendoscope to the papilla was difficult, EST could be performed at first insertion when EBStube was used. This technique will expand the indication of E5T to patients with Billroth II gastrectomy who are regarded as technical difficult cases and kept at a distance from EST.
To devise a more sensitive method for identifying proliferative cells in routinely formalin-fixed, paraffin-embedded tissues, we applied an in situ hybridization (ISH) technique for the detection of ...histone H3 mRNA in rat gastric mucosa and amplified the signal by a silver intensification method. ISH was performed using a Fluorescein-labelled, single-stranded DNA probe for the human histone H3 gene. To determine the optimal conditions for detecting H3 mRNA in rat gastric mucosa, we tested the effect of changing conditions, such as fixation time and digestion time, by a proteinase before hybridization. Next, the proliferation indices obtained using H3 ISH were compared with those obtained using bromodeoxyuridine (BrdU) immunohistochemistry. In normal rat gastric mucosa, H3 ISH- and BrdU-positive cells were confined to the neck region of both fundic and pyloric mucosa. The two labelling indices were almost the same. In all the serial sections studied, H3 ISH-positive cells were almost always BrdU-positive too. Taken together, these results indicate that the H3 ISH technique is useful for the evaluation of proliferative activity in gastric epithelial cells by virtue of its detection of S-phase cells.
We present a patient with acute monoblastic leukaemia (AMoL) who achieved a complete remission on combination therapy with macrophage colony-stimulating factor (M-CSF) and low dose of cytosine ...arabinoside (ara-C). This 26-year-old man was admitted with a relapse of AMoL which proved refractory to several chemotherapeutic regimens. To kill dormant leukaemic cells, we administered 20 mg/m2 ara-C by continuous intravenous infusion and 800 x 10(4) unit M-CSF by 30 min drip intravenous infusion together for 14 d. The blasts disappeared, followed by a recovery of normal blood cells. The patient continued the complete remission for 5 months. This observation suggests that a combination M-CSF and a low dose of ara-C may be useful in treating some patients with AMoL.
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth II (B-II) gastrectomy has a number of problems such, as intubation of the afferent loop, reaching the papilla of Vater, ...cannulation and endoscopic sphincterotomy(EST)from areversed position. we reviewed the records of 164 ERCPs performed in 118 consecutivepatients With B-II gastrectomy at Shinshu University Hospital and its affiliated hospitalsbetween January 1989 and December 1996. Standard or therapeutic duodenascopes wereused routinely. EST Was performed using a needle-knife guided by a bitionasal drainagecatheter or biliary endoprosthesis. Cannulation of the desired duct was achieved in 124 of 164(75.6%)ERCPs;98 of 124 (79.0%) ER s and 26 of 40 (65.0%)ERPs. Reasons far failure in FRCP included;the afferent loop was too long to reach the papilla (25), thepapilla was identified but failed cannulation(10), the papilla was not identified in spite of reaching duodenal stump(3), and the afferent loop could not be entered(2). However, irlpatients whom the papilla was seen, cannulation was successful in 98 of 107(91.6%)ERCs and 26 of 27(96.3%)ERPs. Stone was extracted successfully achieved in 27 of 40(67.5%)patients with common bile duct calculi following EST (25) or endoscopic balloon papillarydilation(2), Complications occurred in 4 patients;retroperitoneal perforation(3), andbleeding(1). All complications were recovered by conservative management. Endoscopicbiliary drainage(EBD)was successful in 10 of 16(62.5%)patients with malignant biliaryobstruction. Reasons for failure in EBD included inability to reach the papilla(3)andfailure to cannulate(3). The most common reason for failure in ERCP in patients with B-II gastrectomy was inability to reach the papilla. However, tolerable results of diagnosticand therapeutic ERCP could be obtained in patients wham the papilla of Voter wasidentified. Recently, we have used an oblique-viewing endoscope in patients with B-II anastamoses who had been suspected biliary disease. This scope is superior to duadena-scope in reaching the papilla and in bile duct cannulation.
