JaLCDOI 10.18926/21087
Title Alternative Endoscopic diagosis of gastric malignant lymphoma
FullText URL pitsr_056_045_052.pdf
Author Miyake, Hirofumi| Harada, Hideo| Yasuoka, Masatoshi| Oka, Hiroo| Matsumoto, Shuji| Ochi, Koji| Takeda, Masahiko| Tanaka, Juntaro| Ohnoshi, Taisuke| Kimura, Ikuro|
Abstract To delineate the pitfalls and counter-measures in the endoscopic diagnosis of gastric malignant lymphoma (GML), reviewed were 32 cases of primary GML and 16 cases of systemic ML with gastric involvement (secondary GML). 1) Accurate diagnosis of GML had been made in only 13 cases of primary GML ; 18 cases had been diagnosed of gastric cancer (GC); the remaining one of benign ulcer (BU). Review of the endoscopic films, however, revealed more than two of the three findings characteristic, but not pathognomomic, of GML in 84 percent. This result indicates that possibility of GML must be kept in mind in the differential diagnosis of malignant lesions despite its rarity, because endoscopists tend to be predisposed with an impression of GC. 2) Follow-up examinations made in nine cases of primary GML revealed marked changes in endoscopic findings in three cases : healing of an ulcer lesion in one case, healing of an ulcer lesion on an unchanged tumor in another and enlargement of a tumor in the remaining one. The first case had been followed up for two years with an impression of BU. This result indicates that improvement of ulcer does not necessarily rule out GML because it can show "malignant cycle" just as GC. 3) Endoscopic biopsy performed in 30 cases of primary GML had led to accurate diagnosis in only 16 cases and erroneous diagnosis of GC in five and no malignancy in nine. Review of the cases revealed the importance of having suspicion of GML at first from endoscopic findings, because it can lead to an increase of the number of biopsy specimens, careful selection of biopsy sites, careful use of biopsy instruments to obtain good specimens and closer contact with pathologists. 4) Prospective studies on systemic ML revealed gastric involvement in 17 percent. Examinations of the GI tract, especially of the stomach is one of the important steps for staging of systemic ML and deciding therapeutic modalities. 5) It is extremely difficult to diffierentate primary GML and secondary GML from endoscopic findings alone, although there are a few findings characteristic of the latter.
Publication Title 岡山大学温泉研究所報告
Published Date 1985-03-30
Volume volume56
Start Page 45
End Page 52
ISSN 0369-7142
language 日本語
File Version publisher
NAID 120002310992
JaLCDOI 10.18926/19669
Title Alternative Diagnosis of chronic pancreatitis
FullText URL 057_029_036.pdf
Author Takeda, Masahiko| Harada, Hideo| Matsumoto, Shuji| Ochi, Koji| Tanaka, Juntaro| Yoshida, Mitsuo| Oka, Hiroo| Miyake, Hirofumi| Kimura, Ikuro|
Abstract 近年,各種膵疾患に対する検査法の発達には目を見張るものがあるが,実際の運用にあたっては各検査法の適応,限界,組合わせおよび実施する順序等に迷うことが少なくない。本研究では,最近我々が経験した慢性膵炎Ⅰ群116例の診断過程を振り返ることにより,慢性膵炎の診断における理想的な検査法の組合わせとそれぞれの役割を検討し,同時に診断名のみならず病態と病期が容易に理解できる表現方法を提案した。画像診断法,膵外分泌機能検査法(EX),膵内分泌機能検査法(EN)を比較検討し,以下の結果を得た。①画像診断法は必須である。②内視鏡的逆行性膵胆管造影(ERCP)を軸とした腹部超音波検査(US)あるいは腹部CTスキャン(CT)の組合わせは欠くことができない。③EXもまた必須の検査法である。④ENは慢性膵炎の診断に必要不可欠ではないが,治療方針を決めるうえで重要である。⑤純粋膵液(PPJ)の生化学的検査と組織化学的検査は膵炎の診断と病態生理の解明に重要である。⑥PPJ中の細胞診は慢性膵炎に合併した膵癌の検索に有用である。⑦以下に示すような診断の記載方法を提案した。"Calcified chronic pancreatitis, alcoholic, diffuse, ERCP-3, US-2, CT-3, EX-2, EN-1, Lf(+)"。
Abstract Alternative Endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography (US), computed tomography (CT), exocrine pancreatic function test (EX), endocrine pancreatic function test (EN), and analysis of pure pancreatic juice (PPJ) are currently available for the investigation of pancreatic diseases. The purpose of the present study is to evaluate the roles and preferable combinations of these tests in the diagnosis of chronic pancreatitis and then to propose a way to describe the results of the tests along with diagnosis for a better understanding of the disease process. Comparative studies of imaging, EX and EN led to the following conclusions. 1) imaging procedures (ERCP, US and CT) are mandatory, partly because they were frequently the test that showed diagnostic changes and partly because they often gave key information for operative treatment. Among the imaging procedures, ERCP combined with US and/or CT is mandatory because these combinations alone can reveal detailes of structural changes attendant on chronic pancreatitis. 2) EX is also mandatory, because it was occasionally the only test that showed diagnostic changes and partly because it often gave important information for medical treatment. 3) EN is also important, not because it was indispensable for detecting chronic pancreatitis, but because it often gave important information for medical treatment. For btter understanding of the disease process as well as diagnosis, we propose, as suggested by Seligson, that the test used for the establishment of the diagnosis and the degree as well as extent of abnormalities. An example is "Calcified chronic pancreatitis, alcoholic, diffuse, ERCP-3, US-2, CT-3, EX-2, EN-1, Lf(+)". This attitude will lead to a more rational approach to both diagnosis and treatment.
Keywords 慢性膵炎 (chronic pancreatitis) 画像診断 (imaging diagnosis) PS試験 (pure pancreatic juice) 純粋膵液(PPJ) (Pancreozymin-Secretin test) 内視鏡的逆行性膵胆管造影(ERCP) (endoscopic retrograde cholangiopancreatography (ERCP))
Publication Title 環境病態研報告
Published Date 1986-07
Volume volume57
Start Page 29
End Page 36
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309023