JaLCDOI 10.18926/15150
Title Alternative Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.
FullText URL 065_022_026.pdf
Author Ochi, Koji| Harada, Hideo| Chowdhury, Riaz| Tanaka, Juntaro| Matsumoto, Shuji| Seno, Toshinobu| Mizushima, Takaaki| Mitsunobu, Fumihiro| Tanizaki, Yoshiro| Akiyama, Tsuneo| Nakai, Mutsuo| Hasuoka, Hideaki| Kato, Tadahiro|
Abstract Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった。腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった。腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である。以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。
Abstract Alternative The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination.
Keywords 大腸内視鏡検査 (colonoscopy) 前処置 (preparation)
Publication Title 岡大三朝分院研究報告
Published Date 1994-09
Volume volume65
Start Page 22
End Page 26
ISSN 0918-7839
language 日本語
File Version publisher
NAID 120002307186
JaLCDOI 10.18926/15129
FullText URL 066_085_091.pdf
Author Chowdhury Riaz| Ochi, Koji| Harada, Hideo| Tanaka, Juntaro| Mizushima, Takaaki| Matsumoto, Shuji| Seno, Toshinobu| Ichimura, Mitsuko| Akiyama, Tsuneo| Yokota, Satoshi|
Abstract Experimental model of pancreatitis is mandatory for elucidating the pathobiology of the disease and also to see the response of a novel treatment. In addition, the need for an animal model of chronic pancreatitis is further strengthened by the relative inaccessibility and paucity of the human pancreatitis tissue. Whereas various models of acute pancreatitis and also of exocrine pancreatic tumor have been described, chronic pancr-eatitis has not been consistently reproduced in experimental animals. Many researchers attempted to establish an experimental model of chronic pancreatitis either by partially obstructing the drainage of pancreatic secretion in dogs and cats or by feeding alcohol to dogs and rats with and without temporary occlusion of the biliopancreatic duct or by surgically inducing ischaemia in the pancreas of the dogs. But, none of these models is identical with human disease. A consistently reproducible model of human chronic pancr-eatitis probably does not exist. In this expanding era of molecular biology which promises us to enhance greatly our understanding of this disease, a right experimental model of chronic pancreatitis is still in progress.
Abstract Alternative 疾患の実験モデルの作成は,その疾患の病因,病態の解明,さらに治療法の開発のために重要である。筆者らの一人は厚生省難治性膵疾患調査研究班の班員として,慢性膵炎の病態の解明や治療法の開発に関する研究を行っており,その研究の一環として,慢性膵炎の実験モデルの作成を現在行っている。そこで,これまで報告されている慢性膵炎の実験モデルについて概要を報告した。種々の動物や方法でヒト慢性膵炎に病因,病態,組織像が類似するモデルの作成が試みられてきたが,そのすべてが合致するような慢性膵炎モデルは確 立されてはいない。近年の分子生物学的研究の進歩は著しく,実験モデルへの応用が種々なされている現在,より簡便で再現性のある慢性膵炎モデルの作成が望まれるところである。
Publication Title 岡大三朝分院研究報告
Published Date 1995-09
Volume volume66
Start Page 85
End Page 91
ISSN 0918-7839
language 英語
File Version publisher
NAID 120002307190
JaLCDOI 10.18926/15128
Title Alternative Collagen degradation and in the pathogenesis of dieseases
FullText URL 066_078_084.pdf
Author Ochi, Koji| Harada, Hideo| Chowdhury Riaz| Yamashita, Haruhiro| Ichimura, Mitsuko| Tanaka, Juntaro| Seno, Toshinobu| Matsumoto, Shuji| Mizushima, Takaaki| Yokota, Satoshi| Mitsunobu, Fumihiro| Tanizaki, Yoshiro|
Abstract 組織のコラーゲン沈着にはコラーゲン合成系と分解系の不均衡によって生ずる。従来,主としてコラーゲン合成系が注目されていたが,最近の研究の進歩により,コラーゲン分解系が重要な役割を演ずることが明らかになってきた。コラーゲンの分解系には細胞内と細胞外の二つの経路が存在する。それぞれcollagenolytic cathepsinおよびmatrix metalloproteinases( MMP)がコラーゲン分解能を有する重要な酵素である。その調節因子については細胞外の経路についての解明か進んでいる。MMPの遺伝子の発現にはサイトカインや成長因子が関与し,IL-1やTNF-αは強力な誘導因子である。一旦,遺伝子か発現すれば,MMPは合成され,細胞外に不活性型(latent form)で分泌される。不活性型のMMPが活性化する過程にはplasminogen activator inhibitorやtissue inhibitors of metalloproteinases(TIMP)などの阻害因子が存在し,MMP活性を調節する。TIMPの遺伝子の発現にもサイトカインや成長因子が関与する。MMPがTIMPを上回るような病態では組織破壊が,逆にTIMPがMMPを上回るような病態では綿維化が生ずる。コラーゲン分解能の障害が線維化の維持や不可逆性に関与することが推察される。
Abstract Alternative Fibrosis is the result of net accumulation of collagen in the organ. This may occur as a consequence of alterations in the synthesis of collagen, their degradation, or both. Recent investigations revealed that a decrease in collagen degradation plays a crucial role in fibrogenesis. Two pathways exist in collagen degradation : extracellular and intracellular. Each pathway has an important enzyme; that is, matrix metalloproteinases (MMP) and collagenolytic cathepsin, respectively. Collagenolytic activity is regulated at several levels. Expression of MMP and tissue inhibitors of metalloproteinase (TIMP), which act as inhibitors of MMP, is regulated independently by a number of cytokines and growth factors. MMP, which is synthesized in the cell, is secreted in a latent form. Activation of the latent MMP is controlled by TIMP and plasminogen activator inhibitor. TIMP also inhibits activated MMP which can degrade connective tissue matrices including collagens. In the condition where TIMP is predominant over MMP, activity of collagen breakdown is reduced, and consequently collagen deposition occurrs.
Keywords 線維化 (Fibrosis) コラーゲン (Collagen) TIMP (tissue inhibitor of metalloproteinase) MMP (matrix metalloproteinase)
Publication Title 岡大三朝分院研究報告
Published Date 1995-09
Volume volume66
Start Page 78
End Page 84
ISSN 0918-7839
language 日本語
File Version publisher
NAID 120002307516
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 10.18926/19825
Title Alternative Classification and concepts of pancreatitis
FullText URL 060_083_093.pdf
Author Harada, Hideo| Tanaka, Juntaro| Ochi, Koji| Matsumoto, Shuji| Ishibashi, Tadaaki| Seno, Toshinobu| Miyake, Hirofumi|
Abstract 膵炎の分類は膵臓研究の進歩とともに変遷を重ねたが,ここ20年間はマルセイユ分類(1963年)が国際的に広く用いられてきた。しかし最近,膵検査法の進歩と膵研究の知見の蓄積を背景にして,ケンブリッジ(1983年),マルセイユ(1984年),およびローマ(1988年)において分類の改訂を目的に国際シンポジウムが開催され,それぞれに新しい膵炎の分類が提案された。各分類には多くの共通点が見られるが重要な相違点もある。各分類を十分に理解していないとしばらくは混乱に陥ることが危惧される。幸い筆者の1人はこれらのシンポジウムに招待され参加する機会を得たので,成文の背景にある討議を詳しく紹介し,各分類を比較しながらその特徴を述べた。それとともに将来理想的な分類を完成するために今後検討すべき課題をも指摘した。そして,これら分類の当面の利用法に関する筆者らの提案を述べた。
Abstract Alternative The present paper is a review of the historical changes in the classification and concept of pancreatitis. The Marseille classification and concept had enjoyed its international popularity for more than 20 years since it was adopted at the first Marseille symposium in 1962. However, the recent advancement in the study of the pancreas led to the attempts to revise the classification and concept of pancreatitis : International Symposium in Cambridge in 1983, Second International Symposium in Marseille in 1984 and Symposium at the International Congress of Gastroenterology in Rome in 1988. As one of us was invited to the last two symposia, we described the details of the revised classification and concept of Marseille (1984) and of Marseille-Rome (1988) ; then, we described the similarities and differences between the Cambridge classification, the revised Marseille classification and the Marseille-Rome classification. Finally we summarized the subjects to be further investigated to make better classification of pancreatitis in the future.
Keywords 膵炎 分類 (Classification and concepts of pancreatitis) 急性膵炎 (Acute pancreatitis) 慢性膵炎 (Chronic pancreatitis)
Publication Title 環境病態研報告
Published Date 1989-07
Volume volume60
Start Page 83
End Page 93
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309066
JaLCDOI 10.18926/19821
Title Alternative Interstitial matrix components in relation to the pathogenesis of fibrosis
FullText URL 060_076_082.pdf
Author Seno, Toshinobu| Harada, Hideo| Ochi, Koji| Tanaka, Juntaro| Matsumoto, Shuji| Ishibashi, Tadaaki| Takeda, Masahiko| Miyake, Hirofumi|
Abstract 慢性膵炎の症例は近年増加の一途をたどっており,その発症機序と病態の解明および対策の確立が急がれている。慢性膵炎の重要な所見の一つである膵間質線維化の発生機序の解明および早期発見法の確立は重要な課題であるが,従来の知見は断片的にすぎない。そこで,筆者らは膵線維化の系統的な研究を始めるにあたって,細胞間マトリックスの構成成分と線維化に関する従来の知見および今後の課題を整理した。細胞間マトリックスのうちでも特にコラーゲン,グリコサミノグリカン,フィブロネクチンをとりあげ,その構造と機能および組織の線維化形成における役割について文献的考察を行った。今後,膵組織および膵液中のプロリンハイドロキシラーゼ,コラーゲンとその型別分布および各型コラーゲンの比,ヘキソサミン,デルマタン硫酸,フィブロネクチン,ラミニンを検討することが重要と思われた。
Abstract Alternative Increasing numbers of patients with chronic pancreatitis have been reported all over the world, including Japan. Pathogenesis of chronic pancreatitis has remained to be revealed and the early detection has remaind difficult despite extensive investigations. Interstitial fibrosis forms one of the most important histopathological features of chronic pancreatitis along with loss of parenchyma and irregular dilatation of the ducts and ductules. However, only a limited numbers of reports have been pubiished on the pathogenetic mechanisms of interstitial fibrosis of the pancres, because tissue materials are not easily accessible and blood samples can hardly reflect the fibrotic process of the pancreas unlike the case of the iiver. Our Preliminary studies revealed that biochemical and immunochemical analysis of pure pancreatic juice, such as determination of collagen, hexosamine, fibronectin and proline hydroxylase, might reflect the fibrotic process of the pancreas. The results led us to review the earlier reports on inter-cellular matrix in relation to the formation of fibrosis to find suitable markers to be evaluated in the future systematic investigations. The review revealed that pure pancreatic juice should be analyzed for collagen, types of collagen, hexosamine, dermatan sulfate, fibronectin, larninin, proline hydroxylase, collagenase and cathepsin B(1).
Keywords 慢性膵炎 (Chronic pancreatitis) 膵の線維化 (Interstitial fibrosis of the pancreas) 膵間質成分 (Interstitial matrix of the pancreas)
Publication Title 環境病態研報告
Published Date 1989-07
Volume volume60
Start Page 76
End Page 82
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309179
JaLCDOI 10.18926/19797
Title Alternative Clinical evaluation of co-examination by sigmoidoscopy and barium enema study for early diagnosis of colon cancer
FullText URL 060_039_046.pdf
Author Ochi, Koji| Ishibashi, Tadaaki| Matsumoto, Shuji| Seno, Toshinobu| Tanaka, Juntaro| Harada, Hideo| Akiyama, Tsuneo| Nakai, Mutsurou| Hayashimoto, Kanae|
Abstract 注腸・内視鏡同日併用法の大腸早期癌診断における有用性の検討,その診断能向上のための検査前日食改善を目的に,同法を施行した94例の診断能,従来のBrown変法に準じた献立食とレトルト食(サンケンクリン)とのX線画像の質,内視鏡時の残渣の程度,被検者への味のアンケートを分析した。発見大腸腫瘍は癌5例(早期癌2例,進行癌3例),ポリープ26例32病変である。早期癌はともにポリープの形態をとり,注腸,内視鏡とも病変を指摘できた。病変の好発部位である直腸・S状結腸で注腸・内視鏡によるダブルチェックができる。前日食の検討ではレトルト食が従来の献立食と比し,注腸・内視鏡ともに優れた腸内洗浄能を有し,味のアンケートからも劣ることはなかった。大腸癌早期発見の2次スクリーニングとして,レトルト食を前日食とする同法の有用性が示された。
Abstract Alternative The present study was performed (1) to evaluate the validity of co-examination by sigmoidoscopy and barium enema study for the early diagnosis of colon cancer and (2) to find the most suitable preparation method for the co-examination. The co-examination was performed on 94 patients : those with abdominal symptoms and signs suggestive of colonic diseases : those with positive occult blood test in stool : or those asking for the routine examination of the colon. The examination revealed 5 cases of colon cancer (2 with early cancer and 3 with advanced cancer) and 26 eases (32 lesions) with colon polyp. The high detection rate of colonic neoplasms, especially of minute lesions, along with the high rate of early lesions among cancers suggested the validity of the co-examination method for the early diagnosis of colon cancer. The method was not time-consuming and not demanding for both patients and doctors, but was effective in detecting minute lesions by allowing a doublecheck in the high-risk recto-sigmpid region ; in addition, the upper colon could be examined by X-ray. The comparative studies on the currently popular Preparation method (modified Brown's method) and a new method with retort foods (Sankenclean, Sanwa Kagaku Kenkyusho Co., Ltd) revealed that the latter was significantly more effective in cleaning colon lumen and visualizing fine network pattern of the colonic mucosa. In addition, the patients were more satisfied with the taste of the latter.
Keywords 大腸早期癌 (Ealry diagnosis of colon cancer) 注腸・内視鏡同日併用法 (Co-examination by sigmoidoscopy and barium enema study) 大腸検査前処置 (Preparation for colon examination)
Publication Title 環境病態研報告
Published Date 1989-07
Volume volume60
Start Page 39
End Page 46
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309136
JaLCDOI 10.18926/19771
Title Alternative トランスフェリンを介する鉄の細胞内取り込み機序 ―特に肝細胞への取り込みにおける内皮細胞の関与について―
FullText URL 059_083_092.pdf
Author Irie, Seiji| Matsumoto, Shuji| Ochi, Koji| Takeda, Masahiko| Tanaka, Juntaro| Harada, Hideo| Mehdi, Tavassoli|
Abstract Transferrin (Tf) is thought to play a pivotal role in iron metabolism of various kinds of cells. Tf has specific receptors on the surface of the cells that require iron. Tf-receptor binding is followed by internalization through a system of coated pits and vesicles. The rapid decline of pH of these vesicles leads to the release and sequestration of iron by the cell. Apotransferrin-receptor complex returns to the cell surface, where under neutral pH conditions, apotransferrin is dissociated from the receptor. Recent advances in cellular and molecular biology, gene cloning and monoclonal antibody technique have elucidated many features of these processes at a molecular level. These advances are briefly reviewed, and particularly, our own observations concerning endothelial mediation of uptake of Tf by hepatocytes are discussed.
Abstract Alternative トランスフェリン(Tf)は鉄代謝において重要な役割を担っている。鉄を必要とする細胞の表面には,Tfの特異的受容体が存在し,Ffは受容体との結合に引き続いて,coated pitsとcoated vesiclesを介して細胞内に取り込まれる(internalization)。Vesicle内での急速なpHの低下にともない,鉄はTfから分離し,細胞内で分画される。一方,鉄を失ったTf(アポTf)は受容体と結合したまま細胞表面にもどり,中性のpHのもとで受容体から解離する。最近の細胞・分子生物学の進歩,遺伝子クローニング,ならびにモノクローナル抗体の開発により,分子レベルで鉄代謝経路が解明されつつある。今回,これまでの主要な知見をまとめ,特に,最近筆者らの研究により明らかとなった,肝の鉄代謝における内皮細胞の役割について考察した。
Keywords Iron uptake (鉄の細胞内取り込み) Transferrin (トランスフェリン) Receptor-Mediated Endocytosis Desialation (脱シアル化) Endothelium (内皮細胞)
Publication Title 環境病態研報告
Published Date 1988-08
Volume volume59
Start Page 83
End Page 92
ISSN 0913-3771
language 英語
File Version publisher
NAID 120002309113
JaLCDOI 10.18926/19770
Title Alternative Etiology and pathogenesis of chronic pancreatitis
FullText URL 059_068_082.pdf
Author Harada, Hideo| Matsumoto, Shuji| Ochi, Koji| Takeda, Masahiko| Senou, Toshinobu| Irie, Seiji| Tanaka, Juntaro|
Abstract 慢性膵炎の成因の主たるものは,アルコール性,特発性,胆石性である。病態面では,社会的・家庭的にもっとも責任が重い壮年期に頑固な疼痛,消化吸収障害,二次性糖尿病のために生活の質が低下することが問題になる。経過中に併発してくる膵およびそのほかの臓器の癌,および糖尿病の合併症による死亡も少なくない。アルコール性慢性膵炎の初期病変の発生機序としては,①膵過分泌の結果として細膵管内に形成される蛋白栓による膵液流出障害と,②蛋白栓あるいはアルコールの直接障害作用による細膵管上皮の損傷,およびその結果生じる膵管狭窄による膵液流出障害が注目されている。膵液流出障害はその上流域に実質細胞の破壊と間質の線維化をおこす。膵液には多くの生化学的異常が認められ,いったん発生した膵管の構造異常とあいまって慢性膵炎進展の原因となる。素因および栄養のアンバランスは発症,進展の促進因子となる。発症を予防し,進展を阻止する手段を開発するためには素因および飲酒・食事を含む環境因子の解析が今後の重要な課題である。
Abstract Alternative Main etiologies of chronic pancreatitis (CP)include "alcoholic" (60%), "idiopathic" (27%)and "biliary" (8%). Clinico-pathological features comprise intractable abdominal pain, maldigestion secodary to exocrine pancreatic insufficiency and diabetes secondary to endocrine pancreatic insufficiency. Death is not infrequent during follow-up. Pathogenesis and evolution of alcoholic CP were discussed in connection with "Big Duct Theory", "Toxic-Metabolic Theory", and "Protein Plug Theory". Diet and congenital predisposition as well as alcoholic comsumption play important roles in various combinations in the pathogenesis and evolution of CP. Important initial lesins of alcoholic CP are probably : (1) pancreatic ductular Obstruction due to proetin plug formation resulting from increased protein and mucoprotein concentration in pancreatic juice ; (2) damage and sloughing of ductular epithelia caused by protein plugs or by a direct toxic effect of ethanol secreted into pancreatic juice, and subsequent ductular stenosis and peri-ductular fibrosis. Parenchymal destruction with interstitial fibrosis is induced upstream to the ductular lesions. These, structural abnormalities and multiple biochemical abnormalities of pancreatic juice further lead to self-perpetuating evolution. Anti-acinar-cell antibody, anti-duet-cell antibody and immune complex in serum are most probably mere epiphenomena and not the causes of CP.
Keywords 慢性膵炎 (Chronic pancreatitis) 成因 (Etiology) 発生機序 (Pathogenesis)
Publication Title 環境病態研報告
Published Date 1988-08
Volume volume59
Start Page 68
End Page 82
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002308982
JaLCDOI 10.18926/19752
Title Alternative Early diagnosis of pancreatic cancertrial of a mass screening test for detecting early pancreatic cancer
FullText URL 059_024_030.pdf
Author Matsumoto, Shuji| Ochi, Koji| Irie, Seiji| Takeda, Masahiko| Tanaka, Juntaro| Harada, Hideo|
Abstract 膵癌を治癒に導くためには早期診断,早期切除以外に方法はない。そこで,無症状者のなかから早期膵癌を発見するためのスクリーニング法を検討するためProspective studyを実施した。人間ドック目的の来院患者を主とする三朝分院外来患者776名を対象とし,一次スクリーニング検査として,血清アミラーゼ,エラスターゼⅠ,CA19-9,アルカリフォスファターゼ,γ-GTP,血糖値の測定および腹部超音波検査を施行し,異常者に対して二次スクリーニングとして腹部超音波検査の再精査およびERCPを施行した。その結果,早期膵癌1例および進行膵癌2例を検出し,膵癌発見率は0.39% と満足のいく結果が得られた。しかし一次スクリーニング検査の要精検率は46% と高値を示したこと,一次スクリーニング検査の費用は胃集検の約3.3倍,二次スクリーニング検査の費用は胃精査の約2.6倍かかることからcost-benifitの面で問題となった。また見逃し症例の有無をモニターするためfollow upも今後の問題として残った。
Abstract Alternative There is no other way of curing pancreatic cancer than early diagnosis and resection. However, an effective protocol has not been established for detecting early pancreatic cancer among asymptomatic populations by means of a mass screening test. Therefore, a prospective study was attempted on 776 patients who came to Medical Clinic of Misasa Branch Hospital, Okayama University Medical School mostly for a routine annual check-up. The following tentative protocol was proposed, based on the retrospective analyses of our 13 patients with early pancreatic cancer: (1) a first step test includes serum amylase, elastase Ⅰ, alkaline phosphatase, r-GTP, carcinoembryonic antigen, fasting blood sugar and routine abdominal ultrasonography (US); (2) a second step test includes thorough abdominal US with various kinds of probes and patients' positioning which was performed on individuals with abnormal findings on the first step test, (3) a third step test includes ERCP which was performed on individuals with abnormal or questionable findings on the second step test. Further detail examinations were performed when ERCP was abnormal or questionable. Consequently 357 patients (46% of the total 776 patients) underwent thorough US and 45 patients (5.8%) underwent ERCP. ERCP findings included pancreatic cancer in two patients, suspect of pancreatic cancer in three, advanced chronic pancreatitis in two, equivocal as for chronic pancreatitis (according to the Cambridge classification) in nine, and normal in 29. Final diagnosis was early pancreatic cancer in one patient, advanced pancreatic cancer in two, and calcified chronic pancreatitis in two; detection rate of pancreatic cancer (0.39%) in this series was slightly higher than that usually reported with a mass screening test for stomach cancer. From a cost-benefit point of view, however, examinations for the pancreas cost 2.6 times as much as those for the stomach. Further studies are needed (1) to refine the protocol, (2) to improve cost-benefit efficiency, (3) and also to confirm by follow-up that no cases of pancreatic cancer have passed through the test undetected.
Keywords 膵集検 (Mass screening) 早期膵癌 (Early pancreatic cancer) 膵癌の早期診断 (Early diagnosis of pancreatic cancer)
Publication Title 環境病態研報告
Published Date 1988-08
Volume volume59
Start Page 24
End Page 30
ISSN 09133771
language 日本語
File Version publisher
NAID 120002309153
JaLCDOI 10.18926/19750
Title Alternative Clinical evaluation of endoscopic ultrasonography (EUS) in the diagnosis of gastric disease.
FullText URL 059_017_023.pdf
Author Ochi, Koji| Harada, Hideo| Matsumoto, Shuji| Irie, Seiji| Takeda, Masahiko| Tanaka, Juntaro|
Abstract ラジアルセクタ式超音波内視鏡(EUS)を,15例の胃疾患患者に用い,その有用性を検討した。胃癌の深達度診断は併存潰瘍を有するm癌の1例をsm癌とした以外は,いずれも正診であり,胃癌の深達度診断にEUSが有用であることが示唆された。その他,胃粘膜下腫瘍の占拠部位や発育様式の診断や壁外性圧排との鑑別など胃疾患の診断にEUSの有用性が示唆され,文献的考察を加えて報告した。
Abstract Alternative We performed EUS in seven cases with gastric cancer, one with gastric malignant lymphoma, two with submucosal tumor of the stomach (SMT), two with tumourous compression by extra-gastric organs and three with others. Except one case with early gastric cancer, the depth of cancerous lnvasion was correct1y diagnosed by EUS. It was posible to detect which layer had SMT in the 5 layer strcture of the gastric wall by EUS and it was helpful in determination of histological origin of SMT. Furthermore EUS was able to make the differential diagnosis between SMT and tumourous compression by extra gastric organ. Our result showed that EUS was a useful procedure in the diagnosis of gastric diseases.
Keywords 超音波内視鏡 (Endoscopic ultrasonography) 胃癌 (Gastric cancer) 胃粘膜下腫瘍 (Submucosal tumor of the stomach) 癌深達度診断 (Diagnosis of the depth of cancerous invasion)
Publication Title 環境病態研報告
Published Date 1988-08
Volume volume59
Start Page 17
End Page 23
ISSN 09133771
language 日本語
File Version publisher
NAID 120002309109
JaLCDOI 10.18926/19715
Title Alternative Effect of spa-drink therapy on exocrine pancreatic function
FullText URL 058_012_016.pdf
Author Matsumoto, Shuji| Harada, Hideo| Ochi, Koji| Takeda, Masahiko| Tanaka, Juntaro| Senou, Toshinobu| Irie, Seiji| Ishibashi, Tadaaki| Kimura, Ikuro|
Abstract 膵外分泌機能におよぼす飲泉(三朝温泉水)の効果を飲泉群および非飲泉群を対象として検討した。膵外分泌機能検査法としては,糞便中キモトリプシン活性比色測定法(モノテストカイモトリプシン)を用いた。その結果,糞便中キモトリプシン活性は,飲泉開始2週後に40 % の患者で上昇し,4週後は2週後と変わらなかった。以上より,2週間の飲泉は膵外分泌機能を改善させる効果があることがわかった。
Abstract Alternative The effect of spa-drink therapy (Misasa hot spring) on exocrine pancreatic function was studied on 18 patients after their physical and psychological conditions were stabilized about two weeks following hospitalization. Patients were randomly divided into two groups : eight patients into a control group (continuance of spa-bathing) and 10 patients into a spa-drink therapy group (continuance of spa-bathing plus commencement of spa-drink therapy). Spa-drink therapy refers to drinking 200mℓ of warm spa-water (42℃) two times a day : between meals in the morning and in the afternoon. Exocrine pancreatic function was evaluated by fecal chymotrypsin activity, using a colorimetric method (Boehringer-Mannheim). Following results were obtained : 1) With 2-week's spa-drink therapy, fecal chymotrypsin activity was significantly enhanced in 40 % of the patients, while none of the controls showed an increase in fecal chymotrypsin activity. 2) Fecal chymotrypsin activity at the time of 4 weeks was similar to that obtained at the time of 2 weeks in both groups. In conclusion, spa-drink therapy for 2 weeks was effective for the enhancement of exocrine pancreatic function.
Keywords 糞便中キモトリプシン活性 (Fecal chymotrypsin activity) 飲泉療法 (Spa-drink therapy) 膵外分泌機能 (Pancreatic exocrine function) 膵 (Pancreas) 酵素 (Enzyme)
Publication Title 環境病態研報告
Published Date 1987-08
Volume volume58
Start Page 12
End Page 16
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309038
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
JaLCDOI 10.18926/19662
Title Alternative Effect of aging on pancreatic exocrine function -Aging and fecal chymotrypsin activity-
FullText URL 057_024_028.pdf
Author Matsumoto, Shuji| Harada, Hideo| Ochi, Koji| Takeda, Masahiko| Tanaka, Juntaro| Morinaga, Hiroshi| Yoshida, Mitsuo| Kimura, Ikuro|
Abstract 膵外分泌機能に及ぼす加齢の影響を検討する目的で,健常人43名,非膵疾患患者41名,老人ホーム入居者39名を対象として比色法により糞便中キモトリプシン活性(FCA)を測定し,以下の結論を得た。1)FCAは逐齢的に低下し,60歳以上は60歳未満より有意の低値を示した。しかし,分布図のretrospectiveな検討からは,膵外分泌機能の低下は,実際には65~70歳あたりから明らかになることが示唆された。2)FCAの正常下限値を14.5U/gに定めたが,高齢者の診療にあたってはこの正常値のみを根拠にして疾病の有無を判定すべきではない。3)老人ホーム入居者のFCAは特に低値を取ったがその主要因は高齢者が多いためと考えられた。
Abstract Alternative To examine the effect of aging on the pancreatic exocrine function, fecal chymotrypsin activity (FCA) was measured by the photometric method in 43 healthy controls, 39 controls in an old-age home and 41 patients with non-pancreatic diseases. Following conclusions were obtained. 1) Pancreatic exocrine function showed a significant decrease with aging as indicated by the present prospective study : ① a significantly lower FCA in the B group of 22 healthy controls (≧ 60 years of age) than the A group of 21 healthy controls (< 60 years of ago) ; ② significant correlationship between aging and FCA in the 43 healthy controls and also in the 41 patients with non-pancreatic diseases. 2) FCA in controls in an old-age home was especially low. Presumably it was due to their far-advanced aging. 3) The calculated lower limit of normal in FCA was 14.5U/g. However, the diagnosis of pancreatic diseases should not be coined solely on the basis of decreased FCA value.
Keywords 糞便中キモトリプシン活性 (Fecal chymotrypsin activity) 加齢 (Aging) 膵外分泌機能 (Pancreatic exocrine function) 膵 (Pancreas) 酵素 (Enzyme)
Publication Title 環境病態研報告
Published Date 1986-07
Volume volume57
Start Page 24
End Page 28
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002309096
JaLCDOI 10.18926/15326
Title Alternative Clinical evaluation of an endoscopic image filing system, Olympus SDF-3
FullText URL 063_074_078.pdf
Author Ochi, Koji| Miyake, Hirofumi| Matsumoto, Shuji| Seno, Toshinobu| Tanaka, Juntaro| Harada, Hideo| Mitsunobu, Fumihiro| Tanizaki, Yosiro|
Abstract 光ディスクとパーソナルコンピュータを組み合わせた内視鏡画像ファイリングシステムは電子内視鏡の画像の保存・管理,検索・再生などに威力を発揮する。今回,われわれはオリンパス社製内視鏡ファイリングシステムSDF-3を使用する機会を得たので,その有用性や問題点の検討を行った。有用性としては,①内視鏡画像を検査終了後直ちに再生し,再検討できる,②多数の項目についての検索や統計処理が可能である,③限られたスペース内で大量の画像データの一括保存・管理が可能であるなどが挙げられる。一方,問題点としては,①内視鏡再生画像は画質が劣化する,②検索機能を十分に活用するにはかなり煩雑な人力操作を必要とする,③光ディスクの清掃が必要であるなどがあげられる。本内視鏡ファイリングシステムに今後必要な改良点やその展望についても合わせて考案を加えた。
Abstract Alternative Olympus SDF-3, an endoscopic image filing system using an electronic endoscope in conjunction with a personal computer and an optical disk, has been recently developed. We evaluated the usefulness of this filing system with 449 cases of gastroduodenal endoscopy. As a result, we have found that this filing system has following advantages : (1) one can review endoscopic images immediately after endoscopic examinations ; (2) previously documented endoscopic image can be searched and reviewed in a short time ; (3) statistical analysis of documented cases is facilitated. However, it has some disadvantages as well to be improved : (1) quality of endoscopic images is deteriorated in the process of filing ; (2) putting patients' data into the filing system is time-consuming ; (3) frequent cleaning of an optic disk is required. This endoscopic image filing system needs to be further developed and refined.
Keywords 画像ファイリングシステム (image filing system) 電子内視鏡 (electronic endoscope)
Publication Title 岡大三朝分院研究報告
Published Date 1992-06
Volume volume63
Start Page 74
End Page 78
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002307278
JaLCDOI 10.18926/15317
Title Alternative Diagonosis of pancreatic cyst using post-ERCP CT examination.
FullText URL 064_065_070.pdf
Author Ochi, Koji| Harada, Hideo| Matsumoto, Shuji| Seno, Tosinobu| Tanaka, Juntaro| Riaz Chowdhury| Mizushima, Takaaki| Sugimoto, Keisuke| Mitsunobu, Fumihiro| Tanizaki, Yoshiro| Nakai, Mutsuo| Akiyama, Tsuneo| Hasuoka, Hideaki|
Abstract ERCP直後にCTを撮影するERCP後CTはERCPの際に膵内に注入された造影剤をCTで検出するため,ERCPでは得られない情報が得られる利点がある。われわれはERCP後CTが診断や治療方針の決定に有用であった膵嚢胞の4例を経験した。膵嚢胞では主膵管との連絡,嚢胞の部位,性状診断にERCP後CTは有用な検査法であり,文献的考察を含めて報告した。
Abstract Alternative Post-ERCP CT (computed tomography (CT) examination performed immediately after endoscopic retrograde cholangiopancreatography) detects the contrast medium injected into the pancreatic duct and cystic lesions at the time of ERCP and, therefore, has the advantage of obtaining information which cannot be obtained by ERCP alone. We have experienced four cases of pancreatic cysts in which post-ERCP CT was useful for diagnosis and in deciding on treatment plans. The post-ERCP CT was proved to be a useful method for examining the site and characteristics of the cysts which communicated with the main pancreatic duct.
Keywords ERCP (Endoscopic retrograde cholangiopancreatography) CT (Computed tomography) 膵嚢胞 (pancreatic cyst)
Publication Title 岡大三朝分院研究報告
Published Date 1993-06
Volume volume64
Start Page 65
End Page 70
ISSN 0918-7839
language 日本語
File Version publisher
NAID 120002307547
JaLCDOI 10.18926/15041
Title Alternative Alcohol-induced pancreatitis
FullText URL 062_052_070.pdf
Author Harada, Hideo| Tanaka, Juntaro| Ochi, Koji| Matsumoto, Shuji| Seno, Toshinobu| lzushi, Michihiro| Tanizaki, Yoshiro|
Abstract 膵炎のうちもっとも頻度が高いアルコール性膵炎(AIP)の疫学,臨床像および発生機序に関する従来の知見を総括した。AIPの大多数は慢性膵炎である。通常は長期にわたる多量の飲酒を背景に発症するが,遺伝的素因および食事因子も重要な役割を演じる。発症初期には血中膵酵素の上昇をともなう腹痛が病像を支配するが,進展すると膵外分泌不全による消化吸収障害と膵内分泌不全による糖尿病が病像を支配するようになる。アルコール性慢性膵炎は非アルコール性慢性膵炎にくらべて確診時にすでに進展した症例が多く,合併症が多く,進行が早く,予後が悪い。死亡の主たる原因は癌の併発と糖尿病の合併症で,膵炎の急性増悪発作がこれにつぐ。併発する癌のなかでは膵癌よりもむしろ上部気道および上部消化管の癌が多い。発生機序としてはDuctal-Plug説とToxic-Metabolic説が有力であるが,最近は細 胞内膵酵素活性化説とFree Radical説も注目をあびている。
Abstract Alternative This paper is to review the literature on the epidemiology, clinical pictures and etiopathogenesis of alcohol-induced pancreatitis (AIP). The incidence of AIP has been increasing worldwide, paralleling the increase in alcohol consumption. AIP manifests itself following a longterm consumption of large amounts of alcohol. There is no known threshold value of alcohol consumption in terms of the risk of developing AIP, although the logarithm of the risk of developing AIP is lineally correlated with the amount of alcohol intake. Why some alcoholics develop pancreatitis whereas others with equal consumption of ethanol are spared remains to be explained. Therefore, two additional factors are considered to play important roles in developing AIP : genetic predisposition and diet. The majority of AIP IS chronic pancreatitis (AICP), although a minority can be acute pancreatitis (AIAP). AIAP shows somewhat higher morbidity and mortality than the common variety of acute pancreatitis. If recovered from an attack, AIAP shows morphological and functional restoration. AICP manifests itself with an acute attack of abdominal pain, insidious onset of abdominal pam, or a pain-free variety. An acute attack in AICP resemble that m AIAP ; often these two can be differentiated only by follow-up studies. AICP shows no morphological and functional restoration, and often shows progressive deterioration. Abdominal pain with elevated serum pancreatic enzymes is a predominant clinical picture m the early stage of AICP, whereas in the late stage symptoms and signs deriving from exocrine insufficiency (maldigestion) and endocrine insufficiency (pancreatic diabetes) begin to dominate the clinical pictures. AICP is in the more advanced stage and shows more complications than nonalcoholic chronic pancreatitis at the time of diagnosis. In addition, AICP shows more rapid progress and higher morbidity and mortality. The incidence of microangiopathy in pancreatic diabetes resemble that in primary diabetes, being higher in patients with a longer history of diabetes, those on insulin treatment and those under poorer control. Main causes of death are development of cancer in the upper respiratory and gastrointestinal tract and diabetic complications (hypoglycemic shock, renal failure, and intractable pneumonia), and acute attack of pancreatitis leads to death less frequently. Ductal-Plug theory and classical Toxic-Metabolic theory are most popular to explain the pathogenesis of AIP ; however, increasing evidence has been reported that oxygen free radicals and intracellular activation of zymogens by lysosomal enzymes may be involved in the pathogenesis.
Keywords アルコール性膵炎 (Alcohol-induced pancreatitis) 慢性膵炎 急性膵炎
Publication Title 環境病態研報告
Published Date 1991-08
Volume volume62
Start Page 52
End Page 70
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002307918
JaLCDOI 10.18926/11708
Title Alternative Re-evaluation of spa-drink therapy for digestive diseases
FullText URL 061_073_078.pdf
Author Tanaka, Juntaro| Seno, Toshinobu| Matsumoto, Shuji| Ochi, Koji| Harada, Hideo|
Abstract 従来飲泉などの温泉治療は経験的知識にもとづいて行われる部分が多かったが,今後は科学的検査法を用いて有用性,適応疾患,適応病態,などを決定する必要がある。筆者らは,最近紹介された簡便な消化器検査法を用いて消化器疾患に対する飲泉療法の適応を再吟味しているので,これまでに得られた成績を中心に概説した。すなわち,(1)飲泉は1回でも連日の飲用でも,胃粘膜血流を改善する作用がある。(2)胃排出機能に対しては調整的効果を有する。(3)連日の飲泉は膵外分泌機能を改善する。したがって慢性の胃,膵疾患において粘膜血流障害,胃運動機能異常あるいは膵外分泌機能低下に起因する病気・病態に対しては積極的に飲泉療法を試みるべきである。温泉水の温度は40℃前後,飲泉の量は150~200ml,タイミングは食間空腹時がよい。
Abstract Alternative With the advent of new instruments for examining the digestive organs, we have attempted to re-evaluate the efficacy and indications of spa-drink therapy for digestive diseases. This report deals with an overview of the results we have obtained so far. Effect of oral intake of thermal water (Misasa thermal water, 38-42℃, 150-200 ml) on gastric mucosal blood flow was evaluated, using an endoscopic organ reflex spectrophotometry together along with an Olympus XQ - 10 forward viewing gastrofiberscope. Single intake of thermal water as well as long-term spa-drink therapy (two times a day between meals for more than two weeks) brought about an improvement of gastric mucosal blood flow. Gastric emptying function was evaluated with an acetaminophen method. Single intake of thermal water brought about disordered gastric emptying (excessively accelerated or suppressed). However, long-term spa-drink therapy brought about an improvement (normalization) of gastric emptying function. Exocrine pancreatic function was evaluated with a synthetic peptide, N-BT-PABA, and also by measuring fecal chymotrypsin actIvIty. Longterm spa-drink therapy brought about an improvement of exocrine pancreatic function. Motility of the gall-bladder was evaluated by abdominal ultra-sonography. Long-term spa-drink therapy gave no effect on the motility of the gallbladder. In conclusion, our recent study indicate that : (1) single oral intake of thermal water as well as longterm spa-drink therapy is effective for gastric diseases related to decreased gastric mucosal blood flow (treatment of intractable peptic ulcer and chronic gastritis, and prevention of recurrence of peptic ulcer) ; (2) long-term spa-drink therapy is effective for dyspepsia syndrome; (3) long-term spa-drink therapy is effective as a supplemental method in the treatment of exocrine pancreatic dysfunction (chronic pancreatitis) ; (4) thermal water should be taken between meals.
Keywords 飲泉療法 (Spa-drink therapy) 消化器機能 (Digestive function) 胃粘膜血流 胃排出能 膵外分泌 胆嚢機能
Publication Title 環境病態研報告
Published Date 1990-09
Volume volume61
Start Page 73
End Page 78
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002313368
JaLCDOI 10.18926/11705
Title Alternative Clinical study on polypoid lesions of the colon
FullText URL 061_036_040.pdf
Author Ochi, Koji| Harada, Hideo| Matsumoto, Shuji| Seno, Toshinobu| Tanaka, Juntaro| Tachibana, Hideo| Akiyama, Tsuneo| Nakai, Mutsuo|
Abstract 1986年4月から1990年2月末までの間に岡山大学医学部附属病院三朝分院で経験した早期大腸癌を含む大腸ポリープ90例(107病変)を対象に,年齢,臨床症状,便潜血反応,病変存在部位について検討を行い,以下の成績を得た。(1)大腸検査総数の22.4%にポリープが発見された。ポリープの77%は腺腫,5%は腺癌(早期癌)であった。(2)便潜血反応はポリープ例の75.9%に陽性であり,右側大腸ポリープでの陽性率は高かったが,S状結腸および直腸ポリープでは70%程度であった。(3)若年者では右側結腸にポリープが発見されることは稀であるが,50才以上では18%程度に認められた。高齢者では右側結腸も内視鏡で検査することが重要である。(4)免疫学的便潜血検査法の導入により大腸ポリープの発見効率が改善するものと考え られた。
Abstract Alternative This report is concerned with clinical study on 90 patients with polypoid lesions (107 lesions) which we have encountered in Misasa Hospital, Okayama University in the past 4 years. Following results were obtained : (1) Polypoid lesions were detected in 90 (22.4%) and advanced adenocarcinoma (mostly resectable) in 22 (5.5%) of 402 patients who were examined by sigmoidoscopy and barium enema ; (2) Histological examination of the polypoid lesions showed adenoma in 77.2%, hyperplastic polyp in 8.7%, inflammatory polyp in 7.6%, neurinoma in 0.3% and early cancer (adenocarcinoma) in 5.4% ; (3) It was impossible to differentiate benign and malignant polypoid lesions on the basis of endoscopic and X-ray findings alone ; (4) Forty-two percent of the polypoid lesions was detected in the sigmoid colon, 30% in the rectum, 16.8% in the descending colon, 9.3% in the ascending colon, 0.9% in the caecum ; (4) Patients younger than 50 years of age showed only one polypoid lesion in the right hemicolon, whereas elder patients showed as many as 17 polypoid lesions ; (5) Among the 90 patients with polypoid lesions, 40 presented with abdominal pain, 20 with no symptoms (annual health check-up), 17 with irregular bowel habits, and 10 with melena ; (6) Among the 90 patients, occult blood in stool was positive in 75.8% with a lower positive rate in the lesions of the sigmoid and rectum ; (7) Among 5 asymptomatic patients with lesions and with a negative hemoccult test, 3 patients with a polypoid lesion were examined because of the patients' request, 1 patient with a polypoid lesion because of a positive family history, and the remaining 1 patient in a search for the primary lesion of the metastatic liver cancer ; (8) Among patients with a positive hemoccult test, the detection rate of polypoid lesions was 41.9% with use of an immunological method, whereas it was 19.7% with use of a chemical method. In conclusion, (1) detection of colonic polypoid lesions can lead to the detection of early cancer, although only histological examination can confirm the accurate diagnosis ; (2) a hemoccult test in stool with an immunological method is an effective method for screening asymptomatic colonic polypoid lesions, although it must be admitted that negative results may occasionally occur ; (3) macroscopic observation of the stool mass is important before sampling, because lesions of the sigmoid colon or the rectum may show scanty blood only on the limited area of the surface of the stool ; (4) patients elder than 50 years of age should be examined more carefully for the whole colon preferably with an endoscope, because they show a high incidence of small polypoid lesions in the right hemicolon.
Keywords 大腸ポリープ (Polyp of the colon) 大腸早期癌 (Early cancer of the colon)
Publication Title 環境病態研報告
Published Date 1990-09
Volume volume61
Start Page 36
End Page 40
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002313590
JaLCDOI 10.18926/11698
Title Alternative Diabetic complications in the advanced stage of chronic pancreatitis.
FullText URL 061_079_088.pdf
Author Ochi, Koji| Tachibana, Hideo| Matsumoto, Shuji| Seno, Toshinobu| Tanaka, Juntaro| Harada, Hideo|
Abstract 慢性膵炎が進行すると膵内外分泌不全に対する治療が主体となる。かつては膵疾患に由来する糖尿病(膵性糖尿病)においては糖尿病性合併症の発症が少ないとされていたが,慢性膵炎の長期経過観察例の増加とともにその頻度が一次性糖尿病にくらべて必ずしも低くないことが指摘されるようになった。そこで今回,厚生省難治性膵疾患調査研究班「慢性膵炎の新しい治療法の開発」小委員会の研究活動の一環として膵性糖尿病の治療法を再検討することになったのを機会に,その手始めに野性糖尿病の合併症に関する従来の報告を整理した。その結果,一次性糖尿病の場合にくらべて,細小血管症(網膜症,腎症,神経障害)はほぼ同程度であるが軽症例が多いこと,大血管症(心筋梗塞,脳硬塞,動脈硬化症)は少ないことが示唆された。そのほか,膵性糖尿病の合併症の発症に関与すると考えられる諸因子についても概説した。
Abstract Alternative Exocrine dysfunction (maldigestion) and endocrine dysfunction (diabetes) are malll clinical features in the advanced stage of chronic pancreatitis. Diabetic complications were previously considered to be infrequent in diabetes secondary to chronic pancreatitis (pancreatic diabetes). However, the recent improvement in life expectancy and closer observation of the clinical course of patients with chronic pancreatitis have revealed that diabetic complications are not infrequent in pancreatic diabetes as compared with primary diabetes mellitus and that diabetes is one of the most important prognostic factors in chronic pancreatitis. We, therefore, reviewed recent articles on the topics before beginning a national survey of diabetic complications in patients with pancreatic diabetes. It has been suggested that : (1) diabetic microangiopathy (retinopathy, nephropathy and peripheral neuropathy) is almost as frequent in secondary diabetes as in primary diabetes, although the severity is less in secodary diabetes : (2) peripheral neuropathy is frequent in alcoholic chronic pancreatitis : (3)macroangiopathy (myocardial infarction, cerebral thrombosis, atherosclerosis) is less frequent in pancreatic diabetes. We also discussed various factors which may precipitate the diabetic complications.
Keywords 膵性糖尿病 (Pancreatic diabetes) 慢性膵炎 (Chronic pancreatitis) 合併症 (Complications)
Publication Title 環境病態研報告
Published Date 1990-09
Volume volume61
Start Page 79
End Page 88
ISSN 0913-3771
language 日本語
File Version publisher
NAID 120002313469