[Three cases of acquired megacolon in the elderly].

As the number of the elderly in society increase, cases of abnormal bowel habit in the aged have also increased. This report describes 3 cases of acquired megacolon in the elderly. Case 1, a 71-year-old female, complained of constipation and developed megacolon after an attack of cerebral infarction. Case 2, a 82-year-old male, developed megacolon while receiving psychoactive medication. Case 3, a 69-year-old male who complained of constipation for a long time and rapidly developed megacolon was diagnosed as idiopathic megacolon.

[A case of early duodenal cancer resected by endoscopic polypectomy in the elderly].

Early duodenal cancer has been detected with increasing frequency of endoscopy and the advent of an aging society. Aged patients, however, are often inoperable because of complications due to various underlying diseases. The authors report a case of early duodenal cancer curatively operated by endoscopic polypectomy and refer to related cases in the literature.

[A case of pancreatic pseudocyst with intracystic hemorrhage and repeated gastrointestinal bleeding].

The case is a 83-year-old woman who came to our hospital with melena and epigastralgia as chief complaints, presenting pre-shock state with high serum amylase value. ERP revealed diffuse dilatation of pancreatic duct and cyst of the accessory pancreatic duct. Endoscopy showed hemorrhage of the accessory papilla. A diagnosis of chronic pancreatitis and hemosuccus pancreaticus was made. Because of the patient's advanced age, conservative treatment (total parenchymal nutrition, transfusion, hemostatics, etc.) were prescribed. The patient succumbed due to heart failure 15 months later. This case of gastrointestinal bleeding from a pancreatic pseudocyst due to neighboring arterial rupture is discussed with reference to some related literature.

[Upper gastrointestinal bleeding in the elderly].

Due to increasing number of the elderly, cases of hematemesis and melena in the aged have been increasing. The authors evaluated 69 such cases over 60 years old in whom emergency endoscopy of the upper digestive tract was carried out because of hematemesis and melena. Twenty cases are diagnosed as gastric ulcer (29%), 12 cases as esophageal ulcer and esophageal erosion (17.4%), 9 as duodenal ulcer (13.0%), 7 as gastric cancer (10.1%), 6 as Mallory-Weiss syndrome (8.7%), 6 as esophageal and gastric varices (8.7%), 4 as acute hemorrhagic gastritis (5.8%), 3 as Dieulafoy's ulcer (4.3%), and one case each of chronic pancreatitis (hemosuccus pancreaticus) and hemorrhage due to gastric angiodysplasia (1.4%). Of these cases, blood transfusion was performed in 46 cases (66.7%), and shock occurred in 27 cases (39.1%). The endoscopical hemostatic procedure was effective for detection of underlying diseases in the aged. Surgery was often impossible because of the rapid deterioration of the systemic condition due to the hemorrhage of the digestive tract.

[Efficacy and safety of percutaneous endoscopic gastrostomy in the elderly].

Percutaneous endoscopic gastrostomy (PEG) was performed in 32 patients with nasogastric feeding (NGF) or total parenteral nutrition (TPN), who were unable to swallow. Our cases of PEG included 10 with dementia, 8 with cerebral infarction, 8 with cerebral bleeding, 3 with gastric cancer, and others. TPN was performed after PEG for a short time. Because of the combination of TPN and PEG, there was no mortality or major complication related to the procedure. Minor complications included subcutaneous abscess and TPN catheter fever. PEG can be safely and rapidly performed. Furthermore, painless life, better cosmetic features and physical condition can be obtained with this procedure. The majority of the patients are able to return home after PEG. PEG can improve the quality of life of the patients who cannot swallow but have an intact gut.

Snake-strike--induced ischemic colitis with colonic stricture complicated by disseminated intravascular coagulation.

A 57-year-old farmer was struck on the right thumb by a pit viper (Agkistrodon blomhoffü). Subsequently, he had acute renal failure and disseminated intravascular coagulation (DIC), associated with melanotic stools and abdominal pain. Renal failure caused by renal cortical necrosis was successfully treated with hemodialysis. A double-contrast barium enema examination revealed multiple stenoses of the colon, regional edema, and longitudinal ulcer. Histologic examination of the stenotic lesions after laparotomy revealed fibrosis of both submucosa and proper muscle layer, with fibrotic thickness in the small arteries of the colonic wall, indicating that ischemic colitis was associated with DIC. In this case, DIC from viper toxins played an etiologic role in the development of ischemic colitis with stricture, as well as acute renal failure.

Induction of pigmentation by continuous X-irradiation of amelanotic tumors of B16-XI mouse melanoma and induced change in chromosomes of amelanotic cells.

Non-pigmented tumor cells of B16-XI mouse melanoma were found to contain a diploid number of chromosomes similarly to those of melanotic tumors and the parental cells in tissue culture. A major difference between pigmented and non-pigmented cells was in the number of biarmed chromosomes per cell. There was no difference in growth rate between non-pigmented and pigmented tumors, but growth usually begins about 2 days earlier in the former. Pigmentation lost in the course of serial transplantation was restored by irradiating the non-pigmented tumor continuously with 2,500-3,000 rads/passage of X-rays during six transfer generations. In the course of repeated irradiations, the chromosomes changed structurally and numerically as the pigmentation of the tumor was gradually restored. The observations of tumor growth and chromosomal changes are discussed in relation to the pigmentation of B16-XI melanoma cells.

Recovery in Burkitt lymphoma cells after X-ray irradiation.

The radiation response of cultured Burkitt lymphoma cell, known as a particular cell line of high radiosensitivity, was studied by the colony formation method. The values of n, Dq, and Do derived from the survival curve after a single dose X-irradiation resulted in small values as 1.1, 10 rad, and 125 rad. The maximum recovery of about 5% was observed 3 hr after the irradiation by a split-dose experiment. In the survival curve derived from a split-dose irradiation, n and Dq increased while Do remained unchanged. The reason for these increases in n and Dq may be attributed to the nonhomogeneous or mixed population response.

Linear energy transfer-dependent radiosensitivity of Burkitt lymphoma cells, with special references to human melanoma HMV, HeLa-S3, and L5178Y cells.

Dependence of the survival curves of Burkitt lymphoma cells, which were featured by their small n or Dq values, on linear energy transfer (LET) obtained for different quality of radiation was revealed markedly in the change of D0 value, together with a small change in n value. Relative biological effectiveness (RBE) compared with Dq, n and D37 values of Burkitt lymphoma cells for high LET radiation was smaller than that of other cell lines. This finding supports the hypothesis that in Burkitt lymphoma cells the recovery capacity from sublethal damage (Dq) is so small even after low LET irradiation that LET does not modify the suppression of recovery. Similar survival curves with n value closely equal to 1 were obtained for four different mammalian cell lines (Burkitt lymphoma p3HR- 1, human melanoma HMV, HeLa-S3, and L5178Y) after 2 MeV neutron irradiation. This fact may suggest that the radiation which has an LET value at which n value of the survival curve is to be 1 will be optimum for therapeutic purpose to the radioresistant tumors.

Comparative study on radiosensitivities of cultured cell lines derived from several human tumors under hypoxic condition.

Three human cell lines, Burkitt lymphoma cells (P3HR-1), epidermoid carcinoma cells (HeLa S3-1), and melanoma cells (HMV) were irradiated with 200 kV X-rays under three different oxygen conditions. The values of D0 and D10(-2) were estimated for survival curves, and then the dose-modifying factors (DMF) were calculated, for the oxygenated and hypoxic irradiations. These DMF values for oxygenation were not different for each cell line, but those for hypoxia revealed considerable difference for cell lines. From the comparison of modifications due to variable oxygen concentrations on the survival curves of Burkitt lymphoma cells with those of other resistant cells, it is concluded that the shoulder of the survival curves becomes larger primarily with lowering of the oxygen tension, and then D0 value increases followed by a decrease in n value, while in oxygenation, the decrease in D0 value takes place after n value becomes close to 1.

Colonic submucosal tumors: a new classification based on radiologic characteristics.

OBJECTIVE: Despite advances in gastrointestinal radiologic techniques, findings from barium enema studies cannot be used reliably to predict the histologic nature of a colonic submucosal tumor. Therefore, we generated a new and comprehensive classification system for all colonic submucosal tumors based on a correlation between their radiologic characteristics and their histopathologic features. MATERIALS AND METHODS: Between 1978 and 1990, 89 patients had 95 colonic submucosal tumors diagnosed on the basis of barium enema studies and confirmed by biopsy or surgery. Of these, 39 patients (44%) were symptomatic and 50 patients (56%) were asymptomatic. Single lesions (82 cases) and multiple lesions (12 cases of lymphoma and one case of blue rubber bleb nevus) were observed. The 95 lesions included 21 carcinoids, 27 malignant lymphomas, 17 lipomas, 10 lymphangiomas, six leiomyosarcomas, five leiomyomas, and nine others. We analyzed the radiologic findings and classified these lesions according to their appearance. RESULTS: All tumors were classified on the basis of their morphologic appearance into five types: (1) wide-based sessile lesion with gradually sloping margin and smooth surface (17 cases); (2) wide-based sessile lesion, more polypoid than the first type, with a smooth surface, with or without a central depression (49 cases); (3) wide-based sessile lesion with lobulated surface (six cases); (4) pedunculated lesion with smooth or granular surface (17 cases); (5) unclassified, not any of the previously mentioned types, may be diffusely stenotic or aneurysmal (six cases). The most common finding was the wide-based sessile lesion with a smooth surface and a possible central depression; next most common was the wide-based sessile lesion with gradually sloping margin and smooth surface; next was the pedunculated lesion with a smooth or granular surface. Eighty-six percent of the lesions were single; 14% were multiple. Histologic confirmation revealed mainly lymphoma (29%) and carcinoid (22%), of which the most common finding was a wide-based sessile lesion with a smooth surface, with or without a central depression. CONCLUSION: This new classification based on radiologic characteristics covers all varieties of colonic submucosal tumors. It can serve as a guideline for predicting a specific diagnosis of a colonic submucosal tumor on the basis of radiologic findings.