Gastric pseudopolyposis: a new clinical manifestation of type A gastritis.

Three cases of type A gastritis associated with multiple polypoid lesions of the body of the stomach are presented. The endoscopic congo-red test showed the red to black color changes of the sprayed congo-red only on the top of the polypoid lesions. The endoscopic methylene-blue test revealed no dye absorption on the antral mucosa or on the top of the polypoid lesions, while the dye was absorbed on the flat mucosa surrounding the top of the polypoid lesions. Histological examinations revealed well-preserved oxyntic glands on the top of the polypoid lesions. The flat mucosa showed marked atrophy or intestinal metaplasia. There have been several reports of experimental models of type A gastritis, where chief and parietal cells decreased in considerable number. These findings and the experimental models suggest that the polypoid lesions resulted from atrophic changes of type A gastritis. The top of the polypoid lesions is the residual oxyntic glands. The lesions, therefore, should be called "gastric pseudopolyposis." The spontaneous disappearance of the polypoid lesions seen in one case is thought to be a result of a further progression of the atrophic gastritis. A pronounced G-cell increase was noted in the antrum and lower body of the stomach. This is considered a secondary phenomenon following the marked reduction of acid secretion.

Epidemio-hygieological aspects of gastric neoplasms in aged patients.

A 100-year-old male who died of gastric carcinoma was discussed and illustrated epidemiohygieologically. According to dynamic population statistics of the Health and Welfare Ministry of Japan, 418 persons over the age of 100 years died in 1979. Among them, 157 (38%) died of cardiovascular diseases and 49 (12%) died of pulmonary diseases, but only six died of neoplasms including two with gastric carcinomas (0.48%). To our knowledge no such case has been reported previously in the literature.

Gastric acid secretion and plasma gastrin response to test meal in patients with gastric cancer.

Gastric acid secretion and plasma gastrin response to test meals were examined in 110 patients with gastric cancer and a comparative study was made in accordance with depth of invasion, macroscopic shape, histological type, location and size of the lesion. Cases were classified into two large groups by the depth of invasion: early cancer (invasion was limited to the mucosa and submucosa) and advanced cancer (invasion reached the muscularis propria or deeper). Patients showed hypoacidity on the whole. Cases of early cancer showed significantly higher acid secretion than cases of advanced cancer, although no significant differences were observed in gastrin release. Among the cases of early cancer, cases of the elevated shape showed significantly lower acid secretion and higher gastrin release than cases of the depressed shape, and cases of the histologically differentiated type showed significantly higher acid secretion than cases of the undifferentiated type although no significant differences were observed in gastrin release. Among the cases of advanced cancer, cases with large carcinomas in the corpus tended to show low acid secretion and cases with large carcinomas in the antrum tended to show low gastrin release. High gastrin release was observed in cases of the Borrmann IV type with giant folds.

A comparative study on application of Nd-YAG laser radiation and electrocautery in canine gastric mucosa--magnified observations by dissecting microscopy and scanning electron microscopy, and histological examinations.

The mucosal change, the depth of injury and the healing process in the canine gastric wall after Nd-YAG laser (YAG) exposure and electrocautery were studied comparatively by magnified observations. The results were as follows: 1. Mucosal changes caused by the YAG laser beam were more localized within the exposure area than those by electric current. 2. The depth of tissue damage to the canine gastric wall by YAG laser exposure was easy to control when compared to that caused by electrocautery. 3. The healing time of the ulcer caused by the YAG laser was shorter than that caused by high frequency current. 4. In the present study on the mucosal changes due to laser exposure and electrocautery using endoscopy, dissecting microscopy and SEM, it was found that these examinations appear to be helpful as experimental procedures to clarify the detailed appearance of the mucosal surface. It was suggested that endoscopic application of the YAG laser to the gastrointestinal tract was safe and effective when compared with other procedures which have been applied endoscopically for diagnosis and treatment.

The PFD test for pancreatic disease patients.

The PFD test was performed on various pancreatic disease patients. The urinary PABA excretion rate was significantly lower in chronic pancreatitis patients and in pancreatic carcinoma patients than in the controls, but no difference was observed between PABA excretion in the two diseases. After surgery, PABA excretion values of pancreatic carcinoma patients were significantly lower than those of non-pancreatitis non-pancreatic carcinoma patients. This was thought to be caused by the difference in residual anastomosed pancreatic tissues. Mild to severe pancreatitis, fibrosis and/or fat necrosis were seen in the pancreatic tissues of carcinoma patients, but these changes were minimal in non-pancreatitis non-pancreatic carcinoma patients. The PFD test is useful in detecting decreases in pancreatic exocrine functions or measuring the grade of pancreatic disorders in various pancreatic diseases, although it can not be used to differentiate pancreatic diseases.

The coexistence of gastric cancer and duodenal ulcers.

The records of 356 gastric carcinoma patients who were treated surgically were reviewed. Among them, six patients (1.7%) had duodenal ulcers. Five cancers of the six patients were "early" gastric cancers classified as type "IIc" or "IIc + III" according to "The general rules for the gastric cancer study in surgery and pathology". The cancers of the six patients were located in the lower half of the stomach. Gastric secretion activity was normal in four and above normal in two cases. Three had signet ring cell carcinomas, two had poorly differentiated adenocarcinomas and one had a well differentiated adinocarcinoma. Our results were similar to other results reported in many papers. In Japan gastric carcinomas coexisting with duodenal ulcers were more often confirmed in the "early" gastric cancer stage. This is probably because endoscopic examinations of the stomach were more often performed in Japan than in other countries because of te large number of gastric disease patients. In addition, it is assumed that the growth of gastric cancer in the stomach is slow because of the very active gastric secretion.

Hematemesis and Melena: gastritis.

The records of a total of 60 gastritis patients who showed hematemesis and/or melena are reviewed. The mean age was 40. The ratio of males to females was two to one. During the examination, 19 upper G-I lesions were confirmed in addition to gastritis. Sixteen patients had severe underlying diseases which were thought to be the cause of the bleeding tendency. Thirteen patients took alcohol or drugs which induced bleeding. Prognoses of the patients were relatively good when they were treated medically.

magnified endoscopic observations on the healing process of experimental ulcers.

Experimental gastric ulcers in the canine stomach were observed and followed up using a magnifying endoscope. There were differences in the healing processes between antral ulcers and ulcers on the corpus. Antral ulcers were healed linearly by epithelization with a glandular structure, and ulcers on the body were healed by covering with a singly layer of epithelium without pit-formation and the scar resembled a shallow depression. These differences were thought to be caused by differences in blood flow, mucosal regenerability and glandular structure.

Hematemesis and melena: Endoscopic examination.

Today, gastrointestinal endoscopy has become a routine examination. In our "Endoscopy center", about five hundred gastroscopies are performed every month. It has been said in many reports that endoscopy, especially emergency endoscopy, is an effective method of discovering sources of bleeding. In this report, we also emphasize that emergency endoscopy is effective in diagnosing upper gastrointestinal bleeding on the basis of reviewing 318 endoscopic examinations.

Hematemesis and melena: Mallory-Weiss syndrome.

The records of 29 patients with Mallory-Weiss tears diagnosed by endoscopy are reviewed. Ingestion of alcohol was a chief cause of bleeding. Single tears were the largest in number and 68% of the lacerations were seen just distal to the esophago-cardial junction. Lacerations occurred more frequently on the right lateral wall of cardia than on the left lateral wall. Most of these lesions were mild and could be treated medically except for two cases which were surgically treated.

Serum CEA levels in gastrointestinal diseases.

Preoperative carcinoembryonic antigen (CEA) levels in 36 colorectal carcinoma patients were corrected in accordance with pathological stage and tumor location. Increasing levels of CEA were found in advanced stages of the disease. There were no significant differences among the CEA levels of right-sided colon tumors, left-sided tumors and rectal tumors.

Lesions of the upper gastrointestinal tract in patients with chronic renal failure.

Endoscopy of the upper gastrointestinal tract was performed on 84 patients with end-stage chronic renal failure undergoing hemodialysis. Gastric acid secretion and fasting plasma gastrin levels were also examined in these patients. Hemorrhagic gastritis was most frequently observed (23 cases) followed by erosive gastritis (18 cases). No patients had gastric ulcers. Duodenal ulcers were observed in only two patients. Gastrointestinal bleeding was observed in 15 cases (17.9%). Thirteen of these 15 cases had hemorrhagic gastritis, one of which had a duodenal ulcer as a complication. Fasting plasma gastrin levels (359.6 +/- 336.5 pg/ml) were significantly higher than those of normal subjects (35.2 +/- 37.1 pg/ml), but no acceleration in gastric acid secretion was observed either in the basal condition (BAO 0.8 +/- 0.7 mEq/h) or following tetragastrin stimulation (MAO 9.0 +/- 6.9 mEq/h). Our results were inconsistent with the previous reports that high frequencies of peptic ulcers and increased gastric acid secretion were observed in patients with chronic renal failure. Our data suggest that the defensive factors rather than the aggressive factors of the gastroduodenal mucosa may be involved in chronic renal failure.

B.T.PABA test: a new absorption test.

B.T.PABA has been evaluated as a new pancreatic exocrine function diagnostant. In this study, it was used as a new absorption test. After ingestion of 1 gm of B.T.PABA and the test meal, PABA in 6-h collected urine was determined. The urinary PABA excretion rate in Billroth I type postgastrectomy patients, 8-14 days after surgery, was lower than that of controls and that in Billroth II patients, 10-14 days after surgery, was the lowest of the three. However, the PABA excretion values of postgastrectomy patients 10 months to 20 years after surgery recovered nearly to the normal level of PABA excretion. These decreases in PABA excretion were considered to be caused by postgastrectomy digestion-absorption impairment. In addition, there was a significantly high correlation between the conventional 131I-labeled albumin absorption test and the B.T.PABA test. Therefore, it was concluded that the B.T.PABA test can be used as a simple absorption test.