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We performed this study to determine which biopsy sites in the stomach are suitable for the diagnosis of Helicobacter pylori infection and the assessment of the extent of atrophic gastritis.Endoscopy was performed in 76 H. pylori-positive patients with histologically confirmed chronic gastritis. Biopsies were taken from the following six sites: the lesser curvatures of the mid-antrum (site 1), the angulus (site 2), the middle body (site 3), and the greater curvatures of the mid-antrum (site 4), the angulus (site 5), and the middle body (site 6) of the stomach. The extent of atrophic gastritis was assessed endoscopically as well as histologically, and patients were classified into five groups according to its extent. H. pylori status was assessed histologically. The histological severity of inflammation, activity, atrophy, and intestinal metaplasia was assessed according to the Updated Sydney System. The grades of these items were compared among the six biopsy sites in each group of patients.Site 6 was most reliable for the diagnosis of H. pylori infection, and site 4 was suitable for examining the status of H. pylori colonization in the antrum. Site 1, site 3, and site 6 were suitable for the assessment of the extent of atrophic gastritis.Our results indicate that for an accurate diagnosis and assessment, biopsies should be taken from the following four sites: the lesser curvatures of the mid-antrum (site 1) and middle body (site 3), and the greater curvatures of the mid-antrum (site 4) and middle body (site 6) of the stomach.

Aim: To evaluate the efficacy and safety of two 1-week low-dose triple-therapy drug regimens involving antisecretory drugs for Helicobacter pylori infection, 99␣patients with H. pylori infection were treated with either lansoprazole or ranitidine used together with clarithromycin and metronidazole. Methods: The drug combination and administration periods in the proton pump inhibitor group were lansoprazole 30 mg o.m., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d., all given for 7 days (LCM group). The ranitidine group received ranitidine 150 mg b.d., clarithromycin 200 mg b.d. and metronidazole 250 mg b.d. also for 7 days (RCM group). The presence or absence of H. pylori was determined from gastric biopsy specimens taken from both the antrum and the body, by smear, culture and tissue section (Giemsa stain). Cure was defined as failure to find evidence of H. pylori infection 4 weeks after antimicrobial therapy had ended. Results: The cure of H. pylori infection was 88% in the LCM group (44 of 50; 95% confidence interval (CI) = 79–97%) and 92% in the RCM group (45 of 49; 95% CI = 84–99%). The incidence of adverse events was 16% and 18% for the two groups, respectively. Conclusions: No significant differences in cure rate and safety profiles were noted between the two regimens, suggesting that moderate acid inhibition using an H2-blocker is sufficient to achieve optimal H. pylori eradication.

Background. The aim of this study was to evaluate the efficacy and tolerability of 1-week, low-dose triple therapy with lansoprazole, clarithromycin, and metronidazole (LCM) for the cure of H. pylori infection and to establish the adequate dosage of a new triple therapy for Japanese patients. Materials and Methods. One hundred four H. pylori–positive Japanese patients were assigned alternatively to one of two groups: one to receive either 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily for 1 week (LCM1; n = 52); the other to receive 30 mg lansoprazole once in the morning, 200 mg clarithromycin twice daily, and 500 mg metronidazole twice daily for 1 week (LCM2; n = 52). H. pylori infection was assessed by smear, culture, and histological assessment (Giemsa stain) performed before and 4 weeks after cessation of the therapy. Results. The overall cure rates of H. pylori infection were 92.3% (48 of 52; 95% confidence interval (CI), 85% to 100%) in LCM1 and 92.3% (48 of 52; 95% CI, 85% to 100%) in LCM2. The cure rates in the patients without prior treatment were 95.7% (44 of 46; 95% CI, 89%–100%) in LCM1 and 95.7% (45 of 47; 95% CI, 89%–100%) in LCM2. Minor side effects were observed in 7.7% of LCM1 and 9.6% of LCM2, respectively. Conclusion. The LCM1 regimen consisting of 30 mg lansoprazole once daily, 200 mg clarithromycin twice daily, and 250 mg metronidazole twice daily (the regular doses in ordinary use in Japan) is a highly effective and safe regimen for Japanese patients. LCM1 as a new triple therapy is a promising regimen for the first-line treatment of H. pylori infection in Japanese patients.

At present, the evaluation of anti-ulcer drugs is generally accomplished simply by calculating the cumulative healing rate at a certain point of time during treatment, which does not implicate any analysis of the healing speed of the ulcer. If the cumulative healing rate of an ulcer is expressed as a function of drug administration time, t, then it will be possible to calculate parameters concerning the healing speed of ulcers and thus evaluate drug efficacy as the time series analysis of the cumulative healing rate. A new method of evaluating anti-ulcer drugs by a statistical analysis of healing speed is proposed. A non-linear regression analysis was performed between two variables, t (time of drug administration : week) and y (non-healing rate : %), to obtain the exponential function y = Ae -kt . The theoretical values calculated from the exponential equation were in close proximity to the observed values. With this analysis, four parameters concerning the healing speed were defined, namely the healing rate constant, the initiation time of healing, the half-life of non-healing rate and the time necessary for 50% healing. With this method, the efficacy of drugs on peptic ulcer healing was dynamically analysed, the non-healing rate (y) being expressed as an exponential function of length of time (t) of treatment, thus obtaining digital parameters for healing speed.

A retrospective study was conducted of two groups of patients over (group 1, n = 57) and under (group 2, n = 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre-operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre-operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra-operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.

Fifty-eight Helicobacter pylori-positive ulcer patients received omeprazole 20 mg (n = 15), or lansoprazole 30 mg (n = 23), lansoprazole 60 mg (n = 13), or E3810 20 mg (n = 7) q.d. Another 63 H. pylori-positive ulcer patients received lansoprazole and clarithromycin for 2 weeks. Patients received lansoprazole 30 mg and clarithromycin 400 mg (group 1, n = 22), lansoprazole 30 mg and clarithromycin 800 mg (group 2, n = 12), or lansoprazole 60 mg and clarithromycin 800 mg (group 3, n = 29). Neither proton pump inhibitor (PPI) was capable of eradication by monotherapy, but the clearance rates in the lansoprazole group were 60.9 and 69.2%, which were higher than those for omeprazole (p < 0.05). In the dual therapy, eradication rates were 50, 50, and 72.4% in groups 1,2, and 3, respectively. Minor side effects were observed in one case each in groups 1 and 3. Lansoprazole monotherapy proved more efficacious than omeprazole monotherapy, but it was unable to eradicate H. pylori. Dual therapy with lansoprazole 60 mg and clarithromycin 800 mg was an efficacious and safe regimen for H. pylori eradication in this study.

During intraoperative cholangiography, cystic duct stones were diagnosed in 79 of 898 consecutive patients (8.8%) who underwent laparoscopic cholecystectomy over a 45-month period. The stones were successfully removed laparoscopically. In addition, it should be mentioned that the stones were identified and retrieved before the cholangiography was started in all but 8 of the 79 cases. Of these 79, only 27 cases (34.2%) had been diagnosed as having cystic duct stones preoperatively by intravenous cholangiography and/or endoscopic retrograde cholangiography. From the results obtained, it can be concluded that intraoperative cholangiography is mandatory to detect unsuspected retained stones not only in the common duct but also in the cystic duct during laparoscopic cholecystectomy, and also provides vital information as to biliary anatomic variations, the proximity of the cystic duct to the common duct, and the confirmation of inadvertent bile duct injury.

An ultrastructural and immunohistochemical study was done to investigate the normal developmental process of rat gastric wall. Neuronal processes were observed on the external side of immature muscle cells on gestational day 15, and Auerbach's plexus was found on gestational day 18, after which neuronal elements extended just under the subepithelial area. Myofilaments appeared in undifferentiated mesenchyme cells on gestational day 15. On day 17, stomach was responsive to Ach stimulation. On the day after the initiation of gastric motility, gastric glands started to form on the mucosal surface. At the same developmental stage, some parts of the mucosal epithelium and the submucosal connective tissues were stained with antiserum against tenascin. Endocrine and parietal cells appeared in the mucosal epithelium on gestational day 19. Dense secretory granules on the apical surface of mucosal epithelium were increased between day 20 and 21. The cytoplasmic organelles gradually developed with advancing fetal age. We suggest that tenascin may play a role in gastric gland formation and that there are some relationships between gastric gland formation and gastric motility. We believe that the development of subepithelial tissues may be closely associated with epithelial growth.

A mechanism of cytoprotection by 16,16-dimethylprostaglandin E2 (16,16-dimethyl-PGE2) was investigated in rats with respect to possible roles of the gastric juice and the mucus gel layer. 16,16-Dimethyl-PGE2 significantly increased the volume of gastric juice and mucus thickness. In a gastric juice-emptied stomach, 16,16-dimethyl-PGE2 protected the gastric mucosa against 30% ethanol, but not against 40% ethanol. Moreover, this agent did not show any cytoprotective action even against 30% ethanol when both gastric juice and mucus gel were removed. In this situation there was no histological change in the depth of injury, whether 16,16-dimethyl-PGE2 was given as pretreatment or not. These results suggest that there are two mechanisms that may play major roles in the cytoprotection of the gastric mucosa by 16,16-dimethyl-PGE2: (a) dilution of necrotizing agents by increased gastric juice and (b) thickening of the mucus gel layer.

Infection with Helicobacter pylori (H. pylori) plays an important role in the pathogenesis of gastritis, peptic ulcer and gastric cancer, and the 13C-urea breath test (13C-UBT) is a convenient and non-invasive method for the detection of H. pylori in the stomach. We have examined the sensitivity, specificity and accuracy of 13C-UBT. The 13CO2/12CO2 ratio was measured using infrared spectroscopy (IR) and gas chromatography/mass spectrometry (GC-MS).

Early syphilitic hepatitis is uncommon and tends to be overlooked. However, the diagnosis of this disease is important, because appropriate treatment results in rapid resolution of the hepatitis. We report a case of subclinical early syphilitic hepatitis exaggerated by a Jarisch-Herxheimer reaction. This reaction helped to realize the diagnosis in this case.

Endoscopic studies of Japanese patients with gastritis have revealed the existence of an endoscopic atrophic border that marks the transition between non-atrophic gastritis and atrophic gastritis, and between fundic glands and pyloric glands. Marked changes in cell type, gastritis activity, atrophy and density of Helicobacter pylori infection occur across this border. Gastritis appears to extend from the antrum to the corpus more quickly in Japanese patients than in patients from other populations. Infection with H. pylori may be an important factor influencing the rate of progression of gastritis in Japanese patients.

Venous stasis of the legs during laparoscopic cholecystectomy was compared between patients without graded compression leg bandages (Group 1; n = 12) and patients with such bandages (Group 2; n = 12) by measuring mean blood flow velocity and cross-sectional area of the femoral vein using a color Doppler ultrasonography. In Group 1, when velocity and area were measured in the supine position, a significant decrease in velocity (p < .05) and a significant increase in area (p < .05) occurred after abdominal insufflation to 10 mm Hg. These changes were greater during abdominal insufflation in the reverse Trendelenburg position than during abdominal insufflation in the supine position. In Group 2, flow velocity was significantly higher (p < .05) before abdominal insufflation as compared with Group 1. After abdominal insufflation to 10 mm Hg and a postural change, velocity significantly decreased (p < .05) and area significantly increased (p < .05) in Group 2, similar to the results in Group 1. During abdominal insufflation at 5 mm Hg or lower, the use of the graded compression bandage was found to be useful for preventing femoral vein stasis. During abdominal insufflation at 10 mm Hg or in the reverse Trendelenburg position, the bandage did not prevent femoral vein stasis.

The ultrastructure of microvessels in the gastric mucosa of patients with atrophic gastritis was investigated. In the gastric mucosa of atrophic gastritis, the endothelial cells of microvessels were irregularly swollen and subendothelial spaces were enlarged. The basement membrane underlying the endothelium was thickened. Degeneration of smooth-muscle cells was also evident in the media. These changes appear to correspond to sclerosis or aging of the microvessels. Such sclerotic changes in microvessels may initiate deterioration of the microenvironment in the gastric mucosa and may consequently affect metabolic activity of the gastric mucosal cells. Those sequences might induce degeneration or abnormal differentiation of mucosal cells. Such vascular changes may advance slowly and increase in intensity with advancing age. The final result would be the histologic changes associated with atrophic gastritis.

The present study shows the excellent efficacy of endoscopice hemostatic therapy by ethanol injection. At the same time, the results emphasize the significant efficacy of intensive pharmaceutical treatment for peptic ulcer patients with clinical symptoms of hematemesis and/or melena. Concerning endoscopic hemostatic therapy, we prefer ethanol injection therapy to most other methods, such as laser irradiation, microtase or heat probe, because the ethanol injection method is the most simple, inexpensive, safe, technically easy, can be performed any time and in any place, and is more effective than other methods. In rare cases where direct ethanol injection into the exposed blood vessels is difficult , we do not hesitate to select other contact methods such as heat probe or microtase.

酸素飽和度の変化に影響されないヘモグロビンの吸収波長569nmと,ヘモグロビン濃度に影響されない吸収波長650nmの2種類の狭帯域干渉フィルターを通して照明された電子腹腔鏡画像からヘモグロビン量を算出し,組織ヘモグロビン濃度分布の画像化を試みた.電子腹腔鏡の画像解析から得た組織ヘモグロビン分布の画像は,1. 二次元でのヘモグロビン分布図が得られること,2. 任意の関心領域でのヘモグロビンインデックスが求められること,3. 非接触法であり生理的条件下での測定が可能なこと,4. 検査手技による再現誤差のないこと,5. 瞬時に連続的に測定可能であることなど,従来腹腔鏡的に行なわれている他の血流測定法にはない数多くの特徴があり,その臨床及び研究に果たす役割は極めて大きいと考えられた.