著者

野ッ俣 和夫 山崎 忠男 伊藤 慎芳 桜井 幸弘 多賀須 幸男 安部 孝 池上 文詔 奥平 剛史 山口 和克

出版者

一般社団法人 日本肝臓学会

雑誌

肝臓 (ISSN:04514203)

巻号頁・発行日

vol.32, no.9, pp.879-883, 1991

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症例は81歳,男.東京都在住の飲食業者.1989年3月下旬からの発熱が軽快した後,食思不振と黄疸が増強し同年4月25日入院.眼球血膜の充血,著明な胆汁うっ滞型黄疸,腎機能不全,蛋白尿・血尿を認め,ネズミとの接触があったためWeil病を疑い抗生剤投与を開始した.第4病日より意識障害が出現し,第6病日に突然心室細動・粗動が出現した.5月に入り徐々に軽快し,第43病日肝生検施行.小葉中心性の胆汁うっ滞像と巣状壊死が見られたが,肝細胞の解離やWarthin-Starry染色によるレプトスピラ菌の直接証明は出来なかった.また,血・尿中レプトスピラ菌培養は陰性であったが,ペア血清顕微鏡的レプトスピラ生菌凝集反応でserovar icterohaemorrhagiaeとserovar copenhageniの抗体の上昇が見られたためWeil病と診断した.その後著変なく第48病日に退院した.Weil病に重篤な不整脈を初めとした合併症を伴ったが救命し得た.

著者

多賀須 幸男

出版者

Japan Gastroenterological Endoscopy Society

雑誌

日本消化器内視鏡学会雑誌 (ISSN:03871207)

巻号頁・発行日

vol.21, no.10, pp.1159-1177, 1979-10-20 (Released:2011-05-20)

参考文献数

65

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For the endoscopic observation of organs apart from the body surface such as the stomach, introduction of a light source into the body cavity was indispensable for sufficient illumination. Its first attempt was performed by Juluius Bruck Jr., a dentist of Braslau in 1867. He introduced a platinum-loop glow lamp with a water cooling device into the oral cavity or the vagina and tried to observe the root of the teeth or the urinary bladder by trans-illumination (Fig-1). It had no clinical use but the idea was adopted for endoscopy. Max Nitze (1848-1906) was working at a city hospital of Dresden where diaphanoscopy by Bruck's method was actively studied by Schramm . In 1876 Nitze made a cystoscope using a platinum-loop glow lamp. At the same time he applied an optical system to his endoscope for the first time. It was inserted into a tube incorporated with the lamp and cooling device (Fig-2). Later he collaborated with Leiter, an engineer of Wien and completed his instrument. In 1876 he demonstrated his new cystoscope at a meeting of Wien Medical Association under a title of “On a new method for the observation of human cavity ” and made a great success (Fig-3). Nitze is called as the father of cystoscopy today. Nitze and Leiter made various endoscopes. Their gastroscope had an angle of 90 degree at the level of the throat and was flexible when it was introduced into a patient (Fig-4). Because of the angle and its complicated structure, it was never applied for living subjects. Soon disagreement happened between Nitze and Leiter and their collaboration was broken. In 1881 Johanes von Mikulcz (1850-1905), a surgeon of Wien completed his gastroscope with Leiter (Fig-6). It was designed following his careful anatomical and clinical considerations. Its practical application was also studied in detail . Gastroscopy today bases on the technique established by him. The stomach was insuf f lated with air and the examination was carried out in the decubitus position after the injection of morphine . Mikulicz may be the first one who was really able to inspect the stomach with an endoscope. In 1886 Edison's incandenscent lamp became available for endoscopes and sufficient illumination without complicated cooling system was obtained In 1895 Rosenheim showed that a straight rigid gastroscope could be introduced into the stomach by proper manipulation. Until 1930 many types of gastroscope were made (Table-1, Fig-7) They can be divided into three groups :1) open tubes, 2) straight or angulated rigid tubes with optical system and 3) flexible tubes to be straightened after introduction. Among them the straight rigid gastroscopes of Elsner and of Schindler were most extensively uses. When we look at the beautiful color pictures on Elsner's (1911) or Schindler's (1923) textbook, we are astonished by their exact and minute observations (Color photos, Fig-3-9). Needless to say that gastroscopy with a rigid instrument was not easy for a doctor and painful for a patient. Schindler reported that he succeeded in the observation of the stomach in 55% of his examination. Until 1924 at least 15 perforations due to gastroscopy had been reported. Sauerbruch strongly claimed that gastroscopy should be refused by a surgeon. A word of this famous thoracic surgeon retarded the development of gastroscopy considerably. Esophogoscopy was actively carried out by Rosenheim. Light of an electric bulb was reflected from the outside of the body. Since Rosenheim was an internist, he introduced his esophagoscope without observing the pharynx. Bronchoscopy was established by Killian, an otolaryngologist of Freiburg in 1897. He succeeded to remove foreign bodies from the right bronchus. Later on Jackson eagerly endeavored for the practical application of esophagoscopy and bronchoscopy in USA. Their instrument was a straight open tube and it was used until the completion of a fiberscope chiefly for the extraction of foreign bodies. Killian had much interest in

著者

原田 康司 南雲 久美子 山崎 忠男 野ツ俣 和夫 伊藤 慎芳 土谷 春仁 桜井 幸弘 池上 文詔 多賀須 幸男

出版者

一般社団法人 日本消化器内視鏡学会

雑誌

日本消化器内視鏡学会雑誌 (ISSN:03871207)

巻号頁・発行日

vol.33, no.2, pp.257-263, 1991-02-20 (Released:2011-05-09)

参考文献数

16

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上部消化管粘膜には,細血管が限局性に集籏拡張したAngiodysplasiaがときどき見られる.2年間に施行したPanendoscopy延べ10,163例で認め/れたAngiodysplasia230例を対象に検討した. その頻度は2.26~3.98%,男性に有意に多く,加齢とともに頻度は増加する.単発81.3%,多発18.7%であった.少数が食道・十二指腸に存在したが,98%は胃にあり,胃A・M領域に多くC領域に少ない.血液のstealによると思われる白暈を周辺に持つ「日の丸型」は43.4%,持たない「赤丸型」は56.6%であった. 顕出血例はなく,出血の危険は少ないと思われる.特定の疾患との関連は確認出来なかった.Angiodysplasiaと紛らわしい形態の早期胃癌2例に遭遇した.