We studied 118 patients using endoscopic color Doppler ultrasonography (ECDUS) to evaluate perforating veins of esophageal varices. The ECDUS was performed with a PENTAX FG‐32UA or FG‐36UX (7.5 MHz, convex type) and a HITACHI EUB 565 was used as a display device. We defined the perforating veins as communicating vessels between esophageal varices and paraesophageal veins. We evaluated the detection rate and the direction of blood flow in the perforating veins. Color flow images of perforating veins were obtained in 43 of the 118 (36.4%) patients. We classified the perforating veins into three types. Type 1 was characterized as an inflow type from paraesophageal veins to esophageal varices, Type 2 as an outflow type from esophageal varices to paraesophageal veins and Type 3 as a mixed type showing both inflow and outflow. Type 1 was recognized iri 37 (86.0%), Type 2 in four (9.3%) and Type 3 in two (4.7%) of 43 patients. We conclude that ECDUS is a useful modality for obtaining diagnostic color flow images of perforating veins, and for evaluating the blood flow direction in perforating veins. (Dig Endosc 1996; 8: 180‐183)

Using our new culture system for multinucleate cells (MNCs) that have many characteristics of osteoclasts, we examined the effects of factors produced by osteoblastic cells on osteoclastic cell formation. Conditioned medium (CM) from undifferentiated osteoblastic MC3T3-E1 cells during their growth phase inhibited MNC formation in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3]. Diluted CM (1:81) from differentiated cells obtained after cultivation for more than 20 days stimulated MNC formation, but at lower dilutions inhibited their formation. Dialyzed CM (greater than 2000 mol wt) from the differentiated cells was more stimulatory than undialyzed CM and showed no inhibitory effect on MNC formation. The inhibitory effect was observed with filtered (less than 3000 mol wt) CMs and was specific for osteoblastic cell CM. Prostaglandin E2 (PGE2) was detected in the CM from undifferentiated or differentiated MC3T3-E1 cells at concentrations (317 +/- 66 and 1287 +/- 179 pg/ml, respectively) sufficient to inhibit MNC formation, and this inhibition was partially abolished with CM (at 3-fold dilution) in indomethacin-treated cells (PGE2, less than 20 pg/ml), suggesting PGE2-mediated inhibition of MNC formation and the presence of another factor(s) besides PGE2 that influenced MNC formation. In contrast to day 3 CM plus 1,25-(OH)2D3, day 60 CM plus 1,25-(OH)2D3 induced MNC formation even in the absence of GM-CSF, and this induction was inhibited by an antibody to GM-CSF. Secondary colony formation assays showed the presence of a GM-CSF-like factor in the day 60 CM. These findings indicate that osteoblastic cells are involved in the process of osteoclastic cell formation, with at least two soluble factors produced by osteoblasts, a GM-CSF-like factor, which is stimulatory, and PGE2, which is inhibitory. The effects of CMs also differed depending on the stage of osteoblast differentiation.

We studied 14 patients using endoscopic color Doppler ultrasonography (ECDUS) to evaluate the hemodynamics of gastric varices, and evaluated the endoscopic therapeutic effects on gastric varices in 8 patients. Three patients had F3 type gastric varices and eleven had F2. The ECDUS was performed with a PENTAX FG‐32UA (7.5MHz, convex type) and a HITACHI EUB 565 was used as a display machine. The intramural blood flow in the gastric varices and inflows from the extra‐gastric wall were clearly observed with the ECDUS in all 14 patients. The extramural blood flow (gastro or spleno‐renal shunts) was detected in 9 of 14 patients. The velocity of the intramural flow in tumorous type varices (F3) was higher than in the nodular or flat elevated type (Fa). Next, we evaluated the therapeutic effects on gastric varices of the ECDUS. The successful disappearance of intramural blood flow was observed in 6 of 8 patients who had this endoscopic therapy. In two of the 8 patients, there was not enough therapeutic effect on the intramural blood flow. The extramural blood flow, however, did not change before or after endoscopic therapy with the ECDUS. Therefore, we concluded that ECDUS is a very useful modality for the diagnosis of hemodynamics and to evaluate the therapeutic effects on gastric varices.

A 71-year-old male suffering from an intraductal papillary tumor of the pancreas was admitted to our hospital for further investigation. Diagnostic trials, including endoscopic retrograde pancreatography, did not produce an adequate ductography because of a large amount of mucinous fluid. Therefore, we performed endoscopic ultrasonographic-guided punctured pancreatic ductography (EPPD). This procedure was safely performed without any complications. We report this initial and successful trial of EPPD.

We treated 14 patients with high risk intramucosal venous dilatation (high risk IMVD) of esophageal varices using heat‐probe coagulation. Two of the 14 patients experienced bleeding from the high risk IMVD. We used an Olympus heat‐probe unit CD‐20Z to stop or prevent variceal bleeding. The 14 patients were treated one to four times (mean: 1.9 times) using a total of 450–2100 joules (mean: 1459 joules). The high risk IMVD disappeared with healing of the heat‐probe‐induced ulcers. No severe side effects were recorded. Two patients with bleeding from high risk IMVD were successfully treated by the heat‐probe technique. In addition, we studied the effects of endoscopic heat‐probe coagulation for esophageal varices via endoscopic color Doppler ultrasonography (ECDUS) in six patients. Our ECDUS study was conducted with a PENTAX FG‐32UA, 7.5MHz convex type, and a HITACHI EUB 565 display monitor. Following heat‐probe treatment, the esophageal walls thickened from 5.1 to 8 mm (mean: 6.3 mm) and a low echoic pattern was visualized by ECDUS. Esophageal intramural blood flow was not observed in any of the six patients. Paraesophageal veins and passageways remained patent in all six patients.