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Patient: Female, 84 Final Diagnosis: Bouveret syndrome Symptoms: Abdominal and/or epigastric pain vomitting Medication: — Clinical Procedure: Electrohydraulic lithotripsy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Bouveret syndrome is a rare complication of cholelithiasis that often leads to symptoms of gastric outlet obstruction. Case Report: An 84-year-old woman developed acute abdominal symptoms due to impaction of a gallstone in the horizontal part of the duodenum. The diagnosis was supported by abdominal computed tomography and double balloon endoscopy. Considering her advanced age and the position of the calcified gallstone, we decided to perform electrohydraulic lithotripsy using double balloon endoscopy for treatment. Finally, the impacted stone was removed with reduced size. She was discharged home 10 days after admission without recurrence. Conclusions: This case illustrates that electrohydraulic lithotripsy using double balloon endoscopy is very effective, especially for treatment of Bouveret syndrome caused by gallstone impaction in the horizontal part of the duodenum.

The prevalence of chronic diarrhea in the general population is reported to be 4%-5%. Since various pathological conditions cause diarrheal symptoms, etiological diagnosis of chronic diarrhea is difficult in many cases. Medical history taking, physical examinations, and laboratory testing are not adequately sensitive or specific, thus a colonoscopic investigation is frequently employed for etiological evaluation. However, for cases with non-bloody chronic diarrhea, the diagnostic yield of a colonoscopy procedure is reported to be not high enough. Furthermore, endoscopically identifiable findings are not adequately specific for the diagnosis of diarrheal disease, except for inflammatory bowel disease, while microscopic colitis, amyloidosis, eosinophilic gastroenteritis, celiac disease, and bile acid diarrhea are difficult to definitively diagnose using endoscopic findings. Thus, a histopathological examination of biopsy samples obtained with endoscopy is critically important. Endoscopists should consider obtaining biopsy samples from even normal-appearing gastrointestinal mucosa for chronic diarrhea diagnosis.

Patient: Male, 73 Final Diagnosis: Pancreatitis Symptoms: Upper abdominal pain Medication: — Clinical Procedure:— Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Adenomatous polyposis coli is an autosomal dominant hereditary disorder. Duodenal adenocarcinoma and adenoma, which are extracolonic lesions, not only affect the prognosis of patients but also cause acute pancreatitis. Case Report: We present the case of a 73-year-old male. He had undergone proctocolectomy for familial adenomatous polyposis and distal gastrectomy (Billroth II reconstruction with Braun anastomosis) for gastric ulcer; he presented with acute pancreatitis caused by ampullary duodenum adenoma. Double-balloon endoscopy showed 2 adenomatous polyps in the major papilla and descending limb of the duodenum. Based on the findings of endoscopy and biopsy, the duodenal polyps were diagnosed as adenomas and classified as Spigelman stage II. Conclusions: Our case report suggests that duodenal surveillance is necessary for patients with adenomatous polyposis coli. In addition, surveillance using double-balloon endoscopy is useful for patients with an altered gastrointestinal anatomy.

Background Hepatocellular adenoma (HCA) is a rare liver tumor that has the potential for rupture and malignant transformation. Here, we report a case of multiple hepatocellular adenomas (HCAs) that were treated by surgical resection. Case presentation An 18-year-old man was admitted to our hospital with proteinuria. His height was 176.5 cm, weight was 126 kg, and body mass index was 40 kg/m2. A liver tumor was incidentally found on abdominal ultrasonography. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed three hepatic tumors that were 68 mm, 16 mm, and 9 mm in segments 3/4, 8, and 1, respectively. A percutaneous needle biopsy of the largest tumor was performed, the diagnosis of unclassified type HCA was made, and laparoscopic partial liver resection was performed of all three. The postoperative course was uneventful, and the patient was discharged 12 days later. An immunohistochemical examination revealed positivity for serum amyloid A protein, no decrease in fatty acid-binding protein, and negativity for β-catenin, glutamine synthetase, and cytokeratin 7. Therefore, these tumors were diagnosed as inflammatory type HCAs. Conclusions We reported an extremely rare case of multiple resected HCAs in a young, obese Japanese man. Our findings suggest that HCA should be considered in the differential diagnosis of liver tumor in obese patients. Further studies that consider clinical and molecular risk factors are required to establish individualized treatment plans for HCA in obese patients.

The membrane fraction of anterior pituitary in laying hens was found to possess a vasoactive intestinal polypeptide (VIP)-binding component having the properties of a receptor. Scatchard analysis of saturation studies revealed that the binding component had a single class of binding site with an equilibrium dissociation constant (Kd) of 0.092 ± 0.008 (mean ± SEM; n=5) nM and the maximum binding capacity (Bmax) of 631 ± 41 fmol/mg protein. The Kd value determined from kinetic analysis (0.091 ± 0.002 nM; n=3) was very similar to that obtained from Scatchard analysis. The Kd value obtained from Scatchard analysis was not significantly different between the laying and nonlaying hens. The Bmax in laying hens was greater than that in nonlaying hens. The administration of chicken VIP to nonlaying hens caused a marked decrease in the VIP receptor binding in the anterior pituitary with a concomitant increase in the blood serum concentrations of prolactin. The results may provide an evidence for a direct action of VIP on the anterior pituitary of female chickens.

The existence of specific progesterone-binding sites with a high affinity and a limited capacity was demonstrated by [3H] progesterone exchange in the nuclear fractions of the pituitary and hypothalamus as well as in those of the oviduct magnum in the hen.