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Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer.Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked).A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection.Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.

A 6-year-old female was sent to our ER due to nausea, vomiting and abdominal distension for 2 days. This child had a history of constipation and failed intermittent medical treatment for 2 years. Her plain abdominal X-ray showed multiple intestinal loops and under the impression of acute abdomen with mechanical intestinal obstruction, an exploratory laparotomy was performed. A huge mesenteric tumor was discovered to be the cause of the intestinal obstruction; the involved bowel and the mesenteric lymphangioma were resected and primary anastomosis was done. Mesenteric cystic lymphangioma is a rare cause of bowel obstruction; preoperative diagnosis is difficult due to silent clinical course and lack of awareness of the clinical and morphological features of this disease. The case is presented along with a review of literature with the conclusion that a high index of suspicion is recommended. An abdominal ultrasonography may be recommended to evaluate a long-term constipated child to ascertain that any cystic lesion will not be missed.

Background: Eradication of Helicobacter pylori infection has been shown to prevent recurrent bleeding from peptic ulcers. However, the detection rate for H pylori infection seems to be underestimated in this group of patients and has been scarcely investigated. Methods: Eighty patients with bleeding peptic ulcer were studied for evidence of H pylori infection. Seventy-seven of these patients were enrolled as having H pylori infection after any one of the following 3 tests were positive: culture, histologic study, or any 2 of rapid urease test (CLO test), carbon 13‐labeled urea breath test (UBT), and serologic examination. Fresh blood or blood-containing material in the gastric antrum was noted by panendoscopy in 22 patients (group A). In the remaining 55 cases there was no blood in the antrum (group B). Results: The sensitivities of the CLO test, bacterial culture, histologic study, 13 Clabeled UBT, and immunoglobulin G serologic test were 45.5%, 36.4%, 77.2%, 95.4%, and 100% in group A, respectively, and 70.9%, 40.0%, 70.9%, 92.7%, and 96.4%, respectively, in group B. There was a statistically significant difference between the sensitivities found for CLO test and 13 C-labeled UBT (p < 0.05). Of these 5 tests, only the sensitivity of the CLO test showed a statistically significant difference between groups A and B (p < 0.05). A delayed positive CLO test result was recorded in 13 patients (3 in group A, 10 in group B). Conclusion: Noninvasive tests seemed to be more sensitive than invasive tests in detecting H pylori infection in patients with bleeding peptic ulcers. Blood in the antrum might reduce the sensitivity of the CLO test but have no effect on the other tests. The CLO test should be observed for more than 24 hours because of the possibility of a delayed positive result in some patients with bleeding peptic ulcers. (Gastrointest Endosc 1999;49:302-6)

OBJECTIVE AND IMPORTANCE: Intraosseous schwannomas (neurilemomas) are rare neoplasms. In one large series, schwannomas accounted for less than 0.2% of all primary bone tumors. These schwannomas most commonly arise in the mandible and have also been observed, very rarely, in the vertebra. We present a patient with an unusual intraosseous schwannoma in the lumbar vertebra. CLINICAL PRESENTATION: A 58-year-old man who was admitted to Cathay General Hospital had complained of numbness and pain in his lower extremities for approximately 1 year. At the time of admission, a neurological examination revealed mild motor weakness and sensory numbness bilaterally in his lower legs. Magnetic resonance images showed a neoplastic lesion occupying the entire L4 body and the superior part of the L5 body, with marked perivertebral protrusion and compression of the thecal sac and bilateral neuroforamina. INTERVENTION: The patient underwent a computed tomography-guided needle biopsy and a two-stage operation. During the initial surgical procedure, the tumor mass was totally removed via an anterolateral approach. Fixation and fusion of the third to fifth lumbar vertebral bodies was accomplished using a full-thickness iliac bone graft with an anterior locking plate and screws. During the second operation, posterior fusion of L2, L3, L4, L5, and S1 with Luque wires and a Hartshill rectangle rod was performed to increase the spinal stability. CONCLUSION: Intraosseous schwannomas are rare neoplasms that are not commonly observed in the lumbar vertebral bodies. Schwannomas in the lumbar spine commonly originate from the nerve passing through the neural foramina. We report a rare case of L4 intraosseous schwannoma, the magnetic resonance imaging, computed tomographic, and histological findings, and the surgical procedures.

Background and objective. Some women with persistent or recurrent disease after repeated conization for high grade cervical intraepithelial neoplasia (CIN) may desire to preserve uterus if not fertility. In such case, a partial trachelectomy may become treatment of choice for them. We undertook this prospective study to determine the feasibility of partial trachelectomy as a treatment choice for persistent or recurrent high grade CIN. Method. Twenty premenopausal women with persistent or recurrent high grade CIN after initial LEEP and repeated conization refused hysterectomy thus elected to undergo excision of vaginal portion of uterine cervix under general anesthesia in a tertiary university-affiliated medical center. High risk human papillomavirus (HPV) detection was done before initial loop electrosurgical excisional procedure (LEEP) and 3 months after partial trachelectomy. Follow-up PAP smear and colposcopy were done every 3 months during the first 2 years. If both examinations were negative, they were changed to yearly follow-ups. Results. The out-patient procedure is simple and takes only 6.5 min in average. High risk human papillomavirus (HPV) were eradicated after procedure in all cases. During an average follow-up of 48 months, no recurrent dysplasia was observed. Conclusions. Partial trachelectomy is a reasonable alternative treatment choice for those who suffer persistent or recurrent CIN and desire to preserve their uterine corpri.

Background Auricular tophi are firm deposits of monosodium urate in crystal form, which may slowly develop in subcutaneous tissue of the ear. Ear is not usual locations for gout tophi, but when this growth does occur, helix and the antihelix are common sites. Case presentation We present a 64-year-old man who had multiple painless nodules over bilateral helix. An excisional biopsy was performed. Hematoxylin-eosin staining of biopsy specimens revealed a proteinaceous matrix that surrounded dissolved crystals, consistent with gout tophi. Bilateral auricular tophi are not common and may resemble a number of other diseases including squamous cell carcinomas, Kaposi’s sarcoma, epidermal and dermoid cysts, rheumatoid nodules. Biopsy should be performed to rule out malignancy. Conclusions Tophi of the auricle are usually asymptomatic but can become inflamed and occasionally ulcerate through the overlying skin. Chronic tophaceous gout is treated with dietary control and medication. Surgical excision is performed under local anesthetic if symptoms progression or cosmetically deformity is concerned.

Serous surface papillary carcinoma (SSPC) is a distinct type of ovarian cancer; most of the patients present with extensive intraabdominal disease at the time of diagnosis. In a 48-year-old patient with 6-month history of inguinal and then scalene lymphadenopathy, although series workup did not disclose any primary tumor, an exploratory laparotomy was performed because of the abnormally high serum CA-125 level (1024 U/ml) and the pathologic examination of the inguinal node suggesting an ovarian origin. At exploration, there was only a discernible SSPC lesion on the right ovary; no intraperitoneal spread but extensive lymph node metastasis was found. The patient died of disease 30 months after surgery, although adjuvant and salvage chemotherapy was given. Ovarian cancer should be part of the differential diagnosis in a woman with systemic lymphadenopathy but without any evidence of intraabdominal disease.

An 81 year old woman with extensive polycystic liver disease received laparoscopic unroofing and fenestration, followed by 95% ethanol sclerotherapy, resulting in almost complete disappearance of the cysts. Such a procedure can avoid complications of both the multi-segmental liver resections and extensive fenestrations, and untoward reactions from a large amount of alcohol. In addition, it can achieve a satisfactory result. It is suggested that this procedure could be a safe and effective alternative to traditional open surgery in selective patients.

To investigate the clinical characteristics of a coexisting sharp ductal angulation (90 degrees) with biliary stricture and to evaluate the difficulties it imposes in the management of retained or recurrent hepatolithiasis.Case-controlled study.A referral center.Eighteen consecutive patients having right-sided hepatolithiasis and a coexisting sharp ductal angulation associated with biliary stricture (group 1) were compared with 84 patients matched with sex, age, and conditions of hepatolithiasis and intrahepatic biliary stricture(s) but no sharp angulated duct (group 2).Postoperative cholangioscopic management (electrohydraulic lithotripsy or other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube tract or percutaneous transhepatic route).Sessions of manipulations, incidence of complications associated with interventions or disease, and mortality were compared.Patients of group 1 needed more sessions of postoperative manipulation of stones and strictures (13.7 +/- 4.2 vs 8.0 +/- 2.3; P.001). During management, there was a significantly increased vulnerability of severe and/or recurrent cholangitis (66.7% vs 9.5%; P.001), septic shock (77.8% vs 11.9%; P.001), liver abscess (55.6% vs 7.1%; P.001), or massive hemobilia (33.3% vs 7.4%) in group 1 than in group 2. Their risks of coexisting secondary biliary cirrhosis (55.6% vs 9.5%; P.001) and/or cholangiocarcinoma (16.6% vs 2.4%; P.04) and mortality (27.8% vs 4.8%; P.01) were also significantly higher in group 1.Our results suggest that the coexisting sharp ductal angulation with biliary strictures in right-sided hepatolithiasis is a distinct difficult clinical entity in the field of biliary tract calculi.

To evaluate the association of pre-treatment (13)C-urea breath test (UBT) results with H pylori density and efficacy of eradication therapy in patients with active duodenal ulcers.One hundred and seventeen consecutive outpatients with active duodenal ulcer and H pylori infection were recruited. H pylori density was histologically graded according to the Sydney system. Each patient received lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1 g b.i.d.) for 1 week. According to pre-treatment UBT values, patients were allocated into low (16 per thousand), intermediate (16-35 per thousand), and high (35 per thousand) UBT groups.A significant correlation was found between pre-treatment UBT results and H pylori density (P0.001). H pylori eradication rates were 94.9%, 94.4% and 81.6% in the low, intermediate and high UBT groups, respectively (per protocol analysis, P=0.11). When patients were assigned into two groups (UBT resultsor =35 per thousand and35 per thousand), the eradication rates were 94.7% and 81.6%, respectively (P=0.04).The intragastric bacterial load of H pylori can be evaluated by UBT, and high pre-treatment UBT results can predict an adverse outcome of eradication therapy.

Growth at the anastomotic site after continuous vascular anastomosis in the pediatric patient remains a problem. Primary end-to-end anastomosis of the infrarenal aorta was performed with absorbable Maxon suture or nonabsorbable Prolene suture in 20 piglets. Ten of the Maxon suture group and nine of the Prolene suture group survived; one pig died of infection. The animals were put to death 6 months after the operation. Each abdominal aorta was removed and a roentgenogram was obtained. The aorta was then burst-tested to 300 mm Hg, measured, and examined both grossly and histologically. All anastomoses were patent and no burst failures were observed in either group. However, Prolene sutures protruded into lumen and were partially embedded in the aortic wall in all animals in the Prolene suture group. Thrombus adhered to the intraluminal Prolene suture in six of nine animals. The growth of the anastomotic area was wider in the Maxon suture group (446.4% +/- 131.8% versus 317.6% +/- 121.5%, p less than 0.05). Stenosis was more common in the Prolene suture group (7/9) than in the Maxon suture group (1/10) (p less than 0.01), but the distal segment was widely patent in both groups. Dilatation at the anastomotic site was present in eight of 10 pigs in the Maxon suture group and in two of nine in the Prolene suture group. Histologic study showed that the area of tissue reaction was more prominent in the Prolene suture group. No sutures were observed in the Maxon suture group. We therefore recommend the use of absorbable Maxon sutures for anastomoses in which the suture line must be able to grow.

In humans, chronic infection with the gammaherpesvirus Epstein–Barr virus is usually asymptomatic; however some infected individuals develop hematological and epithelial malignancies. The exact role of EBV in lymphomagenesis is poorly understood partly because of the lack of clinically relevant animal models. Here we report the detection of serological responses against EBV capsid antigens in healthy dogs and dogs with spontaneous lymphoma and that dogs with the highest antibody titers have B cell lymphoma. Moreover, we demonstrate the presence of EBV-like viral DNA and RNA sequences and Latent Membrane Protein-1 in malignant lymph nodes of dogs with lymphoma. Finally, electron microscopy of canine malignant B cells revealed the presence of classic herpesvirus particles. These findings suggest that dogs can be naturally infected with an EBV-like gammaherpesvirus that may contribute to lymphomagenesis and that dogs might represent a spontaneous model to investigate environmental and genetic factors that influence gammaherpesvirus-associated lymphomagenesis in humans.

Background This study aimed to investigate whether the DNA methylation of human ovarian carcinoma stromal progenitor cells (OCSPCs) could promote the tumorigenesis of ovarian carcinoma. Methods OCSPCs were first isolated from fresh tumor tissues and ascites of ovarian cancer patients. In vivo and in vitro experiments on the effect of the OCSPCs on tumorigenesis and the effects of DNA demethylation on the OCSPCs were then performed. Results The OCSPCs possessed self-renewal and multipotent differentiation capacity with elevated expressions of OCT4, NANOG, BMP2, BMP4, Rex-1, AC133 and TGF-β. The OCSPCs, when combined with tumor cells in vivo could promote tumor growth. The methylation profiles of tumor suppressor genes (TSGs) were significantly higher in the OCSPCs than in ovarian cancer cells (p

Background The root of Gentiana scabra is commonly known as Longdan in Chinese herbal medicines and has been used in the treatment of inflammation, anorexia, indigestion and gastric infections for over 2000 years. High market demand had made G. scabra (GS) plants not to be the only source of Longdan in China, other Gentiana spp., G. triflora, G. manshurica and G. rigescens, were also recognized as Longdan in China now. Results In this study, we identified three Taiwan-specific Gentiana spp., G. davidii var. formosana (GDF) and G. arisanensis (GA) and G. scabrida var. punctulata (GSP) that are phylogenetically different from GS (main source of Longdan). However, the active compounds of Longdan, gentiopicroside and swertiamari, were found in GSP and GDF showed higher antioxidant ability and free radical scavenging activities than Chinese Longdan. This discovery might explore the medicinal potential of GDF. Meanwhile, another Taiwan-specific Gentiana spp., GSP, was found to have the strongest antioxidant ability and free radical scavenging activities which might suggest a possible use of GSP as a source of natural antioxidant agents for industrial purpose. Conclusions The finding of this study indicated that ITS analysis can be used to identify Taiwan-specific Gentiana spp. Also the Taiwan-specific Gentiana spp. which has strongest antioxidant and free radical scavenging activities among others could be a better choice for industrial purpose.