Search

Introduction: The purpose of this study was to optimize the surveillance frequency and period for efficient detection of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication. Methods: Data from patients with eradicated HP infection were extracted from the endoscopy databases of two institutions from January 2016 to March 2021. The patients were divided into a close follow-up group with frequent surveillance after eradication and an open follow-up group with an intermittent surveillance method, and the cases of post-eradication EGC found in the two groups were analyzed. Results: Thirty-six out of 9,322 patients (0.39%) in the close follow-up group and 20 out of 11,436 patients (0.17%) in the open follow-up group were found to have EGC. The cumulative incidence of EGC after eradication was significantly higher in the close follow-up group (p = 0.004). The duration between eradication and EGC detection was significantly shorter in the close follow-up group (51.7 vs. 90.5 months, p = 0.002). A logistic regression model revealed that duration after eradication was an independent predictor for detecting EGC in the close follow-up group (p = 0.045). A Cox proportional hazards model revealed that the close follow-up strategy was effective in patients with an eradication duration of less than 65 months to identify EGC (p = 0.015), but there was no difference between the two strategies in patients with an eradication duration of more than 65 months (p = 0.624). Discussion/Conclusions: Frequent surveillance after HP eradication is efficient for the early detection of EGC during the first 65 months.

There is concern that the COVID-19 pandemic may cause people to refrain from undergoing examination resulting in delayed detection of colorectal cancer (CRC). The purpose of this study was to investigate whether there was a delay in CRC detection due to withholding of screening.The colonoscopy screening rate and the CRC detection rate were calculated for patients who underwent fecal immunochemical tests (FITs) from 2018 to 2021 in the longitudinal cohort. The stages of CRC cases detected as a result of positive FIT in each year were compared.A total of 39,521 patients were initially screened by FIT over a 4-year period. The FIT-positive rate was 4.7% (441 /9,349) in 2018, 4.6% (420 /9,156) in 2019, 4.9% (453 /9,255) in 2020, and 4.3% (504 /11,760) in 2021. The colonoscopy screening rate for positive FIT results was lower in 2020 than in 2019 (25.8% vs. 38.1%, P 0.001), and higher in 2021 than in 2020 (56.7% vs. 25.8%, P 0.001). The CRC detection rate among colonoscopy recipients was higher in 2021 than in 2020 (13% vs. 4%, P = 0.014). Stage 1 or higher CRC accounted for 25.0% (1/4) in 2020, and 78% (18/23) in 2021. Among the CRC cases detected each year, 1 (14%), 1 (25%), and 10 (43%) did not undergo colonoscopy despite positive FIT results in the previous year.The COVID-19 pandemic has reduced the detection of CRC by screening colonoscopy following FIT and might have led to a delay in the detection of CRC.

It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image-enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.

The UPICC has never been explicitly used by Japanese courts in interpreting or supplementing Japanese law. There is no institutional or legal barrier for using the UPICC for that purpose as far as the principles in the UPICC can be viewed as representing “customs” or “trade usages”. Nonetheless, that has not happened. One possible explanation for this is the general reluctance (or style of drafting judgments) of judges to refer to foreign laws in their judgments. Another possible explanation may be the lack of familiarity of judges with the UPICC, although this may change once the 2017 Revision of the Civil Code, which took into account modern contract law rules including the UPICC, comes into effect in 2020. Another possibility is the general consistency of Japanese law with the UPICC on the one hand, and the lack of ambiguity of Japanese law when they differ from the UPICC on the other. Many principles of the UPICC concerning interpretation, termination, interest etc. are largely compatible with Japanese contract law rules found either in the Codes or developed by case law.

Abstract: Compared to European countries, the fragmentation of law is not so material and has not caused serious problems in Japan, because Japan does not belong to a regional framework such as the European Union and Japanese law clearly stipulates the priorities between different norms in Japanese legal practice. On the other hand, in academic, there have been researches on the fragmentation of international norms, such as the applicability of non-state norms and the importance of soft laws. Japanese government considered it necessary to strengthen the proficiency of judicial professionals in dealing with transnational cases. I agree. However, the education at law schools has put too much stress on Japanese basic laws and has failed to strengthen the proficiency of young Japanese lawyers. In relation to the Japanese court practice, some academics point out that judges tend to avoid application of foreign laws because the application of Japanese law makes the handling of the case easier. In my view, it should be considered to set up a special branch of a special department of the Japanese court which deals with cases with cross-border elements and could hear cases in English if necessary. Résumé: Par rapport aux pays européens, la fragmentation du droit n'est pas aussi marquée au Japon et n'y a pas créé de problèmes graves car ce pays n'appartient pas à un cadre régional, comme cela peut être le cas pour l'Union européenne. En outre, la loi japonaise stipule clairement les priorités qui s'appliquent entre les différentes normes de la pratique juridique. D'autre part, dans les milieux universitaires, des recherchesont été menées sur la fragmentation des normes internationales, telles que l'applicabilité des normes non-étatiques et l'importance des lois douces. Le gouvernement japonais a jugé nécessaire de renforcer les compétences des professionnels de justice pour traiter les affaires transnationales. Je suis d'accord. Toutefois, l'enseignement dans les écoles de droit a trop insisté sur les lois japonaises fondamentales et n'a pas réussi à renforcer les compétences des jeunes avocats japonais. En ce qui concerne la pratique judiciaire du pays, certains universitaires soulignent que les juges ont tendance à éviter l'application des lois étrangères car la loi japonaise facilite le traitement de l'affaire. À mon avis, il faudrait envisager de mettre en place une division spéciale du tribunal japonais, qui traite des affaires contenant des éléments internationales et qui pourrait traiter les affaires en anglais si nécessaire.

Background: The clinical significance of Helicobacter pylori antibody titer has been controversial, and the association between the extent of gastric atrophy or acid secretion and H. pylori antibody concentration has not been elucidated. Materials and Methods: Serum pepsinogen, H. pylori antibody concentration, and fasting gastric pH (as an indicator of acid secretion) were measured in 231 patients undergoing upper gastrointestinal endoscopy. “Atrophic” pepsinogen was defined as pepsinogen-I

Background/Aims: In the normal acid-secreting stomach, luminally generated nitric oxide, which contributes to carcinogenesis in the proximal stomach, is associated with the concentration of nitrate plus nitrite (nitrate/nitrite) in gastric juice. We investigated whether the serum nitrate/nitrite concentration is associated with that of gastric juice and whether it can be used as a serum marker. Methods: Serum and gastric juice nitrate/nitrite concentration, Helicobacter pylori antibody, and gastric pH were measured in 176 patients undergoing upper endoscopy. Results: Multiple regression analysis revealed that serum nitrate/nitrite concentration was the best independent predictor of gastric juice nitrate/nitrite concentration. On single regression analysis, serum and gastric juice nitrate/nitrite concentration were significantly correlated, according to the following equation: gastric juice nitrate/nitrite concentration (µmol/l) = 3.93 – 0.54 × serum nitrate/nitrite concentration (µmol/l; correlation coefficient = 0.429, p < 0.001). In analyses confined to subjects with gastric pH less than 2.0, and in those with serum markers suggesting normal acid secretion (pepsinogen-I >30 ng/ml and negative H. pylori antibody), the serum nitrate/nitrite concentration was an independent predictor of the gastric juice nitrate/nitrite concentration (p < 0.001). Conclusion: Measuring the serum nitrate/nitrite concentration has potential in estimating the gastric juice nitrate/nitrite concentration. The serum nitrate/nitrite concentration could be useful as a marker for mutagenesis in the proximal stomach.

Previous studies have suggested that hypochlorhydria has the potential to produce adverse effects such as the development of infections of the intestinal or respiratory tract and impaired drug absorption. This indicates the importance of obtaining a noninvasive method by which this condition may be diagnosed. The purpose of this study was to determine whether fasting gastric pH could be predicted noninvasively using serum biological markers.One hundred thirty-two patients undergoing diagnostic upper gastrointestinal endoscopy were recruited. Serum levels of pepsinogen-I, pepsinogen-II and Helicobacter pylori antibody were analyzed and the pH of fasting gastric juice determined. Multiple linear regression analysis was used to determine the best predictors of fasting gastric pH.Pepsinogen-I and the presence of Helicobacter pylori were independent predictors of fasting gastric pH, and a high coefficient of determination was obtained (R2 = 0.503, root mean square error = 1.45). The equation for this model was as follows: fasting gastric pH = 2.97-0.026 (pepsinogen-I)+2.76 (presence of Helicobacter pylori: 0=absent, 1=present).The model equation offers a noninvasive method by which to identify patients at high-risk of developing complications induced by hypochlorhydria.

Objective.To identify a biomarker for prediction of the response to infliximab (IFX) in patients with rheumatoid arthritis (RA), we focused on a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5) that seems to play a key role in aggrecan degradation in cartilage.Methods.Seventy-three randomly selected patients with active RA were treated with IFX. Peripheral blood samples were collected at baseline and ADAMTS5 messenger RNA (mRNA) was quantified using real-time polymerase chain reaction.Results.Baseline ADAMTS5 mRNA levels in the good responder group were significantly lower (1.84 ± 1.56; p = 0.0408) than those in the moderate and nonresponder groups (2.54 ± 1.70) at 38 weeks of treatment with IFX. The 28-joint count Disease Activity Score (DAS28) at 38 weeks of treatment was significantly lower in the low ADAMTS5 group (2.30 ± 1.28; p = 0.0038) than in the high ADAMTS5 group (3.90 ± 1.61). The percentage reduction of the DAS28 was significantly higher in the low ADAMTS5 group (52.5% ± 28.8%; p = 0.0156) than in the high ADAMTS5 group (29.4% ± 27.2%). Further, the Δ Health Assessment Questionnaire (ΔHAQ) score, an estimate of the improvement in the HAQ score, at 38 weeks of treatment was significantly higher in the low ADAMTS5 group (1.18 ± 0.60; p = 0.0102) than in the high ADAMTS5 group (0.21 ± 0.78). The positive predictive value of a low baseline ADAMTS5 level for predicting good response and remission (DAS28 < 2.6 at 38 weeks) was 90.0% and 70.0%, respectively.Conclusion.The baseline ADAMTS5 mRNA level is a candidate biomarker for prediction of the response to IFX in patients with RA.

In this report, we describe two cases of small-cell lung cancer (SCLC) presenting with fulminant hepatic failure as the initial manifestation. Neither of the patients had a previous history of liver disease, evidence of viral infection, or exposure to hepatotoxins. Both presented with hepatomegaly and an increase in the serum LDH level. Although they had a history of smoking and respiratory symptoms such as dyspnea on exertion, their most striking initial symptoms were those of hepatic failure, which made it difficult to suspect the underlying primary lung cancer. In one case, contrast-enhanced CT of the abdomen revealed hypovascular nodules that were not visible on plain CT. After a rapidly deteriorating course, both patients died, 8 and 13 days after admission, respectively. Autopsy revealed diffuse infiltration of the hepatic sinusoids and extensive replacement of the liver parenchyma by metastatic small-cell carcinoma. We conclude that metastatic SCLC should be considered in the differential diagnosis in patients of advanced age with a smoking history presenting with rapidly progressive liver failure associated with hepatomegaly and elevation of the serum LDH.

Granulysin is a recently characterized cytotoxic granule expressed in cytotoxic T cells and NK cells. Although its cytotoxic effect against a number of tumor cell lines has been demonstrated in vitro, recent study with transgenic mice, and a number of clinical studies, have further established its significance in cancer immunology. Granulysin may offer a useful indicator in the prognosis of cancer, and an understanding of the mechanism by which it destroys target cells would provide vital information in the development of new therapies for the treatment of this disease.

Summary Background Ghrelin, growth-hormone-releasing peptide, has been reported to accelerate food intake and gastrointestinal motility. Aim The present study was designed to investigate the plasma ghrelin levels in patients with functional dyspepsia (FD). Patients and Methods Ninety-seven patients, who showed no evidence of peptic ulcer disease or gastrointestinal cancer on upper gastrointestinal endoscopy, were recruited. Seventeen patients who had no gastrointestinal symptoms were recruited as controls. Forty-seven patients were diagnosed to be suffering from FD, based on the Rome II criteria. The FD patients were further subdivided into those with ulcer-like FD, dysmotility-like FD and non-specific-type FD, based on their Gastrointestinal Symptom Rating Scale (GSRS) scores. Fourteen patients were categorized as having gastro-oesophageal reflux disease, and 19 patients were excluded as having the irritable bowel syndrome, based on the GSRS. The plasma ghrelin levels were measured by radioimmunoassay. Results The plasma ghrelin levels were significantly higher in FD patients, especially in those with dysmotility-like FD, as compared with those in controls. The plasma ghrelin levels were also correlated well with the indigestion scores. Conclusion Plasma ghrelin levels are significantly higher in patients with dysmotility-like FD, suggesting that this parameter could become useful as a novel supportive marker for the diagnosis of FD.

Summary Aim To examine whether Helicobacter pylori induces structural chromosomal aberrations, such as loss of heterozygosity (LOH) and microsatellite instability (MSI) in the infected gastric mucosa. Methods Subjects were 13 patients with H. pylori-positive and 9 with H. pylori-negative gastric cancer and 20 patients with H. pylori-positive and 4 patients with H. pylori-negative chronic gastritis. Gastric mucosal tissues were endoscopically sampled from each subject. Each sample was checked for structural chromosomal aberrations (LOH and MSI) by PCR and microsatellite analysis, using a total of 31 primers corresponding to the regions containing the major genes of chromosomes 1q, 5q, 7q, 17p, 17q, 18q and 21q. Results All tissue samples obtained from cancer-affected regions of the stomach had structural chromosomal aberrations (LOH or MSI), irrespective of H. pylori infection. The degree of structural chromosomal aberration was greater in poorly differentiated than well-differentiated adenocarcinoma. In addition, structural chromosomal aberrations were also found in a few samples obtained from the chronic atrophic gastritis group, irrespective of H. pylori infection. Conclusions It seems unlikely that H. pylori serves as a direct promoter of gastric cancer, and H. pylori-positive chronic gastritis may not always be a precancerous state.

Diesel exhaust particles (DEP) are associated with respiratory disease and exposure to diesel exhaust induces an inflammatory response associated with marked leukocytic infiltration in the lung. This study examined whether neutrophils are activated by the active component of DEP (methanol extract of DEP [me-DEP]). The authors demonstrated that neutrophils exposed to me-DEP had increased levels of the f-actin content, the surface expression of adhesion molecules, and the release of interleukin (IL-8) and leukotriene B4 (LTB4), superoxide, and matrix metalloproteinase (MMP-9). Thus, the author conclude that DEP exposure activates neutrophils and that these activated neutrophils could contribute to the adverse respiratory health effects associated with DEP and to the pathogenesis of chronic inflammatory lung diseases.

Background: Ethanol exposure contributes to infectious complications in burn and trauma patients through a process known as “bacterial translocation.” Two major factors, 1) physical disruption of the intestinal mucosal barrier and 2) suppression of immune defense, explain this phenomenon. However, little information is available concerning the immune mechanisms of ethanol-induced bacterial translocation. In this study we investigated the effect of physiological concentrations of ethanol on immune function, especially on CXC-chemokine secretion, neutrophil migration, and barrier function in the small intestine Methods: A rat small intestinal intestinal cell line (IEC-18 cells) was exposed to 50–500 mM ethanol for 24 hr with or without IL-1β. Secretion of CXC chemokines (GRO/CINC-1 and MIP-2) was measured by ELISA assay, and barrier dysfunction was assessed by the apical-to-basolateral flux of HRP-dextran. Neutrophil transmigration was assessed by enzyme histochemistry (AS-D chloroesterase staining) Results: Exposure to ethanol concentrations of 200mM and over increased GRO/CINC-1 secretion, and MIP-2 secretion increased at 500 mM. Administration of ethanol in combination with IL-1β had no additive effect on the release of GRO/CINC-1 and MIP-2. Exposure of IEC-18 monolayers to ethanol resulted in a dose-dependent increase in peameability but IL-1β had no effect on barrier function. Ethanol had no effect on neutrophil migration in enzyme histochemistry analysis Conclusions: The above observations suggest that ethanol induced physical disruption of the intestine but not neutrophil transmigration is the main cause of the bacterial translocation that leads to bacteremia and endotoxemia in alcoholics.

The rectum is spared in most patients with spontaneous ischemic colitis because of its abundant collateral blood supply, and thus ischemic proctitis is a rare clinical entity. In most reported cases, it has been of acute onset after aortoiliac surgery, radiotherapy, or other vascular intervention. This report describes the endoscopic diagnosis and the treatment of recurrent rectal hemorrhage in apatient withspontaneous chronic ischemic proctitis. Chronic ischemic proctitis should be included in the differential diagnosis of lower-GI bleeding, especially for elderly, bed-ridden patients with atherosclerotic disease.

BACKGROUND: Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE: A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION: The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.

Dieulafoy’s lesion, also known as a caliber-persistent artery of the stomach, is an uncommon cause of GI bleeding; it accounts for only 2% of episodes of acute and chronic bleeding.1,2 This mucosal lesion, usually occurring along the lesser curvature of the proximal stomach, is small and shallow but can be associated with a massive, life-threatening hemorrhage. Dieulafoy’s lesion may be difficult to diagnose, especially when bleeding is absent. Although initial descriptions were based on surgically resected specimens, endoscopy is a sensitive and accurate means of diagnosis. Dieulafoy’s lesion is now almost always treated endoscopically, with hemostasis achieved in most patients.3,4 A patient is described with gastric cancer who presented with massive upper GI hemorrhage from a Dieulafoy’s lesion in the stomach; hemostasis was established endoscopically. To the investigators’ knowledge, there is only one other report of gastric cancer associated with a histopathologically proven Dieulafoy’s lesion.5 Whenever the slightest suspicion of malignancy is present in cases with atypical endoscopic findings for Dieulafoy’s lesion, follow-up endoscopy with biopsies should be performed for accurate diagnosis.

We studied the usefulness of a new assay method that detects only the intact human osteocalcin molecule in haemodialysed patients.Iliac bone biopsy specimens obtained from 62 haemodialysed patients were analysed.Bone formation rates (BFR/BS) correlated positively with serum intact osteocalcin concentrations (n=62), osteocalcin concentrations assayed by a conventional method (n=31), parathyroid hormone (PTH) concentrations (n=62), and total alkaline phosphatase concentrations (r=0.602, 0. 588, 0.650, and 0.401 respectively). Based on ROC curve and Youden index analysis, the optimal cut-off value to distinguish adynamic bone disease from a mild lesion was 195 pg/ml of serum PTH concentration (Youden index=0.233) or 30 ng/ml of serum intact osteocalcin concentration (Youden index=0.628). The optimal cut-off value to distinguish between hyperparathyroid bone and a mild lesion was 455 pg/ml of serum PTH level (Youden index=0.63) or 50 ng=ml of serum intact osteocalcin concentration (Youden index=0.634). Since both ROC curve and Youden index suggested that the serum PTH concentration was not a good marker to distinguish adynamic bone from a mild lesion or hyperparathyroid bone, we designed a two-step procedure. The first step was the diagnosis of adynamic bone (cut-off: 65 pg/ml) or hyperparathyroid bone (cut-off: 455 pg/ml) according to serum PTH concentration. In a second step, we assessed serum intact osteocalcin concentration in patients with serum PTH concentrations between 65 and 455 pg/ml. The cut-off values for adynamic and hyperparathyroid bone in this diagnostic approach were 30 and 70 ng/ml respectively. As a result, 49 out of 62 patients were diagnosed properly. The Youden index of this two-step diagnosis was 0.527 and 0.661 for adynamic bone and hyperparathyroid bone respectively. Sensitivity markedly improved to 94.4% and 96.2% for adynamic bone and hyperparathyroid bone respectively, without sacrificing specificity (84.0 and 88.8% respectively).Measurement of serum intact osteocalcin concentration is useful for the diagnosis of adynamic bone in haemodialysed patients. A two-step procedure involving also simultaneous measurement of serum PTH concentration further improved the sensitivity of each individual marker while maintaining specificity.

Background: The pharmacologic response and microvascular effects associated with the endoscopic injection of sclerosing agents around vessels (paravascular injection) to stop bleeding from the digestive tract remain to be clarified. Methods: Using in vivo microscopy, we directly visualized submucosal microvessels of the rat stomach and intestine. We studied differences among sclerosing agents in thrombus formation and vascular diameter change that occur through a pharmacologic response and/or local compression after topical application or paravascular injection of the agents. Results: Except for absolute ethanol, topical application of the agents did not cause constriction or thrombi in either arterioles or venules. Polidocanol topical application and paravascular injection significantly dilated arterioles. Injecting ethanolamine oleate near venules constricted them the longest and most effectively, but vasoconstriction in arterioles was transient. Injecting absolute ethanol formed long-lasting thrombi and caused vasoconstriction in venules, but arteriole thrombi persisted no more than 3 minutes. The vascular response to thrombin did not significantly differ from that to physiologic saline. Conclusion: The paravascular injection of ethanolamine oleate, because of its long-lasting vasoconstriction, or of absolute ethanol, because of its thrombogenic effect, is a valid therapeutic approach to treating venous bleeding. The efficacy of paravascular injection of sclerosing agents for treating acute arterial bleeding, however, is not supported in this experimental model. (Gastrointest Endosc 1999;50:499-505.)

Endoscopic injection sclerotherapy is useful in stopping bleeding from esophageal varices. We compared the in vivo effects of sclerosants on thrombogenesis, hemostasis, and endothelial injury. We injected aethoxysclerol (AS) of ethanolamine oleate (EO) into the small veins of the rat intestine. The maximum thrombogenic index with AS was 30.7 and with EO was 9.2. The venous flow stopped sooner with EO than with AS. The thrombi caused by EO were mixed with red blood cells. Heparin pretreatment decreased the thrombogenic index with AS by 96.7%, but not that with EO. The area of the fluorescein-albumin conjugate that permeated from veins with AS was larger than that with EO. The fluorescent intensity with AS was lower than that with EO. We thus conclude that: (1) the size of thrombi is not necessarily proportional to the hemostatic efficacy; (2) change in a patient's coagulation may affect the potential of sclerosants; (3) the excellent hemostatic efficacy of EO is based on localized injury to the endothelium and the involvement of red blood cells aggregation; and (4) in vivo microscopy is useful in determining the rational selection of sclerosants.

We administered calcium carbonate orally to determine its safety and efficacy in treating nondialyzed patients with mild to moderate renal failure and secondary hyperparathyroidism. Twenty patients with chronic renal failure (creatinine clearance levels ranging from 7.9 to 42.7 mL/min) participated in this study. After a 6-month control period, 3 g calcium carbonate was administered daily for 6 months. We studied the effect for another 6 months after discontinuation of the regimen. We found that serum-intact parathyroid hormone was suppressed from 183 +/- 149 pg/mL to 85 +/- 61 pg/mL (P < 0.05) by treatment. This suppression was achieved with no increase in serum concentrations of 1,25(OH)2D3. Serum phosphorus levels decreased from 3.4 +/- 0.7 to 3.0 +/- 0.7 mg/dL (P < 0.01) and Ca2+ concentration increased significantly from 2.40 +/- 0.12 mEq/L to 2.57 +/- 0.08 mEq/L (P < 0.001) at 6 months. These changes were reversed after the 6-month period of withdrawal from calcium carbonate. Deterioration of renal function was not exacerbated by the therapy. Calcium carbonate administration also suppressed the serum concentrations of alkaline phosphatase and osteocalcin, indicating that improvement of hyperparathyroid bone disease is possible without a vitamin D3 supplement at an earlier stage of renal failure. Thus, administration of 3 g oral calcium carbonate daily was highly effective in treating secondary hyperparathyroidism in patients with mild to moderate renal failure.

The correlation between ultrastructural changes in gastric epithelia inHelicobacter pylori (HP)-positive chronic gastritis and the amounts of the bacteria was studied. The amounts of bacteria were determined semiquantitatively by a cultural method using gastric biopsy specimens. In an ultrastructural study, vacuolar degeneration, disruption of basement membranes, infiltration of eosinophils and lymphocytes, and HP involvement in gastric epithelial cells were observed. These findings were more conspicuous in the patients who had greater amounts of HP in the stomach. In addition to these findings, the junctional spaces between the gastric epithelia were looser in the patients who had greater amounts of bacteria. These tendencies were milder in the patients who had smaller amounts of HP. in severe HP infections, morphological changes in the gastric tissues seem to add to a vicious circle, perpetuating the condition of chronic gastritis.

Background/Aims: In the small intestine, lymphocytes migrate through Peyer's patches. The distribution of lymphatic microvessels in rat Peyer's patches and lymphocyte traffic through them were studied. Methods: Vital dyes were injected via a micropipette into the Peyer's patches tissue to fill lymphatic microvessels and to stain lymphocytes in lymphatic microvessels. Results: Direct microscopic observation revealed a dense plexus of lymphatic microvessels in the perifollicular and interfollicular areas. Injection of the dyes into the germinal center failed to delineate lymphatic microvessels. The lymphatic microvessels in the perifollicular area were filled with lymphocytes. Most lymphocytes in the perifollicular lymphatics stayed in the lymphatic microvessels. Some lymphocytes became detached and drained into lymphatic microvessels in the interfollicular areas. Lymphocytes then moved toward the submucosal lymphatics beneath the villi around the Peyer's patches. The interfollicular lymphatics did not display contractile activity but had valves. Opening and closing of valves was synchronized with the respiration and the back and forth flow of lymphocytes. Conclusions: There are numerous lymphocytes in a dense lymphatic network in the perifollicular and interfollicular areas of Peyer's patches. This welldeveloped lymphatic network has the potential capacity for storage of lymphocytes and modulation of lymphocyte migration.

This paper reports a case of TSS complicated with SSSS in an adult with liver cirrhosis. A 52-year-old male, heavy drinker, was referred to our clinic complaining lumbago and painful swelling of the right arm. The patient had peeling of the skin over the hips, knees and elbows with positive Nikolsky's sign. The patient was in a state of shock on admission. Pyrexia persisted for 4 days and finally the body temperature rose up to 39 degrees C. The laboratory studies revealed hypoxia, DIC and multiple organ failure, and these became progressively worse. He died 4 days after admission. According to the criteria, he was diagnosed as TSS, and TSST-1 was detected from his serum. Staphylococcus aureus, coagulase type V was cultured both from the blood and from the wound of his right middle finger. This isolated strain did not produce TSST-1. The skin specimen at autopsy showed that the cleavage plane lied at the subcorneal region and close to the granular layer, with specific changes caused by exfoliative toxin. It was compatible to the exfoliation which was caused by exfoliative toxin produced from the S. aureus coagulase type V. The autopsy also revealed alcohol liver injury, liver cirrhosis and multiple organ failure due to shock state. SSSS is rare in adults, to our knowledge this is the first reported case of TTS complicated with SSSS.

The efficacy and toxicity of concurrent chemoradiotherapy with carboplatin (AUC=5) +docetaxel (70 mg/m(2)) were analyzed retrospectively in 20 patients with stage III non-small-cell lung cancer (NSCLC). The median age of the patients was 65 years (range, 53-73 years). The performance status (ECOG), clinical stage, and tumor histology of the patients were as follows: PS: PS 0, 12 patients; PS 1, 8 patients; disease stage: stage III A, 6 patients; stage III B, 14 patients; tumor histology: adenocarcinoma, 11 patients; squamous cell carcinoma, 6 patients; large cell carcinoma, 3 patients. The median number of treatment courses administered was 4. The median survival time was 23 months, and the 2-year survival rate was 50%. The median progression free survival was 17.5 months. The response rate was 75%. Common toxicities included grade 3/4 neutropenia (95%), grade 3 esophagitis (5%), grade 3 anorexia (30%), grade 3 febrile neutropenia (35%) and grade 5 radiation pneumonitis (5%). Further studies are warranted to evaluate the efficacy and toxicity of this regimen.

Ascaris lumbricoides is spreading throughout the entire world. In its adult form it usually lives in the human intestine, but biliary or pancreatic complications due to the worn's infestation are not uncommon in endemic areas like Bolivia and have become a significant problem. Many authors recommended surgical treatment for the removal of the worn. In this paper we present our experiences with the endoscopic management of bilialy ascariasis. From June 1985 to August 1991, 38 patients were diagnosed as having biliary ascuriasis by means of an endoscopic retrograde cholungiography. In the duodenoscopic treatment, all of the procedures were performed under fluoroscopic control. These Ascaris lumbricoides were located in the choledocus and common hepatic ducts in 33 patients (86.8%), 3. patients had them in the gallbladder (7.9%) and 2 patients had them (5.3%) in the intrahepatic ducts. Endoscopic extractions were successful in 17 out of 20 (85.0%) non-jaundice patients, in the other 3 cases the woms were removed surgically. In the jaundice cases, 3 of the 6 patients with woms (50.0%) were successfully treated by endoscopic extractions with simultaneous stones prior to an endoscopic sphincterotomy and the rest were treated surgically. Since no significant complications were observed after this endoscopic treatment method we recommend endoscopic extractions of biliary ascariasis.

症例は77歳,男性.主訴は左精巣腫大.泌尿器科での左精巣摘出術で精巣上体に乾酪性類上皮肉芽腫を認め,当科に紹介された.胸部X線写真では所見に乏しく,胸部CTにて左S1+2の結節影と両側肺野に気道散布性の小粒状影を認め,尿と喀痰から結核菌が培養同定された.さらに腹部CTでは腎病変や腰椎破壊像,両側腸腰筋膿瘍が明らかとなった.多臓器病変は結核菌の血行性感染と考えられたが,精巣腫大をみるまでは症状に乏しく,慢性全身感染症である結核の診断の難しさを認識させられた.

A 73-year-old woman smoker presented with dyspnea on exertion due to massive left pleural effusion. A CT scan after drainage of the pleural effusion demonstrated a nodule in the left lung, and cytology of the pleural effusion showed adenocarcinoma. We diagnosed advanced adenocarcinoma of the lung, and clinical stage IIIB. Chemotherapy with carboplatin and docetaxel was discontinued after the second course because of anorexia, and gefitinib was administered from October 2004. The lung nodule and pleural effusion had disappeared on CT by November 2004. A complete response continued for 5 years. We report a 5-year complete response in a case of advanced adenocarcinoma of the lung by treatment with gefitinib.

A 62-year-old man, treated with corticosteroids and immunosuppressants for rheumatoid arthritis, visited hospital with high fever and dyspnea on exertion. A CT scan of the chest demonstrated bilateral diffuse ground glass opacities. On the basis of the findings of the CT scan, he was initially given a diagnosis of interstitial pneumonia. He was then referred to our hospital and admitted to the intensive care unit (ICU), where because of progressive respiratory failure, he was put on mechanical ventilation. A bronchoscopy specimen after intubation turned out to be positive for acid-fast bacilli, which were confirmed to be mycobacterium tuberculosis by a polymerase chain reaction test. He was given a diagnosis of miliary tuberculosis complicated with acute respiratory distress syndrome (ARDS). He died of respiratory failure despite treatment with antituberculosis drugs. The autopsy revealed necrotizing epithelioid granulomas in both lungs, mediastinal lymph nodes, the liver, both kidneys, vertebrae and other organs. Diffuse alveolar damage was also found in both lungs. It is often difficult to detect disseminated nodules in the miliary tuberculosis with ARDS. Miliary tuberculosis should be suspected in patients in an immunosuppressant state with rheumatoid arthritis, and who have respiratory symptoms or fever of unknown origin.

A 64-year-old woman visited our outpatient clinic because of bloody stools and abdominal fullness. Digital rectal examination revealed a 6 x 4-cm oval mass. Abdominal CT scans demonstrated a concentric, multilayered structure in the rectum. Colonoscopy showed segments of the bowel were dark-purplish, and intussusception. Deeper insertion of the colonoscope through the lumen revealed a type 1 lesion. Under a diagnosis of sigmoid colon cancer with intrarectal intussusception, emergency surgery was performed. The resected specimen showed a type 1 advanced cancer and two early cancers at the base of the intussuscepted colon, all of which appear to have contributed to the intussusception.