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Introduction: Ovarian granulosa cell tumor is a relatively rare tumor that accounts for 2-5% of malignant ovarian tumors. This tumor progresses slowly and may recur late in life.Case presentation: A 70-year-old woman was admitted to our hospital with a left secondary pneumothorax due to metastatic lung tumors of granulosa cell tumor. Reports of secondary pneumothorax due to granulosa cell tumor are rare. Thoracoscopic suturing and pleurodesis using talc were effective in the treatment of this pneumothorax.Conclusions: We experienced a rare case of secondary pneumothorax due to multiple pulmonary metastases of granulosa cell tumor. It should be noted that pulmonary metastasis of granulosa cell tumor can lead to secondary pneumothorax.

Endoscopic population-based screening for gastric cancer began in April 2016, and the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has rapidly become popular. With UT-EGD, discomfort associated with an examination is reduced, patient satisfaction is high, and adverse effects on cardiopulmonary function are fewer. Consequently, UT-EGD is a good option for gastric screening in an aging society. Because of the narrower diameter of the endoscope, however, image quality is inferior to that obtained using transoral conventional esophagogastroduodenoscopy (C-EGD). As a result, lesions observed by UT-EGD must be viewed at close proximity and chromoendoscopy should be used concurrently, which is burdensome for the endoscopist. Recent innovations by endoscope manufacturers have enabled dramatic improvements in transnasal UT-EGD and facilitated Hi-Vision imaging. Furthermore, image enhancement that allows for observation on a par with transoral C-EGD is now feasible. In the future, UT-EGD will be equipped with functions that permit magnified endoscopic image. It is anticipated that a multiroute transition between transnasal and transoral UT-EGD will become possible.

Lung cancer is a major health concern worldwide, but new immunotherapeutic treatments for lung cancer have shown great promise and the prognosis for many severe cancers including lung cancer has been improving. In May 2017, the Food and Drug Administration approved pembrolizumab, a therapeutic antibody that blocks lymphocytic programmed death-1 (PD-1), as a first-line treatment for any solid tumor with specific genetic features. Pembrolizumab is a therapeutic antibody that blocks lymphocytic PD-1, the ligand of which (PD-L1) is expressed on tumor cells and which can prevent the immune system from recognizing and destroying tumors. Here, we report two cases of double cancer (case 1: lung and bladder cancer; case 2: gastric and lung cancer) in which pembrolizumab was effective for the treatment of both cancers in each patient.

This study investigated the pathophysiological features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) by analysing and comparing cytokine profiles in aqueous humour (AH) collected from 18 PNV, 18 nAMD and 11 control patients. Responses to intravitreal injection of aflibercept were also analysed in the PNV and nAMD groups. In the PNV group, vascular endothelial growth factor (VEGF)-A was significantly lower than in the nAMD group (p = 0.03) but was almost identical to that in the control group (p = 0.86). The nAMD group showed positive correlations between interleukin (IL)-6 and IL-8 (r = 0.78, p r = 0.68, p = 0.002) and IL-8 and MCP-1 (r = 0.68, p = 0.002). In the nAMD group, eyes with dry maculae one month after the first aflibercept injection showed significantly lower VEGF-A and placental growth factor (PlGF) at baseline than those with wet maculae (p = 0.02 for both). However, there was no significant difference between dry and wet maculae in the PNV group. The results suggest that angiogenic factors and proinflammatory cytokines may play the distinct roles in the pathogenesis of PNV and nAMD.

Background and Aim Newly developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. We conducted surveillance of subjects with Barrett's esophagus using this ultrathin transnasal endoscopy. In Japan the lower margin of the lower esophageal palisade vessels is defined the gastroesophageal junction in deep inspiration. We diagnose Barrett's esophagus if columnar epithelium is present on the oral side of the gastroesophageal junction. Methods and Results Barrett's esophagus was confirmed in 116 out of 135 subjects (85.9%), with 17 cases of short-segment Barrett's esophagus (SSBE) and 99 of ultra-short-segment Barrett's esophagus. Close observation of the Barrett's esophagus mucosal structural pattern using narrow band imaging revealed 29 cases with an oval or round pattern, 29 with a long straight pattern, 47 with a villous pattern, 8 with a cerebriform pattern, and 6 with an irregular pattern according to Goda classification. Mucosal biopsies from all subjects with SSBE are examined. Histological examination revealed intestinal metaplasia in only eight subjects. We grouped the oval/round and long straight patterns as closed type, and the villous, cerebriform, and irregular patterns as open type. Analysis of the relationship between these mucosal patterns and background factors revealed a significant correlation between intestinal metaplasia and the open-type pattern. Conclusion We consider this new ultrathin transnasal endoscopy to be a useful technique for surveillance of Barrett's esophagus, especially SSBE.

Background/aimsTo evaluate the axial length (AL) and refractive status in central serous chorioretinopathy (CSC).MethodsThis retrospective observational case series involved 140 patients with CSC (180 eyes) and 78 age-matched and gender-matched control subjects. A detailed ophthalmic examination was performed, including an interferometer measurement of AL. Multimodal imaging comprised colour fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence photography and spectral domain optical coherence tomography.ResultsEighty eyes of 40 patients were categorised into the bilateral-CSC (b-CSC) group and 100 eyes of 100 patients were categorised into the unilateral-CSC (u-CSC) group. AL of the b-CSC (23.19 mm) and u-CSC (23.75 mm) groups was significantly shorter than that of the control (24.85 mm) group (pConclusionAnatomical features, such as shorter AL and greater SE, may be associated with the pathogenesis of CSC.

Purpose To clarify the distinct molecular pathogenesis of central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV). Methods Aqueous humor (AH) was collected from 18 acute CSC, 20 chronic CSC, and 20 PNV patients. Concentrations of 30 cytokines in the AH were analyzed using a multiplex bead immunoassay, and the cytokine profiles were compared among these three groups of patients. The areas of choroidal vascular hyperpermeability (CVH) and choroidal thickness (CT), including measurement of the vascular layers, were investigated to analyze the features of choroidal abnormality in acute CSC, chronic CSC, and PNV. Additionally, associations between cytokine profiles and choroidal abnormalities were analyzed. Results Proinflammatory cytokines, IL-6 and IL-8 were significantly upregulated in the chronic CSC group compared with the acute CSC or PNV groups. Angiogenic cytokines and VEGF-A were upregulated at levels that almost reached significance along with disease progression from acute to chronic CSC, whereas the upregulation was not significant from chronic CSC to PNV. In the chronic CSC group, strong positive correlations were confirmed between VEGF-A and placental growth factor (PlGF) (r = 0.75, P < 0.001) and IL-6 and VEGF-A (r = 0.74, P < 0.001), and angiogenesis-related cytokines were positively correlated with the typical choroidal abnormalities, areas of CVH, mean CT, and mean large choroidal vessel layer thickness. However, there was no association between these choroidal abnormality parameters and AH cytokines in the PNV group. Conclusions The results suggest that choroidal abnormalities in chronic CSC may be associated with upregulated angiogenesis.

Purpose To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD). Design Prospective, consecutive, interventional case series. Participants Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients. Methods Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs. Main Outcome Measures Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period. Results Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months ( P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 μm at baseline to 234±66 μm at 1 month ( P = 0.013), 226±68 μm at 3 months ( P P = 0.002), and 226±66 μm at 12 months ( P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 μm at baseline to 238±83 μm at 12 months ( P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories. Conclusions Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To investigate and compare the characteristics of fundus autofluorescence (FAF) in polypoidal choroidal vasculopathy (PCV) with those in typical neovascular age-related macular degeneration (AMD). Design Retrospective, observational, consecutive case series. Participants Ninety-two patients with PCV (92 affected eyes and 86 unaffected fellow eyes) and 31 patients with typical neovascular occult AMD with no classic choroidal neovascularization (31 affected eyes and 24 unaffected fellow eyes). Methods All study eyes underwent FAF photography with a fundus camera–based system. The incidence and distribution of hypoautofluorescence, that is, the manifestation of retinal pigment epithelium (RPE) damages, were evaluated. Main Outcome Measures The characteristic FAF findings in PCV. Results In the affected eyes with PCV, the sites of the neovascular lesions showed 2 distinct FAF patterns: (1) the confluent hypoautofluorescence at the polypoidal lesions and (2) the granular hypoautofluorescence at the branching choroidal vascular networks. The confluent hypoautofluorescence, most of which was surrounded by a hyperautofluorescent ring, was seen in 74 eyes (80.4%) with PCV but was seen in no eyes with typical neovascular AMD ( P P = 0.014). In addition, the eyes with PCV more frequently showed hypoautofluorescence outside the macular area than those with typical neovascular AMD ( P = 0.021). In the unaffected fellow eyes, the hypoautofluorescence was more frequently observed in patients with PCV than in those with typical neovascular AMD, inside the macular area and in the entire FAF image ( P = 0.012, P = 0.003, respectively). Conclusions In eyes with PCV, the polypoidal lesions and the branching choroidal vascular networks appeared to affect the RPE and induce peculiar FAF findings. When compared with the patients with typical neovascular AMD, widespread RPE damage was more frequently observed in the patients with PCV, both in the affected eyes and in the unaffected fellow eyes. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.

To investigate the subfoveal choroidal thickness in eyes with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using enhanced depth imaging optical coherence tomography.Retrospective observational case series of 44 eyes of 44 patients (12 females and 32 males) with typical AMD or PCV located in the subfoveal region. Cross-sectional images of the choroid of each of the involved eyes were obtained by a spectral-domain OCT. The choroidal thickness under the fovea was retrospectively studied.Of the 44 eyes involved in this study, 21 eyes were diagnosed as typical AMD and the other 23 eyes were diagnosed as PCV. The difference in subfoveal choroidal thickness between the eyes with typical AMD (245 μm) and those with PCV (293 μm) was statistically significant, even after adjusting for age, spherical equivalent, and gender distribution (P = 0.045). When compared to eyes with subfoveal choroidal thickness less than 300 μm, those with subfoveal choroidal thickness of 300 μm or more were 5.6 times more likely to have PCV (adjusted odds ratio 5.60, 95% confidence interval 1.30-24.0, P = 0.021).The choroid under the fovea was thicker in eyes with PCV than those with typical AMD. This result suggests that the choroidal vascular lesion seen in PCV may not be just the choroidal neovascularization accompanied by saccular capillary dilations at the border, but may have a significant structural difference in the choroid compared to typical AMD.

Background and Aims: Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE). Methods: The subjects were 418 patients who underwent esophagogastroduodenoscopy and measurement of serum immunoglobulin G H. pylori antibodies examined as part of their routine health checks. Their mean age was 39.2 ± 8.3 years (range 22–58). We analyzed the RE findings (Los Angeles classification: A, B, C, D). Results: The total H. pylori infection rate was 33.7% (141/418). By age group, infection rates were 15.7% in the 20–29 years group, 28.0% in the 30–39 group, 34.3% in the 40–49 group and 69.1% in the 50–59 group. The proportion of H. pylori-negative subjects with RE was 23.5% (20–29, 22.9%; 30–39, 31.7%; 40–49, 32.4%; 50–59, 41.7%), significantly higher than that (12.1%) in H. pylori-positive subjects (20–29, 0%; 30–39, 16.7%; 40–49, 12.2%; 50–59, 10.5%). The severity of RE increased with advancing age in H. pylori-positive subjects, but not in H. pylori-negative subjects. Conclusion: In this study, higher rates of RE were seen in H. pylori-negative subjects. It may be, however, that the presence of H. pylori infection influences the progression of RE.

Aim In this study, transnasal endoscopy was used to observe the time-course changes of gastrointestinal mucosa with low-dose aspirin (ASA), and the preventive effect of rebamipide was compared with placebo. Methods Twenty healthy H.pylori-negative subjects were divided between those receiving 100 mg aspirin with placebo, and those receiving 100 mg aspirin+300 mg rebamipide for 7 days daily. Transnasal endoscopy was performed at 0, 2, 6 and 24 hrs on the first day, and then on the third and seventh days. Results Ulcers, in the duodenum at 24 hrs and in the antrum at 72 hrs, improved with continuous ASA. Erosions were mainly observed in the duodenum; erosions amounted to 14 at 3 days and 19 at 7 days in the placebo group. No ulcers and some erosions were mainly observed in the duodenum; erosions amounted to 5 at 3 days and 3 at 7 days in the rebamipide group. Conclusion In short-term gastrointestinal damage induced by ASA, damage was observed in the duodenum most frequently, and peak damage was at 24 hrs and 72 hrs. Almost all damage improved gradually in spite of continuous ASA. Rebamipide reduced the damage of low-dose aspirin-induced GI complications.

Background: We used transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) to simultaneously perform realtime esophageal manometry and observe esophageal peristalsis. Methods: The subjects were 22 healthy volunteers and 10 patients with proton-pump inhibitor (PPI) dependent gastroesophageal reflux disease (GERD). We induced the primary peristaltic wave associated with swallowing and observed it endoscopically in the lower esophagus, at the same time measuring the intraesophageal pressure using a manometry catheter. Results: The mean primary peristaltic amplitude associated with swallowing was 65.6 ± 47.4 mmHg in the volunteer group, and 28.0 ± 25.6 mmHg in the GERD group. Although peristalsis was observed endoscopically in the GERD group, in some cases incomplete peristalsis left a small but definite lumen and in these subjects, the primary peristaltic wave was almost flat. Conclusions: The use of an ultrathin transnasal endoscope makes possible simultaneous manometry and endoscopic observation of the esophagus. This combination should prove useful in the evaluation of esophageal peristaltic function, such as in the diagnosing of GERD.

Newly developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. We conducted surveillance of subjects with Barrett's esophagus using this ultrathin transnasal endoscopy. In Japan the lower margin of the lower esophageal palisade vessels is defined the gastroesophageal junction in deep inspiration. We diagnose Barrett's esophagus if columnar epithelium is present on the oral side of the gastroesophageal junction.Barrett's esophagus was confirmed in 116 out of 135 subjects (85.9%), with 17 cases of short-segment Barrett's esophagus (SSBE) and 99 of ultra-short-segment Barrett's esophagus. Close observation of the Barrett's esophagus mucosal structural pattern using narrow band imaging revealed 29 cases with an oval or round pattern, 29 with a long straight pattern, 47 with a villous pattern, 8 with a cerebriform pattern, and 6 with an irregular pattern according to Goda classification. Mucosal biopsies from all subjects with SSBE are examined. Histological examination revealed intestinal metaplasia in only eight subjects. We grouped the oval/round and long straight patterns as closed type, and the villous, cerebriform, and irregular patterns as open type. Analysis of the relationship between these mucosal patterns and background factors revealed a significant correlation between intestinal metaplasia and the open-type pattern.We consider this new ultrathin transnasal endoscopy to be a useful technique for surveillance of Barrett's esophagus, especially SSBE.

The aim of this study was to examine the levels of platelet-activating factor (PAF) and lyso-PAF in tears from experimental animals developing allergic conjunctivitis (AC).AC was induced in guinea pigs by application of ovalbumin in eye drops. Tear samples were collected from 5 actively sensitized animals and from 5 unsensitized control animals before the challenge, and 1, 2, 4, and 6 h postchallenge. C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF levels in the tear samples were determined using liquid chromatography-tandem mass spectrometry.The concentrations of C16:0-PAF, C16:0-lyso-PAF, and C18:0-lyso-PAF were measurable in both unsensitized and sensitized groups, whereas C18:0-PAF was undetectable in tear samples from either group. The levels of C16:0-PAF, C16:0-lyso-PAF, and C18:0-lyso-PAF in sensitized animals increased throughout the time course of the experiment, whereas there was no corresponding increase in the levels of these molecules in the unsensitized group. There were strong correlations between the concentrations of C16:0-PAF and C16:0-lyso-PAF, both in the sensitized and in the unsensitized group, and the concentrations of C16:0-lyso-PAF and C18:0-lyso-PAF within each group.The data from this study demonstrated that the levels of PAF and lyso-PAF increase in tears in a guinea pig model of AC development and implicate a role for PAF for the development of AC.

Malignant melanoma in the anorectal region is a rare disease associated with a very poor prognosis. Taking a biopsy of malignant melanoma is generally contraindicated because of the high risk of inducing metastasis. Although clinical examination and imaging findings are important for the preoperative diagnosis, conventional imaging techniques sometimes fail to provide information from which an accurate diagnosis can be made. We recently treated an 84-year-old woman with rectal malignant melanoma, in whom magnetic resonance imaging showed atypical findings. On the other hand, N-isopropyl- p-(123)I-iodoamphetamine single photon emission computed tomography and 5- S-cysteinyl dopa in blood serum, as a tumor marker of malignant melanoma, proved very effective for establishing the preoperative diagnosis. Despite radical abdominoperineal resection, the patient died of multiple liver and lung metastases about 5 months after surgery.

PURPOSE: To investigate the subfoveal choroidal thickness in patients with retinal angiomatous proliferation (RAP). METHODS: In consecutive patients with RAP, subfoveal choroidal thickness was retrospectively measured by the use of enhanced depth imaging spectral domain optical coherence tomography in comparison with age-matched control subjects. RESULTS: Nineteen eyes of 19 patients with RAP and 32 eyes of 32 control subjects were included in this study. No significant differences were found between the eyes with RAP and the control eyes regarding age, gender, spherical equivalent, and axial length. Mean subfoveal choroidal thickness in 19 eyes with RAP was significantly less than that in the control eyes (129.5 ± 35.8 μm vs. 201.3 ± 55.0 μm, P < 0.0001). The difference in mean subfoveal choroidal thickness between eyes with Stage 2 RAP (132.8 ± 38.2 μm) and eyes with Stage 3 RAP (126.4 ± 36.6 μm) was not significant, though each measurement was significantly less than that in the control eyes (P < 0.001 and P = 0.002, respectively). CONCLUSION: Eyes with RAP had a significantly thinner subfoveal choroid compared with normal eyes. Such morphologic features may be related to the pathologic mechanism of RAP.

Multiplanar reconstruction (MPR) is a method that allows free selection of computerized reconstruction images. We reviewed a total of six MPR magnetic resonance (MR) examinations in five cases of adenoid cystic carcinoma of the central airway, which is a rare low-grade malignant tumor. MPR MR provides images either longitudinally or at right angles to the longitudinal axis of the trachea and main bronchi, so it was useful to diagnose tumor extent along airways more precisely and to evaluate therapeutic effects. MPR MR may help in planning therapeutic strategy and in posttherapeutic follow-up.

This paper evaluates the effect of iodinated X-ray contrast media on plasma clotting time, plasma thrombin generation and thrombin activity. Investigated materials consisted of diatrizoate, iothalamate and ioxaglate as ionic contrast media (ICM), and iopamidol, iohexol, ioversol and iotrolan as nonionic contrast media (NICM). Both the prothrombin time and the activated partial thromboplastin time of normal pooled plasma were markedly prolonged in the presence of contrast media in a dose-dependent manner. All the contrast media also inhibited thrombin generation in plasma, as assessed in the def ibrinated plasma with a chromogenic substrate, S-2238. Although these contrast media did not affect the thrombin amidolytic activity, they interfered with thrombin-clotting of fibrinogen by affecting either thrombin-fibrinogen interaction or fibrin polymerization, or both. The anticoagulant activities of the contrast media were more evident in 3 ICM than in 4 NICM used in this study. These results suggested that NICM could not sufficiently suppress the thrombin generation in the catheter-syringe system because of this lesser degree of anticoagulant activity than that of ICM. In a separate set of experiment, heparin cofactor activity of antithrombin III was not impaired in the presence of these contrast media, suggesting that heparin would be an effective agent to prevent the thromboembolic complications during angiography using NICM.

To investigate the relationship between the clinical characteristics of polypoidal choroidal vasculopathy (PCV) and choroidal vascular hyperpermeability seen on indocyanine green angiography.Retrospective, consecutive, interventional case series.We reviewed the medical records and the angiograms of 89 patients with PCV. The relationship between choroidal vascular hyperpermeability and background factors, associated clinical manifestations, and treatment responses to intravitreal injections of ranibizumab were evaluated.Of the 89 patients with PCV, 31 patients (34.8%) demonstrated choroidal vascular hyperpermeability. The patients with choroidal vascular hyperpermeability more frequently showed bilateral neovascular membrane than those without choroidal vascular hyperpermeability (P=.009) and had a significant relationship with a history of central serous chorioretinopathy (CSC) (P=.01). Of the 98 eyes with treatment-naïve PCV, 34 eyes with choroidal vascular hyperpermeability demonstrated significantly greater subfoveal thickness than the 64 eyes without choroidal vascular hyperpermeability (P.001). However, no significant relationship was found between choroidal vascular hyperpermeability and the other biomicroscopic and angiographic phenotypes of PCV. Three monthly intravitreal injections of ranibizumab were performed on 57 patients with treatment-naïve PCV, and the presence of choroidal vascular hyperpermeability was significantly related to the persistent retinal fluid 1 month after the third ranibizumab injection (P=.01).The patients with PCV associated with choroidal vascular hyperpermeability more frequently demonstrated bilateral neovascular membrane, a history of CSC, a thickened choroid, and poor responses to intravitreal injections of ranibizumab than those without choroidal vascular hyperpermeability.

Purpose: The purpose of the study was to describe the choroidal findings in eyes with posterior serous retinal detachment associated with inferior staphyloma by enhanced depth imaging optical coherence tomography. Methods: The study involved five eyes of five patients with the inferior staphyloma accompanied by posterior serous retinal detachment. In each case, the upper border of the staphyloma was lying across the macula. Enhanced depth imaging spectral domain optical coherence tomography was performed in a vertical–sectional manner through the fovea, and the choroidal thicknesses at the thinnest point, at the fovea, and at 0.5 mm and 1.0 mm superior and inferior to the thinnest point were measured. Fluorescein angiography and indocyanine green angiography were also performed. Results: In all 5 eyes, the choroid was thinnest at the upper border of the staphyloma (mean, 37.4 μm; SD, 13.5 μm; range, 23–53 μm). Fluorescein angiography showed a band of window defects along the upper border of the staphyloma, where indocyanine green angiography demonstrated persistent hypoperfusion in all 5 eyes. Conclusion: The choroid was markedly thin at the upper border of the inferior staphyloma accompanied by posterior serous retinal detachment. Such choroidal abnormality seemed to play an important role in the development of serous retinal detachment.

To investigate the predictive factors for the resolution of retinal fluid after intravitreal injections of ranibizumab (IVRs) for polypoidal choroidal vasculopathy (PCV).Forty-seven eyes of 45 patients with symptomatic PCV received 0.5 mg of IVR monthly for 3 months. One month after the third IVR, the presence of dry macula, defined as absence of retinal fluid as detected by the use of optical coherence tomography, was retrospectively evaluated and correlated with clinical characteristics at baseline. Most of the eyes were followed for over 6 months.Of the 47 eyes, 31 eyes (66%) achieved the dry macula along with increased best-corrected visual acuity (BCVA) (0.64 to 0.46 logarithm of the minimum angle of resolution units, p0.0001), while the other 16 eyes without dry macula showed no significant change of BCVA. Univariate analyses of the baseline characteristics identified the smaller size of the largest polyp (p=0.0008) and the absence of serous or haemorrhagic pigment epithelial detachment (p=0.045) as predictive factors for the dry macula. Multivariate logistic regression found the independent predictor for the dry macula to be the smaller size of the largest polyp (p=0.001). No severe systemic or ocular adverse events were observed.IVR may be helpful for resolution of retinal fluid and increased BCVA in the short term, but larger polyps and pigment epithelial detachments at baseline may be negative prognostic factors for a therapeutic response. Further studies are needed to clarify the long-term efficacy of IVR for PCV.

Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE).The subjects were 418 patients who underwent esophagogastroduodenoscopy and measurement of serum immunoglobulin G H. pylori antibodies examined as part of their routine health checks. Their mean age was 39.2 +/- 8.3 years (range 22-58). We analyzed the RE findings (Los Angeles classification: A, B, C, D).The total H. pylori infection rate was 33.7% (141/418). By age group, infection rates were 15.7% in the 20-29 years group, 28.0% in the 30-39 group, 34.3% in the 40-49 group and 69.1% in the 50-59 group. The proportion of H. pylori-negative subjects with RE was 23.5% (20-29, 22.9%; 30-39, 31.7%; 40-49, 32.4%; 50-59, 41.7%), significantly higher than that (12.1%) in H. pylori-positive subjects (20-29, 0%; 30-39, 16.7%; 40-49, 12.2%; 50-59, 10.5%). The severity of RE increased with advancing age in H. pylori-positive subjects, but not in H. pylori-negative subjects.In this study, higher rates of RE were seen in H. pylori-negative subjects. It may be, however, that the presence of H. pylori infection influences the progression of RE.

In Japan, rapid spread in the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) is reported. Problems have been identified with the new technique, however, including poor endoscopic imaging quality. In this study, we investigated detection rates for esophageal and gastric cancers using transnasal UT-EGD, and compared endoscopic imaging quality between UT-EGD and conventional EGD (C-EGD). The subjects were 959 patients who underwent transnasal UT-EGD. We investigated the detection rates for esophageal cancer, gastric cancer and gastric adenoma. We compared endoscopic image between UT-EGD and C-EGD. We detected 2 cases of esophageal cancer, 13 of gastric cancer and 5 of gastric adenoma. The detection rate for esophageal and gastric cancer was 1.56% (15/959). The border between an abnormal area and the surrounding mucosa was less distinct on the UT-EGD image than on the C-EGD image in 5 cases, and similar clarity was seen in 2 cases. In this study the esophageal-gastric cancer detection rate was high at 1.56%. Although we found no difference in the ability to distinguish abnormalities between UT-EGD and C-EGD, it is possible that problems with determining the extent or depth of invasion of lesions may arise compared with C-EGD image.

Background and Aim: Helicobacter pylori (H. pylori) eradication rates using the PPI/AC regimen (proton pump inhibitor + amoxicillin + clarithromycin) are declining. We trialed tailoring eradication regimens according to clarithromycin (CAM) susceptibility. Methods: The subjects were 70 H. pylori positive adults. They were randomly allocated to a tailored group and a control group. In the tailored group, subjects with CAM-sensitive strains were given PPI/AC eradication therapy, and those with CAM-resistant strains were given PPI/AM (metronidazole instead of clarithromycin) therapy. The control group were all given PPI/AC therapy. CAM sensitivity was measured by collecting fecal specimens, and extracting the DNA. The 23S rRNA domain, associated with CAM susceptibility in H. pylori, was amplified using a nested polymerase chain reaction (PCR), and DNA sequencing was used to detect point mutations at A2143G and A2144G. Results: Eradication rates were 94.3% in the tailored group and 71.4% in the control group. In particular, the eradication rate was 100% for CAM-resistant strains in the tailored group. Conclusions: In Japan, where CAM-resistant H. pylori strains are expected to continue to increase, tailored eradication therapy according to CAM sensitivity will be of benefit.

A 62-year-old man was admitted for gastric cancer. He was performed a distal gastrectomy with Billroth I reconstruction in August 1999. Then he had remnant gastric cancer and metachronous liver cancer in November 2002. He was performed a total gastrectomy and partial hepatic resection. The histological findings of remnant stomach and liver cancer showed a same pattern of the primary gastric cancer. Another metachronous liver cancer appeared in March 2006. He was treated with chemotherapy using S-1 (day 1-21) and CDDP 20 mg/m2 (day 1, 8 and 15) q5w. The size of liver metastasis was kept the same for 16 months.

We reviewed the recent literature concerning investigations of esophageal peristaltic function. The gold standard for the assessment of esophageal peristaltic function is manometry with pH monitoring. Even with this investigation modality, however, we are in fact doing no more than estimating esophageal peristaltic function from the manometry and pH results. With esophageal fluoroscopy and scintigraphy, where we observe esophageal motility, there are problems with radiation exposure and handling of radioactive agents that make widespread use difficult. In recent years, the development of multichannel intraluminal impedance (MII) manometry has allowed simultaneous measurement of intraesophageal pressure and assessment of esophageal peristalsis. Using MII it is also possible to distinguish whether gas or liquid is passing down the esophagus. When manometry is performed in conjunction with transnasal esophagogastroduodenoscopy, with this unique combination it is possible to measure the intraesophageal pressure while actually observing the swallowing motion at the same time. Assessment of esophageal peristaltic function is now moving from simple measurement of intraesophageal pressure to simultaneous impedance manometry and endoscopic observation of esophageal peristalsis itself.

Transnasal esophagogastroduodenoscopy (EGD) is reported to be more pleasant than conventional transoral EGD. In this study, we compared the hemodynamic effects of transnasal and transoral EGD.The subjects were 120 patients with upper gastrointestinal conditions. Transnasal and transoral EGD were performed on 60 subjects each. Oxygen saturation, heart rate and blood pressure were monitored. Subjects were also asked for their condition with each EGD.VAS scores for discomfort at the insertion, and for trouble breathing and nausea during the procedure, were significantly lower for transnasal than for transoral EGD. A significant increase in the heart rate and significant decrease in oxygen saturation were seen only in the transoral group during EGD. The double product (heart rate x systolic blood pressure) was also significantly increased only in the transoral group. No significant changes were seen in the transnasal EGD.Double product has been reported to correlate with myocardial oxygen consumption. Transnasal EGD is a safe technique, and is not only less stressful to patients, but also has fewer hemodynamic effects than the transoral method.

The pepsinogen (PG) test result is used in Japan for screening for gastric cancer. In this study, we investigated the changes in evaluation of the PG test result following H. pylori eradication.The subjects were 120 consecutive H. pylori-positive patients with upper gastrointestinal symptoms. Subjects underwent endoscopy prior to, and at 2 months after the eradication therapy, at which time blood was taken for determination of changes in PG levels.The overall eradication rate was 79.3% (per protocol). Following eradication therapy, the evaluation of PG test result converted from positive to negative in 80.4% (37/46) of cases of successful eradication, and in 0% (0/6) of cases of eradication failure.These results suggest that the evaluation of PG test result should be used after the definitive confirmation of the success or failure of H. pylori eradication therapy.

Background It is often difficult to distinguish gallbladder cancers (GBC) from benign gallbladder diseases, which show thickened walls. Objectives To evaluate the efficacy of bile cytology using endoscopic transpapillary gallbladder drainage (ETGD) and CT. Design Retrospective study. Setting Division of Gastroenterology, Tokyo Medical University, Tokyo, Japan. Patients and Interventions Eighty-five patients with gallbladder diseases, consisting of 27 GBC and 58 benign gallbladder diseases, were reviewed. A pigtail-type nasobilliary drainage tube was left indwelling in the gallbladder, and through this drainage tube washing cytology was performed with an ETGD tube. Main Outcome Measurements Diagnostic accuracy of CT and cytology. Complications and outcome were also evaluated. Results CT and cytology with the ETGD tube had 81% and 81% sensitivity, 91% and 83% specificity, and 88% and 82% accuracy, respectively (P > .05). Looking only at the 71 successful ETGD cases, CT and ETGD cytology had 82% and 100% sensitivity, 92% and 98% specificity, and 89% and 99% accuracy, respectively (P = .036 and .025, respectively). Four patients with GBC in whom CT showed benign findings underwent open cholecystectomy because ETGD cytology revealed malignant findings. In contrast, 4 patients with benign diseases in whom CT suggested malignant finding underwent LC because the findings of ETGD cytology suggested benign disease. Conclusions Cytology using an ETGD tube is very useful in the diagnosis and management of gallbladder diseases.

In this paper, we present a combination of high-resolution (HR) data from magnetic resonance cholangiopancreatography (MRCP) and omni-directional viewing of stereoscopic maximum-intensity-projection. Since the presented method takes advantage of the property of magnetic resonance-hydrography (MR-hydrography) as one of the most selective signal acquisitions, the segmentation process is very simple, and loads in data-processing is drastically reduced. The source data acquisition was performed with a slice thickness of 0.8mm. Images created by this method are precise and realistic enough to enhance the diagnostic capabilities of MRCP. The stereoscopic viewing and omnidirectional surveying can facilitate an accurate grasp of the three-dimensional extent of the entire pancreaticobiliary system, even in the regions which can not be assessed, due to signal-overlay of either neighboring organs or between pan-creaticobiliary ducts. We are convinced that the presented post-processing is less time consumption and have a potential of optimizing HR-MRCP data sets.

Though magnetic resonance cholangiopancreatography (MRCP) is one of the most useful modalities, its capability for precise and realistic description of the biliary system has been inferior to endoscopic retrograde cholangiopancreatography (ERCP). Current MR scanner’s spatial resolution of MRCP has become remarkably improved. However, it is time consuming and unpractical to read HR image data as a series of pictures on plain films. This presentation is to show that the combination of HR data and stereoscopic viewing leads to a decisive increase of speed and diagnostic value of MRCP.

We describe a patient with chronic expanding hematoma that was pathologically confirmed by examination of the resected specimen. It has increased gradually in the right lower lung field during a period of 10 years without symptoms. The MR T2-weighted image was useful to establish a diagnosis of chronic expanding hematoma, because of the mosaic of various signal intensities we named the “mosaic sign”.