Results of Hepatitis B Vaccination 3 Years After a Primary Vaccine Series in Medical Students

Objective：To investigate the significance of additional hepatitis B （HB） vaccination in medical students who were unresponsive to a primary vaccine series or those who had lost antibody to hepatitis B surface antigen （anti-HBs）.Methods：Subjects were followed up for 3 years after completion of a primary HB vaccine series. One additional dose was given to those who lost the anti-HBs within 3 years after the initial series, while 3 doses were given to those who had not responded to the initial vaccination. Subjects：100 medical students （59 men and 41 women；mean age on admission to university, 19.4±1.6 years） enrolled at the School of Medicine, Dokkyo Medical University in April 2012.Results：The rate of positivity for anti-HBs was 98％ soon after completion of the primary HB vaccine series and decreased without the need for additional vaccination to 79％, 61％, and 55％ at 1, 2, and 3 years after the primary series, respectively. Eighteen vaccinated subjects （18％） lost the anti-HBs 2 years after the primary series, and all of them responded to 1 additional dose. Another 18 successfully vaccinated subjects （18％） were anti-HBs negative both 1 and 2 years after the primary series；17 of them responded to 1 additional dose. As for 2 subjects （2％） who were unresponsive to the primary series, 1 became anti-HBs-positive for the first time after 3 additional doses given 2 years after the primary series.Conclusion：A number of students became or remained anti-HBs negative after the primary HB vaccination, indicating that its timing and dose of additional vaccination need to be studied further to evaluate its utility

Pathological Approach for Surveillance of Ulcerative Colitis-associated cancer:Usefulness of Immunohistochemistry for p53

The patients with long-standing ulcerative colitis( UC) have a high-risk of neoplastic lesions in the colonicmucosa. The UC-associated neoplastic lesion is difficult to detect by endoscopic examination or diagnosehistologically. In the present study, we aimed to clarify whether immunohistochemistry for p53 is useful todiscriminate the UC-associated neoplasia from inflammed regenerating epithelium. Tissue samples were obtainedfrom colorectomy specimens from 20 patients with long-standing UC (range 6-29 years). The surfaceof microstructure of the tissues was observed by stereomicroscopy, and the sections were examined usingimmunohistochemistry for p53. All of T2-4 carcinomas were detectable by endoscopic examination beforesurgery, whereas considerable number of dysplasias (52.5%), Tis carcinomas (33.3%), and T1 carcinomas(60.0%) were undetectable. Fifty-three of 67 UC-associated neoplastic lesions (79.1%) were of flat-typemacroscopically. The detection rate of flat-type neoplasias( 45.3%) was significantly lower than that of protrudingones (100%). The positivity of p53 overexpression was 0 % in UC-II, 52.5 % in UC-III, and 70.4 %in UC-IV, respectively. UC-II lesions had lower positivity of p53 overexpression than UC-III( P=0.027) or-IV lesions( P=0.003). Immunohistochemical analysis of p53 protein is useful to discriminate the UC-associatedneoplasia from inflammed regenerating epithelium

Effects of daily aspirin on cancer incidence and mortality in the elderly Japanese

BackgroundLong‐term follow‐up of studies to investigate preventive effects of aspirin on arterial thrombosis indicate that aspirin reduces the incidence and mortality of some cancers in Western populations.ObjectivesTo explore the effects of aspirin on cancer incidence and mortality in the elderly Japanese.Patients/MethodsPatients aged 60 to 85 years, presenting with hypertension, dyslipidemia, or diabetes mellitus (n = 14 601, 7297 in the aspirin group and 7304 in the no‐aspirin group) participated the Japanese Primary Prevention Project (JPPP), a multicenter, open‐label, randomized, parallel‐group trial. A subanalysis of JPPP was performed to analyze the incidence of newly diagnosed cancer and death related to cancer.ResultsThe cumulative incidence of newly diagnosed cancer was 5.60% (4.65‐6.64%) in the aspirin group and 4.14% (3.67‐4.66%) in the no‐aspirin group. The hazard ratio for newly diagnosed cancer was 1.24 (1.06‐1.46), and the cancer incidence was significantly higher in the aspirin group. The cumulative cancer mortality was 1.96% (1.65‐2.31%) in the aspirin group and 1.87% (1.56‐2.22%) in the no‐aspirin group, with no statistically significant difference. The Fine and Gray model suggested that the difference in the incidence of newly diagnosed cancer between the two groups decreased year by year.ConclusionsLow‐dose aspirin use did not reduce the cancer incidence or cancer mortality during a 5‐year‐average study period in the elderly Japanese. The cancer incidence in the aspirin group might decrease, however, to less than that in the no‐aspirin group after the study period. Aspirin use might have led to earlier cancer diagnosis in our study

ナマ シラス ノ セイ ショク ニヨル カンセン ガ ウタガワレタ クジラ フクショクモンジョウチュウ ショウ ノ 1レイ

埼玉県在住の男性・64 歳.2012 年11 月初旬,近医で日本海裂頭条虫症の診断を受け,駆虫目的で本院消化器内科を紹介受診.外来で駆虫治療したところ,全長約250 cm の白色紐状で,全体的に肉厚感のある虫体を排出した.虫体は形態学的特徴より日本海裂頭条虫ではなく,クジラ複殖門条虫が強く疑われたため,遺伝子解析を行った.PCR によって増幅されたcytochrome c oxidase subunit 1 遺伝子(cox1)の全長塩基配列を解析したところ,既知のクジラ複殖門条虫の塩基配列と99%の相同性を示したことから,本症例はクジラ複殖門条虫症と確定した.該当患者は,便に白色紐状物が混入する2〜3 か月前に,生シラスを生食しており,これが感染源となった可能性が高いと考えられた.We have reported a case of infection with whale tapeworm,Diplogonoporus balaenopterae, in Dokkyo MedicalUniversity Hospital. The patient, a 64-year-old Japanesemale, living in Saitama Prefecture was admitted to our hospitalon Nov. 1st 2012, owing to pieces of tapeworm beingdischarged. He was treated with Biltricide® (20 mg/kg)and Magcorol P®( 100 g) in the hospital and he expelled atapeworm about 250 cm, in length along with the scolex afterabout 2 hours of treatment. Based on the morphologicalfeatures of the strobila and the scolex we strongly suspectedthat the tapeworm belongs to the genus Diplogonoporus.To identify the species of the discharged tapeworm, thecomplete cox1 gene was amplified by PCR and the nucleotidesequence was analyzed. The sequence showed 99 %homology against those from D. balaenopterae. From theseresults the patient was diagnosed as a diplogonoporiasiscaused by D. balaenopterae, whale tapeworm. We could notfind any proglottides of tapeworm nor eggs in stools whenwe performed follow up medical examinations three monthsafter treatment. Therefore it can be concluded that the patientwas cured of this disease. In most cases the infectionsource of the whale tapeworm to humans is reported ascoming from marine fish such as sardines and bonitos. Thepatient had frequently consumed various kinds of raw marinefish, and we suspect that the infection source can beattributed to eating raw whitebait

フククウキョウ カ Roux-Y イ バイパス ジュツ ノ ジュツゴ クウチ イ ニ タイスル ダブル バルーン ショウチョウ ナイシキョウ オ モチイタ スクリーニング ケンサ ノ ケイケン : ダイ1ポウ

高度肥満に対する外科治療として腹腔鏡下Roux-Y胃バイパス術を施行した症例に対し,ダブルバルーン小腸内視鏡(DBE)の経口的アプローチにより,バイパスに吻合された十二指腸を経由し逆行性に空置胃内のスクリーニング検査を施行した.胃バイパス術には術後の空置胃内に発生する病変の診断に関して,従来の内視鏡では空置胃のスクリーニングが困難であり,特に胃癌の多い本邦では重大な問題であった.今回我々は, DBEの空置胃の観察に対する有用性を報告した.A pathological change in bypassed stomach after Roux-en-Y gastric bypass for morbid obesity is of interest, especially in Japan where gastric cancer is prevalent. However, endoscopic approach to bypassed stomach has not been feasible. Therefore, we presently report that we successfully performed endoscopic evalution of the bypassed stomach via the retrograde route using the Double-Balloon enteroscopy