The role of Kyoto classification in the diagnosis of Helicobacter pylori infection and histologic gastritis among young subjects in Japan

　BACKGROUND AND AIM: Helicobacter pylori (H. pylori) infection induces inflammation of the gastric mucosa and leads to erosions, gastro-duodenal mucosa atrophy, and intestinal metaplasia. The Kyoto classification diagnoses H. pylori infection via endoscopic findings. We aimed to clarify the role of the Kyoto classification in diagnosing H. pylori infection and histologic gastritis in young Japanese individuals.　METHODS: From1031 consecutive subjects aged ≤29 years who underwent esophagogastroduodenal endoscopy at our two hospitals from 2010 to 2017, 220 were selected for participation in the present study. Endoscopic biopsy specimens from the antrum and corpus were used to investigate H. pylori infection and histology. Endoscopic and histological interpretations were based on the Kyoto classification and updated Sydney System. H. pylori infection was confirmed by histology and Giemsa or Gimenez staining.　RESULTS: Endoscopic findings were normal in 103 cases. Atrophy was found in 56 cases; diffuse redness, in 45 cases; nodularity, in 38 cases; and mucosal swelling, in 34 cases. The infection rate was 30.9% (68/220). In total, 67 subjects with H. pylori -positive endoscopic findings and confirmed as H. pylori -positive had histologic gastritis of the antrum and corpus. In contrast, of 153 subjects with H. pylori -negative endoscopic findings only 1 was subsequently confirmed to be H. pylori positive. Among the 67 subjects with H. pylori -positive endoscopic findings, 23 (34.3%) presented with histological atrophic gastritis of the corpus and 6 (9.0%) with intestinal metaplasia.　CONCLUSIONS: Our findings show that H. pylori infection is strongly associated with endoscopic and histologic gastritis in young subjects and both H. pylori infection and histologic gastritis can be evaluated endoscopically based on the Kyoto classification. Furthermore, prompt H. pylori eradication may prevent gastric cancer development given the high prevalence of atrophic gastritis and intestinal metaplasia in young Japanese individuals

Clinicopathological features of advanced gastric cancer discovered after Helicobacter pylori eradication

　Helicobacter pylori infection is closely associated with gastric cancer, and its eradication is expected to prevent gastric cancer. However, gastric cancer is often detected discovered after eradication therapy for H. pylori infection. We aimed to investigate the endoscopic and clinical features of advanced gastric cancer after H. pylori eradication.　We retrospectively investigated tumor location, macroscopic and histological type, endoscopic gastric mucosal atrophy (using the Kimura-Takemoto classification), and the interval between eradication and detection of gastric cancer.　Nine patients (five males; mean age, 65.3 years [range, 44-79 years]), histologically diagnosed with advanced gastric cancer after successful H. pylori eradication between April 2003 and December 2018, were enrolled in this study.　In all cases, the cancer was located in the middle-to-upper portion of the stomach. With respect to macroscopic type, six cases were ulcerative, two were scirrhous, and one was polypoid. Histologically, all cancers were poorly or moderately differentiated adenocarcinomas. Endoscopic mucosal atrophy was mild in two cases, moderate in two cases, and severe in five cases. Two cases of scirrhous tumors developed from mild mucosal atrophy. Moreover, the tumor was detected within 36 months after H. pylori eradication in six patients (maximum: 120 months, mean: 38.7 months).　Our data demonstrated that post-eradicated advanced gastric cancers were located in the middle-to-upper portion of the stomach and were mainly ulcerative, poorly or moderately differentiated adenocarcinoma. More than half of the patients exhibited severe mucosal atrophy

Four cases of gastric cancer in patients with autoimmune gastritis

　Here, we report on four cases of gastric cancer in patients with autoimmune gastritis (AIG). AIG is characterized by the corpus-predominant atrophic gastritis with preserved antrum caused by autoimmune mechanisms. Although AIG is a high risk factor for gastric cancer and neuroendocrine tumors (NET), there are few reports describing the characteristics of gastric cancer in patients with AIG. In this case report, all four cases were diagnosed as having AIG by endoscopic findings and the presence of extra-gastric autoimmune diseases before the treatment for gastric cancer

肝転移を伴う胆嚢腺内分泌細胞癌の一例

症例は50歳代,女性.20XX 年1月ごろより前屈での心窩部付近の疼痛と右季肋部違和感を認めていた.同年3月初旬に疼痛が増強したため近医を受診し,CTで胆嚢に造影効果のある腫瘤と肝内の腫瘤陰影が認められた.肝転移を伴う胆嚢癌が疑われ,精査加療目的に当院へ紹介された.当院での画像検査でも胆嚢底部から体部にかけて約4.5cm大の隆起性病変を認めた.胆嚢底部では漿膜面が腫瘤に引き込まれ陥入している像を認め,肝床と一部で接しており境界不明瞭ではあったが,肝実質内への浸潤像は認めなかった.肝S4に約2cm大のリング状に造影される腫瘤を認め,肝転移が疑われた.ERCPでは胆嚢頸部,胆嚢管,総胆管への浸潤は認めなかった.胆汁細胞診はClass Vであった.単発の肝転移以外には遠隔転移を認めず,主要血管への浸潤も認めないため肝S4a+5切除,胆嚢摘出術,リンパ節郭清を施行した.切除標本では,病変は約4.5cm大の乳頭・結節型であり漿膜外まで浸潤していた(T3).組織学的には腺管構造を呈する腺癌とシナプトフィジン,クロモグラニンAが陽性の内分泌細胞癌が混在していた.肝転移巣は約2cmの結節・浸潤型であり,組織学的には同様にCD56強陽性,シナプトフィジン,クロモグラニンA陽性となる内分泌細胞癌が認められた(M1).リンパ節転移は認めなかった(N0).病理診断は腺内分泌細胞癌,UICC Stage-IVBであった.本症例は孤立性の肝転移を伴った胆嚢癌であったが,肝転移がS4であり,通常の胆嚢癌手術の切除範囲内であり,大きなリスクもなかったため,切除手術を行った.術後,gemcitabineとcisplatinによる補助化学療法を行った.A 57 year-old-female was referred to our hospital, because of an epigastric pain and discomfort for 2 months. Contrast-enhanced CT showed the tumor in the gallbladder body with a liver tumor in S4. An ERCP and other examinations showed no evidence of invasion to bile duct, vessels and other distant metastasis. It was diagnosed as the gallbladder cancer with a solitary liver metastasis. Preoperatively, we assessed that the curative operation might be possible. Then, we performed subsegmentectomy of liver S4a+5, cholecystectomy, and lymphadenectomy. The gallbladder cancer invasion remained extra serosa and no direct invasion to the liver tissue. Immuno-histochemical examinations showed that the tumor contained tubular adenocarcinoma and endocrine cell carcinoma with synaptophysin and chromogranin A positive. Also, the metastasis in liver S4 showed almost same results in synaptophysin, chromogranin A and CD56 positive. According to those results, she was diagnosed as mixed adeno - neuroendocrine carcinoma and Stage-IVB. Although she recovered uneventfully, she developped other liver metastases, 4 months after surgery. The chemotherapy including gemcitabine and cisplatin was introduced. Clinical cases of mixed adenoneuroendocrine carcinoma of gallbladder have been rarely reported. We present this case with a review of literatures

当院で経験したA 型胃炎の４例

A 型胃炎は稀な疾患で，悪性貧血や胃癌，胃NET の発生母地として知られている．抗胃壁細胞抗体陽性，高ガストリン血症，さらに胃体部を中心とした萎縮性胃炎が診断基準とされている．今回，過去１年に４例のA 型胃炎を診断した．全例で自覚症状は見られなかったが，内視鏡検査での逆萎縮所見からA 型胃炎を疑い，胃生検の病理所見と血液検査で確診した．A 型胃炎が他の自己免疫性疾患に合併することが多いとされているが，本症例にも高齢発症のBasedow 病が１例あり，A 型胃炎は日本でも決してまれな疾患ではないと考えられた．診断には内視鏡所見からA 型胃炎を疑うことが重要で，胃生検や血清ガストリンと抗胃壁細胞抗体の測定を行うことにより確診できる．Type A gastritis is a rare disease and is known as a cause of various conditions including pernicious anaemia, gastric cancer and gastric NETs (Neuroendocrine tumour). The diagnostic criteria of type A gastritis include positive parietal cell antibody, hypergastrinaemia and the presence of atrophic gastritis mainly corpus predominantly atrophic gastritis. We diagnosed four cases of type A gastritis in the past year in our hospital. Although they were all asymptomatic, type A gastritis was suspected by the endoscopic findings (the reverse atrophy) and all confirmed by pathological examination of biopsy specimens and blood test subsequently. It is well known that the patients with autoimmune disease are frequently associated with type A gastritis and there is a case of late onset of Basedow’s disease in our case report. Our study suggests that type A gastritis is not as rare as initially thought in Japan. In order to diagnose type A gastritis, it is important to have a high index of suspicion with endoscopic findings, and to confirm it with gastric biopsy, serum gastrin level and parietal cell antibody

Diagnostic yield of transabdominal ultrasonography of pancreatic solid pseudopapillary neoplasm: a case report

　症例は10歳代，女性．主訴は左上腹部痛．部活中に腹部を強打し，左上腹部痛が出現した．食物残渣様嘔吐も認め，当院に救急搬送された．当院搬送時，左上腹部に疼痛及び圧痛を認めたが，反跳痛はなかった．当院搬送時の血液検査は白血球8,950 /μl，アミラーゼ204 U/l と高値を示していた．体外式腹部超音波検査では膵体部に76.1×68.1 mm 大の境界明瞭な被膜を伴う類円形腫瘤を認めた．周囲臓器への浸潤所見は認めず，腫瘍内部は不整で一部無エコー領域を伴い，ペルフルブタン（ソナゾイド ®）による造影超音波検査では腫瘍内部の血流は乏しい所見であった．超音波内視鏡検査所見も体外式腹部超音波検査と同様であった．以上より，腫瘍内出血を伴った solidpseudopapillary neoplasm（SPN）が最も考えられた．第10病日に膵体尾部切除術を施行し，術後経過は良好である．腹部打撲を契機に偶然発見され，体外式腹部超音波検査が質的診断に有用であった膵 SPN を経験したので文献的考察を加えて報告する．　We report a teenage girl with a solid pseudopapillary neoplasm (SPN) of the pancreas. The patient was transported to our hospital by ambulance and presented with left-sided abdominal pain after sustaining abdominal trauma during sports activities. Her white blood cell count (8950 cells/μl) and serum amylase level were increased (204 U/l) on admission. Transabdominal ultrasonography showed a well-encapsulated, complex pancreatic body mass measuring 76.1 × 68.1 mm with solid and cystic components. Contrastenhanced ultrasonography using Perflubutane (Sonazoid®) revealed poor contrast inside the tumor. Abdominal computed tomography and magnetic resonance imaging revealed similar findings. Partial pancreatectomy was performed 10 days after admission. The gross appearance of the resected specimen revealed mixed cystic and solid components with thick walls, and microscopy revealed the characteristic pseudopapillary pattern of SPN. The patient’s postoperative course proceeded well without recurrence as of this report. The imaging features of transabdominal ultrasonography and contrast-enhanced ultrasonography are useful to diagnose SPN. We discussed this patient’s detailed information and reviewed the related literature in this report

Seasonal Variations of the Growth in Body Height and Weight of Children Exposed to Natural Environment Stresses

論文(Article)http://webcatplus-equal.nii.ac.jp/libportal/DocDetail?txt_docid=NCID%3AAA1132132

Using digital teaching material for cancer education : A pilot study

The purpose of this study was to develop digital teaching material for cancer education with the aim to fulfill cancer education and implement digital textbooks. Digital teaching material for cancer learning was produced for junior high school students. The students who participated in this study were taught using this material online. Simultaneously, awareness of cancer was measured for the participating students both before and after providing the education using the online material. A total of 19 out of the 72 students who were invited participated (26.4% participation rate). Results supported the usefulness of the developed online cancer teaching material for junior high school students. The percentage of questions regarding cancer treatment that were answered correctly was high. However, there was misunderstanding regarding one question about the factors that increase risk of cancer; specifically, eating burnt food. It was confirmed that students’ understanding of cancer, such as whether cancer can be treated and whether it can be prevented, was enhanced after exposure to the digital educational material. At the same time, the ratio of participants who thought cancer was scary decreased 10 points. In future, it is desirable to expand the study, including efforts to increase the number of participants, to plan for randomized controlled trials and to measure long-term effects