Primary Follicular Lymphoma of the Duodenum with Erosions as Atypical Macroscopic Features

A 52-year-old Japanese woman who was eventually diagnosed with primary follicular lymphoma of the duodenum showed atypical endoscopic features, namely, erosions with peripheral whitish edematous mucosa. Initial biopsy specimens taken from the erosions revealed insufficient numbers of lymphoma cells for histological diagnosis. Subsequent biopsy specimens from the peripheral mucosa containing the whitish enlarged villi showed infiltration of the lymphoma cells forming lymphoid follicles, which led us to the appropriate diagnosis. This case indicates that endoscopists should take biopsy samples from the peripheral mucosa with whitish enlarged villi rather than erosions in the rare instances that erosions appear as the main macroscopic feature of intestinal follicular lymphoma

THE INCIDENCE OF PEPTIC ULCER SURGERY BEFORE AND AFTER THE INTRODUCTION OF H2-RECEPTOR ANTAGONISTS

Since the introduction of H2-receptor antagonists, the incidence of ulcer surgery has decreased markedly. Based on the number of patients who underwent ulcer surgery and upper gastrointestinal endoscopy in our hospital, the number of operations for peptic ulcer disease has decreased, although the number of peptic ulcer patients diagnosed by endoscopy has increased after the introduction of cimetidine (the first H2-receptor antagonist in Japan). The decreasing rate of surgical therapy before and after the administration of H2-receptor antagonists was 49.1%. The number of emergency operations has also decreased among ulcer patients diagnosed by endoscopy although the number of perforated and bleeding ulcer patients has increased. It is also reported that the most common operative procedure for both gastric and duodenal ulcer was distal gastrectomy reconstructed by gastroduodenostomy (Billroth Ⅰ)

Stability test results on the aluminum stabilized superconductor for the helical coils of LHD

Stability tests have been carried out on short samples of the aluminum/copper stabilized composite-type superconductors developed and used for the pool-cooled helical coils of the Large Helical Device. The waveform of the longitudinal voltage initiated by resistive heaters shows a short-time rise before reaching a final value, which seems to correspond to the diffusion process of transport current into the pure aluminum stabilizer. The propagation velocity has a finite value even for the transport current being lower than the recovery current, and it differs depending on the direction with respect to the transport current

Lipid control profile in patients with acute coronary syndrome at Tokushima Prefectural Central Hospital

In Japan atherosclerosis society guideline, it is recommended for secondary prevention of acute coronary syndrome to manage lipid. In particular, hyper-LDLemia is known to develop and promote atherosclerosis, and lowering the LDL-C level leads to suppression of recurrence of atherosclerosis. We investigated the profile of lipid control in patients who succeeded in percutaneous coronary intervention for acute coronary syndrome（ACS）at our hospital, and examined by high risk patients（chronic kidney disease, diabetes, obesity）. The achievement rate of LDL-C <１００ at discharge was６２％ of all cases, and the achievement rate of LDL-C <７０was only１６％. In particular, only１２％ of obese patients achieved LDL-C <７０. In recent years, it has been shown that additional administration of ezetimibe or PCSK９ inhibitor to statins further lowers LDL-C and significantly reduces the risk of developing cardiovascular disease. We should recognize that some ACS patients have not reached their goals and actively treat them for secondary prevention

Clinical characteristics and course of sporadic non-ampullary duodenal adenomas A multicenter retrospective study

Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA. We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection. Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 +/- 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate. With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions

Novel SUZ12 mutations in Weaver‐like syndrome

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146320/1/cge13415_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146320/2/cge13415-sup-0001-AppendixS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146320/3/cge13415.pd