A Rare Case of Appendiceal Mucocele with Myxoglobulosis

A 63-year-old man was admitted with an abdominal mass in the right lower quadrant. The tumor was diagnosed as mucocele of the appendix after admission and surgically removed. The appendix containing gelatinous mucus with numerous round bodies was distended to the size of an egg. Therefore, a diagnosis of myxoglobulosis was postoperatively made. This is a rare disease and the diagnosis has been preoperatively made in none of patients in Japan. The present case could present an echographic pattern characteristic of this cyst. Studies on all available echograms from previous patients could provide information necessary for preoperative diagnosis of myxoglobulosis

Long-term Ultrasonographic Follow-up Study of Gastric Motility in Patients with Functional Dyspepsia

Although patients with functional dyspepsia complain of epigastric symptoms, the relation between these symptoms and gastric motility remains controversial. There are few reports on the clinical course of functional dyspepsia, including changes in gastric motility, observed over a considerably long period. We conducted a study to examine association between changes in symptoms and changes in ultrasonographically evaluated gastric motility over a long-term follow-up period in patients with functional dyspepsia. Forty patients (18 men, 22 women; mean age, 53.7 years) with functional dyspepsia were followed up by medical interview, physical examination, endoscopy, and ultrasonography for gastric motility. Follow-up ranged from 1.0 to 7.8 years (mean, 3.0 years). Ultrasonographic evaluation of gastric motility included gastric emptying rate and antral contractions. During the follow-up period, patients were treated with proton pump inhibitors, H2-blockers, or prokinetics. Symptoms improved in 21 patients (group A), but symptoms persisted or worsened in 19 patients (group B). There were no significant differences in clinical characteristics between the two groups. Gastric motility improved in group A but not in group B. In conclusion, improved gastric motility appears to correspond to and may explain improved symptoms in some patients with functional dyspepsia

Mesenteric Bleeding due to a Ruptured Aneurysm of the Middle Colic Artery

An outpatient with repeated colic attacks of unknown cause was hospitalized and was subjected to CT scan, ultrasound inspection, cytodiagnosis via abdominocentesis, resulting in the diagnosis of epigastrial hematoma. Further angiographical investigation evidenced the presence of middle colic artery. Aneurysm was also detected in the right colic artery. Other celiac arteries, however, were normal. The aneurysms detected were surgically removed with a portion of the intestinal tract. The pathological investigation of the resected aneurysm in the present cast could not prove the association with several other diseases which have been mentioned as possible causes for aneurysm. While only 10 cases of aneurysm at the superior mesenteric arterial branch have been reported, the authors believe that angiographical inspection should indispensably be attempted for diagnosis in cases of abdominal pain or abdominal tumors of unknown causes

Obesity and Perioperative management – Review –

　Obesity is a contributing factor to life-style related diseases such as diabetes, hypertension and dyslipidemia, as well as being a cause of metabolic syndromes. It has been predicted that more than half of the adult population in the world might be obese within the next twenty years. Once a person is diagnosed with metabolic syndrome, conditions such as diabetes, hypertension and dyslipidemia may remain mild even while visceral fat obesity slowly advances arterial sclerosis. Eventually, severe clinical conditions such as heart diseases and stroke can result. In recent years, there are more and more patients diagnosed with morbid obesity both inside and outside of Japan. This case report will discuss some concerns and tasks in treating patients with obesity and morbid obesity

Efficacy and safety of temporary biliary stent for prevention of post-ERCP cholangitis after endoscopic common bile duct stone removal: a retrospective study

　Although post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis (PEC) is not as severe as post-ERCP pancreatitis, this complication should not be disregarded. The aim of the present study was to evaluate the efficacy of a temporary biliary stent for prevention of PEC. Between April 2011 and May 2017, 190 patients underwent complete stone removal in a first session of ERCP at our hospital. Using propensity score matching, 72 pairs were enrolled in this study. After common bile duct (CBD) stone removal, the endoscopists decided to insert a temporary biliary stent if necessary. The incident rate of PEC was significantly lower in the stent group than the no-stent group (1% vs. 11%, p = 0.03). The length of hospital stay was also significantly shorter in the stent group than the no-stent group (5 days vs. 7 days, p < 0.01). In the stent group, one case had stent migration into the bile duct and two cases had a mooring stent at the papilla after 1 month. Multivariate analysis identified the pancreatic guide wire technique as a risk factor for PEC. We demonstrated that a temporary biliary stent reduced the incidence of PEC significantly and the outcome of its placement contributed to shortening the hospital stay. Furthermore, the placement of a temporary biliary stent caused fewer adverse effects than expected. Mooring stents were noted in three cases, which were confirmed by plain abdominal X-ray, but the patients had no symptoms. In two cases, the stent remained in the orifice of the papilla, and in one case it migrated into the CBD. All three stents were retrieved by elective endoscopic procedures. In conclusion, a temporary biliary stent can reduce the incidence of PEC and shorten the length of hospital stay without severe adverse outcomes

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

Antral Somatostatin Contents and Acidity of Gastric Juice in Normal Subjects and Patients with Duodenal Ulcer

The antral somatostatin contents were investigated in biopsy specimens of the antrum from normal subjects and patients with duodenal ulcer. There was good correlation (r=0.77044) between antral somatostatin contents and maximal acidity in normal subjects, but the correlation between antral somatostatin contents and maximal acid output was not significant (r=0.254367). This result may indicate that antral somatostatin content is regulated by intragastric pH in normal subjects. On the other hands, no correlation was observed between antral somatostatin contents and acidity or acid output in patients with duodenal ulcer. Therefore the impaired regulation of acid on antral somatostatin contents could be one of the important factors in the pathogenesis of duodenal ulcer disease