Novel Method for Differentiating Histological Types of Gastric Adenocarcinoma by Using Confocal Raman Microspectroscopy

[[abstract]]Gastric adenocarcinoma, a single heterogeneous disease with multiple epidemiological and histopathological characteristics, accounts for approximately 10% of cancers worldwide. It is categorized into four histological types: papillary adenocarcinoma (PAC), tubular adenocarcinoma (TAC), mucinous adenocarcinoma (MAC), and signet ring cell adenocarcinoma (SRC). Effective differentiation of the four types of adenocarcinoma will greatly improve the treatment of gastric adenocarcinoma to increase its five-year survival rate. We reported here the differentiation of the four histological types of gastric adenocarcinoma from the molecularly structural viewpoint of confocal Raman microspectroscopy. In total, 79 patients underwent laparoscopic or open radical gastrectomy during 2008–2011: 21 for signet ring cell carcinoma, 21 for tubular adenocarcinoma, 14 for papillary adenocarcinoma, 6 for mucinous carcinoma, and 17 for normal gastric mucosas obtained from patients underwent operation for other benign lesions. Clinical data were retrospectively reviewed from medical charts, and Raman data were processed and analyzed by using principal component analysis (PCA) and linear discriminant analysis (LDA). Two-dimensional plots of PCA and LDA clearly demonstrated that the four histological types of gastric adenocarcinoma could be differentiated, and confocal Raman microspectroscopy provides potentially a rapid and effective method for differentiating SRC and MAC from TAC or PAC[[notice]]補正完

An Uncommon Cause of Hiccups: Sarcoidosis Presenting Solely as Hiccups

Common causes of hiccups are over-distension of the stomach, a sudden change in gastrointestinal temperature, excessive alcohol and tobacco ingestion, and sudden excitement or emotional changes. Common presenting symptoms of sarcoidosis include cough, dyspnea, and chest pain. It is very rare for a sarcoidosis patient to present with hiccups. A 48-year-old man presented with hiccups of 2 weeks' duration. He denied having headaches, earache, cough, abdominal pain, fever, or body weight loss history. On physical examination, he had no peripheral lymphadenopathies in the neck, axilla and inguinal regions, no organomegaly in the abdomen and no skin abnormalities. A neurological examination showed normal findings. Laboratory investigations revealed a normal complete blood count, liver function, renal function, serum calcium, and tumor markers. Transabdominal ultrasound was negative, and panendoscopy revealed a small healing duodenal ulcer. Chest radiography showed an enlarged right lung hilum, while computed tomography showed enlargement of multiple mediastinal lymph nodes. Endoscopic ultrasound-guided fine-needle aspiration with a 22-gauge needle and trucut biopsy with a 19-gauge needle (quick-core biopsy needle) were performed, and cytology, cell block and histology revealed non-caseating granuloma, with negative tuberculous and fungus cultures. Mediastinal lymph node due to sarcoidosis can be a rare cause of hiccups

Linear endoscopic ultrasound for clinically suspected bile duct stones

Background: Radial endoscopic ultrasound (EUS) is a less invasive imaging modality used to evaluate common bile duct stones (CBDS) and is as accurate as endoscopic retrograde cholangiography (ERCP). Patients classified as high risk for suspected CBDS were found to have stones in only two-thirds of cases, and an argument could be made for performing EUS in these high-risk patients. There are very few reports of linear EUS for CBDS detection. Our aim was to evaluate the diagnostic efficiency of linear EUS in patients with suspected CBDS in intermediate- and high-risk groups. Methods: This is a retrospective analysis of prospectively collected data for 30 patients with suspected CBDS assessed using linear EUS. The inclusion criteria were acute epigastric pain, abnormal liver function test (LFT), and CBDS not detected by transabdominal ultrasound or computed tomography. The exclusion criteria were failure to insert a linear EUS endoscope into the duodenum and Billroth II gastrectomy. ERCP was performed in patients with positive CBDS on linear EUS. Cases with negative CBDS after linear EUS examination were followed in terms of clinical symptoms and LFT for at least for 3 months as outpatients. Results: There were 17 male and 13 female patients with a mean age of 53 (±17.6) years. Twelve cases were positive for CBDS, of which 11 were confirmed by ERCP and one was a false positive. In cases with negative CBDS on linear EUS, the median follow-up duration was 9 (3–12) months. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 94.7%, 91.7%, 100%, and 96.7%, respectively. CBDS was positive in 56% (9/16) of high-risk patients and 14.3% (2/14) of intermediate-risk patients. Conclusion: Linear EUS is sensitive for the detection of CBDS. It detected 56% of CBDS in a high-risk group and 14.2% in an intermediate-risk group and therefore is a useful assessment tool in patients with high or intermediate risk of CBDS