Three Cases of Tsutsugamushi Disease successfully treated with Clarithromycin.

Three cases of tsutsugamushi disease were successfully treated with clarithromycin, a new macrolide antibiotic. This is the first report describing tsutsugamushi disease in Hirado area and the clinical application of clarithromycin to this rickettsial disease

Hepatocellular Carcinoma with Direct Invasion to the Duodenal Bulb, Presenting with Gastrointestinal Bleeding

Hemorrhage from hepatocellular carcinoma (HCC) directly invading the gastrointestinal tract is very rare. A 71-yearold man, who had been treated with transcatheter arterial embolization and percutaneous ethanol injection for HCC in the right hepatic lobe, presented with melena. Endoscopic examination showed a crater-like ulceration coated with blood clot in the duodenal bulb, and microscopic examination of a biopsy specimen from the duodenal lesion confirmed HCC. Abdominal computed tomography (CT) revealed that the HCC mass containing air-density invaded the duodenum. Recurrent bleeding continued from the lesion and the patient died of liver failure. Postmortem examination revealed massive HCC with hepatoduodenal fistula caused by direct tumor invasion into the duodenum

Detection of Epstein-Barr Virus and Helicobacter pylori in Primary Malignant Gastric Lymphomas

We studied five patients diagnosed with primary gastric lymphoma between 1985 and 1995 in Omura Munisipa Hospital to investigate the relationship between Helicobacter pylori, Epstein-Barr virus and primary malignant gastric lymphoma. H. pylori was detected by hematoxylin-eosin stain, Giemsa stain, immunohistochemistry while EBV was detected by in situ hybridization in the lymphoma and background mucosa. H. pylori but not EBV, was detected in all cases. Furthermore, malignant lymphomas were mainly located in the area of the fundic gland where H. pylori was frequently identified and caused inflammation. In contrast, malignant lymphomas were not detected in areas with intestinal metaplasia. Our results suggest that malignant lymphoma may develop in a region where the immune system has been activated by H. pylori. In contrast, EBV is unlikely to play an important role in the development of gastric lymphoma, compared to H. pylori

Ultraflex Stent Placement for Palliation of Esophageal Cancer

Nine patients with malignant esophageal obstruction were treated with non-covered or covered Ultraflex stents. All patients achieved palliation, six of nine patients showed improvement of at least one dysphagia grade, and five patients could tolerate a normal or near-normal diet. Major (massive bleeding) and minor complications (ingrowth, overgrowth, stent migration, and bleeding) were encountered during follow-up in 2 and 4 patients, respectively. Ultraflex stents for esophageal cancer offer effective palliative treatment and quickly improve dysphagia. However, care should be exercised particularly of potentially serious life-threatening complications such as massive bleeding

Three Cases of Tsutsugamushi Disease successfully treated with Clarithromycin.

Three cases of tsutsugamushi disease were successfully treated with clarithromycin, a new macrolide antibiotic. This is the first report describing tsutsugamushi disease in Hirado area and the clinical application of clarithromycin to this rickettsial disease