Two Cases of Early Carcinoma of a Reconstructed Gastric Tube after Esophagectomy Treated Extendedly with Endoscopic Submucosal Dissection

We report two cases of gastric tube carcinoma (GTC) treated with endoscopic submucosal dissection (ESD) after esophagectomy. Case 1 was a 47-year-old woman who had received esophagectomy with reconstruction of the gastric tube (GT) for esophageal squamous cell carcinoma. Sixty-seven months later, endoscopy showed a carcinoma in the lower part of the GT. The removed tumor showed a 0-IIc lesion, 10 mm in diameter, diagnosed as a signet ring cell carcinoma limited to the mucosa. Case 2 was an 83-year-old woman who simultaneously underwent lower esophagectomy for basaloid-squamous cell carcinoma of the esophagus and colectomy for ascending colon carcinoma. Sixty-one months later, endoscopy showed a carcinoma in the middle part of the GT. The tumor removed by ESD showed a 0-IIa+IIc lesion, 50 mm in diameter, diagnosed as a moderately differentiated tubular adenocarcinoma limited to the mucosa. The clinicopathologic features of 48 Japanese cases, including Cases 1 and 2, with GTC were reviewed. An extended indication of endoscopic resection for gastric carcinoma was present in 12 (25%) including Cases 1 and 2. In conclusion, ESD may be safe for GTC; however, further investigations may be necessary to confirm the safety and curative potential of ESD for GTC.Article信州医学雑誌 59(2): 81-88(2011)departmental bulletin pape

Emergency Operation for Non-Hodgkin Lymphoma of the Small Intestine

We report 5 cases of non-Hodgkin lymphoma of the small intestine (S-NHL) treated with emergency operation. These cases showed three reasons for emergency operation :［1］massive hemorrhage with shock before diagnosis of S-NHL (Case 1),［2］obstruction of the small intestine before and during chemotherapeutic treatment for S-NHL (Cases 2 and 3),and［3］spontaneous perforation with peritonitis before diagnosis of SNHL or iatrogenic perforation following chemotherapy (Cases 4 and 5).For tumor discovery,double-balloon endoscopy of the small intestine was employed in 3 cases.Three tumors were histologically diagnosed before treatment,while 2 were histopathologically diagnosed using the resected specimens after emergency operation. An advanced stage of NHL was frequently observed.No surgical mortality accurred.We always consider the possibility of emergency operation before, during, and after the diagnosis and treatment of patients with SNHL. Shinshu Med J 60 : 21-25, 2012Article信州医学雑誌 60(1): 21-25(2012)departmental bulletin pape

Pathophysiological Investigation of the Gastric Surface Mucous Gel Layer of Patients with Helicobacter pylori Infection by Using Immunoassays for Trefoil Factor Family 2 and Gastric Gland Mucous Cell-Type Mucin in Gastric Juice

Background The trefoil factor family (TFF) 2 protein is produced by gastric gland mucous cells (GMCs), and the secreted TFF2 shares a mucosal barrier function with GMC-type mucin. Recently, we presented an enzyme-linked immunosorbent assay (ELISA) method for measurement of GMC-type mucin in the gastric juice. Aims We aimed to develop an ELISA for TFF2 and to assess pathophysiological changes in the gastric surface mucous gel layer (SMGL) of patients with Helicobacter pylori infection. Methods The distribution of TFF2 and GMC-type mucin in the SMGL was immunohistochemically determined. The ELISA for TFF2 was based on a polyclonal goat antibody. Recombinant TFF2 was employed to prepare the calibrators. TFF2 and GMC-type mucin in the gastric juice in healthy individuals (n = 33) and patients with gastritis (n = 37), gastric ulcer (n = 16), and duodenal ulcer (n = 10) were assayed using ELISA. Results TFF2 and GMC-type mucin were immunohistochemically co-localized in the gastric SMGL and GMCs. The TFF2 levels in the patients were significantly higher than those in the healthy individuals. Further, the TFF2 levels in the H. pylori-positive patients were significantly higher than those in the H. pylori-negative patients, and decreased after the eradication of the infection. GMC-type mucin levels showed a tendency similar to that of TFF2 levels. Conclusions The upregulation of TFF2 and GMC-type mucin secretion may reflect the response of the gastric mucosa to H. pylori-induced injuries. TFF2 and GMC-type mucin secreted into the SMGL may protect the gastric mucosa against H. pylori.ArticleDIGESTIVE DISEASES AND SCIENCES. 56(12):3498-3506 (2011)journal articl

Takayasu's Arteritis in a Patient with Crohn's Disease: An Unexpected Association during Infliximab Therapy

We report a 20-year-old woman with Crohn's disease (CD) who developed anterior neck pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. She showed no symptoms suggestive of active CD except for tenderness along the left common carotid artery with marked increases in serum TNF-alpha and inflammatory reactions. Based on thickened walls of large vessels with enhancement effects on computed tomography, she was diagnosed as having associated Takayasu's arteritis (TA), which was successfully treated with corticosteroid. Even if CD is controlled by infliximab, other autoimmune disorders, such as TA, may develop as a complication.ArticleINTERNAL MEDICINE. 49(2):179-182 (2010)journal articl