Early Diagnosis of Pancreatic Cancer Report of Five Cases of the Small Pancreatic Cancer

Eighty-nine cases of pancreatic cancers were experienced during the last 12 years. Among them, 5 cases (5.6%) were small pancreatic cancer (below 2cm in diameter); 3 cases were pancreas head cancer, 1 case body cancer and 1 case tail cancer. These cancers were all resectable. The patient of the small pancreatic cancers were survived comparatively long; the average period was 18 months. All of the 3 cases of pancreas head cancers were started with jaundice, 1 case of body cancer was started with elevation of urinary amylase output and 1 case of tail cancer was started with continuously high level of serum amylase value indolently. In this report, the 5 cases of small pancreatic cancers as well as the positive rate of laboratory data are first outlined. The clue for diagnosis and the details are stated herewith, and regarding a patient of body cancer (2.0X1.5 cm) who survived comparatively long for 36.3 months after surgery and also a patient of tail cancer (0.7X0.6 cm) who, 45 months after surgery, is still survived without relapse

A Case of Adult Respiratory Distress Syndrome Associated with Acute Pancreatitis

A 52-year-old man was admitted to our department for acute pancreatitis. He developed adult respiratory distress syndrome (ARDS) on the 2nd hospital day, and was treated with respiratory management using positive endexpiratory pressure (PEEP) in addition to pharmacologic therapy for pancreatitis. The treatment was very effective, and he was discharged on the 72nd hospital day

The Echogenic Patterns of the Pancreatic Parenchyma in the Endoscopic Ultrasonography

Using the pancreas of the Japanese Macaque and human pancreas from autopsy cases, the echogenic patterns of the pancreatic parenchyma obtained by the ultrasonic endoscopy were compared with the histological findings. The parenchyma of the normal pancreas was observed as an echogenic pattern with homogeneous accumulation of small granular echoes. Such granular echoes are suggested to represent pancreatic acini on comparison with the tissue structure. This was confirmed by widening the pancreatic interstitium by infusing physiological saline into the main pancreatic duct. Such granular echoes became indistinct in the pancreas from autopsy cases due to autolysis. In the experimental pancreatic lesion produced by local injection of 1 % deoxycholic acid into the pancreas of Japanese Macaque, hemorrhage and fibrosis were noted 1 week later and fibrosis appears after 2 to 3 weeks. Hemorrhagic lesions were appeared as an area of high echogenicity, and fibrosis was appeared as an area of low echogenicity, with irregularity of the granular structure seen in the normal tissue

PANCREATIC HISTOLOGY IN PATIENTS UNDER LONG TERM CORTICOSTEROID TREATMENT

In 52 autopsy cases (30 cases treated with corticosteroid and 22 cases not treated), changes of the pancreas due to corticosteroid administration were histologically studied. Light microscopy revealed a significantly more frequent appearance of PAS positive materials inside of the acinar lumen, goblet cell metaplasia and hyperplasia of the pancreatic duct epithelium and spotty necrosis of the acinar cells in corticosteroid- treated cases than in non-treated cases. The mean number of dilated acini containing PAS positive materials (DAPPM) in ten 400 power fields was 1.63±2.0 in the non-treated group and 3.76±2.6 in the corticosteroid-treated group(p<0.01). Thus, these findings seems to play an important role in outflow disturbance of pancreatic juice. Electron microscopy revealed filamentous and electron dense materials filling in the dilated acinar lume, probably representing pancreatic juice with high viscosity and degradate on products of exocrine pancreatic cells

Lorazepam as a Cause of Drug-Induced Liver Injury

Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia. A 51-year-old Japanese man with yellowish discoloration of the eyes and skin and pruritus was admitted due to liver dysfunction. He had taken lorazepam approximately 5 months prior to this admission. The clinical presentation and pathologic findings in the liver were consistent with drug-induced liver injury. After cessation of lorazepam, treatment with Stronger neo-minophagen C and ursodeoxycholic acid was started, and his liver injury resolved after 59 days. This case must serve as a warning to physicians to be aware of the possibility of unexpected liver injury caused by lorazepam

Analysis of virulence factors of Helicobacter pylori isolated from a Vietnamese population

BACKGROUND: The incidence of gastric cancer differs among countries in Asia, and it has been suggested that virulence factors associated with Helicobacter pylori are partly responsible. The aim of this study was to investigate several genetic factors regarded as virulence or molecular epidemiologic markers in H. pylori isolates from Vietnamese subjects. RESULTS: The cagA, vacA and cag right-end junction genotypes of 103 H. pylori strains from Vietnam (54 from Hanoi and 49 from Ho Chi Minh) were determined by PCR and sequencing. Three types of deletion in the region located upstream of the cagA Glu-Pro-Ile-Tyr-Ala (EPIYA) repeat region were identified: the 39-bp deletion type, the 18-bp deletion type, and the no-deletion type. The majority of strains studied (77%; 80/103) had the 18-bp deletion irrespective of geographical location in the country or clinical outcome. All of the 39-bp and 18-bp deletion-type strains possessed the East Asian type cagA repeat region. The type II cag right-end junction genotype was predominant (84%). The vacA m1 genotype was significantly more common in strains isolated in Hanoi, where the incidence of gastric cancer is higher, than in strains from Ho Chi Minh. CONCLUSION: Pre-EPIYA-region typing of the cagA gene could provide a new genetic marker of H. pylori genomic diversity. Our data support the hypothesis that vacA m1 is closely associated with gastric carcinogenesis

Helicobacter pylori infection and gastroduodenal diseases in Vietnam: a cross-sectional, hospital-based study

<p>Abstract</p> <p>Background</p> <p>The rate of <it>H. pylori </it>infection in Vietnam is reportedly high, but the spectrum of <it>H. pylori</it>-associated gastroduodenal diseases has not been systematically investigated. Moreover, despite the similarities of ethnicity and diet, the age-standardized incidence rate of gastric cancer in the northern city of Hanoi is higher than that in the southern city of Ho Chi Minh, but the reason for this phenomenon is unknown. The virulence of Vietnamese <it>H. pylori </it>has also not been investigated in detail.</p> <p>Methods</p> <p>Individuals undergoing esophagogastroduodenoscopy were randomly recruited. <it>H. pylori </it>infection status was determined based on the combined results of culture, histology, immunohistochemistry, rapid urine test and serum ELISA. Peptic ulcer (PU) and gastroesophageal reflux disease was diagnosed by endoscopy, and chronic gastritis was determined histologically. <it>H. pylori </it>virulence factors were investigated by PCR and sequencing.</p> <p>Results</p> <p>Among the examined patients, 65.6% were infected with <it>H. pylori</it>. The prevalence of infection was significantly higher in those over 40 years of age than in those aged ≤40. Chronic gastritis was present in all <it>H. pylori</it>-infected individuals, 83.1% of whom had active gastritis, and 85.3% and 14.7% had atrophy and intestinal metaplasia, respectively. PU was present in 21% of infected patients, whereas its incidence was very low in non-infected individuals. The prevalence of PU was significantly higher in Hanoi than in Ho Chi Minh. The prevalence of <it>vacA m1</it>, which has been identified as an independent risk factor for PU in Vietnam, was significantly higher among <it>H. pylori </it>isolates from Hanoi than among those from Ho Chi Minh.</p> <p>Conclusions</p> <p><it>H. pylori </it>infection is common in Vietnam and is strongly associated with PU, active gastritis, atrophy and intestinal metaplasia. <it>vacA m1 </it>is associated with an increased risk for PU and might contribute to the difference in the prevalence of PU and gastric cancer between Hanoi and Ho Chi Minh.</p

Genomic Profiling of Submucosal-Invasive Gastric Cancer by Array-Based Comparative Genomic Hybridization

Genomic copy number aberrations (CNAs) in gastric cancer have already been extensively characterized by array comparative genomic hybridization (array CGH) analysis. However, involvement of genomic CNAs in the process of submucosal invasion and lymph node metastasis in early gastric cancer is still poorly understood. In this study, to address this issue, we collected a total of 59 tumor samples from 27 patients with submucosal-invasive gastric cancers (SMGC), analyzed their genomic profiles by array CGH, and compared them between paired samples of mucosal (MU) and submucosal (SM) invasion (23 pairs), and SM invasion and lymph node (LN) metastasis (9 pairs). Initially, we hypothesized that acquisition of specific CNA(s) is important for these processes. However, we observed no significant difference in the number of genomic CNAs between paired MU and SM, and between paired SM and LN. Furthermore, we were unable to find any CNAs specifically associated with SM invasion or LN metastasis. Among the 23 cases analyzed, 15 had some similar pattern of genomic profiling between SM and MU. Interestingly, 13 of the 15 cases also showed some differences in genomic profiles. These results suggest that the majority of SMGCs are composed of heterogeneous subpopulations derived from the same clonal origin. Comparison of genomic CNAs between SMGCs with and without LN metastasis revealed that gain of 11q13, 11q14, 11q22, 14q32 and amplification of 17q21 were more frequent in metastatic SMGCs, suggesting that these CNAs are related to LN metastasis of early gastric cancer. In conclusion, our data suggest that generation of genetically distinct subclones, rather than acquisition of specific CNA at MU, is integral to the process of submucosal invasion, and that subclones that acquire gain of 11q13, 11q14, 11q22, 14q32 or amplification of 17q21 are likely to become metastatic

A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn\u27s disease.

BACKGROUND:Small bowel stricture is one of the most common complications in patients with Crohn\u27s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.METHODS:Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.RESULTS:A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.CONCLUSIONS:In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD