Two Types of Polyp Shape Observed in the Stomach of Patients with Peutz-Jeghers Syndrome

The characteristics of gastric polyps in patients with Peutz-Jeghers (PJ) syndrome (PJS) have not been fully investigated. The objective of this study was to reveal the endoscopic and pathologic findings of gastric polyps in patients with PJS. We reviewed 11 patients with PJS treated at 6 institutions, and summarized the endo-scopic and pathologic features of their gastric polyps. The polyps were mainly classified into 2 types: (i) soli-tary or sporadic polyps > 5 mm, reddish in color with a sessile or semi-pedunculated morphology (n = 9); and (ii) multiple sessile polyps ≤ 5 mm with the same color tone as the peripheral mucosa (n = 9). Patients who underwent endoscopic mucosal resection for polyps > 5 mm were diagnosed with PJ polyps (n = 2), whereas those who underwent biopsy were diagnosed with hyperplastic polyps. Polyps ≤ 5 mm were pathologically diagnosed as fundic gland polyps or hyperplastic polyps. This study revealed that patients with PJS present with 2 types of polyps in the stomach. Endoscopic mucosal resection of polyps > 5 mm seems necessary for the pathologic diagnosis of PJ polyps

Importance of Second-look Endoscopy on an Empty Stomach for Finding Gastric Bezoars in Patients with Gastric Ulcers

　Most gastric bezoars can be treated with endoscopic fragmentation combined with or without cola dissolution, whereas laparotomy or laparoscopic surgery is generally inevitable for small intestinal bezoars because they cause small bowel obstruction. Therefore, early diagnosis and management of gastric bezoars are necessary to prevent bezoar-induced ileus. To investigate the incidence of overlooked gastric bezoars during the initial esophagogastroduodenoscopy, we retrospectively reviewed the cases of 27 patients diagnosed with gastrointestinal bezoars. The bezoars were diagnosed using esophagogastroduodenoscopy (n=25), abdominal ultrasonography (n=1), and barium follow-through examination (n=1). Bezoars were overlooked in 9/25 patients (36.0%) during the initial endoscopy examination because the bezoars were covered with debris in the stomach. Of the 9 patients, 8 had concomitant gastric ulcers, and the other patient had gastric lymphoma. Although a computed tomography (CT) scan was performed before the second-look endoscopy in 8 of the 9 patients, the bezoars were mistaken as food debris on CT findings and were overlooked in these patients. In conclusion, gastric bezoars may not be discovered during the initial esophagogastroduodenoscopy and CT scan. In cases with debris in the stomach, second-look endoscopy is essential to detect bezoars

Stability of energy landscape for Ising models

In this paper, we explore the stability of the energy landscape of an Ising Hamiltonian when subjected to two kinds of perturbations: a perturbation on the coupling coe cients and external fields, and a perturbation on the underlying graph structure. We give su cient conditions so that the ground states of a given Hamiltonian are stable under perturbations of the first kind in terms of order preservation. Here by order preservation we mean that the ordering of energy corresponding to two spin configurations in a perturbed Hamiltonian will be preserved in the original Hamiltonian up to a given error margin. We also estimate the probability that the energy gap between ground states for the original Hamiltonian and the perturbed Hamiltonian is bounded by a given error margin when the coupling coe cients and local external magnetic fields of the original Hamiltonian are i.i.d. Gaussian random variables. In the end we show a concrete example of a system which is stable under perturbations of the second kind

First result of large size Scintillating Glass GEM imager

A large size x-ray imaging gaseous detector, which has 280 × 280 mm2 effective area has been successfully developed and x-ray imaging has been demonstrated. The imaging system consists of a chamber filled with Ne/CF4 scintillating gas mixture, inside of which Glass GEM (G-GEM) is mounted for gas multiplication. In this system electrons are generated by the reaction between x-rays and the gas, and visible photons by excited Ne/CF4 gas molecules during the gas electron multiplication process in the G-GEM holes. These photons are simply detected with CCD-camera and a radiograph is formed. Here, we report on the properties of large size scintillation G-GEM and the results of using it as a digital x-ray imager with a large sensitive area

First result of large size Scintillating Glass GEM imager

A large size x-ray imaging gaseous detector, which has 280 × 280 mm2 effective area has been successfully developed and x-ray imaging has been demonstrated. The imaging system consists of a chamber filled with Ne/CF4 scintillating gas mixture, inside of which Glass GEM (G-GEM) is mounted for gas multiplication. In this system electrons are generated by the reaction between x-rays and the gas, and visible photons by excited Ne/CF4 gas molecules during the gas electron multiplication process in the G-GEM holes. These photons are simply detected with CCD-camera and a radiograph is formed. Here, we report on the properties of large size scintillation G-GEM and the results of using it as a digital x-ray imager with a large sensitive area

Long-Term Outcome in Patients with a Solitary Peutz-Jeghers Polyp

BACKGROUND: Clinical characteristics and prognosis of patients with a solitary Peutz-Jeghers polyp (PJP) have not been fully investigated. METHODS: Solitary PJP was diagnosed when a single hamartomatous lesion was identified in the gastrointestinal tract of patients without mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. We retrospectively reviewed 51 patients (32 men and 19 women) with a solitary PJP and analyzed the sex, age at diagnosis, endoscopic features, and outcomes in this patient group. The STK11/LKB1 germline mutation was not investigated in any of the patients. RESULTS: The mean age of the 51 patients was 66.1 years. The polyp was found in the duodenum (N = 10), jejunum (N = 2), cecum (N = 2), transverse colon (N = 5), sigmoid colon (N = 21), or rectum (N = 11). Most of the polyps presented as a pedunculated lesion (N = 40), followed by semipedunculated (N = 9) and sessile (N = 2) morphologies. The mean size of a solitary PJP was 15.6 mm (range: 5 to 33 mm). During a mean endoscopic follow-up period of 4.5 years (range: 0.1 to 16.1 years), no recurrence was identified. Eighteen of the enrolled patients had a history of cancer or concomitant cancer. Five patients died due to non-gastrointestinal-related causes. No additional cancer or death directly related to solitary PJP was observed. CONCLUSIONS: Solitary PJPs did not recur in this study. Although examination of the entire gastrointestinal tract using esophagogastroduodenoscopy, enteroscopy, and colonoscopy is desirable to exclude Peutz-Jeghers syndrome, follow-up endoscopy after endoscopic polyp resection may be unnecessary, once the diagnosis of a solitary PJP is made