[Liver metastasis from alpha-fetoprotein-producing gastric cancer 27 years postoperation:a case report].

A 75-year-old man with a history of distal gastrectomy for gastric cancer at 48 years of age underwent abdominal computed tomography, which revealed a left hepatic lobe tumor alongside direct gastric invasion. His blood test results revealed significant increase in serum alpha-fetoprotein (AFP) levels (32240.3ng/mL). A gastroscopy revealed that the histopathological findings of the biopsy specimens of the gastric invasion area were identical to those observed in the surgical specimens of gastric cancer, which was diagnosed 27 years earlier. The evaluation of the biopsy and surgical specimens revealed AFP positivity, which confirmed the diagnosis of the late recurrence of AFP-positive gastric cancer. Herein, we presented a rare clinical case of this malignancy. Additionally, a close, long-term postoperative follow-up is warranted in patients with AFP-producing gastric cancer.

A case of anisakiasis in the sigmoid colon.

Colonic anisakiasis is rare because most cases of anisakiasis occur in the stomach. An accurate diagnosis is sometimes difficult because of the rarity and symptom nonspecificity. We should consider the possibility of colonic anisakiasis when examining patients who have a history of consuming raw fish.

[Diagnosis of an ileal neuroendocrine tumor based on lymph node metastases: a case report].

A 72-year-old man was diagnosed with tumors outside of the stomach and mesentery of the small intestine on abdominal computed tomography. Histopathological examination of an endoscopic ultrasound-guided fine-needle aspiration biopsy specimen confirmed the diagnosis of lymph node metastasis of a neuroendocrine tumor (NET). Gastroscopy, colonoscopy, small bowel capsule endoscopy, somatostatin receptor scintigraphy, and 18F-fluorodeoxyglucose positron emission tomography were performed. However, the primary lesion could not be diagnosed. The patient underwent surgery, and an ileal submucosal tumor, which was not identified preoperatively in addition to the aforementioned abdominal tumors, was detected. All tumors were diagnosed as NET, and the ileal tumor was considered the primary lesion. The patient has shown no recurrence postoperatively. The current study presents a case of an ileal NET with lymph node metastases in a patient in whom the primary lesion remained preoperatively undiagnosed.

Adaptation and validation of the Japanese version of the Health Education Impact Questionnaire (heiQ-J) for the evaluation of self-management education interventions.

AIM: In many countries, health education interventions are popular; however, few valid measures exist for evaluation of multifactorial interventions. The aim of the present study was to translate and culturally adapt the widely-used 8 scale Health Education Impact Questionnaire (heiQ) for the evaluation of the Japanese Specific Health Consultation (SHC) in people with metabolic syndrome. METHODS: A draft was generated using a standardized forward and back translation protocol with independent translators and consensus meetings. Pilot testing included cognitive interviews (n = 12) resulting in question refinements. To explore psychometric properties, 250 participants aged between 40 and 64 years (retest = 116) completed the Japanese version of the heiQ (heiQ-J) and comparator scales, mental health and vitality scales of the Medical Outcomes Study 36 item Short-Form Health Survey, Sense Of Coherence scale, and Social Support Measurement scale. RESULTS: Cognitive interviews revealed that the translation was understood as intended by participants. Internal consistency (α) was good to very good for all scales (0.70-0.88) and test-retest intraclass correlation coefficients were high (≥ 0.83). Concurrent validity was supported by high correlation with like scales and weak correlation with dissimilar scales. CONCLUSION: The translated and adapted heiQ-J has good face and concurrent validity and is reliable. The heiQ-J is likely to be a useful measure of the quality and impact of the SHC and return valuable data to clinicians and commissioners of health education in Japan.

Diuretics aggravate zinc deficiency in patients with liver cirrhosis by increasing zinc excretion in urine.

AIM: Liver cirrhosis is often accompanied by zinc deficiency. The exact mechanisms underlying zinc deficiency remain unclear. This study was undertaken to clarify the influence of diuretics on blood zinc levels and zinc excretion in urine in liver cirrhosis. METHODS: Seventy-nine outpatients with liver cirrhosis were divided into four groups: (i) patients receiving no zinc preparations or diuretics (LC group); (ii) those receiving zinc preparations only (LCZ group); (iii) those receiving diuretics only (LCD group); and (iv) those receiving both zinc preparations and diuretics (LCDZ group). Among these groups, the effects of the administrated drugs on blood zinc levels and urinary zinc excretion were analyzed. RESULTS: Blood zinc levels were significantly lower in the LCD group (47.8 ± 10.5 µg/dL) than in the other groups (LC: 68.8 ± 17.1 µg/dL, P = 0.0056, post-hoc test; LCZ: 78.4 ± 18.1, P < 0.0001; LCDZ: 70.3 ± 21.4, P = 0.0008). The creatinine-adjusted urinary zinc excretion was significantly higher in the LCDZ group (548.1 ± 407.6 µg/mg creatinine) than in the other groups (LC, 58.5 ± 43.7; LCZ, 208.1 ± 227.8; LCD, 105.2 ± 154.4; each P < 0.0001). The fraction of urinary zinc excretion was also significantly higher in the LCDZ group (5.6 ± 2.9%) than in the other groups (LC, 0.6 ± 0.5; LCD, 1.7 ± 1.5; LCZ, 1.6 ± 1.2; each P < 0.0001). CONCLUSION: In patients with liver cirrhosis, treatment with diuretics can increase zinc excretion by suppressing the reabsorption of zinc through renal tubules, which might lead to zinc deficiency.