A rare case of schwannoma of the small intestine discovered during intussusception.

A woman in her 60s with anemia was diagnosed with a small intestinal intussusception on computed tomography. She underwent a double-balloon endoscopy, which revealed submucosal tumor in the ileum. Suspected to be the cause of anemia and intussusception, surgical intervention was carried out, revealing it to be a schwannoma. Schwannomas of the small intestine are very rare, and because exophytic growths are common, intussusception due to luminal side development is even rarer.

Asymptomatic intestinal tuberculosis of the terminal ileum diagnosed on colonoscopy: a case report and literature review.

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis. Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test. Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions. Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Distal oesophageal spasm in a patient with multiple system atrophy: A case report.

A 74-year-old man developed orthostatic syncope, a feeling of food stuck in his chest, and postprandial vomiting 3 years before presentation. Examination revealed severe orthostatic hypotension and cerebellar ataxia, and he was diagnosed with multiple system atrophy (MSA) with predominant cerebellar ataxia. Videofluoroscopic examination of swallowing showed lower oesophageal stricture and barium stagnation within the oesophagus. Oesophagogastroduodenoscopy revealed hypercontraction of the lower oesophagus, and high-resolution oesophageal manometry showed premature contractions of the lower oesophagus and decreased oesophageal peristalsis. The median integrated relaxation pressure in the lower oesophageal sphincter was normal, and achalasia was therefore excluded. Based on the Chicago classification version 4.0, his oesophageal dysmotility was classified as distal oesophageal spasm (DES). The stuck feeling in his chest and vomiting improved following endoscopic balloon dilation. This case suggests that DES can cause oesophageal food stagnation and postprandial vomiting in patients with MSA.

An Elderly Patient Developed Ulcerative Colitis after SARS-CoV-2 mRNA Vaccination: A Case Report and Review of the Literature.

An 86-year-old man presented to our hospital with symptoms of diarrhea and bloody stool, which had manifested two weeks after receiving his third severe acute respiratory syndrome coronavirus 2 mRNA vaccination. Colonoscopy revealed diffuse, rough-surfaced mucosa extending from the ascending colon to the rectum. Despite attempting probiotic treatment, the patient's condition did not improve, leading to admission. Endoscopic findings at admission worsened. Based on endoscopic and histopathological findings, the patient was diagnosed with ulcerative colitis. Corticosteroids and 5-aminosalicylic acid were administered, and the clinical symptoms improved. Subsequently, the disease worsened during steroid tapering, and filgotinib was added, leading to steroid-free remission.

Cross-Correlation of Confocal Images for Excised Breast Tissues of Total Mastectomy.

OBJECT: The purpose of this study is to develop an image artifact removal method for radar-based microwave breast imaging and demonstrates the detectability on excised breast tissues of total mastectomy. METHODS: A cross-correlation method was proposed and measurements were conducted. A hand-held radar-based breast cancer detector was utilized to measure a breast at different orientations. Images were generated by multiplying the confocal image data from two scans after cross-correlation. The optimum reconstruction permittivity values were extracted by the local maxima of the confocal image intensity as a function of reconstruction permittivity. RESULTS: With the proposed cross-correlation method, the contrast of the imaging result was enhanced and the clutters were removed. The proposed method was applied to 50 cases of excised breast tissues and the detection sensitivity of 72% was achieved. With the limited number of samples, the dependency of detection sensitivity on the breast size, breast density, and tumor size were examined. CONCLUSION AND SIGNIFICANCE: The detection sensitivity was strongly influenced by the breast density. The sensitivity was high for fatty breasts, whereas the sensitivity was low for heterogeneously dense breasts. In addition, it was observed that the sensitivity was high for extremely dense breast. This is the first detailed report on the excised breast tissues.

Steroid refractory severe ulcerative colitis after kidney transplantation successfully treated with infliximab.

A 54-year-old man underwent kidney transplantation at the age of 50 for end-stage renal failure owing to diabetic nephropathy. The patient was subsequently treated with three immunosuppressive drugs (tacrolimus, mycophenolate mofetil, and methylprednisolone) to prevent organ rejection, and no renal failure was noted. He visited our department with bloody stools and diarrhea, and a colonoscopy revealed mucosal edema and redness of the entire colon. After excluding infection and drug-induced enteritis based on the endoscopic and pathological findings, he was diagnosed with ulcerative colitis (UC). He was admitted and received a high dose of steroids, but did not demonstrate improvement. We initiated infliximab (IFX), and his symptoms improved within 3 days. After the second IFX treatment, the patient achieved clinical remission and was discharged. After the third IFX dose, the biomarker level became normal, and a colonoscopy after the fourth IFX dose revealed that all ulcers had become scarred and achieved endoscopic remission. The patient continued all medications to prevent organ rejection after the onset of UC and had no graft dysfunction or infection for 1 year.

Efficacy of a Gastroscope for Cecal Intubation during Colonoscopy in Patients with Severe Sigmoid Adhesion.

BACKGROUND: Cecal intubation during colonoscopy is difficult to achieve in patients with severe sigmoid adhesions. This retrospective observational study assessed the efficacy of using a gastroscope for colonoscopy in patients with severe sigmoid adhesions. Furthermore, the ability of computed tomography (CT) to predict the possibility of cecal intubation using a gastroscope was examined. METHODS: A total of 1,626 patients who underwent colonoscopy for total colon observation by one endoscopist were enrolled. Cecal intubation rate and other procedure-related outcomes were evaluated. We also investigated whether identification of the sigmoid colon pathway by CT was involved in cecal intubation rate using a gastroscope. RESULTS: Of the enrolled patients, cecal intubation by colonoscope was not feasible in 19 patients (1.2%) because of severe sigmoid adhesions. Cecal intubation was possible in 13 patients (68.4%) using a gastroscope, and the cecal intubation rate of peritoneal carcinomatosis (0%, p < 0.01) was significantly lower than that of other causes such as a diverticulum (100%) and history of gynecologic surgery (80%). The identifiable case of the sigmoid colon pathway by horizontal section on CT showed significantly higher cecal intubation rate compared to those of unidentifiable cases (92.3% vs. 16.7%, p < 0.01). CONCLUSION: Using a gastroscope is effective in performing cecal intubation during colonoscopy in patients with severe sigmoid adhesions. However, in patients with sigmoid adhesions caused by peritoneal carcinomatosis, cecal intubation may be difficult, even when a gastroscope is used. The ability of CT to identify the sigmoid colon pathway may predict success of cecal intubation.

Case report: Long-term management of occlusion after surgical-orthodontic treatment for a patient with drug-induced open bite developed after the onset of schizophrenia.

Background: Schizophrenia is a major mental disorder, with an estimated incidence of 1%. Since they are sensitive to sensory changes, orthodontic treatment to move teeth should be avoided as aggressively as possible in these patients because of strong concerns about the possibility of causing adverse psychological effects, thus there are few reports on orthodontic treatment for schizophrenia patients. We report a case of severe open bite caused by medication after the onset of schizophrenia, even though the patient's occlusion had been stable for a long time after surgical orthodontic treatment. Medication control and the use of a minimally invasive orthodontic appliance improved the occlusion without adversely affecting the patient's mental health. Case: A 22-year-old woman presented to the clinic with a chief complaint of an anterior open bite. Intraoral findings showed an overbite (vertical overlap of the incisor teeth) of -3.0 mm and an overjet (horizontal overlap of the incisor teeth) of -0.5 mm. The preoperative orthodontic treatment included bilateral extraction of the maxillary first premolars. Subsequently, orthognathic surgery was performed to achieve a harmonized skeletal relationship and occlusion. Occlusion was stable for 3 years after surgery. However, 10 years after surgery, the patient returned to the clinic complaining of an anterior open bite (overbite = -4.0 mm). Six years prior to the return, the patient was diagnosed with schizophrenia. We thought that ignoring the patient's strong desire to treat her open bite might also cause psychological problems; therefore, in addition to medication control, we treated her using a minimally invasive removable orthodontic appliance (retainer with tongue crib). Her anterior open bite improved (overbite, +1.0 mm) to within the normal range. Conclusion: In this case, medication control was thought to be essential to improve her drug-induced open bite. However, minimally invasive orthodontic treatment, such as the use of a removable appliance, might be helpful in promoting her mental stability as well as for improving occlusion. Careful support is required to obtain information about the patient's mental state and medications through close cooperation with psychiatrists.

Three-dimensional characteristics of temporomandibular joint morphology and condylar movement in patients with mandibular asymmetry.

BACKGROUND: Investigating the morphological and functional effects on mandibular asymmetry (MA) is important not only to understand the developmental process of masticatory dysfunction, but also to provide suggestions for evidence-based occlusal treatment. AIM: To evaluate three-dimensional temporomandibular joint (TMJ) morphology and its relationship to asymmetrical condylar movement in MA patients. MATERIALS AND METHODS: Fifty subjects were divided into MA and control groups (n = 25 each) according to a menton deviation of 4 mm from the mid-sagittal plane. TMJ morphology (condyle, glenoid fossa and TMJ spaces) were evaluated using a three-dimensional analysis programme. Three-dimensional condylar movements (from the sagittal and horizontal planes) were recorded and measured by computerized axiography on protrusion. Side-to-side asymmetry was measured for each parameter. The asymmetry index value was calculated to assess the correlation between TMJ morphology and condylar movement. For the statistical analysis, Wilcoxon's signed-ranked test, the Mann-Whitney U test, and Spearman's rank correlation were used. RESULTS: Glenoid fossa volume, surface area, anteroposterior length, and condylar volume were significantly smaller, and articular eminence angle, glenoid fossa, and condylar axial angle were significantly larger, on the shifted side of the MA group when compared with those on the non-shifted side and the mean values of the control group (P < 0.05). The TMJ spaces of the MA group showed no bilateral difference but were significantly narrower in the medial, superior, and anterior joint spaces when compared with the control group (P < 0.05). Condylar path length and sagittal condylar inclination were significantly asymmetrical. The asymmetry index of the condyle volume was significantly correlated with that of the condylar path length (P = 0.005). The asymmetry index of the glenoid fossa volume and the articular eminence angle were significantly correlated with that of the sagittal condylar inclination (P = 0.009 and P = 0.002, respectively), and the asymmetry index of glenoid fossa volume was significantly correlated with the bilateral transverse condylar inclination (P = 0.006 and P = 0.016, respectively). CONCLUSIONS: Morphological asymmetry of the TMJ is significantly different between the shifted and non-shifted sides and is closely related to functional asymmetry of condylar movement in MA patients. (350/350).

Endoscopic fenestration for benign complete anastomotic obstruction following rectal surgery.

Video 1Endoscopic fenestration for benign complete anastomotic obstruction after rectal surgery.

Eco-Benign Orange-Hued Pigment Derived from Aluminum-Enriched Biogenous Iron Oxide Sheaths.

Inorganic pigments have been widely used due to their low cost of production, strong hiding power, and chemical resistance; nevertheless, they have limited hue width and chromaticity. To eliminate these disadvantages, we herein propose the use of an ingenious biotemplate technique to produce Al-enriched biogenic iron oxide (BIOX) materials. Spectrophotometric color analysis showed that high levels of Al inclusion on heat-treated BIOX samples produced heightened yellowish hues and lightness. The Al-enriched BIOX sheaths exhibited a stable tubular structure and excellent thermal stability of color tones after heating at high temperatures and repetitive heat treatments. Ultrastructural analysis and mechanical destruction experiments revealed that the highly chromatic orange-hue of these pigments are ascribed probably to an ingenious cylindrical nanocomposite architecture composed of putative Fe-included low crystalline Al oxide regions and hematite particles embedded therein. The present work therefore demonstrates that the bioengineered material can serve as an epochal orange-hued inorganic pigment with low toxicity and marked thermostability that should meet large industrial demand.

[Gastric Ulcer Caused by Contact with a Bumper Type Gastrostomy Tube in Amyotrophic Lateral Sclerosis: A Case Report].

An 86-year-old man was diagnosed with bulbar type of amyotrophic lateral sclerosis (ALS). He underwent a bumper-tube type of gastrostomy due to dysphagia 16 months after the onset of ALS. Twenty months after the onset, he developed dyspnea due to anemia. Upper gastrointestinal endoscopy showed a gastric ulcer contralateral to the gastrostomy site with bumper indentation from the gastrostomy tube. Patients with ALS might develop gastric ulceration due to mechanical stimulation with a percutaneous endoscopic gastrostomy tube.

Correlation between the position of the glenoid fossa and condylar translational movement in skeletal Class III mandibular asymmetry patients.

OBJECTIVES: Understanding the mechanism of mandibular asymmetry (MA) is important to provide suggestions for occlusal treatment and to know the developmental process of masticatory dysfunction. To investigate the morphological and functional effects on MA, we evaluated the three-dimensional position of the glenoid fossa and its relationship to asymmetrical condylar translational movement. METHODS: In this retrospective study, 50 subjects who previously underwent computed tomography for surgical purposes were divided into MA and control groups according to a menton deviation of at least 4 mm from the mid-sagittal plane. The glenoid fossae positions were evaluated using a three-dimensional analysis program. Condylar translational movements were recorded and measured by computerized axiography on protrusion. Side-to-side asymmetry was measured for each parameter. Asymmetry index value was calculated to assess the correlation between glenoid fossa position and condylar movement. Wilcoxon's signed-ranked test, Mann-Whitney U-test, and Spearman's rank correlation were used for the statistical analysis. RESULTS: In the MA group, glenoid fossa position on the shifted side was significantly inferior and posterior as compared to that on the non-shifted side and of the control group. Condylar path length and sagittal condylar inclination were significantly greater on the shifted side versus non-shifted side, while no significant difference was found in transverse condylar inclination. The asymmetry index of the anterior-posterior glenoid fossa position was significantly correlated with that of condylar path length and bilateral transverse condylar inclination. In the control group, there were no significant correlations among the morphological and functional parameters. LIMITATIONS: This study did not consider muscle activity and disc position, which may affect condylar movement. CONCLUSIONS: Functional asymmetry of condylar translational movements is closely related to asymmetry of glenoid fossa position in MA patients.

Skeletal Muscle Depletion: A Risk Factor for Pneumonia following Gastric Endoscopic Submucosal Dissection in Elderly Patients.

INTRODUCTION: Endoscopic submucosal dissection (ESD) is an effective treatment for gastric neoplasms in elderly patients; however, it involves several adverse events, including pneumonia. This study aimed to investigate whether skeletal muscle depletion (SMD) was associated with the development of pneumonia in elderly patients who underwent gastric ESD. METHODS: This retrospective observational cohort study included 157 patients (≥80 years) who had undergone gastric ESD. The skeletal muscle cross-sectional area was measured by CT, and the value of the third lumbar vertebra skeletal muscle index (L3 SMI) was evaluated. The SMD was defined as an L3 SMI value ≤38.0 cm2/m2 for women and ≤42.0 cm2/m2 for men. Pneumonia was also diagnosed using CT to identify all included patients. RESULTS: Among 157 patients, 66 (42.0%) showed SMD. In the SMD group, the incidence of pneumonia was 21.2%, whereas it was 7.7% in the non-SMD group (p = 0.018). The longest hospitalization duration was 19 days. Antibiotics were administered in 61.9% of the patients. Procedure time was not significantly different between the groups (72 ± 54 min vs. 62 ± 44 min, p = 0.201). On multivariate analysis, SMD was an independent risk factor for the development of pneumonia (odds ratio = 3.16, 95% confidence interval, 1.18-8.50, p = 0.023). CONCLUSIONS: SMD was not a rare entity in patients aged ≥80 years with gastric neoplasms. SMD was a significant risk factor for pneumonia related to gastric ESD in elderly patients.

Preparation and Characterization of Additional Metallic Element-Containing Tubular Iron Oxides of Bacterial Origin.

Biogenic microtubular iron oxides (BIOXs) derived from Leptothrix spp. are known as promising multifunctional materials for industrial applications such as ceramic pigments and catalyst carriers. Here, we report unprecedented BIOX products with additive depositions of various metallic elements prepared by a newly devised "two-step" method using an artificial culture system of Leptothrix cholodnii strain OUMS1; the method comprises a biotic formation of immature organic sheaths and subsequent abiotic deposition of Fe and intended elements on the sheaths. Chemical composition ratios of the additional elements Al, Zr, and Ti in the respective BIOXs were arbitrarily controllable depending on initial concentrations of metallic salts added to reaction solutions. Raman spectroscopy exemplified an existence of Fe-O-Al linkage in the Al-containing BIOX matrices. Time-course analyses revealed the underlying physiological mechanism for the BIOX formation. These results indicate that our advanced method can contribute greatly to creations of innovative bioderived materials with improved functionalities.

Advanced appendiceal goblet cell carcinoids with intestinal obstruction: two case reports.

A goblet cell carcinoid is quite rare and has features, wherein, a carcinoid-like image and an adenocarcinoma-like image coexist. We encountered two cases of rare goblet cell carcinoid originating in the appendix. Case 1 is that of a 48-year-old man with a chief complaint of abdominal distension and case 2 is that of a 64-year-old woman with a chief complaint of constipation. At the time of diagnosis, both cases had already metastasized to the peritoneum and other organs, and no radical surgical treatment could be administered in either case. Chemotherapies were performed according to the regimen for colon cancer, and they were effective to a certain extent. During the course of treatment, however, both cases developed intestinal obstruction, presumably due to peritoneal dissemination, which led to worse condition and death several months afterwards. Chemotherapy for goblet cell carcinoids has not yet reached a consensus, and further studies and establishment of therapeutic strategy are desired in the future.

Bright Yellowish-Red Pigment Based on Hematite/Alumina Composites with a Unique Porous Disk-like Structure.

Inspired by a bacteriogenic, iron-based oxide material and a traditional Japanese red pigment, a bright yellowish-red pigment was prepared by heating an Al-containing iron oxyhydroxide precursor. The obtained red pigment had a unique porous disk-like structure, comprising Al-substituted hematite particles and crystalline alumina nanoparticles. Although these disk-like structures loosely gathered to form an aggregate in powder, they can be easily dispersed into a single, disk-like structure by simple ultrasonic irradiation. The powder exhibited a bright yellowish-red color and high thermostability, making it attractive as a coloring material for various industrial products needing a bright-red color, high weather resistance, and durability. Quantitative color measurements revealed extremely high L*, a*, and b* values that are much greater than those of commercially available hematite. The thermostability test showed that even after exposure to high temperatures, the pigment retained the red color, indicating its high thermostability. The unique microstructure should be strongly related to the bright yellowish-red color and the high thermostability of the developed red pigment.

Endoscopic and Pathological Characteristics of Helicobacter pylori Infection-Negative Early Gastric Cancer.

BACKGROUND: The characteristics of Helicobacter pylori (HP) infection-negative gastric cancer (HPINGC) have not been well documented because of the rareness. The aim of this study was to classify HPINGC endoscopically and clinicopathologically. METHODS: This retrospective study included 1,741 early gastric cancer lesions and evaluated their HP infection status. Expression levels of MUC5AC, MUC6, MUC2, CD10, p53, MIB-1, pepsinogen-I, H+/K+ ATPase, chromogranin A, E-cadherin, and gastrin were evaluated in tumors by immunohistochemistry (IHC). RESULTS: Among the analyzed lesions, 19 (1.1%) were diagnosed as HPINGC and classified into 6 types: undifferentiated (5 lesions), fundic gland (2 lesions), cardiac gland (1 lesion), pyloric gland (3 lesions), foveolar (5 lesions), and mixed (3 lesions) types. Undifferentiated lesions were of pale color, with unclear demarcation and decreased E-cadherin expression. Fundic-type lesions were tan to reddish in color, with submucosal tumor-like protrusions, and positive for pepsinogen-I and H+/K+ ATPase. The cardiac gland type was located in the gastroesophageal junction and was positive for MUC6 and pepsinogen-I. Pyloric gland-type lesions were of the same color as normal mucosa, with mild elevation and unclear demarcation, likely positive for CD10 and chromogranin A. Foveolar epithelial-type lesions were white and elevated, with defined demarcation, and contained MUC5AC-positive cells. Mixed-type lesions, showing various staining patterns in IHC, had both elevated and depressed shape and reddish color. CONCLUSION: Endoscopic observation and IHC were useful for classifying the characteristics of HPINGC, which may preserve the characteristics of its region of origin.