Primary Bile Duct Diffuse Large B-cell Lymphoma Diagnosed by Repeated Endoscopic Ultrasound-guided Fine-needle Aspiration and Endoscopic Retrograde Cholangiopancreatography.

A 54-year-old man was admitted with obstructive jaundice. Computed tomography showed common bile duct stricture and a tumor around the celiac artery. Repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) as well as a laparotomic biopsy around the celiac artery were diagnostically unsuccessful. Since the bile duct stricture progressed, EUS-FNA and ERCP were performed a third time, finally leading to the diagnosis of diffuse large B-cell lymphoma. The treatment plan and prognosis of obstructive jaundice differ greatly depending on the disease. It is important to conduct careful follow-up and repeated histological examinations with appropriate modifications until a diagnosis is made.

Impact of social relationships on income-laughter relationships among older people: the JAGES cross-sectional study.

OBJECTIVES: Laughter has a positive and quantifiable effect on certain aspects of health, and previous studies have suggested that income influences the emotion. However, it is unknown whether social relationship-related factors modify the association between equivalised income and laughter among older people. In the present study, we examined the relationship between equivalised income and the frequency of laughter. In addition, we examined the impact of social relationship-related factors on the association between equivalised income and frequency of laughter using a cross-sectional study design. DESIGN: Cross-sectional study and binomial regression analysis. SETTING: We sampled from 30 municipalities in Japan. PARTICIPANTS: We examined 20 752 non-disabled Japanese individuals aged ≥65 years using data from the Japan Gerontological Evaluation Study. PRIMARY OUTCOME: Frequency of laughter. RESULTS: Laughter increased significantly with an increase in equivalent income (p for trend <0.0001). Prevalence ratios (PR) for laughing almost every day were calculated according to quartile equivalised income after adjusting for age, instrumental activities of daily living, depression, frequency of meeting friends, number of social groups and family structure. The results revealed that PRs in Q4 (men; ≥€24 420, women; ≥€21 154) were 1.21 (95% CI 1.13 to 1.30) among men and 1.14 (95% CI 1.08 to 1.20) among women, as compared with Q1 (men; <€12 041, women; <€9518), respectively. After excluding participants with depression, the association remained significant. In addition, we found inadequate social relationships and living alone were associated with a lower frequency of laughter. In comparison with the lowest equivalent income with meeting friends less frequently and living alone, the PRs of the highest equivalent income with meeting friends frequently and living with someone were higher, respectively. CONCLUSIONS: The results revealed a significant relationship between equivalent income and the frequency of laughter. Social relationships and family structure were also associated with the frequency of laughter.