Correction to: The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection.

The article "The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection", written by Motoi Azumi, Manabu Takeuchi, Youhei Koseki, Masaru Kumagai, Yoko Kobayashi, Masafumi Takatsuna, Aiko Yoshioka, Seiichi Yoshikawa, Tsutomu Miura, and Shuji Terai, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 28 September 2018 without open access.

The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection.

BACKGROUND: Delayed bleeding is an important complication after gastric endoscopic submucosal dissection (ESD). The search, coagulation, and clipping (SCC) method can be used to prevent delayed bleeding after ESD. However, its safety and efficacy are unclear. We compared the SCC method with post-ESD coagulation (PEC) to clarify the safety and efficacy of the SCC method for preventing delayed bleeding after gastric ESD. METHODS: This retrospective study included 438 patients (478 lesions) who underwent gastric ESD. Multivariate logistic regression analysis was performed to identify the significant independent factors associated with delayed bleeding and we performed propensity-score matching (PSM) to reduce the effect of procedure-selection bias of SCC method. RESULTS: Of the 438 patients, 216 underwent PEC and 222 underwent SCC. Delayed bleeding was significantly less common in the SCC than in the PEC (2.6% vs. 7.2%; P = 0.013). Among patients treated with antithrombotic therapy, the delayed bleeding rate was lower in the SCC group than in the PEC group; however, the difference was not significant (P = 0.15). The SCC method was found to be a significant independent factor for the prevention of delayed bleeding. PSM was performed in 156 patients in the PEC group and SCC group. There was a significant difference in the incidence of bleeding in the PEC and SCC groups (P = 0.013). No patient had perforation/bleeding associated with the SCC method. CONCLUSIONS: Our findings suggest that the SCC method is a simple, safe, and effective approach for preventing delayed bleeding after gastric ESD.

Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: The JPHC study.

BACKGROUND AND AIMS: Although a potential benefit of drinking green tea has been suggested to reduce the development of cardiovascular disease, no study has investigated the relationship between plasma tea catechin and risk of cardiovascular disease. METHODS: A prospective, nested case-control study was conducted to examine the association between plasma tea catechin and risk of stroke and coronary heart disease (CHD) in a cohort of 29,876 men and women aged 40-69 years without history of heart disease, stroke or cancer. Participants completed a survey and donated blood samples between 1990 and 1994, and were followed-up through 2008. A total of 1132 stroke cases and 209 CHD cases, matched 1:1 to controls (n = 1132) for stroke and 1:2 to controls (n = 418) for CHD, were included in the analysis. RESULTS: We found no significant association between plasma tea catechin and the incidence of stroke or CHD in either men or women. However, we found that high plasma levels of epigallocatechin gallate (EGCG) were associated with reduced risk of stroke in non-smoking men; the adjusted odds ratio (95% CI) for the highest vs. non-detectable levels was 0.53 (0.29-0.98). The respective OR in male smokers was 1.23 (0.75-2.16). A significant interaction by smoking status was found for the highest vs. non-detected plasma EGCG in relation to stroke (p-for-interaction: p = 0.09). CONCLUSIONS: Plasma tea catechin was not associated with reduced risks of either stroke or CHD, while a protective effect of certain tea catechin on stroke risk is suggested for male non-smokers.

Determination of Ultra-trace Metal Impurities in High-purity Cadmium Using Inductively Coupled Plasma Mass Spectrometry after Matrix Separation with Anion Exchange Resin.

The analytical method for ultra-trace metal impurities at µg kg-1 level in high-purity Cd was examined by inductively coupled plasma mass spectrometry (ICP-MS) combined with matrix separation by Bio-Rad AG MP-1M anion exchange resin. After the separation of Cd, the metal impurities such as Li, In, Cr, Mn, Fe, Co, Ni, Cu, Ga, Sr, Ba and Pb were measured by an ICP-quadrupole mass spectrometer (ICP-QMS) and ICP-sector field mass spectrometer (ICP-SFMS). From the comparison of measured results, it was evaluated that the analytical sensitivity by ICP-SFMS was 10 times higher than ICP-QMS. In addition, ICP-SFMS could obtain determined values of Li and Fe that could not be determined by ICP-QMS. These results suggest the ICP-SFMS combined with matrix separation by anion exchange resin could be utilized for the determination of ultra-trace metal impurities in high-purity materials for the assessment of the purity of the materials.

Plasma isoflavone concentrations are not associated with gastric cancer risk among Japanese men and women.

The incidence of gastric cancer throughout the world is ~2-3 times higher in men than in women. Previous research suggested that isoflavones, which are structurally similar to 17ß-estradiol, may prevent gastric cancer. Based on a large, population-based, prospective study, we recently reported a null association between dietary isoflavone intake and gastric cancer. However, epidemiologic studies using blood concentrations of isoflavones might better reflect the effect of isoflavones on gastric cancer carcinogenesis than dietary assessment. We therefore conducted a nested case-control study within the Japan Public Health Center-Based Prospective Study. Participants were followed-up from 1990 to 2004. Among 36,745 participants who answered the baseline questionnaire and provided blood samples, 483 gastric cancer cases matched to 483 controls were used in the analysis. ORs and 95% CIs were estimated with a conditional logistic regression model. The overall distribution of plasma isoflavone concentrations was not associated with the development of gastric cancer. Compared with groups with the lowest plasma concentrations (reference groups), the groups with the highest daidzein and genistein concentrations had adjusted ORs and 95% CIs of 1.11 (0.74-1.66; P-trend = 0.6) and 0.96 (0.64-1.44; P-trend = 0.9), respectively. The results did not change when analysis was based on sex, subsite, or histological type. We found no association of plasma isoflavone concentrations with gastric cancer risk. Our data support the previously observed null association between isoflavone intake and gastric cancer risk.

Plasma cells and the chronic nonsuppurative destructive cholangitis of primary biliary cirrhosis.

UNLABELLED: There has been increased interest in the role of B cells in the pathogenesis of primary biliary cirrhosis (PBC). Although the vast majority of patients with this disease have anti-mitochondrial antibodies, there is no correlation of anti-mitochondrial antibody titer and/or presence with disease severity. Furthermore, in murine models of PBC, it has been suggested that depletion of B cells may exacerbate biliary pathology. To address this issue, we focused on a detailed phenotypic characterization of mononuclear cell infiltrates surrounding the intrahepatic bile ducts of patients with PBC, primary sclerosing cholangitis, autoimmune hepatitis, chronic hepatitis C, and graft-versus-host disease, including CD3, CD4, CD8, CD20, CD38, and immunoglobulin classes, as well as double immunohistochemical staining for CD38 and IgM. Interestingly, CD20 B lymphocytes, which are a precursor of plasma cells, were found in scattered locations or occasionally forming follicle-like aggregations but were not noted at the proximal location of chronic nonsuppurative destructive cholangitis. In contrast, there was a unique and distinct coronal arrangement of CD38 cells around the intrahepatic ducts in PBC but not controls; the majority of such cells were considered plasma cells based on their expression of intracellular immunoglobulins, including IgM and IgG, but not IgA. Patients with PBC who manifest this unique coronal arrangement were those with significantly higher titers of anti-mitochondrial antibodies. CONCLUSION: These data collectively suggest a role for plasma cells in the specific destruction of intrahepatic bile ducts in PBC and confirm the increasing interest in plasma cells and autoimmunity.

Rice cake ileus--a rare and ethnic but important disease status in east-southern Asia.

INTRODUCTION: Rice cake is a traditional but very popular food in Asia including Japan and has never been known as a cause of ileus. Rice cake is now becoming widespread in the United States and European countries along with other Japanese foods. We may encounter rice cake ileus all over the world. This study was aimed at characterizing the rice cake ileus. METHODS: We consecutively encountered 14 patients with rice cake ileus from April 2003 to October 2010 in our hospital. All of the characteristics of the cases were reviewed and analyzed. RESULTS: All patients had ingested rice cake by swallowing without chewing. It has most frequently occurred in January (57.1%). The main symptoms were abdominal colicky pain (100%) and nausea (85.7%) and physical findings included abdominal tenderness (100%) and muscular defense (28.6%). All patients improved by conservative therapy including fluid supply (100%), naso-gastric tube (28.6%) and long tube (28.6%) insertion. No patient needed emergency open surgery. CONCLUSION: Rice cake ileus which is caused by swallowing the rice cake without chewing, frequently occurs in January, has previous history of abdominal surgery and shows high density intestinal contents on CT and only needs conservative therapy. Globalism in food culture may provide a new disease entity. Therefore, we should be aware of this type of ileus and be prepared to manage it appropriately.

[Palliative anti-cancer chemotherapy is safely executable in a hemodialytic patient with unresectable advanced gastric cancer].

A 75-year-old man with chronic renal failure was on maintenance hemodialysis.He was admitted to our hospital for advanced gastric cancer with multiple liver metastases (cStage IV).Three courses of tegafur-uracil (300 mg/day daily) plus docetaxel (20 mg/m², every 3 weeks) as first-line treatment and nine courses of tegafur-uracil (same dose) plus CPT-11 (64 mg/m², day 1, 15, every 4 weeks) were given without any complications.Docetaxel and CPT-11 were given on days between hemodialyses. No severe adverse effects of more than grade 3 were encountered. The standard regimens in our country for unresectable advanced gastric cancer are the S-1 single or S-1/CDDP combined chemotherapies that have already been evidenced in the JCOG 9912 and SPIRITS trial. However, no standard chemotherapy for patients on hemodialysis has been reported as yet.Therefore, doctors in charge must arrange an individualized regimen for each patient, considering metabolic characteristics of each anti-cancer agent.In this context, our case was considered to be very suggestive, and that is why we report it here in detail.

Hepatocellular carcinoma, with portal thrombus after viral eradication, disappeared by 5-fluorouracil and interferon.

Hepatocarcinogenesis after a sustained virological response (SVR) in type C chronic hepatitis and cirrhosis is an important issue in endemic areas; hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) therapy is especially very hard. We herein report a first case in which combination therapy with interferon-α and continuous intra-arterial infusion of 5-fluorouracil (designated as FAIT) provided a complete response in HCC with PVTT after SVR. Therefore, we think that FAIT is a good option to treat HCC with or without PVTT, even after SVR.

TTF-1 is useful for primary site determination in duodenal metastasis.

We report here on a case of duodenal metastasis from primary lung adenocarcinoma. A 69-year old man was diagnosed with primary lung adenocarcinoma. Four courses of combined chemotherapy with carboplatin and paclitaxel associated with irradiation of 60 Gy shrunk the lung tumor. However, soon after,the para-aortic lymph node became swollen. Esophagogastroduodenoscopy revealed three duodenal tumors. Differential diagnosis between malignant lymphoma and metastatic duodenal cancer was endoscopically difficult. The histology of biopsied specimens was poorly differentiated adenocarcinoma. Immunohistochemical analysis revealed a positive reaction for thyroid transcription factor-1 (TTF-1). Thus, we concluded that these were metastatic duodenal tumors from lung adenocarcinoma. Two courses of gemcitabine led to a complete remission in this duodenal metastasis and para-aortic lymph node swelling with only scarring remaining in computed tomography. He is now on the continuous generalized chemotherapy. In conclusion, duodenal metastasis from primary lung adenocarcinoma is rare and hard to diagnose. In such an instance, TTF-1 immunostaining is crucial to obtain the correct diagnosis.

[An elderly hemodialytic case of recurrent esophageal cancer given combination chemotherapy with docetaxel and nedaplatin who showed temporal relief of swallowing disturbance].

An 82-year-old man was admitted for recurrent and unresectable esophageal cancer. His performance status was grade 2, although he was on hemodialysis due to chronic renal failure since 2003. Esophagogastroduodenoscopy revealed stenosis of esophagus by the recurrent tumor. After percutaneous endoscopic gastrostomy, he received biweekly combination chemotherapy with docetaxel (18 mg/m(2)) and nedaplatin (16 mg/m(2)). Hemodialysis was carried out one hour after termination of nedaplatin infusion. As severe adverse reactions due to anticancer-chemotherapy were not encountered, he could receive four courses of chemotherapy in our outpatient clinic. Difficulty in swallowing improved after the second course was finished. Finally, he died of acute myocardial infarction. In conclusion, combination chemotherapy with docetaxel and nedaplatin can be safely carried out for a patient with recurrent and unresectable esophageal cancer even on hemodialysis by appropriate down-dosing of anticancer agents.

Plasma tea polyphenol levels and subsequent risk of breast cancer among Japanese women: a nested case-control study.

Although many in vitro and animal studies have suggested a protective effect of green tea against breast cancer, findings from epidemiological studies have been inconsistent. No study has used prediagnostic biomarkers of tea polyphenols, which might play a protective role. A total of 24,226 women aged 40 to 69 years in the Japan Public Health Center-based Prospective Study who responded to the baseline questionnaire and provided blood in 1990-1995 were followed to December 2002. During a mean 10.6 years of follow-up, 144 newly diagnosed breast cancers were identified. Two matched controls for each case were selected from the cohort. Plasma levels of (-)-epigallocatechin (EGC), (-)-epicatechin (EC), (-)-epigallocatechin-3-gallate (EGCG), and (-)-epicatechin-3-gallate (ECG) were measured, and the odds ratio (OR) of breast cancer according to plasma level was estimated using a conditional logistic regression model. We found no statistically significant association between plasma tea polyphenol levels and breast cancer risk. Adjusted ORs for the highest versus lowest group were 0.90 (95% CI 0.42-1.96; P for trend = 0.98) for EGC, 0.95 (95% CI 0.43-2.08; P for trend = 0.86) for EC, 1.21 (95% CI 0.52-2.80; P for trend = 0.53) for EGCG, and 1.75 (95% CI 0.81-3.78; P for trend = 0.15) for ECG. Stratified analyses according to baseline menopausal status showed no remarkable difference between two strata. This nested case-control study found no overall association between plasma tea polyphenols and the risk of breast cancer in Japan.

Intestinal anisakiasis can cause intussusception in adults: an extremely rare condition.

We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography revealed the presence of intussusception. As pneumo-dynamic resolution by colonoscopy failed, surgery was performed. The anisakis body was found in the submucosal layer of the resection specimen. The patient was discharged 9 d after the operation. Anisakiasis may cause intussusception in any country where sushi or sashimi now exists as a popular food. If suspicious, detailed clinical interview as to food intake prior to symptom development is crucial.

[Retrospective analysis of generalized chemotherapy for unresectable advanced gastric cancer].

In Japan where the incidence of gastric cancer is high, the standard regimens for unresectable advanced gastric cancer are the S-1 single or S-1/CDDP combined therapies that are evidenced by the JCOG9912 and SPIRITS trial. We performed retrospective analysis on chemotherapy for unresectable advanced gastric cancer in our division from 2003 to 2008. Seventy-six patients were subjected to this study. Among them, 66 patients (86.8%) received S-1-containing regimens. Mean survival time (MST) of all patients was 309 days. MST of S-1/Paclitaxel (PTX), S-1/CPT-11 and S-1/CDDP regimens were 289, 339 and 411 days, respectively. MST of S-1/CPT-11 was significantly longer than that of S-1/PTX (p<0. 01). Next, we compared the MST among different performance statuses (PS). The respective MST of PS 0, 1, 2 cases (361, 289 and 161 days) evidenced no statistically significant difference, although the MST was shorter depending on the progression of PS. Considering the histology, the MST of patients with well- and moderately-differentiated adenocarcinoma was significantly longer than that of poorly-differentiated adenocarcinoma and signet-ring cell carcinoma (p=0. 04). The call is for more effective chemotherapy in the future based on results we will obtain from controlled studies that may also deal with the second-line chemotherapy regimens, chemotherapy for aged people and molecular-targeting cancer agents.

Thyroid Metastasis of Gastric Cancer: A Rare Occasion With Poor Prognosis.

A 68-year-old man was diagnosed as having advanced gastric cancer. Computed tomography showed a thyroid tumor with trachea deviation. This tumor exhibited mosaic echogenecity in ultrasonography. Signet-ring cell carcinoma was found by means of fine needle aspiration biopsy. This tumor gradually became swollen and the thyroid hormone levels in blood were increased without any clinical symptom. Shortly, he died from his illness in the 29th hospital day. Autopsy disclosed that the left lobe of the thyroid gland was highly invaded by malignant cells and that lymphogenic rather than angiogenic metastasis was highly probable. Thyroid metastasis of gastric cancer is extremely rare. The prognosis is very poor. Ultrasonography is a very useful modality especially when coupled with recently developed fine needle aspiration biopsy in differential diagnosis of thyroid tumors once malignancy is suspected. Therapeutic strategy largely depends on the nature of primary malignant tumor. If the tumor is slowly progressive such as renal cell carcinoma and breast cancer, extirpation of thyroid tumors may extend life expectancy. In conclusion, the metastatic thyroid tumor of gastric cancer is rare and shows poor prognosis. Fine needle aspiration biopsy under ultrasonography is strongly recommended as a useful diagnostic tool.

[A pregnant woman with inoperable advanced gastric cancer who received systemic anti-cancer chemotherapy after the non-full term fetus delivery by cesarean section].

A 28-year-old pregnant woman at 26 weeks and 2 days gestation visited a local outpatient clinic complaining of a tender abdominal mass. Examinations revealed an advanced gastric cancer with multiple liver, bone, lymph node metastasis and mesenteric dissemination, thus she was transferred to our division at 27 weeks and 1 day-gestation. With her consent we decided to maintain her pregnancy until 28 weeks when the delivered fetus could be kept alive an incubator, avoiding the adverse effect on the fetus by anti-cancer chemotherapy to mother. Rapid fetus delivery by cesarean section was carried out at 28 weeks and 1 day gestation, yielding a 958-gram baby. The mother complained of respiratory distress and suffered from lymphangitis carcinomatosa on the 3 postoperative day. We began combination chemotherapy with S-1 and paclitaxel (S-1 100 mg/day, 3 weeks on, 2 weeks off and paclitaxel 70 mg/day on 1, 8 and 15) was started on the 4th postoperative day. Although temporary regression of lymphangitis carcinomatosa was seen with a relief of symptoms, her condition deteriorated on the 24th days. The second course chemotherapy was started on the 28th days without any relief of symptoms. Her general status deteriorated and she died on the 33rd postoperative day. The association of pregnancy and gastric cancer is rare but such cases are often in an advanced clinical stage, with bad prognosis. It is necessary to determine the treatment strategy on the basis of comprehensive consideration of the status of both the mother and fetus. Upper gastrointestinal endoscopy when gastric cancer is suspected is recommended in any pregnant woman with long-term morning sickness.

[A case of interstitial pneumonia induced by gemcitabine hydrochloride for unresectable bile duct cancer].

A 78-year-old man was admitted for obstructive jaundice and unresectable bile duct cancer on March 4, 2008. Since biliary drainage was extremely difficult, he began 2 treatment courses of gemcitabine hydrochloride (GEM 800 mg/m(2) on days 1, 8, 15 every 4 weeks). He suffered from dry cough and dyspnea on May 13, 2008. He was diagnosed as GEM-induced interstitial pneumonia with severe hypoxemia by CT scan and arterial blood gas examination. He recovered with two courses of steroid pulse therapy, diuretics and antibiotics. Alternatively, he was given oral S-1 ( 80 mg/m(2) 4 weeks on and 2 weeks off) from June 12, 2008. His QOL was well kept without jaundice for as long as a half year. This is the first report of GEM-induced interstitial pneumonia in bile duct cancer. In conclusion, interstitial pneumonia must be taken into consideration as a rare adverse reaction when GEM is used for biliary neoplasms.

[A case of hepatocellular carcinoma with liver cirrhosis type C surviving over 2 years by repeated transarterial infusion therapy using cisplatinum].

A 58-year-old man with hepatocellular carcinoma (HCC) with liver cirrhosis type C was admitted to our division in April, 2004 to receive transarterial chemo-embolization (TACE) as a first-line chemotherapy for HCC. Thereafter, he had TACE twice for multicentric HCC. In December, 2005, TACE was thought to have become ineffective since his multicentric HCC progressed. So, we employed transarterial injection therapy (TAI) with fine powder cisplatinum (IAC) as a second-line chemotherapy. Stable disease was accomplished by the 22 sessions of TAI with IAC. After February 2008, IAC was given in combination with degradable starch microspheres (DSM) to reinforce the anti-cancer effect. The total therapeutic sessions using IAC became 26 in number. Total IAC amount used reached to more than 2,200 mg without any serious adverse reaction. In conclusion, TAI using IAC is thought to be effective in the chemotherapy of HCC, safely controlling the tumor progression.

A case of lamivudine-sensitive de novo acute hepatitis B induced by rituximab with the CHOP regimen for diffuse large B cell lymphoma.

A case of de novo acute hepatitis B that showed symptoms of general malaise and anorexia during rituximab therapy with the CHOP regimen for diffuse large B cell lymphoma is reported. Lamivudine was strikingly effective, showing a rapid recovery from liver damage with jaundice. Hepatitis B virus (HBV) DNA in serum became and stayed undetectable even after the withdrawal of lamivudine, although HBsAg remained positive over 42 months from the onset. Liver biopsy showed a picture suggestive of acute viral hepatitis with multinucleated giant hepatocytes and CD38-positive plasma cell infiltration into liver parenchyma. Immunohistochemically, CD3-positive T-cells were predominant cells that infiltrated in liver parenchyma, whereas CD20-positive B cells were essentially null. Hence, it is suggested from these findings that B lymphocytes might be crucial for the continuous latency in HBV infection and may give rise to de novo acute hepatitis B if totally deleted. Moreover, the CHOP regimen might have some additive effects with the repeated on-off use of corticosteroids to the onset of the disease. In addition, significance of plasma cell infiltration in this setting is discussed.

Laparoscopic peritoneal biopsy can be crucial for diagnosis of tuberculous peritonitis.

A 28-year-old woman was admitted to a nearby hospital because of low-grade fever and lower abdominal pain, where ascites and slightly elevated serum CA125 level were found. Both acid-fast stain (AFS) and polymerase chain reaction (PCR) failed to detect Mycobacterium tuberculosis in her ascitic fluid, sputum, and gastric juice. She was referred to our division under suspicion of tuberculous peritonitis or ovarian carcinoma. Finally, diagnostic laparoscopy was carried out, showing yellowish-white small nodules disseminated on her whole peritoneum with thin fibrous adhesions. Peritoneal biopsy of these nodules showed epithelioid cell granulomas without caseous necrosis. AFS and PCR again failed to show any evidence of Mycobacterium tuberculosis in these biopsied samples. Based on the laparoscopic findings, however, we thought that she suffered from tuberculous peritonitis. Antituberculous therapy was started and she improved soon. Later, Mycobacterium tuberculosis was demonstrated in the 4-week culture of a peritoneal biopsy specimen. We conclude that laparoscopy may be the only way to detect Mycobacterium tuberculosis in tuberculous peritonitis whenever doubtful but no direct evidence is obtained.