[A case of foveolar-type gastric adenocarcinoma with a raspberry-like appearance followed up by endoscopy].

A 47-year-old man was referred to our hospital for detailed examination of a gastric polypoid lesion. Esophagogastroduodenoscopy revealed a raspberry-like polyp at the gastric body. Pathological examination of the biopsy specimen revealed this polypoid lesion to be a gastric adenocarcinoma. Endoscopic submucosal dissection was performed, and histopathological examination revealed that lesion to be a well-differentiated adenocarcinoma. Immunohistochemical staining showed that the neoplasm was positive for MUC5AC and negative for MUC6, CD10, and pepsinogen I, indicating that this lesion was a foveolar-type gastric adenocarcinoma. From about 10 years now, this patient has been undergoing esophagogastroduodenoscopy almost every year. This lesion was absent until six years ago. Five years ago, a small polypoid lesion appeared at the gastric body, and this lesion gradually enlarged. The present case showed the growing process of the foveolar-type gastric adenocarcinoma with a raspberry-like appearance.

Initial Progressions of Carotid Artery Plaque Are Associated with Risk Factors of Cardiovascular Disease.

BACKGROUND: Carotid artery plaque, white matter disease (WMD), and silent lacunae infarcts (initial indicators) are associated with symptomatic cerebral infarction (CI) caused by atherosclerosis. We retrospectively examined the association between the initial indicators and risk factors for cerebrovascular disease, considering the primary prevention of symptomatic CI. METHODS: We divided 1503 individuals who were neurologically healthy and enrolled in a brain screening program (brain dock) at our institution, into three initial plaque grades (grade 0, 1, and 2) based on having no plaques, having plaques on the right or left carotid artery, or having plaques on both carotid arteries, respectively. We analyzed the risk factors according to the presence/absence of the initial indicators. RESULTS: WMD and the risk factors (low-density lipoprotein [LDL], hemoglobin A1c, systolic blood pressure [BP], and smoking cigarettes) were positively correlated with the initial plaque grades, even when their laboratory values were within normal ranges. Systolic BP (116.5 ± 14.0 mmHg) was significantly lower in group 00 (without carotid plaque and WMD) than that in age-adjusted others (with carotid plaque or WMD). In young participants aged between 40 and 52 years, LDL (132.8 ± 24.5 mg/dl) was significantly higher in subgroup ++ (with carotid plaque and WMD) compared to others (without carotid plaque or WMD). CONCLUSION: Initial plaque grade and WMD grade as clinical initial indicators of symptomatic CI are associated with risk factors. To avoid deterioration of the initial indicators, it was suggested that the risk factors should be maintained at the lower ends of normal ranges and smoking cessation should be recommended.

[Epidemiological investigation of colonic diverticulosis detected by computed tomography colonography].

Among 586 patients who underwent computed tomography colonography (CTC) from May 2012 to September 2017, 333 were diagnosed with colonic diverticulosis. The incidence of colonic diverticulosis increases with age. Despite a high frequency of ascending colonic diverticulosis, multiple diverticulosis (>10 in a colonic segment) were the most frequent in the sigmoid colon. In previous studies, the frequency of detection of colonic diverticulosis by CTC was higher than that by colonoscopy and barium enema. In addition, using CTC, the detection rate of colonic diverticulosis has been recently increasing, suggesting that CTC is the most sensitive procedure for detecting colonic diverticulosis.

[A refractory case of ulcerative colitis developed after the cessation smoking achieved clinical and endoscopic remission after resuming smoking].

A 42-year-old man, who had stopped smoking almost one year ago, visited our hospital for hematochezia. He was diagnosed as having ulcerative colitis and was prescribed 5-amino salicylic acid and corticosteroids, which led to the remission of his disease. However, the disease relapsed after sufficient continuous corticosteroids administration and persisted despite 5-amino salicylic acid administration and intensive treatment with corticosteroids, immune modulators, leukocyte apheresis, and anti-TNF-α antibodies. Curiously, clinical remission was achieved after he resumed smoking, and colonoscopy revealed mucosal healing. Such remission may be attributable to anti-inflammatory effects of smoking nicotine and carbon oxides.

Diagnosis of a subarachnoid hemorrhage with only mild symptoms using computed tomography in Japan.

BACKGROUND: Japan is currently an aging society, with a huge proportion of elderly citizens. Consequently, the incidence and severity of subarachnoid hemorrhage (SAH) is predicted to increase in the future. Computed tomography (CT) is very important in the initial diagnosis of SAH. The proportion of hospitals owning CT systems in Japan is around four times greater than the mean number of systems owned by hospitals in other countries belonging to the Organisation for Economic Co-operation and Development. Because CT is readily available in Japan, it follows that this technique, with its impressive diagnostic power, might be more in demand in Japan compared to other countries. However, misdiagnosis of SAH is a relatively common problem and is associated with increased mortality and morbidity, even in individuals who initially present in good condition. CASE PRESENTATION: We describe a patient with subtle clinical and CT signs of SAH. A 39-year-old Japanese man visited our hospital with a 3-day history of mild headache, shoulder stiffness, and a feeling of dizziness. His physical examination was normal aside from mild neck stiffness. Although CT did not reveal obvious abnormalities, we noticed subtle signs of SAH on CT images, which have been observed in SAH patients with mild symptoms. Thus, we diagnosed our patient with SAH and provided appropriate treatment (aneurysm clipping). Following this, the patient progressed without development of the initial complications, and he was subsequently discharged from our hospital without sequela. CONCLUSION: Thus, physicians should be able to recognize subtle characteristics of CT imaging in case of SAH patients with low grade symptoms, as this can facilitate early diagnosis.

[A case of cavernous sinus aspergillosis].

We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.

Warfare rather than agriculture as a critical influence on fires in the late Holocene, inferred from northern Vietnam.

Fire has played an essential role in the development of human civilization. Most previous research suggests that frequent-fire regimes in the late Holocene were associated with intensification of human activities, especially agriculture development. Here, we analyze fire regimes recorded in the Song Hong delta area of Vietnam over the past 5,000 years. In the prehistoric period, 2 long-term, low-charcoal abundance periods have been linked to periods of low humidity and cool climate, and 5 short-term fire regimes of 100-150 years in duration occurred at regular intervals of approximately 700 years. However, over the last 1,500 years, the number, frequency, and intensity of fire regimes clearly increased. Six intensified-fire regime periods in northern Vietnam during this time coincided with changes of Vietnamese dynasties and associated warfare and unrest. In contrast, agricultural development supported by rulers of stable societies at this time does not show a positive correlation with intensified-fire regime periods. Thus, warfare rather than agriculture appears to have been a critical factor contributing to fire regimes in northern Vietnam during the late Holocene.

[Relationship between living arrangements and stroke in Sano-Kosei General Hospital].

We retrospectively reviewed the relationship between living arrangements and stroke in Sano-Kosei General Hospital, for the 3-year period from December, 2007 to November, 2010. The proportion of live-alone among stroke patients was 14.9% (131/877). The indirect standardized live-alone ratio (95% confidence interval), compared with Sano city's live-alone ratio as a standard group, was 1.34 (1.13-1.60). Among live-alone patients with stroke, sex ratio showed no significant difference (p=0.46). Comparing live-alones with non-live-alones in stroke patients, the mean age of live-alones was younger for men, but older for women (p<0.001). There was no significant difference between living arrangements and diseases risk factors. However, on the point of the mean number of risk factors, live-alones tended to have more risk factors than non-live-alones (p=0.032). Therefore, living arrangements are considered as an important factor for prevention of stroke.

Radiolytic cyclization of stem-and-loop structured oligodeoxynucleotide with neighboring arrangement of α,ω-bis-disulfides.

Upon X-ray irradiation of hypoxic aqueous solution, modified oligodeoxynucleotides (ODNs) bearing a pair of disulfides at both ends of the strand that forms a stem-and-loop structure with a neighboring arrangement of α,ω-bis-disulfides underwent efficient cyclization via an intramolecular exchange reaction at the disulfide moieties with a multiple turnover process. Mechanistic studies revealed that hydrogen atoms generated in the radiolysis of water are key active species initiating a chain reaction to produce cyclic ODN disulfides, in which addition of hydrogen atom results in dissociation of the original disulfide bond to generate a thiyl radical intermediate as the chain carrier for the succeeding disulfide exchange into cyclization. The properties were also assessed for the resultant cyclic ODN disulfide that has several favorable features for use in the transcriptional decoy strategy. The cyclic ODN disulfides produced by the present radiolytic method showed high thermal stability, resistance to nuclease, and high binding activity to a representative transcriptional factor of nuclear factor κB.

Exploration of an Easy and Simple Method for Decompressive Craniectomy: The "Spiral Dural Incision Method".

Decompressive craniectomy (DC) is performed to alleviate intracranial hypertension as much as possible. There are two additional goals that surgeons should strive to achieve: minimization of operating time (i.e., the time issue) and avoidance of manually pushing on the surface of the bulging brain to prevent iatrogenic brain injury (i.e., "stuffing risk"). Many authors have made progress on the time issue, but stuffing risk remains largely unmitigated. We recently presented a new DC method that resolved both issues, but the incision design was too complicated for general use. A recent study has presented a duraplasty method that does not use watertight sutures and does not exacerbate the risk associated with DC. Employing the simplified method without sutures, we developed a new, easy-to-perform DC method that resolves stuffing risk. We analyzed the incision design geometrically and verified it by simulations generated with a physics engine. Three patients with massive cerebral infarction, subarachnoid hemorrhage, and hemorrhagic infarction underwent the new procedure. The targeted incision design was composed of four or five curved incision lines. Expansion of the dura resulted in transformation into a centroclinal form with spiral rifts and canopy. The dura expanded as expected in each case, and no cases required manual stuffing of the bulging brain. The operative time was acceptable, and no complications were reported. The concept of the incision design could be applied to any polygonal duraplasty in DC. We developed a new DC method that involves a simple and easily executed incision design, avoided stuffing risk.

Usefulness of radiofrequency ablation with micro-convex probe for hepatocellular carcinoma.

BACKGROUND/AIMS: It was aimed to assess whether a micro-convex probe is superior to the present conventional probe for ultrasonography from the points of safety and efficacy during percutaneous radiofrequency ablation therapy for hepatocellular carcinoma. METHODOLOGY: Twenty-one patients with 23 hepatocellular carcinoma lesions who had one or 2 lesions, each 4 cm or less in diameter, and liver function of Child-Pugh class A or B were enrolled. All the patients except for 2 patients were seropositive for hepatitis C virus. Radiofrequency ablation was carried out under a real-time US guidance. The cooled-tip electrodes used were single and clustered. RESULTS: It was possible to perform safe and accurate percutaneous radiofrequency ablation procedure using micro-convex probes for the treatment of all hepatocellular carcinoma nodules. It was also possible to treat hepatocellular carcinoma located in the right subphrenic region without artificial pleural effusion under intercostal ultrasonography guide. Improved clustered needles were successfully applied to treat the nodules more than 3 cm in diameter with less resistance for penetration compared with the conventional needle. The findings of advanced dynamic flow image on ultrasonography to assess the therapeutic efficacy indicated the consistency with those of dynamic CT which was done 3 to 5 days later radiofrequency ablation. Major complication of radiofrequency ablation procedure was noted in none. CONCLUSIONS: These results suggest that micro-convex probe with clustered tips is superior to conventional probe for ultrasonography from the points of safety and efficacy during radiofrequency ablation for hepatocellular carcinoma nodule located in the right subphrenic region and for larger sized nodule more than 3 cm.

Implications of excess 210Pb and 137Cs in sediment cores from Mikawa Bay, Japan.

Four sediment cores were collected from Mikawa Bay, Japan, and excess 210Pb and 137Cs were measured by gamma spectrometry. Sedimentation rates for the four cores were determined by 210Pb method. The sedimentation rate range is 0.10-0.70 g/(cm2 x year). The bio-mixing depth for each core is less than 7.0 cm, and was determined by the excess 210Pb profiles as well. Therefore, the bioturbation is slight. The 210Pb-derived dates coincided with the results from 137Cs geochronology. Acceleration in sedimentation rate due to environmental alteration has been found in cores A2.5 and 05AS8, representing two depocenters due to their topography. Evidence of the Tokai Flood in 2000 was found in core 05AS8 according to the profiles of both radioisotopes and trace metals.

[A case of liposarcoma of the ascending colon mesenterium].

We encountered a rare case of liposarcoma of the ascending colon mesenterium. A 53-year-old man visited our hospital because of a mass, 12x8cm in diameter, in the right upper abdomen. On computed tomography (CT), the tumor showed irregular density with a smooth surface and was enhanced irregularly. A part of the tumor protruded into the colon in the upper portion of the ascending colon. The tumor was surgically resected by right hemicolectomy. Histological diagnosis of the tumor was well-differentiated liposarcoma, sclerosing variant. Radiological findings seemed to reflect the pathological findings well.

Risk factors for local and distant recurrence of hepatocellular carcinomas after local ablation therapies.

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) recurs frequently after local ablation therapies. Recurrence following the therapies may be of two types: local recurrence and distant recurrence. The aim of the current study is to separately elucidate the predisposing factors for each recurrence. METHODS: Among the 2141 consecutive patients with HCC who were admitted to our institute and affiliated hospital between May 1997 and April 2004, 621 patients who had undergone local ablation therapies as the initial treatment were enrolled. Correlations between the clinical backgrounds of the patients and the type of recurrence were analyzed by the Cox proportional hazard model. RESULTS: A multivariate analysis revealed that tumor size (>30 mm; risk ratio 2.80; 95% confidence interval, 1.77-4.45; P < 0.0001), tumor number (> or =2; 1.74, 1.23-2.47, P = 0.002), and the serum alpha-fetoprotein level (>100 ng/mL; (1.62, 1.09-2.41, P = 0.014), which were classified as "tumor factors", were significant predisposing factors for the local recurrence of HCC. In contrast, a low platelet count (<100,000/microL; 1.34, 1.04-1.74, P = 0.03) and the presence of ascites (1.73, 1.16-2.57, P = 0.008), which were classified as "background factors", as well as tumor size (1.83, 1.11-3.01, P = 0.02) and tumor number (2.23, 1.72-3.00, P < 0.0001) were predisposing factors for distant recurrence. CONCLUSION: The predisposing factors for local and distant recurrence of HCC differ and different precautions must be observed to prevent recurrence, depending on the HCC status and background liver functions.

Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp.

We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.

Effect of vitamin K2 on the recurrence in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Vitamin K2 (VK2) appears to have a potent inhibitory activity for cell growth including HCC cells. We investigated whether VK2 could reduce incidence of tumor recurrence after treatment of HCC. Forty-five patients with cured or possibly cured HCC were randomly selected, assigning patients to treatment (n=21) or control group (n=24) with randomization list. METHODOLOGY: For the treatment group, forty-five mg of Glakay was given orally every day after therapy for HCC. No patients complained of adverse effects. Abdominal ultrasonography and dynamic CT were performed at 3-month intervals. Recurrence was confirmed by abdominal angiography. RESULTS: Recurrence of HCC occurred in 7 cases (33.3%) for the treatment group and 12 cases (50.0%) for the control group during mean observation periods of 19.5 and 16.5 months, respectively. Administration of VK2 was not an independent variable for the recurrence on univariate analysis. Cumulative incidence of HCC recurrence did not differ between the two groups, and the cumulative survival rate tended to be high in treatment group (p =0.054). Cox regression analysis revealed that serum albumin concentration alone was an independent factor affecting the recurrence. CONCLUSIONS: These findings suggest that VK2 does not appear to prevent recurrence of HCC after curative treatment. Our study is preliminary and large-scale trials are needed to determine whether VK2 is of benefit to decrease the recurrence of HCC.

Alteration of serum cytokine balances among different phases of chronic hepatitis B virus infection.

To understand the pathogenesis of chronic hepatitis B virus (HBV) infection, we examined the serum levels of IL-10, TNF-alpha IL-12 p70, and IL-12 p40 in 77 patients chronically infected with HBV and 19 controls. The patients were classified into four groups: asymptomatic carriers (ASC), patients with chronic hepatitis (CH), patients with liver cirrhosis (LC), and patients with hepatocellular carcinomas (HCC). The cytokine values among these groups were compared and their relations to clinical parameters were investigated. All these cytokine values were higher in the patient groups than in controls. IL-10 and TNF-alpha became higher in accordance with the progress of the disease phases, from ASC to LC, and lowest when the patients had HCC. IL-12 p40 was also lowest in HCC, however, the group with highest levels was CH. IL-12 p70 was unchanged among ASC, CH, and LC, but were raised in HCC. Serial analyses for the cytokine values in the same patients showed the similar tendencies. Regression analysis showed the significant correlations between ALT and IL-10. Serum cytokine values well reflected the pathological differences of the individual disease phases, and may become useful indices to understand the pathogenesis of chronic HBV infection.

Four-dimensional ultrasonography for therapeutic radiofrequency ablation for hepatocellular carcinoma.

BACKGROUND/AIMS: We examined whether four-dimensional real-time flow imaging on ultrasonography (US) is valuable to display the accurate position of percutaneous radiofrequency ablation (RFA) needle in the nodule of hepatocellular carcinoma (HCC). METHODOLOGY: Ten patients with 12 HCC nodules were studied; nine were infected with hepatitis C virus (HCV) and one was diagnosed as non-B non-C. Diagnosis was done by helical dynamic CT and/or celiac angiography. Tumor vascularities in the early arterial and post-vascular phases after injection of a microbubble contrast agent were assessed by real-time US scanning of coded harmonic imaging and intermittent interval-delay scanning with a wide-band power Doppler technology. Percutaneous RFA was performed with four-dimensional real-time flow imaging under US to display the accurate position of cool-tip needle. RESULTS: It was possible to obtain accurate position of the needle during RFA procedure in all 12 nodules. The needle was confirmed to be inserted into the center of the tumor nodule by various angles. The simultaneous study before RFA therapy showed the inflow of arterial blood and tumor staining in all nodules at early arterial phase of coded harmonic angio on contrast-enhanced US scan. Posttreatment study to evaluate the therapeutic efficacy showed no blood flow at both early vascular and post-vascular phases. No residual blood flow was noted on early phase of CT scan with adequate safety margin. There was no discrepancy in the finding at early phase between contrast-enhanced US and dynamic CT. CONCLUSIONS: It appeared that four-dimensional real-time US provided more perceptible information on the spatial relationship between RFA needle and the target lesion, and resulted in accurate therapeutic efficacy for percutaneous RFA procedure.

IGFBP-3 expression in hepatocellular carcinoma involves abnormalities in TGF-beta and/or Rb signaling pathways.

Insulin-like growth factor binding protein-3 (IGFBP-3) is a mediator of growth suppression signals and a putative tumor suppressor gene. The growth suppression mechanisms of IGFBP-3 have not been well clarified. We examined the expression of IGFBP-3 transcripts in human hepatocellular carcinoma (HCC) and the relationship between IGFBP-3 expression and the transforming growth factor-beta (TGF-beta) and/or retinoblastoma (Rb) signaling pathways. In situ hybridization revealed IGFBP-3 transcripts in cancer cells in 6 of 57 (10%) HCCs, including moderately and poorly differentiated HCCs with intrahepatic metastasis. In contrast, all lung metastatic nodules of 4 HCCs showed IGFBP-3 transcripts in cancer cells. The cDNA microarray showed that genes for the TGF-beta pathway and Rb were up-regulated in IGFBP-3-expressing HCCs. In 6 HCCs presenting IGFBP-3, immunohistochemical analyses showed abnormalities in the TGF-beta and/or Rb pathways; the loss of phosphorylated-Smad2 was observed in 2, and overexpression of phosphorylated-Rb was observed in the remaining 4 HCCs. The present study suggests that IGFBP-3 mediates growth suppression signals via the TGF-beta and/or Rb pathways in HCC.

[Observation of statistics of screening for unruptured cerebral aneurysms in Tochigi prefecture].

Screening for unruptured cerebral aneurysms (UCAs) using magnetic resonance imaging (MRI) and angiography (MRA) is prevalent in Japan. To reveal the prevalence of UCAs found during screening, we collected data of the results in 1999, in Tochigi prefecture. In the prefecture, of which the population was about 2 million, 26 institutions had been established in 1999, and 5,222 persons had been screened. These corresponded to 0.26% of all inhabitants of Tochigi prefecture. Of the 26 institutions, 24 cooperated in this study, and data was collected for 4,961 persons. We investigated the prevalence of UCAs, and compared it with that of subarachnoid hemorrhage (SAH) in Japan using the existing statistics. The UCAs were found in 143 (2.9%) of the 4,961 cases, 69 men and 74 women, with a mean age of 59.2 years. The prevalence of UCAs at screening and the prevalence of SAH in Japan co-relate in that this prevalence increases with age in both UCAs and SAH. However, after the age of 75, the provalence of SAH decreases. People found with UCAs at screening were mainly in their 50's, but the member of those found with SAH increased gradually after that age. The rate of screening of women was lower than that of men, although both the prevalence of UCAs at screening and SAH of women is higher than that of men. We recommend that middle-aged persons, in their 40's and older, should request screening for UCAs.