Effective Endoscopic Closure of Cholecysto-duodenal and Transverse Colon Fistulas Due to Squamous Cell Carcinoma of the Gallbladder Using Polyglycolic Acid Sheets and a Covered Metal Stent.

An 81-year-old woman presented with abdominal distension and right hypochondrial pain. Abdominal contrast computed tomography and magnetic resonance imaging revealed an 11-cm gallbladder tumor. The patient was diagnosed with squamous cell carcinoma of the gallbladder by endoscopic ultrasound-guided fine-needle aspiration from the gastric antrum. Thereafter, the gallbladder tumor enlarged, and cholecysto-duodenal and transverse colon fistulas were formed. A covered metal stent was placed on the transverse colon, and polyglycolic acid sheets were injected into the duodenum to close the fistulas endoscopically. Endoscopic closure is less invasive than surgery and considered effective for patients with poor general health conditions.

Interventional Treatment for Giant Hepatic Hemangioma Accompanied by Arterio-portal Shunt with Ascites.

A 73-year-old woman with massive ascites associated with a giant hepatic mass accompanied by arterio-portal (AP) shunt was admitted to our hospital. Based on contrast-enhanced computed tomography (CT) and angiography findings, hepatic hemangioma with AP shunt and ascites due to portal hypertension was diagnosed. Transcatheter arterial embolization (TAE) by N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's ascites disappeared, and her liver function test results improved after the treatment. The patient has maintained a steady state for two years. This case indicates that TAE with NBCA is a safe and effective treatment for hepatic hemangioma accompanied by AP shunt.

Comparison between a new 13C-urea breath test, using a film-coated tablet, and the conventional 13C-urea breath test for the detection of Helicobacter pylori infection.

BACKGROUND: In Japan, urea breath-testing includes mouth rinsing with water immediately after the ingestion of (13)C-urea solution, to prevent false-positive results that are caused by oral bacteria with urease activity. Our objective was to evaluate the diagnostic performance of a urea breath test using a film-coated (13)C-urea tablet and omitting mouth rinsing. METHODS: The study was a multicenter trial comparing the solution- and tablet-based urea breath tests (UBTs). Helicobacter pylori status was determined by histology, culture, and rapid urease testing. RESULTS: Of the 255 subjects who completed the study, evaluation of the tablet-based UBT was possible in 254, and comparison of the tablet-based UBT and the solution-based UBT was possible in 250 patients. When the assessment achieved by a combination of biopsy-based methods was used as a reference standard, the sensitivity, specificity, and accuracy of the tablet-based method were determined to be 97.7%, 98.4%, and 98.0%, respectively. When the results of the solution-based UBT were used as a reference standard, the sensitivity, specificity, and accuracy of the tablet-based UBT were determined to be 96.9%, 97.6%, and 97.2%, respectively. CONCLUSIONS: The (13)C-urea tablet-based method proved to be a simple and accurate test for the diagnosis of H. Pylori infection. Mouth rinsing was not required.

A tube-fed liquid formula diet containing dietary fiber increased stool weight in bed-ridden elderly patients.

OBJECTIVE: The number of bedridden elderly patients who need a liquid diet has been increasing. We evaluated the usefulness of a tube-fed liquid diet containing cellulose and oligosaccharide for elderly bedridden patients. METHODS: Twenty-two elderly bedridden patients were given a liquid diet containing cellulose and lafinose for 4 wk. Parameters associated with blood and stool weight were measured during this period. RESULTS: Stool weight increased by 32.0 g in men and 8.8 g in women at 2 wk and remained at these weights up to 4 wk (P < 0.05 before and after 2 wk, 3 wk, and 4 wk in men, and P < 0.05 before and after 3 wk in women). Body weight increased in men (0.5 kg) and women (0.7 kg) 15 d after starting the diet and then remained at these values up to 29 d thereafter, and statistically significant differences were not seen. There were no changes in nutritional parameters such as total protein. CONCLUSION: No significant changes were observed in the general condition of elderly patients, with the exception of a positive increase in fecal weight, by 30-d supplementation of a liquid diet containing cellulose and lafinose.

A successful case of transcatheter arterial embolization with n-butyl-2-cyanoacrylate for pancreatic arteriovenous malformation.

A 57-year-old man was referred and admitted to our hospital for treatment of a symptomatic pancreatic mass. Pancreatic arteriovenous malformation (AVM) was diagnosed based on the findings of contrast-enhanced computed tomography (CT) and angiography, and transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's symptoms subsequently improved after TAE, and resolution of the pancreatic AVM was detected on contrast-enhanced CT performed six months after the embolization procedure. This case indicates that TAE with NBCA is a safe and effective treatment for pancreatic AVM.

Helicobacter pylori infection is associated with a decreased risk of tooth loss in healthy Japanese men.

The association between Helicobacter pylori infection and tooth loss has been studied in Western countries; however, this relationship remains controversial. Although the prevalence of H. pylori infection is higher and atrophic gastritis is usually observed in patients with H. pylori infection in Japan unlike that in Western population, no study has examined the association between H. pylori infection and tooth loss. We examined 959 healthy adults who participated in a mass survey. We counted the number of residual teeth and measured both H. pylori stool antigen and serum anti-H. pylori antibodies. Serum pepsinogen levels were measured to determine the presence of atrophic gastritis. Multiple logistic regression analysis was performed after adjustments for age, body mass index (BMI), smoking and alcohol habits, and educational background. In men, H. pylori infection was a significantly reduced risk factor for loss of all the teeth even after adjustments for other factors (OR, 0.32; 95% CI, 0.12-0.81; P < 0.05). However, such an association was not found in women (0.91; 0.49-1.69). The calculated OR for the presence of atrophic gastritis among individuals with tooth loss was not significant in both men and women. H. pylori infection was associated with a decreased risk of tooth loss in healthy Japanese men.

Effects of cellulose supplementation on fecal consistency and fecal weight.

We investigated the effects of cellulose supplementation on fecal consistency and fecal weight. About 26 women were classified into two groups-normal defecation and constipation groups. All subjects ate the following meals during the experiment: ordinary meals (first week), experimental meals (second week), and experimental meals mixed with 4 g (third week) and 8 g (fourth week) cellulose. The experimental meal contained 16.7 g fiber. Fecal weights, fecal water content, fecal consistency, and defecation frequency were measured during the experimental period. As a result, in the normal defecation group, the mean fecal weight was 222.9 g day(-1) in the first week, and thereafter decreased. Although 20/24 g of fiber intake in the third/fourth week increased the fecal weight to over 150 g, the fecal consistency was still lower than the optimal consistency of around 300 g cm(-2). However, these changes were not observed in the constipated group.

The prevention of colon carcinogenesis in rats by dietary cellulose is greater than the promotive effect of dietary lard as assessed by repeated endoscopic observation.

We developed a method which we used in the current study to observe the rat colon endoscopically. Our goal was to evaluate the entire course in the development of experimental large bowel tumors through serial observations in the same rat. We compared the effects of dietary lard and cellulose on rat colon tumorigenesis in a 2 x 3 factorial design. Sprague-Dawley rats (n = 90) were divided into 6 diet groups: rats were fed a diet without cellulose that contained 5, 10, and 15 g/100 g lard, or diets containing 15% cellulose diet (15 g cellulose/100 g diet) and the same concentrations of lard. The development of large bowel tumors induced by the administration of 1,2-dimethylhydrazine (25 mg/kg body weight) for 19 wk was examined endoscopically. Tumor induction rates in the 15% cellulose groups were lower than in the 0% cellulose groups (P = 0.008), independent of the lard concentration. These results suggest that the preventive effect of cellulose against large bowel tumorigenesis is greater than the promotive effect of fat under the current experimental conditions.

The fermentation of different dietary fibers is associated with fecal clostridia levels in men.

Only a few reports have compared the fermentation of pectin and cellulose using the hydrogen-breath test, and no studies have examined the relation between the hydrogen breathing pattern and colonic microflora. Using breath-hydrogen measurements, we investigated whether different dietary fibers (DFs) were fermented differently and whether there were individual differences after ingestion of the same DF; we also examined the relation between individual fecal microflora and the fermentation of DF. Results of hydrogen tests in 14 men were compared after they had ingested 20 g of pectin, 20 g of cellulose, or 6 g of lactulose (a DF-like substance). We examined the relation between the breath hydrogen results and the subjects' fecal microflora. We defined significant fermentation (i.e., positive cases) as a continuous rise in hydrogen in the expiratory air of >19 ppm. The subjects were divided into 3 groups according to their hydrogen breath test pattern, i.e., positive for lactulose and pectin (Group LP, n = 4); positive for lactulose alone (Group L, n = 7); and negative for pectin, cellulose, and lactulose (Group N, n = 3). Individual differences were noted in subjects from Group LP and Group L. The detection frequency of lecithinase-negative clostridia was higher in Group LP than in the other groups (P < 0.05), and the detection frequency and the number of lecithinase-positive clostridia were higher in Groups LP and L than in Group N (P < 0.05). These findings suggest that the Clostridium species are associated with hydrogen production. The hydrogen breath test results of DFs depend on both the type of DF and the individual colonic microflora. The amount and constitution of colonic microflora might be predicted by the hydrogen-breath test using different DFs.