Gastric adenocarcinoma of fundic gland type (chief cell predominant type) with unique endoscopic appearance curatively treated by endoscopic submucosal resection.

Gastric adenocarcinoma of fundic gland type [chief cell predominant type; (GA-FD-CCP)] is a rare gastric cancer variant arising from non-atrophic mucosa without Helicobacter pylori infection in the upper third portion of the stomach. GA-FD-CCP originates deep in the mucosal layer; hence, endoscopic lesion detection is often difficult at an early stage because of a minimal change in the mucosal surface. Here we present a 66-year-old man with an early stage of GA-FD-CCP showing characteristic endoscopic features. Esophagogastroduodenoscopy demonstrated a flat, slightly reddish area with black pigment dispersion and irregular micro-surface structure at the gastric fornix. The tumor was resected by endoscopic submucosal dissection and was pathologically diagnosed as GA-FD-CCP. Prussian blue staining revealed that the black pigment was a hemosiderin deposition. We reported a rare case of successfully treated GA-FD-CCP with black pigmentation that aided in early lesion detection.

Effect of cilostazol in preventing restenosis after percutaneous transluminal coronary angioplasty.

This study sought to evaluate the effect of cilostazol in preventing restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) in 68 patients: 35 patients received cilostazol immediately after PTCA and 33 patients received aspirin or ticlopidine. Repeat coronary angiography was performed 4 to 6 months after PTCA and the incidence of restenosis was significantly lower (17%) in the cilostazol group than in the non-cilostazol group (40%) (p < 0.05), which indicates that cilostazol has the potential to prevent restenosis after PTCA.

Genesis of the third heart sound. Phonoechocardiographic studies.

To clarify the genesis of the third heart sound (IIIS), phonoechocardiographic analysis was made in 31 cases with apparent IIIS. The mitral valve, either anterior or posterior, showed no definite movement coincided with the IIIS. At the time of IIIS, mitral valve is in the closing process, but it is still widely open, and there was no evidence of the stretch or tension of the valve apparatus. On the other hand, the endocardial echoes, either of interventricular septum or of posterior wall of the left ventricle, almost always showed definite check point (point of inflexion) during (or exactly at the end of) rapid ventricular filling as manifested by the sudden change in the diastolic dimension of the left ventricle near the apex. The IIIS seems likely to originate from the abruptly arrested momentum of the moving mass of blood at this check point and then the vibration of the relaxed cardiohemic system.