Transcatheter arterial embolization for uncontrolled bleeding during endoscopic submucosal dissection of the stomach.

Bleeding during endoscopic submucosal dissection (ESD) is an important complication. Here, we report a case of early gastric cancer in which endoscopic hemostasis during ESD failed, hemostasis by transcatheter arterial embolization (TAE) was performed, and ESD was subsequently completed. ESD was scheduled for an 89-year-old male with a type IIa + IIc lesion located on the anterior wall of the gastric antrum. During ESD, bleeding started and then increased. Hemoclips were used but the bleeding could not be controlled. ESD could not be continued because of a poor field of vision. We decided on TAE for hemostasis of the bleeding. Celiac angiography clearly showed extravasation in a branch of the right gastric artery. TAE with a microcoil and gelfoam was performed through the right gastric artery. ESD was started again directly after TAE. We were able to completely resect the lesion with a good field of vision. No complications occurred after therapy. He was alive without recurrence at 18 months after ESD. Thus, TAE is suggested to be a useful hemostatic method during ESD.

Eosinophilic gastroenteritis with eosinophilic infiltration of the gall bladder.

Eosinophilic gastroenteritis (EG) is a rare disease of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal tract wall with various gastrointestinal manifestations. Several organs in the digestive tract may be involved by EG, but biliary tract involvements are rare. We report here a case of EG with eosinophilic infiltration of the gall bladder. A 57-year-old man was admitted to the hospital complaining of abdominal pain and diarrhea. As ultrasonography and magnetic resonance imaging showed thickened gall bladder wall and debris in the neck of gall bladder, we performed cholecystectomy, but his symptoms were not improved. Esophagogastroduodenoscopy showed multiple erosions, redness and edema in the duodenum and stomach. Biopsy specimens from the duodenum and stomach showed infiltration of eosinophils, plasma cells and lymphocytes. Microscopic findings of resected gall bladder showed eosinophilic infiltration into the all layers of gall bladder wall without vasculitis. Based on these findings, EG with eosinophilic infiltration of the gall bladder was diagnosed. Following oral steroid administration, clinical symptoms were immediately improved. One month after the therapy, esophagogastroduodenoscopy did not show any findings of gastritis or duodenitis, and there were no eosinophilic infiltrations in biopsy specimens from duodenum and stomach.

A chromogenic substrate culture plate for early identification of Vibrio vulnificus and isolation of other marine Vibrios.

Vibrio vulnificus infection can result in necrotizing fasciitis and sepsis, which have short latentcy periods and high mortality rates. Thus, an easy and quick detection method is needed to improve the outcome. To distinguish V. vulnificus from other pathogens that cause necrotizing fasciitis, we developed a selective isolation culture agar plate (Chromochecker Vibrio Agar-1; CVA-1) for use in environmental monitoring and in the clinical setting. One hundred four strains of V. vulnificus, already identified biochemically, showed typical colony form and color when grown on CVA-1. Thirty-six of 51 marine bacteria samples suspected to be V. vulnificus on CVA-1 were subsequently identified as V. vulnificus by a biochemical identification system. Of 8 bacteria known to cause necrotizing fasciitis, only V. vulnificus grew on CVA-1. In addition, growth on CVA-1 allowed ready differentiation of Vibrio species. CVA-1 can be used to distinguish pathogenic Vibrios according to colony form and chromatic differences.