[Submucosal bacterial abscesses of the ascending colon and liver associated with portal and superior mesenteric vein thrombosis due to Enterococcus faecalis infection: a case report].

A 72-year-old woman with diabetes mellitus was admitted with fever and general fatigue. Blood biochemistry showed elevated hepatic and biliary enzyme levels, abdominal computed tomography showed multiple liver abscesses with portal and superior mesenteric vein thrombosis, and total colonoscopy revealed a submucosal bacterial abscess in the ascending colon. The abscesses were determined to be associated with Enterococcus faecalis infection. The patient was treated conservatively with antibiotics (meropenem) and anticoagulants (warfarin), which led to a gradual amelioration of symptoms and resolution of thrombosis.

Magnifying endoscopic observation with narrow band imaging for specialized intestinal metaplasia in barrett's esophagus with special reference to light blue crests.

AIM: Barrett's esophagus (BE) with specialized intestinal metaplasia (SIM) is at high risk of esophageal adenocarcinoma. Magnified endoscopy with narrow band imaging (ME-NBI) can be useful for detecting this condition. In addition to pit patterns, light blue crests (LBC), blue-whitish patchy areas on the metaplastic epithelia of the stomach, can predict SIM in BE under ME-NBI observation. METHODS: A total of 54 patients with BE underwent ME-NBI to identify IM pits (tubular and villous pits) and LBC. Biopsy samples were taken for histological evaluation of IM, immunohistochemical staining for CD10, MUC2 and MUC5AC antigen, transmission electron microscopy and real-time polymerase chain reaction (RT-PCR) analysis of CD10 mRNA expression. RESULTS: IM pit pattern with ME-NBI for the diagnosis of IM yielded acceptable sensitivity, specificity and accuracy at 92%, 77% and 83%, respectively. However, the sensitivity, specificity and accuracy of LBC with ME-NBI for IM were comparably high at 79%, 97% and 89%, respectively. Upon immunohistochemistry, all 19 metaplastic epithelia of LBC-positive BE showed immunoreactivity against anti-MUC2 antibody, whereas CD10 antigen was identified in 11 of the 19 LBC-positive BE. Brush borders were seen on IM epithelia using electron microscopy. On real-time PCR analysis, CD10 mRNA levels in the LBC-positive BE were higher compared to those in the LBC-negative BE. CONCLUSION: The appearance of LBC can be an accurate sign to predict SIM in BE and may be associated with high CD10 expression, possibly along with brush borders.

[A case of sacroiliitis complicated with ulcerative colitis which was treated with leukocytapheresis].

A 51-year-old woman was admitted to our hospital because of fever and pain in the right buttock. She had ulcerative colitis. She was given a diagnosis of sacroiliitis complicated with ulcerative colitis, based on a physical examination and magnetic resonance imaging (MRI) . Her sacroiliitis was successfully treated by leukocytapheresis (LCAP) . Sacroiliitis complicated with ulcerative colitis is rare in Japan, and its treatment and pathogenesis remain unclear. We report an unusual case of sacroiliitis complicated with ulcerative colitis, which was successfully treated by LCAP.

[A case of groove pancreatitis observed from initial stage].

We report a case of groove pancreatitis. A 60-year-old man was admitted to our hospital because of nausea and vomitting. CT showed a mass lesion in the groove between the pancreas head, duodenum and common bile duct. He was given a diagnosis of the groove pancreatitis, and underwent endoscopic balloon dilation. Groove pancreatitis is rare, and we discuss this case with references.

[A case of endocrine carcinoma of the sigmoid colon].

We report a case of endocrine carcinoma of the sigmoid colon. A 71-year-old man was admitted to our hospital because of constipation and bloody stool. Colonoscopy showed a mass lesion with irregular ulceration in the sigmoid colon. He was given a diagnosis of the poorly differentiated adenocarcinoma of the colon, and underwent sigmoidectomy with dissection of the lymph nodes. Histological and immunohistochemical examinations of the resected specimen revealed endocrine carcinoma. Endocrine carcinoma of the colon is rare, and the prognosis is very poor. We discuss this case with references.

Analysis of the tumor color patterns of early esophageal cancer using an autofluorescence imaging video endoscopy.

BACKGROUND: Using a novel autofluorescence imaging video (AFI) endoscopy system, early esophageal cancers (EECs) appeared purple or brown in green background. However, the factors associated with these color patterns remain unraveled. The aims of this study were to classify the AFI color patterns of EECs and to investigate the correlation between the color patterns and clinicopathologic features of EECs. PATIENTS: From April 2008 to April 2010, 32 patients with 42 EECs who underwent endoscopic submucosal dissection at the Nagasaki University Hospital were enrolled in this study. They consisted of 25 men and 7 women, with the mean age of 64.7 years old (range, 52 to 82 y). METHODS: With AFI endoscopy, we classified 2 color patters in EECs into purple in green patterns (P in G) and brown with purple dots in green patterns (BP in G), and we assessed the association with clinicopathologic factors. These factors included tumor morphology, location, size, histologic depth of invasion, and histologic lymphatic and vessel permeations. RESULTS: The color patterns of EECs were classified into 2 groups: purple in green patterns (P in G) (14%) and brown with purple dots in green patterns (BP in G) (86%). Univariate analysis revealed that only macroscopic type was associated with the EECs color pattern. CONCLUSIONS: This study revealed the association of AFI color patterns with clinicopathologic factors of EECs. Recognition of the color patterns in AFI images might be useful for the detections and diagnosis of EECs as one of the new endoscopic modalities.

Intraosseous fat necrosis associated with alcoholic pancreatitis.

A 50-year-old man with a 30-year history of alcohol abuse was admitted because of abdominal pain. Based on an elevated serum amylase level and abdominal computed tomography findings, a diagnosis of alcoholic pancreatitis was made. The pancreatitis improved after 1 month of conservative therapy, but the patient complained of a tender right ankle that showed no abnormal findings on X-ray examination. Two months later, the patient was readmitted for recurrent pancreatitis and a swollen, warm, tender right ankle. Imaging studies, including plain radiographs, magnetic resonance imaging, and a bone scintigram showed the typical findings of intraosseous fat necrosis of the right tibia. We report a rare case of intraosseous fat necrosis associated with alcoholic pancreatitis.