Prevalence of irritable bowel syndrome and its relationship with Helicobacter pylori infection in a Japanese population.
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Biomedical subjects
Publications and source records attributed to T Takashima.
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We present a case of solitary cystic lymph node metastasis from an occult thyroid papillary carcinoma mimicking a lateral cervical cyst, and a case of thyroid papillary carcinoma with a true lateral cervical cyst. Based on a comparison of the radiographical findings of the two cases, differential diagnosis between cystic lymph node metastasis of papillary carcinoma and branchial cyst is discussed.
In general, extensive lymph node metastasis indicates poor prognosis in breast cancer. Nevertheless, some patients with this condition survive for a long time without recurrent disease. This study involved 112 breast cancer patients with four or more lymph node metastases and without distant metastasis who underwent surgery. p53 expression was associated with shorter overall and disease-free survival. High PCNA labeling index was associated with shorter overall disease-free survival. p53-negative and low-PCNA patients survived much longer than p53-positive and high-PCNA patients. This study showed that p53-negative or low-PCNA index patients have relatively good prognoses despite extensive lymph node metastasis.
Recent advances in endoscopic sinus surgery suggested the potential for its surgical application to pituitary surgery. A number of institutions have reported the advantage of endoscope use in pituitary surgery, which is now widely accepted, but approaches to the sella vary in the literature. We retrospectively studied sella approaches in endoscopic pituitary surgery as rhinologists. Subjects included 6 cases of pituitary adenoma and 2 cases of Rathke's cleft cyst. A both-nostril transnasal transsphenoidal approach, our standard technique, was used in 6 cases. This approach consisted of elevation of mucoperiosteal flaps, resection of the vomer and sphenoid anterior wall, and opening of the sellar floor. Elevated mucoperiosteal flaps were used to close of the sella after tumor resection. All tumors were removed and no significant postoperative complications occurred. We found the both-nostril transnasal approach to be easy and time-saving and provided surgeon with a broad surgical field necessary to treat large tumors and accidental cases. Postoperative observation of the sella was easy for wide opening of the anterior wall of the sphenoid sinus. In our experience with reoperation, we quickly accessed the sella and easily removed tumors in the second operation. Our technique therefore has an advance in treatment of recurrence. The both-nostril transnasal approach involves the same procedures as median drainage of the sphenoid sinus, so our technique may have advantages in preventing mucocele of the sphenoid sinus as a late complication of transsphenoidal surgery. The transnasal transsphenoidal approach via both nostrils is preferable rhinologically.
Peroxisome proliferator-activated receptor gamma (PPAR-gamma), a member of the nuclear hormone receptor superfamily, is involved in suppression of growth of several types of tumors such as liposarcoma, breast cancer, prostate cancer, and colon cancer, possibly through induction of cell cycle arrest and/or apoptosis. In this study, we demonstrated expression of PPAR-gamma mRNA and protein in human esophageal carcinoma cells. Expression of PPAR-gamma protein was higher in an adenocarcinoma cell line (TE-7 cells) than in a squamous cell carcinoma cell line (TE-1 cells). PPAR-gamma ligands such as 15-deoxy-Delta12,14-prostaglandin J2 and troglitazone significantly inhibited the growth of TE-7 cells but had less or no effect on growth of TE-1 cells. 15d-PGJ2 and troglitazone induced apoptosis in TE-7 cells but not in TE-1 cells. Troglitazone caused G1 cell cycle arrest and reduced ornithine decarboxylase activity (ODC) in TE-7 cells but not in TE-1 cells. Inhibition by PPAR-gamma ligands of growth of esophageal adenocarcinoma cells may thus be due to induction of apoptosis, G1 cell cycle arrest and reduction of ODC activity.
Recently a number of patients have received home enteral nutrition (HEN) as well as home parenteral nutrition (HPN) in Terumo's home healthcare network 'Home-Joint'. This study was undertaken to compare the patients who received HEN with those who received HPN. 1. HPN patients in 2000. Number: 1,789 (45% females), age: 0-101 (mean: 66 years old, 48% over 70 years old), diagnosis: cancer 54%, therapeutic periods: 0-916 days (mean: 80 days). 2. HEN patients in 2000. Number: 736 (40% females), age: 1-101 (mean: 50 years old, 33% over 70 years old), diagnosis: Crohn's disease 44%, therapeutic periods 0-1,618 days (mean: 183 days). 3. Adoption of HPN and HEN in home care agents. HPN only 66%, HEN only 24%, both HPN and HEN 10%. It suggested that following two issue take place against making choice of HPN or HEN in home nutrition care. 1) Adoption of both HPN and HEN in more clinics. 2) Establishment of the guidelines for systematic HPN/HEN choice.
The detection rate of mycobacteria from patients' specimens and the time required to get positive culture were compared among newly developed MYCOACID SYSTEM, MGIT, Ogawa K medium and 2% Ogawa medium (S). A total of 249 sputum samples taken from patients were used as the study subjects and 124 kinds of mycobacteria were isolated. For 135 cases clinically diagnosed as pulmonary tuberculosis, the detection rate was 44.4% for MYCOACID, 47.4% for MGIT and 38.5% for Ogawa K medium, showing that there are no significant differences in the detection rate between MYCOACID and MGIT, and MYCOACID and Ogawa K medium but the differences was significant between MGIT and Ogawa K medium (p = 0.02). The mean days needed for detection of Mycobacterium tuberculosis complex was 12.3 days for MYCOACID, 13.4 days for MGIT, and 26.8 days for Ogawa K medium, indicating significant differences in the time to get positive culture between Ogawa K medium and either of both liquid media (p < 0.001). Furthermore, 2% Ogawa medium (S) was used only for the detection of mycobacteria among previously untreated tuberculosis and there were no significant differences in the detection rate between 2% Ogawa medium (S) and either of both liquid media. The time to get positive culture for 2% Ogawa medium (S) was 18.2 days, which was longer than that for either of liquid media, MYCOACID and MGIT, but it was significantly shorter (7.9 days) than that for Ogawa K medium (p = 0.003). These results demonstrate that the liquid culture systems both MYCOACID and MGIT were very useful for the detection of mycobacteria compared with Ogawa K medium.
We retrospectively reviewed 289 cases followed for a long time after extracorporeal shock wave lithotripy (ESWL) for gallstones. Follow-up periods ranged from 0.5 years to 9.2 years, with a median of 4.1 years. The complete resolution rate was 45.6%. A solitary gallstone, non-calcified gallstones on CT, and Tsuchiya's sonographic type Ia and Ib gallstones were found to be statistically significant variable for resolution of the disease. With a maximum follow-up period of 9 years, the cumulative recurrence rate was 30.7%. Among the 156 patients whose gallstones did not resolve, 70 were symptomatic and the other 86 were asymptomatic. Thirty-eight of the symptomatic patients (54.3%) became symptom-free, while 23 asymptomatic patients (29.1%) became symptomatic. The cumulative rate of occurrence of colic attacks and/or acute cholecystitis was significantly higher in the cases with lithotripsy fragments 4 mm or more in size than in the cases wih fragments 3 mm or less in size (51.8% vs. 16.7%; p < 0.05). ESWL was followed by surgery in 23.1% because symptoms developed or became aggravated after ESWL in 58.3% of them. Gallbladder cancer was discovered in one case. Patients undergoing ESWL should be followed by focusing on postoperative recurrence, symptoms, and gallbladder cancer.
The purpose of this study was to identify contrast enhancement patterns of dense breast parenchyma and to investigate the ability of dynamic magnetic resonance imaging (MRI) to detect cancer in the dense breast. Thirty-two patients with breast cancer in dense breast underwent gadolinium-enhanced dynamic MRI. The detectability of cancer by dynamic MRI, mammography, and physical examination was compared. Two parenchymal enhancement patterns could be identified. One was increasingly multiple patchy enhancement found predominantly in the periphery (type A), and the other was faint enhancement without any nodular opacification (type B). Type A was thought to reflect severe proliferative fibrocystic change (PFC). For both patterns, the detection rate of primary cancers by dynamic MRI was found to be superior to that by other modalities. Dynamic MRI also could detect multifocal cancers, which could not be found with other modalities, although the detectability of these small cancers might be reduced in patients with severe PFC.
To assess the usefulness of evaluating basilar arterial flow by magnetic resonance angiography (MRA), MRA results for patients with vertebrobasilar insufficiency (VBI) were compared with those for age-matched individuals with no vestibular disorders. The presence of stenosis in the basilar artery, its severity and the presence of complications associated with atherosclerosis in the two groups were statistically compared. Analyses revealed significant differences in the incidence of stenosis, its severity, and the incidence of complications between the two groups. These findings suggest that MRA is valuable for the estimation of vertebrobasilar hemodynamics. MRA evaluation of basilar artery stenosis appears to be suitable for identifying a high-risk group among VBI patients, since basilar artery stenosis can result in serious disabilities.
A case is presented of an adult chylous cyst of the mesentery that was preoperatively diagnosed to be a pancreatic cystadenoma. A 66-year-old asymptomatic male was followed up for 15 months under the diagnosis of a benign pancreatic cyst. On October 1997, computed tomography showed a 45 x 40 mm cystic mass in the upper abdomen which came in contact with the pancreas. Endoscopic ultrasonography revealed a multilocular mass with a 7 x 4 mm elevated lesion. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed the cystic mass to be unrelated to the pancreatic duct. The preoperative diagnosis was a pancreatic cystadenoma or cystadenocarcinoma. A laparotomy showed a 50 x 40 mm cystic mass containing chylous fluid, that arose from the mesentery of the upper part of the jejunum. The pathological diagnosis was a chylous cyst of the mesentery. The preoperative diagnosis in this case was very difficult because the chylous cyst appeared to be attached to the pancreas and this phenomenon is considered to be extremely rare.
The anaerobic oxidation of dissolved H2S to elemental sulfur was studied at 23 degrees C and pH 6.5+/-0.3 in continuous culture of the phototrophic green sulfur bacterium Prosthecochloris aestuarii. The number of cells formed in the cultures was proportional to the amount of H2S oxidized, and the growth yield was independent of light intensity. The specific growth rate was significantly dependent on the dissolved H2S concentration and light intensity. The kinetic data were analyzed with a rate expression as a function of each rate-limiting factor. Under illumination by white fluorescent lamps, the specific oxidation rate of P. aestuarii reached a maximum of 2.02 x 10(-14) mol-H2S.h(-1).cell(-1) when the dissolved H2S concentration was 2.1 mM at 5000 lx. Simultaneous use of near infrared LED (light-emitting diode) and white fluorescent lamps provided a 35% increase in the maximum specific H2S oxidation rate.
BACKGROUND: Sucralfate has an inhibitory action against Helicobacter pylori and enhances the anti-H. pylori activity of antimicrobials. AIM: To evaluate the efficacy and safety of sucralfate-based eradication therapy for H. pylori infection, compared with that based on lansoprazole, in a randomized multicentre study. SUBJECTS AND METHODS: The subjects were 150 H. pylori-positive patients. They were randomly assigned to one of two regimens for 2 weeks: sucralfate 1 g t.d.s., amoxycillin 500 mg t.d.s., and clarithromycin 400 mg b.d. (SAC regimen: 75 patients); or lansoprazole 30 mg o.m. with the same antimicrobial medications (LAC regimen: 75 patients). Cure of infection was assessed by a 13C urea breath test 1 month after completion of treatment. RESULTS: Eight patients (four in the SAC group and four in LAC group) could not continue therapy because of severe diarrhoea, and three did not take the 13C urea breath test after therapy. Cure rates for intention-to-treat, all-patients-treated, and per protocol analysis in the SAC group were 80%, 83%, and 88%, respectively, and those in the LAC group were 87%, 87%, and 92%, respectively. There were no significant differences in cure rate or adverse effects between the two regimens. CONCLUSION: Sucralfate in combination with amoxycillin and clarithromycin is as effective as lansoprazole-based eradication therapy for H. pylori.
BACKGROUND: CYP2C19 has an important role in the catabolism of several proton pump inhibitors. However, the relative contribution of CYP2C19-mediated metabolism varies among the different proton pump inhibitors. AIM: To determine the effect of CYP2C19 genotype status on intragastric pH during dosing with lansoprazole or rabeprazole. SUBJECTS AND METHODS: The subjects were 20 male volunteers without Helicobacter pylori infection. Their CYP2C19 genotype status was determined by a polymerase chain reaction-restriction fragment length polymorphism method. Twenty-four-hour monitoring of intragastric acidity was performed three times: once without medication, once on the last day of a 7-day course of rabeprazole, and once on the last day of a 7-day course of lansoprazole. RESULTS: Subjects were divided into three groups on the basis of their CYP2C19 genotype status: homozygous extensive metabolizers (homo-EMs, n=7), heterozygous extensive metabolizers (hetero-EMs, n=9), and poor metabolizers (PMs, n=4). The median pH during rabeprazole administration was not influenced by CYP2C19 genotype. On the other hand, the median pH in PMs during lansoprazole dosing was higher than in homo-EMs and hetero-EMs. The percentage of time with pH < 4.0 had a similar tendency to that of median pH. CONCLUSION: CYP2C19 genotype status influences gastric acid suppression by lansoprazole, but not by rabeprazole.
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We report 2 cases of relapsing nummular dermatitis according to mercury sensitivity, which was confirmed by patch testing. Removal of the amalgam from dental metal alloys markedly improved their skin eruptions. One of the patients, a dentist, experienced exacerbation of the eruptions on his lower legs after handling dental amalgam. Hypersensitivity to haptens such as metals is possibly involved in, at least in some patients, the pathogenesis of nummular dermatitis.
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