Artificial Intelligence ; Deep Learning ; Diabetic Retinopathy ; diagnosis ; Humans ; Image Processing, Computer-Assisted ; Machine Learning ; Mass Screening ; Melanoma ; diagnosis ; Referral and Consultation ; Skin Neoplasms ; diagnosis ; Triage

The prognosis of an early gastric cancer (EGC) is generally excellent, with a 5-year survival rate of 90% in most reports; however, there have been few reports of EGC with distant metastases. Recently we encountered a rare case of EGC with synchronous multiple bone metastases. A 43-year-old woman visited a local clinic due to back pain. Lumbar spine metastases were suspected by MRI. She was transferred to our hospital and underwent bone marrow biopsy which revealed an adenocarinoma. After endoscopic evaluation for primary cancer work-up, we found a suspicious EGC lesion. The results of endoscopic biopsy was signet ring cell carcinoma. Our pathologist additionally reviewed the bone marrow biopsy slides and found signet ring cells in it. PET CT showed disseminated multiple bone metastases but, there wasn't any other malignant lesion. Here we report a rare case of EGC with synchronous multiple bone metastases.
Adult ; Back Pain ; Biopsy ; Bone Marrow ; Carcinoma, Signet Ring Cell ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Prognosis ; Spine ; Stomach Neoplasms* ; Survival Rate

The prognosis of an early gastric cancer (EGC) is generally excellent, with a 5-year survival rate of 90% in most reports; however, there have been few reports of EGC with distant metastases. Recently we encountered a rare case of EGC with synchronous multiple bone metastases. A 43-year-old woman visited a local clinic due to back pain. Lumbar spine metastases were suspected by MRI. She was transferred to our hospital and underwent bone marrow biopsy which revealed an adenocarinoma. After endoscopic evaluation for primary cancer work-up, we found a suspicious EGC lesion. The results of endoscopic biopsy was signet ring cell carcinoma. Our pathologist additionally reviewed the bone marrow biopsy slides and found signet ring cells in it. PET CT showed disseminated multiple bone metastases but, there wasn't any other malignant lesion. Here we report a rare case of EGC with synchronous multiple bone metastases.
Adult ; Back Pain ; Biopsy ; Bone Marrow ; Carcinoma, Signet Ring Cell ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Prognosis ; Spine ; Stomach Neoplasms* ; Survival Rate

BACKGROUND/AIMS: The inadequacy of information on the treatment of gastric candidiasis with antifungal agents promoted us to evaluate patients with fungal infections who had gastric ulcers and assess the need for proton-pump inhibitors or antifungal agents. METHODS: Sixteen patients were included in the study. The criterion for the diagnosis of candidiasis was finding yeast and hyphae in the tissue or an ulcer on histological sections of biopsy samples. Surface fungi were not considered infections. RESULTS: In all cases with benign ulcers, follow-up endoscopy performed 6 weeks after proton-pump-inhibitor treatment revealed that the ulcer had improved without antifungal medication. However, in patients with malignant ulcers, surgical resection was necessary for a definitive cure. Two patients with lymphoma received combined chemotherapy and a proton-pump inhibitor, which improved their condition. CONCLUSIONS: The results of this study suggest that benign ulcers with candidiasis can be effectively treated by a proton-pump inhibitor without antifungal medication. However, surgical resection should be considered for malignant ulcers with candidiasis.
Antifungal Agents ; Biopsy ; Candidiasis ; Endoscopy ; Follow-Up Studies ; Fungi ; Humans ; Hyphae ; Lymphoma ; Proton Pump Inhibitors ; Stomach Ulcer ; Ulcer ; Yeasts

Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.
Acute Disease ; Aged ; Bezoars/*complications ; *Carbonated Beverages ; *Cola ; *Diospyros ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/diagnosis/*etiology ; Intestine, Small/*pathology ; Male ; Risk Factors

BACKGROUND/AIMS: Recently, the eradication rate of Helicobacter pylori (H. pylori) infection has decreased to less than 80% worldwide with the use of clarithromycin-based triple therapy owing to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole. This prospective study aimed to determine eradication rate of H. pylori following high and frequent doses of extended-release dexlansoprazole and amoxicillin, as a dual therapy in a region with high clarithromycin resistance rate. METHODS: A total of 50 treatment-naïve patients with active H. pylori infections, who were confirmed through via rapid urease test or histology and serology between November 2015 and February 2016 at our hospital, were included for analysis. All enrolled patients were treated with 750 mg amoxicillin and 30 mg dexlansoprazole, four times a day for a total duration of 14 days. Treatment success was determined using urea breath test four weeks after treatment completion. RESULTS: Seven out of the 50 patients (29 men and 21 women; mean age, 57 years) dropped out during the study. The total eradication rate was 52% (26/50), and that for those with a compliance rate of over 90% was 68.4% (26/38). H. pylori infections were not successfully eradicated in patients with a compliance rate of less than 90%. Nine patients (18%) reported side effects, such as mild diarrhea and abdominal fullness. No significant factors, such as smoking and alcohol consumption, affected the infection the eradication rate. CONCLUSIONS: High and frequent doses of proton pump inhibitor–amoxicillin dual therapy were not effective in eradicating H. pylori infection in a province with high clarithromycin resistance rate.
Alcohol Drinking ; Amoxicillin* ; Anti-Bacterial Agents ; Arm* ; Breath Tests ; Clarithromycin ; Compliance ; Dexlansoprazole* ; Diarrhea ; Female ; Helicobacter pylori* ; Helicobacter* ; Humans ; Male ; Metronidazole ; Prospective Studies* ; Proton Pumps ; Smoke ; Smoking ; Urea ; Urease

BACKGROUND: This study was performed to compare the clinical outcomes of intestinal Behcet's disease with a simple ulcer. METHODS: We analyzed the medical records of 52 patients that were suspected as having intestinal Behcet's disease. Of these patients, 27 patients (Group 1) met both the criteria of the International Study Group for Behcet's Disease and the Behcet's Disease Research Committee of Japan. Thirteen patients (Group 2) met only the latter criteria and the other patients (Group 3) did not meet any criteria. The efficacy of medical treatment was assessed by the presence of gastrointestinal symptoms and follow-up colonoscopic findings. RESULTS: The mean age for patients with a diagnosis of an intestinal lesion was 38.6+/-12.2 years. The sex ratio was 1.08:1 (M:F) and the mean follow-up duration was 35.2+/-39.5 months. A single, smaller than 5 mm, round and shallow ulcer with an erythematous margin that was located at the leocecal area showed most typical colonoscopic features for intestinal Behcet's disease. No significant differences were found in the clinical manifestations and colonoscopic findings among the three groups of patients. Nineteen (44%) patients achieved complere remission from a sumptomatic point of view and 10 (39%) patients were proved to be complete remission according to follow up colonoscopy after medical treatment. Eleven patients (21.2%) underwent surgery. The overall cumulative rates of a first surgery and re-surgery were 40.5% and 71.9% at 10 years. No statistical relationship was found in the response of medical treatment and the cumulative rate of surgery among the groups. CONCLUSIONS: The clinical course and outcomes of an intestinal simple ulcer are not different from that for intestinal Behcet's disease.
Colonoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Japan ; Medical Records ; Sex Ratio ; Ulcer*

Introduction: The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronationexternal rotation fractures. Materials and methods: Thirty patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud–Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups Results: There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost. Conclusion: Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.