Endoscopic mucosal resection (EMR) has been accepted as one of the standard treatments of early gastric cancer (EGC) with a negligible risk of lymph node metastasis. EMR is similar to surgery in efficacy but less invasive and more cost-effective. And it allows accurate histological staging of the tumor, which is critical in deciding whether additional treatment is necessary. Standard indications for EMR of EGC include differentiated elevated cancer less than 2 cm in size and depressed cancer without ulceration less than 1 cm in size. Recently, expanded indication has been proposed in Japan to cover other lesions with a negligible risk of lymph node metastasis, which include larger lesions and lesions with ulceration. With the development of endoscopic submucosal dissection (ESD), en bloc resection of larger and even ulcerative lesion is possible. However, the lack of long-term data makes it difficult to widely accept expanded indication. More long-term studies about therapeutic outcomes are needed to fully bolster the safety and establish correct therapeutic role of ESD in treatment of EGC.
Japan ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms ; Ulcer

Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.
Barrett Esophagus* ; Diagnosis ; Endoscopy ; Molecular Imaging* ; Narrow Band Imaging ; Optical Imaging ; Stomach Neoplasms ; Stomach* ; Upper Gastrointestinal Tract

No abstract available.
Carcinoid Tumor/etiology/*pathology/ultrasonography ; Colonoscopy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Muscles/pathology ; Neoplasm Invasiveness ; Rectal Neoplasms/etiology/*pathology/ultrasonography

No abstract available.
Stents

PURPOSE: To evaluate the CT findings and clinical significance of colonic edema in liver cirrhosis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 221 cases of clinically diagnosed liver cirrhosis in 173 patients. In 30 of these [23 men and six women aged between 35 and 67 (mean, 54) years], colonic edema was present. We evaluated its distribution (ascending, transverse or descending colon), analysed serum albumin and bilirubin levels, and in both the colonic edema and non-colonic edema group, determined whether ascites was present. Thus, we sought correlation between the presence of colonic edema, the severity of liver cirrhosis, and each parameter. RESULTS: CT revealed colonic edema in 30 of 221 cases (14 %). Of the 30, 13 cases (43 %) were diffuse colonic edema and 17 (57 %) were regional edema. Among these 17 cases, 12 (71 %) were seen only in the ascending colon, while five (29 %) were seen in both the ascending and transverse colon. In the group with colonic edema, the mean level of serum albumin was 2.6 g/dl, and that of serum bilirubin was 4.9 mg/dl; 20 patients ( 67 %) had ascites. In the group without colonic edema, mean levels of serum albumin and serum bilirubin were 3.0 g/dl and 4.1 mg/dl, respectively ; 43 patients (30 %) had ascites. There was no significant statistical difference in serum albumin and bilirubin levels between the colonic edema and non-colonic edema group (p>0.05), though ascites was more common among the former group. CONCLUSION: In cases of liver cirrhosis, CT evidence of colonic edema is not uncommon. The ascending colon is most frequently involved, though disease severity does not vary significantly according to site. When CT reveals the presence of colonic edema, further diagnostic evaluation is not necessary if there is no evidence of clinical symptoms.
Ascites ; Bilirubin ; Colon* ; Colon, Ascending ; Colon, Transverse ; Edema* ; Female ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Retrospective Studies ; Serum Albumin ; Tomography, X-Ray Computed

PURPOSE: The information in the internet is increasing and the number of people using the Internet to obtain medical information is increasing rapidly too. But, compared to the amount of information, the quality of information is extremely variable. To assess the accuracy of medical information on the Internet, the quality of information about food allergies available on the internet examined. METHODS: Online searches using the phrase "food allergy" were conducted on five major Internet search engines. The first 50 web pages generated by each engine were examined. Making an exception of the web pages which were inaccessible, irrelevant, and duplicated, sixty out of two hundred and fifty web pages were evaluated. Information scores were developed from 1(no statement) to 4 (sufficient) and designed to assess how well the web pages mentioned the summary, symptom, diagnosis, treatment, and education of the patients, and emergent management. RESULTS: When classified by ownership, there were six(10%) oriental clinics, twelve(20%) hospitals, twenty one(35%) profit-making institutions, fourteen(23%) non-profit institutions and seven others (12%). The mean information score(IS) was 10.7. Summary got the highest IS(2.25) and the education for patients and supporters got the lowest IS(1.33). Medical institutions such as hospital and clinic got 12.33 and non-medical institutions got 10.25. But there were no statistically significant differences between these two institutions(P=0.107). CONCLUSION: Overall, the quality of information on food allergy through the Internet was poor. The main reasons are unlimited listings of related information on the Internet and an absence of a reviewing process of the information. Therefore, people should not entirely rely on the Internet for medical information and medical-related institutions such as hospitals, schools, clinics and relevant academic associations should develop an Internet system to improve the quality of information.
Diagnosis ; Education ; Food Hypersensitivity* ; Humans ; Internet* ; Ownership ; Search Engine

Infantile digital fibromatosis(IDF) is a rare, benign fibrous tumor, first described in 1965 by Reye. IDF may occur single or multiple lesions exclusively on the fingers or toes, rare occurrence outside the digit have been reported. This tumor grow slowly and may adhere to the deeper tissue, and may lead to deformity of the digit, but do not distant metastasis or dissemination. There is a marked tendency for recurrence after surgical excision. Up to now, only 6 cases have been reported in the literature showing spontaneous regression. We experienced a case of infantile digital fibromatosis located on hypothenar area at birth. Also that spontaneous regressed at 13 months of age. We reported a case of IDF showing spontaneous regression with brief review of related literature.
Congenital Abnormalities ; Fibroma* ; Fingers ; Neoplasm Metastasis ; Parturition ; Recurrence ; Toes

Interferon-alpha is an established therapy for the patients with myeloproliferative disease. Unusual immune-mediated side effects have been reported during treatment. Among them, renal and cardiac toxicities are rare complications. Recently we experienced a case of hemolytic uremic syndome found in a 40-year old male undergoing interferon-alpha therapy for chronic myelogenous leukemia, chronic phase. On admission, his chief complaints were generalized edema and azotemia. Bone marrow biopsy revealed transformation into accelerated phase. bcl/abl gene was positive. Peripheral blood smear showed hemolytic anemia. Despite prompt diagnosis, institution of plasmapheresis, and steroid, his renal function did not recover, as expected. Hemolytic uremic syndrome was a chronic form of renal toxicity due to interferon-alpha. In this case, renal function did not recovered to normal level. However, early detection of renal toxicity such as proteinuria or acute tubular necrosis, and the discontinuation of interferon-alpha could achieve the recovery of normal renal function. Therefore, periodic examination of renal function should be performed in the patients with the use of long-term interferon-alpha.
Adult ; Anemia, Hemolytic ; Azotemia ; Biopsy ; Bone Marrow ; Diagnosis ; Edema ; Hemolytic-Uremic Syndrome ; Humans ; Interferon-alpha* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Male ; Necrosis ; Plasmapheresis ; Proteinuria

BACKGROUND/AIMS: The Barrett's esophagus is confirmed by performing a biopsy when the gastroesophageal junction (GEJ) and Z-line do not coincide. In Japan, the GEJ is at the distal end of the palisading vessel while Western countries define it as the proximal tip of the gastric fold. However, there is little data on the prevalence of an endoscopic Barrett's esophagus and the inter-observer variation. METHODS: Four experienced endoscopists reviewed the endoscopic still images of 111 consecutive patients. The level of inter-observer agreement was expressed as a kappa value. RESULTS: The average percentage of patients with an endoscopically confirmed esophagus was 34.2%. The level of inter-observer agreement was substantial (kappa=0.698). CONCLUSIONS: The prevalence of an endoscopic confirmed Barrett's esophagus was high, and the inter-observer variation was substantial when the GEJ was defined as the distal end of the palisading vessel. Considering the low incidence of esophageal adenocarcinoma and the risk of hemorrhage from a biopsy, a more specific marker is needed in this high-risk group.
Adenocarcinoma ; Barrett Esophagus* ; Biopsy ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Incidence ; Japan ; Observer Variation* ; Prevalence*

Cystic lesions of the stomach are rare and usually detected incidentally during surgery or autopsy. Amongseven cases of cystic masses, duplication cysts accounted for four, retension cysts of ectopic pancreas for two,and cystic lymphangioma remaining one. In the upper gastrointestinal series, all were submucosally, whileendoscopic ultrasonography showed that the location of cystic masses was also submucosal. Except for two cases ofduplication cyst and cystic lymphangioma which were thin-walled, lesions were well-defined and showed lowattenuation. In addition, abdominal CT scanning showed two cases of retension cyst of ectopic pancreas.
Autopsy ; Lymphangioma, Cystic ; Pancreas ; Stomach* ; Tomography, X-Ray Computed ; Ultrasonography