During the 13-year period from 1979 Jan. to 1992 Apr., 93 patients with carcinomas of the biliary tract including the ampulla of Vater and the pancreas were surgically treated at Kumiai General Hospital in the northern Hida district of Gifu Prefecture. In these 93 patients, 31 were diagnosed as suffering from carcinomas of the extrahepatic bile duct; 19, gallbladder carcinomas; 5, carcinomas of the ampulla of Vater and 38, pancreatic carcinomas. But the majority of these patients were classified into the far-advanced stages in accordance with the Japanese stage classification. Resectability was 58.1% in carcinoma of the extrahepatic bile duct, 42.1% in gallbladder carcinoma, 100% in periampullary carcinoma and 31.5% in pancreatic carcinoma and their survival rates were discouragingly low. To improve the postoperative results, it should be advocated that early diagnosis and treatment are most important for biliary tract carcinoma of m and fm in pathological depth, gallbladder carcinoma of m and pm in depth and small pancreatic carcinoma smaller than 2 cm.

Background: Lung cancer screening by chest X-rays and/or cytological tests of sputum has been practiced for many years. Nonetheless the number of deaths from lung cancer was kept increasing all this while. We wanted to find a way to decrease the mortality from lung cancer by investigating the screening methods or lifestyle to prevent the lung cancer.
Methods: I. The detection rate of lung cancer was investigated according to each method of screening-helical CT, chest X-rays or sputum tests, from 1998 to 2000.
II. Seventy-nine cases of lung cancer detected by the screening carried from 1995 to 2000 at our institute were compared with control cases matched with respect to age, sex and seasons of screening.
Results: I. The detection rate by helical CT in 1998, 1999, and 2000 was 0.29%, 0.24%, and 0.19%, respectively, while the detection rate by chest X-rays was 0.01%, 0.02% and 0.2%. There was no detection of lung cancer by sputum tests in those three years.
II. The ingestion of vegetables was the only one statistical difference between the lung cancer group and the control group. A lesser ingestion of vegetables increased the risk for lung cancer.
Conclusions: The detection rate of lung cancer by helical CT is remarkably higher than chest X-rays or cytological tests of sputum. People who eat a lot of vegetables have a lesser chance to suffer from lung cancer.

OBJECTIVESThe aim of this study was to survey the prevalence of fascioliasis in slaughtered cattle in order to provide breeders with feedback which may prevent cattle fascioliasis, as well as human fascioliasis.

METHODSThe results of meat inspection and the information extracted from the Discriminative Data Base on Individual Livestock in Japan were analyzed statistically in 6,224 cattle slaughtered at the Tsuyama Abattoir during the fiscal year 2002.

RESULTSThe age-adjusted fascioliasis and cholangitis rates of all cattle were 2.0% and 7.2%, respectively. When analyzed by cattle breed, both rates were significantly higher in Japanese native cattle than in Holstein or Jersey (Chi-square test, p<0.01). The cattle raised in Okayama Prefecture, Tochigi Prefecture and Shimane Prefecture were significantly different from cattle raised in other prefectures in the age-adjusted fascioliasis and cholangitis rates.

CONCLUSIONThe age-adjusted fascioliasis and cholangitis rates of all cattle can be considered as nationwide rates for slaughtered cattle. The results of the comparisons suggest that cattle fascioliasis is related to feeding with rice straw and that the measures to prevent cattle fascioliasis might differ a mong prefectural governments.

We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×104/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×104/μl received treatment, but most children with platelet counts above 2×104/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×104/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.
Purpura, Thrombocytopenic, Idiopathic ; Child ; Platelet Count ; seconds ; Chronic

  We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×10⁴/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×10⁴/μl received treatment, but most children with platelet counts above 2×10⁴/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×10⁴/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.
Abdominal Abscess ; Abscess ; Anastomotic Leak ; Drainage ; Gastrectomy ; Humans ; Needles ; Pancreatic Fistula ; Punctures ; Stomach Neoplasms ; Ultrasonography

BACKGROUND/AIMS: There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time 13C breath test (BreathID system). METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, T1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), Tlag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group. CONCLUSIONS: This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.
Autonomic Nervous System ; Breath Tests ; Chewing Gum ; Cross-Over Studies ; Gastric Emptying ; Humans ; Male ; Mastication ; Meals ; Saliva

Most patients on hemodialysis (HD) have left ventricular (LV) remodeling as a result of pressure and volume overload, which may lead to hypertrophy (LVH) and dilation, resulting in heart failure (HF). LV torsion by the inner and outer oblique myocardial bands may contribute in part to the ejection fraction (EF). LV dilation is associated with reduction of torsion. We assessed the hypothesis that LV dilation and decreased torsion at the sub-epicardium assessed by 3-dimensional speckle tracking echocardiography (3D-STE) may cause reduced LVEF in patients on HD. LV volume, strain, and torsion at the sub-endocardium and sub-epicardium were examined using 3D-STE in 76 patients on HD (age 64 ± 2 years) and 22 controls (age 71 ± 9 years). The HD patients were divided into 2 subgroups according to LV size (17 HD with LV end diastolic volume ≥ 70 and 59 HD with volume ＜ 70 mL/m2). Torsion (°/cm) is defined as the difference in the rotation angle between base and apex divided by the length of the LV long axis. LVEF, strain, and torsion at both layers in all HD patients (n = 76) were comparable to those in the controls (torsion at the sub-endocardium: 2.2 ± 0.7 vs 2.4 ± 1.1°/cm) despite increased LV mass and volume. In HD with dilation, LV volume increased and LVEF reduced compared to HD without dilation (LVEF: 63 ± 7, 64 ± 6, 57 ± 9％), with decreased longitudinal strain and torsion at both layers (torsion at sub-epicardium: 1.4 ± 0.7, 1.6 ± 1.0, 1.1 ± 0.6°/cm). There was no significant difference in circumferential strain at the sub-epicardium among the 3 groups. There was some correlation between torsion and EF (r = 0.34, p ＜ 0.01) and end diastolic volume (r = －0.36, p ＜ 0.01). LVEF and torsion at the sub-endocardium and sub-epicardium were reduced in HD with LV dilation, suggesting that volume control is important in HD to prevent HF with reduced EF because of reduced LVEF by LV dilation and oblique myocardial fiber damage at the sub-epicardium.