Although duodenal diverticula are found relatively frequently in adult gastrointestinal tracts, the majority are asymptomatic. We report a case of duodenal diverticulum complicated with hemorrhage. A ...74‐year‐old woman developed hematemesis and tarry stools. An emergent upper gastrointestinal endoscopy revealed a diverticulum, about 3 cm in diameter, in the posteromedial aspect of the second duodenal segment, right oral to the papilla. The diverticulum was filled with blood clots. After removing them by gentle suction, a linear ulcer became visible and an actively oozing site was seen at one edge of the ulcer. Three injections of epinephrine in a 2.5% sodium chloride solution (epinephrine concentration 0.05 mg/mL), each 1.0 mL for a total volume of 3.0 mL, were made at the oozing site. The exuding ceased immediately after the third injection and bleeding did not reappear. In our patient, successful and complete hemostasis was obtained by this endoscopic injection of epinephrine, although most cases of duodenal diverticulum complicated with hemorrhage had been treated surgically. We think that endoscopic, instead of surgical treatment is considerably becoming another choice for treating patients with a bleeding duodenal diverticulum.
We report a 75-year-old Japanese man infected with hepatitis C virus (HCV) who died of acute hepatic failure due to the hepatic infiltration of B-cell non-Hodgkin's lymphoma (NHL) cells. He suddenly ...developed jaundice, fatigue, fever, and hepatosplenomegaly during the course of chronic infection with HCV. Postmortem liver necropsy revealed extensive infiltration of lymphoma cells into the liver. Although the association between HCV infection and NHL has recently become a matter of concern, we believe this to be the first reported case of acute hepatic failure caused by hepatic involvement of non-Hodgkin's lymphoma in an HCV-infected patient.
In microscopic polyangiitis (MPA), renal manifestations are very common as first symptoms. Here, we report a case of MPA which presented liver dysfunction prior to noted renal manifestations. A ...58-year-old woman was hospitalized because of a fever for 8 weeks. A laboratory examination revealed marked elevation of alkaline phosphatase and γ-glutamyl transpeptidase, while blood urea nitrogen and creatinine levels remained normal. Although apparent renal dysfunction developed in this case soon after hospitalization, physicians should be aware of the variety of clinical manifestations in MPA. Moreover, antineutrophil cytoplasmic autoantibodies were found to be helpful for diagnosing MPA. (Internal Medicine 39: 517-521, 2000)
A 77 year-old man was admitted to our hospital with the chief complaint of heartburn. Endoscopic examination revealed Yamada' stype III polypoid lesion with smooth surface at the middle portion of ...the thoracic esophagus. The tumor was resected easily by endoscopic polypectomy. Resected tumor was 15 mm in diameter and soft. A diagnosis of cystadenoma was made by histological examination. This tumor consisted of multiloculated cysts and proliferated epitherial cells lining on the cystic wall. Benign tumors of the esophagus are relatively rare and there was no case report of cystadenoma of the esophagus as far as we reviewed the literature. Therefore, origin of cystadenoma of the esophagus has not been established.
Numerous studies investigated patients with IPF; however, only a few examined patients with idiopathic interstitial pneumonias (IIPs).
The Japanese Idiopathic Interstitial Pneumonias (JIPS) Registry, ...which was initiated in December 2016, is a multicenter prospective observational study of patients newly diagnosed with IIPs from 86 facilities treating ILDs. The plan is to enroll more than 600 new patients during the 2-year enrolment period and to follow their progress for 3 years after the last case enrolment. If additional consent is obtained, the study will continue for another 2 years. Research questions mainly focus on identifying the frequency by IIP classification, patient background, and diagnostic methods during enrolment, survival, acute exacerbation rate, changes in high-resolution CT imaging, forced vital capacity, and interstitial pneumonia markers over time. Other research questions, including those regarding disease behavior in patients with progressive fibrosing-ILD and new biomarkers associated with genetic predispositions, will be investigated.
The JIPS Registry will provide a comprehensive description of the disease progression, prognosis, treatment status, new biomarkers, and validity of guidelines and central multidisciplinary decisions for IPF and similar diseases that can be differentiated from IPF among IIPs.
Ethical approval was obtained from the institutional review board of Kanagawa Cardiovascular and Respiratory Center (KCRC-16-0005), and that of Jichi Medical University approved the biobank part (I18-005). Results will be published in peer-reviewed journals and will be presented at national and international conferences.
ClinTrials.gov Registry (NCT03041623, first posted on February 3, 2017).
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