Kazuya Fujimori

Diagnosis of intraocular lymphoma by polymerase chain reaction

Abstract• Background: Cytopathological examinations have been used in the diagnosis of intraocular lymphoma. However, sometimes it is not easy to detect malignant cells in the biopsy specimens. We applied a method that identified monoclonal proliferation of B lymphocytes by using polymerase chain reaction (PCR) in the diagnosis of patients suspected to have intraocular B-cell lymphoma. • Methods: Threè specimens of the diagnostic vitrectomy were studied by cytological examination and by PCR to amplify the complementary determining region (CDR3) of immunoglobulin heavy chain (IgH) gene. As a positive control, a biopsy specimen of an orbital lymphoma was examined; four vitrectomy specimens from patients with diabetic retinopathy, proliferative vitreo-retinopathy, acute retinal necrosis (ARN) and macular hole were negative controls. • Results: On cytologic examination, no malignant cells were found in three specimens: suspected intraocular lymphoma and one ARN. In contrast, a discrete band that reflected monoclonal proliferation of B lymphocytes was detected by PCR in specimens from two patients and the positive control. Vitrectomy specimens from the negative controls, including ARN, did not show a discrete band on PCR. • Conclusions: Two cases of ocular malignant lymphoma were diagnosed by PCR identification of monoclonal proliferation of B lymphocytes. This method may be an additional diagnostic tool in the diagnosis of intraocular B-cell lymphoma.

Colonic diverticular hemorrhage: the hood method for detecting responsible diverticula and endoscopic band ligation for hemostasis

BACKGROUND AND STUDY AIMS Although colonic diverticular hemorrhage is a common cause of lower gastrointestinal bleeding, the low rate of detection of the diverticula responsible for bleeding, together with inadequate evaluation of endoscopic hemostasis, remain unsatisfactory. PATIENTS AND METHODS Over 3 years, we employed the hood method to diagnose diverticular hemorrhage in 53 patients and applied endoscopic band ligation (EBL) for hemostasis in 27 patients with responsible diverticula. RESULTS The hood method revealed active bleeding in 13 patients (24.5%), nonbleeding visible vessels in 14 patients (26.4%), and presumptive diverticular hemorrhage in 26 patients (49.1%). The nonbleeding visible vessels were located in the diverticular dome in 13 patients and at the diverticular orifice in one patient. EBL was performed in 27 patients, and a hemostasis rate of 96.3% was achieved. In 9 of 12 patients treated with EBL, follow-up colonoscopy revealed resolution of the responsible diverticula. CONCLUSIONS The hood method improves the detection rate of diverticula responsible for bleeding by revealing potential nonbleeding visible vessels in the diverticular dome. EBL may become an effective procedure for hemostasis of colonic diverticular hemorrhage.

Diagnostic accuracy of immunochemical faecal occult blood test for gastric cancer

Objectives –Toinvestigate the accuracy of the immunochemical occult blood test in screening for gastric cancer and to evaluate whether or not the upper digestive tract should be examined when the occult blood test is positive but there is no abnormal sign in the colorectum. Methods –In a case-control study an occult blood test was carried out on 150 subjects with gastric cancer, ISO subjects with colorectal cancer, and on 300 healthy subjects. Data were analysed from 44 996 persons attending a population screening programme who underwent both radiological gastric cancer screening (barium meal) and colorectal cancer examination by occult blood test. Results –In the case—control study the occult blood test was positive in 27/150 (18%) subjects with gastric cancer, in 112/150 (75%) subjects with colorectal cancer, and in 24/300 (8%) healthy controls. In the population screening programme the occult blood test was positive in 4/50 (8%) persons with gastric cancer and 3232/44 950 (7%) persons without gastric cancer,- indicating no difference between them. Conclusions –These data show that the immunochemical faecal occult blood test is worthless as a screening test for gastric cancer, and that examination of the upper digestive tract is unnecessary in cases where the faecal occult blood test is positive but there is no sign of colorectal disease.

Immunochemical Fecal Occult Blood Test Is Not Suitable for Diagnosis of Hemorrhoids

PURPOSE This study was conducted to clarify the diagnostic value of an immunochemical fecal occult blood test for hemorrhoids. PATIENTS AND METHODS In a case-control study, an immunochemical fecal occult blood test with a 2-day method was carried out on 82 subjects with hemorrhoids, on 82 subjects with colorectal cancer, and on 82 healthy subjects. In a population-based cross-sectional study, 29,714 subjects who received an immunochemical occult blood screening with a 2-day method were divided into two groups, according to the results of a questionnaire on hemorrhoids, and the positivity rate of an immunochemical test as well as the predictive value for colorectal cancer were compared in the two groups. Moreover, both an immunochemical occult blood test with a 2-day method and colonoscopy were conducted at the same time on asymptomatic subjects during a medical checkup. RESULTS In the case-control study, the test was positive in 13.4% subjects with hemorrhoids, in 84.1% subjects with colorectal cancer, and in 4.9% healthy subjects, respectively, showing a significant difference in the detection rate between the two diseases (P < 0.001). In the population screening program, the test was positive in 6.9% subjects with hemorrhoids and in 6.5% subjects without hemorrhoids, and the predictive value was 3.2% in subjects with and without hemorrhoids, respectively, indicating no significant difference in the positivity rate as well as the predictive value between the two groups. Among 232 subjects in a medical checkup, 28 patients with hemorrhoids and 21 patients with colorectal polyp 1 cm or larger were diagnosed by colonoscopy, and the occult blood test was positive in 16.7% patients with hemorrhoids and in 52.4% patients with colorectal polyp, respectively. There was a significant difference in the sensitivity between the two disease groups (P < 0.05). CONCLUSIONS These findings indicate that the immunochemical fecal occult blood is unsuitable for the diagnosis of the patients with hemorrhoids and an examination of the colorectum is necessary in cases where the occult blood test is positive but there is a sign of hemorrhoids.

Detection rate of immunochemical fecal occult blood test for colorectal adenomatous polyps with severe dysplasia.

This study was conducted to assess the accuracy of an immunochemical occult blood test for detecting colorectal adenomas with severe dysplasia, and to determine the relationship between the grading of adenomatous dysplasia and the results of this test. Sixteen colorectal adenomas under 1cm with severe dysplasia, 65 adenomas 1 cm or larger with severe dysplasia, 65 adenomas under 1 cm with mild-to-moderate dysplasia, 65 adenomas 1 cm or larger with mild-to-moderate dysplasia, 65 colorectal cancers and 130 healthy controls were investigated. Each subject was tested with an immunochemical fecal occult blood test on 3 consecutive days, and the accuracy of the test was evaluated. The detection rate of this test was 13% for severe dysplasia under 1 cm 45% for severe dysplasia 1cm or more, 17% for mild-to-moderate dysplasia under 1 cm, 40% for mild-to-moderate dysplasia 1 cm or more, and 89% for colorectal cancers, and the false positive rate was 5%, showing a significant difference in the detection rate between severe dysplasias 1 cm or more and those under 1 cm (P<0.05) as well as a significant difference between severe dysplasias 1cm or more and mild-to-moderate dysplasia under 1 cm (P<0.01), and between cancers and adenomas (P<0.001), whereas there was no significant difference between the detection rates for severe dysplasia 1 cm or more and mild-to-moderate dysplasia 1 cm or more. These results indicate that there is no association between the detection rate of this immunochemical occult blood test for adenomas and the grade of adenomatous dysplasia.

Relationship between fecal sampling times and sensitivity and specificity of immunochemical fecal occult blood tests for colorectal cancer

PURPOSE: The present study was conducted to assess the accuracy of three testing methods using an immunochemical fecal occult blood test based on the number of samples as the optimum means for screening of colorectal cancer. METHOD: One hundred eighty-four patients with colorectal cancer and 368 healthy controls served as the subjects for this study. Each subject was tested by an immunochemical fecal occult blood test for three consecutive days. For evaluation of the most desirable number of sampling times, we used the results of the first day for the one-day method, results of the first and second days for the two-day method, and results of three consecutive days for the three-day method. Sensitivities and specificities of the three testing methods were evaluated. RESULTS: Sensitivities of an immunochemical fecal occult blood test were calculated as 67.9 percent for the one-day method, 88 percent for the two-day method, and 90.8 percent for the three-day method; specificity was as follows: 97.5 percent for the one-day method, 95.6 percent for the two-day method, and 92.1 percent for the three-day method. A significant difference in sensitivity was shown between the one-day and two-day and the one-day and three-day methods (P<0.01); also, a significant difference in specificity was shown between one-day and three-day and two-day and three-day methods (P<0.05). CONCLUSIONS: These results indicate that the two-day method is recommended for immunochemical fecal occult blood testing as a means of screening for colorectal cancer.

Gastric inflammatory fibroid polyp manifesting massive bleeding and marked morphological changes for a short period.

was difficult to restore the tumor into the stomach by snare wire, requiring several tries. EUS showed a homogeneous hypoechoic tumor with a distinct border in the third sonographic gastric layer. Endoscopic snare polypectomy was performed 5 days after EUS. At this time, the shape of the tumor was markedly changed compared with findings of the prior endoscopy; most of the mucosa covering the tumor had peeled off, its oval shape had become distorted, and it had reduced in size (Fig. 1d). Moreover, fresh blood was oozing from the tumor, and coffee grounds-like material adhered to its surface (Fig. 1d). The resected specimen was 4.5 2.5 cm in size. This tumor was diagnosed as an IFP according to the microscopic findings, which revealed proliferation of fibroblasts and collagen fibers with infiltration of mononuclear cells and eosinophils (Fig. 2). Since endoscopic polypectomy, no further symptoms of anemia or tarry stools have occurred in this patient. In this case, the tumor was observed prolapsing to the duodenal bulb. This tumor was quite large; possibly, the tumor was incarcerated in the duodenal bulb in association with strangulation by the pyloric ring at the time of prolapse. This process could cause necrosis and depletion of the tumor surface mucosa, which resulted in the marked morphological changes observed in our case. Although prolapse to the duodenal bulb has sometimes been reported in gastric IFP,1 prolapse was reversible in all previous cases, and no previous report has described morphological changes resembling those seen in our case.

Characteristics of colorectal cancer with false negative result on immunochemical faecal occult blood test.

Objectives –A comparative study was carried out to clarify the clinicopathological features of colorectal cancer diagnosed after a false negative result on the immunochemical faecal occult blood test. Methods –236 patients with colorectal cancer were studied: 48 patients with negative results and 188 patients with positive results with the faecal occult blood test. The two groups were compared according to their age and sex and by the site, size, macroscopic type, Dukess classification, and histological type of their cancer lesions. Additionally, the above factors were investigated prospectively and compared in 40 cases of colorectal cancer cases diagnosed as false negative and in matched cases diagnosed as true positive in cancer screening by the immunochemical faecal occult blood test. Results –In both the hospital based case-control study and the screening programme based nested case—control study the prevalence of rectal cancers was higher in the false negative group than in the true positive group (P = 0.02, P = 0.03), but there were no differences between the two groups for any other factors. Conclusion –These results suggest that the immunochemical faecal occult blood test is unsuitable for the diagnosis of rectal cancer.

EVALUATION OF COLONOSCOPIC FINDINGS IN PATIENTS WITH DIARRHEAGENIC ESCHERICHIA COLI-INDUCED HEMORRHAGIC COLITIS

Background:  We evaluated the clinical significance of colonoscopic findings in the acute infectious phase of diarrheagenic Escherichia coli (E. coli)‐induced hemorrhagic colitis.

Autoimmune Hepatitis Associated with Immune Thrombocytopenic Purpura

Although autoimmune hepatitis (AIH) is frequently complicated with chronic thyroiditis or other autoimmune disorders, reports on its association with immune thrombocytopenic purpura (ITP) are scarce. We herein describe a case of AIH associated with ITP. A 75-year-old Japanese woman was admitted to our hospital due to increased aminotransferase levels and severe thrombocytopenia. Elevated serum immunoglobulin G (IgG) was detected, and tests for platelet-associated IgG and anti-nuclear antibody were positive. Following the diagnosis of AIH-associated ITP, prednisolone treatment of 0.6 mg/kg/day resulted in a decrease in the aminotransferase levels and an increased platelet count.