Kunihiko Murase

Previous inflammation alters the response of the rat colon to stress

BACKGROUND & AIMSnPatients with inflammatory bowel disease have symptoms of irritable bowel syndrome (IBS) with a higher than expected prevalence. Stress is an important factor in the pathogenesis of IBS. Thus, previous inflammation may predispose to IBS by rendering the bowel more susceptible to the impact of stress. The aim of this study was to examine the effect of previous colitis on stress-induced responses in rats.nnnMETHODSnAcute colitis was induced in rats by intrarectal administration of trinitrobenzene sulfonic acid (TNBS), and the rats were allowed to recover for 6 weeks before application of mild restraint stress for 3 consecutive days. In vitro measurements included myeloperoxidase activity, plasma corticosterone levels, interleukin 1 beta messenger RNA expression, and [3H]noradrenaline release from the myenteric plexus.nnnRESULTSnSix weeks after administration of TNBS, stress caused a significant increase in myeloperoxidase activity in TNBS-treated rats but not in stressed controls; plasma corticosterone responses were similar. Stress also caused an exaggerated and significant suppression of [3H]noradrenaline release in TNBS-treated stressed rats compared with stressed controls. This was accompanied by a significant decrease in interleukin 1 beta messenger RNA expression in the colon.nnnCONCLUSIONSnPrevious colitis rendered the colon more susceptible to effects of stress on enteric nerve function and also increased some parameters of inflammation in response to stress.

A case of haemorrhagic radiation proctitis: successful treatment with argon plasma coagulation

Argon plasma coagulation (APC) has been used extensively for a wide range of indications in gastrointestinal endoscopy. We describe a case of haemorrhagic radiation proctitis treated successfully with APC. A 54-year-old Japanese woman presented with daily rectal bleeding 4 months after cessation of radiotherapy for uterine cancer. Colonoscopic examination showed friable bleeding teleangiectasias in the rectum. Her haemoglobin level was decreased to 5.4 g/dl, requiring frequent blood transfusions. Endoscopic APC set at 1.2 l/min and 45 W was applied. After four treatment sessions without any complications, the patient showed complete resolution of haematochezia and subsequent haematological improvement. Standard and magnifying endoscopic follow-up revealed complete eradication of the vascular lesions and cicatrization of the treated areas, and mucosal covering with normal crypt lining. Endoscopic APC is an effective and well-tolerated treatment modality for the management of haemorrhagic proctitis.

Five minute endoscopic urea breath test with 25 mg of 13C-urea in the management of Helicobacter pylori infection

Objective The endoscopic 13C-urea breath test (13C-EUBT), which combines the urea breath test (UBT) with endoscopy, provides high accuracy for the detection of Helicobacter pylori. This study was conducted to determine whether the 13C-EUBT using low doses of urea and short sampling times could preserve accuracy in the management of H. pylori infection. Methods Three hundred and twenty-five patients were randomized to receive the EUBT with 100, 50 or 25 mg of 13C-urea by endoscopic spraying. The breath samples collected at 5, 10 and 20 min were analysed using an isotope selected non-dispersive infrared spectrometer. H. pylori infection was assessed by the rapid urease test and histology. In each sampling schedule and protocol, cut-off values were calculated by a receiver operating characteristic curve. We applied the EUBT with 25 mg of 13C-urea at 5 min to the assessment of H. pylori eradication in 135 patients who had received the antimicrobial treatment or to the detection of the organism in 61 patients with previous partial gastrectomy. Results Based on histology and the urease test, patients who had discordant results were excluded from the analysis. Using 100 mg of urea, the sensitivity and specificity of the test were both 100% at 10 and 20 min, and the sensitivity and specificity at 5 min were best with 98.6% and 100%, respectively. With 50 mg, they were both 100% at 20 min, and the best combination of sensitivity and specificity at 5 and 10 min was 97.3–96.6% and 97.3–100%, respectively. Even with 25 mg, the sensitivity and specificity were both 100.0% at 20 min, and at the 5 min and 10 min time point, the EUBT yielded a sensitivity of 98.7% and a specificity of 100%. There was a significant positive correlation between the test values of the 5 min 13C-EUBT with 25 mg of test urea and those of the conventional UBT. The 5 min EUBT with 13C-urea offered high accuracy in the assessment of H. pylori eradication, with the sensitivity and specificity being 100% and 96.4%, respectively. In patients with previous gastrectomy, the EUBT provided acceptable accuracy (a sensitivity of 96.4% and a specificity of 97.0%). Conclusions Our results indicate that the 13C-EUBT is an accurate method for detecting H. pylori infection. The EUBT using only 25 mg of 13C-urea at the early (5 min) time point has satisfactory diagnostic efficacy in pre- and post-eradication treatment settings, providing a less expensive and more rapid way of performing the test. The EUBT may be a reliable method of assessing H. pylori status in the remnant stomach.

Two cases of adult T-cell leukaemia/lymphoma with oesophageal involvement

We describe two cases of adult T-cell leukaemia/lymphoma (ATLL) with oesophageal involvement. The first case, a 51-year-old Japanese woman with an acute subtype of ATLL, had an irregular ulcerative lesion in the distal oesophagus. The second case, a 76-year-old Japanese man with a lymphoma subtype of ATLL, had a polypoid lesion in the middle portion of the oesophagus. Both cases had gastric involvement. Biopsies from these lesions revealed mucosal invasion of ATLL cells in each case. Combination chemotherapy was ineffective in both cases. Prospective and careful examination of additional cases may eventually provide specific advice for treatment of this unusual condition.

Exercise-Induced Pulmonary Edema in a Triathlon

Introduction. Family physicians have more opportunities to attend athletic competitions as medical staff at first-aid centers because of the increasing popularity of endurance sports. Case. A 38-year-old man who participated in a triathlon race experienced difficulty in breathing after swimming and was moved to a first-aid center. His initial oxygen saturation was 82% and a thoracic computed tomography scan showed bilateral ground glass opacity in the peripheral lungs. His diagnosis was noncardiogenic pulmonary edema associated with exercise or swimming: exercise-induced pulmonary edema (EIPE) or swimming-induced pulmonary edema (SIPE). Treatment with furosemide and corticosteroid relieved his symptoms of pulmonary edema. Discussion. Noncardiogenic pulmonary edema associated with endurance sports is not common, but knowledge about EIPE/SIPE or neurogenic pulmonary edema associated with hyponatremia, which is called Ayus-Arieff syndrome, is crucial. Knowledge and caution for possible risk factors, such as exposure to cold water or overhydration, are essential for both medical staff and endurance athletes. Conclusion. To determine the presence of pulmonary edema associated with strenuous exercise, oxygen saturation should be used as a screening tool at a first-aid center. To avoid risks for EIPE/SIPE, knowledge about these diseases is essential for medical staff and for athletes who perform extreme exercise.

Two cases of adult T-cell leukemia/lymphoma involving the terminal ileum.

We describe two cases of adult T-cell leukemia/lymphoma (ATLL) with terminal ileal involvement. The first case, a 71-year-old man with lymphoma subtype of ATLL, had a polypoid lesion in the terminal ileum, in addition to a duodenal mass. The second case, a 58-year-old woman with lymphoma subtype of ATLL, had an irregular ulcerative lesion in the terminal ileum and multiple ulcers throughout the stomach. Biopsies from these lesions revealed mucosal invasion of ATLL cells in each case. In the second case, combination chemotherapy was transiently effective, resulting in the disappearance of gastric and terminal ileal lesions. Prospective and careful examination of additional cases should further characterize the clinicopathological features of terminal ileal involvement in ATLL.

Eosinophilia, a marker of asymptomatic Strongyloides infection, in a young patient with extrapulmonary tuberculosis

Strongyloides stercoralis infection is a common and neglected public health problem in many areas of the world. Here we report the case of a 21-year-old woman who emigrated from Cambodia to Japan and presented with swelling of the right supraclavicular region of 2 months’ duration. She had no other symptoms. Tuberculous lymphadenitis was diagnosed based on a fine-needle aspiration biopsy of the right supraclavicular lymph node. The laboratory examination revealed mild eosinophilia (eosinophils 1348/µL). S. stercoralis and Hymenolepis nana were detected serologically and in faeces examination. This case demonstrates that clinicians should search for S. stercoralis infection in patients with tuberculosis who have epidemiological risk factors and/or laboratory signs of eosinophilia, even if other symptoms and signs of helminths infection are less obvious.

Association between adult short stature and cerebral microbleeds

Dear editor, Cerebral microbleeds (CMBs) are frequently detected on T2*-weighted magnetic resonance imaging in patients with stroke and are also predictive of future stroke. We hypothesized that a short stature is a risk factor for CMBs because height and the risk of stroke are inversely associated. To determine the association between height and CMBs, we carried out a cross-sectional study on Japanese adult subjects in a general hospital on Goto Island. All brain magnetic resonance images using a T2*-weighted gradient-recalled echo sequence between 26 November 2012 and 30 June 2014 were collected. We excluded subjects with use of osteoporosis medication and maintenance hemodialysis. CMBs were defined as being 10mm in diameter, and the location of CMBs was recorded and categorized into three groups: lobaronly distribution, deep-only distribution, and any CMBs according to a previous report. Subjects were divided into tertiles according to height, and the shortest height tertile was treated as a reference group. A total of 219 of 911 subjects had any CMBs, 76 had lobar-only distribution, and 71 had deep-only distribution. In logistic regression analysis, the tallest stature compared with the shortest stature was significantly associated with any CMBs (odds ratio 0.36, 95% confidence interval 0.24–0.53) and lobar-only CMBs (0.22, 0.11–0.44) but not deep-only CMBs (0.55, 0.30–1.00). These associations of any and lobar-only CMBs remained significant after further adjustments for age, sex, past history of stroke, antiplatelet/anticoagulant medication use, hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation (0.63, 0.40–1.00; 0.33, 0.15–0.70, respectively). The results of these analyses were consistent after we excluded subjects with acute cerebrovascular events or dementia. This study showed a significant inverse association between height and the risk of CMBs in the Japanese population. This association is particularly evident among CMBs with a strictly lobar distribution. Declaration of conflicting interests