Shiann Pan

Histological Maturity of Healed Duodenal Ulcers and Ulcer Recurrence After Treatment With Colloidal Bismuth Subcitrate or Cimetidine

The relationship between histological maturity of healed duodenal ulcers and ulcer recurrence after 6 weeks of treatment with colloidal bismuth subcitrate or cimetidine was investigated. There was no significant difference in healing rates between colloidal bismuth subcitrate- and cimetidine-treated patients (85.7% and 71.8%, respectively; P greater than 0.05). Histologically, the regenerating mucosa of healed ulcers was divided into three categories--good, fair, and poor--according to pattern. Sixty percent of healed colloidal bismuth subcitrate-treated and 30.9% of healed cimetidine-treated ulcers had a good pattern; the difference was statistically significant (P = 0.027). The difference in recurrence rates between healed colloidal bismuth subcitrate-treated and healed cimetidine-treated patients was statistically significant at 3 months (3.45% and 20%, respectively; P = 0.044). All recurrent ulcers in both groups had fair or poor patterns of regenerating mucosa. It was concluded that the greater histological maturity of the regenerating mucosa may contribute to the lower recurrence rate in colloidal bismuth subcitrate-treated patients than in cimetidine-treated patients.

Acrokeratosis paraneoplastica (Bazex syndrome) with adenocarcinoma of the colon: report of a case and review of the literature

Abstract: Acrokeratosis paraneoplastica is a rare disease and is uncommon even in patients with upper aerodigestive tract cancer. We report a 63-year-old man with a 1-month history of numerous pruritic lesions and vesicles on both feet. Although he had received local therapy, progressive dense scale formation involving both palms and both soles was found. Colonoscopy was performed because of hematochezia, and it revealed an early colon cancer. After the resection of the cancer, the skin lesions began to fall off dramatically. To the best of our knowledge, there is no report of acrokeratosis paraneoplastica associated with colon cancer in the literature. This is the first case report of acrokeratosis paraneoplastica associated with early colon cancer.

Rapid resolution of liver metastasis from cholangiocarcinoma after bevacizumab with cisplatin and high-dose fluorouracil plus leucovorin.

Accessible online at: www.karger.com/onk Fax +49 761 4 52 07 14 E-mail Information@Karger.de www.karger.com therapy in a patient with liver metastasis from cholangiocarcinoma and achieved a rapid response. The 63-year-old man was first diagnosed with cholangiocarcinoma with liver metastasis in May 2005. All tumors were surgically removed. However, 3 months later, he was readmitted to our hospital due to recurrent liver metastasis discovered by abdominal computed tomography (CT) and ultrasound examination (fig. 1, 2). At that time, the tumor markers CEA and CA19–9 were Dear editors, Bevacizumab has previously been used in the treatment of metastatic colorectal cancer as a first-line salvage treatment, achieving good response rates [1, 2]. Nonetheless, so far, little research has been carried out concerning its use in other types of cancer. We used bevacizumab with cisplatin and high-dose fluorouracil plus leucovorin (deGramond regimen) as salvage Rapid Resolution of Liver Metastasis from Cholangiocarcinoma after Bevacizumab with Cisplatin and High-Dose Fluorouracil plus Leucovorin

Investigation of the extent of gastric metaplasia in the duodenal bulb by using methylene blue staining

Background and Aims: The existence of gastric metaplasia (GM) of the duodenal mucosa has been considered to be highly related to the recurrence of duodenal ulcers (DU). The aims of this study are to evaluate the usefulness of methylene blue staining in the detection of GM, and to clarify the relationship between GM and the deformity of the duodenal bulb.

Large Early Gastric Cancers Treated by Endoscopic Submucosal Dissection with an Insulation-tipped Diathermic Knife

It is difficult to remove a large early gastric cancer (> or = 3 cm) in one-piece resection using conventional endoscopic mucosal resection. We tried to use an insulation-tipped (IT) diathermic knife to dissect these lesions. IT-endoscopic submucosal dissection (ESD) was performed in four aging patients with gastric malignancy. All lesions could be removed in one-piece resection by IT-ESD, although three of them exhibited remarkable fibrosis and ulceration. Three cases experienced curative treatment with IT-ESD after the pathologic evaluation, but it was not curative in one case because the pathology showed angiolymphatic invasion. This patient refused additional surgery in consideration of existing major systemic diseases. At 3 months to 1 year of follow-up, endoscopy showed no evidence of residual cancer. IT-ESD is effective in the treatment of large early gastric cancer and is an alternative treatment for early gastric cancer patients who are at risk for major operation.

Case report: Spontaneous isolated mesenteric fibromatosis presenting as megaduodenum

A case of spontaneous isolated mesenteric fibromatosis presenting as megaduodenum is reported. The lesion was small, only 2 cm in its greatest diameter. However, because of its location near the ligament of Treitz and because of its characteristic infiltrative growth pattern, the tumour involved the distal duodenum and resulted in acute angulation and obstruction early in its course. We successfully resected the mass and the patient is in fair physical condition 6 months after operation.

Gastric metaplasia of regenerating duodenal mucosa and deformity of duodenal bulb: A correlative study

The correlation between the presence and degree of gastric metaplasia of regenerating duodenal mucosa and the deformity of duodenal bulb was studied. Based on the endoscopically morphological patterns of bulb, the duodenal ulcers were divided into three types: type I, with a normal‐shaped bulb; type II, with a mildly deformed bulb; and type III, with a markedly deformed bulb. A total of 159 patients with active duodenal ulcers were scheduled to be treated with H2‐receptor antagonists. Of these patients, 124 proved to have a healed duodenal ulcer 4 weeks after initial treatment upon follow‐up endoscopic examinations. Two biopsies were taken from the centre of the ulcer scar when the ulcer was found to be healed for light microscopic study. Histologically, the degree of gastric metaplasia was divided into three grades: grades 0, 1 and 2. The results show that a healed duodenal ulcer with a normal‐shaped bulb is not frequently accompanied by gastric metaplasia. However, a healed ulcer with a markedly deformed bulb has a high incidence and degree of gastric metaplasia, which may be easily colonized by Helicobacter pylori and thus develop an environment of easy recurrence. Therefore, a cycle of healing and recurrence may exist in patients with a duodenal ulcer and a markedly deformed bulb. Eradication of H. pylori may be the best way to break this cycle.

Early colonic carcinoma with extensive lymph node metastases: Case report and review of literature

Abstract. An 81-year-old woman had an early carcinoma invading focally into the upper submucosa of the middle-transverse colon, which was accompanied by extensive lymph node metastases and resulted in a poor prognosis. Although her tumor was small and flat, a rim of pale yellow-speckled mucosa adjacent to the tumor enabled its earlier detection. To further study the exceptional lymph node metastases we studied the expression of intestinal trefoil factor and sialyl Tn antigen immunohistochemically on the resected specimen. Their simultaneous expression in lymph node metastasis further supports the aggressive nature of this tumor.

Development of multifocal duodenal erosions after anti-Helicobacter pylori triple therapy.

BACKGROUND AND PURPOSE Anti-Helicobacter pylori triple therapy is effective for healing duodenal ulcer (DU) diseases and reducing disease recurrence. However, multifocal duodenal erosions or shallow ulcers may develop after triple therapy. The purpose of this study was to investigate the incidence and outcome of duodenal erosions that developed after triple therapy. METHODS A total of 106 Taiwanese with active DU and with H. pylori infection were enrolled in this study. All patients received anti-H. pylori triple therapy (i.e., 2 weeks of antimicrobial agents combined with treatment for 4 to 6 weeks with acid suppression agents). Follow-up endoscopy was performed immediately after stopping treatment. The incidence of multifocal erosions or shallow ulcers over the bulb and/or second portion of the duodenum was studied. Additional acid suppression agent was given for 4 weeks whenever duodenal erosions or shallow ulcers were found. RESULTS Out of 106 patients, 11 (10.4%) were found to have multifocal duodenal erosions and/or shallow ulcers on the duodenal bulb and/or second portion of the duodenum at the end of treatment. Ten of the 11 patients with newly developed erosions had healed DU in the S1 or S2 stage, and all 11 had successful H. pylori eradication. The duodenal erosions and/or shallow ulcers of these 11 patients were healed after an additional 4 weeks of histamine-2-receptor antagonist therapy. CONCLUSIONS Multifocal duodenal erosions and/or shallow ulcers were noted in around 10% of Taiwanese DU patients who received anti-H. pylori triple therapy. An additional 4 weeks therapy with acid suppression agents healed these lesions.

Regression of Multiple Liver Adenomas after Withdrawal of Oral Contraceptives in a Hepatitis C Virus Carrier

We report on a case of multiple liver adenomas in a hepatitis C virus (HCV) carrier. A 40-year-old woman was asymptomatic and has been taking oral contraceptives continuously for 15 years. Abdominal ultrasonography revealed multiple iso-and hypoechoic tumors in both lobes of the liver. Enhanced computed tomography (CT) and magnetic resonance imaging demonstrated multiple hypervascular tumors in the lives; with the biggest one at segment Ⅳ, which measured 7cm in diameter. Cellar angiography revealed multiple hyervascular tumor staining of varying sizes in the liver. Histologically, the tumor showed features typical of a liver cell adenoma with no evidence of malignant transformation. These tumors progressively decreased in size and number after the patient discontinued the use of oral contraceptives. Eighteen months after the initial diagnosis, these tumors had almost completely disappeared on follow-up abdominal ultrasonography. We suggest that in an asymptomatic patient with contraceptives-related multiple liver adenomas, discontinuing the use of oral contraceptives is one of the choices of treatment, and close follow-up by ultrasonography or CT is mandatory.