Yatsugi Noda

Utility and limitations of a method for detecting Helicobacter pylori-specific antigens in the stool

Background: Recently, a method for detecting Helicobacter pylori-specific antigens in the stool (HpSA) has been proposed to be useful clinically. The aim of this study was to determine the accuracy of HpSA for the diagnosis of H. pylori infection, including early assessment after eradication treatment, and the potential for quantitative evaluation of H. pylori in the stomach. Methods: The subjects were 85 patients with gastroduodenal disorders who underwent endoscopic examination. Of these, 36 were treated for eradication of H. pylori infection and reassessed 4–8 weeks after treatment. HpSA was tested by enzyme immunoassay. For the definitive diagnosis of H. pylori infection, biopsy specimens were taken endoscopically and examined by quantitative culture, rapid urease test, and immunohistostaining. In addition, serum antibody against H. pylori was tested before the eradication treatment and a 13C-urea breath test was conducted after treatment. The results of these reference tests were compared with those obtained by HpSA. Results: The sensitivity and specificity of HpSA were 90.4% and 100% before eradication treatment and 57.1% and 100% after the treatment. There was a positive correlation between the optical density of HpSA and the number of H. pylori bacilli evaluated by quantitative culture. Conclusions: The HpSA test is considered to be an accurate method for the diagnosis of H. pylori infection, with high specificity. However, there may be problems of false negativity if HpSA is used for the early assessment of treatment efficacy. Furthermore, HpSA is suggested to have potential for the quantitative evaluation of H. pylori status in the stomach.

Gastric adenocarcinoma of fundic gland type: Five cases treated with endoscopic resection

Recently, a new disease entity termed gastric adenocarcinoma of fundic gland type (GA-FG) was proposed. We treated five cases of GA-FG with endoscopic submucosal dissection. All tumors were small and located in the upper third of the stomach. Four tumors were macroscopically identified as 0-IIa and one was identified as 0-IIb. Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder. All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion. Lymphatic invasion was seen only in one case, while no venous invasion was recognized. All tumors were positive for pepsinogen-I  and MUC6 by immunohistochemistry. None showed p53 overexpression, and the labeling index of Ki-67 was low in all cases. All cases have been free from recurrence or metastasis. Herein, we discussed the clinicopathological features of GA-FG in comparison with past reports.

Novel diagnostic method of testing for Helicobacter pylori infection using the rapid leukocyte strip test, Leukostix

Background and Aim:  A characteristic of gastric mucosa infected with Helicobacter pylori is infiltration of inflammatory cells, mainly consisting of neutrophils. The present study aimed to detect neutrophils in homogenates of biopsied gastric mucosa semiquantitatively using the rapid leukocyte strip test, Leukostix. The authors then investigated the association of these results with H. pylori status.

Effect of exogenous mouse interferon on murine fulminant hepatitis induced by mouse hepatitis virus type 2

We investigated the effect of exogenous mouse α-+β-interferon produced by mouse L cells on the growth of mouse hepatitis virus type 2 (MHV-2) in the liver, the development of liver cell necrosis, and survival in murine fulminant hepatitis induced by MHV-2. Murine fulminant hepatitis was induced in 4-week-old male ICR mice by intraperitoneal inoculation of MHV-2. Mouse interferon (103 IU/mouse/day) was intraperitoneally injected every day. Exogenous mouse interferon suppressed both the growth of MHV-2 in the liver tissue and development of liver cell necrosis, and prolonged the survival. It was also found that the earlier mouse interferon was administered, the greater was the prolongation of survival.

Endoscopic metallic stenting by double‐balloon enteroscopy and its overtube for malignant gastrointestinal obstruction as palliative treatment

1 Kuwatani M, Kawakami H, Sakamoto N. Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography: Is this beneficial for all patients? Dig. Endosc. 2013; 25: 205. 2 Muraki T, Arakura N, Kodama R et al. Comparison of carbon dioxide and air insufflation use by non-expert endoscopists during endoscopic retrograde cholangiopancreatography. Dig. Endosc. 2013; 25: 189–96. 3 Uraoka T, Kato J, Kuriyama M et al. CO2 insufflation for potentially difficult colonoscopies: Efficacy when used by less experienced colonoscopists. World J. Gastroenterol. 2009; 15: 5186–92.

A Case of Acute Gastric Anisakiasis Presenting with Malignant Tumor-like Features: A Large Gastric Vanishing Tumor Accompanied by Local Lymph Node Swelling

Here we present a case of acute gastric anisakiasis with rare manifestations such as vanishing gastric tumor and accompanying local lymph node swelling. This report offers some important clues for considering the immunopathological features of gastric infection by Anisakis.

Rhabdomyolysis following Status asthmaticus

A case of rhabdomyolysis following an asthmatic attack is reported. A 71-year-old man was admitted because of wheezing and hypoxemia. Brown urine was present on admission. Although these symptoms completely disappeared with the treatment with aminophylline, salbutamol and corticosteroid, transiently elevated serum creatine phosphokinase and myoglobinuria were present. Rhabdomyolysis has rarely been reported in cases of bronchial asthma. This case represents an extremely rare case of rhabdomyolysis following status asthmaticus.

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type): A review of endoscopic and clinicopathological features

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type, GA-FG-CCP) is a rare variant of well-differentiated adenocarcinoma, and has been proposed to be a novel disease entity. GA-FG-CCP originates from the gastric mucosa of the fundic gland region without chronic gastritis or intestinal metaplasia. The majority of GA-FG-CCPs exhibit either a submucosal tumor-like superficial elevated shape or a flat shape on macroscopic examination. Narrow-band imaging with endoscopic magnification may reveal a regular or an irregular microvascular pattern, depending on the degree of tumor exposure to the mucosal surface. Pathological analysis of GA-FG-CCPs is characterized by a high frequency of submucosal invasion, rare occurrences of lymphatic and venous invasion, and low-grade malignancy. Detection of diffuse positivity for pepsinogen-I by immunohistochemistry is specific for GA-FG-CCP. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP. Nearly all GA-FG-CCPs are treated by endoscopic resection due to their small tumor size and low risk of recurrence or metastasis.

Activation of Tubuloglomerular Feedback in Rat Nephrons by Sera from Rabbits with Fulminant Hepatic Failure

Experiments were designed to determine whether substance(s) other than electrolytes might activate tubuloglomerular feedback in experimental fulminant hepatic failure. Severe hepatic damage and renal dysfunction were induced by intravenous administration of D-galactosamine. Sera from normal or D-galactosamine-treated rabbits were dialyzed against glucose solution to reduce electrolyte concentrations. Tubuloglomerular feedback response was evaluated in rat nephrons by measuring the early proximal flow rate (EPFR) during orthograde perfusion of the loop of Henle. EPFR was reduced by 28 and 48% with Ringers solution and sera from D-galactosamine-treated rabbits, respectively, but was not altered by normal sera. Substance(s) other than electrolytes in the sera from D-galactosamine-treated rabbits might activate the tubuloglomerular feedback to reduce glomerular filtration.

Treatment patterns and outcomes of unresectable pancreatic cancer patients in real-life practice: a region-wide analysis

Background FOLFIRINOX (FFX) and gemcitabine (GEM) plus nab-paclitaxel (GnP) have recently been available for treating pancreatic ductal adenocarcinoma (PDAC). We investigated trends in characteristics, treatment and outcomes of unselected patients with unresectable PDAC in real-life practice in Japan. Methods We retrospectively reviewed the medical records of 1085 patients diagnosed as having unresectable or recurrent PDAC in multiple centers in the Hokuriku area between January 2009 and July 2015. Results The incidence of pathologically proven PDAC had increased from 18.7% in 2009 to 56.2% in 2015. Oncological therapy was administered to 779 patients (71.8%): chemotherapy (n = 675), chemo-radiotherapy (n = 92) or radiotherapy (n = 12); the remaining patients were treated with best supportive care. Of 100 patients diagnosed in 2009, 62.0% received GEM as first-line chemotherapy; whereas 30.7% of the 75 patients diagnosed in 2015 received FFX, 25.3% GnP, 22.7% GEM and 17.3% S-1. The objective response rates of patients treated with FFX, GnP and GEM were 14.9%, 35.0% and 5.5%, respectively and the OS 10.3, 9.9 and 7.5 months after FFX, GnP and GEM, respectively. Grade 3 or greater any hematological toxicity occurred in 70.2%, 70.0% and 18.8% of the patients treated with FFX, GnP and GEM, respectively. The reasons for treatment discontinuation were adverse events in 9.8%, 26.7% and 24.1% of the patients treated with FFX, GnP and GEM, respectively. Conclusion Chemotherapeutic protocols changed dramatically between 2009 and 2015. Continuous collection and analysis for our cohort with longer follow-up provides useful information about treatment selection and prediction of outcome.