Background; Several studies have identified a positive, independent association between uric acid and atherosclerosis whereas uric acid was once considered to be a major antioxidant in human plasma with possible beneficial anti-atherosclerotic effects. Several other studies have found an inverse association between height and stroke, while a previous study of ours detected a positive association between height and hyperuricemia. However, even though uric acid levels may be strongly affected by alcohol consumption and serum creatinine, no published study has examined the possible associations between hyperuricemia and carotid atherosclerosis while taking both height and drinking status into account. 　Methods; We conducted a cross-sectional study of 1,337 men aged 30-89 years undergoing a general health check-up to investigate the associations of hyperuricemia and carotid atherosclerosis with height in relation to drinking status. 　Results; Of the total study population, 312 men were diagnosed with carotid atherosclerosis (carotid intima-media thickness (CIMT) ≥ 1.1 mm) and 365 men with hyperuricemia (serum uric acid > 7.0mg/dL). For shorter non-drinkers, a significantly positive association between these two abnormalities was detected, which was independent of classical cardiovascular risk factors except for serum creatinine. However, this association ceased to exist after further adjustment for serum creatinine. However, while the age-adjusted model showed no significant association for taller drinkers, adjustment for serum creatinine produced a significantly inverse association. 　Conclusion;Our study established that hyperuricemia is associated with carotid atherosclerosis for Japanese men, while body height, drinking status and serum creatinine are important determining factors for this association.

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　Background; The CD44 and CD133 expressions have been identified to be putative cancer stem cell (CSC) markers. Some reports have revealed a correlation between these CSC markers and a poor prognosis in the clinical setting. However, clinical impact of combined use of these markers has not been determinated in advanced gastric cancer. 　Methods; Specimens were obtained from 73 patients with gastric cancer with invasion beyond the muscularis (T3/4a) who underwent curative gastrectomy. Immunohistochemically, tumors with more than 5% CD44-positive cells or at least one CD133- positive cancer cell were regard as being CSC marker-positive. 　Results; Forty patients were CSC marker-positive. There were significant correlations between the CSC marker expression and the extent of lymphatic (p=0.04) and vessel invasion (p < 0.001). The CSC marker-positive patients exhibited poor prognoses in both the overall (p=0.006) and disease-free survival analyses (p=0.019). Based on the results of the univariate analysis, the peritoneal CEA value, the extent of lymph node metastasis and CSC marker positivity were analyzed in the multivariate analysis. The results revealed that the extent of lymph node metastasis (p < 0.001) and CSC marker positivity (p=0.04) were significant risk factors. 　Conclusion; CSC marker positivity is an independent prognostic factor in patients with T3/4a gastric cancer.

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Although our previous study found that diabetes combined with a high serum triglycerides to high-density lipoprotein cholesterol (TG-HDL) ratio constitutes a risk for atherosclerosis and chronic kidney disease (CKD), the association, in terms of TG-HDL ratio, between diabetes and white blood cell (WBC) count, which is an independent risk factor for atherosclerosis, has not been clarified. To investigate this association, we conducted a cross-sectional study of 3,998 Japanese subjects aged 30-89 years undergoing a general health check. We investigated the associations between WBC count and diabetes for all subjects, who were divided into tertiles according to TG-HDL level. Independent of classical cardiovascular risk factors, WBC count of both men and women was positively associated with diabetes combined with high but not with low TG-HDL. The multivariable odds ratios (ORs) and 95% confidence intervals (95%CIs) of 1SD (standard deviation) increment in WBC count (1,538/μL for men, 1,382/μL for women) for high TG-HDL diabetes and low TG-HDL diabetes were 1.39 (95%CI: 1.04-1.85) and 0.88 (95%CI: 0.66-1.19) for men, and 1.83 (95%CI: 1.45-2.33) and 0.91 (95%CI: 0.64-1.29) for women, respectively. In conclusion, for both men and women, WBC count is associated with high TG-HDL diabetes but not with low TG-HDL diabetes. These findings suggest that measuring WBC count is clinically relevant for estimating the risk of atherosclerosis and CKD in patients with diabetes categorized according to TG-HDL ratio.

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Case 1: A 58-year-old woman with rheumatoid arthritis (RA) suffered from pontine and cerebellar infarctions and underwent three-dimensional computed tomography angiography (3D-CTA) of the vertebral artery (VA) with left-sided rotation of the head. This revealed a destroyed right atlantoaxial (AA) joint and right VA occlusion, which had caused the infarction. No recurrent infarctions have been observed after transarticular screw fixation (Magerl technique) was performed. Case 2: A 68-yearold woman with RA also suffered from pontine and cerebellar infarctions and underwent 3D-CTA of the VA with right-sided rotation of the head. This revealed a destroyed left AA joint and left VA occlusion, which had caused the infarction. No recurrent infarctions have been observed after posterior fusion between the occiput and 3rd cervical vertebra was performed. 　In both cases of RA, who had multiple infarctions due to VA occlusion and a temporary thrombus formation, 3D-CTA in a rotated position helped to diagnose arterial occlusion. In addition, posterior fusion of the AA joint was a useful surgical technique.

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Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer, but it is not generally used for colorectal lesions because of its high risk of adverse events. An unanticipated adverse event of rectal ESD is reported. A 71-year-old man was found to have a laterally spreading tumor at the upper rectum. ESD was performed. During the ESD, rectal perforation occurred, and emergency laparoscopic surgery was performed. At the operation, rectal perforation with retroperitoneal emphysema was detected. Surprisingly, an 8-cm-long, lacerated wound was found at the cecum wall. It was thought to have been caused by heat injury due to ESD. The perforated site was resected, and the laceration of the cecum was repaired by extracorporeal suture. In patients with perforation during ESD, it is essential to keep in mind that other organs might have heat-induced injury, and the patient should be more carefully followed.

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Background: Sebaceous carcinoma (SC) is a relatively rare tumor that usually arises from the eyelid. Local extension down the nasolacrimal duct is relatively rare event for SC. 　Method: We herein report two cases of recurrent SC in the nasal cavity. Both patients had previously received primary treatment for SC of the eyelid. Seven years after the initial treatment, the first patient presented with a mass on the left medial canthus of the eyelid. Sixteen months after the initial treatment, the second patient presented with a large mass in the right nasal cavity. 　Results: The wide intraepithelial spread of SC over 30 mm from the initial surgical margin was beyond our expectations. The first patient is currently alive with local recurrence following the administration of chemoradiotherapy 46 months after treatment, while the second patient died of distant metastasis. 　Conclusion: This report focuses on the unique clinical features of intranasal recurrence of SC after treatment.

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