Objective The pathophysiological data on Barrett's esophagus are scant in Asia, so the purpose of this study was to compare and analyze the pathophysiological characteristics of Barrett's esophagus and reflux esophagitis among Chinese in Taiwan. Patients and Methods From November 2001 to January 2003, fifteen patients with Barrett's esophagus were consecutively enrolled as the Barrett's esophagus group. Fourteen patients with Los Angeles grade A/B esophagitis (mild esophagitis group) and fourteen patients with LA grade C/D esophagitis (severe esophagitis group) who were matched in age and gender with the Barrett's esophagus group were enrolled. The data of esophageal manometry and ambulatory 24-hour pH monitoring were collected. Results We found that the Barrett's esophagus group had significantly weaker lower esophageal sphincter (LES) pressure and distal esophageal body contractions (p<0.05) than the mild esophagitis group. Both the Barrett's esophagus group and severe esophagitis group had significantly higher esophageal acid reflux scores and frequency (p<0.05-0.01) compared to the mild esophagitis group. However, data on esophageal manometry and 24-hour pH monitoring in the Barrett's esophagus and severe esophagitis groups did not significantly differ. Conclusion We concluded that Barrett's esophagus had significantly stronger acid reflux, lower LES pressure, and weaker distal esophageal peristalsis compared to mild esophagitis. Barrett's esophagus and severe reflux esophagitis share common pathophysiological characteristics among Chinese in Taiwan.
Objective We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients. Methods The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as ≥50% stenosis on coronary computed tomographic angiography. Results Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), ≥50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05). Conclusion The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.
Objective Primary systemic AL amyloidosis arises from immunoglobulin light chains produced by plasma cell dyscrasia. To prospectively investigate the production of M-protein and plasma cells in bone marrow before and after chemotherapy, we performed flow cytometry and analysis of serum free light chains (FLCs). Patients and Methods Fifty-nine patients with primary systemic AL amyloidosis (mean age, 59.9±8.8 years) were enrolled in this study, and of these 31 were serially studied before and after chemotherapy. Complete hematological remission was defined as normalization of the FLC κ/λ ratio. Results MPC-1-CD45- (p<0.05) and MPC-1+CD45-CD49e- (p<0.005) were significantly higher, and MPC-1--CD45+ (p<0.05), MPC-1+CD45+CD49e- (p<0.0001) and MPC-1+CD45+CD49e+ (p<0.0005) were significantly lower in the patients with AL amyloidosis than in controls. There was a significantly positive correlation between the serum predominant FLC/serum creatinine ratio and MPC-1+CD45-CD49e- (p<0.05). After chemotherapies, such as high-dose melphalan with autologous stem cell support, 20 of 31 patients with AL amyloidosis achieved complete hematological remission. There were no significant differences in any subtype of plasma cells before treatment between the remission and non-remission groups, but in the former group MPC-1+CD45-CD49e- and MPC-1-CD45+ were significantly decreased and increased after chemotherapy compared with before, respectively. Conclusion Abnormal plasma cells in the bone marrow, particularly the MPC-1+CD45-CD49e- subset, may be important as a follow-up marker before and after chemotherapy in primary systemic AL amyloidosis. These cells maintain low levels as long as no relapse occurs.
Objective Since mild COPD can be detected in the annual health check by lung function tests, we conducted a questionnaire survey on how such examinations are used to assess chronic obstructive pulmonary disease (COPD). Methods We mailed questionnaires to 633 facilities performing comprehensive medical check-up from June to July 2005 and obtained responses from 254 (40.1%). Results At participating facilities, the proportion of full or part-time physicians specializing in respiratory diseases was low [40 of 366 full timers (10.9%) and 114 of 2,044 part-timers (5.6%)], with very few physicians certified by the Japanese Respiratory Society (6.8%). Non respiratory physicians were involved in evaluating the results of thoracic diagnostic imaging at 32 facilities. Lung function tests were carried out at 98.2% of facilities though relatively few facilities evaluated test results with COPD in mind. All stages (mild, moderate, severe) of COPD were diagnosed in patients at 85 facilities (39.2%), while only severe COPD was targeted by chest imaging at 97 facilities (44.7%), disregarding mild and moderate cases. Counseling for smoking cessation was provided at 113 facilities (20.6%), while 30 facilities (14.4%) provided no form of smoking cessation. Conclusion At most facilities performing a comprehensive medical check-up, there was not a sufficient number of respirologists to ensure early diagnosis of COPD and this may have compromised COPD diagnosis. The newly proposed Japan Society of Comprehensive Medical Check-up (Ningen-dock) Standards based on the Japanese Respiratory Society may be useful to reveal early stages of COPD.
A rare case is reported with a large foreign body in the upper gastrointestinal tract. A 19-year-old girl accidentally swallowed her toothbrush which was successfully removed via endoscopy using a polypectomy snare under topical pharyngeal anesthesia. The extracted toothbrush was 20 cm long, and it had the characteristic radiographic image.
Ventricular tachycardia originating from the right ventricular outflow tract (RVOT) is considered benign, but sometimes it causes polymorphic ventricular tachycardia and ventricular fibrillation, resulting in sudden cardiac death. A 58-year-old woman without structural heart disease was admitted for evaluation of recurrent episodes of syncope. Surface ECG showed frequent repetitive premature ventricular contraction (PVC) of RVOT origin. Polymorphic ventricular tachycardia triggered by the same PVC was documented by Holter ECG during an episode of syncope. Radiofrequency catheter ablation was performed to eradicate this PVC. No polymorphic ventricular tachycardia has developed after the procedure, and the patient has had no recurrence of syncope.
We describe the case of an 85-year-old woman in whom pericardiocentesis, prolonged bed rest and blood pressure control were performed without surgery to successfully treat an oozing-type myocardial rupture due to myocardial infarction.
We describe a 59-year-old Japanese woman with post-parathyroidectomy transient thyrotoxicosis and atrial fibrillation. She underwent parathyroidectomy for secondary hyperparathyroidism due to chronic renal failure. Three days after surgery, she complained of palpitation and chest pain due to atrial fibrillation. Results of thyroid function tests were compatible with thyrotoxicosis. Twelve days after parathyroidectomy, the elevated level of free thyroxine decreased spontaneously to the normal range. These features were compatible with post-parathyroidectomy transient thyrotoxicosis. No further recurrences of thyrotoxicosis or atrial fibrillation were observed for one year. This is the first report of atrial fibrillation induced by post-parathyroidectomy transient thyrotoxicosis.
We describe a patient with mesial temporal T2-weighted image hyperintensity on magnetic resonance imaging that mimicked paraneoplastic limbic encephalitis. The patient showed pupillary abnormalities suggestive of a diagnosis of neurosyphilis, and the diagnosis was supported by the results of a serum Treponema pallidum hemagglutination assay (TPHA) and cerebrospinal fluid examination. Making a diagnosis of neurosyphilis is occasionally difficult because of the variety of clinical and imaging findings. Appropriate diagnosis and commencing adequate treatment are needed for a good prognosis; thus, neurosyphilis should be included in the differential diagnosis of mesiotemporal magnetic resonance imaging abnormalities.