Purpose Obesity, smoking and alcohol are modifiable putative risk factors for colorectal neoplasms (CRN) and hyperplastic polyps (HP). The aim of this study was to evaluate the strength of association between these modifiable risk factors and colorectal polyps. Methods These risk factors were assessed by using a questionnaire completed by the patient prior to colonoscopy. Eight hundred-seventy consecutive patients satisfying inclusion criteria who had undergone a complete colonoscopy were divided into 4 groups: CRN (n=194), HP (n=132), CRN and HP (n=42) and control (neither CRN nor HP; n=586). Multiple logistic regression was performed. Results The ORs [95%CI] of both CRN and HP for incremental body mass index expressed in 2 categories (≥22, ≥25) were 2.12 [1.00, 4.50] and 1.41 [0.53, 3.77], respectively. The ORs [95%CI] of CRN and HP for heavy smoking of over 20 pack-years were 1.66 [1.05, 2.64] and 1.67 [1.01, 2.77], respectively. The ORs of CRN and HP for habitual alcohol drinking (median ethanol intake 32 g/day and interquartile range 18-40 g/day) were 1.31 [0.86, 1.98] and 1.91 [1.06, 3.47], respectively. CRN and HP were correlated with each other (p=0.0043, chi-square test). Aging was a significant risk factor for all three groups of colorectal polyps. Conclusion These findings are especially important since smoking and alcohol consumption are modifiable risk factors. Heavy smokers should be encouraged to quit to reduce their risk of CRN and HP. Habitual drinkers should be warned of the risk of HP. HP can be a marker of coincidence of CRN.
Objective and Background In Japan, an increase in the elderly population is associated with an increased incidence of aspiration pneumonia. Treatment guidelines for aspiration pneumonia recommend the use of antibiotics effective against anaerobic bacteria, such as carbapenems. However, the role of anaerobic bacteria in aspiration pneumonia and the clinical efficacy of meropenem in elderly aspiration pneumonia patients have only begun to be investigated. Methods A prospective study of 62 elderly hospitalized patients with aspiration pneumonia (34 males, 28 females; mean age 86.6 years) was conducted. The causative organisms of aspiration pneumonia, including anaerobic bacteria, were investigated using fiberoptic bronchoscopy. In addition, the efficacy and safety of intravenous meropenem for this treatment of this condition were evaluated. Results When disease severity was classified according to the Japanese Respiratory Society (JRS) guidelines, 80.7% of the cases in this study were graded as "most severe". The overall detection rate of bacteria was 87.1% (monomicrobial, 32.3%; polymicrobial, 54.8%). Of the 111 pathogens detected (14 anaerobic pathogens remained unidentified), anaerobic bacteria accounted for 19.8% and gram-negative enteric bacilli made up 19.8%. The overall clinical efficacy rate of meropenem therapy (1.0 g/day) was 61.3%. The mortality rate was 9.7%, and anaerobic bacteria coexisted with aerobic bacteria in 66.7% of the patients who died. Conclusion The use of antibiotics effective against anaerobic bacteria may be necessary for patients with potentially fatal aspiration pneumonia. Meropenem therapy for aspiration pneumonia is clinically effective and tolerable in elderly patients.
Objective To evaluate the clinical utility of the T-SPOT.TB test for patients with indeterminate results on the QFT-2G test. Materials and Methods Forty patients (10.6%) showed indeterminate results among 378 patients who underwent QFT-2G test because active TB disease was clinically suspected. T-SPOT.TB test was performed for these 40 patients before the initiation of antituberculous treatment. Results Forty patients (10.6%) were judged as showing indeterminate results on QFT-2G test because the positive control presented a lower IFN-γ level. Elderly patients (68.2 versus 57.7) or immunocompromised patients receiving immunosuppressive treatments and patients with a decrease in lymphocyte count, serum protein and albumin were more frequently recognized in the patients with indeterminate results compared to those with determinate results on QFT-2G test. T-SPOT.TB test could clearly demonstrate the results in 26 of the 40 patients (65.0%) with indeterminate results of QFT-2G test; these were divided into six patients with positive results and 20 with negative results of T-SPOT.TB test. Elderly patients (73.5 versus 64.3) or patients with underlying diseases such as malignant disease and those receiving immunosuppressive treatment and patients with hyponutritional conditions were more frequently recognized in the patients with indeterminate results compared to patients with determinate results on both tests. Conclusion We think it may be necessary to introduce T-SPOT.TB test to increase the diagnostic rate of TB disease including latent tuberculosis infection because indeterminate results of QFT-2G test might be further decreased using T-SPOT.TB test. Although 14 patients showed indeterminate results on both tests, the lymphocytes of these patients may not possess functional cytokine production activity.
Pancreatic carcinoma associated with portal vein tumor thrombus (PVTT) is rare. Here, we report three cases of resected pancreatic carcinoma associated with PVTT. In all three cases, preoperative images obtained using computed tomography and endoscopic ultrasonography revealed a tumor thrombus in the portal vein, which was connected to an irregular mass in the pancreas. All cases underwent surgical resection of the primary lesion and the PVTT. The pathological diagnoses of the tumors were two cases of tubular adenocarcinoma and one case of nonfunctioning endocrine carcinoma. We also retrospectively examined other patients who underwent surgical excision with portal vein resection.
A 59-year-old man diagnosed as gastric cancer with peritonitis carcinomatosa was treated with paclitaxel and TS-1; 60 mg/m2/day of paclitaxel was given on days 1 and 8, and 60-80 mg/m2/day of TS-1 was given for 2 weeks. Six courses of combination therapy were administered, and the ascites disappeared completely. Because multiple bone metastases occurred, we attempted combination therapy with cisplatin and irinotecan hydrochloride; 50 or 30 mg/m2/day of cisplatin was given on day 1 or day 15, and 70 mg/m2/day of irinotecam hydrochloride was given on days 1 and 15. The patient achieved a remarkable response, however, intrameningeal dissemination occurred and he died from rapidly progressive meningitis carcinomatosa.
Autoimmune pancreatitis is characterized by diffuse enlargement of the pancreas, irregular narrowing of the pancreatic duct, high serum levels of IgG4, and lymphoplasmacytic infiltration in the pancreatic parenchyma. Accumulating evidence suggests that this autoimmune disease could present with diffuse infiltration of IgG4-positive plasmacytes in multiple organs. Recently, a new concept of IgG4-related systemic disease including autoimmune pancreatitis, characterized by high serum IgG4 level and tissue infiltration by IgG4-positive plasma cells, has been proposed. Renal lesions in IgG4-related diseases have been reported recently. Most of them are tubulointerstitial nephritis; however, glomerulonephritis associated with IgG4-related diseases is very rare. We describe here a patient with membranoproliferative glomerulonephritis-like glomerular disease, together with tubulointerstitial nephritis, idiopathic thrombocytopenic purpura, and autoimmune pancreatitis. An 80-year-old Japanese man was referred to our hospital with a 14-month history of proteinuria, and a progressively rising serum creatinine level. Renal biopsy revealed membranoproliferative glomerulonephritis-like glomerular disease and concurrent tubulointerstitial nephritis. Immunolabeling of renal tissue showed numerous IgG4-positive plasma cells in the interstitium. The rare association between glomerulonephritis and IgG4-related systemic disease is discussed.
A 66-year-old man was admitted for progressive proximal weakness and myalgia in his shoulder girdles without skin lesions. A muscle biopsy showed infiltration of inflammatory cells, degeneration of muscle fibers, and perifascicular atrophy. Remarkably, MHC-I antigen was expressed in the muscle membrane and most of the inflammatory cells were CD8-positive, suggesting that class-I antigen-dependent cytotoxic T-cells played a crucial role in the muscle pathology, which supported a diagnosis of polymyositis rather than dermatomyositis. Magnetic resonance imaging of his chest revealed two mediastinal tumors, which were extirpated and diagnosed as thymic carcinoma. The muscle weakness was completely recovered after the operation and subsequent administration of oral prednisolone. Postoperative clinical improvement and decline of serum creatinine kinase suggested a paraneoplastic nature of the polymyositis in this patient.
Extrinsic left atrial compression is an uncommon source of hemodynamic compromise that can be caused by many mediastinal structures including bronchogenic cysts, carcinoma, lymphoma, thymoma, aortic aneurysm and diaphragmatic hernia. We describe an unusual case of a 26-year-old man presenting with symptoms of left heart failure. Transthoracic echocardiography demonstrated extrinsic left atrial compression caused by a metastatic testis non-seminomatous germ cell tumor. Compression of the left atrium caused impaired left atrial filling, leading to pulmonary venous hypertension and pulmonary edema. To our knowledge, the present case is the first reported case of mediastinal metastatic testis non-seminomatous germ cell tumor causing symptoms of left heart failure by externally compressing the left atrium.