Background: Approximately 100 cases of giardiasis incidence are reported each year in Japan. The actual infection rate, however, is suspected to be higher since giardiasis is often overlooked due to the mildness of its symptoms. We investigated the presence of trophozoites of Giardia lamblia microscopically in sediment of whole gut lavage fluid obtained from patients undergoing colonoscopy. Methods: Whole gut lavage fluid was collected from all 3035 cases (2355 persons) undergoing colonoscopy at Osaka Medical Center for Cancer and Cardiovascular Diseases from 1993 to 1997. After Papanicolaou staining, sediment specimens of the lavage fluid were microscopically observed. Results: Giardia lamblia were identified in 15 cases (12 persons: 0.51%). Among them, four patients had diarrhea and/or abdominal pain. Subsequently, three of them were treated with metronidazole. Conclusion: Giardiasis is not a rare infectious disease among the Japanese; therefore it should be taken into consideration in evaluating enteritis.
A 31-year-old man has visited our hospital, complaining diarrhea and leg edema. Blood test showed hypoalbuminea, but we couldn't find the reason by several examinations. Therefore, we performed double balloon enteroscopy, and intestinal lymphangiectasia was diagnosed histologically by biopsy. It's useful and effective to perform double balloon enteroscopy and histological examination for the unknown origin case of protein loosing enteropathy.
Case1 was a 52-year-old man who had recurrence of postoperative intra-abdominal disseminations from gastrointestinal stromal tumor (GIST) of the jejunum. Case2 was a 66-year-old man who had GIST of the jejunum with multiple liver metastases. Two cases presented hemoperitoneum caused by administration of imatinib mesylate, and we conducted emergent surgery. In spite of surgically non-curative cases, it is suggested that the surgical management for GIST of high grade group with peritoneal exposure should be followed by the administration of imatinib mesylate.
A 73-year-old man, who was diagnosed as having advanced anorectal malignant melanoma (Stage IV), was treated with combination chemotherapy using dacarbazine, nimustine, cisplatin, and tamoxifen plus interferon-beta. After the first course of chemotherapy, rectal tumor was decreased in size with less anal pain and liver tumor was disappeared. Twenty-four months after the first treatment, the patient is survived. DAC-Tam IFN-β therapy may improve the management of patients who have advanced MM of the anorectum.
The patient was a 72-year-old man who had a history of hepatic cyst, which had, however, not been followed up. It was noted that he had internal hemorrhage in the hepatic cyst as well as a contrast-enhanced tumorous lesion in the cystic wall. Further detailed examination could not rule out hepatic cystadenocarcinoma or cystadenoma, so a right hepatic lobectomy was performed. The lesion was histopathologically diagnosed as non-malignant cyst with angiogenesis simulating cavernous hemangioma and intra-cystic hemorrhage. Although this disease is difficult to diagnose, its diagnosis is not impossible as long as the disease is kept in mind.
A 35-year-old woman was admitted to our hospital for right upper quadrant pain and multiple liver tumor were detected by diagnostic imaging. Tumors located near the surface of the liver which accompanied capsular retraction. Diagnostic laparoscopy showed multiple white tone tumors with retraction of the adjacent liver capsule. Tumor targeted biopsy was performed. The pathologic diagnosis of epithelioid hemangioendothelioma (EHE) was made by the positive staining of factor VIII-related antigen. EHE tend to locate in peripheral and extend to the liver capsule. Therefore, we face difficulties in getting biopsy sample safely. Here we report a useful case of laparoscopic examination and biopsy in the diagnosis of EHE.
A 72-year-old man was admitted to our hospital with refractory gastrointestinal bleeding. He received extrahepatic bile duct resection, hepaticojejunostomy and pancreatojejunostomy for bile duct stenosis and pancreatic pseudocyst 6∼8years ago. We revealed that the cause of shock state was bleeding from varices of an interposed jejunum and portal vein obstruction as a complication of these operations. He received transileocolic vein obliteration with coils. Refractory gastrointestinal bleeding stopped. We concluded that this obliteration was effective and useful treatment for this complication.
The first evaluated case was a 71-year-old man with melaena. A huge tumor mass was observed in the tale of the pancreas, which we diagnosed as pancreatic carcinoma. Pathological findings confirmed that it was anaplastic pancreas carcinoma (giant cell type). The second case was a 61-year-old woman with upper abdominal pain. Irregular tumors with scattered cysts were observed in the tale of the pancreas, which rapidly increased. Autopsy findings confirmed that it was anaplastic pancreas carcinoma (pleomorphic type). Both cases showed positive for epithelial marker and mesenchymal markers and decrease in stainability by E-cadherin staining, a result which suggested diversity of tumor cells in anaplastic pancreas carcinomas.