To evaluate the efficacy of lafutidine (20mg) , famotidine (40mg) and placebo in patients with mild reflux esophagitis (Grades A and B according to the Los Angeles classification) , a double-blind, multicenter, randomized clinical trial was performed for the first time in Japanese patients. In addition to each physician's evaluation, efficacy was evaluated by judging panels using images submitted by each physician. The healing rate after 8 weeks for lafutidine, famotidine and placebo were 67.7%, 56.6% and 41.2%, respectively. Lafutidine was significantly more effective than placebo (p=0.002, according to the judging panels) . Based on the evaluation of endoscopic images by the judging panels, 91 (27.1%) of 336 images submitted by each physician were judged to not be mucosal breaks. Judging panels are considered one of the ways to resolve the problem of the need to unify the criteria.
The cases were a 64-year-old man and a 57-year-old woman both with discomfort and dysphasia. They were given a diagnosis of esophageal achalasia after gastrointestinal endoscopy, barium esophagography and esophageal internal pressure tests. Their symptoms were dramatically improved by localized botulinum toxin injections, which were commonly available in the US. The localized botulinum toxin injection treatment is safe and minimally invasive with few complications. It is effective to reduce symptoms in esophageal achalasia.
A 51-year-old woman was admitted to our hospital because of fever and pain in the right buttock. She had ulcerative colitis. She was given a diagnosis of sacroiliitis complicated with ulcerative colitis, based on a physical examination and magnetic resonance imaging (MRI) . Her sacroiliitis was successfully treated by leukocytapheresis (LCAP) . Sacroiliitis complicated with ulcerative colitis is rare in Japan, and its treatment and pathogenesis remain unclear. We report an unusual case of sacroiliitis complicated with ulcerative colitis, which was successfully treated by LCAP.
A 62-year-old man was referred to our hospital with enlargement of mucosa-associated lymphoid tissue (MALT) lymphoma of the rectum after the eradication of Helicobacter pylori. The patient was given a diagnosis of stage I MALT. Endoscopic observation revealed an enlarged rectal tumor with 3, 18 double trisomy. Rituximab monotherapy was given and complete remission was achieved. Rituximab monotherapy can be useful for MALT lymphoma of the rectum.
We report a rare case of internal hernia through an abnormal defect in the broad ligament of the uterus. A 49-year-old woman, without any previous surgery, was admitted because of vomiting and lower abdominal pain. Three days after admission a small amount of small intestinal gas was pointed out on her plain abdominal X-ray film. An enema examination by ileus tube revealed a pooling of gastrografin on the left side of the pelvic cavity, showing an obstruction of the ileum. Therefore, an emergency operation was performed, whereupon we found an abnormal defect in the left broad ligament of the uterus. This case describes an internal hernia through an abnormal defect in a female ileus patient without a history of surgery.
A 61-year-old woman with an unresectable malignant rectal stricture underwent placement of an expandable metallic stent under endoscopic guidance. The stent was successfully implanted and her bowel obstruction was relieved. After treatment with bevacizumab for unresectable rectal cancer, she was admitted to our hospital because of rectal perforation. This case suggests that placement of a metallic stent in colorectal cancer cases may increase the risk of bowel perforation during bevacizumab-based chemotherapy.
A 38-year-old man was admitted to our hospital with a diagnosis of pulmonary sarcoidosis accompanied with elevated biliary enzyme levels. Various imaging modalities, and percutaneous liver biopsy confirmed the diagnosis of hepatic sarcoidosis. Abnormalities of biliary enzymes improved after the administration of ursodeoxycholic acid (UDCA). In this case, the mechanism of pharmacologic action was considered to be the glucocorticoid-like effect of UDCA. UDCA might be a therapeutic option for hepatic sarcoidosis without general symptoms.
A 28-year-old man complained of tarry stool. A series of examinations showed a submucosal tumor with bleeding at the papilla of Vater and a swollen # 17b lymph node, both of which indicated a hypervascular tumor. The pathological findings of the enucleated tumor specimens revealed gangliocytic paraganglioma with metastasis to the # 17b lymph node. Additional pancreaticoduodenectomy revealed another # 17b lymph node metastasis 7-mm in diameter. Although the majority of gangliocytic paragangliomas are benign, 7% of reported cases have lymph node metastases, as shown in the present case. These findings are important in treating patients with gangliocytic paraganglioma.