The LZ test "Eiken" for H. pylori antibody (LZ test) was examined. In patients with an antibody titer of ≥3.0U/mL and <10.0U/mL among 698 patients who underwent breath tests, the status of H. pylori infection was assessed from the results of the 13C urea breath test and the findings of gastric mucosal atrophy by performing an upper gastrointestinal endoscopy. A positive 13C urea breath test was observed in 22.3% of these patients (156/698, 95% confidence interval 19.4-25.6%), and gastric mucosal atrophy of C-2 or greater was observed in 39.7%. We presumed that 156 (22.3%) patients had present H. pylori infections, 141 (20.2%) patients had experienced a previous infection, and 401 (57.5%) patients were uninfected. The infection rate of H. pylori (current infection+previous infection) was treated as a so-called "risk of gastric cancer" and was 42.6% (297/698, 95% confidence interval 38.9-46.3%). In the LZ test, the concept of a negative high value should be understood. A receiver operating characteristic curve plotted depending on whether the 13C urea breath test was positive or not gave a positive cutoff value of 5.6U/mL;values greater than the cutoff value were taken as indicative of the need to investigate the status of H. pylori infection. Even without gastric mucosal atrophy, 2.0% of these patients had a positive breath test. For gastritis localized in the antrum (C-1), 17.8% of the patients had positive breath test results.
A 55-year-old man was admitted to our hospital because of massive gastrointestinal bleeding. He had a history of type B liver cirrhosis, multiple abdominal surgeries, and endoscopic treatment of esophageal varices. Colonoscopy was performed, but the source of bleeding could not be identified. Computed tomography during arterial portography (CTAP) demonstrated small intestinal varices and collateral veins from the superior mesenteric vein to the epigastric vein. We performed phlebosclerozation by directly puncturing the epigastric vein under the skin. Remission of bleeding was then attained. No recurrence of gastrointestinal hemorrhage has occurred after the phlebosclerozation. We believe that CTAP is useful when diagnosing small intestinal varices and that percutaneous phlebosclerozation should be considered as a treatment option for small intestinal varices.
A 67-year-old man visited our hospital with an enlarging abdominal mass several months after he had first noticed his symptoms. An elastic firm tumor was palpated on the left side of the abdomen upon physical examination. The blood test results were normal. Contrast-enhanced computed tomography of the abdomen revealed a 10-cm-diameter homogeneous low-density cystic tumor located at the dorsal portion of the gastric corpus. Enhancement of a few net-like structures was noted, but most of the lesion was not enhanced. Gastroendoscopy revealed the lesion to be a submucosal tumor with a smooth mucosal surface and no ulceration. Endoscopic ultrasonography showed the tumor arising from the fourth layer of the gastric wall. The tumor was completely resected by laparotomy and partial gastrectomy. It was capsulated and contained serous fluid with little solid tissue. Histologically, there were sparse tumor cells within the myxoid interstitium. Immunostaining results were weakly positive for KIT and CD34-positive accompanied by mast cell infiltration. A platelet-derived growth factor receptor alpha (PDGFRA) exon 18 (D842V) mutation was identified, and the lesion was ultimately diagnosed as myxoid epithelioid gastrointestinal stromal tumor (GIST) of intermediate- and low-risk according to Fletcher's classification and Miettinen's classifications, respectively. GISTs with PDGFRA D842V mutations are reportedly resistant to imatinib, and GISTs originating from the stomach are reportedly less malignant than others. The patient was observed without adjuvant therapy after surgery because of the relatively low risk of metastasis or recurrence and the potential risk of imatinib resistance. No recurrence was observed for ≥5 years after the surgery. We herein report this rare case and describe its clinical characteristics.
We report an uncommon case of an elderly patient with cecal volvulus caused by intestinal malrotation. We performed lower gastrointestinal endoscopy on an 84-year-old man with a chief complaint of abdominal distention and fever. However, emergency surgery had to be performed because intestinal perforation had occurred. The patient had cecal volvulus associated with incomplete rotation of the intestine. Subsequently, the patient developed multiple organ failure and died 2 days after the surgery. Despite its low incidence, we believe that the possibility of intestinal malrotation should be considered in elderly patients who present with abdominal distention for which the definitive diagnosis cannot be easily obtained.
A 78-year-old woman had undergone total gastrectomy and chemotherapy for gastric cancer (pT4N3bM0 Stage IIIC, poorly differentiated adenocarcinoma). She received S-1 monotherapy 3 times weekly (S-1 at 80mg twice daily for 14 days, every 3 weeks). She underwent routine examinations, including tumor markers and computed tomography. She had no signs of recurrent disease, but she suffered from a loss of eyesight 2 years and 8 months after the operation. A choked disc was found, but she had no headaches, nausea, or unconsciousness, which indicated high intraventricular pressure. Enhanced T2-weighted magnetic resonance imaging showed high intensity around the optic nerve. We performed cerebrospinal fluid cytological analysis, which showed poorly differentiated adenocarcinoma. She was diagnosed as having leptomeningeal carcinomatosis of gastric cancer. The patient chose best supportive care and died 2 months after symptoms appearance. Histological analysis during the autopsy showed moderately to poorly differentiated adenocarcinoma. The carcinoma had also infiltrated the spinal cord, peritoneum, and adrenal glands. Histologically, the carcinoma had infiltrated the optic nerve, which caused loss of eyesight. We have not yet established effective therapies for leptomeningeal carcinomatosis, and the prognosis is poor. Leptomeningeal carcinomatosis of gastric cancer that appears by loss of eyesight is very rare. This case illustrates that the possibility of leptomeningeal carcinomatosis should be considered when we treat patients with loss of eyesight of an unknown cause after surgery.