Immunoglobulin G4-related gastrointestinal diseases, are they immunoglobulin G4-related diseases?

In immunoglobulin G4(IgG4)-related disease(RD),organ enlargement or nodular lesions consisting of abundant infiltration of lymphocytes and IgG4-positive plasma cells and fibrosis are seen in various organs.Although infiltration of many IgG4-positive plasma cells is detected in the gastric and colonic mucosa and major duodenal papilla of patients with autoimmune pancreatitis,it cannot be diagnosed as a gastrointestinal lesion involved in IgG4-RD,because none of the following is observed in these lesions:a mass-like formation;dense fibrosis;or obliterative phlebitis.Based on our review of the literature,there appear to be two types of IgG4-related gastrointestinal disease.One is a gastrointestinal lesion showing marked thickening of the wall of the esophagus and stomach,consisting of dense fibrosis with abundant infiltration of IgG4-positive plasma cells,which usually show submucosal spreading.The other is an IgG4-related pseudotumor occurring in gastrointestinal regions such as the stomach,colon,and major duodenal papilla,showing polypoid or mass-like lesions.Most solitary IgG4-related gastrointestinal lesions that are not associated with other IgG4-RD appear to be difficult to diagnose.It is of utmost importance to rule out malignancy.However,these lesions may respond to steroid therapy.To avoid unnecessary resection,IgG4-related gastrointestinal diseases should be considered in the differential diagnosis.

胃癌预防亚太地区共识指南

背景与目的:胃癌是亚太地区的主要健康负担之一,但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法:多学科专家组应用德尔菲(Delphi)法制订共识条文,提呈相关数据,对证据等级、推荐强度以及共识水平予以分级。结果:幽门螺杆菌(H.pylori)感染是非贲门胃腺癌必要但非充分的致病因子。盐的高摄入与胃癌强烈相关。新鲜果蔬对胃癌具有预防作用,但维生素和其他饮食补充并不能预防胃癌。H.pylori感染中的宿主-细菌相互作用导致不同类型的胃炎和胃酸分泌,从而决定疾病结局。胃癌阳性家族史是一个重要的危险因素。低血清胃蛋白酶原反映胃萎缩程度,可作为检出胃癌高危人群的标志物。H.pylori筛查和治疗被推荐作为减少高危人群胃癌危险性的一种策略,该策略在萎缩性胃炎发生前实施最为有效,但并不排除对胃癌高危人群的内镜监测。对胃癌低危人群不推荐行H.pylori筛查。H.pylori感染的一线治疗应遵循国家治疗指南。结论:高危人群中H.pylori筛查和根除策略可能会减少胃癌的发生率,本共识根据现有证据予以推荐。

Regular arrangement of collecting venules:Does patient age affect its accuracy?

AIM:To address the diagnostic value of the regular arrangement of collecting venules(RAC)among old age patients. METHODS:A total of 390 consecutive patients whose Helicobacter pylori(H.pylori)status was known and who received upper gastrointestinal endoscopy,were retrospectively studied for the presence or absence of RAC as well as gastric mucosal atrophy.The sensitivity, specificity,positive predictive value,negative predic-tive value and accuracy of RAC to detect normal gastric mucosa were assessed and were compared among two different age groups of patients. RESULTS:The mean age±standard deviation(SD)of included patients(n=390),was 62.9±13 years.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC to detect normal gastric mucosa were 91.7%,66.1%,18.8%,99%and 68.1%respectively.Although the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of RAC among patients<60 years(n= 139)was 94.7%,71.2%,46.2%,98.1%and 76.1%,respectively,it was 80%,64.3%,5.1%,93%and 64.6%, respectively,among patients≥60 years(n=251). Younger Patients(<60 years),have highly significant rates of RAC sensitivity,positive predictive value,and accuracy(P≤0.001,≤0.001 and≤0.02,respectively).Older patients had highly significant rates of H. pylori infection and gastric mucosal atrophy(P≤0.01). CONCLUSION:Although RAC is a valuable sign for real-time identification of normal gastric mucosa,its accuracy seems to be affected by the patient's age.

Mucocele of the appendix due to endometriosis:A rare case report

Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.

Salvage Photodynamic Therapy Is an Effective and Safe Treatment for Patients with Local Failure after Definitive Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

Although chemoradiotherapy (CRT) is one curative treatment option for patients with esophageal squamous cell carcinoma (ESCC), local failure after CRT remains a major problem for patients’ curability. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) as a salvage treatment for local failure. From August 2007 to March 2012, 193 consecutive ESCC patients were treated with definitive CRT in Kyoto University Hospital. Eighteen of the patients with T2 or earlier T-stage local failure after CRT underwent salvage PDT. After the salvage PDT, 11 patients (61.1%) achieved a complete response at the primary site. Over a median follow-up period of 28.3 months, the 1-year survival and progression-free survival rates were 77.8% and 38.9%, respectively;and the 2-year survival and progression-free survival rates were 60.6% and 33.3%, respectively. Adverse events were mild esophageal stricture in seven (38.9%), esophageal obstruction because of necrotic tissue in nine (50.0%), and photosensitivity in three (16.7%) patients. There were no severe complications or treatment-related deaths. Salvage PDT may be a promising treatment option for the patients with a local residual or recurrent tumor after CRT for ESCC when the lesion is suspected to be in T2 or earlier.