Lymphoepithelial cyst of the hypopharynx

A rare case of lymphoepithelial cyst formed in the piriform sinus of the hypopharynx is reported. Histopathological examination revealed a lymphoepithelial cyst. It was removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. Because this cyst was wide-based on the antero-medial region in the right piriform sinus of the hypopharynx, the mucous membrane around the cyst was incised electrosurgically and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing the cyst in this case and discuss the possible causes of the disease.     

Proton pump inhibitor H2 receptor antagonist

Recently, Japanese guidelines for the treatment and prevention of peptic ulcers were established by the Japanese Society of Gastroenterology. Herein, we focus on proton pump inhibitor(PPI) and H2 receptor antagonist (H2RA) for prophylaxis and treatment of peptic ulcer associated with NSAIDs including low dose of aspirin. Double dose of H2RAs are effective at preventing chronic NSAID related ulcers, however, the effect is not superior to PPI. Full-dose misoprostol and PPI are clinically equivalent, although the potential adverse effects of misoprostol are a major cause of poor compliance. Overall, PPIs have the best profile of efficacy and side-effects for the healing and prevention of NSAID-associated ulcers, especially in the patients with high risk, such as history of peptic ulcer.     

Treatment and prevention of histamine-2 receptor antagonist for elderly gastric ulcer

H. pylori infection and non-steroidal anti-inflammatory drugs(NSAIDs) are considered the two major causes of gastric mucosal lesions. Chronic administration of NSAIDs is associated with an increased incidence of significant adverse events such as upper gastrointestinal hemorrhage or perforation. The inhibition of prostaglandin synthesis, the decrease of gastric mucosal blood flow and the involvement of gastric acid are believed to be the mechanisms of NSAIDs-associated gastric mucosal lesions. In future, the significance of NSAIDs-associated gastric mucosal lesions may increase in Japan. Many studies have reported that proton pump inhibitor, high dosages of histamine-2 receptor antagonist (H2RA), and prostaglandin analogs provide excellent prevention and therapeutic actions for NSAIDs-associated gastric ulcer. Additionally, recent studies have shown that regular dosages of H2RA provide excellent prevention and therapeutic actions for NSAIDs-associated gastric mucosal lesions in Japan.     

Newly designed specula for laryngomicroscopy

We produced specula for laryngomicroscopy to observe blind spots in the operating field. Use of these specula has facilitated detailed observation of the lower surface of the false vocal folds, laryngeal ventricle, and subglottis, which were previously in blind spots. The specula are useful in the following ways: 1) clarifying blind spots for improved diagnosis and providing more accurate surgical margins; 2) observing the lower lips of the vocal folds in phonosurgery; and 3) Vaporizing with laser reflection. The specula are cheap and easy to use and are well worth considering for application to laryngomicroscopy.     

Histamine-2 receptor antagonist

H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs) are considered the two major causes of gastric mucosal lesions. Chronic administration of NSAIDs is associated with an increased incidence of significant adverse events such as upper gastrointestinal hemorrhage or perforation. The inhibition of prostaglandin synthesis, the decrease of gastric mucosal blood flow and the involvement of gastric acid are believed to be the mechanisms of NSAIDs-associated gastric mucosal lesions. In future, the significance of NSAIDs-associated gastric mucosal lesions may increase in Japan. Many studies have reported that proton pump inhibitor, high dosages of H2-RA, and prostaglandin analogs provide excellent prevention and therapeutic actions for NSAIDs-associated gastric ulcer. Additionally, recent studies have shown that regular dosages of H2-RA provide excellent prevention and therapeutic actions for NSAIDs-associated gastric mucosal lesions in Japan.     

Usefulness of Ultrasonography for Diagnosis of Small Bowel Tumors: A Comparison Between Ultrasonography and Endoscopic Modalities

Ultrasonography is a standard, noninvasive modality used to evaluate patients with gastrointestinal diseases. This study assessed the usefulness of ultrasonography in the detection of small bowel tumors.This study enrolled 558 consecutive patients (295 males, 263 females; mean age 71.1 years) who underwent ultrasonography before capsule endoscopy and/or balloon-assisted endoscopy. Ultrasonographic detection of small bowel tumors was compared with detection by capsule endoscopy and/or balloon-assisted endoscopy. In addition, factors affecting small bowel tumor detection by ultrasonography and clinical characteristics of patients with small bowel tumors undetected by ultrasonography were evaluated.Ninety-seven tumors (52 benign, 45 malignant) detected by capsule endoscopy and/or balloon-assisted endoscopy were retrospectively analyzed. The sensitivity and specificity of ultrasonography in the detection of small bowel tumors were 50.5% (47/93) and 100% (465/465), respectively. If we restricted patients to those with a tumor >20 mm in size, its detection ratio would become higher (91.7%): the ratio of submucosal tumor >20 mm in size was 85.7% (6/7) and that of partial and circumferential ulcerative tumors >20 mm in size was 96.9% (31/32), respectively. Small bowel tumors detected by ultrasonography (mean 33.2 mm) were significantly larger than those undetected by ultrasonography (mean 8.7 mm). The percentage of small bowel tumors located in the ileum detected by ultrasonography (70.6%) was significantly higher than those undetected by ultrasonography (29.4%). Of the 46 small bowel tumors undetected by ultrasonography, 42 (91.3%) were benign tumors with good clinical prognosis.Ultrasonography is a useful modality for detecting larger small bowel tumors and ulcerative lesions. Ultrasonography should be considered a first-line modality for patients suspected of having small bowel tumors, because most small bowel tumors undetected by ultrasonography were benign tumors with good clinical prognosis.     

Prevalence of Helicobacter pylori infection and its link to coronary risk factors in Japanese patients with acute myocardial infarction.

The association between Helicobacter pylori (H. pylori) infection and coronary artery disease, as well as the association between H. pylori infection and classic coronary risk factors, is controversial in patients from Western countries. The high prevalence of H. pylori infection in Japanese subjects enables an examination of these associations in a large population, especially in young patients, because coronary risk factors may be more strongly associated with younger individuals than with older individuals. The IgG seropositivity to H. pylori was assessed in 618 cases with acute myocardial infarction (AMI) and in 967 controls. The prevalence of seropositivity to H. pylori was similar between cases and controls, but in subjects younger than 55 years, the rate was significantly higher in cases than in controls (58.7% vs 43.3%, p = 0.009). After adjustment for age, gender, diabetes mellitus, hypertension, smoking, body mass index, total cholesterol, and high density lipoprotein cholesterol, the odds ratio for acute myocardial infarction was 2.97 (95% confidence interval, 1.37-6.41; p = 0.006). Worsening of classic coronary risk factors was not associated with H. pylori infection in subjects younger than 55 years. These results suggest that in younger individuals in Japan, H. pylori infection is significantly associated with AMI independent of the classic coronary risk factors.     

Electron microscopic identification of histidine decarboxylase-containing endocrine cells of the rat gastric mucosa. An immunohistochemical analysis

The localization of histidine decarboxylase-like immunoreactive structures in the mucosal cells of the rat stomach was studied by the peroxidase-antiperoxidase method. At the light microscopic level, histidine decarboxylase-like immunoreactivity-containing cells were concentrated in the basal part of the oxyntic region, whereas in other areas no immunoreactive cells were seen. Ultrastructural study showed that reaction end products were diffusely distributed within the cytoplasm of the enterochromaffinlike cells but other cell types such as A cells, G cells, and enterochromaffin cells were not labeled. These findings suggest that enterochromaffinlike cells synthesize histamine.     

Variations in early gross motor milestones and in the age of walking in Japanese children

Background: Gross motor development is usually assessed in terms of age of achievement of motor milestones. Although there is generally an impression of faster development if the milestones are achieved at younger ages, no longitudinal studies have been done on the associations between the milestones, especially in Japan. As a part of the Japan Children's Study, the purpose of the present study was to determine whether the achievement of gross motor milestones in infancy is related with the age of walking. Methods: This was a prospective cohort study of 290 healthy and term infants born in a district of Osaka City, Japan. Three milestones (rolling over, sitting, and crawling) were observed in the laboratory for infants aged at 4 and 9 months by a pediatrician and a developmental psychologist, and the age of walking was confirmed in questionnaires filled in by the parents at 18 and 27 months. Results: Children who could roll over at 4 months, and sit and crawl at 9 months, walked earlier than children who could not roll over, sit and crawl, respectively. With regard to crawling, children who were creeping had a 1 month delay in walking, and those who could not move forward had a 2 month delay compared to typical crawlers. On multiple regression analysis these three milestones were positively associated with walking: rolling over (β= 0.567), sitting (β= 1.973) and crawling (β= 1.473). Conclusion: The age and the patterns of sitting, crawling and rolling over were all related to the age of independent walking among Japanese infants. Consideration of milestone definition and variations is essential in medical check‐up.