Glycogenic Acanthosis of the Esophagus—An Analysis of Clinically Relevant Factors (Glycogenic Acanthosis of the Esophagus)

Abstract: Glycogenic acanthosis (GA) of the esophagus is often found in routine endoscopic examination of the upper GI tract but has not received much attention. However, there is controversy concerning the nature, clinical significance and prevalence of this condition. An endoscopic study of 654 patients studied consecutively revealed a higher incidence of the lesion (72.3%) than previously reported. Its incidence was found to be significantly higher in males (p<0.01). An increasing incidence tendency was observed with respect to age in patients in their twenties to sixcties, but in patients in their seventies the incidence was lower than in those in their sixties, Smoking increased the frequency of GA. Extensive lesions were significantly more prevalent in smokers in their 40's (p<0.01). The number of cigarettes per day had a positive correlation with the incidence. GA did not have a clear relationship with alcohol intake, dietay, habits, condiments or acid reflux. Therefore, age, sex and smoking appear to be risk factors of GA, as in esophageal carcinoma.     

Reduction of the DTH response is related to morphological changes of Langerhans cells in mice exposed to acute immobilization stress

There is a large body of evidence indicating that stress influences immune competence. For example, psoriasis and atopic dermatitis may be exacerbated by psychic stress and related to abnormalities in the cellular constituents of the immune system in the skin. However, the underlying mechanisms remain unclear. We therefore investigated the potential of acute immobilization stress to affect the DTH response in BALB/c mice. DTH was significantly reduced in an immobilization time-dependent manner when stress exposure was just before sensitization. Although the number of Langerhans cells (LC) did not change under these conditions, marked alteration of LC morphology was observed with a significant decrease in area. Recovery of LC was observed within 24 h when the DTH response was also restored. Expression of the calcitonin gene-related peptide (CGRP), which inhibits LC antigen presentation, was significantly increased up to 1.6-fold in nerve fibres of immobilized mice. We conclude that stress-induced suppression of DTH could be due to reduction of LC antigen presentation with morphological change in association with CGRP elevation.     

Induction and Aggravation of Mid-esophageal Ulcers by Endoscopic Biopsy—Report of a Case—

Abstract: A 33-year-old male was admitted to our hospital with a seven months history of retrosternal pain and odynophagia. On admission the patient could take only liquid or soft diet. An endoscopic examination revealed a mid-esophageal ulcer. The ulcer was intractable. No known etiological factor of esophagitis was found. A biopsy of the ulcer exacerbated the ulcer and symptoms. Biopsies of normal-looking esophageal mucosa gave rise to new ulcers at the site of biopsy accompanied by an increase in the symptoms. While these newly formed ulcers healed within 6 weeks, it took an additional 6 months for the primary ulcer to completely disappear. The elimination of hard and hot foods, large boluses, condiments and alcohol from the patient's diet appeared to improve the condition of the ulcer and prevent recurrence. The esophageal mucosa of this patient may have an exaggerated potential to react to mechanical stimulation. Such intractable esophageal ulcers rarely appear in healthy young men and the mechanism of the abnormal reactivity of the esophageal mucosa needs to be clarified.     

Nipradilol, a new β-blocker with vasodilatory properties, in experimental portal hypertension: A comparative haemodynamic study with propranolol

The haemodynamic effects of nipradilol, a new non-selective β-adrenoreceptor blocker with vasodilating actions like nitroglycerin, were examined in rats with portal hypertension due to portal vein stenosis. Portal hypertensive rats were divided into five groups receiving infusion of placebo, 3 mg of propranolol, 300, 600 and 1200 μg of nipradilol. At its highest dose, nipradilol achieved a reduction of 34.4 ± 4.4% in heart rate which was similar to that in the propranolol group (36.5 ± 2.4%). Also for other systemic haemodynamic parameters, the nipradilol 1200 μg group exhibited changes not significantly different from those in the propranolol group; mean arterial pressure (- 13 vs - 14%), cardiac index (- 37 vs - 31%) and systemic vascular resistance (+ 29 vs+ 32%). In contrast to the similar changes in the systemic circulation, a 1200 μg dose of nipradilol lowered portal pressure significantly more than propranolol (- 4.3 ± 0.6 vs - 2.9 ± 0.2 mmHg, P≤ 0.05). Nipradilol then reduced portal blood flow by 22% (P≤ 0.05) without a significant change in portocollateral resistance. On the other hand, propranolol not only caused a reduction in portal blood flow of 30% (P≤ 0.01), but also an increase in portocollateral resistance of 21% (P≤ 0.05). The results suggest that nipradilol may ensure a more effective control of portal hypertension than propranolol, presumably via its venodilatory action on portocollateral vessels.     

Adult Wilms'' tumor mimicking hemorrhagic renal cyst

A 36-year-old man presented with macroscopic hematuria associated with right flank pain. Examination of the patient revealed a cystic mass in the right kidney. Because the mass had increased in size, enucleation of the mass was performed. Histopathological findings revealed nephroblastoma, therefore, radical nephrectomy was performed. We believe the pathogenesis of the cystic formation to be a process in which a tumor that had developed in the pericalyceal region spontaneously ruptured, exuding urine into the perinephric space, forming a cystic mass. The patient is alive with no evidence of disease 24 months after the operation.     

Anatomical and histological studies of so-called Müllerian duct cyst

BACKGROUND: We examined so-called Müllerian duct cysts both histologically and immunohistochemically with anatomical observation to investigate the etiology of the 'Müllerian duct cyst'. METHODS: Five cystic lesions located in the prostatic midline were obtained from surgical specimens. A communication between the cystic lesion and the urethra via the utricular orifice was looked for and the specimens were subjected to histological and immunohistochemical testing. RESULTS: A communication between the cyst and the urethra was confirmed in four cases, but not in one case. Histological and immunohistochemical examinations of the epithelium lining indicated that its characteristics were identical to those of the prostatic utricle in all cases. CONCLUSIONS: The so-called Müllerian duct cyst exhibits features comparable to those previously described in the prostatic utricle. There is no evidence that these cystic lesions originate from the Müllerian duct remnant, at least in the epithelial lining. We suggest that they should be termed a prostatic utricular cyst or cystic dilation of the prostatic utricle, depending on whether an outlet to the urethra is absent or present, respectively.     

Urinary incontinence among community‐dwelling people aged 40 years or older in Japan: Prevalence,risk factors,knowledge and self‐perception

Background : Urinary incontinence (UI) is a common problem in adults, especially among the elderly. We examined the prevalence and risk factors of UI and potential factors hindering individuals from seeking treatment for UI among a community‐dwelling population aged over 40 years. Methods : Data were collected by mailing a 23‐item urinary incontinence questionnaire to a random sample of community‐dwelling individuals aged 40–75 years (n = 3500) in seven towns of Shiga Prefecture, Japan. Collected data were then used to estimate the prevalence of UI and to provide information regarding subtypes of UI, knowledge and self‐perception about UI. Results : The overall response rate was 52.5%. Prevalence of UI for male and female respondents were 10.5% and 53.7%, respectively. The incidence of urge incontinence increased as age increased in the male group. In women, stress incontinence was prevalent at all ages and the incidence of urge incontinence increased over 70 years of age. Urinary incontinence was more likely as activities of daily living limitations and cystitis increased. Women with a history of hysterectomy or diabetes mellitus and men who had stroke were at increased risk for UI. Of those who reported UI, only 3% had ever consulted doctors or other health care professionals concern‐ ing it, 25% recognized their condition as a disease and 38% considered it curable by appropriate treatments. In addition, 63% regarded UI as an unavoidable consequence of aging, 63% con‐ sidered their condition was embarrassing and 54% were reluctant to seek treatment from a health professional. Conclusions : Although UI is common among community‐dwelling individuals over 40 years of age, the majority of affected individuals remained untreated due to lack of knowledge and/or a negative perception of UI. Thus, community education on UI may be needed to increase the number of UI patients who receive treatment.     

Diagnostic Value of 201Tl-chloride Scintigraphy for Thyroid Tumors

Among 114 patients with thyroid disease examined by ²⁰¹Tl-chloridescintigraphy, 101 were given a histological diagnosis. Of 28cases of thyroid carcinoma, 22 (78.6%) were positive. In threeof the 22, an obvious accumulation of ²⁰¹Tl-chloride was revealedin the metastatic lymph nodes of the neck and mediastinum. Only 12 of 50 (24%) cases of thyroid adenoma were positive.In comparison, all cases of hyperthyroidism and chronic thyroiditiswere positive and all cases of subacute thyroiditis were negative.The histological types of thyroid tumor were examined. Of 22cases of papillary carcinoma, 18 (81.8%) were positive. In fourcases which revealed negative figures, the tumor was almostcompletely encysted in three and the tumor was small in theother. Of the adenomas, eight cases of tubular adenoma and threeof trabecular adenoma were all positive, but colloid adenomaand thyroid cyst cases were all negative. It was concluded that ²⁰¹Tl-chloride has no specific affinityfor malignant tumors and cannot be used to discriminate betweencarcinoma and adenoma, but surgery should be indicated for noduleswhich are positive scanning by ²⁰¹Tl-chloride.