Intramucosal Carcinoma in Gastric Adenoma: A Report of Two Cases

Gastric adenomas are uncommon in Japan, especially in comparisonwith carcinoma. Two cases of a minute intramucosal carcinomaarising in adenoma are reported. The adenomas and the adjacentmucosa showed extensive intestinal metaplasia. Both patientsare elderly, and have been well for 2 1/2 and 9 years respectivelyafter surgery. Intramucosal carcinoma of the stomach does occur,though rarely, in adenoma.     

High serum levels of granulocyte-macrophage colony-stimulating factor in patients with liver cirrhosis and granulocytopenia

Summary Leucopenia is often observed in patients with liver cirrhosis. We measured levels of serum granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with liver cirrhosis by a sensitive enzyme linked immunosorbent assay. Eight out of 22 patients with liver cirrhosis had detectable serum GM-CSF (range, 55 to 245 pg/ml:mean, 135 pg/ml). Serum GM-CSF was detected in all patients with a granulocyte count below 2.0 × 10⁹/l, but in only one patient with a granulocyte count above 2.0 × 10⁹/l. Haemoglobin concentration, platelet count, serum albumin, total bilirubin and aminotransferase levels did not correlate with serum GM-CSF levels. These findings may reflect a feedback mechanism between the number of circulating granulocytes and serum GM-CSF levels in patients with cirrhosis.     

Intussusception Caused by Subserosal Lipoma of the Ileum

Abstract: In this study a case of ileal subserosal lipoma with ileocolic intussusception is reported, together with a review of the literature. The patient, a 37-year-old female, was admitted with melena and abdominal pain. A complete blood cell count revealed microcytic anemia. An ultrasonography and CT scan revealed ileocolic intussusception. On colonoscopy, a tumor was seen at the site of the ileocecal valve. Subsequently, the tumor was retracted mechanically using an endoscope. An ileogram taken after retraction revealed the tumor to have been about 50 cm proximal to the ileocecal valve. In addition to the tumor, 6 cm of the ileum was resected. The tumor was 2.5 cm in diameter; the histological diagnosis was subserosal lipoma of the ileum. This is a rare case of intussusception due to an intestinal lipoma diagnosed by various visual examinations before surgery.     

Endoscopic Diagnosis of Colorectal Villous Adenoma

Villous adenoma or adenoma with a predominant villous componentshowed a characteristic finding on macroscopic or endoscopicobservation. The fundamental elements which constitute thisfinding were reddish sulcus and whitish ramified relief similarto the villous pattern normally seen on the mucosa of the smallbowel. We called this feature "V (villous) pattern." A comparativestudy of the endoscopy and pathology of 70 polypoid lesionsof the large intestine was conducted, with the following results:The frequency of the V pattern in the endoscopic picture increasedin proportion to the population of the villous component inhistological picture of the polypoid lesions. However, evenin small polyps the V pattern could be observed when the lesionhad a villous component. Careful and close endoscopic observationmay allow the diagnosis of villous component (which means ahigh frequency of malignancy) of the colorectal polyp even withoutbiopsy. Dr. Makino's present address: Av. Ceará, 335, Belém—Pará,Brasil.     

Six Cases of So-Called Carcinosarcoma of the Esophagus -- Histological and Ultrastructural Study on its Histogenesis --

Histopathological aspects of six cases of so-called carcinosarcomaof the esophagus are reported. Four of the patients had polypoidtumors and the other two had ulcerated lesions. Histologically,every tumor in the six cases was composed of both carcinomatousand "sarcoma-like" elements. The carcinomatous element was squamouscell carcinoma in five cases and anaplastic carcinoma in thesixth. The "sarcoma-like" element was "sarcomatous" proliferationof spindle cells. Histologically transitional features betweencarcinomatous and "sarcoma-like" components were observed inevery tumor. Electron microscopic study of semi-serial sectionsadjacent to toluidine blue-stained histological sections revealedthat the spindle-shaped cells in the "sarcoma-like" tissue wereof squamous epithelial cell origin. Therefore, these findingsled to a conclusion that so-called carcinosarcoma of the esophagusof the six cases was carcinoma associated with "sarcomatous"proliferation of carcinoma cells.     

Relevance of postcatheter removal incontinence to postoperative urinary function after radical prostatectomy

AIM: We examined whether postoperative urinary function after radical prostatectomy is associated with immediate incontinence just after catheter removal. PATIENTS AND METHODS: The current study included 80 patients with clinically localized prostate cancer, who underwent radical retropubic prostatectomy between January 2002 and May 2004. The amount of immediate incontinence was measured with a 24-h pad test just after catheter removal. The patients were categorized into the three groups based on the stratified grade of immediate urinary incontinence: groups I (0 g; 47 patients), II (1-99 g; 23 patients) and III (100 g and above; 10 patients), respectively. Urinary function and bother were assessed by a self-administered questionnaire using the University of California Los Angeles, Prostate Cancer Index at baseline, and at 3, 6 and 12 months postoperatively. The differences in scores of urinary function, bother and clinicopathological parameters were assessed in the three groups with one-way analysis of variance. RESULTS: No significant difference was observed in the clinicopathological parameters in the three groups. Preoperatively significant difference of urinary function scores was not evident and that of urinary bother scores was not observed in the three groups. Postoperatively urinary function scores were significantly different throughout the postoperative periods investigated, whereas difference in urinary bother scores observed at 3 months tended to disappear with time. CONCLUSION: Postcatheter removal incontinence might be related to postoperative urinary function after radical prostatectomy, although further investigation is necessary regarding the criteria for categorization because of a small number of the patients.     

Ammonium acid urate urolithiasis in Japan

AIM: Ammonium acid urate (AAU) calculi are a rare urolithiasis in developed countries but are endemic in developing countries. We assessed the features of AAU urolithiasis in Japanese patients. METHODS: We reviewed hospital charts of patients with urolithiasis who were treated with extracorporeal shock wave lithotripsy and endourological procedures at Sagamidai Hospital (Kanagawa, Japan) from January 1992 to December 2001. On the basis of the results of stone analysis with an infrared spectrophotometer, AAU stones were found. RESULTS: Of 8664 urolithiasis that we reviewed, 33 calculi (0.38%) from 29 patients contained AAU crystals. From crystallographic findings, we defined two types of AAU-containing stones: pure and mixed AAU urolithiasis. Pure AAU urolithiasis were seen in 13 stones from 10 patients and mixed AAU in 20 stones from 19 patients. We found significant differences between the groups: the pure AAU group predominantly consisted of young, thin women and the mixed group consisted of middle-aged men. Laboratory findings showed trends of low levels of serum protein, potassium, and urine pH in the pure AAU group. CONCLUSIONS: Because each type of AAU urolithiasis is associated with different patient characteristics and pathophysiological features, it is important to understand the type of AAU urolithiasis in patients with calculi.