The prevalence of small intestinal polyps in patients with familial adenomatous polyposis: a prospective capsule endoscopy study

Familial adenomatous polyposis (FAP) is a genetic disorder in which multiple colorectal polyps and cancers develop. However, the prevalence of small intestinal tumors in patients with FAP remains unclear. We elucidated the prevalence of polyps in the small intestine and duodenum using capsule endoscopy (CE). Patients with FAP receiving a periodic screening colonoscopy at Kyoundo Hospital were encouraged to participate in the study. All study participants underwent esophagogastroduodenoscopy (EGD) within 2 weeks before CE. Outcome measurements were the prevalence of duodenal polyps (DP) and small intestinal polyp (SIP), detectability of the ampulla of Vater, and concordance of the duodenal findings between CE and EGD. Twenty-three patients (mean age, 47 years; 15 males) were enrolled in the study. CE showed DPs in 11 patients (52 %) and SIPs in nine patients (43 %). The mean numbers of DPs and SIPs was 11.5 ± 6.2 and 11.9 ± 10.9, respectively. SIPs were more often detected in patients with DPs versus those without (62 vs. 13 %, P = 0.07). The ampulla of Vater was observed by CE in four patients (21 %). EGD showed DPs in 13 patients (62 %). EGD missed DPs in two of 11 patients with DPs detected by CE. EGD found DPs in four of 10 patients without DPs using CE. The kappa index was 0.422. Patients with FAP have a high prevalence of polyps in the small intestine. Although the clinical significance of small intestinal polyps remains unclear, patients with FAP seem to be good candidates for CE.     

Endotoxic activity and enterotoxigenicity of human strains of Campylobacter jejuni isolated from patients in a Nigerian hospital

Limulus gelation assay and dermal Schwartzman reaction provided a sensitive and reproducible means of testing the endotoxic activity of hospital strains of Campylobacter jejuni in Lagos, Nigeria. All the 22 isolates of Campylobacter jejuni tested for the limulus gelation assay were positive for the production of endotoxin. Furthermore, the Campylobacter suspensions caused a positive dermal Schwartzman reaction in rabbits. The area of skin reaction was less extensive than that produced by Escherichia coli 01114B and E7539/77 which served as positive controls. Five local strains of Campylobacter jejuni tested for enterotoxin production showed negative reaction in the infant mouse test whereas enterotoxin production was observed in Campylobacter jejuni strain 11168 and Escherichia coli E7539/77. Consequently, the infant mouse test may not be suitable for enterogenicity testing of our local isolates of Campylobacter jejuni.     

Two species of antiganglioside antibodies in a patient with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome.

A patient with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome had anti-GT1a and anti-GD1a antibodies (IgG) in the serum. The activities of anti-GT1a antibodies were stronger than anti-GD1a antibodies and their activities declined later in the clinical course. These two different antibodies bound independently to each ganglioside in an absorption study with polystyrene beads coated with GT1a or GD1a.     

Bilateral Panuveitis in HIV-1-Infected Patients with CD8 Lymphocytosis

Aims: To report the presence of HIV-1-infected patients with bilateral panuveitis, CD8 lymphocytosis, and an absence of parotid involvement. Methods: Case series of four HIV-1-infected patients naive to antiretroviral treatment. Results: Four patients with symptomatic panuveitis are presented. Ocular, systemic, and investigation findings are reported. Recognised causes of panuveitis were excluded. All patients showed a clinical response to steroids and antiretroviral therapy. Conclusions: Symptomatic panuveitis may occur in HIV-1-infected individuals with CD8 lymphocytosis in the absence of a recognised cause. These patients have clinical features that resemble diffuse infiltrative lymphocytosis syndrome and may represent a subgroup of this syndrome.     

Pulmonary arterial hypertension in pregnancy

Pulmonary hypertension is a medical condition characterized by elevated pulmonary arterial pressure and secondary right heart failure. Pulmonary arterial hypertension is a subset of pulmonary hypertension, which is characterized by an underlying disorder of the pulmonary arterial vasculature. Pulmonary hypertension can also occur secondarily to structural cardiac disease, autoimmune disorders, and toxic exposures. Although pregnancies affected by pulmonary hypertension and pulmonary arterial hypertension are rare, the pathophysiology exacerbated by pregnancy confers both high maternal and fetal mortality and morbidity. In light of new treatment modalities and the use of a multidisciplinary approach to care, maternal outcomes may be improving.     

Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients

BACKGROUND: The prognosis of hepatocellular carcinoma (HCC) is highly dependent on tumour extension and liver function. Recently, two new prognostic scoring systems-the CLIP score, developed by Italian investigators and the BCLC score, developed in Barcelona-have been widely used to assess prognosis in patients presenting with hepatocellular carcinoma. Each system has its own relative limitations. AIMS: To create a new prognostic scoring system which is simple, easy to calculate, and suitable for estimating prognosis during radical treatment of early HCC. METHODS: A total of 403 consecutive patients with HCC treated by percutaneous ablation at the Department of Gastroenterology, University of Tokyo Hospital, between 1990 and 1997 were used as the training sample to identify prognostic factors for our patients and used to develop the Tokyo score. As a testing sample, 203 independent patients who underwent hepatectomy at the Department of Hepato-Biliary-Pancreatic Surgery were studied. Prognostic factors were analysed by univariate and multivariate Cox proportional hazard regression. RESULTS: The Tokyo score consists of four factors: serum albumin, bilirubin, and size and number of tumours. Five year survival was 78.7%, 62.1%, 40.0%, 27.7%, and 14.3% for Tokyo scores 0, 1, 2, 3, and 4-6, respectively. The discriminatory ability of the Tokyo score was internally validated by bootstrap methods. The Tokyo score, CLIP score, and BCLC staging were compared by Akaike information criterion and Harrell's c index among training and testing samples. In the testing sample, the predictive ability of the Tokyo score was equal to CLIP and better than BCLC staging. CONCLUSIONS: The Tokyo score is a simple system which provides good prediction of prognosis for Japanese patients with HCC requiring radical therapy.