Human intestinal spirochetosis is a common condition in Western countries, but is not well recognized in Japan. To demonstrate the incidence and clinicopathologic findings of human intestinal spirochetosis in Japan, we retrospectively investigated biopsy, and endoscopically or surgically resected specimens of the large intestine. Among a series of 2556 samples, 11 cases of human intestinal spirochetosis were detected (0.4%). Together with additional nine cases sporadically found, 20 cases of human intestinal spirochetosis were subjected to molecular detection of two strains of spirochetes (Brachyspira aalborgi and Brachyspira pilosicoli) by amplifying species-specific portion of 16S ribosomal RNA and NADH oxydase gene by polymerase chain reaction. B. aalborgi was detected in all cases examined, three of which revealed dual infection of both species. Our results suggest that human intestinal spirochetosis infection is relatively rare, and B. aalborgi is the most prevalent species in Japan. Most of human intestinal spirochetosis were asymptomatic, although symptomatic in exceptional cases. In addition, we emphasize a usefulness of immunostaining with anti-Treponema pallidum and anti-Mycobacterium bovis polyclonal antibodies for detecting the spirochetes.

Sitafloxacin showed MICs of less than or equal to 0.5 g/ml against 105 isolates of Helicobacter pylori, including 44 isolates with mutations in the gyrA gene. The highest MICs for garenoxacin and levofloxacin were 8 and 64 times, respectively, higher than the highest MICs observed for sitafloxacin.The guidelines for the management and treatment of Helicobacter pylori infections established by the European Helicobacter Study Group Third Masstricht Consensus Report recommend an eradication antimicrobial chemotherapy consisting of amoxicillin, clarithromycin, and a proton pump inhibitor alone or in combination with metronidazole and clarithromycin (10). On the other hand, a trend toward increased clarithromycin resistance in Japan has been reported (8); furthermore, high metronidazole resistance rates associated with H. pylori eradication failure have been seen in the United States, Europe, and Asia with the exception of Japan (11). In the search for alternative eradication treatment regimens, it has been recently reported in the United States and Europe that levofloxacin may be efficacious in H. pylori eradication therapy (7, 13). At the same time, the increased use of levofloxacin-based eradication regimens has led to increasing resistance to levofloxacin in H. pylori as a result of mutations in the quinolone resistance-determining region (QRDR) of the gyrA gene correlating with the decreased effectiveness of levofloxacin in eradication regimens (16). Sitafloxacin is a recently developed fluoroquinolone with wide-spectrum activity, ranging from gram-positive cocci to gram-negative bacilli (1, 15). We studied the effect of mutations in the gyrA gene and its impact on the antimicrobial activity of sitafloxacin in H. pylori.(This study was presented at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, 25 to 28 October 2008.)A total of 105 H. pylori isolates were recovered from the gastric mucosa of patients presenting with gastroduodenal diseases in health care facilities in Japan between 2004 and 2005. Of the 105 patients, 57 (54.3%) were males and 48 (45.7%) were females, and the average age was 57.9 years (range in age from 21 to 84). None of the patients had previously undergone eradication therapy. The spectrum of peptic ulcers included 39 (37.1%) cases of chronic gastritis, 21 (20.0%) gastric ulcers, 18 (17.1%) duodenal ulcers, 9 (8.6%) gastric cancers, 8 (7.6%) gastroduodenal ulcers, and 10 (9.5%) cases with other causes or an unspecified diagnosis. Only one isolate per patient was included among the 105 isolates.Susceptibilities to sitafloxacin (Daiichi Sankyo, Japan), garenoxacin [a novel des-fluoro(6)quinolone (Astellas, Japan) (6)], and levofloxacin (Daiichi Sankyo, Japan) were determined by agar dilution method according to CLSI guidelines by using drugs with known potency (4, 5). The agar dilution method was performed by serial twofold dilution on MuellerHinton agar (Becton Dickinson, MD) with 5% sheep blood using 1 to 3 l of a McFarland 2.0-adjusted inoculum and

The final diagnosis was cutaneous myoepithelial carcinoma. At present, it seems to be difficult to predict the behavior of myoepithelioma of the skin and soft tissue, although atypia and high mitotic rate are reported to be associated with local recurrence and metastasis.

Mutations in CTNNB1, APC, AXIN1, and AXIN2 are not implicated in nuclear accumulation of beta-catenin, and that the expression of cyclin D1 is accelerated independently of beta-catenin in ameloblastomas. Other Wnt signaling members or alternative pathways involved in the degradation of beta-catenin should be subject of further investigation.

Gangliocytic paragangliomas are exceedingly rare tumors that arise in close proximity to the papilla of Vater. There are few reports of the endoscopic resection of duodenal gangliocytic paraganglioma. A 61-year-old woman was admitted with a complaint of melena. Endoscopic examination revealed a pedunculated submucosal tumor with erosion in the third portion of the duodenum. Hemostasis, using a gold probe, was performed. Nine days later, we successfully resected the tumor, using endoscopic polypectomy. To determine the depth of tumor invasion, endoscopic ultrasonography was used. The size of the tumor was 3.0 x 2.5 x 1.0 cm. A total of 25 cases of duodenal gangliocytic paraganglioma have been reported in Japan. Generally, this tumor is considered benign. However, resection was performed in many patients because preoperative diagnosis was impossible. In Japan, no previous studies have reported using endoscopic hemostasis, to our knowledge. Our patient is the fourth in Japan to be treated by endoscopic resection. We report on our patient, with a review of the literature.