Background: Nodular gastritis (NG) was considered a physiological change with little pathological significance, mostly in young women. In recent years, however, it has been often reported in patients with Helicobacter pylori (H. pylori) infection, or in patients with gastroduodenal ulcer/gastric cancer, suggesting possible clinical significance. Methods: From July 2003 to July 2006, 59 patients were diagnosed with NG among 32 404 patients examined endoscopically. The incidence of NG was evaluated in relation to age, sex, H. pylori infection status, symptoms leading to endoscopy, associated lesions in the upper digestive tract at the time of NG diagnosis, and existence of other systemic conditions. Results: The NG patients consisted of 13 out of 18 152 (0.07%) male patients and 46 out of 14 252 (0.32%) female patients, with a mean age of 45.3 ± 17.7 years. All 28 patients who were examined for H. pylori infection were positive. Endoscopic examination was performed for precordial pain and upper abdominal pain in 24 (40.7%) patients, symptoms of gastroesophageal reflux disease in eight (13.6%) patients, and symptoms of functional dyspepsia in six (10.2%) patients. NG was associated with duodenal ulcer in eight (13.6%) patients, hyperplastic gastric polyps in five (8.5%), gastric ulcer in one (1.7%), and gastric cancer in one (1.7%) patient. Conclusion: NG is a specific gastritis resulting from H. pylori infection that may be strongly associated with H. pylorirelated lesions.

A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for β-catenin. Thus, the tumors were diagnosed as β-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.

Objective

Objective: To assess the usefulness of C-arm cone beam computed tomography (CBCT) combined with ultrasound for the treatment of hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA). Methods: Patients underwent RFA following transcatheter arterial chemoembolization (TACE) or RFA alone under ultrasound or CBCT guidance combined with ultrasound-based techniques. They were divided into 2 groups based on the use (C group) and nonuse (NC group) of CBCT guidance. The technical success of RFA and local tumor progression after the first RFA session were evaluated by dynamic contrast-enhanced imaging methods. Between-group differences were assessed retrospectively. Results: We enrolled 198 patients with 260 HCC nodules. The complete ablation rates were 63.0 and 89.4% in the NC and C groups, respectively. In log-rank testing, local tumor progression occurred significantly more often in the NC group when RFA was used without TACE, in males when des-gamma-carboxy prothrombin was ≥29 mAU/mL, and when the diameter of a nodule was ≥18 mm. On Cox proportional-hazards regression analysis, the NC group, RFA alone without TACE, and male gender were significant independent variables. Conclusion: TACE followed by RFA under CBCT and ultrasound guidance improves the reliability of ablation of target HCC nodules, reduces the need for additional treatment sessions, and prevents local tumor progression.

Background: Bronchoscopic examinations are vital to diagnose pulmonary diseases. However, as coughing is triggered during and after the procedure, it is imperative to take measures against nosocomial infections, especially for airborne infections like tuberculosis (TB). The interferon-γ release assay (IGRA) has recently been established as a method to evaluate the infection status of TB. We aimed to ascertain the efficacy of IGRA and clinical findings in estimating the prevalence of active TB before bronchoscopy.Methods: We obtained IGRA results from 136 inpatients using a QuantiFERON-TB Gold In-Tube test.Bronchoscopy samples were cultured in Mycobacteria Growth indicator tubes and 2% Ogawa solid medium.We evaluated the adjusted effects of multiple clinical variables on active TB status using a logistic regression model. In addition, multiple variables were converted into a decision tree to predict active TB. Results: Five (3.7%) patients were diagnosed with culture-positive TB, two of whom were simultaneously diagnosed with non-small-cell lung carcinoma or small-cell lung carcinoma. The multivariate analysis suggested the probability of predicting active TB using the IGRA [odds ratio (OR), 72.7; 95% confidence interval (CI), 3.169-1668; P=0.007] and decreased estimated glomerular filtration rate (eGFR) (OR, 0.937; 95% CI, 0.882-0.996; P=0.038) in patients undergoing bronchoscopy. A decision tree validated the use of these two variables to predict active TB. Conclusions: IGRA test results are useful for predicting active TB before bronchoscopy. This strategy could identify patients who require antibiotic therapy to prevent TB or who are in the active phase of TB.