Subphrenic splenic implantation after splenectomy： A case report / 中南大学学报(医学版)

Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University. Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography (CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery (NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.

Pólipos gástricos: experiencia en el hospital Daniel Alcides Carrión - Callao 2014-2016 / Gastric polyps: experience in Daniel Alcides Carrion Hospital 2014-2016

Objetivos: El propósito de este estudio fue determinar la prevalencia y las características endoscópicas e histopatológicas de los distintos tipos de pólipos gástricos en el Hospital Daniel Alcides Carrión entre los años 2014-2016. Materiales y métodos: Se revisó 7559 reportes endoscópicos, donde se encontró 148 pólipos gástricos y se consignó datos de edad, sexo, localización, número de lesiones, tamaño, y aspectos macroscópicos y microscópicos de la lesión. Resultados: La prevalencia de pólipos gástricos fue 1,9%; el 74,3% de estos se presentaron en mujeres donde la edad promedio fue de 61,5 años. El 59,46% de los pólipos gástricos fueron únicos, la mayoría localizándose en el antro y cuerpo del estómago. El 74,29% de pólipos fueron menores de 1 cm en diámetro y el 83,64% tenían un aspecto macroscópico sésil. Con respecto al tipo histológico, se encontró que la mayoría de los pólipos gástricos en esta población son hiperplásicos (76,4%), seguidos por los de glándulas fúndicas (17,5%) y la minoría fueron adenomas (6,1%). Cabe resaltar que los pólipos múltiples fueron en su gran mayoría de tipo de glándulas fúndicas mientras que en los demás tipos histológicos predominó el pólipo único. Conclusión: La prevalencia de pólipos de glándulas fúndicas ha aumentado, mientras los otros tipos de pólipos han mantenido su prevalencia esperada.

Objective: The purpose of this study was to determine the prevalence of the different types of gastric polyps in the Daniel Alcides Carrión Hospital between the years of 2014 and 2016, and also define the endoscopic and histopathological characteristics of the lesions. Materials and methods: 7559 endoscopic reports were reviewed, in which 148 gastric polyps were found. The patients' age and sex as well as the localization, number, size and macroscopic and microscopic aspects of the polyps were recorded. Results: The prevalence of gastric polyps was 1.9%; 74.3% of these were found in women with an average age of 61.5 years. 59.4% of the gastric polyps found were singular, and the majority were located on the body and antrum of the stomach. 74.29% of the polyps were less than 1 cm in diameter and 83.64% of these were sessile when seen macroscopically. According to the histological type, it was found that the majority of gastric polyps were hyperplasic (76.4%), followed by fundic gland polyps (17.5%) and gastric adenomas (6.1%). It was also found that multiple gastric polyps were associated with fundic gland polyps while singular polyps were most likely hyperplastic or adenomas. Conclusion: The prevalence of fundic gland polyps has increased, while the other types of polyps have maintained their estimated prevalence.

Asymptomatic Localized Gastric Amyloidosis with Two Separate Lesions

Amyloidosis is a disease in which amyloid is abnormally accumulated in the tissue. The kidney and heart are the most commonly involved organs. Gastric involvement is relatively common in systemic disease; however, localized gastric amyloidosis is rare. Here, we report a case of localized gastric amyloidosis with two separate lesions. A 56-year-old woman underwent a health surveillance checkup without any noticeable symptoms. She was under medication for diabetes and dyslipidemia, and was otherwise healthy. On surveillance upper endoscopy, an irregularly shaped hyperemic elevated erosion at the gastric fundus and a 1.5-cm, yellowish subepithelial tumor-like lesion with intact overlying mucosa at the lesser curvature of the lower body of the stomach were detected. Endoscopic biopsy revealed submucosal eosinophilic material deposition in both lesions. Congo-red staining showed amyloid deposit appearing as a yellow-green birefringence under polarizing microscopy. Echocardiography, abdominal sonography, and colonoscopy revealed no abnormality. The patient was diagnosed as having localized gastric amyloidosis and is now undergoing regular follow-up without any treatment. Localized gastric amyloidosis is a rare disease that may mimic nonspecific gastritis or subepithelial tumor. However, endoscopic biopsy with appropriate staining may be diagnostic and thorough evaluation for systemic involvement is important.

Lesão de Dieulafoy do fundo gástrico / Dieulafoys lesion of the gastric fundus

Hemorragia digestiva alta (HDA) é uma emergência clínica exteriorizada através de melena, hematêmese, além de alterações hemodinâmicas decorrentes de perda volêmica. Existem vários diagnósticos etiológicos causadores de hemorragias digestivas altas; dentre eles, uma causa rara é lesão de Dieulafoy, sendo relacionada acerca de 2% dos casos de HDA. Neste relato, descreveremos um caso de lesão de Dieulafoy, evidenciando a relevância desta lesão como um importante diagnóstico diferencial nas causas de hemorragia digestiva alta. O procedimento diagnóstico e o manejo atual são fundamentados pela endoscopia digestiva alta. A hemostasia endoscópica é realizada, utilizando técnicas como eletrocoagulação, injeções com adrenalina e hemoclips.

Upper gastrointestinal bleeding (UGBI) is a clinical emergency externalized through melena, hematemesis and hemodynamic changes due to volume loss. There are a lot of etiological diagnosis of gastroduodenal hemorrhages, including Dieulafoy which is a rare cause related about 2% of the UGBI cases. In this report we describe a case of Dieulafoy lesion highlighting the importance of this lesion as a rare and important differential diagnosis in cases of upper gastrointestinal bleeding. The current diagnostic and management is justified by endoscopy. Endoscopic hemostasis is performed using techniques such as electrocoagulation, injections of adrenaline and hemo-clips.

Polipose gástrica / Gastric polyposis

Paciente do sexo feminino, com 54 anos, branca, com obesidade grau I, portadora de dispepsia crônica, dependente do uso de Omeprazol para o satisfatório controle do quadro dispéptico. Submetida à endoscopia digestiva alta que evidenciou um pregueado mucoso bem distribuído, incisura gástrica integra, hiperemia leve difusa da mucosa gástrica, com vários pólipos sésseis medindo aproximadamente entre 0,5 e 2,5 cm, difusos em corpo e fundo gástrico, com o piloro pérvio e duodeno sem alterações. O exame anatomopatológico de uma amostra dos pólipos evidenciou a presença de pólipo gástrico de glândulas fúndicas, com pesquisa do Helicobacter pylori negativo.

Application of endoscopic full-thickness resection in the treatment of gastric tumors originated from the muscularis propria / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the curative effect and safety of endoscopic full-thickness resection (EFR) in the treatment of gastric tumor originated from the muscularis propria.
@*METHODS@#Clinical data were collected from 34 patients, who underwent EFR of gastric tumor originated from muscularis propria, to observe the resection rate and complications from November 2012 to August 2014.
@*RESULTS@#Of the 34 patients, 15 were male, 19 were female, with the age of 38.3-70.6 (52.3±4.3) years old. The lesions of 25 patients located in the fundus of stomach and the rest was in the gastric body. EFR was successfully performed in the 34 patients with no need for surgery. The complete resection rate was 100%. Lesion diameter ranged from 1.0 to 5.0 (2.8±1.2) centimeters. The operation time was 50-100 (76.5±18.2) min. Patients with pneumoperitoneum were relieved after abdominal puncture exhaust, without post-operation bleeding and perforation. The hospitalization duration was 3-5 (3.6±0.8) days. Except 1 case, the remaining 33 cases were spindle cell tumors, consistent with the results of immunohistochemistry. The risk for two lesions with 4.5 cm and 5.0 cm was moderate. The risk of invasion was low or very low in the remaining 31 cases. Among them, 2 stromal tumors near the cardia showed a differentiation tendency toward smooth muscle. No lesion residual or recurrence happened during the follow-up period (range 5-23 months) in 34 cases. 
@*CONCLUSION@#EFR is a safe and effective method for gastric tumor originated from muscularis propria.

Gastrointestinal Stromal Tumor of the Stomach Presenting as Multilobular with Diffuse Calcifications

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract and usually appear as a well-circumscribed mass. However, it may be difficult to confirm the extent of the disease for some GISTs. A 70-year-old asymptomatic female presented for a regular physical exam. An esophagogastroduodenoscopy showed a 2.0 cm protruding mass on the gastric fundus. Endoscopic ultrasound revealed an ill-defined heterogenous hypoechoic lesion (3.0×1.5 cm). A computed tomography (CT) scan demonstrated a 4.5 cm multifocal calcified mass at the gastric body as well as at the gastric fundus. Laparoscopic gastric wedge resection was performed according to the extent of multifocal calcifications that are shown on the CT. Intraoperative specimen mammography and intraoperative biopsy might be helpful to obtain a tumor-free margin. Final pathologic diagnosis was an intermediate risk GIST in multilobular form. In patients with diffuse multifocal calcifications in the stomach, the possibility of GIST should be considered.

Fundal Variant of Adenomyomatosis of the Gall Bladder: An Uncommon Entity.

Adenomyomatosis of the gallbladder is a benign and degenerative condition of the gallbladder. It is an incidental finding in gall bladder specimens resected for chronic cholecystitis or cholelithiasis. It frequently occurs after 3rd or 4th decade of life and is often an incidental finding in cholecystectomy specimens resected for chronic cholecystitis or cholelithiasis. Patients with adenomyomatosis are usually asymptomatic it can be classified into three types: Segmental, fundal and diffuse types. The fundal variant is uncommon compared to the other two types. Here, in we present a case of a fundal variant of adenomyomatosis of the gall bladder in a 65-year-old male patient.

Extragastroesophageal Malignancy-Associated Secondary Achalasia: A Rare Association of Pancreatic Cancer Rendering Alarm Manifestation

Secondary achalasia or pseudoachalasia is a rare esophageal motor abnormality, which mimics primary achalasia; it is not easily distinguishable from idiopathic achalasia by manometry, radiological examination, or endoscopy. Although the majority of reported pseudoachalasia cases are associated with neoplasms at or near the esophagogastric (EG) junction, other neoplastic processes or even chronic illnesses such as rheumatoid arthritis can lead to the development of pseudoachalasia, for example, mediastinal masses, gastrointestinal (GI) tumors of the liver and biliary tract, and non-GI malignancies. Therefore, even if a patient presents with the typical findings of achalasia, we should be alert to the possibility of other GI malignancies besides EG tumors. For instance, pancreatic cancer was found in the case reported here; only four such cases have been reported in the literature. A 47-year-old man was admitted to our center with a 3-month history of dysphagia. His endoscopic and esophageal manometric findings were compatible with primary achalasia. However, unresponsiveness to diverse conventional achalasia treatments led us to suspect secondary achalasia. An active search led to a diagnosis of pancreatic mucinous cystadenocarcinoma invading the gastric fundus and EG junction. This rare case of pseudoachalasia caused by pancreatic carcinoma emphasizes the need for suspecting GI malignancies other than EG tumors in patients refractory to conventional achalasia treatment.

Endoscopic Ultrasonographic Characteristics of Gastric Schwannoma Distinguished from Gastrointestinal Stromal Tumor / 대한소화기학회지

BACKGROUND/AIMS: Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. METHODS: A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. RESULTS: GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada's classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. CONCLUSIONS: The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.

Responses to Enteric Motor Neurons in the Gastric Fundus of Mice With Reduced Intramuscular Interstitial Cells of Cajal

BACKGROUND/AIMS: Interstitial cells of Cajal (ICC) play important functions in motor activity of the gastrointestinal tract. The role of ICC as pacemakers is well established, however their participation in neurotransmission is controversial. Studies using mutant animals that lack ICC have yielded variable conclusions on their importance in enteric motor responses. The purpose of this study was to: (1) clarify the role of intramuscular ICC (ICC-IM) in gastric motor-neurotransmission and (2) evaluate remodeling of enteric motor responses in W/W(V) mice. METHODS: Kit immunohistochemistry and post-junctional contractile responses were performed on fundus muscles from wild-type and W/W(V) mice and quantitative polymerase chain reaction (qPCR) was used to evaluate differences in muscarinic and neurokinin receptor expression. RESULTS: Although ICC-IM were greatly reduced in comparison with wild-type mice, we found that ICC-IM persisted in the fundus of many W/W(V) animals. ICC-IM were not observed in W/W(V) group 1 (46%) but were observed in W/W(V) group 2 (40%). Evoked neural responses consisted of excitatory and inhibitory components. The inhibitory component (nitrergic) was absent in W/W(V) group 1 and reduced in W/W(V) group 2. Enhanced excitatory responses (cholinergic) were observed in both W/W(V) groups and qPCR revealed that muscarinic-M3 receptor expression was significantly augmented in the W/W(V) fundus compared to wild-type controls. CONCLUSIONS: This study demonstrates that ICC-IM mediate nitrergic inhibitory neurotransmission in the fundus and provides evidence of plasticity changes in neuronal responses that may explain discrepancies in previous functional studies which utilized mutant animals to examine the role of ICC-IM in gastric enteric motor responses.

Nitrergic Pathway Is the Major Mechanism for the Effect of DA-9701 on the Rat Gastric Fundus Relaxation

BACKGROUND/AIMS: DA-9701 significantly improved gastric accommodation by increasing the postprandial gastric volume. In this study, we investigated how DA-9701 affects the rat gastric fundus relaxation. METHODS: Gastric fundus muscle strips (9 longitudinal and 7 circular muscles) were obtained from rats. Electrical field stimulation (EFS) was performed at various frequencies (1, 5, 10 and 20 Hz) and train durations (1, 5, 10 and 20 seconds) to select optimal condition for experiments. Isometric force measurements were performed in response to EFS. Peak and nadir were observed during the first 1 minute after initiation of EFS in control state and after sequential addition of atropine (1 microM), DA-9701 (0.5, 5, 25 and 50 microg), N-nitro-L-arginine (L-NNA, 100 microM), MRS2500 (1 microM) and tetrodotoxin (TTX, 1 microM) to the organ bath. RESULTS: The optimal frequency and duration of EFS to evoke nerve-mediated relaxation was determined as 5 Hz for 10 seconds. Addition of L-NNA in the presence of atropine and DA-9701 (50 microg) decreased nadir by inhibiting relaxation from -0.054 +/- 0.021 g to -0.022 +/- 0.015 g (P = 0.026) in longitudinal muscles. However, subsequent application of MRS2500 in the presence of atropine, DA-9701 (50 microg) and L-NNA did not affect nadir. In circular muscles, subsequent addition of L-NNA and MRS2500 in the presence of atropine and DA-9701 (50 microg) did not show significant change of nadir. CONCLUSIONS: Our data suggest that the effect of DA-9701 on the rat gastric fundus relaxation is mainly mediated by nitrergic rather than purinergic pathway.

A Rare Presentation of Metastasis of Prostate Adenocarcinoma to the Stomach and Rectum

Prostate cancer is the second most common cause of cancer death in men in the United States. The most common sites of metastasis include the bone, lymph nodes, lung, liver, pleura, and adrenal glands, whereas metastatic prostate cancer involving the gastrointestinal tract has been rarely reported. A 64-year-old African-American man with a history of prostate cancer presented with anemia. He reported the passing of dark colored stools but denied hematemesis or hematochezia. Colonoscopy revealed circumferential nodularity, and histology demonstrated metastatic carcinoma of the prostate. Esophagogastroduodenoscopy showed hypertrophic folds in the gastric fundus, and microscopic examination revealed tumor cells positive for prostate-specific antigen. Bone scanning and computed tomography of the abdomen and pelvis did not show metastasis. It is crucial to distinguish primary gastrointestinal cancer from metastatic lesions, especially in patients with a history of cancer at another site, for appropriate management.

Sporadic fundic gland polyps are not associated with proton pump inhibitors therapy but negatively correlate with Helicobacter pylori infection in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sporadic fundic gland polyps (FGPs) are common gastric polyps. Some studies reported that FGPs dramatically increased due to proton pump inhibitors (PPIs) use and a decreased prevalence of Helicobacter pylori (H. pylori) infection in Western countries. However, data are still controversial. This study aimed to identify the relationships between these two factors and FGPs in China.</p><p><b>METHODS</b>Consecutive patients with FGPs detected were retrospectively analyzed. Data including patients' age, sex, symptoms, H. pylori infection, history of PPIs use, and the polyps were documented. Each patient was compared with two randomly selected age- and sex-matched controls with similar symptoms in the same period.</p><p><b>RESULTS</b>During the period from March 2011 to March 2012, a total of 328 patients were diagnosed as FGPs in 23 047 patients who underwent routine esophagogastroduodenoscopy and 656 patients without FGPs as controls. The mean age was (55.12±12.61) years, and 75.91% were women. The prevalence of H. pylori in patients with FGPs was significantly lower than in those without FGPs (22.30% (64/287) vs. 42.26% (224/530), P < 0.001, OR 0.392, 95% CI 0.283-0.544). Overall, a total of 54 patients with FGPs (54/328, 16.46%) and 136 patients without FGPs (136/656, 20.73%) received PPIs therapy (P = 0.110). According to the different duration of PPIs use, no significant differences of PPIs use were found between the cases and controls among all subgroups. Moreover, the PPIs use was also similar, regardless of age, sex, H. pylori infection, and the number of polyps.</p><p><b>CONCLUSION</b>Sporadic FGPs may not be induced by PPIs therapy but negatively correlate with H. pylori infection in China, which is not the same with the data in Western countries.</p>

The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis

BACKGROUND/AIMS: The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. METHODS: In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. RESULTS: There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). CONCLUSIONS: Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.

safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single Canadian tertiary care centre

Bleeding from Gastric Varices [GV] is not only life threatening, but also leads to many hospitalizations, contributes to morbidity and is resource intensive. GV are difficult to diagnose and their treatment can be challenging due to their location and complex structure. To assess the safety and efficacy of endoscopic gastric fundal variceal gluing using periodic endoscopic injections of N-butyl-2-cyanoacylate [NBCA] and to assess the utility of endoscopic ultrasound [EUS] in assessing for the eradication of GV post-NBCA treatment. Analysis of prospectively collected data of a cohort of patients with GV who underwent periodic endoscopic variceal gluing from 2005 to 2011. Outcomes included success of GV obliteration, incidence of rebleeding, complications from the procedure, and analysis of factors that might predict GV rebleeding. The success of GV eradication was assessed by both EUS and direct endoscopy. The cohort consisted of 29 consecutive patients that had undergone NBCA injection for GV. The mean age was 60.8 years standard deviations [SD 13.3, range 20-81]. The average follow-up was 28 months [SD 19.61, range 1-64] and the most common cause for GV was alcoholic liver cirrhosis [34.48%]. A total of 91 sessions of NBCA injections were carried out for 29 patients [average of 3.14 sessions/patient, SD 1.79, range 1-8] with a total of 124 injections applied [average of 4.28 injections/patient, SD 3.09, range 1-13]. 24 patients were treated for previously documented GV bleeding while five were treated for primary prevention. Overall, 79% of patients were free of rebleeding once three sessions of histoacryl[registered sign] injection were completed. None of the patients treated for primary prevention developed bleeding during follow-up. 11 of the 24 patients [46%] with previous bleeding however had rebleeding. 4/11 [36%] patients had GV rebleeding while awaiting scheduled additional NBCA sessions. 19/29 [60%] patients had complete eradication of GV, 11/19 [58%] documented by endoscopic assessment alone, 4/19 [21%] by EUS alone and 4/19 [21%] by both techniques. Two of the 11 [18%] patients that had rebleeding had recurrence of GV bleeding after documented eradication by EUS compared to 5/11 [45%] patients documented eradication by endoscopic assessment and 2/11 [18%] patients that had rebleeding after documented eradication by both modalities. Twenty five patients in total had documented residual GV by EUS [14, 56%], direct endoscopic assessment [18, 72%] or both modalities [9, 36%], two of which developed recurrent bleeding [13%]. No immediate or long-term complications of NBCA injection occurred, nor any related endoscopic complications were reported in any of these cases during the time of follow-up. NBCA injection of GV is a safe and successful therapeutic intervention. A minimum of three endoscopic sessions is required to significantly decrease the risk of bleeding/rebleeding. In this small sample of patients, neither EUS nor direct endoscopic assessment was reliable in predicting the recurrence of GV bleeding

Manejo de pólipos gástricos / Management of gastric polyps

Most of gastric polyps are benign and do not need specific treatment. However, some types have significant malignant potential that can lead to gastric cancer if they are not managed appropriately. The malignant potential depends on the histological type of the polyp, therefore it is important to sample and make biopsies.

La mayoría de los pólipos gástricos son benignos y no requieren tratamiento específico; no obstante, algunos de ellos pueden malignizarse. Si estos pólipos no son tratados pueden ser causa de cáncer gástrico. El potencial maligno depende del tipo histológico del pólipo, por lo que estas lesiones debieran ser siempre biopsiadas.

High K(+)-Induced Relaxation by Nitric Oxide in Human Gastric Fundus

This study was designed to elucidate high K(+)-induced relaxation in the human gastric fundus. Circular smooth muscle from the human gastric fundus greater curvature showed stretch-dependent high K+ (50 mM)-induced contractions. However, longitudinal smooth muscle produced stretch-dependent high K(+)-induced relaxation. We investigated several relaxation mechanisms to understand the reason for the discrepancy. Protein kinase inhibitors such as KT 5823 (1 microM) and KT 5720 (1 microM) which block protein kinases (PKG and PKA) had no effect on high K(+)-induced relaxation. K+ channel blockers except 4-aminopyridine (4-AP), a voltage-dependent K+ channel (KV) blocker, did not affect high K(+)-induced relaxation. However, N(G)-nitro-L-arginine and 1H-(1,2,4)oxadiazolo (4,3-A)quinoxalin-1-one, an inhibitors of soluble guanylate cyclase (sGC) and 4-AP inhibited relaxation and reversed relaxation to contraction. High K(+)-induced relaxation of the human gastric fundus was observed only in the longitudinal muscles from the greater curvature. These data suggest that the longitudinal muscle of the human gastric fundus greater curvature produced high K(+)-induced relaxation that was activated by the nitric oxide/sGC pathway through a KV channel-dependent mechanism.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.