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1.
ACG Case Rep J ; 10(5): e01061, 2023 May.
Article in English | MEDLINE | ID: mdl-37235001

ABSTRACT

A sebaceous carcinoma is rarely seen in extracutaneous sites. We present a 75-year-old man who was admitted with epigastralgia and melena. Endoscopic examination revealed an ulcer on the posterior wall of the gastric antrum, and distal gastrectomy was performed. Histopathological examination revealed thin to thick trabeculae of polygonal cells with scattered foci of foamy cells, whereas Sudan 3 staining showed lipid vacuoles. Immunohistochemistry was positive for both p40 and SALL4. After considering these findings, we suggest sebaceous differentiation as the diagnosis. To the best of our knowledge, this is the first case of gastric carcinoma with sebaceous differentiation.

2.
Digestion ; 83(3): 198-203, 2011.
Article in English | MEDLINE | ID: mdl-21266816

ABSTRACT

BACKGROUND AND AIM: Immunosuppressive drugs are recommended for use as replacements of steroid therapy in sustaining remission of steroid-dependent ulcerative colitis (UC). However, discontinuation of these therapeutic agents leads to a high relapse, and their long-term administration has not been proven safe. A newly introduced antibiotic combination therapy led to improvement and remission of active UC. The aim of this study is to examine whether this new therapy can replace immunosuppressive agents and allow discontinuation of steroids in steroid-dependent UC remission. METHODS: 48 patients with steroid-dependent UC were recruited for a 2-week treatment with amoxicillin, tetracycline, and metronidazole (ATM). Examination of clinical symptoms, endoscopy, and histological evaluation were performed before and 6 and 12 months after treatment. RESULTS: The proportion of patients who showed clinical improvement at 6 and 12 months after treatment was 54.2% (26/48) and 75.0% (36/48), respectively. The rate of clinical remission at 6 and 12 months was 31.3% (15/48) and 37.5% (18/48), respectively. Steroid withdrawal was attained in 64.6% (31/48) and 70.8% (34/48) of patients at 6 and 12 months, respectively. Endoscopic improvement was detected in 56.3% (27/48), and histological improvement was detected in 52.1% (25/48) at the final observation point for each patient. CONCLUSION: The triple antibiotic therapy resulted in improvement, remission, and steroid withdrawal in steroid-dependent UC patients.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Colitis, Ulcerative/drug therapy , Glucocorticoids/therapeutic use , Adolescent , Adult , Aged , Amoxicillin/administration & dosage , Azathioprine/administration & dosage , Drug Therapy, Combination , Female , Humans , Immunosuppressive Agents/administration & dosage , Male , Metronidazole/administration & dosage , Middle Aged , Remission Induction , Tetracycline/administration & dosage , Young Adult
3.
Intern Med ; 49(23): 2537-45, 2010.
Article in English | MEDLINE | ID: mdl-21139290

ABSTRACT

BACKGROUND: We aimed to elucidate the risk factors and preventive factors associated with chronic low-dose aspirin (L-ASA)-induced gastroduodenal mucosal injury in Japanese patients with arteriosclerotic disease. METHODS: This retrospective observational study included 400 L-ASA users who underwent upper gastrointestinal endoscopy. We investigated patients' clinical characteristics, including age, peptic ulcer history, concomitant drugs [i.e. gastric agents, antiplatelet drugs, anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids], abdominal symptoms, endoscopic findings, and interruption of L-ASA before endoscopy. The severity of gastroduodenal mucosal lesions was evaluated using the modified LANZA score (MLS). RESULTS: Of 400 patients, 249 (62%) and 41 (10%) had gastroduodenal mucosal lesions (MLS ≥1) and gastroduodenal ulcers, respectively. Peptic ulcer history, abdominal symptoms, proton pump inhibitor (PPI), histamine type 2-receptor antagonists (H2RA), and the cessation of L-ASA before endoscopy were significantly associated with L-ASA-induced gastroduodenal ulcers; the odds ratio (OR) (confidence interval (CI)) was 5.49 (1.82-16.55), 4.56 (1.93-10.75), 0.12 (0.03-0.42), 0.13 (0.04-0.40) and 0.11 (0.04-0.29), respectively. Moreover, patients having two or more of five factors [i.e. advanced age (≥75), anticoagulants, antiplatelet drugs, NSAIDs and corticosteroids] had a significantly higher prevalence of L-ASA-induced gastroduodenal ulcers [OR (CI): 2.39 (1.002-5.69)]. CONCLUSION: Peptic ulcer history, abdominal symptoms and the summation of risk factors increased the risk for L-ASA-induced gastroduodenal ulcers. H2RAs and PPIs were effective for the prevention of L-ASA-induced gastroduodenal ulcers. The cessation of L-ASA before endoscopy might lead to the underestimation of L-ASA-induced gastroduodenal injury.


Subject(s)
Arteriosclerosis/drug therapy , Asian People , Aspirin/administration & dosage , Aspirin/adverse effects , Intestinal Mucosa/drug effects , Peptic Ulcer/chemically induced , Adult , Aged , Aged, 80 and over , Arteriosclerosis/epidemiology , Female , Histamine H2 Antagonists/therapeutic use , Humans , Intestinal Mucosa/pathology , Male , Middle Aged , Peptic Ulcer/diagnosis , Peptic Ulcer/prevention & control , Proton Pump Inhibitors/therapeutic use , Retrospective Studies , Risk Factors , Young Adult
4.
J Gastroenterol ; 45(9): 944-51, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20499110

ABSTRACT

OBJECTIVE: Recently, guidelines for the treatment and prevention of ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) were established. This study investigated the association between the current adherence to the guidelines and the incidence of gastric mucosal lesions caused by NSAIDs. METHODS: This study included 254 NSAIDs users (128 regular and 126 on-demand users) who had undergone upper gastrointestinal endoscopy. The patients were characterized as high risk based on the following: age 65 years or older, history of peptic ulcers, concurrent use of corticosteroids or anticoagulants, and high-dose NSAIDs use. Adherence was defined as the prescription of NSAIDs with proton pump inhibitors, prostaglandin analogues, or high-dose histamine 2 receptor antagonists in high-risk NSAIDs user. The severity of gastric mucosal lesions was evaluated using the modified LANZA score (MLS). RESULTS: Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of the on-demand NSAIDs users met our definition of high-risk patients. Adherence in the regular NSAIDs users and on-demand NSAIDs users was 25 (31.7%) and 16 (24.6%), respectively. The incidence of gastric mucosal lesions (MLS ≧ 1) was significantly higher in the nonadherence group than in the adherence group for both regular NSAIDs users (59.3 vs. 28.0%, P = 0.01) and on-demand NSAIDs users (63.3 vs. 25.0%, P = 0.01). Gastric ulcers in the regular NSAIDs users were more frequently observed in the nonadherence group than in the adherence group (29.6 vs. 4.0%, P < 0.01). CONCLUSION: Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Peptic Ulcer/chemically induced , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Drug Interactions , Endoscopy, Gastrointestinal/methods , Evidence-Based Medicine , Female , Gastric Mucosa/drug effects , Gastric Mucosa/pathology , Guideline Adherence , Humans , Male , Middle Aged , Peptic Ulcer/epidemiology , Peptic Ulcer/pathology , Prevalence , Retrospective Studies , Risk Factors , Severity of Illness Index , Young Adult
5.
Intern Med ; 46(13): 927-31, 2007.
Article in English | MEDLINE | ID: mdl-17603228

ABSTRACT

OBJECTIVE: Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events. METHODS: We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name, pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs. RESULTS: Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%). CONCLUSION: Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anti-Ulcer Agents/administration & dosage , Histamine H2 Antagonists/administration & dosage , Peptic Ulcer/prevention & control , Adult , Attitude of Health Personnel , Drug Therapy, Combination , Drug Utilization , Female , Gastric Mucosa/drug effects , Gastric Mucosa/pathology , Health Care Surveys , Humans , Japan , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/drug therapy , Orthopedics/standards , Orthopedics/trends , Peptic Ulcer/chemically induced , Practice Patterns, Physicians' , Primary Prevention/methods , Proton Pump Inhibitors , Surveys and Questionnaires
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