Endocytoscopic findings of colorectal neuroendocrine tumors (with video).

Background and study aims Gastrointestinal neuroendocrine tumors (NET) are generally submucosal in location. Because these tumors are covered with normal mucosa, biopsy is necessary to confirm histological diagnosis before treatment. We explored the diagnostic capabilities of the endocytoscope, which can perform ultra-high magnification in vivo, for staining and diagnosing submucosal tumors in situ.

[The specificity of cognitive reactivity in recurrent major depressive episodes].

The present study examined cognitive vulnerability to relapses of depression by clarifying the characteristics of "cognitive reactivity" in people with recurrent major depressive episodes. Study 1-1 and 1-2 developed a Japanese version of the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), which assessed cognitive reactivity, and evaluated the reliability and validity of the scale. Study 2 examined the characteristics of cognitive reactivity which differentiate people with recurrent major depressive episodes from people with a single episode or none. The Japanese version of the LEIDS-R was shown to have reasonable reliability and validity. Participants with recurrent major depressive episodes showed more repetitive thoughts about negative issues and avoidance from internal and external aversive events when depressive mood was induced, compared to participants with only a single episode of depression. These results suggest that the characteristics of cognitive reactivity are important considerations for preventing relapse of depression.

Pulmonary thrombosis associated with antidiuretic hormone replacement therapy due to secondary diabetes insipidus after traumatic brain injury: A case report.

INTRODUCTION: Diabetes insipidus is a well-recognized complication of traumatic brain injury. The majority of patients with post-traumatic diabetes insipidus will require antidiuretic hormone (ADH) replacement therapy and tend to show dehydration. On the other hand, some negative effects of ADH on blood coagulation, such as increased platelet cohesion and the promotion of von Willebrand factor release, have also been reported. However, the incidence of thrombosis during antidiuretic hormone replacement therapy is disputed. PRESENTATION OF CASE: A case of pulmonary thrombosis associated with ADH replacement therapy due to secondary diabetes insipidus after traumatic brain injury is presented here. DISCUSSION: In our case, there were three factors that may have contributed to the observed thrombosis (dehydration, bed rest for a long period and ADH replacement therapy). CONCLUSION: We believe that controlling urinary output and monitoring urinary and serum osmotic pressure are necessary for the management for diabetes insipidus patients after traumatic brain injury. In particular, we must carefully monitor the management of such patients during antidiuretic hormone replacement therapy.

Unroofing technique for endoscopic resection of a large colonic lipoma.

A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.

Castleman's disease along the left tracheobronchial tree with a difficult preoperative diagnosis.

A 39-year-old man was referred to our hospital because of an asymptomatic middle mediastinal tumor. A preliminary histological diagnosis of the tumor by bronchoscopy was difficult to obtain because the tumor was located along the left tracheobronchial tree, which is difficult to approach. The tumor was resected through a right anteroaxillary thoracotomy without any major complications, and histopathological examination revealed that the lesion was Castleman's disease, hyaline-vascular type. Radiological findings of the lesion were typical; however, the rarity of the tumor made the imaging diagnosis difficult. If a lesion is located along the tracheobronchial tree, Castleman's disease should be considered in the differential diagnosis.

Pancreatic lymphoepithelial cyst with an intracystic papillary projection. Report of a case.

CONTEXT: Lymphoepithelial cysts of the pancreas show various presentations on imaging studies often making a differential diagnosis difficult. CASE REPORT: A 58-year-old man was admitted to our hospital with epigastric discomfort and abdominal bloating. Abdominal US was carried out and demonstrated a cystic lesion 5 cm in diameter which included an intracystic projection into the pancreatic body. This intracystic projection was also seen on CT and MR images. On FDG-PET images, the projection was positively visualized. Since we could not exclude a pancreatic cystic neoplasm, a distal pancreatectomy was performed. Postoperative pathological examination demonstrated that the lesion was a lymphoepithelial cyst of the pancreas. There were no atypical cells in the intracystic projection. CONCLUSION: Resection is inevitable when a true pancreatic neoplasm cannot be excluded.