Size reduction of gastric fundic gland polyposis by de-escalation of acid-suppressive therapy.

The patient, a 73-year-old woman, had been taking acid-suppressive therapy for refractory reflux esophagitis for 10 years. A potassium-competitive acid blocker was administered to strengthen acid-suppressive therapy for worsening symptoms of gastroesophageal reflux disease. Esophagogastroduodenoscopy showed an increase in the number and size of fundic gland polyposis (FGPs). When acid-suppressive therapy was changed from potassium-competitive acid blocker to proton pump inhibitor, the FGPs showed reduced size 1 year later. Furthermore, when acid-suppressive therapy was changed from proton pump inhibitor to histamine-2 receptor antagonist, FGPs were even smaller after 1 and 2 years. The patient, who had no flare-up of gastroesophageal reflux disease symptoms, continues to be treated medically with histamine-2 receptor antagonist. This case report describes changes in endoscopic findings of a patient with FGPs caused by acid-suppressive therapy for refractory gastroesophageal reflux disease.

Gastric Dieulafoy's lesion with subepithelial lesion-like morphology.

Most cases of Dieulafoy's lesion, a rare cause of upper gastrointestinal bleeding, occur in the upper gastric corpus, usually with no edematous bulging or fold convergence around the mucosal defect. This report describes a case of Dieulafoy's lesion with subepithelial lesion (SEL)-like morphology. Endoscopic treatment by hemoclipping was difficult. Because of repeated bleeding, abdominal dynamic contrast computed tomography (CT) was conducted. Results showed a large caliber, tortuous artery branching directly from the celiac artery and feeding into the gastric wall of the gastric fundus. Rupture of this vessel in the submucosa was thought to be responsible for the SEL-like morphology. All findings indicated endoscopic treatment from the gastric mucosal side was too difficult. Therefore, we treated the lesion using interventional radiology (IR) technique of vascular embolization. If an SEL-like Dieulafoy's lesion cannot be treated by endoscopic hemostasis, then IR might be necessary to treat the vascular anomaly.

Huge Amoebic Liver Abscess in the Left Lobe Treated by Oral Administration of Metronidazole.

A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.

Cancer patients' distresses and inquiries: proposal of four-level classification based on consultation service and questionnaire survey.

The present study was undertaken to understand the realities of cancer patients' and their family members' distresses and inquiries, including medical/physical, emotional/spiritual and social/economic problems, from scientific viewpoints. The initial step of the study was to develop the classification category for these distresses and inquiries. The category was proposed based on information from two different sources; one is the consultation records of the Patient Support and Inquiry Division, Shizuoka Cancer Center and the other is the database of the Questionnaire Survey, which consisted of more than 25,000 distresses from 7885 people who faced up to cancer. The four-level classification category was constructed from 16 primary categories, 35 secondary categories, 129 tertiary categories and 619 quaternary categories. The classification category made it possible to analyze the distresses of cancer patients and their family members. The present study demonstrated the differences between the patterns of distresses for the consultation service and the questionnaire survey. In consultation centers belonging to hospitals, such as the Patient Support and Inquiry Division in the Shizuoka Cancer Center, patients wanted to consult on distresses and inquiries related to medical care. In contrast, they rarely consulted on emotional/spiritual or social problems. Based on the present classification category, we are developing a database called 'Questions and Answers for Cancer Patients' Distresses'. The database enables medical staff to learn what distresses patients and their family members, and to implement high-quality consultation in cancer clinics.