Introduction: Helicobacter pylori (Hp) leads to chronic gastritis and eventually causes gastric cancer. Recently, several studies have shown the existence of a small number of Hp—negative gastric cancers (HPNGC). With the decline of the Hp infection rate, the HPNGC should increases. However, the clinichopathological and endoscopic features of HPNGC are still unclear. The aim of this study is to clarify the characteristics of HPNGC. Methods: We analyzed 628 lesions of early gastric cancer that underwent endoscopic resection at our hospital from April 2009 to June 2017, retrospectively. Thirty—five HPNGC cases (38 lesions, 6.1%) were enrolled in this study, and evaluated clinichopathologically. Hp—negative status was defined as the fulfillment of all the following criteria: no eradication history, no mucosal atrophy in endoscopic and pathological findings, negative rapid urease test or urease breathe test or serum Hp—immunoglobulin G test or stool antigen. Results: In HPNGC (n=38), the frequency according to the histology was as follows: gastric adenocarcinoma of fundic gland type (GAFG) / gastrointestinal phenotype of well—differentiated adenocarcinoma (GI—WDA) / gastric phenotype of WDA (G—WDA) / signet—ring cell carcinoma (Sig) = 23(60.5%) / 7(18.5%) / 1(2.5%) / 7(18.5%). GAFG was presented as a whitish elevated lesion in the upper to middle part of the stomach. Although GAFGs exhibited submucosal invasion despite the small size of the lesions, neither lymphatic nor venous invasion was observed. GI—WDA presented as a reddish lesion in the lower part of the stomach. G—WDA presented as a whitish elevated lesion in the upper part of the stomach. Sig presented as a whitish flat or depressed lesion in the middle to lower part of the stomach. In magnifying endoscopy simple diagnostic algorithm for gastric cancer (MESDA—G) diagnosis, WDA was diagnosed as a cancer, GAFG and Sig were diagnosed as non—cancer. Conclusion: HPNGC has distinct endoscopic and clinicopathological features by each histological type and may be classified into 3 types; 1. Whitish elevated lesion in the upper or middle part of the stomach (GAFG and G—WDA), 2. Reddish lesion in the lower part of the stomach (GI—WDA), 3. Whitish flat or depressed lesion in the middle or lower part of the stomach (sig). Early detection of HPNGC enables minimally invasive treatment which preserves the patient's quality of life. Endoscopists should fully understand the characteristics and endoscopic findings of HPNGC.1219 Figure 1 No Caption available.
Background/Aims: To evaluate the usefulness of linked color imaging (LCI) and blue LASER imaging (BLI) in Barrett’s esophagus (BE) compared with white light imaging (WLI). Methods: Five expert and trainee endoscopists compared WLI, LCI, and BLI images obtained from 63 patients with short-segment BE. Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and one (decreased). Scores were evaluated to assess visibility. The inter- and intra-rater reliability (intra-class correlation coefficient) of image assessments were also evaluated. Images were objectively evaluated based on L* a* b* color values and color differences (ΔE*) in a CIELAB color space system. Results: Improved visibility compared with WLI was achieved for LCI: 44.4%, BLI: 0% for all endoscopists; LCI: 55.6%, BLI: 1.6% for trainees; and LCI: 47.6%, BLI: 0% for experts. The visibility score of trainees compared with experts was significantly higher for LCI (p = 0.02). Intra- and inter-rater reliability ratings for LCI compared with WLI were “moderate” for trainees, and “moderate-substantial” for experts. The ΔE* revealed statistically significant differences between WLI and LCI. Conclusion: LCI improved the visibility of short-segment BE compared with WLI, especially for trainees, when evaluated both subjectively and objectively.
Abstract Background and Aims: Identifying the invasive depth of cancers less than 10 mm in diameter remains a challenge. This study examines the clinicopathological characteristics of colorectal cancers less than 10 mm in diameter and invading submucosal layer (SM)3 and below, which require surgery and must never be treated by endoscopic mucosal resection. Methods: We studied 54 cases of colorectal cancer less than 10 mm in diameter and invading the submucosa and deeper tissues, by dividing them into two groups: those invading SM1 and SM2 versus those invading SM3 and below. We investigated the clinicopathological characteristics of cancers invading SM3 and below by comparing them with cancers invading SM1 and SM2. Similarly, 38 cases, whose endoscopic findings could be analyzed, were selected and examined. Results: In cases invading SM3 and below, the rates of moderately to poorly differentiated adenocarcinoma, lymphatic and venous permeation and lymph node metastasis were significantly higher than those invading SM1 and SM2. Among cases invading SM3 and below, the presence of endoscopic findings—including white spots of the protruded type, and fullness, white spots, hardness and protruded lesions in the depressed area of the depressed type—was significantly higher than among those invading SM1 and SM2. Conclusion: Colorectal cancers less than 10 mm in diameter and invading SM3 and below have high malignant potential. Cancers of this invasive depth can be identified by looking for characteristics such as white spots, fullness, hardness and protruded lesions in the depressed area. Careful endoscopic observation for these signs aids in determining the appropriate treatment.
The study was performed to clarify if apomorphine at the level of the rat corpus cavernosum can produce erectile responses or interfere with nerve-induced penile erection. Apomorphine (10(-9)-10(-4) M) exhibited a 10-fold higher potency to relax phenylephrine (Phe)- than endothelin-1 (ET-1)-induced contractions. Relaxant effects of apomorphine in Phe-activated corpus cavernosum did not change tissue levels of cyclic nucleotides, and were unaffected by inhibition of the synthesis of nitric oxide, or by inhibition of the soluble guanylate cyclase. Relaxations by apomorphine of ET-1-contracted rat corpus cavernosum were not influenced by alpha2-adrenoceptor blockade (yohimbine, 10(-7) M), or by the dopamine D1-like receptor antagonist SCH 23390 (10(-6) M). Clozapine (10(-6) M), a proposed dopamine D2-like receptor antagonist, partly reduced apomorphine-induced relaxations, and significantly altered the -log IC50 value for apomorphine. Nerve-induced contractions of the rat corpus cavernosum were attenuated by apomorphine in a concentration-dependent and biphasic manner. Yohimbine (10(-7) M) abolished the biphasic concentration-response pattern. SCH 23390 (10(-6) M) attenuated the inhibitory effects of apomorphine on contractions, and significantly altered the -log IC50 value for the compound. In anesthetized rats (50 mg kg(-1) pentobarbital sodium, 10 mg kg(-1) ketamine), intracavernous apomorphine (100, 300, or 1000 nmol) did not have effects on basal cavernous pressure under resting conditions, and did not affect filling or emptying rates, or peak pressures of the rat corpus cavernosum during submaximal activation of the cavernous nerve. In awake rats, apomorphine produced a maximal number of erections at 300 nmol kg(-1). In the rat isolated corpus cavernosum, pre- and postjunctional effects of apomorphine appear to involve dopamine D1- and D2-like receptors, as well as alpha-adrenoceptors. At relevant systemic doses of apomorphine, peripheral effects of the compound are unlikely to contribute to its proerectile effects in rats.
