Primary jejunal malignant mixed tumor in a patient with von Recklinghausen neurofibromatosis

A rare case of primary jejunal malignant mixed tumor arising in a 49-64-old Japanese male with von Recklinghausen's disease is reported. The patient, who had a past history of partial gastrectomy due to duodenal ulcer, was admitted with a complaint of epigastric pain. Upper gastrointestinal examinations showed a huge polypoid tumor located in the efferent loop of the gastrojejunostomy site. Because the tumor was strongly suggestive of leiomyosarcoma on histological examination of biopsy specimens, laparotomy was performed. The resected tumor measuring 10 X 7 X 7 cm was composed of adenocarcinoma admixed with various sarcomatous components, including rhabdomyosarcoma, osteosarcoma, and other sarcomas. Immunohistochemical analysis also supported this diagnosis. The features of this tumor closely resembled malignant mixed mullerian tumor of heterologous type that develops in female genital organs. It is well known that patients with von Recklinghausen neurofibromatosis have an increased incidence of mesenchymal tumors and malignant neoplasias, and therefore, it seems that there is a possible relationship between the histogenesis of this peculiar tumor and the genetic abnormality in this patient.

Dysplasia in ulcerative colitis: is radiography adequate for diagnosis?

PURPOSE

To determine to usefulness of barium enema examination in detecting dysplasia in patients with ulcerative colitis.

MATERIALS AND METHODS

Radiographic findings of 22 areas of dysplasia in 10 patients (seven men, three women; aged 34-81 years at diagnosis) were reviewed. Serial changes in radiographic features of four areas of dysplasia in three patients were retrospectively investigated.

RESULTS

Fourteen of 22 areas of dysplasia were shown on radiographs. Dysplasia in the rectum or sigmoid colon was depicted less frequently than that in other segments of the colon. Radiographic features were classified as obvious nodular protrusions (seven lesions), irregular mucosa (five lesions), or nodular protrusions with irregular mucosa (two lesions). Six of the seven areas of dysplasia shown as irregular mucosa were accompanied by minute spiculations in the margin of the colonic lumen. There was no correlation between radiologic features and histologic grade of dysplasia.

CONCLUSION

Barium enema examination may be used as a complementary method of cancer surveillance with endoscopy. These methods show about two-thirds of lesions associated with dysplasia.

The demonstration of pericryptal fibroblasts in background mucosa and dysplasia complicating ulcerative colitis

The demonstration of pericryptal fibroblasts in background mucosa and dysplasia in ulcerative colitis was investigated by immunohistochemistry using monoclonal antibody for alpha-smooth muscle actin. Pericryptal fibroblasts were reduced in 18 (26%) of the 68 sections of non-dysplastic mucosa. The reduction was significantly correlated with goblet cell depletion and villous change. Pericryptal fibroblasts were more frequently reduced (50%) in dysplastic mucosa, the reduction being greater in villous than in non-villous dysplasia. Pericryptal fibroblast development was not related to grade of dysplasia (low or high-grade), distance from carcinoma (adjacent to or distant from carcinoma) or growth pattern (polypoid or non-polypoid). These findings suggest that: 1 reduction of pericryptal fibroblasts in background mucosa may relate to the development of dysplasia in ulcerative colitis, 2 reduction of pericryptal fibroblasts in villous regeneration, analogous to that in dysplasia, reinforces the hypothesis that villous change may be a marker for risk of development of carcinoma in ulcerative colitis.

Inverse correlation between the expression of bcl-2 and p53 proteins in primary gastric lymphoma

The immunohistochemical expression of bcl-2 and p53 proteins was evaluated in formalin-fixed, paraffin-embedded surgical specimens from 212 patients with primary gastric lymphoma. bcl-2 protein was found to be expressed in 145 specimens (68%). Among the 179 specimens with B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), bcl-2 positivity decreased significantly as the histological grade advanced; bcl-2 was expressed in 93% of low-grade tumors, 88% of mixed-grade (low-grade with a focal high-grade component) tumors, and 44% of high-grade tumors (Cochran's linear trend test; P<.001). p53 protein expression was detected in 43 of 212 cases (20%). Among the B-cell MALT lymphomas, p53 positivity increased significantly as the histological grade advanced; p53 was expressed in 6% of low-grade tumors, 12% of mixed-grade tumors, and 31% of high-grade tumors (Cochran's linear trend test; P<.001). An inverse correlation was observed between the expression of bcl-2 and p53 in all 212 lymphomas (gamma = -0.531; P<.05) as well as in all 179 B-cell MALT lymphomas (gamma = -0.671; P<.01). Although the bcl-2 expression did not correlate with the patient survival, the p53 positive cases showed a significantly poorer prognosis compared with the p53 negative cases (log-rank test; P<.05). These results suggest that the expression of bcl-2 and p53 may, therefore, be associated with the transition from low-grade to high-grade tumors in primary gastric lymphoma.

Radiographic findings of intractable gastric ulcers with H2-receptor antagonists

BACKGROUND

To clarify the radiographic characteristics of intractable gastric ulcers with H2-receptor antagonists.

METHODS

The radiographic findings at the time of starting treatment were compared between 42 patients with gastric ulcers that did not heal within eight weeks of starting treatment with H2-receptor antagonists (the intractable group) and 58 patients whose ulcers healed within the eight-week period (the tractable group).

RESULTS

The following radiographic findings in the intractable group were observed at a significantly higher incidence than those in the tractable group and included: an ulcer located on the angle, linear ulcers, a greater depth, an uneven mound surrounding an ulcer, prominent folds' convergence, an overhanging gastric mucosa, an irregular ulcer base, a shortening of the lesser curvature and a U-shaped deformity of the angle. A multiple logistic regression analysis showed that the following three factors had a significant and independent delaying effect on healing: a U-shaped deformity of the angle, an uneven mound surrounding an ulcer and prominent folds' convergence. The relative risk of these factors were 12.7, 14.4 and 12.5, respectively.

CONCLUSIONS

Intractable gastric ulcer with H2-receptor antagonists can be predicted based on the characteristic radiographic findings at the start of treatment.

Control of gastric pH with ranitidine in patients with Crohn's disease receiving total parenteral nutrition. Comparison of two intravenous regimens

Eleven patients with Crohn's disease in remission who were receiving total parenteral nutrition (TPN) underwent continuous intragastric 24-h pH monitoring before and during ranitidine administration. The patients were randomly allocated to receive 200 mg/day (group 1) or 400 mg/day (group 2) of ranitidine by continuous infusion. The mean basal 24-h gastric pH was sustained at a low value. After raintidine administration, the mean pH increased significantly both in group 1 (from 2.13 to 3.28) and in group 2 (from 1.91 to 3.36), with the mean holding-time at pH-3 also increasing significantly in both groups. There were no differences in the mean pH or holding-time at pH-3 between the two groups during ranitidine administration; however, the plasma ranitidine concentration was significantly higher in group 2. These findings indicate that the continuous infusion of a standard dose of ranitidine exerted a maximal inhibitory effect on the sustained hyperacidity induced by TPN, but that this infusion was unable to maintain the intragastric pH level at above 3.5.

Solitary Peutz-Jeghers type polyp of the duodenum containing a focus of adenocarcinoma

The case of an 84-year-old woman with evidence of continuous gastrointestinal bleeding is presented. A barium study and endoscopy showed a 25 x 20 mm sized semipedunculated polyp in the second portion of the duodenum. No other lesion was found throughout the entire gastrointestinal tract, and endoscopic resection of the duodenal polyp was performed. The resected polyp showed typical histologic features of a Peutz-Jeghers type hamartomatous polyp, although the patient lacked any familial history and signs related to the Peutz-Jeghers syndrome. A focus of adenocarcinoma was also found within the polyp. The present case would appear to be the first demonstration of a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum containing a focus of adenocarcinoma.

Vitamin E therapy of acute CCl4-induced hepatic injury in mice is associated with inhibition of nuclear factor kappa B binding

Oxidative stress, with reactive oxygen intermediate formation, may represent a common mechanism by which liver injury is induced by diverse etiologies. Oxidative stress enhances nuclear factor kappa B (NF-kappa B) activity, and NF-kappa B activity has been shown to enhance the expression of cytotoxic cytokines. Acute hepatic injury caused by reactive oxygen intermediate production was induced by an intraperitoneal injection of CCl4 in mice. This injury was significantly inhibited by intravenous pretreatment of the mice with a water-soluble emulsion of alpha-tocopherol. Alpha-tocopherol treatment of the mice given the CCl4 also reduced the NF-kappa B binding to levels approaching those found in normal mice. In vitro treatment of a monocyte/macrophage cell line with CCl4 led to enhanced NF-kappa B binding and an increase in tumor necrosis factor-alpha (TNF-alpha) messenger RNA levels. Liver specimens taken from patients with acute fulminant hepatitis had markedly increased NF-kappa B binding activity in comparison with the binding of normal livers. These data demonstrate that abolishing acute hepatic injury with alpha-tocopherol, a free radical scavenger, also eliminated increased NF-kappa B binding. It is tempting to speculate that enhanced NF-kappa B expression caused by free radical production/oxidative stress may modulate liver injury, perhaps through an effect on cytotoxic cytokine synthesis.

Long-term follow-up study of ulcerative colitis in Japan

To clarify the long-term prognosis of Japanese patients with ulcerative colitis, we investigated the cumulative colectomy rate and the survival rate, and compared the results with reports from Western countries. The subjects were 778 patients who had visited 8 hospitals from 1973 to 1990. A total of 114 of the 778 patients (14.7%) had required colectomy and 21 (2.7%) had died. These rates were higher in the patients who had total colitis, and in those who had acute fulminant type of severe type. There were no significant differences in these rates according to age of onset (under 29 years, 30-49 years, and more than 50 years). The cumulative colectomy rate increased rapidly within 2 years after onset. Thereafter, the rate increased gradually, by 1%-2% per year. In patients with total colitis, 14.1% required colectomy within 2 years. The age at onset had no effect on this rate. The cumulative survival rate decreased gradually throughout the first 10 years, the rate being 96.2% in the 10th year. No deaths occurred in the 11-18th years after onset. Despite our inclusion of more patients with total or severe colitis, our results were similar to or slightly superior to those reported from Western countries; this may be attributed to a temporal bias.

Indications and options of nutritional treatment for Crohn's disease. A comparison of elemental and polymeric diets

Several studies on enteral nutrition undertaken by our group led to the following findings: (1) A semielemental diet was as effective as an elemental diet in inducing remission. (2) A low-residue diet was useful for the maintenance of remission, with the effect depending upon the quantity given. (3) Intractability to enteral nutrition was found in patients with long-standing disease, in those with severe activity, and in those with colonic disease. Currently there is insufficient evidence to make specific recommendations for altering accepted indications for nutritional therapy.

Long-term follow-up study of Crohn's disease in Japan. The Research Committee of Inflammatory Bowel Disease in Japan

Two hundred and three patients with Crohn's disease seen at Kyushu University, Fukuoka University, and their affiliated centers from 1973 to 1988 were followed for 4.4 +/- 3.2 years (mean +/- SD), to evaluate the prognosis relative to life span and surgery. Cumulative survival rate and cumulative operation rate were calculated by the life table method. Cumulative survival rates 5 and 10 years after diagnosis were 98.9% and 98.9%, respectively; these figures were not different from the expected survival rates in the sex-and age-matched general population. Cumulative operation rates 5 and 10 years after the onset of symptoms were 16.2% and 39.1%, respectively, In a second study, we investigated 419 patients with Crohn's disease, diagnosed at nine institutions from 1975 to 1990. The follow-up period was 6.3 +/- 3.9 years and the information was obtained from mailed questionnaires. Cumulative survival rates 5 and 10 years after diagnosis were 99.2% and 96.9%, respectively. Cumulative operation rates 5 and 10 years after the onset of symptoms were 30.3% and 70.8%, respectively. These results indicate that the prognosis of Japanese patients with Crohn's disease may be superior to that reported in Western countries.

Vitamin E therapy of acute CCl4-induced hepatic injury in mice is associated with inhibition of nuclear factor kappa B binding

Oxidative stress, with reactive oxygen intermediate formation, may represent a common mechanism by which liver injury is induced by diverse etiologies. Oxidative stress enhances nuclear factor kappa B (NF-kappa B) activity, and NF-kappa B activity has been shown to enhance the expression of cytotoxic cytokines. Acute hepatic injury caused by reactive oxygen intermediate production was induced by an intraperitoneal injection of CCl4 in mice. This injury was significantly inhibited by intravenous pretreatment of the mice with a water-soluble emulsion of alpha-tocopherol. Alpha-tocopherol treatment of the mice given the CCl4 also reduced the NF-kappa B binding to levels approaching those found in normal mice. In vitro treatment of a monocyte/macrophage cell line with CCl4 led to enhanced NF-kappa B binding and an increase in tumor necrosis factor-alpha (TNF-alpha) messenger RNA levels. Liver specimens taken from patients with acute fulminant hepatitis had markedly increased NF-kappa B binding activity in comparison with the binding of normal livers. These data demonstrate that abolishing acute hepatic injury with alpha-tocopherol, a free radical scavenger, also eliminated increased NF-kappa B binding. It is tempting to speculate that enhanced NF-kappa B expression caused by free radical production/oxidative stress may modulate liver injury, perhaps through an effect on cytotoxic cytokine synthesis.

Therapeutic efficacy of cyclic home elemental enteral alimentation in Crohn's disease: Japanese cooperative Crohn's disease study

Crohn's disease (CD) often flares up and requires frequent hospitalization and/or surgery. Cyclic home elemental enteral alimentation (C-HEEA) was developed to prevent flare-up of CD and to minimize patient hospitalization. However, its therapeutic efficacy has not been studied in a large patient population. Therefore, questionnaires were sent to members of the Inflammatory Bowel Disease (IBD) Research Group of Japan to evaluate the therapeutic efficacy of C-HEEA and to define the factors that may affect the efficacy of the treatment. Data for 410 patients (C-HEEA-treated n = 322; drug-treated n = 88) were collected from 29 institutions and analysis showed the following results. The cumulative remission and non-hospitalization rates of the C-HEEA treated group were significantly higher than the rates of the drug-treated group in all patients and in those with ileitis and ileo-colitis (P < 0.0001, P < 0.001, and P < 0.01, respectively), but no significant difference was noted in patients with colitis. Cumulative remission and non-hospitalization rates were also influenced by the daily calorie content of the elemental diet (ED); more than 1200 kcal of the ED per day was found to be more effective than lower amounts to maintain remission and to prevent hospitalization. The therapeutic efficacy of C-HEEA was shown to be superior to that of drug treatment in patients with CD with ileal involvement, and it is suggested that more than 1200kcal per day should be supplied by the ED to enhance its therapeutic efficacy.

A clinicopathologic study of 233 cases with special reference to evaluation with the MIB-1 index

BACKGROUND

Few articles have analyzed the prognostic data from a large series of primary gastric lymphoma classified according to the concept of mucosa-associated lymphoid tissue (MALT).

METHODS

The resected specimens from 233 patients with primary gastric lymphoma were investigated retrospectively, including immunostaining with MIB-1 (Ki-67).

RESULTS

Histologically, 70 (30%) of the cases were low grade B-cell lymphoma of MALT, 27 (12%) low grade B-cell lymphoma of MALT with a focal high grade component, 100 (43%) high grade B-cell lymphoma of MALT, 15 (6%) other B-cell lymphomas, 14 (6%) T-cell lymphomas, and 7 (3%) undetermined. Macroscopically, 96 (41%) were superficial-spreading type, 100 (43%) mass-forming, 14 (6%) diffuse-infiltrating, and 23 (10%) unclassified. The MIB-1 index correlated with phenotype, histologic grade, stage, depth of invasion, and macroscopic type. A significantly better survival was noted for young patients, and those with tumors of a B-cell phenotype, histologic low grade, macroscopic superficial-spreading type, low stage, low depth of invasion, and low MIB-1 index. No significantly different survival rates were found between the patients who underwent gastric resection alone and those who also received additional chemotherapy. By Cox multivariate analysis, independent prognosticators included B-cell phenotype, low stage, and macroscopic superficial-spreading type.

CONCLUSIONS

In addition to stage, phenotype and macroscopic type are also important prognostic indicators of primary gastric lymphoma. Immunostaining with MIB-1 had limited independent value for predicting prognosis.

Evaluation of disease activity in patients with moderately active ulcerative colitis: comparisons between a new activity index and Truelove and Witts' classification

OBJECTIVES

We have recently proposed a new activity index (AI) for ulcerative colitis. The aim of this study was to examine how AI would reflect the effect of medical therapy in comparison with Truelove and Witts' criteria.

METHODS

In this trial, we studied 35 patients with extensive colitis who persisted with moderate disease for 2 wk. They showed no change in disease activity according to Truelove and Witts' classification despite 2 wk of corticosteroid therapy. Nine of the 35 patients underwent surgery (operated group), and 26 responded to the medical therapy and went into remission (nonoperated group).

RESULTS

In the nonoperated group, AI values significantly decreased at 1 and 2 wk after treatment compared with pretreatment values, whereas there was no significant change in AI in the operated group during the clinical course. Remission occurred in all patients indicating below 180 of AI values 2 wk after therapy, whereas approximately 65% of patients indicating above 180 of AI values subsequently needed colectomy.

CONCLUSIONS

This study suggests that AI will be useful in evaluation of response to medical therapy and prediction of remission and colectomy in patients with moderately active ulcerative colitis.

An intestinal counterpart of pyogenic granuloma of the skin. A newly proposed entity

Pyogenic granuloma is a common disease in the skin, but it is extremely rare in the gastrointestinal tract except for the oral cavity. We have seen three lesions (from three patients) of an intestinal counterpart of pyogenic granuloma and have reviewed their clinicopathologic features. Macroscopically, all three lesions revealed a polypoid growth with either a sessile or pedunculated configuration. All had an ulceration on the top. Microscopically, all these lesions were composed of a lobular proliferation of varying sizes of capillaries with an edematous stroma. Endothelial cells of the capillaries were swollen variously and in one case revealed a few mitotic figures. An inflammatory process was associated with the presence of ulcerations. Immunohistochemically, both Factor VIII-related antigen and QB-end/10(CD34) were positive only for the endothelial cells in all three cases. The characteristic macroscopic and histologic features thus allow for an early diagnosis of pyogenic granuloma in the gastrointestinal tract, which is similar to that observed in the skin.

[Effect of angiotensin II on vasopressin gene transcription in the hypothalamus of rats]

Experiments were carried out in male Sprague-Dawley rats. 3'-end digoxigenin-labeled 26 bp oligonucliotide probe was used to detect the vasopressin (AVP) mRNA in the hypothalamus. Dot blotting technique was used in the investigation of AVP gene transcription level. The results showed that continuous intracerebroventricular administration (i.c.v.) of angiotensin II at a rate of 0.2 nmol/h for 2 days by using a miniosmotic pump resulted in a significant increase in daily water intake. An increase of AVP gene transcription level in the hypothalamus was also observed, but statistically insignificant. When daily water intake was limited (25 ml/d), continuous i.c.v. infusion of ANG II caused a significant increase in hypothalamic AVP gene transcription. It was also observed that hypothalamic AVP gene transcription level increased after salt loading and dehydration. However, intraperitoneal application of angiotensin converting enzyme inhibitor captopril (5 mg/(kg.d)) or i.c.v. nonpeptide angiotensin II receptor antagonist Dup753 (0.9 nmol/h) did not attenuate the increase of AVP gene transcription level induced by salt loading or dehydration. It is therefore suggested that the administration of ANG II enhances AVP gene transcription in the hypothalamus, especially when water intake is limited. However, this increase does not involve the participation of endogenous ANG II.

Small flat cancer of the rectum: clinicopathologic and endoscopic features

The clinicopathologic and endoscopic features of 15 patients with small flat cancer of the rectum were investigated. Whereas 4 patients had hematochezia, the remaining 11 patients were asymptomatic, and stool positive for occult blood was the only remarkable clinical feature in 8 of them. Endoscopic features were slight elevation with central depression in 8 lesions, flat-topped elevation in 4, and shallow depression with irregular margin in 3. The surface of the tumor was often faint red in color and frequently characterized by mucosal friability. Five flat rectal cancers were missed during initial endoscopy, and they were found by repeated endoscopic examination. Three flat cancers were not identified in the distal rectum until retroflexed colonoscopic observation was performed. Although all tumors were smaller than 2 cm in diameter and 6 of them were under 1 cm, 9 lesions had deeply invaded the submucosal layer and 7 tumors showed lymphovascular permeation. Two lesions of 1 cm or greater had metastasized to perirectal lymph nodes. These results suggest that careful observation during endoscopy is necessary to detect flat rectal cancers, and a U-turn to examine the anorectal junction should be routinely done in the appropriate age group.

Characterization of vitelline membrane outer layer protein I, VMO-I: amino acid sequence and structural stability

Vitelline membrane outer layer protein I (VMO-I) tightly bound to ovomucin fibrils of hen's egg yolk membrane was characterized in terms of its amino acid sequence and structural stability. The deduced sequence of VMO-I using the conventional sequencing method is: RTREYTSVITVPNGGHWGKWGIRQFCHSGYANGFALKVEPSQFGRDDTALNGIRLRCLD- GSVIESLVGKWGTWTSFLVCPTGYLVSFSLRSEKSQGGGDDTAANNIQFRCSDEAVLVGD- DLSWGRFGPWSKRCKICGLQTKVESPQGLRDDTALNNVRFFCCK. Thus, VMO-I is composed of 163 amino acid residues with a calculated molecular weight of 17,979. The sequence confirms the cDNA sequence of VMO-I we recently determined and does not show any significant similarity to proteins compiled in the NBRF database. Two of the four disulfide bonds found in VMO-I were estimated to lie between Cys26 and Cys57 and between Cys79 and Cys110. The sequence analyses show that VMO-I contains three 53-residue internal repeats that contain distinctive regions of turns flanked by beta-sheets consistent with the recent finding that the molecule contains a new beta-fold motif, the beta-prism. The molecular characteristics of VMO-I in solution were examined by CD spectroscopy in the far and near ultraviolet regions, NMR spectroscopy, and high sensitive differential scanning calorimetry (DSC). CD spectra in the far UV region at room temperature were similar to that assigned to a random coil, while in the near UV region, small positive peaks were observed. The ellipticity in both regions decreased on raising the temperature. Proton NMR experiments showed the native structure unfolds to unordered conformations at 70 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Villous adenoma of the duodenum in a patient with familial adenomatosis coli

A case of familial adenomatosis coli with villous adenoma of the third portion of the duodenum, which falls in the category of a Gardner's syndrome, is described. The patient, who had complained of an abdominal mass which had been diagnosed as a desmoid tumor after surgical resection, had numerous adenomatous polyps throughout the colon confirmed by colonoscopy with biopsy. Endoscopic examination of the upper gastrointestinal tract revealed fundic gland polyposis in the stomach and numerous small adenomas in the duodenum. In addition, there was a pedunculated polyp in the third portion of his duodenum, measuring 30 mm in diameter, the surface of which had a cauliflowerlike appearance. The polyp was removed with the electrocautery snare and was histologically diagnosed as villous adenoma. Our case report supports the concept that villous adenoma, which possesses a high malignant potential, may occur in the upper gastrointestinal tract in patients with familial adenomatosis coli, and careful examination of the upper gastrointestinal tract including the distal duodenum seems to be necessary in the follow-up patients with this disease.

Effects of dehydration and salt-loading on hypothalamic vasopressin mRNA level in male and female rats

Experiments were carried out on 9- to 11-week-old male and female Sprague-Dawley rats. Dot-blot analysis and 3'-end digoxigenin-labeled 26mer oligonucleotide probe were used in the investigation of vasopressin (AVP) mRNA level in the hypothalamus of male and female rats. The normal hypothalamic AVP-mRNA level in males was 48% higher than that in females (P < 0.05). Plasma osmolality was also higher in males than in females (P < 0.05). In dehydrated rats, the hypothalamic AVP-mRNA level was 2.47 and 1.98 times in females (P < 0.001) and males (P < 0.01), respectively, as much as in their normal controls; the difference in hypothalamic AVP-mRNA level between dehydrated females and males was statistically insignificant. Plasma osmolality was higher in dehydrated females than in dehydrated males (P < 0.01). In salt-loaded rats, hypothalamic AVP-mRNA level was 2.47 and 2.17 times in females (P < 0.001) and males (P < 0.01), respectively, as much as in their controls. The difference in hypothalamic AVP-mRNA level between salt-loaded males and females was not statistically significant. Plasma osmolality in salt-loaded females was also higher than that in salt-loaded males (P < 0.001). These findings indicate that there is sex difference in hypothalamic AVP mRNA level and plasma osmolality under normal conditions; during dehydration and salt-loading AVP mRNA level increases and the difference in AVP mRNA level between males and females becomes insignificant.

Endoscopic evaluation of gastric inflammatory fibroid polyp

Clinical and endoscopic manifestations of 18 gastric inflammatory fibroid polyps (IFP) in 16 patients who underwent endoscopic or surgical removal were retrospectively analyzed. All of the lesions were located within the pyloric antrum, and the sizes varied from 0.8 to 7.0 cm. On endoscopy, six polyps which measured 1.0 cm or less uniformly seemed to be sessile or intramural tumors, whereas four of the nine polyps between 1.1 and 2.0 cm in size were additionally accompanied by a central depression. The remaining three, which measured more than 2.0 cm, showed characteristic polypoid growth with ulcerations. Three polyps more than 1.0 cm in size occasionally prolapsed into the duodenal bulb. Three patients with these prolapsing polyps and two with polyps accompanied by ulcerations experienced abdominal pain, nausea, or severe anemia. Two polyps (11%) were precisely diagnosed as IFP by means of conventional forceps biopsy. Histological examinations revealed that all of the polyps proliferated within the submucosa. Therefore, this type of polyp may be subject to endoscopic removal to enable a precise diagnosis and treatment.