Foveolar gastric metaplasia of the duodenum: a frequent, so far neglected type of duodenal polyp

Foveolar gastric metaplasia of the duodenum (FGM) is considered as imperfect mucosal healing in the context of H. pylori gastritis and intake of NSAIDs or ASS.  Typical endoscopic findings are redness of the mucosa, erosion/ulcer and loss of mucosal folds. During diagnostic histological examinations we observed a frequent so far not described association of FGM with endoscopically observed duodenal polyps. The archives of two institutes of pathology with high gastroenterological workload (approximately 100 000 patients per year) were investigated for an association between "duodenal polyp" and "foveolar gastric metaplasia". In Institute 1, of 481 duodenal polyps 41 % were classified as FGM, 9 % as adenoma and 2 % as heterotopic gastric mucosa. In 48 % no histological correlate was present. In Institute 2, 217 cases of FGM were diagnosed. Of these, in 69 cases the endoscopic finding was "polyp" (32 %). In the other cases, the endoscopic findings were mucosal defect (18 %), redness/inflammation (16 %), suspicion for gastric heterotopia (5 %) and scar (3 %). In 26 % of cases no pathologic endoscopic finding was reported. Both groups of patients with FGM showed a similar distribution of age ranges (24 - 83 years and 16 - 88 years), median age (62 years and 61 years, respectively) and a dominance of male sex (both 1.5:1). In conclusion, foveolar gastric metaplasia is a frequent, so far neglected correlate of endoscopically detected duodenal polyps.

Effect of using GPS autosteer guidance systems on the eye-glance behavior and posture of tractor operators

Tractor operators are prone to neck and back discomfort and disorders. It is well known that awkward posture is a major contributor to this problem. Previous studies have investigated the prevalence of awkward posture and the resulting discomfort and disorders among tractor operators. They have also suggested various ways to mitigate this problem. With the introduction of new autosteer guidance systems, the tractor operator is relieved from the task of steering the tractor for most of the time during field work. Therefore, it is expected that the operator's posture will change. The goal of this study was to investigate the changes in the eye-glance behavior and posture of tractor operators as a result of using autosteer guidance systems. An eye-tracking system and a camcorder were used to record the eye-glance behavior and posture of 13 tractor operators as they performed seeding operations. The experiment with each operator consisted of two sessions. In one session, the operator used an autosteer system, while in the other session the operator steered the tractor manually. Analysis of the data showed that the eye-glance behavior and posture of the operators were significantly different between the autosteer and manual steering sessions. With the autosteer system, the operators spent less time in an awkward posture, and they changed their posture less frequently. However, even with the autosteer system, the operators spent 1/3 of their time in an awkward posture. Subjective feedback from the operators indicated that more than half of them experienced back or neck/shoulder discomfort during or after seeding. It is essential that the recommendations of the previous studies, such as using large rear-view mirrors or a rotating tractor seat, be evaluated when the operator is using an autosteer system. Other tools, such as video cameras that show the attached equipment, should also be tested to evaluate their effectiveness in reducing the operator's exposure to awkward postures.

[Paraneoplastic acanthosis nigricans of the esophagus: a case report]

A 69-year-old man presented for endoscopic examination of the upper gastrointestinal tract because of dysphagia for solid food and unintended weight loss. Several months before, he had noticed brownish-gray skin lesions in the neck, in the thorax and in both axillae. A dermatological consultant expressed the suspicion of a paraneoplastic disease. Endoscopic examination revealed an adenocarcinoma of the esophagogastric junction as well as multiple small polyps in the middle and the lower thirds of the esophagus. Histological examination showed papilloma-like proliferations without atypia, which were diagnosed as acanthosis nigricans of the esophagus. After completion of the staging investigation regarding the cardiac carcinoma, combination chemotherapy was started because of the presence of liver metastases. Subsequently, partial regression of the carcinoma as well as of the dermal and esophageal lesions was noted. Acanthosis nigricans is a rare paraneoplastic disease of the esophagus. As an indicator lesion, its detection should prompt a search for a malignant tumor in the gastrointestinal tract.