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Prognosis for patients with early gastric cancer who undergo gastric resection is far better than that for patients with advanced disease. However, patients with advanced liver cirrhosis may not be suitable for general anesthesia and major surgery. We used a less invasive endoscopic mucosal resection (EMR) with a cap-fitted endoscope to resect an early gastric cancer in a 58-year-old male with decompensated liver cirrhosis. Although postoperative pathology revealed that the tumor had focal invasion to the submucosa, the patient had an uneventful course and was well during 4 years' follow-up. This method may be effective for the treatment of early gastric cancer with focal submucosal invasion when patients are not suitable for major surgery.

Background and Purpose: This study investigated changes in the severity of gastric metaplasia (GM) of the duodenal mucosa before and after ulcer healing and Helicobacter pylori eradication. It also investigated whether deformity of the duodenal bulb affects the severity of GM and the likelihood of ulcer recurrence., Methods: Eleven patients were consecutively enrolled in this study. They all had duodenal ulcer(s) and H. pylori infection, for which they had received anti-H. pylori triple therapy during the active ulcer stage, and had all undergone serial endoscopic examinations during both the active ulcer and scarring ulcer stages, and at 1 year after ulcer healing. Duodenal biopsies were obtained at each endoscopy to identify the severity of GM. Duodenal ulcers were divided into three types by bulbar shape and GM was classified into four grades of severity., Results: All 11 patients had increased GM severity just after ulcer healing. The 1-year follow-up study revealed that the GM was unchanged in six of eight patients with grade 3 GM severity at the scarring stage, while in the other two it regressed to grade 1 or 2; these two patients suffered ulcer recurrence. A markedly deformed bulb (type III) was found in three patients, of whom two had ulcer recurrence., Conclusion: Two characteristic conditions were found in patients with duodenal ulcer recurrence after H. pylori eradication: a markedly deformed bulb with grade 3 GM at the scarring stage, and a change in GM from high to low grade at or around the previous ulcer site after ulcer healing.

Microscopic epididymal sperm aspiration (MESA) for sperm retrieval and intracytoplasmic sperm injection (ICSI) is currently our routine treatment for selected male patients with obstructive azoospermia. In order to refine the surgical technique and obtain better quality sperm for our assisted reproductive technology program, we observed the epididymal tubules in 40 sessions of surgical exploration of the epididymis for sperm aspiration. Epididymal tubules with long-term obstruction could be divided into three groups on the basis of clinical observations and pathology findings: markedly dilated, mildly dilated, and nondilated. All of the markedly dilated epididymal tubules (grade III, n = 10) were azoospermic and ICSI could not be done. Epididymal sperm obtained from the mildly dilated tubules (grade II, n = 9) resulted in poorer fertilization (49%) and pregnancy (33%) rates than sperm obtained from nondilated epididymal tubules (grade I, n = 21, fertilization rate 72%, pregnancy rate 57%). These findings demonstrate that nondilated epididymal tubules are best for sperm retrieval and successful ICSI. We believe this observation will be a good surgical parameter for urologic surgeons performing MESA.

Primary linitis plastica carcinoma of the colon is rare. Most lesions are located on the left side of the colon and these tumors often involve the lymph nodes, peritoneum, and ovaries. We report a case of primary linitis plastica of the sigmoid colon in a 32-year-old Chinese woman who presented with a 7-month history of constipation and associated abdominal pain and tenesmus. Colonoscopy and barium-enema studies showed a stricture at the sigmoid colon. The patient underwent radical surgical resection and received adjuvant radiation therapy and chemotherapy. She died 12 months after the initial diagnosis. The poor prognosis seen with this tumor is due largely to a delay in diagnosis. With increasing familiarity with this tumor, it is hoped that earlier diagnosis and curative surgery will be possible, leading to improvement in survival.