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Kato T, Hikichi T, Nakamura J, Hashimoto M, Kobashi R, Yanagita T, Takagi T, Suzuki R, Sugimoto M, Asama H, Sato Y, Shioya Y, Kobayakawa M, Ohira H. Visibility of esophageal squamous cell carcinoma under iodine staining on texture and color enhancement imaging. DEN Open 2025; 5:e370. [PMID: 38725874 PMCID: PMC11079435 DOI: 10.1002/deo2.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024]
Abstract
Objective Iodine staining on white light imaging (WLI) is the gold standard for detecting and demarcating esophageal squamous cell carcinoma (ESCC). We examined the effects of texture and color enhancement imaging (TXI) on improving the endoscopic visibility of ESCC under iodine staining. Methods Twenty ESCC lesions that underwent endoscopic submucosal dissection were retrospectively included. The color difference between ESCC and the surrounding mucosa (ΔEe) on WLI, TXI, and narrow-band imaging was assessed, and ΔEe under 1% iodine staining on WLI and TXI. Furthermore, the visibility grade determined by endoscopists was evaluated on each imaging. Result The median ΔEe was greater on TXI than on WLI (14.53 vs. 10.71, respectively; p < 0.005). Moreover, the median ΔEe on TXI under iodine staining was greater than the median ΔEe on TXI and narrow-band imaging (39.20 vs. 14.53 vs. 16.42, respectively; p < 0.005 for both). A positive correlation in ΔEe under iodine staining was found between TXI and WLI (correlation coefficient = 0.61, p < 0.01). Moreover, ΔEe under iodine staining on TXI in each lesion was greater than the corresponding ΔEe on WLI. The visibility grade assessed by endoscopists on TXI was also significantly greater than that on WLI under iodine staining (p < 0.01). Conclusions The visibility of ESCC after iodine staining was greater on TXI than on WLI.
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Affiliation(s)
- Tsunetaka Kato
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Jun Nakamura
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Minami Hashimoto
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Ryoichiro Kobashi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takumi Yanagita
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Rei Suzuki
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Mitsuru Sugimoto
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hiroyuki Asama
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuki Sato
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yasuo Shioya
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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Yoshida S, Koga T, Fujita Y, Yatsuhashi H, Matsumoto H, Sumichika Y, Saito K, Sato S, Asano T, Kobayakawa M, Ohira H, Mizokami M, Sugiyama M, Migita K. Serum Mac-2 binding protein glycosylation isomer and galectin-3 levels in adult-onset Still's disease and their association with cytokines. Front Immunol 2024; 15:1385654. [PMID: 38711500 PMCID: PMC11073344 DOI: 10.3389/fimmu.2024.1385654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Autoinflammation with cytokine dysregulation may be implicated in the pathophysiology of adult-onset Still's disease (AOSD); however, the relationship between galectins and cytokines in patients with active AOSD remains unknown. We aimed to examine the relationship between circulating cytokines/chemokines and galectin-3 (Gal-3) or its ligand, Mac-2 binding protein glycosylation isomer (M2BPGi), in Japanese patients with AOSD. Methods We recruited 44 consecutive patients diagnosed with AOSD according to the Yamaguchi criteria, 50 patients with rheumatoid arthritis (RA) as disease controls, and 27 healthy participants. Serum M2BPGi levels were directly measured using a HISCL M2BPGi reagent kit and an automatic immunoanalyzer (HISCL-5000). Serum Gal-3 concentrations were measured by enzyme-linked immunosorbent assay. The serum levels of 69 cytokines were analyzed in patients with AOSD using a multi-suspension cytokine array. We performed a cluster analysis of each cytokine expressed in patients with AOSD to identify specific molecular networks. Results Significant increases in the serum concentrations of Gal-3 and M2BPGi were found in the serum of patients with AOSD compared with patients with RA and healthy participants (both p <0.001). There were significant positive correlations between serum Gal-3 levels and AOSD disease activity score (Pouchot score, r=0.66, p <0.001) and serum ferritin levels. However, no significant correlations were observed between serum M2BPGi levels and AOSD disease activity scores (Pouchot score, r = 0.32, p = 0.06) or serum ferritin levels. Furthermore, significant correlations were observed between the serum levels of Gal-3 and various inflammatory cytokines, including interleukin-18, in patients with AOSD. Immunosuppressive treatment in patients with AOSD significantly reduced serum Gal-3 and M2BPGi levels (p = 0.03 and 0.004, respectively). Conclusions Although both Gal-3 and M2BPGi were elevated in patients with AOSD, only Gal-3 was a useful biomarker for predicting disease activity in AOSD. Our findings suggest that circulating Gal-3 reflects the inflammatory component of AOSD, which corresponds to proinflammatory cytokine induction through inflammasome activation cascades.
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Affiliation(s)
- Shuhei Yoshida
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroshi Yatsuhashi
- Department of Hepatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Yuya Sumichika
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Kenji Saito
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, National Center for Global Health and Medicine, Chiba, Japan
| | - Masaya Sugiyama
- Department of Viral Pathogenesis and Controls, National Center for Global Health and Medicine, Chiba, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
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3
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Kawashima K, Hikichi T, Onizawa M, Gunji N, Watahiki Y, Sakuma C, Mochimaru T, Murakami M, Suzuki O, Hashimoto Y, Kobayakawa M, Ohira H. Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection. DEN Open 2024; 4:e300. [PMID: 37841650 PMCID: PMC10569401 DOI: 10.1002/deo2.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD. Methods Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed. Results In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; p < 0.001) and more lesions with >50% circumference than did the HM0 group (p < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group (p < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group. Conclusions The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis.
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Affiliation(s)
- Kazumasa Kawashima
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Michio Onizawa
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Yu Watahiki
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Chiharu Sakuma
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Tomoaki Mochimaru
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Mai Murakami
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Osamu Suzuki
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Yuko Hashimoto
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
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Watanabe S, Hikichi T, Yanagita T, Nakamura J, Hashimoto M, Kato T, Kobashi R, Waragai Y, Kobayakawa M, Ohira H. Esophageal squamous cell carcinoma complicated with varices successfully treated by endoscopic injection sclerotherapy and argon plasma coagulation: A case report. DEN Open 2024; 4:e348. [PMID: 38425713 PMCID: PMC10902612 DOI: 10.1002/deo2.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Treatment guidelines for esophageal squamous cell carcinoma (ESCC) with concomitant esophageal varices (EVs), which increase the risk of bleeding, are unavailable. A 66-year-old man with a history of total gastrectomy was admitted to the hospital owing to hematemesis. Emergency upper gastrointestinal endoscopy revealed variceal bleeding near the anastomosis between the esophagus and jejunum, and endoscopic clipping stopped the bleeding. Upper gastrointestinal endoscopy following hemostasis revealed four EVs and a two-thirds ESCC circumference. The ESCC depth was suspected to be up to the mucosa. The patient underwent intravariceal endoscopic injection sclerotherapy (EIS) for EVs, followed by paravariceal EIS. However, after these treatments, blood flow in the EVs just below the ESCC remained, and endoscopic resection of the ESCC was judged to be difficult to perform. Therefore, we prioritized EV treatment and performed a second EIS on the ESCC, followed by argon plasma coagulation (APC). APC was expected to not only solidify the EVs but also eliminate the ESCC existing in the mucosa. Finally, EVs and ESCC were treated by EIS and APC. EIS followed by APC may be useful for treating concurrent EVs and intramucosal ESCC in patients with liver cirrhosis when embolization of the EVs is ineffective.
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Affiliation(s)
- Sayuri Watanabe
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Takumi Yanagita
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Jun Nakamura
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Minami Hashimoto
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Tsunetaka Kato
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Ryoichiro Kobashi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Yuichi Waragai
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologySoma General HospitalFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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5
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Kato T, Hikichi T, Kobayakawa M, Nakamura J, Takasumi M, Hashimoto M, Kobashi R, Yanagita T, Takagi T, Suzuki R, Sugimoto M, Asama H, Sato Y, Ohira H. L-Menthol for Color Difference Change Between Early Gastric Cancer and Surrounding Mucosa: A Prospective Study. Dig Dis Sci 2024; 69:922-932. [PMID: 38170335 DOI: 10.1007/s10620-023-08239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND L-Menthol sprayed on early gastric cancer (EGC) has been reported to improve the visibility of the lesion. However, its impact when used in combination with novel image-enhanced endoscopy has not been investigated. AIM This study aimed to evaluate the visual effect of spraying L-menthol on EGC under linked color imaging (LCI). METHODS This open-label, single-arm, prospective study investigated the color difference between EGC and the surrounding mucosa (ΔEG) before and after spraying L-menthol. The primary endpoint was the percentage of lesions with ΔEG ≥ 5 on LCI. The percentage of lesions with ΔEG ≥ 5 on white light imaging (WLI) and blue laser imaging (BLI), ΔEG before and after spraying L-menthol, and percentage of lesions with increased ΔEG after spraying L-menthol constituted the secondary endpoints. RESULTS Sixty patients were included in the final analysis. 100% lesions had ΔEG ≥ 5, both before and after spraying L-menthol on LCI, with similar results observed in WLI as well as BLI. The median ΔEG on LCI, WLI, and BLI increased after spraying L-menthol (LCI: 16.9 vs. 21.5, p < 0.01; WLI: 10.4 vs. 13.4, p < 0.01; BLI; 12.1 vs. 15.7, before and after, respectively, p < 0.01); and LCI demonstrated the highest percentage of lesions with increased ΔEG (LCI, WLI, and BLI: 98.3%, 81.7%, and 76.7%, respectively, p < 0.01). CONCLUSION Although spraying L-menthol did not improve the visibility of EGC under LCI observation, a significant increase in ΔEG was observed in LCI (jRCTs 021200027).
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Affiliation(s)
- Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan.
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima-City, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-City, Fukushima, 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City, Fukushima, Japan
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Yanagita T, Hikichi T, Nakamura J, Hashimoto M, Kato T, Suzuki R, Sugimoto M, Sato Y, Irie H, Takagi T, Kobayakawa M, Ohira H. Novel Photodynamic Therapy for Esophageal Squamous Cell Carcinoma following Radiotherapy. Life (Basel) 2023; 13:1276. [PMID: 37374059 DOI: 10.3390/life13061276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Radiotherapy (RT) or chemoradiotherapy (CRT) are frequently selected as treatments for esophageal squamous cell carcinoma (ESCC). However, salvage treatment remains challenging when endoscopic resection is not indicated for residual or recurrent ESCC following RT or CRT. Recently, owing to the emergence of second-generation photodynamic therapy (PDT) using talaporfin sodium, PDT can be performed with less phototoxicity and therefore has regained popularity in the treatment of ESCC. In this study, the effectiveness and safety of second-generation PDT in patients with residual or recurrent ESCC following RT or CRT were examined. Local complete response (L-CR) rates, procedure-related adverse events, and prognosis were evaluated. In 12 patients with 20 ESCC lesions, the L-CR rates were 95.0%. Perforation, postoperative bleeding, and photosensitivity were not observed. Esophageal stricture following PDT developed in one patient, but this could be addressed using balloon dilation. During a median follow-up period of 12 (range, 3-42) months, the 3-year cause-specific survival rate was 85.7%. Even in patients with a Charlson comorbidity index score ≥ 3, the 2-year overall survival rates were 100%. In conclusion, PDT was an efficacious and a safe salvage treatment in patients with local residual or recurrent ESCC following RT or CRT.
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Affiliation(s)
- Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Suto K, Hikichi T, Shioya Y, Ishizaki N, Saito S, Nakamura J, Kobayakawa M, Ohira H. A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report. Clin J Gastroenterol 2023:10.1007/s12328-023-01797-8. [PMID: 37040045 DOI: 10.1007/s12328-023-01797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.
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Affiliation(s)
- Kazuto Suto
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuo Shioya
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
| | - Natsuki Ishizaki
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Saito
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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8
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Mochimaru T, Hikichi T, Hashimoto M, Nakamura J, Takasumi M, Kato T, Kobashi R, Yanagita T, Suzuki R, Sugimoto M, Sato Y, Irie H, Takagi T, Kobayakawa M, Ohira H. Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in patients with cirrhosis and esophageal varices. DEN Open 2023; 3:e117. [PMID: 35898831 PMCID: PMC9307718 DOI: 10.1002/deo2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Endoscopic submucosal dissection (ESD) has become the standard treatment for superficial esophageal squamous cell carcinoma (SESCC). However, the treatment strategy for SESCC complicated by esophageal varices (EVs) has not been established. We report two cases of SESCC in patients with alcoholic cirrhosis complicated by EVs who underwent ESD. Case 1 presented with EVs on the anal side of the SESCC, and endoscopic variceal ligation (EVL) was performed before ESD. After EVL, the SESCC was successfully treated by ESD without any adverse events. Case 2 presented EVs from the anal side of the SESCC to the submucosa just below the SESCC. Then, EVL and endoscopic injection sclerotherapy with polidocanol were performed before ESD. However, ESD was not completed because of severe bleeding by uncontrolled blood flow below and around the SESCC. Bleeding during ESD was controlled in case 1, but not in case 2.
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Affiliation(s)
- Tomoaki Mochimaru
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Takuto Hikichi
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
| | - Minami Hashimoto
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
| | - Jun Nakamura
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
| | - Mika Takasumi
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Tsunetaka Kato
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
| | - Takumi Yanagita
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Rei Suzuki
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Yuki Sato
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Hiroki Irie
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Tadayuki Takagi
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
| | - Masao Kobayakawa
- Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
- Medical Research Center Fukushima Medical University Fukushima Japan
| | - Hiromasa Ohira
- Department of Gastroenterology School of Medicine Fukushima Medical University Fukushima Japan
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9
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Yanagita T, Hikichi T, Waragai Y, Shimizu H, Takahashi Y, Abe N, Hashimoto C, Kumakawa H, Kobayakawa M, Ohira H. Mixed high-grade serous and large cell neuroendocrine carcinoma arising from rectal endometriosis 11 years after hysterectomy. Clin J Gastroenterol 2023; 16:366-371. [PMID: 36763235 DOI: 10.1007/s12328-023-01769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
The malignant gastrointestinal endometriosis transformation is represented by endometriosis-associated intestinal tumors. Endometrioid adenocarcinoma and clear cell adenocarcinoma are most common among the endometrial cancers of all organs. Only four cases of mixed serous carcinoma and large cell neuroendocrine carcinoma have been reported, and all these cases originated from the uterus. A 59-year-old woman with a month's history of bloody stools was admitted. She was stable until the hematochezia occurred but is 11 years post-hysterectomy. A circumferential type-3 advanced upper rectum tumor was seen on colonoscopy. Adenocarcinoma was revealed from the forceps biopsies of the type-3 tumor component. Computed tomography showed narrowed lumen with a thickened rectum wall, a continuing mass, and a component on the anorectal side. Swollen lymph nodes were observed around the rectum, but no distant metastatic lymph nodes or organs were found. To treat the lesion, rectal surgical resection with D3 lymph node dissection was performed. Histological examination revealed combined high-grade serous and large cell neuroendocrine carcinomas. Tumor was contiguous to the endometrium in the sub-serosa. Endometriosis was determined to be the origin of both carcinomas. Therefore, endometriosis-associated intestinal tumors should be included in the differential diagnosis when rectal tumors with cystic structures are found post-hysterectomy.
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Affiliation(s)
- Takumi Yanagita
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yuichi Waragai
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiroshi Shimizu
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuta Takahashi
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan
| | - Naoto Abe
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Choichiro Hashimoto
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromi Kumakawa
- Department of Gastroenterology, Soma General Hospital, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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10
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Kobayakawa M, Yamane H, Asayama N. [Letter to the Editor. To the Editor]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:276. [PMID: 36908147 DOI: 10.11405/nisshoshi.120.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Masao Kobayakawa
- Center for Medical Research Promotion, Fukushima Medical University
| | - Hirohiro Yamane
- Center for Medical Research Promotion, Fukushima Medical University
| | - Naoki Asayama
- Center for Medical Research Promotion, Fukushima Medical University
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11
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Kato T, Hikichi T, Nakamura J, Hashimoto M, Kobashi R, Yanagita T, Suzuki R, Sugimoto M, Sato Y, Irie H, Takasumi M, Oka Y, Takagi T, Hashimoto Y, Kobayakawa M, Ohira H. Association between Submucosal Fibrosis and Endoscopic Submucosal Dissection of Recurrent Esophageal Squamous Cell Cancers after Chemoradiotherapy. Cancers (Basel) 2022; 14:cancers14194685. [PMID: 36230608 PMCID: PMC9563937 DOI: 10.3390/cancers14194685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
Simple Summary The efficacy and safety of endoscopic submucosal dissection for early esophageal cancer after chemoradiotherapy have not been established. In this study, we focused on the fibrosis of the submucosa. As a result, we found that endoscopic submucosal dissection for early esophageal cancer can be performed reliably without adverse events, but the procedure takes longer for lesions with strong fibrosis of the submucosa. Abstract Endoscopic resection is a treatment of choice for a metachronous early-stage esophageal squamous cell carcinoma (ESCC) appearing after a radical cure of esophageal cancer by chemoradiotherapy (CRT). However, non-curative resection, and procedural complications including perforation due to radiation-induced submucosal fibrosis, are a concern. This study aimed to evaluate the association between submucosal fibrosis and the usefulness and safety of endoscopic submucosal dissection (ESD) in ESCC after CRT. This study retrospectively analyzed 13 lesions in 11 patients in our institute. Submucosal fibrosis under the lesion (F score) was classified into three levels (F0: none or mild, F1: moderate, and F2: severe) based on endoscopic and histopathologic findings. All lesions were F1 or greater (F1: 8 lesions and F2: 5 lesions). En bloc and R0 resection rates were both 100%. The procedural speed was slower in F2 than in F1 (F1 vs. F2; 15.1 mm2/min vs. 7.1 mm2/min, p = 0.019), without procedure-related adverse events. At a median follow-up of 42 months (range: 14–117 months) after ESD, 7 of 11 (63.6%) patients were alive without recurrence, and without ESCC-related death. ESCC after CRT reliably and safely resected en bloc by ESD but was more difficult in lesions with strong submucosal fibrosis.
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Affiliation(s)
- Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Correspondence: ; Tel.: +81-24-547-1583
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Ryoichiro Kobashi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuka Oka
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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12
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Kawashima K, Hikichi T, Onizawa M, Gunji N, Takeda Y, Mochimaru T, Ishizaki Y, Murakami M, Kobayashi R, Shioya Y, Suzuki O, Hashimoto Y, Kobayakawa M, Ohira H. Colonic Endoscopic Submucosal Dissection for a Granular Cell Tumor with Insufficient Endoscopic Manipulation in the Hepatic Flexure. Case Rep Gastroenterol 2022; 16:216-222. [PMID: 35528769 PMCID: PMC9035920 DOI: 10.1159/000523963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
This report describes a granular cell tumor (GCT) with insufficient endoscopic manipulation in the hepatic flexure (HF) of the colon, which was treated by endoscopic submucosal dissection (ESD) using a splinting tube and the spring S-O clip traction method. A 44-year-old man presented with a 10 mm subepithelial tumor in the HF near the ascending colon on colonoscopy. The lesion had a smooth surface without erosion. The histology of biopsied specimen from the lesion was suspected as a GCT. Most GCTs are considered low-grade malignant, but ESD was chosen to treat the lesion due to the patient’s insistence on endoscopic treatment. Because the lesion was located in the HF, it was assumed that the scope manipulation during ESD would be difficult. During ESD, a splinting tube was utilized to stabilize endoscopic manipulation and the spring S-O clip traction method to keep clear visualization of the submucosa, and the procedure was completed without adverse events. An 8 × 7 mm lesion with negative margins was removed by ESD. Hematoxylin and eosin staining showed atypical cells with round-to-oval nuclei and acidophilic vesicles, and immunohistochemical staining for S-100 protein was strongly positive with a Ki-67 labeling index of 5%. The lesion was pathologically confirmed as a GCT. This case showed the usefulness and safety of ESD for GCT with insufficient endoscopic manipulation in the HF.
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Affiliation(s)
- Kazumasa Kawashima
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- *Kazumasa Kawashima,
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Michio Onizawa
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naohiko Gunji
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yutaro Takeda
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoaki Mochimaru
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuto Ishizaki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mai Murakami
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Reiko Kobayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yasuo Shioya
- Department of Gastroenterology, Jusendo Hospital, Koriyama, Japan
| | - Osamu Suzuki
- Department of Diagnostic Pathology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Medical Research Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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13
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Takeda Y, Hikichi T, Hashimoto M, Hayashi M, Nakamura J, Takasumi M, Kato T, Kobashi R, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Murakami M, Takagi T, Kobayakawa M, Ohira H. Esophageal achalasia with severe malnutrition and liver enzyme elevation. Clin J Gastroenterol 2022; 15:345-350. [DOI: 10.1007/s12328-021-01576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
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14
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Kato T, Hikichi T, Nakamura J, Takasumi M, Hashimoto M, Kobashi R, Yanagita T, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Kobayakawa M, Ohira H. Usefulness of Endoscopic Ultrasound with the Jelly-Filling Method for Esophageal Varices. Diagnostics (Basel) 2021; 11:1726. [PMID: 34574067 PMCID: PMC8472088 DOI: 10.3390/diagnostics11091726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/25/2022] Open
Abstract
Although the importance of endoscopic ultrasound (EUS) for esophageal varices (EVs) has been demonstrated, it is difficult to obtain sufficient EUS images with the water-filling method because of poor water stagnation in the esophagus. In this study on EVs, we aimed to evaluate the usefulness of the jelly-filling method for EUS. Consecutive patients who underwent EUS for EVs were included. The quality of EUS images, the diagnostic ability of the presence of blood vessels inside and outside the esophageal wall, and the procedure time were compared between the jelly-filling and water-filling methods. Thirty cases were analyzed (jelly-filling method in 13 and water-filling method in 17). The EUS image quality score was significantly higher in the jelly-filling method (jelly vs. water; three points vs. two points, p < 0.001). Additionally, EUS image quality scores in both nonexperts and experts were significantly higher in the jelly-filling method. The diagnostic ability of the presence of perforation veins was significantly higher in the jelly-filling method (jelly vs. water; 100% vs. 52.9%, p = 0.004). However, the procedure time was significantly longer in the jelly-filling method (p = 0.024). In conclusion, EUS using the jelly-filling method for EVs provided sufficient image quality.
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Affiliation(s)
- Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Ryoichiro Kobashi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Takumi Yanagita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yoshinori Okubo
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan; (T.K.); (J.N.); (M.H.); (R.K.); (Y.O.); (M.K.)
- Medical Research Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.T.); (T.Y.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
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15
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Nakamura J, Hikichi T, Watanabe K, Hashimoto M, Kato T, Takagi T, Suzuki R, Sugimoto M, Takasumi M, Sato Y, Irie H, Kobashi R, Kikuchi H, Waragai Y, Kobayakawa M, Yamasaki M, Ohira H. Efficacy of Sodium Carboxymethylcellulose Compared to Sodium Hyaluronate as Submucosal Injectant for Gastric Endoscopic Submucosal Dissection: A Randomized Controlled Trial. Digestion 2021; 102:753-759. [PMID: 33611330 DOI: 10.1159/000513148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/17/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sodium hyaluronate (SH) is a useful submucosal injectant for gastric endoscopic submucosal dissection (ESD). On the other hand, sodium carboxymethylcellulose (SCMC), which has high viscosity, has also been applied clinically. We evaluated the efficacy of SCMC compared to that of SH in gastric ESD. METHODS A prospective randomized controlled trial was conducted to assess the efficacy of 1.0% SCMC as the injectant (SCMC group) compared to 0.4% SH (SH group) for ESD of gastric neoplasms. The primary end point was the procedure time of ESD. Secondary end points were treatment outcomes such as en bloc and R0 resection rates, number of hemostases, amount of injectant, ease of treatment (visual analog scale, 1-10 points), adverse events, and rate of ulcer healing 8 weeks after ESD. RESULTS A total of 60 patients were enrolled between October 2014 and October 2018, and 30 patients were allocated in each group. The procedure time (mean ± SD, minutes) was not significantly different between the SCMC (74.7 ± 54.5) and SH groups (67.1 ± 41.4) (p = 0.547). Furthermore, there were no differences between the 2 groups in terms of en bloc and R0 resection rates, number of hemostases, amount of injectant, ease of treatment, and rate of ulcer healing. No serious adverse events were observed in either group. CONCLUSION SCMC was comparable to SH in terms of procedure time, treatment outcome, and ease and safety of treatment in gastric ESD. Further studies are needed to demonstrate the differences between the 2 injectants.
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Affiliation(s)
- Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan,
| | - Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitomi Kikuchi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Waragai
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Yamasaki
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyusyu, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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16
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Hashimoto C, Hikichi T, Hashimoto M, Waragai Y, Takasumi M, Nakamura J, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Satake S, Kobayakawa M, Hashimoto Y, Ohira H. Localized gastric amyloidosis diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:1036-1041. [PMID: 33886105 DOI: 10.1007/s12328-021-01416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
A 49-year-old man was found to have an elevated lesion on esophagogastroduodenoscopy (EGD) for gastric cancer screening. This lesion had been noted in EGD 13 years earlier, but the patient had not received EGD since then. Endoscopy showed a relatively soft subepithelial lesion (SEL) in the gastric antrum. In addition, endoscopic ultrasonography (EUS) showed a 20-mm-sized, slightly non-uniform hypoechoic mass in the submucosa. Since the diagnosis could not be confirmed by mucosal biopsy, EUS-guided fine-needle aspiration (EUS-FNA) was performed. Hematoxylin-eosin staining of EUS-FNA samples revealed deposition of acidophilic unstructured materials. The structure was positive on Congo red staining, and green polarized light was also observed under a polarizing microscope. Moreover, it was resistant to potassium permanganate reaction, negative for serum amyloid A protein, positive for anti-λ chain antibody, and negative for anti-κ chain, anti-amyloid A, anti-transthyretin, and anti-β2-microglobulin antibodies. Therefore, the lesion was diagnosed as AL-λ-type amyloidosis. No systemic amyloidosis findings were found; thus, the patient was finally diagnosed with localized gastric AL amyloidosis. If an SEL is seen without disease-specific endoscopic findings, amyloidosis should be included in the differential diagnosis, and EUS-FNA can contribute to obtaining tissue samples in such cases.
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Affiliation(s)
- Choichiro Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
| | - Minami Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuichi Waragai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mika Takasumi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshinori Okubo
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shunsuke Satake
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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17
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Fujii M, Kobayakawa M, Saito K, Inano A, Morita A, Hasegawa M, Mukasa A, Mitsuhara T, Goto T, Yamaguchi S, Tamiya T, Nakatomi H, Oya S, Takahashi F, Sato T, Bakhit M. Rationale and Design of BeatNF2 Trial: A Clinical Trial to Assess the Efficacy and Safety of Bevacizumab in Patients with Neurofibromatosis Type 2 Related Vestibular Schwannoma. ACTA ACUST UNITED AC 2021; 28:726-739. [PMID: 33572546 PMCID: PMC7985777 DOI: 10.3390/curroncol28010071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Neurofibromatosis type 2 (NF2) is a rare genetic hereditary disease characterized by multiple central nervous system tumors, most frequently bilateral vestibular schwannomas (VSs). No chemotherapeutic agents are available for clinical use, and surgery and radiotherapy are the only therapeutic options available now. Still, neither treatment option alleviates hearing loss in patients with NF2 and VS; they may even exacerbate it. However, bevacizumab has been reported to be effective in suppressing the tumor’s growth and has shown unprecedented efficacy in improving hearing. We describe a new ongoing and novel clinical trial, BeatNF2, a randomized, double-blinded, placebo-controlled, multicenter trial to assess bevacizumab’s efficacy and safety in patients with NF2. The study’s primary endpoint is improved hearing function 24 weeks after the beginning of the treatment protocol. Abstract Neurofibromatosis type 2 (NF2) causes bilateral vestibular schwannomas (VSs), leading to deafness. VS is treated by surgery or radiation, but neither treatments prevent hearing loss. Bevacizumab was found to be effective in suppressing the tumor’s growth and may help to improve hearing. We are conducting a randomized, double-blind, multicenter clinical trial to verify the efficacy and safety of bevacizumab in NF2-related VS. The primary objective is to evaluate the efficacy of bevacizumab in improving hearing in the affected ear. One of the secondary objectives is to evaluate bevacizumab’s efficacy in rechallenge treatment in relapsed cases. Sixty patients will randomly receive either bevacizumab or a placebo and will be clinically observed for 48 weeks in the initial intervention phase. In the first half (24 weeks), they will receive either 5 mg/kg of bevacizumab or a placebo drug. In the second half, all patients will receive 5 mg/kg of bevacizumab. If hearing function deteriorated in a patient who had shown improvement during the first phase, a rechallenge dose with bevacizumab would be offered.
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Affiliation(s)
- Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan; (K.S.); (T.S.); (M.B.)
- Correspondence: ; Tel.: +81-24-547-1268
| | - Masao Kobayakawa
- Medical Research Center, Fukushima Medical University, Fukushima 960-1247, Japan; (M.K.); (A.I.)
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan; (K.S.); (T.S.); (M.B.)
| | - Akihiro Inano
- Medical Research Center, Fukushima Medical University, Fukushima 960-1247, Japan; (M.K.); (A.I.)
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo 113-8602, Japan;
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University, Toyoake 470-1192, Japan;
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University, Kumamoto 860-8555, Japan;
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8511, Japan;
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University, Osaka 558-8585, Japan;
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Hokkaido University, Sapporo 060-0808, Japan;
| | - Takashi Tamiya
- Department of Neurosurgery, Kagawa University, Takamatsu 760-0016, Japan;
| | - Hirofumi Nakatomi
- Department of Neurosurgery, University of Tokyo, Bunkyo-Ku, Tokyo 113-8654, Japan;
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Kawagoe 350-8550, Japan;
| | - Fumiaki Takahashi
- Center for Liberal Arts and Sciences, Iwate Medical University, Morioka 020-0023, Japan;
| | - Taku Sato
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan; (K.S.); (T.S.); (M.B.)
| | - Mudathir Bakhit
- Department of Neurosurgery, Fukushima Medical University, Fukushima 960-1247, Japan; (K.S.); (T.S.); (M.B.)
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18
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Hikichi T, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Kobayakawa M, Ohira H. Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature. J Clin Med 2020; 10:jcm10010020. [PMID: 33374780 PMCID: PMC7796365 DOI: 10.3390/jcm10010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022] Open
Abstract
Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Correspondence:
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Yoshinori Okubo
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City 960-1295, Fukushima, Japan; (J.N.); (M.H.); (T.K.); (Y.O.); (M.K.)
- Department of Medical Research Center, Fukushima Medical University, Fukushima-City 960-1295, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima-City 960-1295, Fukushima, Japan; (M.T.); (R.K.); (T.T.); (R.S.); (M.S.); (Y.S.); (H.I.); (H.O.)
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19
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Kubota K, Tanaka N, Miyata Y, Ohtsu H, Nakahara T, Sakamoto S, Kudo T, Nishiyama Y, Tateishi U, Murakami K, Nakamoto Y, Taki Y, Kaneta T, Kawabe J, Nagamachi S, Kawano T, Hatazawa J, Mizutani Y, Baba S, Kirii K, Yokoyama K, Okamura T, Kameyama M, Minamimoto R, Kunimatsu J, Kato O, Yamashita H, Kaneko H, Kutsuna S, Ohmagari N, Hagiwara A, Kikuchi Y, Kobayakawa M. Comparison of 18F-FDG PET/CT and 67Ga-SPECT for the diagnosis of fever of unknown origin: a multicenter prospective study in Japan. Ann Nucl Med 2020; 35:31-46. [PMID: 33037581 DOI: 10.1007/s12149-020-01533-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). METHODS The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient's attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. RESULTS A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study's analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1-58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5-37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). CONCLUSIONS FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
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Affiliation(s)
- Kazuo Kubota
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan. .,Department of Radiology, Southern TOHOKU General Hospital, Koriyama City, 7-115 Yatsuyamada, Fukushima, 963-8563, Japan.
| | - Noriko Tanaka
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoko Miyata
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Radiology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Hiroshi Ohtsu
- Clinical Epidemiology/JCRAC Data Center, Department of Data Science National Center for Global Health and Medicine Center for Clinical Sciences, Tokyo, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Setsu Sakamoto
- PET Center, Dokkyo Medical University Hospital, Tochigi, Japan.,Department of Diagnostic Radiology, Hyogo Cancer Center, Hyogo, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Murakami
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tomohiro Kaneta
- Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Joji Kawabe
- Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Nagamachi
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsuyoshi Kawano
- Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Youichi Mizutani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazukuni Kirii
- Department of Diagnostic Radiology, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Kunihiko Yokoyama
- Department of Thyroidology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Terue Okamura
- PET Center, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Masashi Kameyama
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junwa Kunimatsu
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - On Kato
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.,Medical Research Center, Fukushima Medical University, Fukushima, Japan
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20
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Sugaya T, Hikichi T, Nakamura J, Hashimoto M, Takasumi M, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Rikimaru M, Uematsu M, Minemura H, Kobayakawa M, Ohira H. Esophagobronchial fistula complicated by esophageal achalasia treated by per-oral endoscopic myotomy. Clin J Gastroenterol 2020; 13:1051-1056. [PMID: 32909156 DOI: 10.1007/s12328-020-01226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
A 48-year-old man who underwent balloon dilation for esophageal achalasia more than 20 years prior developed severe dysphagia and cough during mealtimes. Endoscopic findings showed a markedly dilated esophagus with residue, narrowing of the esophagogastric junction (EGJ), and a fistula in the middle thoracic esophagus. Esophagography showed narrowing of the EGJ and outflow of contrast from the esophagus to the bronchus. In addition, computed tomography showed marked esophageal dilatation and diffuse granular shading in both lungs. Based on these imaging findings, the patient was diagnosed with deterioration of esophageal achalasia and an esophagobronchial fistula (EBF) secondary to achalasia. The increased intra-esophageal pressure caused by the achalasia was suspected to have inhibited the closure of the EBF. Therefore, we believed that per-oral endoscopic myotomy (POEM) would help treat the achalasia and simultaneously contribute to closing of the EBF. Immediately after POEM, the dysphagia and cough improved. Furthermore, the EBF was closed. 14 months after POEM, the patient did not exhibit deterioration of esophageal achalasia and EBF. To the best of our knowledge, there have been no reports of POEM implemented in cases of esophageal achalasia complicated by EBF. Therefore, this case is worth reporting.
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Affiliation(s)
- Tatsuro Sugaya
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan.
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Minami Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Manabu Uematsu
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Medical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
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21
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Ujiie M, Terada M, Kobayakawa M, Ohmagari N. Clinical trial with unlicensed yellow fever vaccine in Japan. J Travel Med 2019; 26:5292566. [PMID: 30657930 DOI: 10.1093/jtm/tay151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Mugen Ujiie
- Travel Clinic, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Travel Clinic, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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22
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Kobayakawa M, Ohnishi S, Suzuki H. Recent development of balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 2019; 34:495-500. [PMID: 30170340 DOI: 10.1111/jgh.14463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023]
Abstract
Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.
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Affiliation(s)
- Masao Kobayakawa
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan.,Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shin Ohnishi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
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Kobayakawa M, Kokubu S, Uemura N. [The road to the insurance coverage of balloon-occluded retrograde transvenous obliteration for gastric varices]. Nihon Shokakibyo Gakkai Zasshi 2018; 115:460-466. [PMID: 29743454 DOI: 10.11405/nisshoshi.115.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Masao Kobayakawa
- Department of Gastroenterology, National Center for Global Health and Medicine.,Clinical Research Center, National Center for Global Health and Medicine.,Medical Education Center, Keio University School of Medicine.,Clinical Research Center, Fukushima Medical University Hospital
| | - Shigehiro Kokubu
- Institute for Liver Disease Minimal Invasive Treatment and Institute for Endoscopy, Shinyurigaoka General Hospital
| | - Naomi Uemura
- Kohnodai Hospital, National Center for Global Health and Medicine
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24
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Affiliation(s)
- Masao Kobayakawa
- Department of Gastroenterology, National Center for Global health and Medicine, Tokyo, Japan
| | - Yuki Matsushita
- Department of Gastroenterology, National Center for Global health and Medicine, Tokyo, Japan
| | - Hidetaka Okubo
- Department of Gastroenterology, National Center for Global health and Medicine, Tokyo, Japan
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25
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Hayakawa K, Mezaki K, Kobayakawa M, Yamamoto K, Mutoh Y, Tsuboi M, Hasimoto T, Nagamatsu M, Kutsuna S, Takeshita N, Katanami Y, Ishikane M, Ohmagari N. Impact of rapid identification of positive blood cultures using the Verigene system on antibiotic prescriptions: A prospective study of community-onset bacteremia in a tertiary hospital in Japan. PLoS One 2017; 12:e0181548. [PMID: 28742143 PMCID: PMC5524366 DOI: 10.1371/journal.pone.0181548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Rapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear. Methods We prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately. For GP bacteremia, patients with ≥2 sets of positive blood cultures were included. The primary study objective was evaluating the rates of antibiotic prescription changes within 2 days of rapid identification using the Verigene system. Results Bacteremia due to GN and GP included 144/185 (77.8%) and 41/185 (22.2%) episodes, respectively. Antibiotic prescription changes occurred in 51/185 cases (27.6% [95%CI:21.3–34.6%]) after Verigene analysis and 70/185 cases (37.8% [30.8–45.2%]) after conventional identification and susceptibility testing. Prescription changes after Verigene identification were more frequent in GP (17/41[41.5%]) than in GN (34/144[23.5%]). Among bacteremia due to single pathogen targeted by Verigene test, bacterial identification agreement between the two tests was high (GP: 38/39[97.4%], GN: 116/116[100%]). The Verigene test correctly predicted targeted antimicrobial resistance. The durations between the initiation of incubation and reporting of the results for the Verigene system and conventional test was 28.3 h (IQR: 25.8–43.4 h) and 90.6 h (68.3–118.4 h), respectively. In only four of the seven episodes of COB in which two isolates were identified by conventional tests, the Verigene test correctly identified both organisms. Conclusion We observed a high rate of antibiotic prescription changes after the Verigene test in a population with COB especially in GP. The Verigene test would be a useful tool in antimicrobial stewardship programs among patients with COB.
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Affiliation(s)
- Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | - Kazuhisa Mezaki
- Department of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshikazu Mutoh
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Motoyuki Tsuboi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehiro Hasimoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Maki Nagamatsu
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Division of Global infectious diseases, Department of Infection and Epidemiology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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26
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Cho H, Nagata N, Shimbo T, Sakurai T, Sekine K, Okubo H, Imbe K, Watanabe K, Mikami S, Yokoi C, Kobayakawa M, Mizokami M, Yanase M, Akiyama J, Uemura N. Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding: A long-term cohort study. Hepatol Res 2016; 46:1338-1346. [PMID: 26946225 DOI: 10.1111/hepr.12692] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 12/27/2022]
Abstract
AIM To elucidate the rates of recurrence and mortality in acute esophageal variceal bleeding and the associated risk factors. METHODS A cohort of 174 patients emergently hospitalized for esophageal variceal bleeding was analyzed. All patients underwent endoscopic variceal ligation within 3 h of arrival. Comorbidities, vital signs, drug use, laboratory data, etiology, endoscopic findings, transfusion requirement, and follow-up endoscopy were assessed. Cox's proportional hazards model was used to estimate hazard ratios (HR). RESULTS Rebleeding was identified in 49 patients with a mean follow-up of 18 months. The cumulative rebleeding rate at 1 month, 1 year, and 5 years was 10.2%, 30.0%, and 51.0%, respectively. In multivariate analysis, independent risk factors for rebleeding were child-Pugh class C (HR 1.94; P = 0.027), alcoholic liver cirrhosis (HR 2.32; P = 0.01), and no follow-up endoscopy (HR 13.3; P < 0.001). During the overall mean follow-up of 22 months, 69 patients died (17 due to bleeding), and the cumulative mortality rate at 1 month, 1 year, and 5 years was 12.2%, 26.6%, and 63.0%, respectively. In multivariate analysis, independent risk factors for mortality were child-Pugh class C (HR 2.91; P < 0.001), coexistence of hepatocellular carcinoma (HR 1.92; P = 0.013), and no follow-up endoscopy (HR 23.6; P < 0.001). CONCLUSION This study revealed more than 50% cumulative rebleeding and mortality in the 5-year period after endoscopic variceal ligation for esophageal variceal bleeding in an emergency setting. Child-Pugh C, alcoholic liver cirrhosis, and no follow-up endoscopy increased the risk of rebleeding; Child-Pugh C, coexistence of hepatocellular carcinoma, and no follow-up endoscopy increased the risk of mortality.
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Affiliation(s)
- Hourin Cho
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takuro Shimbo
- Clinical Research and Informatics, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetaka Okubo
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koh Imbe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shintaro Mikami
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chizu Yokoi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masashi Mizokami
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - Mikio Yanase
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
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Hayakawa K, Mezaki K, Yamamoto K, Mutoh Y, Tsuboi M, Hashimoto T, Katanami Y, Kutsuna S, Takeshita N, Kobayakawa M, Ohmagari N. Impact of Rapid Identification of Positive Blood Cultures by Verigene System on Antibiotic Prescription: Prospective Study of Community-Onset Bacteremia in a Tertiary Hospital in Japan. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhisa Mezaki
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshikazu Mutoh
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Motoyuki Tsuboi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehiro Hashimoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Umemoto K, Kojima Y, Nagata N, Yokoi C, Sakurai T, Kobayakawa M, Iizuka T, Igari T, Yanase M, Akiyama J. Cytomegalovirus esophagitis developing during chemoradiotherapy for esophageal cancer: two case reports. J Med Case Rep 2016; 10:259. [PMID: 27655584 PMCID: PMC5031298 DOI: 10.1186/s13256-016-0947-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that cytomegalovirus esophagitis occurs in immunosuppressed patients. However, few reports have described cytomegalovirus esophagitis occurring during chemoradiotherapy for esophageal cancer. CASE PRESENTATION We report two cases of patients with cytomegalovirus esophagitis that developed during chemoradiotherapy for esophageal cancer. Cytomegalovirus esophagitis was diagnosed based on the presence of intranuclear inclusions in tumor biopsy specimens. The two Japanese patients presented with anorexia and fever, which improved with anti-cytomegalovirus treatment, and intranuclear inclusions were no longer seen in the specimens. CONCLUSIONS The possibility of cytomegalovirus esophagitis must be kept in mind for patients with esophageal cancer presenting with prolonged fever or digestive symptoms while receiving chemoradiotherapy.
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Affiliation(s)
- Kumiko Umemoto
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Yasushi Kojima
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Chizu Yokoi
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toshihiko Iizuka
- Departments of Clinical Pathology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, 162-8655, Tokyo, Japan
| | - Toru Igari
- Departments of Clinical Pathology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, 162-8655, Tokyo, Japan
| | - Mikio Yanase
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Junichi Akiyama
- Department of Gastroenterology, National Center of Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
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Togawa K, Matsuzaki J, Kobayakawa M, Fukushima Y, Suzaki F, Kasugai K, Nishizawa T, Naito Y, Hayakawa T, Kamiya T, Andoh T, Yoshida H, Tokura Y, Nagata H, Mori M, Kato K, Hosoda H, Takebayashi T, Miura S, Uemura N, Joh T, Hibi T, Suzuki H. Association of baseline plasma des-acyl ghrelin level with the response to rikkunshito in patients with functional dyspepsia. J Gastroenterol Hepatol 2016; 31:334-41. [PMID: 26252950 DOI: 10.1111/jgh.13074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM We recently conducted a randomized placebo-controlled trial on the efficacy and safety of rikkunshito, a standardized Japanese herbal medicine, for the treatment of functional dyspepsia (FD). The present post-hoc study aimed to evaluate the differences in clinical characteristics between responders and non-responders among FD patients who received rikkunshito for 8 weeks. METHODS Rikkunshito responders were defined by using a global patient assessment. Candidate predictors included age, gender, smoking, alcohol consumption, body mass index, comorbidity, Helicobacter pylori infection, plasma levels of acyl ghrelin and des-acyl ghrelin, severity of dyspeptic symptoms, FD subgroup, previous medication, and the type of recruiting institution (clinic or hospital). We calculated hazard ratios (HRs) by using Cox regression analysis with the factors that were indicated to be associated with responders. RESULTS We assigned 83 and 42 patients to responder and non-responder categories, respectively. Lack of alcohol consumption (HR, 2.04; 95% confidence interval, 1.08-3.88) and low plasma des-acyl ghrelin levels (< 177 fmol/mL; HR, 2.42; 95% confidence interval, 1.24-4.73) were significantly associated with the efficacy of rikkunshito. Lack of alcohol consumption was associated with the efficacy of rikkunshito especially among H. pylori-infected participants. On the other hand, the low plasma des-acyl ghrelin was associated with the efficacy of rikkunshito especially among H. pylori-negative participants. CONCLUSIONS A low baseline level of plasma des-acyl ghrelin was associated with an increased treatment efficacy of rikkunshito against FD. Lack of alcohol consumption was also clinically useful for predicting the response to rikkunshito.
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Affiliation(s)
- Koji Togawa
- Rikkunshito Study Group, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Juntaro Matsuzaki
- Rikkunshito Study Group, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Fumio Suzaki
- Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University, Nagakute, Japan
| | | | - Yuji Naito
- Department of Gastroenterology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Takeshi Kamiya
- Department of Gastroenterology, Nagoya City University School of Medicine, Nagoya, Japan
| | - Takashi Andoh
- Division of Gastroenterology, Social Insurance Kyoto Hospital, Kyoto, Japan
| | - Hideo Yoshida
- Division of Gastroenterology, Eiju General Hospital, Tokyo, Japan
| | | | - Hiroshi Nagata
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
| | | | | | - Hiroshi Hosoda
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Toru Takebayashi
- Department of Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Soichiro Miura
- Department of Gastroenterology, National Defense Medical College, Tokorozawa, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Takashi Joh
- Department of Gastroenterology, Nagoya City University School of Medicine, Nagoya, Japan
| | - Toshifumi Hibi
- Rikkunshito Study Group, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Rikkunshito Study Group, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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30
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Kamei K, Nakatani H, Takeda J, Takeda R, Watabe Y, Kobayakawa M. Surgical treatment of intracapsular fracture of condyle. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Sekine K, Nagata N, Sakamoto K, Arai T, Shimbo T, Shinozaki M, Okubo H, Watanabe K, Imbe K, Mikami S, Nozaki Y, Sakurai T, Yokoi C, Kojima Y, Kobayakawa M, Yanase M, Akiyama J, Noda M, Uemura N. Abdominal visceral fat accumulation measured by computed tomography associated with an increased risk of gallstone disease. J Gastroenterol Hepatol 2015; 30:1325-31. [PMID: 25869941 DOI: 10.1111/jgh.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Visceral adiposity is a strong determinant of insulin resistance, which decreases cholecystokinin response sensitivity, and increases cholesterol saturation in the gallbladder bile; thus, it potentially relates to gallstone disease development. We aimed to investigate whether visceral fat measured by computed tomography (CT) is a risk factor for gallstone disease. METHODS A cohort of 717 participants undergoing CT and ultrasonography was analyzed. The associations between body mass index (BMI), visceral adipose tissue (VAT) area, subcutaneous adipose tissue (SAT) area, and gallstone disease were analyzed adjusted for age, sex, hypertension, diabetes, and dyslipidemia. RESULTS In multivariate analysis, gallstone disease was significantly associated with VAT and SAT areas for both categorical data and trend (P for trend < 0.001, 0.009), but not body mass index (BMI). Among patients with BMI < 25, gallstone disease remained significantly associated with VAT area (P for trend 0.021) and SAT area (P for trend 0.005). Interactions between the obesity indices and being elderly on the risk of gallstone disease were found; specifically BMI (P = 0.005), SAT (P < 0.001), and VAT (P = 0.154). A significant association between all obesity indices and gallstone disease was seen in patients aged < 65 but not among those aged ≥ 65. However, no significant association was noted between the obesity indices and sex. CONCLUSIONS CT-measured adipose tissue, rather than BMI, was a better predictor for risk of gallstone disease. This finding applies to younger people or even those with normal body weight, suggesting the importance of abdominal visceral fat accumulation in the development of gallstone disease.
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Affiliation(s)
- Katsunori Sekine
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naoyoshi Nagata
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kayo Sakamoto
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tomohiro Arai
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuro Shimbo
- Clinical Research and Informatics, International Clinical Research Center Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Shinozaki
- Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hidetaka Okubo
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Watanabe
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koh Imbe
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shintaro Mikami
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuichi Nozaki
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshiyuki Sakurai
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Chizu Yokoi
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasushi Kojima
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masao Kobayakawa
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mikio Yanase
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Junichi Akiyama
- Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mitsuhiko Noda
- Diabetes Research Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan
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Matsuzaki J, Suzuki H, Kobayakawa M, Inadomi JM, Takayama M, Makino K, Iwao Y, Sugino Y, Kanai T. Association of Visceral Fat Area, Smoking, and Alcohol Consumption with Reflux Esophagitis and Barrett's Esophagus in Japan. PLoS One 2015. [PMID: 26225858 PMCID: PMC4520496 DOI: 10.1371/journal.pone.0133865] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Central obesity has been suggested as a risk factor for gastroesophageal reflux disease. The aim of this study was to evaluate the association of visceral fat area and other lifestyle factors with reflux esophagitis or Barrett's esophagus in Japanese population. METHODS Individuals who received thorough medical examinations including the measurement of visceral fat area by abdominal computed tomography were enrolled. Factors associated with the presence of reflux esophagitis, the severity of reflux esophagitis, or the presence of Barrett's esophagus were determined using multivariable logistic regression models. RESULTS A total of 2608 individuals were eligible for the analyses. Visceral fat area was associated with the presence of reflux esophagitis both in men (odds ratio, 1.21 per 50 cm2; 95% confident interval, 1.01 to 1.46) and women (odds ratio, 2.31 per 50 cm2; 95% confident interval, 1.57 to 3.40). Current smoking and serum levels of triglyceride were also associated with the presence of reflux esophagitis in men. However, significant association between visceral fat area and the severity of reflux esophagitis or the presence of Barrett's esophagus was not shown. In men, excessive alcohol consumption on a drinking day, but not the frequency of alcohol drinking, was associated with both the severity of reflux esophagitis (odds ratio, 2.13; 95% confident interval, 1.03 to 4.41) and the presence of Barrett's esophagus (odds ratio, 1.71; 95% confident interval, 1.14 to 2.56). CONCLUSION Visceral fat area was independently associated with the presence of reflux esophagitis, but not with the presence of Barrett's esophagus. On the other hand, quantity of alcohol consumption could play a role in the development of severe reflux esophagitis and Barrett's esophagus in Japanese population.
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Affiliation(s)
- Juntaro Matsuzaki
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Masao Kobayakawa
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - John M. Inadomi
- Division of Gastroenterology, Department of Internal Medicine, University of Washington Medical School, Seattle, Washington, United States of America
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Kanako Makino
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Yasushi Iwao
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Yoshinori Sugino
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Takahashi Y, Nagata N, Shimbo T, Nishijima T, Watanabe K, Aoki T, Sekine K, Okubo H, Watanabe K, Sakurai T, Yokoi C, Kobayakawa M, Yazaki H, Teruya K, Gatanaga H, Kikuchi Y, Mine S, Igari T, Takahashi Y, Mimori A, Oka S, Akiyama J, Uemura N. Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. PLoS One 2015. [PMID: 26208220 PMCID: PMC4514810 DOI: 10.1371/journal.pone.0133589] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of candida esophagitis (CE) might be changing in an era of highly active antiretroviral therapy (HAART) among HIV-infected patients or today’s rapidly aging society among non-HIV-infected patients. However, few studies have investigated long-term CE trends, and CE risk factors have not been studied in a large sample, case-control study. This study aimed to determine long-term trends in CE prevalence and associated risk factors for patients with or without HIV infection. Methods Trends in CE prevalence were explored in a cohort of 80,219 patients who underwent endoscopy between 2002 and 2014. Risks for CE were examined among a subcohort of 6,011 patients. In risk analysis, we assessed lifestyles, infections, co-morbidities, immunosuppressants, and proton-pump inhibitors (PPIs). All patients were tested for HIV, hepatitis B or C virus, and syphilis infection. For HIV-infected patients, sexual behavior, CD4 cell count, history of HAART were also assessed. Results CE prevalence was 1.7% (1,375/80,219) in all patients, 9.8% (156/1,595) in HIV-infected patients, and 1.6% (1,219/78,624) in non-HIV-infected patients. CE prevalence from 2002-2003 to 2012-2014 tended to increase in non-HIV-infected patients (0.6% to 2.5%; P<0.01) and decrease in HIV-infected patients (13.6% to 9.0%; P=0.097). Multivariate analysis revealed increasing age (odds ratio [OR], 1.02; p=0.007), HIV infection (OR, 4.92; p<0.001), and corticosteroid use (OR, 5.90; p<0.001) were significantly associated with CE, and smoking (OR, 1.32; p=0.085) and acetaminophen use (OR, 1.70; p=0.097) were marginally associated. No significant association was found with alcohol consumption, hepatitis B or C virus, syphilis, diabetes mellitus, cardiovascular disease, cerebrovascular disease, chronic kidney disease, liver cirrhosis, anticancer, or PPIs use. In HIV-infected patients, CD4 cell count <100/μL (OR, 4.83; p<0.001) and prior HAART (OR, 0.35; p=0.006) were independently associated with CE, but sexual behavior was not. Among corticosteroid users, CE was significantly associated with higher prednisone-equivalent dose (p=0.043 for trend test). Conclusions This large, endoscopy-based study demonstrated that CE prevalence increased in non-HIV-infected patients but decreased in HIV-infected patients over 13 years. Risk analysis revealed that increasing age, HIV infection, and corticosteroids use, particularly at higher doses, were independently associated with CE, but alcohol, other infections, diabetes, anticancer drugs, and PPIs use were not.
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Affiliation(s)
- Yuta Takahashi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | | | - Takeshi Nishijima
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Watanabe
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetaka Okubo
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chizu Yokoi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hirohisa Yazaki
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Sohtaro Mine
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toru Igari
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuko Takahashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akio Mimori
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
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Mishima S, Nozaki Y, Mikami S, Kihira E, Iikura M, Koketsu R, Sugiyama H, Masuda T, Kaname H, Egami Y, Nakayama T, Hasuo K, Nakamura H, Igari T, Watanabe K, Nagata N, Sakurai T, Yokoi C, Kobayakawa M, Kojima Y, Akiyama J, Imamura M, Masaki N, Yanase M. Diffuse Liver Metastasis of Small-Cell Lung Cancer Presenting as Acute Liver Failure and Diagnosed by Transjugular Liver Biopsy: A Rare Case in Whom Nodular Lesions Were Detected by Enhanced CT Examination. Case Rep Gastroenterol 2015; 9:81-7. [PMID: 25969674 PMCID: PMC4427142 DOI: 10.1159/000381140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Small-cell lung cancer (SCLC) is a subgroup of lung cancer with a high frequency of liver metastasis, which is a predictor of poor prognosis. Diffuse liver metastases of SCLC with no visible nodular lesions in the liver when examined using computed tomography (CT) are relatively rare; however, a few cases with rapid progression to acute liver failure that were diagnosed after death have been reported. In this paper, we report a 63-year-old man with diffuse liver metastases of SCLC that were histologically diagnosed using a transjugular liver biopsy while the patient was alive, even though no lesions were visible during a contrast-enhanced CT examination.
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Affiliation(s)
- S Mishima
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Y Nozaki
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - S Mikami
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - E Kihira
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - R Koketsu
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - H Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - T Masuda
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - H Kaname
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Y Egami
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - T Nakayama
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - K Hasuo
- Department of Radiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - H Nakamura
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - T Igari
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - K Watanabe
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - N Nagata
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - T Sakurai
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - C Yokoi
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Kobayakawa
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Y Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - J Akiyama
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Imamura
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - N Masaki
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Yanase
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
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Suzuki H, Matsuzaki J, Fukushima Y, Suzaki F, Kasugai K, Nishizawa T, Naito Y, Hayakawa T, Kamiya T, Andoh T, Yoshida H, Tokura Y, Nagata H, Kobayakawa M, Mori M, Kato K, Hosoda H, Takebayashi T, Miura S, Uemura N, Joh T, Hibi T, Tack J. Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia--a multicenter, double-blind, randomized, placebo-controlled study. Neurogastroenterol Motil 2014; 26:950-61. [PMID: 24766295 DOI: 10.1111/nmo.12348] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rikkunshito, a standardized Japanese herbal medicine, is thought to accelerate gastric emptying and relieve dyspepsia, although no large-scale, randomized, placebo-controlled trials of rikkunshito have been conducted. This study aimed to determine the efficacy and safety of rikkunshito for treating functional dyspepsia (FD). METHODS FD patients received 2.5 g rikkunshito or placebo three times a day for 8 weeks in this multicenter, randomized, placebo-controlled, parallel-group trial. The primary end point was the proportion of responders at 8 weeks after starting test drug, determined by global patient assessment (GPA). The improvement in four major dyspepsia symptoms severity scale was also evaluated. In addition, plasma ghrelin levels were investigated before and after treatment. KEY RESULTS Two hundred forty-seven patients were randomly assigned. In the eighth week, the rikkunshito group had more GPA responders (33.6%) than the placebo (23.8%), although this did not reach statistical significance (p = 0.09). Epigastric pain was significantly improved (p = 0.04) and postprandial fullness tended to improve (p = 0.06) in the rikkunshito group at week 8. Rikkunshito was relatively more effective among Helicobacter pylori-infected participants (rikkunshito: 40.0% vs placebo: 20.5%, p = 0.07), and seemed less effective among H. pylori-uninfected participants (rikkunshito: 29.3% vs placebo: 25.6%, p = 0.72). Among H. pylori-positive individuals, acyl ghrelin levels were improved just in rikkunshito group. There were no severe adverse events in both groups. CONCLUSIONS & INFERENCES Administration of rikkunshito for 8 weeks reduced dyspepsia, particularly symptoms of epigastric pain and postprandial fullness. (UMIN Clinical Trials Registry, Number UMIN000003954).
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Affiliation(s)
- H Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Kobayashi M, Sako A, Ogami T, Nishimura S, Asayama N, Yada T, Nagata N, Sakurai T, Yokoi C, Kobayakawa M, Yanase M, Masaki N, Takeshita N, Uemura N. Validation of the 3-day rule for stool bacterial tests in Japan. Intern Med 2014; 53:533-9. [PMID: 24633021 DOI: 10.2169/internalmedicine.53.0979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Stool cultures are expensive and time consuming, and the positive rate of enteric pathogens in cases of nosocomial diarrhea is low. The 3-day rule, whereby clinicians order a Clostridium difficile (CD) toxin test rather than a stool culture for inpatients developing diarrhea >3 days after admission, has been well studied in Western countries. The present study sought to validate the 3-day rule in an acute care hospital setting in Japan. METHODS Stool bacterial and CD toxin test results for adult patients hospitalized in an acute care hospital in 2008 were retrospectively analyzed. Specimens collected after an initial positive test were excluded. The positive rate and cost-effectiveness of the tests were compared among three patient groups. PATIENTS The adult patients were divided into three groups for comparison: outpatients, patients hospitalized for ≤3 days and patients hospitalized for ≥4 days. RESULTS Over the 12-month period, 1,597 stool cultures were obtained from 992 patients, and 880 CD toxin tests were performed in 529 patients. In the outpatient, inpatient ≤3 days and inpatient ≥4 days groups, the rate of positive stool cultures was 14.2%, 3.6% and 1.3% and that of positive CD toxin tests was 1.9%, 7.1% and 8.5%, respectively. The medical costs required to obtain one positive result were 9,181, 36,075 and 103,600 JPY and 43,200, 11,333 and 9,410 JPY, respectively. CONCLUSION The 3-day rule was validated for the first time in a setting other than a Western country. Our results revealed that the "3-day rule" is also useful and cost-effective in Japan.
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Affiliation(s)
- Masanori Kobayashi
- Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, Japan
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37
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Umemoto K, Kojima Y, Akiyama J, Nozaki Y, Nagata N, Sakurai T, Yokoi C, Kobayakawa M, Yanase M. Cytomegalovirus Esophagitis During Chemotherapy in Patients with Esophageal Cancer; a Report of Three Cases. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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38
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Watanabe K, Nagata N, Shimbo T, Nakashima R, Furuhata E, Sakurai T, Akazawa N, Yokoi C, Kobayakawa M, Akiyama J, Mizokami M, Uemura N. Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training. BMC Gastroenterol 2013; 13:128. [PMID: 23947684 PMCID: PMC3765341 DOI: 10.1186/1471-230x-13-128] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/08/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accurate prediction of Helicobacter pylori infection status on endoscopic images can contribute to early detection of gastric cancer, especially in Asia. We identified the diagnostic yield of endoscopy for H. pylori infection at various endoscopist career levels and the effect of two years of training on diagnostic yield. METHODS A total of 77 consecutive patients who underwent endoscopy were analyzed. H. pylori infection status was determined by histology, serology, and the urea breast test and categorized as H. pylori-uninfected, -infected, or -eradicated. Distinctive endoscopic findings were judged by six physicians at different career levels: beginner (<500 endoscopies), intermediate (1500-5000), and advanced (>5000). Diagnostic yield and inter- and intra-observer agreement on H. pylori infection status were evaluated. Values were compared between the two beginners after two years of training. The kappa (K) statistic was used to calculate agreement. RESULTS For all physicians, the diagnostic yield was 88.9% for H. pylori-uninfected, 62.1% for H. pylori-infected, and 55.8% for H. pylori-eradicated. Intra-observer agreement for H. pylori infection status was good (K > 0.6) for all physicians, while inter-observer agreement was lower (K = 0.46) for beginners than for intermediate and advanced (K > 0.6). For all physicians, good inter-observer agreement in endoscopic findings was seen for atrophic change (K = 0.69), regular arrangement of collecting venules (K = 0.63), and hemorrhage (K = 0.62). For beginners, the diagnostic yield of H. pylori-infected/eradicated status and inter-observer agreement of endoscopic findings were improved after two years of training. CONCLUSIONS The diagnostic yield of endoscopic diagnosis was high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases. In beginners, daily training on endoscopic findings improved the low diagnostic yield.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Takuro Shimbo
- Department of Clinical Research and Informatics, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Ryo Nakashima
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Etsuko Furuhata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Naoki Akazawa
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Chizu Yokoi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Masashi Mizokami
- Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa City, Chiba 272-8516, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa City, Chiba 272-8516, Japan
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Watanabe K, Nagata N, Nakashima R, Furuhata E, Shimbo T, Kobayakawa M, Sakurai T, Imbe K, Niikura R, Yokoi C, Akiyama J, Uemura N. Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: validation study. World J Gastroenterol 2013; 19:4374-9. [PMID: 23885149 PMCID: PMC3718906 DOI: 10.3748/wjg.v19.i27.4374] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/01/2013] [Accepted: 05/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To validate the usefulness of screening endoscopy findings for predicting Helicobacter pylori (H. pylori) infection status. METHODS H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori-uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings: regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated. RESULTS Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases: uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19). CONCLUSION The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.
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Nakashima R, Nagata N, Watanabe K, Kobayakawa M, Sakurai T, Akiyama J, Hoshimoto K, Shimbo T, Uemura N. Histological features of nodular gastritis and its endoscopic classification. J Dig Dis 2011; 12:436-42. [PMID: 22118692 DOI: 10.1111/j.1751-2980.2011.00532.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To clarify the histological features and endoscopic classifications of nodular gastritis (NG). METHODS Overall 40 996 patients who had undergone an upper gastrointestinal endoscopy were enrolled. NG is defined as a uniform and diffuse protrusion from the antrum to angulus, which has two types at endoscopy: nodular (N) and granular (G). Three biopsy specimens were taken from the antrum, angulus and corpus. The histological features were evaluated using the updated Sydney System (USS). The topography of gastritis (antrum-predominant, pangastritis or corpus-predominant) and the prevalence of lymphoid follicles were also investigated. RESULTS Overall 89 patients (0.22%) were diagnosed with NG, which tended to decrease in prevalence over age and predominantly affected women. All the patients were Helicobacter pylori-positive. Among these, 65 patients underwent biopsy. Activity and inflammation were mostly moderate or severe, while intestinal metaplasia and atrophy were mostly absent at all three sites. Pangastritis was the most frequent (72%) type of gastritis. Lymphoid follicles were found in 69% at the antrum, 65% at the angulus and 51% at the corpus. There were no significant differences between N and G types in clinical features, USS scores, topography of gastritis, and prevalence of lymphoid follicles. CONCLUSIONS Atrophy and intestinal metaplasia are rare but activity and chronic inflammation are severe at the antrum, angulus and corpus in NG. Pangastritis is the commonest type of gastritis. Lymphoid follicles affect everything up to the upper corpus, contrary to endoscopic protrusion found only at angulus. There was no correlation with pathological features between N and G types.
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Affiliation(s)
- Ryo Nakashima
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
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Kobayakawa M, Kojima Y. Tegafur/gimeracil/oteracil (S-1) approved for the treatment of advanced gastric cancer in adults when given in combination with cisplatin: a review comparing it with other fluoropyrimidine-based therapies. Onco Targets Ther 2011; 4:193-201. [PMID: 22162925 PMCID: PMC3233278 DOI: 10.2147/ott.s19059] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
S-1 is a combination of three pharmacological compounds, namely tegafur, gimeracil, and oteracil potassium. Tegafur is a prodrug of 5-fluorouracil (5-FU), an oral fluoropyrimidine, and it has been developed as a replacement for infusional 5-FU therapy. S-1-based chemotherapy and the combination of S-1 and cisplatin are the most reasonable first-line standards for unresectable advanced gastric cancer in Japan. However, the application of S-1 for gastric cancer has been delayed in Western countries. One reason for this delay is that the pharmacokinetics of tegafur is affected by polymorphisms in cytochrome P-450 2A6, and consequently 5-FU concentrations in the plasma are more likely to be elevated in patients from Western countries. Although the dose of S-1 was reduced compared with the approved dose in Japan, a global Phase III study reported similar results regarding overall survival between S-1 plus cisplatin and infusional 5-FU plus cisplatin arms. Significant safety advantages were observed in the S-1 plus cisplatin arm compared with the infusional 5-FU plus cisplatin arm. S-1 plus cisplatin has become acceptable for Western countries, also, as a choice for unresectable advanced gastric cancer. Comparisons with capecitabine and combination of several targeting agents with S-1 are expected in the future.
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Affiliation(s)
- Masao Kobayakawa
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
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42
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Fujiya K, Akiyama J, Yokota E, Asayama N, Ogami T, Nakajima R, Nishimura S, Sakurai T, Nagata N, Yokoi C, Kojima Y, Kobayakawa M, Gotoda T, Shimbo T, Uemura N. [S-1-based chemotherapy for unresectable advanced gastric cancer of the elderly or patients with renal dysfunction]. Gan To Kagaku Ryoho 2011; 38:1817-1820. [PMID: 22083189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE S-1 based therapy is a valued standard chemotherapy regimen for unresectable gastric cancer in Japan. S-1/ CDDP therapy has been highly effective, especially for patients under 75 years old who have good organ function. However, it is the elderly and/or patients with renal dysfunction who make up the majority of the candidates for chemotherapy in general hospitals. These factors make it difficult to apply the results of RCTs to chemotherapy regimens. AIM AND METHODS To investigate clinical outcomes, the medical records of patients who had received S-1 based chemotherapy for gastric cancer at our hospital from January 2002 to September 2009 were retrospectively reviewed. RESULTS A total of 78 patients were evaluated for analyses. Among the patients, 23(29%)were the elderly, 8(10%)had renal dysfunction, and 27(35%)were either the elderly or those who had renal dysfunction. S-1/CDDP therapy was provided for 63% of the patients. Regarding the outcomes from therapy, RR was 44%, mPFS was 5. 4 months, and MST was 10. 6 months. Regarding survival benefit for OS, the elderly, the intestinal type, and therapy with S-1 alone were considered to be good factors in multi-variant analysis, but no significant differences were confirmed. CONCLUSION In general practice, the elderly and/or patients with renal dysfunction account for 35%, and S-1-based chemotherapy has been proven to be very effective. However, additional effects of CDDP were not shown in this study.
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Affiliation(s)
- Keiichi Fujiya
- Dept. of Gastroenterology and Hepatology, International Clinical Research Center, Japan
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Nishimura S, Nagata N, Kobayakawa M, Sako A, Nakashima R, Uemura N. [A case of candidal infection of gastric ulcers with characteristic endoscopic findings]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1393-1398. [PMID: 21817842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
While Candida infection is a common opportunistic infection, Candida-associated gastric lesions are far less frequent. We report a case of gastric ulcers due to candidal infection. A 73-year-old woman had ulcers refractory to treatment with a proton pump inhibitor (PPI) and Helicobacter pylori eradication. Endoscopic findings showed that this case involved 2 gastric ulcers with thick exudate mainly located in the fornix. Biopsy specimens from gastric ulcers revealed numerous Candida forms. The patient was treated with antifungal drugs and the ulcers healed completely on endoscopy. We should draw attention to our observation in elderly patients with gastric ulcers, and if we find gastric ulcers with such characteristic endoscopic findings, candidal infection of gastric ulcers should be considered.
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Affiliation(s)
- So Nishimura
- Department of Gastroenterology, National Center for Global Health and Medicine, Kohnodai Hospital.
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Nagata N, Honda M, Kobayakawa M, Maeda S, Sakurai T, Akiyama J, Gotoda T, Oka S, Uemura N. Mycobacterium lentiflavum ileitis using aspirated intestinal fluid during endoscopy in HIV-infected patient. Dig Endosc 2011; 23:271-2. [PMID: 21699576 DOI: 10.1111/j.1443-1661.2010.01091.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Kobayakawa M. Does the article, "Mass screening for gastric cancer: how to select patients for endoscopic examination," satisfy criteria of scientific quality? Gastric Cancer 2011; 14:200. [PMID: 21344221 DOI: 10.1007/s10120-011-0026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/15/2010] [Indexed: 02/07/2023]
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Nagata N, Kobayakawa M, Shimbo T, Hoshimoto K, Yada T, Gotoda T, Akiyama J, Oka S, Uemura N. Diagnostic value of antigenemia assay for cytomegalovirus gastrointestinal disease in immunocompromised patients. World J Gastroenterol 2011; 17:1185-91. [PMID: 21448424 PMCID: PMC3063912 DOI: 10.3748/wjg.v17.i9.1185] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the utility of the cytomegalovirus (CMV) antigenemia assay for the diagnosis of CMV gastrointestinal disease (GID).
METHODS: One hundred and thirty immunocompromised patients were enrolled in this study. Patients with a history of anti-CMV treatment and who had not undergone examination using the antigenemia assay were excluded. CMV-GID was defined as the detection of large cells with intranuclear inclusions alone or associated with granular cytoplasmic inclusions by biopsy. Biopsy sections were stained with hematoxylin and eosin and immunohistochemically stained with anti-CMV. We evaluated the association between CMV-GID and patient characteristics (symptoms, underlying disease, medication, leukocyte counts, and antigenemia assay). All patients were checked with an human immunodeficiency virus (HIV) antibody test before endoscopic examination. White blood cell (WBC) counts were obtained from medical records within 1 wk of endoscopy. Leukopenia was defined as a total WBC count < 5000 cells/mm3. For HIV patients, we also checked CD4+ counts from medical records.
RESULTS: A total of 99 patients were retrospectively selected for analysis. Of the immunocompromised patients, 19 had malignant disease, 18 had autoimmune disease, 19 had disorders of biochemical homeostasis, three had undergone transplantation, and 45 had HIV infection. A total of 50 patients had received immunosuppressive therapy. No patients had inflammatory bowel disease. Fifty-five patients were diagnosed as having CMV-GID. Univariate analysis indicated an association between HIV infection, leukopenia, and positive antigenemia and CMV-GID (P < 0.05). Multivariate analysis using logistic regression revealed that HIV infection and positive antigenemia were the only independent factors related to CMV-GID (P < 0.01). The sensitivity, specificity, positive predictive value, and negative predictive value of antigenemia for CMV-GID were 65.4%, 93.6%, 91.9%, and 71.0%, respectively. In a subgroup analysis, patients with leukopenia displayed low sensitivity and high specificity. Minimal differences in accuracy were seen among patients with or without leukopenia. HIV-infected patients displayed low sensitivity and high specificity. Accuracy barely differed between HIV-positive and -negative patients. In HIV-infected patients, CD4 count < 50 cells/μL resulted in low sensitivity and high specificity. Differences in accuracy among patients were minor, regardless of CD4 count. In patients who had undergone both quantitative real-time polymerase chain reaction (PCR) and antigenemia assay, real-time PCR was slightly more accurate in terms of sensitivity than the antigenemia assay; however, this difference was not statistically significant (P = 0.312).
CONCLUSION: If the antigenemia test is positive, endoscopic lesions are acceptable for the diagnosis of CMV-GID without biopsy. The accuracy is not affected by HIV infection and leukopenia. Either PCR or the antigenemia assay are valid.
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Ichinohe K, Kobayakawa M. Palliation of recurrent myxofibrosarcoma with radiotherapy and hyperthermia. Singapore Med J 2010; 51:e187-e190. [PMID: 21140105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Soft tissue sarcomas are rare biologically and histologically heterogeneous neoplasms that may arise throughout the body. The preferred treatment is total resection with a sufficient margin. Radiotherapy with or without chemotherapy offers another treatment option, but its effectiveness is limited. Hyperthermia, a treatment method that heats tumour tissue by exposing the target tissues to conductive heat sources or non-ionising radiation, is known to enhance the effect of radiotherapy. We report a case of an elderly man with a second recurrent myxofibrosarcoma in the left groin, who responded well to radiotherapy in combination with hyperthermia. This combination treatment was effective in maintaining the patient's quality of life during his remaining years.
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Affiliation(s)
- K Ichinohe
- Department of Radiotherapy, Fukuroi Municipal Hospital, Fukuroi, Shizuoka, Japan.
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48
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Shirai K, Sako A, Asayama N, Ogami T, Nakajima R, Nishimura S, Fujiya K, Yada T, Yamada A, Akazawa N, Sakurai T, Oshima T, Nagata N, Yago Y, Sasajima K, Kobayakawa M, Akiyama J, Yanase M, Masaki N, Uemura N. [The usefulness and limitations of the new Japanese criteria for severity assessment in acute pancreatitis]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:48-60. [PMID: 20057183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
New Japanese criteria for severity assessment in acute pancreatitis were introduced in October 2008. The new criteria are simpler than the previous ones, and are also expected to be more useful for the severity assessment. We retrospectively analyzed the clinical factors in our patients to predict prognosis, and evaluated the usefulness and limitations of the new criteria. There were few missing data in the new criteria compared with the previous criteria. The areas under the receiver operating characteristic (ROC) curves for mortality prediction were 0.870 for the new criteria and 0.884 for the previous criteria. However, there were more patients whose disease severity on admission were underestimated using the new criteria and who finally progressed to worse stages including death. This evidence strongly suggests the lower sensitivity of the new criteria in mortality prediction. Repeated assessment of severity after admission will be indispensable in the proper treatment of patients with acute pancreatitis.
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Affiliation(s)
- Kiyokazu Shirai
- Department of Gastroenterology, Toyama Hospital, International Medical Center of Japan.
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Yamada A, Sako A, Nishimura S, Nakashima R, Ogami T, Fujiya K, Tsuda N, Asayama N, Yada T, Shirai K, Akazawa N, Sakurai T, Yago Y, Nagata N, Oshima T, Yokoi C, Sasajima K, Kobayakawa M, Akiyama J, Imamura M, Yanase M, Uemura N, Masaki N. [A case of HIV coinfected with hepatitis B virus treated by entecavir]. Nihon Shokakibyo Gakkai Zasshi 2009; 106:1758-1763. [PMID: 19966518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 45-year-old male active homosexual was given a diagnosis of HIV-1 and acute hepatitis B in August 2007. Since his liver function became rapidly impaired, anti-HBV therapy with oral administration of entecavir (ETV) was started, and resulted in a favorable outcome. However, serum concentration of HIV-RNA decreased by log 1.26 within 60 days, which strongly suggested the inhibition of HIV proliferation by ETV. To prevent the appearance of mutated HIV, novel therapeutic strategies should be established in HIV/HBV-coinfected patients.
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Affiliation(s)
- Akihiro Yamada
- Division of Gastroenterology, Toyama Hospital, International Medical Center of Japan, Japan.
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Kamimura M, Watanabe K, Kobayakawa M, Mihara F, Edamoto Y, Teruya K, Kikuchi Y, Oka S. Successful absorption of antiretroviral drugs after gastrojejunal bypass surgery following failure of therapy through a jejunal tube. Intern Med 2009; 48:1103-4. [PMID: 19525608 DOI: 10.2169/internalmedicine.48.1906] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lopinavir, an antiretroviral drug against human immunodeficiency virus (HIV), was administered through various routes to an HIV-infected patient with duodenal malignant lymphoma. Antiretroviral drugs were first administered through a jejunal tube, and then through bypass route between the stomach and jejunum that was 20 cm distal from the ligament of Treitz after surgery. Oral administration through the bypass achieved sufficient serum concentrations of lopinavir, whereas administration through the jejunal tube did not.
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Affiliation(s)
- Mahoko Kamimura
- AIDS Clinical Center, International Medical Center of Japan, Tokyo.
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