Background: Elevated coagulative molecular markers could reflect the prothromb otic state in the cardiovascular system of patients with non-valvular atrial fi brillation(NVAF). A prospective, cooperative study was con...Background: Elevated coagulative molecular markers could reflect the prothromb otic state in the cardiovascular system of patients with non-valvular atrial fi brillation(NVAF). A prospective, cooperative study was conducted to determine wh ether levels of coagulative markers alone or in combination with clinical risk f actors could predict subsequent thromboembolic events in patients with NVAF. Met hods: Coagulative markers of prothrombin fragment 1 +2, D-dimer, platelet fact or 4, and β-thromboglobulin were determined at the enrollment in the prospecti ve study. Results: Of 509 patients with NVAF(mean age, 66.6±10.3 years), 263 pa tients were treated with warfarin(mean international normalized ratio, 1.86), an d 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significa ntly better in patients with D-dimer level< 150 ng/ml than in those with D-dim er level ≥150 ng/ml. Other coagulative markers, however, did not predict thromb oembolic events. Age(≥75 years), cardiomyopathies, and prior stroke or transien t ischemic attack were independent, clinical risk factors for thromboembolism. T hromboembolic risk in patients without the clinical risk factors was quite low(0 .7%/year) when D-dimer was< 150 ng/ml, but not low(3.8%/year) when D-dimer w as ≥150 ng/ml. It was > 5%/year in patients with the risk factors regardless o f D-dimer levels. This was also true when analyses were confined to patients tr eated with warfarin. Conclusions: D-dimer level in combination with clinical ri sk factors could effectively predict subsequent thromboembolic events in patient s with NVAF even when treated with warfarin.展开更多
Background: Several studies have shown that reflux esophagitis (RE) occurs after eradication of Helicobacter pylori. However, endoscopic findings do not allow prediction of the development of RE after successful treat...Background: Several studies have shown that reflux esophagitis (RE) occurs after eradication of Helicobacter pylori. However, endoscopic findings do not allow prediction of the development of RE after successful treatment. In this study, we evaluated the relationship between the prevalence of RE after eradication therapy and the degree of hiatal hernia. Methods: The study comprised 148 patients who had undergone H. pylori eradication therapy over the past 5 years. The degree of RE and hiatal hernia was evaluated based on endoscopic findings. Hiatal hernia was graded according to Hill’s gastroesophageal flap valve (GEFV; grades I-IV) classification. RE after eradication therapy was graded according to the Los Angeles classification system. H. pylori infection was confirmed in all patients by culture, urease test and histological examination of antral and fundic biopsy specimens. Results: Among 148 patients, there were 122 patients (82.4%) with successful and 26 (17.6%) with failed eradication therapy. RE was diagnosed in 25 (20.5%) out of 122 patients with successful therapy but only in 1 (3.8%) out of 26 patients with failed therapy (P <0.05). After successful eradication, 25 patients had mild RE (12 with grade A, 13 with grade B). Among patients of the successful eradication group (n = 122), RE was diagnosed in 2 (5.3%) out of 38 patients without hiatal hernia and in 23 (27.4%) out of 84 patients with hiatal hernia (P = 0.0051). Furthermore, RE was diagnosed in 2 (5.3%) out of 38 patients with GEFV grade I, 13 (24.1%) out of 54 with grade II, 7 (30.4%) among 23 with grade III, and 3 (42.9%) out of 7 patients with grade IV. The pH level of gastric juice after eradication therapy was lower in the group with successful eradication than in the group with failed therapy regardless of the incidence and degree of RE. Conclusions: There is a high incidence of RE after successful H. pylori eradication therapy. This incidence of RE was closely associated with the presence and degree of hiatal hernia and with the decrease in gastric juice pH. These findings suggest that the presence of hiatal hernia together with increase in gastric acidity are important determinant factors for the development of RE after successful H. pylori eradication therapy.展开更多
Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal ...Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal mucosa.In the present study,we aimed to apply LCM to both fresh and formalin-fixed specimens,without additional treatment,in order to validate and compare the quality of the images obtained.Methods:We obtained 18 specimens from 11 patients,either by endoscopic biopsy or following surgical resection.First,we observed the fresh,saline-immersed specimen with LCM using the Fluroview microscope(Olympus Co.Ltd.,Tokyo,Japan).We then fixed the specimen with formalin and obtained further LCM images 1 hour,3 hours,and 24 hours after fixation.Three independent observers observed the images and were asked to assess the origin of the samples,the treatment of the samples,the time after formalin fixation,and whether they showed benign or malignant lesions.We used kappa statistics to compare the agreement among the three observers in each of these four areas of interest.Results:Between January and March 2003,we obtained 191 LCM images from 18 specimens.Thirty images were randomly selected for observation.The overall accuracy for differentiating between esophagus and stomach specimens was 96.6%.The accuracy of differentiating normal from cancerous lesions was 92.2%.The differentiation between saline-immersed and formalin-fixed specimens was 59.7%accurate and the assessment of the time interval after formalin fixation was only 37.3%accurate.The kappa statistics showed that there was strong interobserver agreement on the differentiation of specimen origin and of cancerous from benign lesions.However,there was no agreement among the observers on the method of specimen preparation or on the estimated time interval after formalin fixation.Conclusions:We concluded that images obtained from fresh specimens using LCM were of a quality good enough to make an accurate diagnosis of upper gastrointestinal carcinoma.展开更多
Recent reports on the results of endoscopic ablation of Barrett’s mucosa have been promising, particularly when total mucosal ablation is coupled with aggres sive acid-suppression treatment using high-dose proton-pum...Recent reports on the results of endoscopic ablation of Barrett’s mucosa have been promising, particularly when total mucosal ablation is coupled with aggres sive acid-suppression treatment using high-dose proton-pump inhibitor therapy . There is also a considerable literature on reepithelialization after ablative treatments in Barrett’s esophagus. This report describes a case of multifocal s uperficial adenocarcinoma arising in Barrett’s mucosa that was successfully tre ated with total circumferential endoscopic mucosal resection, with a subsequent follow-up of more than 2 years. This is the first report describing the process of squamous reepithelialization after endoscopic mucosal resection in Barrett’ s esophagus.展开更多
文摘Background: Elevated coagulative molecular markers could reflect the prothromb otic state in the cardiovascular system of patients with non-valvular atrial fi brillation(NVAF). A prospective, cooperative study was conducted to determine wh ether levels of coagulative markers alone or in combination with clinical risk f actors could predict subsequent thromboembolic events in patients with NVAF. Met hods: Coagulative markers of prothrombin fragment 1 +2, D-dimer, platelet fact or 4, and β-thromboglobulin were determined at the enrollment in the prospecti ve study. Results: Of 509 patients with NVAF(mean age, 66.6±10.3 years), 263 pa tients were treated with warfarin(mean international normalized ratio, 1.86), an d 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significa ntly better in patients with D-dimer level< 150 ng/ml than in those with D-dim er level ≥150 ng/ml. Other coagulative markers, however, did not predict thromb oembolic events. Age(≥75 years), cardiomyopathies, and prior stroke or transien t ischemic attack were independent, clinical risk factors for thromboembolism. T hromboembolic risk in patients without the clinical risk factors was quite low(0 .7%/year) when D-dimer was< 150 ng/ml, but not low(3.8%/year) when D-dimer w as ≥150 ng/ml. It was > 5%/year in patients with the risk factors regardless o f D-dimer levels. This was also true when analyses were confined to patients tr eated with warfarin. Conclusions: D-dimer level in combination with clinical ri sk factors could effectively predict subsequent thromboembolic events in patient s with NVAF even when treated with warfarin.
文摘Background: Several studies have shown that reflux esophagitis (RE) occurs after eradication of Helicobacter pylori. However, endoscopic findings do not allow prediction of the development of RE after successful treatment. In this study, we evaluated the relationship between the prevalence of RE after eradication therapy and the degree of hiatal hernia. Methods: The study comprised 148 patients who had undergone H. pylori eradication therapy over the past 5 years. The degree of RE and hiatal hernia was evaluated based on endoscopic findings. Hiatal hernia was graded according to Hill’s gastroesophageal flap valve (GEFV; grades I-IV) classification. RE after eradication therapy was graded according to the Los Angeles classification system. H. pylori infection was confirmed in all patients by culture, urease test and histological examination of antral and fundic biopsy specimens. Results: Among 148 patients, there were 122 patients (82.4%) with successful and 26 (17.6%) with failed eradication therapy. RE was diagnosed in 25 (20.5%) out of 122 patients with successful therapy but only in 1 (3.8%) out of 26 patients with failed therapy (P <0.05). After successful eradication, 25 patients had mild RE (12 with grade A, 13 with grade B). Among patients of the successful eradication group (n = 122), RE was diagnosed in 2 (5.3%) out of 38 patients without hiatal hernia and in 23 (27.4%) out of 84 patients with hiatal hernia (P = 0.0051). Furthermore, RE was diagnosed in 2 (5.3%) out of 38 patients with GEFV grade I, 13 (24.1%) out of 54 with grade II, 7 (30.4%) among 23 with grade III, and 3 (42.9%) out of 7 patients with grade IV. The pH level of gastric juice after eradication therapy was lower in the group with successful eradication than in the group with failed therapy regardless of the incidence and degree of RE. Conclusions: There is a high incidence of RE after successful H. pylori eradication therapy. This incidence of RE was closely associated with the presence and degree of hiatal hernia and with the decrease in gastric juice pH. These findings suggest that the presence of hiatal hernia together with increase in gastric acidity are important determinant factors for the development of RE after successful H. pylori eradication therapy.
文摘Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal mucosa.In the present study,we aimed to apply LCM to both fresh and formalin-fixed specimens,without additional treatment,in order to validate and compare the quality of the images obtained.Methods:We obtained 18 specimens from 11 patients,either by endoscopic biopsy or following surgical resection.First,we observed the fresh,saline-immersed specimen with LCM using the Fluroview microscope(Olympus Co.Ltd.,Tokyo,Japan).We then fixed the specimen with formalin and obtained further LCM images 1 hour,3 hours,and 24 hours after fixation.Three independent observers observed the images and were asked to assess the origin of the samples,the treatment of the samples,the time after formalin fixation,and whether they showed benign or malignant lesions.We used kappa statistics to compare the agreement among the three observers in each of these four areas of interest.Results:Between January and March 2003,we obtained 191 LCM images from 18 specimens.Thirty images were randomly selected for observation.The overall accuracy for differentiating between esophagus and stomach specimens was 96.6%.The accuracy of differentiating normal from cancerous lesions was 92.2%.The differentiation between saline-immersed and formalin-fixed specimens was 59.7%accurate and the assessment of the time interval after formalin fixation was only 37.3%accurate.The kappa statistics showed that there was strong interobserver agreement on the differentiation of specimen origin and of cancerous from benign lesions.However,there was no agreement among the observers on the method of specimen preparation or on the estimated time interval after formalin fixation.Conclusions:We concluded that images obtained from fresh specimens using LCM were of a quality good enough to make an accurate diagnosis of upper gastrointestinal carcinoma.
文摘Recent reports on the results of endoscopic ablation of Barrett’s mucosa have been promising, particularly when total mucosal ablation is coupled with aggres sive acid-suppression treatment using high-dose proton-pump inhibitor therapy . There is also a considerable literature on reepithelialization after ablative treatments in Barrett’s esophagus. This report describes a case of multifocal s uperficial adenocarcinoma arising in Barrett’s mucosa that was successfully tre ated with total circumferential endoscopic mucosal resection, with a subsequent follow-up of more than 2 years. This is the first report describing the process of squamous reepithelialization after endoscopic mucosal resection in Barrett’ s esophagus.
