Specific endoscopic features of ulcerative colitis complicated by cytomegalovirus infection

AIM:To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cyto-megalovirus (CMV) infection.METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms, colonoscopic findings were compared between 15 CMV-positive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Five aspects of mucosal changes were analyzed (loss of vascular pattern, erythema, mucosal edema, easy bleeding, and mucinous exudates) as well as five aspects of ulcerative change (wide mucosal defect, punched-out ulceration, longitudinal ulceration, irregular ulceration, and cobble-stone-like appearance). Sensitivity, specificity, positive predictive value, and negative predictive value of each finding for CMV positivity were determined.RESULTS: The sensitivity of irregular ulceration for positive CMV was 100%. The specificity of wide mucosal defect was 95%. Punched-out ulceration and lon-gitudinal ulceration exhibited relatively high sensitivity and specificity (more than 70% for each).CONCLUSION:Specific colonoscopic findings in patients with UC complicated by CMV infection were identified. These findings may facilitate the early diagnosis of CMV infection in UC patients.

Nutritional supplement drink reduces inflammation and postoperative depression in patients after off-pump coronary artery bypass surgery

BACKGROUND Coronary artery bypass grafting is a surgical treatment for ischemic heart disease.Although development in surgical technique and improvement of perioperative management reduced the postoperative complications,some patients still delayed in progress of postoperative rehabilitation.In this study,we aimed to investigate the effect of daily intake of an herbal medicine-containing drink for rehabilitation after surgery in patients with ischemic heart disease.AIM To investigate the effect of taking an herbal medicine-containing,commercially available drink for postoperative rehabilitation in those patients.METHODS Patients who underwent isolated off-pump coronary artery bypass(OPCAB)surgery were divided into two groups depend on the timing of the admission to the hospital:the Yunker(YKR)group,that consumed one bottle of a caffeine-free nutritional supplement drink on a daily basis and the control group(CTL)that underwent regular rehabilitation.RESULTS A total of 229 patients(CTL=130,YKR=99)were enrolled.No significant differences were observed in the baseline characteristics between the two groups.The YKR group had a significantly increased number of daily steps postoperatively(P<0.05)and had significantly lower postoperative serum tumor necrosis factor-alpha levels(P<0.01),while no significant differences were observed in the levels of other inflammatory or stress-related cytokines(interleukin-6,adiponectin,superoxide dismutase,and urine 8-hydroxy-2′-deoxyguanosine)between the two groups.Also,the YKR group showed a significant improvement in the Hospital Anxiety and Depression Score(P<0.05).Moreover,there were no differences in postoperative complications and the duration of postoperative hospital stay between the two groups.CONCLUSION Our results demonstrated that the daily intake of an herbal medicine-containing drink after OPCAB surgery may have beneficial effects on cardiac rehabilitation by reducing inflammation markers and depression.

Endovascular Repair for Abdominal Aortic Aneurysm Reduces Postoperative Blood Endotoxin Levels Assayed by the EAA Method Compared with Open Abdominal Surgery

Introduction: We hypothesized to demonstrate whether there are significant differences in blood endotoxin (Et) levels after abdominal aortic surgery between endovascular aortic repair (EVAR) and open abdominal surgery. Methods: The patients who underwent the surgical treatment for abdominal aortic aneurysm were divided into two groups according to the procedures: open abdomen surgery (OP) and EVAR (SG). The value of Endotoxin Activity Assay (EAA) was compared between groups. Results: After surgery, Et level was significantly higher in the OP group than in the SG group on postoperative day 3. Neutrophil count was significantly higher in the OP group immediately after treatment, but no significant difference was seen thereafter. There were no differences between the groups in other inflammatory markers. Conclusions: This study indicated that EVAR was less invasive compared to an open abdominal surgery from the standpoint of assessing postoperative endotoxin activity (EA) levels measured by EAA.

Results of aortic valve replacement for aortic stenosis in patients aged 80 years and older

Purpose: The aim of this study was to investigate our clinical experience in a contemporary series of aortic valve replacement (AVR) for aortic stenosis (AS) with or without coronary artery bypass grafting (CABG), and compare the early and mid-term results between patients aged more than 80 years and those aged less than 80 years. Methods: A retrospective review was performed of 258 consecutive patients with aortic stenosis (AS) who underwent AVR between August 2002 and December 2010 at Juntendo University Hospital. Results: Operative mortality was 7.3% in patients aged 80 years and older, compared with 3.6% in younger patients. Thus, operative mortality was higher in the older patients compared with the younger patients, but was not statistically significant between the two groups. Age more than 80 years was not a predictor of operative mortality. Advanced NYHA class (p = 0.03;odds ratio [OR], 9.5) was found to be a multivariate independent predictor of operative mortality. Patients aged 80 years and older were significantly more likely to suffer from respiratory failure after surgery than younger patients, but there were no significant differences in any other complications between the two age groups. Non-home discharge rate was significantly higher in the patients aged 80 years and older (21.9%) than in the younger patients (5.5%). Three-year survival was 84% in patients aged more than 80 years, and 83% of these elderly patients were living at home at the last follow-up. Conclusions: Patients aged 80 years and older have acceptable results of AVR with slightly increased risk of early mortality and morbidity compared with younger patients.

Evaluation of a New Formula for Calculating Heparin Dose for Cardiopulmonary Bypass Patients

Introduction: Anticoagulation is essential during CPB in cardiac surgery. It is generally performed using heparin;however the widely used formula for its dosing is based solely on body weight. Although the formula assumes activated clotting time (ACT) to be within normal range, baseline ACT varies in each patient. Thus, we developed an original formula, which takes into account baseline ACT in addition to body weight to calculate a more proper dose for initial administration of heparin. In this study, we monitored the ACT to examine if the dose of heparin calculated using our formula can prolong the ACT to the target range, and we determined the factors which interfere with the prolongation of ACT. Methods: Between October 2010 and April 2011, 141 consecutive patients underwent cardiac surgery requiring cardiopulmonary bypass at our hospital. We measured ACT 3 minutes after the initial administration of heparin and considered ACT values >400 seconds as appropriate for safe initiation of CPB. Results: Using the proposed formula, administered heparin dose was 241 ± 27 IU/kg and target ACT was achieved in 86.4% of patients. Multivariate analysis was performed to determine the effect of patient background factors on target ACT achievement. Body weight, age, and preoperative heparin therapy, which showed significant differences, were further analyzed. Conclusions: This study demonstrated that our newly developed formula could be used to properly calculate the optimal initial dose of heparin.