AIM:To evaluate the value of ABC(D) stratification [combination of serum pepsinogen and Helicobacter pylori(H.pylori) antibody]of patients with gastric cancer.METHODS:Ninety-five consecutive patients with gastric canc...AIM:To evaluate the value of ABC(D) stratification [combination of serum pepsinogen and Helicobacter pylori(H.pylori) antibody]of patients with gastric cancer.METHODS:Ninety-five consecutive patients with gastric cancer were enrolled into the study.The serum pepsinogenⅠ(PGⅠ) /pepsinogenⅡ(PGⅡ) and H.pylori antibody levels were measured.Patients were classified into five groups of ABC(D) stratification according to their serological status.Endoscopic findings of atrophic gastritis and histological differentiation were also analyzed in relation to the ABC(D) stratification.RESULTS:The mean patient age was(67.9±8.9) years.Three patients(3.2%) were classified into group A,7 patients(7.4%) into group A',27 patients(28.4%) into group B,54 patients(56.8%) into group C,and 4patients(4.2%) into group D,respectively.There were only three cases in group A when the patients taking acid proton pump inhibitors and those who had undergone eradication therapy for H.pylori(group A') were excluded.These three cases had mucosal atrophy in the grey zone according to the diagnostic manual of ABC(D) stratification.Histologically,the mean age of the patients with well differentiated adenocarcinoma was significantly higher than that of the patients with poorly differentiated adenocarcinoma(P<0.05) .There were no differences in the pattern of atrophy in the endoscopies between the well differentiated and poorly differentiated groups.CONCLUSION:ABC(D) stratification is a good method for screening patients with gastric cancers.Endoscopy is needed for grey zone cases to check the extent of mucosal atrophy.展开更多
AIM:To investigate whether endoscopic submucosal dissection(ESD) can be safely performed at small clinics,such as the Shirakawa Clinic.METHODS:One thousand forty-seven ESDs to treat gastrointestinal tumors were perfor...AIM:To investigate whether endoscopic submucosal dissection(ESD) can be safely performed at small clinics,such as the Shirakawa Clinic.METHODS:One thousand forty-seven ESDs to treat gastrointestinal tumors were performed at the Shirakawa Clinic from April 2006 to March 2011.The efficacy,technical feasibility and associated complications of the procedures were assessed.The ESD procedures were performed by five endoscopists.Sedation was induced with propofol for esophagogastorduodenal ESD.RESULTS:One thousand forty-seven ESDs were performed to treat 64 patients with esophageal cancer(E),850 patients with gastric tumors(G:764 patients with cancer,82 patients with adenomas and four others),four patients with duodenal cancer(D) and 129 patients with colorectal tumors(C:94 patients with cancer,21 patients with adenomas and 14 others).The en bloc resection rate was 94.3%(E:96.9%,G:95.8%,D:100%,C:79.8%).The median operation time was 46 min(range:4-360 min) and the mean size of the resected specimens was 18 mm(range:2-150 mm).No mortal complications were observed in association with the ESD procedures.Perforation occurred in 12 cases(1.1%,E:1 case,G:9 cases,D:1 case,C:1 case) and postoperative bleeding occurred in 53 cases(5.1%,G:51 cases,D:1 case,C:1 case);however,no case required either emergency surgery or blood transfusion.All of the perforations and postperative bleedings were resolved by endoscopic clipping or hemostasis.The other problematic complication observed was pneumonia,which was treated with conservative therapy.CONCLUSION:ESD can be safely performed in a clinic with established therapeutic methods and medical services to address potential complications.展开更多
AIM:To define the clinical characteristics,and to assess the management of colonoscopic complications at a local clinic.METHODS:A retrospective review of the medical records was performed for the patients with iatroge...AIM:To define the clinical characteristics,and to assess the management of colonoscopic complications at a local clinic.METHODS:A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010.Data obtained from a tertiary hospital in the same region were also analyzed.The underlying conditions,clinical presentations,perforation locations,treatment types(operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared.RESULTS:A total of 10 826 colonoscopies,and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies,and 7787 therapeutic procedures were performed at the tertiary hospital.The clinic had no perforations during diagnostic colonoscopy and 8(0.3%) perforations were determined to be related to therapeutic procedures.The perforation rates in each therapeutic procedure were 0.06%(1/1609) in polypectomy,0.2%(2/885) in endoscopic mucosal resection(EMR),and 3.8%(5/131) in endoscopic submucosal dissection(ESD).Perforation rates for ESD were significantly higher than those for polypectomy or EMR(P < 0.01).All of these patients were treated conservatively.On the other hand,three(0.01%) perforation cases were observed among the 24 361 diagnostic procedures performed,and these cases were treated with surgery in a tertiary hospital.Six perforations occurred with therapeutic endoscopy(perforation rate,0.08%;1 per 1298 procedures).Perforation rates for specific procedure types were 0.02%(1 per 5500) for polypectomy,0.17%(1 per 561) for EMR,2.3%(1 per 43) for ESD in the tertiary hospital.There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital.The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital.No procedure-related mortalities occurred.Performing closure with endoscopic clipping reduced the C-reactive protein(CRP) titers.The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping,respectively(P < 0.05).An operation is indicated in the presence of a large perforation,and in the setting of generalized peritonitis or ongoing sepsis.Although we did not experience such case in the clinic,patients with large perforations should be immediately transferred to a tertiary hospital.Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained.CONCLUSION:It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.展开更多
AIM: To investigate the in vivo effects of NK2 on liver regeneration after partial hepatectomy (PH). METHODS: Survival after PH was observed with 21 NK2 transgenic mice and 23 wild-type (WT) mice over 10 d. Liver rege...AIM: To investigate the in vivo effects of NK2 on liver regeneration after partial hepatectomy (PH). METHODS: Survival after PH was observed with 21 NK2 transgenic mice and 23 wild-type (WT) mice over 10 d. Liver regeneration was analyzed using histology and immunohistochemistry. Expressions of genes were analyzed using Northern blot analysis, immunoprecipitation and immunoblotting, and reverse transcriptase polymerase chain reaction assay. KaplanMeier method and the log-rank test were used for ahalyzing the survival after PH. Differences in the resultsof immunohistochemistry and percentage of liver regeneration was determined by the Student's t-test. RESULTS: More than half of NK2 transgenic mice died within 48 h after PH. After PH, increased deposition of small lipid droplets in hepatocytes was evident and hepatic proliferation was inhibited in NK2 transgenic mice. The hepatic expression and kinase activity of HGF receptor, c-Met, were unchanged among WT mice and NK2 transgenic mice after PH. The expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in liver tissues were prolonged in NK2 transgenic mice that died after PH.CONCLUSION: Our findings indicate that overexpression of NK2 inhibits liver regeneration after PH.展开更多
文摘AIM:To evaluate the value of ABC(D) stratification [combination of serum pepsinogen and Helicobacter pylori(H.pylori) antibody]of patients with gastric cancer.METHODS:Ninety-five consecutive patients with gastric cancer were enrolled into the study.The serum pepsinogenⅠ(PGⅠ) /pepsinogenⅡ(PGⅡ) and H.pylori antibody levels were measured.Patients were classified into five groups of ABC(D) stratification according to their serological status.Endoscopic findings of atrophic gastritis and histological differentiation were also analyzed in relation to the ABC(D) stratification.RESULTS:The mean patient age was(67.9±8.9) years.Three patients(3.2%) were classified into group A,7 patients(7.4%) into group A',27 patients(28.4%) into group B,54 patients(56.8%) into group C,and 4patients(4.2%) into group D,respectively.There were only three cases in group A when the patients taking acid proton pump inhibitors and those who had undergone eradication therapy for H.pylori(group A') were excluded.These three cases had mucosal atrophy in the grey zone according to the diagnostic manual of ABC(D) stratification.Histologically,the mean age of the patients with well differentiated adenocarcinoma was significantly higher than that of the patients with poorly differentiated adenocarcinoma(P<0.05) .There were no differences in the pattern of atrophy in the endoscopies between the well differentiated and poorly differentiated groups.CONCLUSION:ABC(D) stratification is a good method for screening patients with gastric cancers.Endoscopy is needed for grey zone cases to check the extent of mucosal atrophy.
文摘AIM:To investigate whether endoscopic submucosal dissection(ESD) can be safely performed at small clinics,such as the Shirakawa Clinic.METHODS:One thousand forty-seven ESDs to treat gastrointestinal tumors were performed at the Shirakawa Clinic from April 2006 to March 2011.The efficacy,technical feasibility and associated complications of the procedures were assessed.The ESD procedures were performed by five endoscopists.Sedation was induced with propofol for esophagogastorduodenal ESD.RESULTS:One thousand forty-seven ESDs were performed to treat 64 patients with esophageal cancer(E),850 patients with gastric tumors(G:764 patients with cancer,82 patients with adenomas and four others),four patients with duodenal cancer(D) and 129 patients with colorectal tumors(C:94 patients with cancer,21 patients with adenomas and 14 others).The en bloc resection rate was 94.3%(E:96.9%,G:95.8%,D:100%,C:79.8%).The median operation time was 46 min(range:4-360 min) and the mean size of the resected specimens was 18 mm(range:2-150 mm).No mortal complications were observed in association with the ESD procedures.Perforation occurred in 12 cases(1.1%,E:1 case,G:9 cases,D:1 case,C:1 case) and postoperative bleeding occurred in 53 cases(5.1%,G:51 cases,D:1 case,C:1 case);however,no case required either emergency surgery or blood transfusion.All of the perforations and postperative bleedings were resolved by endoscopic clipping or hemostasis.The other problematic complication observed was pneumonia,which was treated with conservative therapy.CONCLUSION:ESD can be safely performed in a clinic with established therapeutic methods and medical services to address potential complications.
文摘AIM:To define the clinical characteristics,and to assess the management of colonoscopic complications at a local clinic.METHODS:A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010.Data obtained from a tertiary hospital in the same region were also analyzed.The underlying conditions,clinical presentations,perforation locations,treatment types(operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared.RESULTS:A total of 10 826 colonoscopies,and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies,and 7787 therapeutic procedures were performed at the tertiary hospital.The clinic had no perforations during diagnostic colonoscopy and 8(0.3%) perforations were determined to be related to therapeutic procedures.The perforation rates in each therapeutic procedure were 0.06%(1/1609) in polypectomy,0.2%(2/885) in endoscopic mucosal resection(EMR),and 3.8%(5/131) in endoscopic submucosal dissection(ESD).Perforation rates for ESD were significantly higher than those for polypectomy or EMR(P < 0.01).All of these patients were treated conservatively.On the other hand,three(0.01%) perforation cases were observed among the 24 361 diagnostic procedures performed,and these cases were treated with surgery in a tertiary hospital.Six perforations occurred with therapeutic endoscopy(perforation rate,0.08%;1 per 1298 procedures).Perforation rates for specific procedure types were 0.02%(1 per 5500) for polypectomy,0.17%(1 per 561) for EMR,2.3%(1 per 43) for ESD in the tertiary hospital.There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital.The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital.No procedure-related mortalities occurred.Performing closure with endoscopic clipping reduced the C-reactive protein(CRP) titers.The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping,respectively(P < 0.05).An operation is indicated in the presence of a large perforation,and in the setting of generalized peritonitis or ongoing sepsis.Although we did not experience such case in the clinic,patients with large perforations should be immediately transferred to a tertiary hospital.Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained.CONCLUSION:It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.
文摘AIM: To investigate the in vivo effects of NK2 on liver regeneration after partial hepatectomy (PH). METHODS: Survival after PH was observed with 21 NK2 transgenic mice and 23 wild-type (WT) mice over 10 d. Liver regeneration was analyzed using histology and immunohistochemistry. Expressions of genes were analyzed using Northern blot analysis, immunoprecipitation and immunoblotting, and reverse transcriptase polymerase chain reaction assay. KaplanMeier method and the log-rank test were used for ahalyzing the survival after PH. Differences in the resultsof immunohistochemistry and percentage of liver regeneration was determined by the Student's t-test. RESULTS: More than half of NK2 transgenic mice died within 48 h after PH. After PH, increased deposition of small lipid droplets in hepatocytes was evident and hepatic proliferation was inhibited in NK2 transgenic mice. The hepatic expression and kinase activity of HGF receptor, c-Met, were unchanged among WT mice and NK2 transgenic mice after PH. The expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in liver tissues were prolonged in NK2 transgenic mice that died after PH.CONCLUSION: Our findings indicate that overexpression of NK2 inhibits liver regeneration after PH.