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Tomita K.,Education and Research Center | Otani N.,St. Lukes International Hospital | Omata F.,St Lukes Life Science Institute | Omata F.,Gastroenterology Center | Ishimatsu S.,Education and Research Center
Internal Medicine | Year: 2011

Background: Plasma ammonia has been used in emergency departments to assess whether or not generalized convulsion attacks exist in patients who are suspected of having convulsions. However, there are few reports that have assessed the relationship between generalized convulsions and hyperammonemia. The clinical significance of plasma ammonia measurements in the diagnosis of generalized convulsions is investigated in this study. Objective: A total of 293 patients who were transported by ambulance to the emergency department of St. Luke's International Hospital, Tokyo, Japan under suspicion of convulsive seizure or disturbance of consciousness were studied. Methods: The objectives were divided into two groups-"Convulsion" and "Non-convulsion"-according to the information provided by witnesses. Bivariate and multivariate analyses were carried out for patient background, clinical course, past medical history and blood test results. Results: All 11 items showing significant differences on the bivariate analysis were included in the multivariate analysis. Of these, age, total Glasgow Coma Scale score, plasma ammonia level and arterial lactate level showed a significant difference and are recognized as independent findings for the diagnosis of generalized convulsion. The plasma ammonia level had an odds ratio of 14.8 (95% CI, 3.2 to 111.5; p<0.01), 53% sensitivity and 90% specificity when 65 μg/dL was used as the cut-off value. Conclusion: Plasma ammonia values rise during generalized convulsion. Measurement of plasma ammonia is clinically highly significant as an independent finding during the diagnosis of generalized convulsion. © 2011 The Japanese Society of Internal Medicine. Source


Gotoda T.,National Cancer Center Hospital | Iwasaki M.,Research Center for Cancer Prevention and Screening | Kusano C.,National Cancer Center Hospital | Seewald S.,Gastroenterology Center | Oda I.,National Cancer Center Hospital
British Journal of Surgery | Year: 2010

Background: Criteria for endoscopic resection in patients with early gastric cancer (EGC) have been expanded recently by the National Cancer Centre (NCC). This study compared long-term outcomes in patients with EGC who underwent endoscopic treatment according to guideline criteria with those treated according to expanded criteria. Methods: Baseline and outcome data from patients undergoing curative endoscopic resection for EGC between January 1999 and December 2005 were collected from electronic medical records. Survival time hazard ratios and 95 per cent confidence intervals were calculated using the Cox proportional hazards model. Results: Of 1485 patients who had a curative resection, 635 (42.8 per cent) underwent resection according to traditional criteria and 625 (42.1 percent) according to expanded criteria. There was no significant difference in overall survival between the groups. Conclusion: Patients who have treatment following the expanded criteria have similar long-term survival and outcomes to those treated according to guideline criteria. Copyright © 2010 British Journal of Surgery Society Ltd. Source


Onodera H.,Gastroenterology Center
Biotherapy | Year: 2010

Cancer involves multiple tissues in a wide range of locations. There is metabolic diversity among various tumors as well as a metastatic potential that can result in a variety of complications. Cancer patients are indeed at risk of a wide array of medical emergencies that can present under different subspecialties. These may be categorized into four conditions, such as anatomical, hematological, metabolic, and chemotherapeutic side-effect. Because these conditions may require specific emergency treatment, the recognition of these syndromes by clinicians is critical, as quite often they are predictable and can be prevented or adequately managed. Attention must be focused on these problems that threaten vital organs or compromise the long-term quality of life. The overall goal of managing oncology emergencies is to prevent, reverse, or minimize life-threatening complications through prophylaxis, early detection, and effective disease management. Source


Gockel I.,Johannes Gutenberg University Mainz | Muller M.,Gastroenterology Center | Schumacher J.,University of Bonn
Deutsches Arzteblatt International | Year: 2012

Introduction: Many physicians are inadequately familiar with the clinical features of achalasia. Often, it is not diagnosed until years after the symptoms arise. This is unfortunate, because a delay in diagnosis worsens the prognosis. Methods: Selective review of the literature. Results: Achalasia has a lifetime prevalence of 1:10 000. It is a neurodegenerative disorder in which the neurons of the myenteric plexus are lost, leading to dysfunction of the lower esophageal sphincter and to a derangement of esophageal peristalsis. In the final stage of achalasia, esophageal motility is irreversibly impaired, and complications ensue because of the retention of food that is no longer transported into the stomach. Aspiration causes pulmonary disturbances in up to half of all patients with achalasia. There may also be inflammation of the esophageal mucosa (retention esophagitis); this, in turn, is a risk factor for esophageal cancer, which arises in 4% to 6% of patients. The cause of achalasia is not fully known, but autoimmune processes appear to be involved in patients with a genetic susceptibility to the disease. Conclusion: Achalasia should be diagnosed as early as possible, so that complications can be prevented. In addition, guidelines should be established for cancer prevention in achalasia patients. Currently ongoing studies of the molecular causes of achalasia will probably help us understand its pathophysiology. Source


Lender N.,Princess Alexandra Hospital | Lender N.,University of Queensland | Talley N.J.,University of Newcastle | Enck P.,University of Tubingen | And 5 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2014

Background There is emerging debate over the effect of Helicobacter pylori infection on body mass index (BMI). A recent study demonstrated that individuals who underwent H. pylori eradication developed significant weight gain as compared to subjects with untreated H. pylori colonisation. Aim To elucidate the association between H. pylori colonisation and the prevalence of overweight and obesity in developed countries. Methods The literature was searched for publications reporting data on H. pylori prevalence rates and obesity prevalence rates. Studies selected reported H. pylori prevalence in random population samples with sample sizes of more than 100 subjects in developed countries (GDP >25 000 US$/person/year). Corresponding BMI distributions for corresponding countries and regions were identified. Nonparametric tests were used to compare the association between H. pylori and overweight and obesity rates. Results Forty-nine studies with data from 10 European countries, Japan, the US and Australia were identified. The mean H. pylori rate was 44.1% (range 17-75%), the mean rates for obesity and overweight were 46.6 (±16)% and 14.2 (±8.9)%. The rate of obesity and overweight were inversely and significantly (r = 0.29, P < 0.001) correlated with the prevalence of H. pylori infection. Conclusions There is an inverse correlation between H. pylori prevalence and rate of overweight/obesity in countries of the developed world. Thus, the gradual decrease of the H. pylori colonisation that has been observed in recent decades (or factors associated with decrease of) could be causally related to the obesity endemic observed in the Western world. © 2014 John Wiley & Sons Ltd. Source

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