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Onogi F.,Gifu University | Araki H.,Gifu University | Ibuka T.,Gifu University | Manabe Y.,Nagahama City Hospital | And 3 more authors.
Endoscopy | Year: 2010

Background and study aims: A small amount of free air, visible on CT but not on plain chest radiography, which appeared following endoscopic submucosal dissection (ESD) of a gastric neoplasm without endoscopically visible perforation, was defined as a transmural air leak, and a prospective, consecutive entry study was performed to determine its incidence and clinical significance. Patients and methods: Between January 2006 and September 2008, ESD was performed for 246 gastric lesions in 246 consecutive patients. Abdominal CT scan was performed 1 day after ESD. In addition, chest radiography and blood biochemistry tests were performed at different time points before and after ESD. Results: Two hundred and nineteen lesions (89%) were curatively removed by ESD. Among the total of 246 patients, we encountered endoscopically visible perforation during ESD in 2 patients (0.8%), and clinically suspected perforation diagnosed by the presence of free air on chest radiography but invisible during ESD in 3 patients (1%), while transmural air leak was observed in another 33 (13%). Air leak occurred in cases where resection size was larger, procedure time longer, and the muscularis propria on the ulcer base was exposed at the end of ESD. Patients with air leaks developed pyrexia at a higher rate than those without (36% vs. 16%, P=0.018). These patients recovered with antibiotics and required no endoscopic or surgical intervention. The presence of an air leak did not affect the duration of hospital stay. Conclusions: A transmural air leak was observed in 13% of the patients undergoing ESD. Larger resection size, prolonged procedure time, and exposure of the muscularis propria on the ulcer base were risk factors for transmural air leak, but the outcome of patients with this complication was good. © Georg Thieme Verlag KG Stuttgart. Source

Maeda T.,Nishimino Kosei Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

COPD is an independent risk factor for lung cancer. There is emerging evidence that chronic inflammation may play a significant role in the pathogenesis of lung cancer as a tumor promoter. Cigarette smoke exponentially up-regulates the production of cytokines. After stopping smoking, the risk of lung cancer remains increased in patients with COPD. We report 3 patients with COPD in whom lung cancer was detected within 16 months after smoking cessation. All were outpatients of our hospital, and participated in a program for smoking cessation according to their doctor's advice. Two successfully stopped smoking, and the other was in the program for smoking cessation. It was difficult to detect lung cancers on chest X-ray films 8-11 months previously. Periodic medical examination chest X-ray films revealed lung cancers 2-16 months after smoking cessation. Heavy smokers, especially COPD patients, have a high risk of developing lung cancer at the start of smoking cessation, and therefore have a high risk of contracting lung cancer even after halting smoking. Generally, most patients do not visit hospitals for the purpose of only smoking cessation after successfully halting smoking. Nevertheless, it is necessary for previously heavy smokers, especially COPD patients, to undergo repeated careful medical examination to detect lung cancer. Source

Saito K.,Nishimino Kosei Hospital
Journal of Japanese Society of Gastroenterology | Year: 2010

A 72-year-old woman received combination therapy with peginterferon α and ribavirin for treatment of chronic hepatitis C. Approximately 40 weeks after starting treatment, she developed an eruption in the left inner canthus and sarcoidosis was diagnosed after biopsy of the eruption. Combination therapy was discontinued, and further detailed examinations revealed bilateral hilar lymphadenopathy, uveitis, and complete atrioventricular block. A permanent cardiac pacemaker was implanted, and her sarcoidosis improved upon administration of corticosteroids. Source

Ibuka T.,Gifu University | Saito K.,Nishimino Kosei Hospital | Moriwaki H.,Gifu University
Journal of Japanese Society of Gastroenterology | Year: 2010

A 76-year-old woman was admitted to our institution because of high fever and erythema in the upper body with right back pain, and was given a diagnosis of Sweet's syndrome. She also had abdominal pain and developed hematochezia from the fourth hospitalization day. Double balloon enteroscopy detected multiple ulcers with a punched-out appearance at the terminal ileum. Endoscopic hemostasis of the ulcers was achieved using a hemoclip for treatment of a focal pulsating hemorrhage. After oral administration of prednisolone (PSL), both the ileal ulcer and erythema disappeared. The daily dosage of PSL was tapered. Since termination of PSL administration, there has been no recurrence of either Sweet's syndrome or ileal ulcer. We report a rare case of Sweet's syndrome complicated by bleeding ileal ulcers. Source

Nishiwaki S.,Nishimino Kosei Hospital | Araki H.,Gifu University | Fang J.C.,University of Utah | Hayashi M.,Nishimino Kosei Hospital | And 7 more authors.
Gastrointestinal Endoscopy | Year: 2011

Background: Feeding device replacement is often required for long-term maintenance after initial percutaneous endoscopic gastrostomy or jejunostomy placement. Although there are several case reports on serious complications of gastrostomy device replacement, there are few reports of an overall analysis of the complications associated with feeding device replacement. Objective: To evaluate the frequency and variety of complications of transcutaneous replacement of feeding devices. Design: A retrospective study. Setting: Single center: Nishimino Kosei Hospital. Patients: This study involved 363 consecutive patients undergoing a total of 1265 percutaneous gastrostomy or jejunostomy device replacements from March 2000 to September 2010. Intervention: A new replacement device was inserted through the ostomy tract by using an obturator after traction removal of the previous device. Endoscopic treatments were performed in the cases of fistula disruption or hemorrhage. Main Outcome Measurements: Complications and their outcomes. Results: Gastrostomy and jejunostomy devices were replaced 1126 and 139 times, respectively. There were 16 complications (1.3% of total replacements) consisting of 10 cases of fistula disruption caused by misplacement of replacement devices into the peritoneal cavity, 4 cases of hemorrhage, and 1 case each of colocutaneous fistula and device breakage. Anticoagulation or antiplatelet medications were continued in all 4 hemorrhage cases but in only 27 of 347 (7.7%) complication-free cases (P <.0001). There were no replacement-related adverse events that required surgical repair. Limitations: A single center, retrospective analysis. Conclusion: Fistula disruption and hemorrhage were the most common complications associated with device replacement. In patients on anticoagulants, caution is necessary to avoid hemorrhage after replacement. It is also important to verify that the replaced device is located in the GI tract lumen before feeding. © 2011 American Society for Gastrointestinal Endoscopy. Source

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