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1.
J Clin Med ; 13(5)2024 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-38592167

RESUMEN

(1) Background: Delayed perforation after gastric endoscopic submucosal dissection (ESD) for early gastric cancer is a relatively uncommon and serious complication that sometimes requires emergency surgery. This study aimed to determine the clinicopathological features, risk factors, and appropriate management strategies for delayed perforation. (2) Methods: This study included 735 patients with 791 lesions who underwent ESD for early gastric cancer at a single institution between July 2009 and June 2019. We retrospectively compared the clinical features of patients with and without delayed perforations. (3) Results: The incidence of delayed perforations was 0.91%. The identified risk factors included a postoperative stomach condition and histopathological ulceration. A comparison between delayed and intraoperative perforations revealed a postoperative stomach condition as a characteristic risk factor for delayed perforation. Patients with delayed perforation who avoided emergency surgery tended to exhibit an earlier onset of symptoms such as abdominal pain and fever. No peritoneal seeding following delayed perforation was observed for any patient. (4) Conclusions: A postoperative stomach condition and histopathological ulceration were risk factors for delayed perforation. Delayed perforation is a significant complication that requires careful monitoring after gastric ESD for early gastric cancer, particularly in patients with postoperative gastric conditions.

2.
Clin J Gastroenterol ; 17(3): 466-471, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38504057

RESUMEN

Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.


Asunto(s)
Enfermedades del Colon , Resección Endoscópica de la Mucosa , Intususcepción , Humanos , Anciano , Masculino , Intususcepción/cirugía , Intususcepción/etiología , Intususcepción/diagnóstico por imagen , Resección Endoscópica de la Mucosa/efectos adversos , Resección Endoscópica de la Mucosa/métodos , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Colonoscopía/métodos , Tomografía Computarizada por Rayos X , Mucosa Intestinal/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología
3.
Dig Endosc ; 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-37908188

RESUMEN

OBJECTIVES: The aging population, including patients with superficial esophageal cancer, encounters critical dysphagia- and postoperative pneumonia-related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient- (such as sarcopenia) and treatment- (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post-ESD pneumonia-associated factors. METHODS: Comprehensive swallowing function and sarcopenia were evaluated in patients pre-ESD and 2 months post-ESD using high-resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post-ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated. RESULTS: Twenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post-ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter-integrated relaxation pressure (UES-IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES-IRP in pneumonia yielded an area under the curve of 0.82. CONCLUSIONS: Sarcopenia is associated with preoperative dysphagia, which increases post-ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial.

4.
Clin J Gastroenterol ; 16(3): 325-329, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36821066

RESUMEN

Right aortic arch is caused by a malformation of the aorta while Kommerell's diverticulum is a saccular aneurysm arising at the origin of the subclavian artery. Both diseases are caused by malformations during embryonic development and can subsequently cause compression of the esophagus and trachea due to abnormal arterial migration. Here, we report five cases of esophageal stenosis due to aortic angiogenesis anomalies. Three of the five cases had aortic running abnormalities, noted on computed tomography (CT). However, until it was observed for the first time, esophageal stricture was not recognized as an esophagogastroduodenoscopy (EGD) finding due to the lack of knowledge of diseases such as Kommerell's diverticulum even when EGD was performed during regular follow-up after treatment for esophageal cancer or other conditions. Symptoms include dysphagia and dyspnea due to stenosis of the esophagus and trachea, however, regardless of symptomatic presentation, the presence of esophageal stenosis on EGD should be considered as an effect of aortic travel abnormality or Kommerell's diverticulum. Although there have been no reports of Kommerell's diverticulum rupture due to endoscopic manipulation, gastroenterologists should consider the possibility of Kommerell's diverticulum during clinical decision making.


Asunto(s)
Aneurisma , Divertículo , Estenosis Esofágica , Humanos , Estenosis Esofágica/diagnóstico por imagen , Estenosis Esofágica/etiología , Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X
6.
Scand J Gastroenterol ; 58(7): 813-821, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-36708197

RESUMEN

OBJECTIVES: To describe an endoscopic technique named 'underwater endoscopic mucosal resection (UEMR) with submucosal injection and marking (UEMR-SIM)' and to evaluate the therapeutic characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) < 20 mm vis-a-vis classical EMR (CEMR) and UEMR techniques. MATERIALS AND METHODS: This retrospective study included 103 consecutive SNADET patients (103 lesions) who underwent CEMR, UEMR, or UEMR-SIM. The UEMR-SIM procedure included (1) marking and submucosal injection, (2) filling of the duodenal lumen with 0.9% saline, (3) snaring of the lesion, and (4) electrosurgical removal. The procedural outcomes were compared between the UEMR-SIM and other-procedure groups. RESULTS: The en bloc resection rate was significantly higher in the UEMR-SIM group (100%) than in the CEMR group (76.8%) (p = 0.015) but was not statistically different between the UEMR-SIM and UEMR groups (88.0%) (p = 0.236). The R0 resection rate was significantly higher in the UEMR-SIM group (90.9%) than in the UEMR group (48.0%) (p = 0.001) but was not statistically different between the UEMR-SIM and CEMR groups (76.8%) (p = 0.209). CONCLUSIONS: Our study indicates that the proposed method, UEMR-SIM for SNADETs, is feasible to achieve a high R0 resection rate and a potentially low local recurrence rate.


Asunto(s)
Neoplasias Duodenales , Resección Endoscópica de la Mucosa , Neoplasias Glandulares y Epiteliales , Humanos , Estudios Retrospectivos , Resección Endoscópica de la Mucosa/métodos , Duodeno/patología , Neoplasias Duodenales/cirugía , Neoplasias Duodenales/patología , Neoplasias Glandulares y Epiteliales/patología , Mucosa Intestinal/cirugía , Mucosa Intestinal/patología , Resultado del Tratamiento
7.
Sci Rep ; 12(1): 6591, 2022 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-35449185

RESUMEN

Sarcopenia comprises a low skeletal muscle index (SMI) and low muscle strength (MS) or low physical function. Many sarcopenia biomarkers have been reported. With Crohn's disease (CD), a low SMI is predictive of intestinal complications. Therefore, many CD studies have reported that sarcopenia is defined by SMI alone. This study investigated the sarcopenia frequency by assessing the SMI and MS of Japanese patients with CD and biomarkers predicting a low SMI. We evaluated the SMI using a bioelectrical impedance analysis, handgrip strength, and C-reactive protein, albumin, interleukin-6, tumor necrosis factor-α, growth differentiation factor (GDF)-8, and GDF-15 levels as biomarker candidates for 78 CD patients at our hospital. Sarcopenia and a low SMI were observed in 7.7% and 42.3% of the patients, respectively. There was a significant difference in the GDF-15 levels of the low SMI group and normal group according to the multivariate analysis (P = 0.028; odds ratio [OR], 1.001; 95% confidence interval [CI] 1.000-1.002). When evaluated by sex, males exhibited a negative correlation between the GDF-15 level and SMI (Pearson's r = - 0.414; P = 0.0031), and the multivariate analysis indicated a significant difference in the GDF-15 levels (P = 0.011; OR, 1.001; 95% CI 1.000-1.002). GDF-15 levels may indicate a low SMI with CD.


Asunto(s)
Enfermedad de Crohn , Sarcopenia , Biomarcadores , Enfermedad de Crohn/complicaciones , Factor 15 de Diferenciación de Crecimiento , Fuerza de la Mano , Humanos , Masculino , Músculo Esquelético
8.
Sci Rep ; 11(1): 16260, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34376800

RESUMEN

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic intestinal diseases of unknown etiology that present with variable disease extents and outcomes. The use of biomarkers for the diagnosis and management of IBDs is considered beneficial. Palmitoleic acid (PO) is an adipose tissue-derived mono-unsaturated free fatty acid that potentially serves as a lipokine in metabolic and inflammatory diseases. The aim of this study was to investigate the significance of PO levels in the serum of patients with UC and CD. The study included patients with UC (n = 22), patients with CD (n = 35), and controls (n = 22). The levels of serum PO were analyzed using gas chromatography. The association of serum PO levels with the clinical features and disease outcomes in IBD was examined. Serum PO levels were significantly higher in patients with CD than in controls, whereas no difference in these levels was observed between patients with UC and controls. Serum PO levels were significantly associated with the CD activity index. Additionally, high serum PO levels were associated with an increased risk of surgical intervention requirement during follow-up. In a pilot study with a few patients, high PO levels were observed in the mesenteric tissue in the active disease site of patients with CD (n = 7) compared with those with colon cancer (n = 6). Elevated serum PO levels might serve as a marker for local inflammation and prognosis in patients with CD.


Asunto(s)
Biomarcadores/sangre , Colitis Ulcerosa/diagnóstico , Neoplasias del Colon/diagnóstico , Enfermedad de Crohn/diagnóstico , Ácidos Grasos Monoinsaturados/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Colitis Ulcerosa/sangre , Neoplasias del Colon/sangre , Enfermedad de Crohn/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto Joven
9.
Biomed Rep ; 14(2): 25, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33408859

RESUMEN

Gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) can significantly reduce a patient's quality of life. GERD in SSc is occasionally resistant to conventional anti-acid treatment. Vonoprazan is an H+/K+-ATPase blocker that is approved in Japan for treatment of GERD. The aim of the present study was to evaluate the efficacy of vonoprazan in SSc-related GERD. The frequency scale for symptoms of GERD (FSSG) scores were collected before and after vonoprazan treatment in 15 SSc patients with GERD. Additionally, endoscopic esophagogastroduodenoscopy was performed in select patients. Conventional proton pump inhibitors or histamine-2 receptor antagonists had been previously administered in 93% (14/15) of the patients. Although the baseline esophagogastroduodenoscopy examination did not show severe erosion in the majority of patients, the mean total FSSG score before vonoprazan treatment was notably high (25.2±10.7) compared to a normal score of <8. After vonoprazan treatment, the FSSG score decreased to 9.6±7.0. The mean improvement rate of the total FSSG, acid reflux and dysmotility scores were 60.8±21.2% (P=0.0004), 67.3±24.8% (P<0.0001) and 55.4±26.0% (P=0.0022), respectively. These results suggest that vonoprazan may be a potentially effective treatment for GERD in patients with SSc.

10.
Sci Rep ; 10(1): 12546, 2020 07 27.
Artículo en Inglés | MEDLINE | ID: mdl-32719413

RESUMEN

While retrospective studies have compared the efficacy of anti-tumour necrosis factor (TNF) agents and tacrolimus (TAC) in ulcerative colitis (UC), information regarding first-time use of these agents is limited. The aim of our study was to investigate the short- and long-term efficacy of anti-TNF agents [adalimumab (ADA) and infliximab (IFX)] and TAC in anti-TNF agent- and TAC-naïve steroid-refractory UC patients. We evaluated 150 steroid-refractory UC patients receiving anti-TNF agents (IFX: n = 30, ADA: n = 41) or TAC (n = 79) at eight institutions in Japan. Clinical response rates at 8 weeks were 73.2% and 75.9% while remission rates were 30.1% and 25.3% in the anti-TNF and TAC groups, respectively. Logistic regression analysis showed the male sex and higher C-reactive protein to be independent factors for response to anti-TNF agents and TAC, respectively. Use of TAC was an independent factor for relapse. No differences in response to the treatment or relapse were observed between IFX and ADA. In conclusion, TAC and anti-TNF agents promoted similar short-term effects, but anti-TNF agents ensured better long-term outcomes at first-time treatment of steroid-refractory UC patients.


Asunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Esteroides/uso terapéutico , Tacrolimus/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/uso terapéutico , Adulto , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Infliximab/uso terapéutico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/metabolismo
12.
Intern Med ; 58(22): 3331-3336, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31327821

RESUMEN

A 71-year-old woman being treated with methotrexate (MTX) and tacrolimus (TAC) for rheumatoid arthritis (RA) was admitted to our hospital and underwent surgery for gastric perforation and peritonitis. An endoscopic examination six days post-surgery showed an extensive ulcer in the stomach, and a biopsy revealed diffused large B-cell lymphoma. We diagnosed her with immunodeficiency-associated lymphoproliferative disorder (LPD) and discontinued the MTX and TAC. She underwent gastrectomy due to stenosis approximately two months after the first operation, but the histopathological findings of lymphoma had disappeared. LPD should be considered as a potential cause of gastric perforation during RA treatment.


Asunto(s)
Artritis Reumatoide/complicaciones , Trastornos Linfoproliferativos/complicaciones , Úlcera Péptica Perforada/etiología , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Biopsia , Femenino , Humanos , Enfermedad Iatrogénica , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/cirugía , Metotrexato/uso terapéutico , Tacrolimus/uso terapéutico
14.
PLoS One ; 12(3): e0170591, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28278289

RESUMEN

BACKGROUND AND AIMS: A high serum level of saturated free fatty acids (FFAs) is associated with the development of nonalcoholic fatty liver disease (NAFLD). X-box binding protein-1 (XBP-1) is activated by FFA treatment upon splicing. XBP-1 is a transcription factor induced by the endoplasmic reticulum (ER) stress sensor endoribonuclease inositol-requiring enzyme 1 alpha (IRE1α). However, the role of XBP-1 in NAFLD remains relatively unexplored. Toyocamycin was recently reported to attenuate the activation of XBP-1, possibly by inducing a conformational change in IRE1α. In this study, we examined the effect of toyocamycin on hepatocyte lipoapoptosis and steatosis. We also explored the effects of toyocamycin in a mouse model of NAFLD. METHODS: Huh-7 cells and isolated rat primary hepatocytes were treated with palmitic acid (PA), which is a saturated FFA, in the presence or absence of toyocamycin. In addition, male C57BL/6J mice were fed a diet rich in saturated fat, fructose, and cholesterol (FFC) for 4 months, after which the effect of toyocamycin was assessed. RESULTS: Toyocamycin attenuated FFA-induced steatosis. It also significantly reduced PA-induced hepatocyte lipoapoptosis. In addition, toyocamycin reduced the expression of cytosine-cytosine-adenosine-adenosine-thymidine enhancer-binding protein homologous protein (CHOP), which is a key player in ER stress-mediated apoptosis, as well as its downstream cell death modulator, death receptor 5. In the in vivo study, toyocamycin ameliorated the liver injury caused by FFC-induced NAFLD. It also reduced hepatic steatosis and the expression of lipogenic genes. CONCLUSIONS: The data we obtained suggest that toyocamycin attenuates hepatocyte lipogenesis and ameliorates NAFLD in vivo and may therefore be beneficial in the treatment of NAFLD in humans.


Asunto(s)
Antibióticos Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Hepatocitos/efectos de los fármacos , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Ácido Palmítico/toxicidad , Toyocamicina/farmacología , Animales , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patología , Células Cultivadas , Dieta Alta en Grasa/efectos adversos , Estrés del Retículo Endoplásmico/efectos de los fármacos , Hepatocitos/citología , Hepatocitos/metabolismo , Humanos , Lipogénesis , Hígado/citología , Hígado/efectos de los fármacos , Hígado/metabolismo , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Enfermedad del Hígado Graso no Alcohólico/inducido químicamente , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Ratas , Ratas Wistar
15.
Endosc Int Open ; 4(8): E828-31, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27540568

RESUMEN

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) of the pharyngeal region has not been well accepted, although ESD of the gastrointestinal tract is a standard procedure for treating early cancers. However, early detection and treatment of pharyngeal cancers is highly beneficial because surgical resection can be highly invasive and cause serious cosmetic deformities, swallowing disorders, dysgeusia, and speech defects. On the other hand, application of an anchored clip with surgical thread during ESD of the gastrointestinal tract has been reported to be beneficial. This pilot case series reveals the usefulness and clinical feasibility of applying a clip with thread in ESD of the pharyngeal region.

16.
Intern Med ; 55(10): 1375-8, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27181551

RESUMEN

A 36-year-old Japanese woman with intestinal Behcet's disease was admitted to our hospital due to a recurrent ileocecal ulcer. Because infliximab (IFX) showed secondary failure, IFX was switched to adalimumab (ADA). After the third injection of ADA, she was unexpectedly 4-weeks pregnant. ADA was continued until 20 gestational weeks. Remission of the disease activity was maintained during pregnancy, and the birth was uneventful. The ileocecal ulcer disappeared after her delivery. ADA was detected in the umbilical blood after 119 days from the last infusion. The placental transition and timing of neonatal vaccination should be considered in cases of pregnancy with TNF antibody therapy.


Asunto(s)
Adalimumab/uso terapéutico , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Síndrome de Behçet/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Adulto , Síndrome de Behçet/complicaciones , Úlcera Duodenal/etiología , Femenino , Humanos , Embarazo , Resultado del Tratamiento
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