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Background/Aims@#Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. @*Methods@#We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. @*Results@#For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. @*Conclusions@#The SLX F2 showed high performance in fragmenting the pancreatic duct stones.In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
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Background/Aims@#Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs. @*Methods@#POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up. @*Results@#A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin. @*Conclusions@#In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.
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Iron deficiency anemia is the most frequently experienced anemia in common daily practice. It is often difficult to treat due to gastrointestinal side effects of iron drugs. We report a difficult case of iron-deficiency anemia with intolerance to oral iron supplementation, which was resolved by concomitant use of Kampo. Thirty-five-year-old woman visited us because of menoxenia continuing since she was 17 years old. Although tokishakuyakusan with kakobushimatsu (processed aconite root powder) had been administered, remarkable anemia such a low hemoglobin (Hb) level (7.8 g/dL) was observed. After we added an oral iron agent for 5 months, the hemoglobin level increased to 12.8 g/dL, and epigastric discomfort appeared. Therefore, we discontinued iron agent and switched to Kampo monotherapy, but anemia gradually worsened again. Following intravenous iron infusions could not improve the iron deficiency state. Then we administered ryokeijutsukanto with kojinmatsu (ginseng powder) and lower dose of oral iron agent than before, with reference to sinshato described in “Sokeitei Ijishogen” written by Nan'yo Hara. After administration, Hb and serum ferritin level improved from 11.6 g/dL and 4.0 ng/mL to 12.3 g/dL and 32.0 ng/mL, respectively. After that, the iron metabolism marker kept stable, although the oral iron agent had been further reduced. The main indications of sinshato are palpitation, shortness of breath, dizziness and edema according to the original text. These symptoms can be interpreted as ones related to anemia. In our case, it was suggested that prescription composition of sinshato promoted iron absorption and improved anemia.
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Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.
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We report the case of a 46-year-old man with hypertension whose blood pressure decreased due to saiko-karyukotsuboreito consumption.The patient also presented with some symptoms that suggested autonomic imbalance. After consuming 7.5g/day of a spray-dried powder of saikokaryukotsuboreito (Tsumura & Co.) for 3 months, his blood pressure measured at office was considerably lower. Twenty-four hour ambulatory blood pressure monitoring revealed that the surge in morning blood pressure, which is considered to be a risk factor for cerebrovascular disease, diminished in addition to the 24-hour mean blood pressure. A postural test revealed that his autonomic balance, which had been in a sympathetic dominant state, was inversely inclined to a parasympathetic dominant state.Our case report suggests that saikokaryukotsuboreito acts on the autonomic nervous system, which in turn exerts an antihypertensive effect, and that this effect is helpful in lowering the blood pressure in hypertensive patients whose autonomic balance is impaired due to stress.
Subject(s)
Blood Pressure , Postural BalanceABSTRACT
A 60-year-old male was diagnosed as having sarcoidosis four months previously because of bilateral hilar lymphadenopathy seen on a chest X-ray, uveitis, and elevation of serum angiotensin converting enzyme. In summer, the patient suffered from hypercalcemia, hypercalciuria, and renal dysfunction. Renal biopsy showed interstitial nephritis with gallium scintigraphy demonstrating high uptake in the bilateral hilum, eyes, and kidneys. Corticosteroid treatment was effective in remarkably improving the renal disorder and radiographic abnormalities.<BR>The calcium metabolic abnormalities and the granulomatous interstitial nephritis showed a marked response to corticosteroid therapy, so that immediate administration of corticosteroid may be justified even in cases without histological evidences. Gallium scintigraphy is suggested to be useful in noninvasive examination in acute stage of sarcoidosis.
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A 58-year-old man was admitted for pneumonia after several business trips to Thailand, Vietnam, and Malaysia. Despite resolution of pneumonia on chest X-ray, high fever persisted. CT scan revealed a juxtarenal, atypical-shaped abdominal aortic aneurysm of 4.5cm in size, and this was thought to be the cause of persisting fever. After prolonged antibiotic treatment, surgical resection and prosthetic tube replacement of the aneurysm was performed. The aneurysm was a pseudoaneurysm, and histological examination showed chronic inflammation with no atherosclerotic change. It was thought to be of mycotic origin. On the 12th day after operation, he became febrile, and an arterial blood culture yielded <i>Burkholderia pseudomallei</i>. Antibiotics chosen according to sensitivity tests, were given. He was finally discharged with no exidence of persisting infection, on the 55th day after operation.