White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms

Background/Aims@#A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma. @*Methods@#A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma. @*Results@#The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%. @*Conclusions@#This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms

Background/Aims@#A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma. @*Methods@#A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma. @*Results@#The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%. @*Conclusions@#This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

Risk factors for severity of colonic diverticular hemorrhage

BACKGROUND/AIMS: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. METHODS: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. RESULTS: Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. CONCLUSIONS: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.

Immediate-early inducible function in upstream region of junB gene / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To analyze the upstream region of radiation-induced junB gene.</p><p><b>METHODS</b>Four plasmids containing 250 bp, 590 bp, 900 bp and 1650 bp, and CAT reporter gene were constructed separately and introduced to L8704 cells. The cells were irradiated with 2 Gy X-rays and incubated at different intervals. Total RNA was extracted from the cells and fluctuation of the CAT mRNA level was assessed by the RNA ratio of CAT/beta-actin measured by quantitative Northern blot hybridization.</p><p><b>RESULTS</b>CAT mRNA expression containing 900 bp and 1560 bp junB promoter remarkably and rapidly increased, and reached its peak 30 min after 2 Gy X-ray irradiation.</p><p><b>CONCLUSIONS</b>590-900 bp fragments located in the upstream region of junB gene play an important role in the early process of cells against radiation.</p>

Expression of JunB induced by X-rays in mice / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore JunB gene expression in spleen cells of mice after the whole body irradiation as well as in normal hematopoietic and leukemia cells in the primary culture after different dosages of X-ray irradiation.</p><p><b>METHODS</b>Spleen cells were isolated from the mice irradiated with 3 Gy X-rays. Primary cultured cells from mice were incubated in different intervals after X-irradiation at different dosages. Total RNA was extracted from the cells and the fluctuation of JunB mRNA level was assessed by the RNA ratio of JunB/beta-actin measured by quantitative Northern blot hybridization.</p><p><b>RESULTS</b>After the mice were exposed to 3 Gy X-rays irradiation, JunB expression in spleen cells was remarkably and rapidly increased, and reached its peak 0.5 h later in C3H/He mice and 1 h later in Balb/c mice. In the primary culture of normal spleen and leukemia cells, JunB mRNA levels increased 30 min after irradiation. The enhanced levels of JunB mRNA were returned to a normal level within 240 min after irradiation.</p><p><b>CONCLUSIONS</b>JunB gene is responsive to ionizing irradiation and is induced at immediate-early phase after the stimulation. This suggests that the JunB gene plays an important role in the early process of the cells against radiation.</p>

Acute Aortic Dissection Combined with Obstructive Sleep Apnea Syndrome / 日本心臓血管外科学会雑誌

Obstructive sleep apnea syndrome (OSAS) has symptoms such as severe snoring, apneic attack, and daytime hypersomnia due to repeated obstruction of the upper respiratory tract during sleep. The mortality rate due to cardiovascular complications in severe OSAS. We reported 5 cases of OSAS among the acute aortic dissection cases we treated. They were 2 cases of DeBakey I (cases 1, 2) and 3 cases of III b (cases 3, 4, 5). Organ ischemia was recognized in 4 among 5 cases of dissection combined with OSAS. There was 1 case of renal ischemia (case 1), 2 cases of limb ischemia (cases 3, 4), 1 case of visceral and spinal ischemia (case 5). Case 4 was III b type dissection with severely compressed true lumen and limb ischemia. The false lumen occluded by combining antihypertensive therapy and continuous positive airway pressure used to OSAS. Case 5 also had a severely compressed true lumen, and visceral ischemia 4 days after the onset. Angiography showed a severly compressed orifice of the true lumen of the celiac artery and superior mesentric artery due to the occluded false lumen. We placed a stent into the orifice of celiac artery transluminally and then patient recovered. There were many dangerous situations such as organ ischemia, and severely compressed true lumen among the cases of dissection combined with OSAS. Marked changes of intrathoracic pressure in apneic attacks may place stress on the thoracic aorta.

A Case of Acute Type B Dissection with Limb Ischemia and Severely Compressed True Lumen Cured by Conservative Therapy / 日本心臓血管外科学会雑誌

A 73-year-old man suddenly felt severe back pain. Computed tomography showed acute type B dissection. The false lumen existed from the distal arch to the right common femoral artery and was patent. The true lumen was severely compressed by the false lumen and his right leg was cold. In spite of limb ischemia, we started conservative therapy because he had severe airway stenosis due to obesity and obstructive sleep apnea syndrome (OSAS) and we thought surgical intervention very risky. We thought OSAS also involved a risk of high blood pressure and started continuous positive airway pressure. His blood pressure went down along with the improvement of respiratory conditon. After 12 days from the onset he evacuated bloody stool and gastrointestinal fiberscopy revealed giant gastric ulcer bleeding. Platelet counts and prothrombin time began to increase 2 days later. Computed tomography 14 days after onset showed a patent false lumen and severely compressed true lumen. Computed tomography 39 days after onset showed thrombosis of the false lumen and considerable dilatation of the true lumen. Hypercoagulability after bleeding from gastric ulcer and treatment of OSAS were important in this successful conservative therapy.

A Case of Right Atrial Myxoma with Chronic Pulmonary Embolism / 日本心臓血管外科学会雑誌

A 68-year-old man was admitted to our hospital with dyspnea and general fatigue. At first, pulmonary embolism was diagnosed by electrocardiography and pulmonary scintigram. X-ray CT scans and echocardiography revealed a tumor occupying the right atrial cavity. To prevent further pulmonary embolism, he underwent tumor resection. In surgery, two venous drainage cannulas were inserted directly to the superior vena cava and to the inferior vena cava via the right femoral vein, in order to avoid the direct contact with the right atrium prior to institution of extra-corporeal circulation. The tumor was carefully removed together with the atrial wall around the site where the tumor originated. A pathological study showed that the specimens were myxoma in the right atrium. His post-operative course has been uneventful until now, however, long-term observation with respect to the metastasis and/or recurrence of this tumor will be carried out.

A Case of Combined Minimally Invasive Direct Coronary Artery Bypass and Transverse Colectomy / 日本心臓血管外科学会雑誌

An 81-year-old-woman was successfully treated with simultaneous minimally invasive direct coronary artery bypass (MIDCAB) and colectomy. The patient complained of effort angina and tarry stool and had a combination of Bormann type II transverse colon cancer with oozing bleeding and long segmental stenosis of the left anterior descending coronary artery (LAD). Angiography suggested that the anastomotic site on the LAD extramusclarly presented on the tortours LAD. We therefore carried out one-stage operation of MIDCAB and colectomy. First, MIDCAB to the LAD using the left internal thoracic artery was performed via left anterior thoracotomy. After closing the left thoracic wall, we carried out transverse colectomy with lymph node resection via upper median laparotomy. The total operation time was 3hr 30min, 2hr 10min for MIDCAB and 1hr 20min for Colectomy respectively. Postoperative coronary angiography showed good patency of the LITA. The resected colon specimen showed moderately differentiated adenocarcinoma: ss, n1, Po, Mo stage 3a. She was discharged 15 days after the operation.

A Successfully Resected Localized Malignant Pericardial Mesothelioma / 日本心臓血管外科学会雑誌

Malignant pericardial mesothelioma was successfully resected in a 70-year-old man, who had been admitted complaining of palpitation. Chest X-ray films showed slight cardiac enlargement. A moderate amount of pericardial effusion was noted by echocardiography. Chest X-ray commputed tomography and MRI revealed a localized pericardial tumor. Total excision of the tumor was accomplished through a left thoracotomy approach because the tumor showed neither invasion to the myocardium nor dissemination to the pericardium. The patient was discharged following an uneventful postoperative course. No sign of recurrence has been encountered for nine months after surgery. However careful observation is needed.

A Survival following Minor Strut Fracture of a Bjoerk-Shiley60Convexo-Concave Mitral Prosthesis / 日本心臓血管外科学会雑誌

A 47-year-old man, having undergone mitral valve replacement in another hospital 9 years ago, suffered from sudden dyspnea and was transferred to our hospital immediately. On admission, disturbance of consciousness, severe dyspnea, marked hypotension (60/40) and hypo-oxygenation were noted. Under assisted ventilation with endotracheal intubation, diagnosis was confirmed by chest X-ray. The patient was transferred to the operation room after initiation of percutaneous cardiopulmonary support (PCPS). The emergency re-operation was started 7 hours after the onset of the symptoms. Left atriotomy was performed following total cardiopulmonary bypass and cardioplegic solution infusion. The pyrolite disc and the minor strut were missing and could not be found in the cardiac cavity. The fractured prosthesis was removed and replaced with a 29mm Carbomedics prosthesis. He was weaned from cardiopulmonary bypass with large doses of pressor amines. The disc and the strut were removed from the abdominal aorta and right deep femoral artery respectively 4 weeks after re-MVR surgery. The patient was discharged after 8 weeks' admission, and has been doing well so far. Although it is obvious that prompt diagnosis and early operation to replace the fractured prosthesis are essential for patient survival, percutaneous cardio-pulmonary support is helpful to maintain patient's hemodynamics during rediagnosis and preparation for surgery.