Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia.

BACKGROUND: Endoscopic submucosal dissection (ESD) for early-stage colorectal cancer (CRC) has become a common and useful treatment. Although sarcopenia has been identified as an independent risk factor for complications after surgery for CRC, whether sarcopenia is also an independent risk factor for complications after colorectal ESD remains to be clarified. The aim of this study was to compare the outcomes of colorectal ESD in patients with and those without sarcopenia. METHODS: This is a retrospective cohort study. A total of 334 patients underwent colorectal ESD for 361 neoplasms at Hiratsuka City Hospital from March 2012 to October 2018. The neoplasms were divided into two groups depending on the presence or absence of sarcopenia in the patients. RESULTS: Overall, 334 patients underwent colorectal ESD for 361 neoplasms during the study period. We excluded 90 patients (90 neoplasms), and 244 patients (277 neoplasms) were included in the final analysis (134 from the sarcopenia group, 137 from the non-sarcopenia group). The en-bloc resection rate was high and was not significantly different between the sarcopenia group [126/134 (94.1%)] and the non-sarcopenia group [133/137 (97.1%)], P = 0.1778). The rate of perforation and the rate of delayed bleeding were not significantly different between the sarcopenia group and the non-sarcopenia group [6/134 (4.5%) vs. 9/137 (6.6%), P = 0.314, 4/134 (3%) vs. 6/137 (4.4%), P = 0.3885, respectively]. CONCLUSIONS: The presence of sarcopenia did not influence the rate of complications after ESD. Colorectal ESD is safe and effective even in patients with sarcopenia. Prospective multicenter studies are necessary to confirm our results.

Mushroom poisoning with Scleroderma albidum: a case report with review of the literature.

BACKGROUND: Sclerodermataceae are known to be poisonous mushrooms; current published reports regarding the toxicity and treatment for Sclerodermataceae poisoning are limited. CASE PRESENTATION: A 66-year-old man was transferred to our hospital with complaints of visual disturbance, lightheadedness, bradycardia, and shock. The patient's medical history included cerebral hemorrhage and alcoholic hepatitis. He had eaten a mushroom growing in his garden, 30 min before arriving at our hospital. We carried out gastric lavage and gave the patient activated charcoal within an hour of mushroom ingestion. Particles of the mushroom were obtained during lavage, and most complaints were relieved immediately. However, the patient remained in shock for <2 h. He was admitted for observation and discharged 2 days later with no complications. The Public Health and Welfare Office later identified the mushroom as Scleroderma albidum. CONCLUSION: Scleroderma albidum caused muscarinic effects; features of central nervous system toxicity were also apparent.