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71.
Contrast‐enhanced harmonic endoscopic ultrasonography for differential diagnosis of localized gallbladder lesions
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Ken Kamata Mamoru Takenaka Masayuki Kitano Shunsuke Omoto Takeshi Miyata Kosuke Minaga Kentaro Yamao Hajime Imai Tosiharu Sakurai Naoshi Nishida Hiroshi Kashida Takaaki Chikugo Yasutaka Chiba Takuya Nakai Yoshifumi Takeyama Andrea Lisotti Pietro Fusaroli Masatoshi Kudo 《Digestive endoscopy》2018,30(1):98-106
Background and Aim
Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast‐enhanced harmonic endoscopic ultrasonography (CH‐EUS) for diagnosis of localized gallbladder lesions.Methods
One hundred and twenty‐five patients with localized gallbladder lesions were evaluated by CH‐EUS between March 2007 and February 2014. This was a single‐center retrospective study. Utilities of fundamental B‐mode EUS (FB‐EUS) and CH‐EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images.Results
In the differentiation between gallbladder lesions and sludge plug, FB‐EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH‐EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB‐EUS‐based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61–87%, 71–88%, and 74–86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH‐EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB‐EUS and CH‐EUS in terms of carcinoma diagnosis.Conclusion
CH‐EUS was useful for the evaluation of localized gallbladder lesions. 相似文献72.
Makio Kusaoi Ken Yamaji Go Murayama Misa Yasui Risa Yamada Ruka Hishinuma Takuya Nemoto Katsura Hohtatsu Michiaki Kageyama Toshio Kawamoto Kaoru Sugimoto Fumio Sekiya Takayuki Kon Michihiro Ogasawara Kazuo Kempe Hiroshi Tsuda Yoshinari Takasaki 《Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy》2012,16(5):456-466
Leukocytapheresis (LCAP) is a safe, unique therapy pertaining to intractable rheumatoid arthritis (RA) even in cases of drug allergy or infectious states. To investigate how to represent LCAP efficacy, we have conducted gene expression analyses from the peripheral blood of RA patients treated with non‐woven polyethylene terephthalate filters. Peripheral blood samples were collected immediately before and after treatment from eight RA patients who received LCAP. Among these patients, all of them achieved 20% improvement in the core set of the American College of Rheumatology (ACR20), and thus, they were confirmed as LCAP responders. Gene expression analysis was done with a high‐resolution DNA microarray. The results of each of the two groups' gene expression values (immediately before and after LCAP) were calculated using Welch's t‐test. Calculations were performed with a statistical software R.basic package: if the P‐value was less than 0.05, this was seen as a significant change. In a comparison of 25 370 gene expressions, the number of genes showing a P‐value < 0.05 in the upregulating group was 2110, and in the downregulating group it was 1864. The results of pathway analysis using the MetaCore program indicate that gene groups work for cytoskeletal remodeling are upregulated, and genes related to immune responses, such as antigens presenting via major histocompatibility complex class I and II, are downregulated just after LCAP. These findings may relate to LCAP efficacy for RA patients, but this needs further investigation. 相似文献
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Chikako Kusunoki Takuya Hamakawa Kazuhiro Nishikawa Hiromichi Sato Sayumi Imamura Satoru Miyahara Yu Sakano Hazuki Miyazaki Hiroto Seto Ryuta Ueda Reishi Toshiyama Masaaki Miyo Yusuke Takahashi Kenji Sakai Masakazu Miyake Atsushi Miyamoto Takeshi Kato Kiyoshi Mori Motohiro Hirao 《Asian journal of endoscopic surgery》2021,14(4):794-797
Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations. 相似文献
75.
Takashi Kitagataya Goki Suda Kazunori Nagashima Takehiko Katsurada Koji Yamamoto Megumi Kimura Osamu Maehara Ren Yamada Taku Shigesawa Kazuharu Suzuki Akihisa Nakamura Masatsugu Ohara Machiko Umemura Naoki Kawagishi Masato Nakai Takuya Sho Mitsuteru Natsuizaka Kenichi Morikawa Koji Ogawa Shunsuke Ohnishi Yoshito Komatsu Hiroo Hata Satoshi Takeuchi Takashige Abe Jun Sakakibara-Konishi Takanori Teshima Akihiro Homma Naoya Sakamoto 《Journal of gastroenterology and hepatology》2020,35(10):1782-1788
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Acute myocardial infarction due to simultaneous spasm of 3 coronary arteries that worsened over time
Takuya Shimizu Ken Umetani Yu Murata Tomoko Harama Toshiaki Yano Aritaka Makino Keita Sano Masahiko Nakamura 《The American journal of emergency medicine》2018,36(3):528.e3-528.e5
Coronary artery spasm (CAS) rarely worsens from single-vessel to simultaneous multivessel CAS naturally, and simultaneous multivessel CAS leads to serious conditions such as cardiopulmonary arrest (CPA). A 77-year-old Japanese man who took medications for CAS was transferred to our hospital due to persistent chest pain. On arrival, his vital signs were stable, but his electrocardiogram (ECG) showed ST-segment elevation in leads II, III and aVF. Ventricular fibrillation developed suddenly. Although routine cardiopulmonary resuscitation (CPR) including intravenous administration of epinephrine was performed immediately, he could not be resuscitated. After initiation of percutaneous cardiopulmonary support (PCPS), there was a return of spontaneous circulation. His ECG showed exacerbation of myocardial ischemia with ST-segment elevation in leads I, II, III, aVL, aVF and V3–V6. Emergency coronary angiography revealed severe CAS of the right and left coronary arteries, which was relieved completely by intracoronary administration of nitrates. He was diagnosed with acute myocardial infarction due to simultaneous 3-vessel CAS that progressed over time. About 6 h after arrival, he developed hemodynamic instability and died. CAS worsened from single-vessel to simultaneous 3-vessel spasm, and intracoronary administration of nitrates was effective in relieving CAS, which was documented by the ECG and coronary angiogram. Since CAS can progress over time, nitrates must be administered immediately. When CAS leads to CPA, epinephrine may be ineffective in CPR because of its vasoconstrictive effect on coronary arteries; therefore, PCPS should be initiated, and intracoronary nitrates should be administered. 相似文献
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