Morphological and Functional Evaluation of Gastric Ulcer Healing and Recurrence by Endoscopic Ultrasonography

Abstract: The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI-IV ulcers was significantly higher than those in UI-II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurrence.     

Association between activity level and changes in bodyweight in dementia patients

Introduction: Bodyweight is routinely used as an important health assessment measure in care facilities. Recently, the integrated circuit (IC) tag monitoring system became available for measuring the distance walked by patients with dementia (PsWD) over an extended period. The main objective of the present study was to examine an association between the distance walked and changes in bodyweight in PsWD. Methods: Monitoring was conducted in a semi‐acute dementia care unit in Japan between November 2006 and March 2007. All patients had been diagnosed with dementia and were able to walk independently. Demographic and food intake data were obtained from medical records. Bodyweight was measured weekly. The monitoring system calculated the distance walked. The study was approved by the Ethics Committees of Osaka University and Asakayama Hospital and written informed consent was obtained from authorized proxies. Results: In total, 23 patients were monitored. The median distance walked per day for all subjects was 1042.7 m (range 136–7781m) and the mean rate of weight change per month was ?0.1 kg (range ?1.5 to 2.4 kg). The mean food intake per day was 97 ± 5% (range 79–100%). There was a significant negative correlation between median distance walked per day and rate of weight change per month (r = ?0.52; P < 0.05). Distance walked per day was divided into three groups (<1 km, 1–2 km and ≥ 2 km), but there was no change in mean food intake between the three groups. However, PsWD who walked ≥ 2 km/day tended to have higher total Neuropsychiatric Inventory–Nursing Home Version (NPI‐NH) scores and a higher number of symptoms than those who walked < 2 km/day. The former tended to have aberrant motor activity compared with the latter. Conclusion: The present study shows that the distance walked per day seems to play a major role in weight change. Because the IC tag monitoring system can measure the distance walked accurately over an extended period, it could be used to estimate the calorie expenditure for each patient and to reduce the various risks related to weight loss.     

ATP‐Induced Dormant Pulmonary Veins Originating from the Carina Region After Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

Dormant Pulmonary Veins from the Carina Region . Introduction: Elimination of transient pulmonary vein recurrences (dormant PVs) induced by an ATP injection and ablation at the PV carina region is an effective strategy for atrial fibrillation (AF) ablation. The relationship between dormant PVs and the PV carina region has not been evaluated. Methods: A total of 212 consecutive symptomatic AF patients underwent circumferential PV electrical isolation (CPVEI) with a double lasso technique. They were divided into 2 groups in a retrospective review; Group 1: those given an ATP injection during an intravenous isoproterenol infusion after the CPVEI (n = 106), and Group 2: those in which it was not given after the CPVEI (n = 106). Radiofrequency energy was applied at the earliest dormant PV activation site identified using a Lasso catheter on the CPVEI line and then PV carina region if it was ineffective. Results: After a successful PVEI, 54 patients (51%) in Group 1 had PV reconnections during an ATP injection. Acute PVEI sites were observed on the carina region within the CPVEI line in the right PVs (16%) and left PVs (10%). Dormant PVs were reisolated at the carina region in the right PVs (23%) and left PVs (26%). The distribution of the dormant PV sites, except for the RIPV, significantly differed from that of the acute PVEI sites (P < 0.05). Further, AF recurred significantly in the Group 2 patients as compared to those in Group 1 during 16 ± 6.1 months of follow‐up (P < 0.05). Conclusion: PV carina region origins may partly be responsible for an acute PVEI and potential recurrences. (J Cardiovasc Electrophysiol, Vol. 21, pp. 494‐500, May 2010)     

The close relationship between interleukin-1 and fibroblast proliferating factor from peripheral mononuclear cells of patients with chronic hepatitis and liver cirrhosis

The role of peripheral mononuclear cells (PMNC) was investigated in patients with hepatic fibrosis of chronic hepatitis or liver cirrhosis. PMNC from these patients released more fibroblast proliferating factor (FPF) in the conditioned medium than those PMNC from normal subjects in response to PHA stimulation. Production of FPF by PMNC from CAH patients was also observed in response to liver specific protein (LSP) which might act as a naturally occurring antigen in vivo. Analysis of FPF on gel permeation chromatography revealed two active components with molecular weight of 60000 (FPF-1) and 18000 (FPF-II). Both FPF-I and FPF-II exerted thymocyte proliferating activity, but not cytotoxic T cell line (CTLL) proliferating activity, indicating that they are closely related to interleukin-1 (IL-1). Isoelectrofocusing of FPF-I and FPF-II disclosed that each factor consisted of two peaks at similar pI: 5.3 and 7.0. Taking account of the fact the IL-1 consisted of two molecular forms of pI—5.4 (IL-1α) and 7.0 (IL-1β)—FPF-II is considered to be IL-1, which is a mixture of IL-1α and IL-1β, and FPF-I is probably the aggregated form of FPF-II. This assumption was further supported by the evidence that macrophages, which are the major source of IL-1 in patients with chronic hepatitis or liver cirrhosis, also released significantly higher amounts of FPF than those from normal subjects in response to stimulation by lipopolysaccharide. It was therefore concluded that in chronic hepatitis and liver cirrhosis, production of an IL-1, or a factor similar to IL-1, by PMNC is increased in response to mitogen or LPS.     

Measurement of carboxy terminal peptide of type I procollagen in sera of patients with viral hepatitis and liver cirrhosis

In the present investigation, a radioimmunoassay for carboxy terminal peptide of human type I procollagen (type 1 C-peptide) was developed. Its clinical implication for serodiagnosis of hepatic fibrosis in 85 patients with viral hepatitis, 45 patients with post-hepatitic liver cirrhosis and 37 patients with alcoholic liver diseases was evaluated in comparison with that of the previously established amino terminal peptide (type III N-peptide) assay. Anti-sera against type I procollagen was obtained by immunization of rabbit with purified type I procollagen from culture medium of IMR-90. The serum level of type I C-peptide in normal subjects was found to be 42 ng/ml (s.d. = 19). Type I C-peptide levels in patients with acute hepatitis were within normal range, while in chronic hepatitis, the mean type I C-peptide level increased as the grade of fibrosis advanced from grade I to III. However, there was no statistically significant difference between the mean type I C-peptide level of grade III and that of liver cirrhosis. Increments of type I C-peptide levels were also observed in alcoholic liver fibrosis (fatty liver with fibrosis and liver cirrhosis). On the other hand, type III N-peptide assay appeared to reflect not only the degree of hepatic fibrosis, but also the degree of hepatic inflammation, giving the high levels in acute viral hepatitis. Collectively, the results indicate the usefulness of type I C-peptide assay for monitoring hepatic fibrosis in viral hepatitis as well as in alcoholic liver disease.     

Experience With the Atrium Advanta Covered Stent for Aortic Obstruction

Introduction

We sought to assess the efficacy, safety and clinical outcomes of the Advanta V12? covered stent in management of coarctation of the aorta (CoA).

Materials and Methods

Stent functionality was assessed by review of angiographic imaging, clinical data at admission, discharge and at the last clinic visit, stent configuration on chest roentgenogram, radiation exposure, and complications.

Results

Between October 2009 and February 2012, 17 patients underwent stent implantation. There were 9–12, 2–14, and 6–16 mm diameter stents deployed. Balloon angioplasty after implantation was required in 2 patients. Mean percent recoil in the middle of the stent for the 12, 14, and 16 mm implants was 14%, 24%, and 24%, respectively. There was improvement in CoA diameter from 6.6 ± 3.2 to 11.5 ± 1.7 mm (P < 0.0001) and a reduction in the peak pressure gradient from 23.1 ± 10.1 to 0.8 ± 3.3 mmHg (P < 0.0001). No patient had a symptomatic complication. Left arm cuff blood pressure fell 24 hours after implantation and left arm to leg blood pressure gradient fell to <20 mmHg in all (P < 0.0001). Follow‐up was a median 242 days and at the last clinic visit there were no statistically different findings from discharge. Five children (33%) required antihypertensive medications but 3 were off medication at latest follow‐up. Three patients (18%) required reintervention.

Conclusion

The implantation of the Advanta? V12 stent for the treatment of CoA is safe and effective in the early term. However, further study is required to determine longer‐term stent efficacy.

     

Subchronic Oral Toxicity of Glyoxal via Drinking Water in Rats

Subchronic Oral Toxicity of Glyoxal via Drinking Water in Rats.Ueno, H., Segawa, T., Hasegawa, T., Nakamuro, K., Maeda, H.,Hiramatsu, Y., Okada, S., and Sayato, Y. (1991). Fundam. Appl.Toxicol. 16, 763–772. The subchronic oral toxicity ofglyoxal via drinking water and the effect on in vivo proteinsynthesis in tissues following a single treatment with thissubstance were assessed in Sprague–Dawley male rats. Animalsreceived drinking water containing glyoxal levels of 2000, 4000,and 6000 mg/liter ad libitum for 30, 60, and 90 days in PhaseI. In Phase II, the high-dose and control-1 groups fed the dietad libitum, and a diet-limited control-2 group given the sameamount of diet as consumed by the high-dose group were maintainedfor 90 and 180 days. The study designs included observationsof clinical signs, body weights, major organ weights, grossand histopathological examinations, serum clinical chemistry,and biochemical examinations such as glyoxalase activity andglutathione content in selected tissues. Body weight gain andorgan weights significantly decreased with dosage. Althoughconsumption of food and water was also depressed in the exposedgroup, the reduction of body weight gain was greater in thehigh-dose group than in the diet-limited control 2 group. Histopathologicalexaminations revealed only a slight papillary change in thekidneys from the high-dose group at both 90 and 180 days terminationsin Phase II. The induction of both glyoxalase I and II was observedin liver and erythrocytes at 30-day termination of the exposedgroups. Serum enzyme and protein levels were significantly reducedby the mid- and/or high-dose exposures. With a single oral high-dosetreatment of glyoxal, a great decline in the incorporation ofL-[³H]leucine was shown particularly in the liver, and thisprobably led in part to a reduction in the serum protein levelsin rats following subchronic exposure to glyoxal. These dataindicated an overall low degree of systemic toxicity to ratsexposed subchronically to glyoxal via drinking water.     

Clinical and Endoscopic Study of Ischemic Colitis

The clinical signs and symptoms of ischemic colitis have been analyzed. Eighty-one cases were investigated; there were 62 cases of the transient type, 15 of the stricturing type, and 4 cases of the gangrenous type. All cases were diagnosed by colonoscopy. In addition, the healing process of the transient type, observed by colonoscopy, was analyzed. The results were noted as follows. 1. Sudden onset of abdominal pain was the initial complaint in most of the cases. The onset time of this pain was morning (8.7%), afternoon (23.2%), and night (68.1 %). 2. The average amount of time from the onset of abdominal pain to hemorrhage was 6.6 +/- 4.1 hours. Abdominal pain persisted for 1.6 +/- 0.7 days and hemorrhage continued for an average of 1.5 +/- 0.8 days. 3. The transient type was common in the young age group (under 40), and the stricturing type was common in the advanced age group (over 70). 4. In cases of the transient type, the lesions healed within 7 days in 68% of all cases, and within 14 days in 82% of them. On the other hand, in cases of the stricturing type, during these same time spans, the lesions healed in 33% and 50% of affected patients, respectively. 5. The change in the findings of longitudinal ulcers in cases of the transient type, which were typical findings of ischemic colitis, disappeared within about 6 days in most cases. It is concluded that an emergency colonoscopy is essential in the diagnosis of ischemic colitis of the transient type.