Influence of nighttime bathing on evening home blood pressure measurements: how long should the interval be after bathing?

The Japanese Society of Hypertension has recommended that evening home blood pressure measurement be taken just before bedtime. In this study, to elucidate the influence of nighttime bathing on evening home blood pressure and heart rate, measurements were performed for 7 days using volunteers who were employees of a single company and who had no alcohol intake during the study period. We used data obtained from 158 subjects (78 males and 80 females; mean age, 41.6 years) whose evening data consisted of a combination of pre-bathing and post-bathing measurements. We divided the subjects into four groups according to the time interval from bathing: blood pressure was measured at 30 min after bathing in group I (n=40), at 31-60 min after bathing in group II (n=89), at 61-120 min after bathing in group III (n=74) and at more than 121 min after bathing in group IV (n=53). We evaluated the changes after bathing in each group. For all subjects combined, the evening home blood pressure measured after bathing (114.0+/-17.1/69.4+/-10.9 mmHg) was significantly lower than the value before bathing (116.3+/-17.1/70.7+/-11.2 mmHg). However, there was no difference in heart rate. Both systolic and diastolic blood pressure after bathing in group I (109.1+/-15.2/66.3+/-10.8 mmHg) and II (112.0+/-15.2/66.5+/-10.1 mmHg) were significantly lower than those before bathing (group I: 113.2+/-15.8/70.2+/-10.6 mmHg; group II: 115.2+/-15.8/69.3+/-10.3 mmHg), but these differences disappeared in group III and IV. On the other hand, there was no difference in heart rate after bathing in group I, II, or III, but group IV showed a slight but significant decrease after bathing (67.7+/-10.0 --> 65.8+/-10.7 beats/min). In conclusion, if evening home blood pressure is to be measured after bathing, subjects should be instructed to wait more than 60 min after bathing before performing the measurement in order to eliminate the depressor effect of bathing.     

ENDOSCOPIC MANAGEMENT OF BILIOCUTANEOUS FISTULA AFTER PERCUTANEOUS RADIOFREQUENCY ABLATION THERAPY FOR HEPATOCELLULAR CARCINOMA

Our patient was a 70‐year‐old man with hepatocellular carcinoma (HCC) and liver cirrhosis (Child–Pugh B). He had a history of distal gastrectomy with Billroth II reconstruction for duodenal ulcer and hepatectomy for HCC. One month after percutaneous radiofrequency ablation (RFA) for recurrent HCC, biliocutaneous fistula was observed. The cholangiogram demonstrated leakage of contrast material from an intrahepatic duct into the fistula, and a nasobiliary catheter was placed. Subsequently, the discharge of bile steadily decreased and stopped. Follow‐up cholangiogram revealed no evidence of bile leakage. Biliocutaneous fistula is an extremely rare complication after percutaneous RFA, and the present case report suggests that endoscopic drainage is the first‐line therapy for bile leaks after RFA.     

Correlation of Repeated Measurements of Home Blood Pressure on One Occasion and Diagnosis of Hypertension: Study by Measurement over Seven Consecutive Days

In spite of the recent recognition of the usefulness of home blood pressure (BP) measurement, there are no clear guidelines for which measurements should be used for clinical evaluation. Therefore, the present study examined the correlation of repeated measurements of home BP on one occasion and the diagnosis of hypertension (HT) or normotension (NT). Home BP was measured with 700 volunteers aged 20 years or older (468 male and 232 female, mean age 40.6 years) in a sitting position three times each in the morning and evening for seven consecutive days. Excluding the measurements on the first day, the mean values were calculated for the first measurement (group A), second measurement (group B), the mean of the first and second measurements (group C), and the mean of the second and third measurements (group D). The correlation with the frequency of diagnosis of HT (≥135/85 mmHg) and NT (<125/80 mmHg) was studied. Home BP in the morning and evening were both highest in group A (morning: 122.1 ±0.6 (SEM)/75.9 ±0.4 mmHg, evening: 120.4 ±0.6/71.8 ±0.4 mmHg) and lowest in group D (morning: 119.5 ±0.6 / 75.2 ±0.4 mmHg, evening: 117.5 ±0.6/70.6 ±0.4 mmHg). Using morning home BP, HT was diagnosed more often in group A (27.4%) than in group D (24.7%), with a lower frequency of NT diagnosis (55.7% vs. 61.7%; p?=?0.06). With regard to the diagnosis made from evening home BP, HT was diagnosed more often and NT was diagnosed less often in group A (HT/NT: 18.4%/61.4%) than in group D (13.7%/68.0%), with statistical significance (p?=?0.02). In conclusion, when the clinical diagnosis was made from seven-day home BP, the diagnosis of HT was made more frequently and NT diagnosis was made less frequently using the first measurement than the mean of the second and third measurements. This trend was more pronounced when diagnosis was made from evening home BP.     

Hairspray Inhalation-induced Interstitial Pneumonitis Evaluated by a Transbronchial Lung Cryobiopsy

A 60-year-old Japanese woman was admitted to our hospital with a fever and shortness of breath occurring immediately after using hairspray. Chest high-resolution computed tomography (HRCT) showed ground-glass opacities (GGOs) predominantly distributed around the bronchovascular bundles, and a pathological evaluation by a transbronchial lung cryobiopsy (TBLC) revealed fibrotic non-specific interstitial pneumonia (f-NSIP). Her symptoms disappeared without the use of corticosteroids, and GGOs on HRCT improved markedly over time. This case suggests that a pathological evaluation by a TBLC for lung injury due to inhalation pathogen exposure may provide a more accurate diagnosis and a better understanding of the pathology from bronchial to interstitial lesions than transbronchial lung biopsy.     

A phase I/II trial of the oral antiangiogenic agent TSU-68 in patients with advanced hepatocellular carcinoma

Purpose

We studied the safety and effectiveness of TSU-68, an oral tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2, platelet-derived growth factor receptor and fibroblast growth factor receptor, in patients with advanced hepatocellular carcinoma (HCC).

Methods

Patients with unresectable or metastatic HCC were eligible for enrollment. In phase I, the safety, tolerability and pharmacokinetics were assessed in patients stratified based on liver function, from no cirrhosis to Child?CPugh class B. The safety and effectiveness were assessed in phase II at the dose determined in phase I.

Results

Twelve patients were enrolled in phase I. Dose-limiting toxicities were found with TSU-68 at the dose of 400?mg bid in Child?CPugh B patients, and 200?mg bid was established as the phase II dose. Phase II included 23 additional patients, and the safety and efficacy were evaluated in a total of 35 patients. One patient (2.9%) had a complete response. Two patients (5.7%) had a partial response, and 15 patients (42.8%) showed a stable disease. The median time to progression was 2.1?months, and the median overall survival was 13.1?months. Common adverse events were hypoalbuminemia, diarrhea, anorexia, abdominal pain, malaise, edema and AST/ALT elevation. The analysis of angiogenesis-related parameters suggests that serum-soluble vascular cell adhesion molecule-1 is a possible marker to show the response.

Conclusions

TSU-68 at a dose of 200?mg bid determined by stratification into liver function, showed promising preliminary efficacy with a high safety profile in patients with HCC who had been heavily pre-treated.     

Evaluation of prognostic factors of esophageal squamous cell carcinoma (stage II-III) after concurrent chemoradiotherapy using biopsy specimens

BACKGROUND: Recently, attention has been directed to concurrent chemoradiotherapy (CRT) for the treatment of squamous cell carcinoma of the esophagus with regard to efficacy, quality of life and functional preservation, and survival periods comparable to those after standard surgical therapy have been reported in responders to CRT. However, there are some non-responders to CRT, and the prediction of the outcome after CRT is an important subject for future studies. In this study, using biopsy specimens obtained before CRT, we evaluated the relationships between biological markers and the outcome after CRT in order to determine the prognostic factors of CRT. METHODS: The subjects were 51 patients (42 males and nine females: median age 68 years). who were histologically confirmed to have squamous cell carcinoma of the esophagus at stage II or III (UICC). Concurrent CRT consisting of chemotherapy using 5FU and CDDP and radiation therapy (60 Gy) was performed as the initial treatment, and the relationships of overexpression of EGFR, p53, VEGF, PCNA and CyclinD1 were examined immunohistochemically in biopsy specimens collected before treatment. Overall survival was estimated by multivariate analysis. RESULTS: The percentages of patients overexpressing p53, VEGF, PCNA, CyclinD1, and EGFR were 33, 31, 37, 31 and 29%, respectively. On multivariate analysis, T stage (P = 0.0393) and PCNA (P = 0.0302) were found to be significant prognostic factors. CONCLUSIONS: PCNA overexpression appears to be a prognostic factor for squamous cell carcinoma of the esophagus after CRT.     

Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment

Objectives

Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis, and has a favourable response to corticosteroid treatment (CST). Little is known, however, about the long‐term outcome of AIP. This study aimed to document the prognosis without and with CST, and to examine the indication for CST.

Patients and methods

The prognosis and clinical features of 23 patients without CST and 19 patients treated with CST from onset were investigated. In addition, factors concerning the late occurrence of unfavourable events related to AIP were examined.

Results

The patients without CST were 19 men and four women, with an average age of 66 years. After an average observation period of 25 months, 16 patients (70%) developed unfavourable events including obstructive jaundice as a result of distal bile duct stenosis in four, growing pseudocyst in one, sclerogenic changes of extrapancreatic bile duct in nine, hydronephrosis as a result of retroperitoneal fibrosis in one, and interstitial nephritis in one. Patients with obstructive jaundice at onset showed a higher cumulative event occurrence rate (p = 0.025). The patients treated with CST were 16 men and three women, with an average age of 64 years. After an average observation period of 23 months, six patients (32%) developed unfavourable events consisting of interstitial pneumonia in three, and a recurrence of obstructive jaundice in three. In multivariate analysis, CST (HR 0.33, 95% CI 0.12–0.89, p = 0.029) and obstructive jaundice at onset (HR 3.09, 95% CI 1.14–8.32, p = 0.026) were significant predictive factors for unfavourable events.

Conclusion

CST could reduce AIP‐related unfavourable events. The early introduction of CST is recommended especially for patients with obstructive jaundice.     

Serum IgG4 concentrations in pancreatic and biliary diseases

BACKGROUND: Recently, it has been reported that the serum concentration of IgG4, a minor component of IgG subclasses, is increased in autoimmune pancreatitis. However, data regarding IgG4 concentrations in other pancreatic or biliary diseases have been insufficient. METHODS: Serum IgG4 was measured in 116 patients with pancreatic or biliary diseases (35 autoimmune pancreatitis, 24 chronic pancreatitis except autoimmune pancreatitis, 11 primary sclerosing cholangitis, 23 pancreatic cancer, 3 islet cell tumor, 2 papilla cancer, 15 bile duct cancer, and 3 gallbladder cancer patients). The cut-off concentration of IgG4 was 135 mg/dl. RESULTS: Increased serum IgG4 was observed in 33 of 35 patients with autoimmune pancreatitis, 0 of 24 with chronic pancreatitis, 4 of 11 with primary sclerosing cholangitis, 0 of 23 with pancreatic cancer, 0 of 3 with islet cell tumor, 0 of 2 with duodenal papilla cancer, 0 of 15 with bile duct cancer and 0 of 3 with gallbladder cancer patients. CONCLUSIONS: Serum IgG4 was increased in autoimmune pancreatitis and was within normal limits for other pancreatic or biliary diseases except primary sclerosing cholangitis.