Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study.

BACKGROUND: Intestinal fatty acid-binding protein (I-FABP) is a low-molecular-mass (15 kDa) cytosolic protein found exclusively in the epithelial cells of the small bowel mucosa. We aimed to evaluate the clinical usefulness of serum I-FABP measurement for the diagnosis of ischemic small bowel disease. METHODS: Patients with a clinical diagnosis of acute abdomen were recruited for this multicenter trial at one university hospital and nine city hospitals over a 13-month period. Serum I-FABP levels were measured in 361 eligible patients by an enzyme-linked immunosorbent assay using a specific monoclonal antibody. RESULTS: Of the 361 patients, 242 underwent surgery, and small bowel ischemia was diagnosed in 52 patients. The mean serum I-FABP level in the patients with small bowel ischemia was 40.7 ± 117.9 ng/ml, which was significantly higher than that in patients with non-ischemic small bowel disease (5.8 ± 15.6 ng/ml) and those with non-small bowel disease (1.8 ± 1.7 ng/ml). The serum I-FABP cutoff level for the diagnosis of small bowel ischemia was 3.1 ng/ml. Serum I-FABP was more efficient than conventional biochemical markers, in terms of sensitivity and positive and negative predictive values, in the diagnosis of small bowel ischemia. However, its specificity was slightly lower than that of creatinine phosphokinase or lactate dehydrogenase. The positive and negative likelihood ratios of serum I-FABP were 3.01 and 0.29, respectively. CONCLUSION: Serum I-FABP measurement is a non-invasive method that is potentially useful for the efficient identification of patients with acute abdomen who are at risk of small bowel ischemia.

[The optimal volume of medicinal solution in the portable disposable infusion pump (SUREFUSER A) for FOLFOX6, FOLFIRI therapy of colorectal cancer patients].

Oxaliplatin, established as a therapeutic standard globally for advanced/recurrent colorectal cancer, was approved in Japan in April 2005. With this approval the FOLFOX and FOLFIRI regimens are often selected now as 1st or 2nd line treatment for advanced/recurrent colorectal cancer. Patients receiving these regimens needed to be hospitalized, because the total treatment period was as long as 48 hours. However, the patient who hoped for staying at home has become possible to spend more time at home by using a portable disposable infusion pump (SUREFUSER A) for continuous intravenous infusion of 5FU. The duration of continuous 5FU infusion is set at an average of 46 hours, however, large variations are observed in the duration of infusion. Due to limitation of time of a patient, there was a case that finished injection on the way. On the contrary, there was a case that finished in a much shorter time than the pre-designated 46 hours. In an attempt to resolve this problem, we analyzed the relation of the total volume of the medicinal solution in SUREFUSER A and the duration of infusion by regression analysis. The results revealed that it might be possible to bring the total infusion time to close to 48 hours by finding the most suitable volume for continuous 5FU infusion over 46 hours.

Endoscopic findings of adenocarcinoma arising from short-segment Barrett's esophagus.

Adenocarcinoma arising from short-segment Barrett's esophagus (SSBE) is rare in Japan, although the incidence of this condition is increasing in Western countries. Four cases of early adenocarcinoma arising from SSBE were diagnosed and treated at Niigata-prefectural Yoshida Hospital. All patients were male, variously 55, 71, 73 and 79 years of age. All four patients had long-term gastroesophageal reflux disease, although one patient had erosive esophagitis and three patients did not have erosive esophagitis. Three patients were diagnosed as having Helicobacter pylori-free stomach. All adenocarcinomas occurred close to the squamocolumnar junction. Patients with SSBE should undergo detailed endoscopic examination of the squamocolumnar junction in order to detect early adenocarcinoma arising from SSBE.

An early cancer of the gastric cardia arising from carditis after long-term gastroesophageal reflux disease in the absence of Helicobacter pylori infection.

We describe an early gastric cardiac cancer in a patient who had suffered long-term gastroesophageal reflux disease (GERD) but showed no evidence of infection with Helicobacter pylori. Proximal gastrectomy and partial resection of the lower esophagus was performed. Histological examination revealed the lesion to be a gastric cardiac adenocarcinoma, which had partially invaded the submucosal layer. Intestinal metaplasia was also found in some areas. Inflammation, however, appeared to be limited to the gastric cardia. This cancer may have arisen via a sequence of carditis and cardiac intestinal metaplasia, due primarily to the GERD and not to H. pylori infection.