ABSTRACT
Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.
ABSTRACT
Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.
ABSTRACT
The use of hearing aids may not be sufficiently helpful for elderly people with advanced bilateral hearing loss when conversing with others. The patient in this case was an 82-year-old man whose main complaint was difficulty in verbal communication with his family despite using hearing aids. He was diagnosed with advanced bilateral sensorineural hearing loss using Western medicine techniques. He was first prescribed the Kampo formulation, ryokeijutsukanto, followed by goshajinkigan. Later, he took a combination of both of these Kampo formulations, and his hearing ability improved. Pure tone audiometry and speech audiometry demonstrated hearing loss ;however, speech audiometry better reflected his improvement in hearing speech sounds after he began taking the Kampo formulations. Thus, in this case, the patient's hearing and communication abilities improved with Kampo formulations combined with the use of hearing aids. In the future, speech audiometry (maximum discrimination score) can be applied to evaluate the efficacy of Kampo treatment for hearing loss.
ABSTRACT
We investigated the effectiveness of hangekobokuto in alleviating dysphagia and aspiration pneumonia attributed to latestage neurosyphilis. Our study subject, a 67-year-old man treated for his leg pain in our department, hoped this treatment would relieve his severe cough and sore throat. According to a neurological investigation and the analysis of blood and cerebrospinal fluid, his symptoms (swallowing disturbance and aspiration pneumonia in the lower lobes of both lungs) led to the diagnosis of cerebral bulbar paralysis caused by latestage neurosyphilis. The patient requested drug therapy ; thus, we prescribed 7.5 g/day of hangekobokuto, to be administered orally, based on his medical findings of qi stagnation and tan yin. Dysphagia was relieved one week after oral administration of hangekobokuto, and after three weeks, the patient's discomfort had almost disappeared. Moreover, aspiration pneumonia was also improved in his chest CT image finding. Late-stage neurosyphilis symptoms usually develop within 20 to 30 years of contracting syphilis, an infection caused by the bacterium Treponema pallidum. Symptoms may include a loss of swallowing reflex and cough reflex due to the paralysis of cerebral basal ganglia. However, hangekobokuto was found to increase the concentration of substance P released in the pharyngeal head and tracheal mucosa, and thus improve swallowing function. We conclude that hangekobokuto is a useful agent for alleviating the swallowing abnormality of late-stage neurosyphilis.
ABSTRACT
The growing knowledge of cancer immunology during the past 20 years has led to the current implementation of immunotherapy. Immuno-cell therapy, in which ex vivo processed T lymphocytes and dendritic cells are used as agents, has developed and spread and is now accepted as a common treatment with the identification of a number of cancer peptide antigens. The response rate to immuno-cell therapy is reported to be around 10-20%. Some clinical studies have reported that immuno-cell therapy as a postoperative adjuvant therapy improved survival rates. This paper outlines the historic background and the current medical scene of immuno-cell therapy.<br>
